Quick Derm Review Flashcards
vesicles form large bullae (rapidly)–> rupture–> thin “varnish-like crusts”
-fever diarrhea
Bullous impetigo
*S. auersus MC
TX:
- Mupirocin (Bactroban) topically drug of choice TID x10 days
- Extensive disease or systemic symptoms (ex. fever) systemic abx – cephalexin
Describe the different types of hypersensitivity reactions (cutaneous drug reactions)
1- IgE mediated, ex. urticarea and angio edema
2- Cytotoxic, Ab-mediated
3- immune antibody-antigen complex ex. drug-mediated vasculitis and serum sickness
4- delayed (cell mediated) morbiliform reaction ex. erythema Multiforme
5- nonimmunologic- due to genetic incapability to detoxify certain meds
mild fever, URI sx, decreased appetite starting 3-5 days after exposure
-Oral enanthem: vesicular lesion w/ erythematous halos in oral cavity (esp. buccal mucosa and tonge)–> exanthem 1-2 days afterwards- vesicular, macular or maculopapular lesion on the distal extremities on palms and soles
Hand foot and mouth (Coxsackie A)
Tx: supportive, encourage hydration
Cafe au lait macules are commonly associated with what other disease?
neurofibromastosis type 1
*if child has 6 or more cafe au lait macule (esp. w/ axillary or inguinal freckling) they should be evaluated for neurofibromastosis type 1
What type of burn?
- Extends through entire skin
- Waxy, white, leathery, dry
- PAINLESS
- Absent cap. refill
Full thickness (3rd degree)
*months to heal
Red, elevated thickened nodule with adherent white scaly or crusted, bloody margins
-hyperkeratosis and ulceration
Squamous cell carcinoma of the skin
dx: biopsy: atypical keratinocyte and malignat cells with large, pleomorphic, hypercchrommatic nuclei in epidermis
tx: wide local surgical excision*
Describe the rule of nine for burns
Head and neck- 9% (4.5 front and 4.5 back)
Upper limbs- 9% each (4.5 front and 4.5 back)
Trunk- 36% (9 chest, 9 upper back, 9 abdomen, 9 lower back)
Genitalia- 1%
Palms- 1%
Legs 18% each (9 front, 9 back)
Single or multiple dome-shaped, flesh-colored to pearly white WAXY papules with central umbilication.
-curd like material may be expressed from the center if lesion is squeezed
Molluscum Contagiosum
- benign viral condition (poxviridae family/ pox virus)
- highly contagious
TX: self-limited- resolves in 3-6 months
-Curettage
1-2 mm pearly white-yellow* papules esp. seen on cheecks, forehead, chin and nose in a newborn
Milia
TX: none- usually disappears by 1st month of line but may be seen up to 3 months
Diffusely red rash on the groin or on the scrotum.
Tinea cruris (jock itch)
TX: Topical antifungal*, PO Griseofulvin if ineffective
How do you dx Rubella (German measles)
Clinical
Rubella-specific IgM Ab via enzyme immunoassy
pink lesions that develop into Irregular discrete macule and papules of total depigmentation
- milky white patches
- commonly involves DORSUM OF HANDS, axilla, FACE, fingers, body folds and genitalia
Vitiligo
*autoimmune destruction of melanocytes–> skin depigmentation
DX workup: TSH (associated w/ autoimmune disorders like Hashimotots or Grave’s)
TX:
Localized: topical corticosteroids. Calcineurin inhibitors great for facial involvement
-Disseminated: systemic phototherapy (narrow band UVB)
PUVB****
- Comedones: small, noninflammatory bumps from clogged pores (open comedones=black heads= incomplete blockage, closed comedone= whitehead= complete blockage
- papules or pustules surrounded by erythema
- nodular or cysic
Acne vulargis
mild= comedones
moderate= comedones, larger amounts of papules and/or pustules
severe= nodular
TX:
Mild- topical retinoids***, benzoyl peroxide, topical Abx (clindamycin), OCPs (decrease androgen)
Moderate- as above + oral Abx (doxy or minocyline) +/- anti androgen agent (spironolactone)
Severe- Isotretinoins (severely teratogenic)
streaking from the infected area of cellulitis following the lymph vessels
Lymphangitis
Complications/clinical manifestations of high voltage electric injuries
- cardiac arrest: low voltage- Vfib, high voltage- asystole
- Rhabdomyolysis (urinalysis is performed to look for myoglobinuria)
- neurological
numerous, small, discrete, flesh-colored papules measuring 1-5mm in diameter and 1-2mm in height
- MC on hands
- often form linear patterns bc scratchin or shaving spreads the virus
verruca plana (aka flat warts) ***Human papilloma virus
TX: most warts resolve spontaneously w/in 2 yrs
- topical OTC salicylic acid and plasters
- cryotherapy, electrocautery
- Gardasil vx
How do you dx Pityriasis (Tinea) veriscolor
- KOH prep from skin scraping: hyphae and spores “spaghetti and meatball” appearance
- Wood’s lamp: yellow-green fluorescence
-Blanched circular patch with surrounding red perimeter and central punctum (target lesion) associated w/ piloerection* and sweating
Latrodectism: local sx: asymptomatic or pain at site of inoculation with the onset of generalized sx w/in 30 min -2hrs–> systemic sx: muscle pain*, spasms, and rigidity
Black Widow Spider Bites
TX: Mild: wound care, pain control
mod-severe: opioids +/- muscle relaxants (benzo and methocarbamol)
*antivenom reserved for patients not responsive to above meds
Congenital disorder associated with class triad:
- Facial port wine stain (esp. along trigeminal distribution and around eyelids)
- leptomeningeal angiomatosis
- Ocular involvment (ex. glaucoma)
Sturge-Weber syndrome
*may develop hemiparesis contralateral to the facial lesion, seizures or intracranial calcifications and learning disabiliites
Target (iris) lesion classic: dull, dusty-violet red purpuric macules/vesicles or bullae in the center surrounded by pale edematous rim and a peripheral red halo
-often afebrile
+/0 mucosal membrane lesions
Erythema multiforme (type 4 HSN rxn)
EM minor: no mucosal membrane lesions
EM major: 1 or more mucosal membrane lesions, *no epiderlam detachment
Tx: self-limiting, supportive, dc med
PROPHYLAXTIC tx: Acyclovir (MC due to HSV)
- Central blue color of impending necrosis w/ surrounding white area of vasospasm/vasoconstriction and peripheral RED HALO of inflammation
- 24-72 hr after hemorrhagic bullae that undergoes eschar formation
Brown Recluse Spider Bite (MC in SW and Mid-West)
TX: Local wound care: clean w/ soap and water, apply cold packs, keep area elevated or neutral position
- Pain control: NSAIDS
- Tetanus prophylaxis
- Debridement if necrosis develops
When is Rubella most teratogenic in pregnancy and what are the possible consequences?
1st trimester (TORCH infection)
- Sensorineural deafness*
- Cataracts
- TTP (“blueberry muffin rash”)
- mental retardation
- heart defects
What type of burn? -Epidermis -Erythemaous and dry -Painful , tender to touch \+ refill intact, blanches w/ pressure
Superficial 1st degree
- heals w/in 7 days
- no scarring
Inflammatory, erythematous blue-red papules or pustules–> PAINFUL,HEMORRHAGIC, necrotic ulcer with irregular purple/violet undermined borders and a purulent base
**Associated w/ inflammatory diseases: IBD, Crohn, UC, RA, spondyloarthropathies
Pyoderma gangrenosum
TX: Topical corticosteroids (HD) or tacrolimus. local wound care
- 2nd line- systemic corticosteroids
- 3rd line- IVIG
- **Wickham Striae- fine white lines on the skin lesions or on oral mucosa. Nail dystrophy
- Purple, planar, polygonal, pruritic papules w/ fine scales and irregular borders
- MC on flexor surface of extremities, skin, mouth, scalp, genital, nailes
- May develop Koebner’s phenomenon: new lesions at sites of trauma
Lichen planus
TX: topical corticosteroids
antihistamines
What type of burn?
- Entire skin into underlying fat, muscle, bone
- Black, charred, eschar, dry
- PAINLESS
- Absent cap refill.
4th degree
*Does not heal well
Small erythematous macules or papules–> pustules on erythematous base 3-5 days after birth.
- does not involve palms or soles
- individual lesions may disappear spontaneously
Erythema toxicum
Tx: self-limited (resolves 1-2 weeks)
MC type of skin CA in US
2nd MC type of skin CA
MC type of CA-related death
basal cell carcinoma
*slow growing- locally invasive but very low incidence of metastasis
Squamous cell carcinoma of the skin- often preceded by actinic keratosis or HPV infection
Malignant Melanoma
*aggressive, high METS potential, UV radiation associated w/ 80% of cases
painful, erythematous inflammatory nodules seen on anterior shins (range in color from pink, red to purple)
-usually bilateral
Erythema nodosum
TX: self-limiting- resolve w.in weeks
- tx underlying condition
- NSAIDS pain
- peristent: corticosteroids
How do you dx Melasma
Wood’s lamp: appearance is unchanged under black light in dermal melasma
- Erythematous plaques w/ white white scales on scalp of infants
- yellowish-erythematous plaques w/ fine white scales common on scalp (dandruff), eyelids, beard, nasolabial folds, trunk, and intertriginous regions of the groin
- worse in winter months
Seborrheic dermatits (hypersensitivity to Malassezia furfur)* occurs in areas of high sabaceous gland oversecretion
TX:
- Topical:Selenium sulfide, sodium sulfacetamide, Ketoconazole or steroids, Zinc pyrithione
- Systemic: oral antifungals (itraconazole, fluconazole)
- Cradle cap: baby shampoo, ketoconazole shampoo or cream
3 C’s of Rubeola (measles)
3 C’s: Cough, Coryza (aka rhinitis-Irritation and swelling of the mucous membrane in the nose), Conjunctivitis–> Koplik spots (small red spots in uccal mucosa with pale blue/white center)
How do you dx dermatophytosis fungal skin infections
- KOH smear
2. Wood’s lamp: green fluorescence if due to Microsporum
URI prodrome: high fever
3 C’s: Cough, Coryza, Conjunctivitis–> Koplik spots (small red spots in uccal mucosa with pale blue/white center) precedes rash by 24-48hrs, last 2-3 days
–> morbiliform (maculopapular) BRICK-RED* rash on face beginning at hairline–> extremities
-Rash lasts 5-7 days fading from top to bottom
Rubeola (measles- paramyxovirus)
Tx: supportive, vitamin A reduces mortality in all children w/ measles
Mumps is caused by what virus
paramyxovirus
Intense itching (esp in occipital area), papular urticaria near bites -white oval-shaped egg capsules at the base of the hair shafts (nits)
Pediculosis (Lice)
TX:
- Permethrin topical (1st choice)
- Lindane (2nd choice)- neurotoxic: seizure risk if used after showering
- bedding/clothing are laundered in hot water w/ detergent and dried in hot drier for 20 min
What are the 5 P’s of Lichen Planus
- Purple
- Planar
- Polygonal
- Pruritic
- Papules
Chronic abscess of APOCRINE sweat gland or sebaceous cyst w/ tract formation
-Red tender inflammatory nodules/abscesses
Hidradenitis suppurativa
*MC in obese women and MC in axilla, groin, under breasts
TX: mild: topical clindamycin, intralesional injections of trimcinolone
- deep, recurrent infections: punch debridement if small, unroofing of larger ones w/ washout
- painful abscess: I&D - systemic Abx
- Surgical excision of apocrine gland
- Life style changes: avoid high glycemic foods, smoking cessation, local skin care
Tx of pressure ulcers
- wet to dry dressings, hydrogels
2. local wound care, pain management +/- surgical debridement (III and IV)
vesicles, pustules–> honey-colored crust
-associated with regional lymphadenopathy
nonbullous impetigo
*highly contagious superficial skin infection
**Staph aureus MC and GABHS 2nd MC
TX:
- Mupirocin (Bactroban) topically drug of choice TID x10 days
- Extensive disease or systemic symptoms (ex. fever) systemic abx – cephalexin
Scaly, well-demarcated, rough hyperkeratotic plaques w/ *exaggerated skin lines
Lichen Simplex Chronicus (Neurodermatitis)
*skin thickening in pts w/ eczema secondary to repetitve rubbing/scratching- itch-scratch cyle
TX: avoid scratching lesion, topical steroids (high), antihistamine, occlusive skin dressing
Describe fluid resuscitation for burn
Parkland Formula:
Lactated Ringers 4ml/kg/%TSA IV x fist 24 hours
1/2 in 1st 8 hours and other 1/2 over remaining 6 hours
Pink-red sharply demarcated, blanchable macules or papules in infancy. Over time they grow and darken to a purple color and may develop a thickened surface.
-MC on head and neck and usually unilateral or segmental
Port-wine stains (capillary malformation, nevus flammeus)
*vascular malformation of the skin
TX: pulse dye laser treatment (best if used in infancy for best outcomes)
“3-day rash” that spread rapidly
- low grade fever, cough, anorexia, lymphadenopathy (posterior cervical, posterior auricular)*–> pink, light-red spotted maculopapular rash on face–> extremities
- Forchheimer spots: small red macules or petechiae on soft palate
- Transient photosensitivity* and joint pain (esp. in young women)
Rubella (German measles)
TX: support, anti-inflammatories
HA, nausea, malaise, altered mental status, seizures, brain hypoxia, coma
-cardiac dysrhythmias, dyspnea, angina
CO toxicity
*nonirritating gas that has over 200x the affinity for hemoglobin than oxygen
TX: O2 100% nonrebreather 10-12L/min until carboxyhemoglobin <10%
*may need hyperbaric O2 in sever cases
Complications of Rubeola (measles)
- Diarrhea*
- Otitis media*
- pneumonia
- Conjunctivitis and encephalitis
deeper infection of the hair follicle. Tender nodule
-Fluctuant abscess w/ central plug +/- surrounding cellulits
Furuncle (boil)
TX: I&D. Heat compresses, oral abx if associated w/ cellulitis
What is the treatment of cellulitis caused by:
- Cat bite
- Dog bite
- Human bite:
- Puncture wound through shoe
- Cat bite (pasteurella multocida**)- amox/clavulante
- Dog bite: amox/clavulante
- Human bite: amox/clavulante
- Puncture wound through shoe (Pseudomonas)- Ciprofloxacin
How do you dx Mumps
serologies, increased amylase, often clinical dx
Low grade fever, myalgias, headach–> parotid gland pain and swelling*
Mumps (paramyxovirus)
TX: supportive
Preventative: MMR vx
How do you dx malignant melanoma
Full-thickness wide excisional biopsy + lymph node biopsy
**shave biopsy discouraged
Raised, itchy dark-red plaques/papules w/ thick silver/white scales
- MC on extensor surfaces
- Nail pitting- yellow-brown discoloration under the nails (oil spot*)
- Positive Auspitz sign: punctate bleeding w/ removal of plaque/scales
- Koebner’s phenomenon: new skin lesions at sites of trauma
Plaque psoriasis
(due to T cell activation)
TX:
mild-mod: topical steroids (high)
mod-severe: phototherapy, UVB
Systemic tx: methotrexate
Pruritic, “tapioca-like” tense vesicles on the soles, palms, and fingers (lateral digits)
Dyshidrosis (dyshidrotic eczema)
Tx: topical steroids (med-high)
Hyper/hypopigmented, well-demarcated round/oval macules with fine scaling. Often coalesce into patches on trunk, face and extremities.
-involved skin fails to take
Tinea (pityriasis) veriscolor
*caused by overgrowth of yeast Malassezia furfur
TX: topical antifungals: Selenium sulfide, sodium sulfacetamide, zinc pyrithione, “azoles”
Systemic tx: itraconazole or fluconazole
**topical glucocorticoids could exacerbate it!
PVB19 may cause ___ in patients with sickle cell disease or G6PD deficient
aplastic crisis
Oral mucosal membrane erosions and ulcerations 1st–> painful flaccid skin bullae (ruptures easily) leaving painful denuded skin erosions that bleed easily
+ Nikolsky sign: superficial detachment of skin under pressure/trauma
Pemphigus Vulgaris
*autoimmune disorder secondary to desmosome disruption
DX: skin biopsy-
Direct immunofluorescence: IgG throughout epidermis
ELISA
TX: HD corticosteroids*
methotrexate
larger, painful, interlocking furuncles/abscesses w/ multiple openings* + cellulitis
Carbuncle
TX: TX: I&D. Heat compresses, oral abx if associated w/ cellulitis
High fever 3-5 days (well and alert appearing usually)–> fever resolves before onset of a rose, pink maculopapular, blanchable rash that starts on the trunk/back and then later spreads to face
Roseola infantum (6th disease) *only childhood viral exanthem that starts on trunk and spreads to face
TX: supportive, antipyretics
Pruritic scaly eruption rash btwn toes
Tinea pedius (athletes foot)
TX: Topical antifungal*, PO Griseofulvin if ineffective
-clean shoes with antifungal spray
Soft, symmetric, painless easily mobile palpable mass in the subcutaneous tissue
-MC on trunk and extremities
Lipoma
TX: none- surgical removal for cosmetic reasons
Fever and URI sx–> wide spread blisters begin on trunk/face, erythematous, pruritic macules, 1 or more mucous membrane involvement with epidermal detachment
-Most often after drug eruptions (esp. sulfa and anticonvulsant meds)
SJS= sloughing <10% of body surface area
Toxic epidermal necrolysis (TEN): sloughing >30% of body surface area
TX: tx like severe burns, admit to burn unit, pain control, fluids and electrolytes
What type of burn? -Epidermis into portion of dermis (reticular) -red, yellow, pale white, dry \+ BLISTERING -NOT USUALLY PAINFUL -Absent capillary reflex
Deep partial thickness (2nd degree)
- 3 weeks-2 months
- Scarring common
Acne-like rash + erythema, facial flushing, telangiectasia, skin coarsening, papulopustules with burning, stinging, red eyes
-absence of comedones
Triggers: ETOH, high temp, hot drinks, hot/cold weather, hot baths, spicy foods
Rosacea
TX:
- Topical: metronidazole 1st line
- mod-severe: oral abx, laser
- life-style modifications: sunscreen, avoid toners, and triggers
Painful, red swollen area around the nail at the cuticle site
Paronychia (MC cause S. Aureus)
*may progress to felon
TX: warm soaks (reduce pain and swelling)
- Abx: Cephalexin
- I&D
- Blanchable, edematous pink papules, wheals or plaques that may coalesce
- Rash occurs within minutes-hours after drug administration
- MC triggers: abx, NSAIDS, opiates, radiocontrast media
Urticarial (type 1 IgE hypersensitiivty rxn- mast cells release histamine causing vasodilation)
*2nd MC skin eruption
TX: anthistamine*, systemic corticosteroids, dc med
Describe different types of malignant melanoma
- Superficial spreading- MC type, Lesion may raise de novo or from pre-existing nevus
- Nodular- 2nd MC, may be associated w/ rapid vertical growth phase
- Lentigo maligna
- Acral lentiginous: MC found in dark-skinned indivuals
- Desmoplastic: most aggressive type
**thickness most important prognostic factor for METS
Fever, chills, diffuse skin eruption that occurs in the setting of pharyngitis
- Rash is diffuse erythema that blanches w/ pressure plus many small (1-2 mm) papular elevation that feels like “SANDPAPER” when palpated, “sunburn goosebumps”
- MC starts in groin and axillae the rapidly spreads to trunk and extremities
- Rash often dequamates over time
- Associated with flushed faces w/ circumoral pallor and strawberry tongue
- *Pastia’s lines= linear petechial lesion seen at pressure points, axillary, antecubital abdominal or inguinal areas
Scarlet Fever (Scarlatina)
- occurs in setting of GABHS (streptococcus pyognes) infection
- due to Type 4 hypersensitivity rxn
TX: same as strep pharyngitis
- Abx: Penicilin G or VK 1st line. amoxicillin or augmentin
- Macrolides if PCN allergy
- May return to school 24 hours after abx initiation
How do you dx basal cell carcinoma
Punch or shave biopsy: basophilic palisading cell on histology
hyperpigmentation (brown-pigment) symmetrical macules esp. on face and neck
Risk factors: estrogen exposure (OCP, pregnancy), sun exposure
Melasma (Chloasma)
TX: Sunscreen
Topical bleachers: hydroquinone, azelacic acidd
Erythema multiforme is commonly associated with what?
- HSV (MC)
- sulfa drugs
- beta-lactams
- phenyotin
- phenobarbital
Intensely pruritic lesion: papules, vesicles and linear burrows found in intertriginous zones including WEB spaces btwn fingers/toes, scalp
- Increased pruritic intensity at night*
- Red itchy pruritic papules or nodules on the scrotum, glans or penile shaft, body folds
Scabies (mites)
DX: mineral oil scraping
TX: Permethrin topical (Elimite, Nix) drug of choice* 8-14 hrs before showering and then repeat application in 1 week
2. Lindane: (cheaper)- DO NOT USE after bath/shower (causes seizures due to increased absorption)
Dry, rough, scaly, sandpaper skin lesion or erythematous, hyperkeratotic (hyperpigmented) plaques
-MC seen in fair-skinned elderly w/ prolonged sun exposure
actinic keratosis
premalignant condition to squamous cell carcinoma**
TX: observation, surgical cryosurgery*
Small, erythematous teardrops papules with fine scales, discrete lesion and confluent papules
Guttate psorasis
TX:
mild-mod: topical steroids (high)
mod-severe: phototherapy, UVB
Systemic tx: methotrexate
Describe general burn management
- Cleansing: soap and water. DO NOT Apply ice directly. Chemical burns: irrigate for at least 20 min
- Debridement
- Ruptured blisters should be removed
- Pain management w/ acetaminophen, NAIDS
- ABX Topical
- Silver sulfadiazine (SSD) on 2-3rd degree (CI in sulfa alergies, pregnancy and kids <2 and NONE ON FACE) - Dressing: superficial burns do NOT require dressings
- fingers and toes should be individually wrapped - Fluid resuscitation
Tx of voltage electric injuries
- Thermal burn management as needed
- Tele
- managed as outpatient if normal EKG and PE
- Admit if >600V even if asymptomatic
Flat, firm area w/ small, raised, TRANSLUCENT/Pearly/WAXY papule and central ulceration* and raised, rolled borders
- MC on face, nose or turunk
- bleeds easily
- May have overlying telangiectatic vessels
Basal cell carcinoma
TX:
- Electrodesiccation/curettage
- +/- Mohs micrographic surgery for facial involvment
- Surgical excision used for high or low grade tumor recurrence
Uniformly hyperpigmented macules or patches with sharp demarcation. Either present at birth (or developing early in childhood). Varing in colors from light brown to chocolate brown
Cafe au lait macules
due to increased number of melanocytes and melanin in the epidermis
erythematous plaques (circular rash with clear center and defined borders), scaling, cracking and vesicle -scales
Tinea corporis (presence of scale in tinea corporis distinguishes it from erythema migrans)
TX: Topical antifungal*, PO Griseofulvin if ineffective
Nail infection Mc on great toe
-Opaque, thickened, discolored and cracked nails with subungual hyperkeratinization
Onychomycosis
TX: Itraconazole, Terbinafine
Flesh colored papules (due to sweating in the papillary dermis)
Miliaria profunda
There is an increased incidence of ___ with Lichen Planus
Hep C
Grossly exaggerated scar that often grows pedunculated (esp. on the earlobes, face and upper extremities)
-MC in African-Americans
Keloids
TX: Corticosteroid injections (1st line)- intralesional Triamcinolone
Mobile masses of fibrous tissue and keratinous (cottage cheese like) substance
Sebaceous Cyst
TX: none- cosmetic removal
Describe the different stages of pressure ulcers
Stage I: superficial, NONBLANCHABLE REDNESS that does not dissipate after pressure is relieved
Stage II: epidermal damage extending into the dermis, resembles blister or abrasion
Stage III: FULL THICKNESS of skin that may extend into subcutaneous layer
Stage IV: deepest, extends beyond fascia INTO MUSCLE, tendon or bone
MC viral cause of pericarditis and myocarditis
MC cause of pancreatitis in kids
Coxsackie B
Mumps
Superficial hair follicle infection w/ singular or clusters of small papules or pustules with surrounding erythema
Folliculitis
*S. aureus MC
TX:
1. Topical Mupirocin, Clindamycin, Erythromycin
severe/refractory: oral cephalexin
What is Bowen’s disease
squamous cell carcinoma insitu, slow growing
TX: topical imiquimod (Aldara) or surgical excision
How do you dx CO toxicity
Measure SaO2, carboxyhemoglobin, methemoglobin
- Increased carboxyhemoglobin levels on ABG or VBG* (levels do NOT correspond with severity)
- most pulse ox can’t differentiate btwn HbO2 and carboxyhemoglobin
Malaise, fever, irritability, extreme skin tenderness–> cutaneous, blanching erythema- often starting centrally and around the mouth before spreading diffusely
- Erythema is worse over flexor areas and around orficies
- develop sterile, flaccid BLISTERS esp. in area of mechanical stress (hands, feet, flexural areas and butt)
- Positive Nikolsy sign- separation of the dermis and rupture of the fragile blisters when gentle pressure is applied to skin
- Dequamative phase-skin that easily ruptures, leaving moist, denuded skin before healing
Staphylococcal Scalded Skin Syndrome (Ritter Disease)
TX:
- Abx: Penicillinase-resistance penicillin 1st line- Nafcillin or oxacilin +/- clindamycin
- Supportive skin care- keep clean and moist
- Fluid and electrolyte replacement
- Solitary salmon-colored macule on the trunk 2-6cm in diameter–> general exanthem 1-2 weeks lateral: smaller very pruritic 1 cm round/oval salmon-colored papules with white circular (collarette) scaling along cleavage lines* in a Christmas tree pattern
- Confined to trunk and prox. extremities (face usually spared)
Pityriasis Rosea
TX: None- antihistamines
Annular, scaling lesions and broken hair shafts.
-inflamed plaques with multiple spustules (kerion) with scarring and alopecia
Tinea captius (ring worm)
TX:
PO Griseofulvin 1st line
PO terbinafine, itraconazole
Well demarcated margins of cellulitis, intensely erythematous (St. Anthonys fire) (MC on face)
Erysipelas
*GABHS MC cause
TX: IV penicillin
Sudden onset of high fever, stomatitis*, small vesicles on the soft palate, uvula and tonsillar pillars that ulcerate before healing, sore throat, 3-5 days.
Herpangia (Coxsackie A)
Tx: supportive, encourage hydration
Small papule/plaque velvety warty lesion with “greasy/stuck on appearance”
- varied possible colors ex. flesh-colored, grey, brown and black
- MC in fair-skinned elderly
Seborrheic keratosis
*MC benign skin tumor
TX:- non needed
-cosmetic management- cryotherapy
Coryza, fever–> “slapped cheeks” rash on face w/ circumoral pallor 2-4 days–> lacy reticular* rash on extremities (esp. upper)
- Spares palms and soles
- Arthropathy/arthralgias: older children and adults
- Associated w. increased fetal loss in pregnancy )fetal hydrops, CHF, spontaneous abortion)
Erythema infectiosum (fifth disease)–> parvovirus B19
DX: serologies
Tx: support
macular erythema (flat margins, not sharply demarcated), swelling, warmth, and tenderness
Local cellulitis
TX:
Cephalexin; dicloxacillin 7-10 days
MRSA: IV vanco or oral trimethoprim-sulfamethoxazole
macular, papular nodules, plaque like brown/pink/red or violaceous lesions
-MC in immunosuppressed or HIV (CD count <100)
Kaposi sarcoma (CT CA caused by Human herpesvirus 8-HHV-8)
TX: HAART therapy, radiation for local disease
Complications of mumps
- Orchitis in males (usually unilateral)
2. pancreatitis
How do you dx Condyloma acuminata
Whitening of lesion with acetic acid application
-clinical, seroliges
Histology: koiocystic squamous cells with hyperplastic hyperkeratosis
-Gardasil vx
How do you dx actinic keratosis
- punch or shave biopsy- atypical epidermal keratinocytes and cells w/ large hyperchromatic pleomorphic nuclei from the basal layer upwards
area of surface capillary dilation.
-MC seen on nape of neck, eyelids and forehead
Nevus Simplex (Stork bite)
TX: observation- most resolve spontaneously by age 2
OR laser therapy will reduce appearance of lesion
- asymmetry, irregular borders, color variation (dark blue, black), diameter usually 6mm or greater
- Varying thickness
Superficial Spreading Malignant Melanoma
*MC type 70%
TX: complete wide surgical excision with lymph node biopsy or dissection
+/- adjuvant therapy in high risk
- Blue or slate gray pigmented macular lesion most commonly seen in presacral/sacral-gluteal area (may be seen on shoulders, legs, back and posterior thighs) w/ indefinite borders
- Congenital dermal melanocytosis due to mid-dermal melanocytes that fail to migrate to the epidermis from neural crest
Mongolian Spots
*spots usually fad over the first few years of life (before 10 yrs of age)
Tiny, painless* papules evolve into soft, fleshy cauliflower-like lesion ranging from skin-colored to pink or red, occurring in clusters in the genital regions and oropharynx
Genital wars (Condyloma acuminata) **mucosal Human papilloma virus
Tx: -lesions persist for months and may spontaneously resolve, remain unchanged or grow it not treated
- Chemical, salicylic acid, cryotherapy
- Gardasil vx
Generalized distribution of “bright-red” macules and papules that coalesce to form plaques.
-rash typically begins 2-14 days after medication initiation (ex. NSAIDS, abx, allopurinol, thiazide diuretics)
Exanthematous/Morbiliform Rash (type 4 hypersensitivity)
*MC skin eruption
TX: oral histamine and d/c med
Firm, hyperkeratotic papules between 1-10mm w/ red-brown punctations (thrombosed capillaries*)
-borders +/- be rounded or irregular
vulgaris and plantis (common and planter warts)
**Human papilloma virus
TX: most warts resolve spontaneously w/in 2 yrs
- topical OTC salicylic acid and plasters
- cryotherapy, electrocautery
What type of burn?
-Epidermis + portion of dermis (papillary)
-Erythematous, pink, moist weeping
+ BLISTERING
-Most painful of ALL BURNS (VERY TENDER TO TOUCH)
+ refill intact, blanches w/ pressure
Superifical partial thickness (2nd degree)
- heals 14-21 days
- No scarring (but +/- leave pigment changes)
Tiny, friable clear vesicles (due to sweat in the superficial stratum corneum)
-MC in neonates
Miliaria crystallina
*blockage of eccrine sweat glands
Positive Auspitz sign is seen with what conditions
Koebner’s phenomenon is seen w/ what conditions
Plaque psoriasis and actinic keratosis
*punctate bleeding w/ removal of plaque/scales
Plaque psoriasis, eczema, lichen planus
*new skin lesions at site of trauma
Pruritic, ill-defined blister/papules/plaques MC on flexor creases
Atopic dermatitis (eczema)
Tx: topical corticorsteroids, antihistamine for itching
Etiologies of Erythema nodosum
- Estrogen exposure: OCPs, pregnancy
- Inflammatory dz: sarcoidosis, IBD, leukemia
- Infections: streptococcal, TB, sarcoidosis, fungal (**Coccidiomycosis)
MC drugs that cause erythema multiforme
sulfonamides
penicillins
phenobarbital
Dilantin
Smooth discrete circular patches of complete hair loss and exclamation point hairs
Alopecia areata
Tx:
Local: intra-lesional corticosteroids
Extensive: topical corticosteroids
Pruritic, papulovesicular rash on the extensor surfaces (including the forearms) and scalp
-Strongly associated w/ celiac disease
Dermatits herpetiformis
DX: immunofluorescence of skin biopsy- *IgA immune complex deposition in the dermal papillae
TX: gluten free diet. Dapsone.
pruritic, sharply defined discoid/coin-shaped lesion on the dorsum of the hands, feet and extensor surfaces
nummular eczema
Tx: topical corticorsteroids, antihistamine for itching
How do you dx Staphylococcal Scalded Skin Syndrome (Ritter Disease)
- clinical dx- intact blisters are sterile
- cultures from urine, blood and nasopharynx
- Skin biopsy: lower stratum granulosum layer splitting
Complications: sepsis, PNA, cellulitis, fluid loss, electrolyte imbalance
Solitary glistening, SESSILE, FRIABLE red (raspberry-like) nodule or papule (may bleed or ulcerate if bumped)
- usually evolve over a period of weeks. MC on arms, hands, fingers, and legs
- *increased incidence in pregnancy (higher incidence of gingival involvement)
Pyogenic Granuloma
*aka lobal capillary hemangioma
TX: Pedunculated: shave excision or curettage followed by cautery of the base
2. non-pedunculated (sessile): surgical excision
Rashes that affects the palms and soles
- Coxsackie (hand, foot, and mouth)
- Rocky mountain spotted fever (esp. wrist/ankles)
- Syphilis (secondary)
- Janeway lesions
- Kawasaki
- Measles (Rubeola)
- Toxic Shock syndrome
- Reactive arthritis (Keratoderma Blenorrhagica)
- Meningococcemia
“STC-R(R-M)M-JK”
severely pruritic papules (may develop pustules). deeper in the epidermis
Miliaria rubra
Linear vesicles w/ underlying erythema on hands, arms and legs after being outside/hiking
toxicodendrons dermititis (allergic phytocontact dermatitis from plans of poison ivy, poison sumac, or poison oak
velvety, hyperpigmented, papillomatous lesions of the neck and axillae on an obese patient
Acanthosis nigricans
DX: fasting blood sugar
an *older adult w/ dark red pruritic urticarial plaques on flexor surfaces, which begin to develop tense bullae overlying the surface of the plaques
Bullous pemphigoid
*autoimmune blistering disease of older adults
DX: Direct immunofluorescence IgG and C3 deposition at the dermal-epidermal junction
Painful flaccid bulla and erosions on skin or mucous membrane
Pemphigus vulgaris
*rare autoimmune disorder
Immunosuppressive agents required following organ transplant greatly increase the risk (65-fold) for developing ____
*hx of organ transplant presents w/ 6mm, red irregularly shaped, sharply demarcated, eroded lesion on forehead
squamous cell carcinoma
small soft skin-colored to brown papules that occur on the lower eyelids, face, neck and trunk
Syringomas
African american presents w/ indurated, translucent reddish orange lesion on face and neck and indurated painful nodules on the shins bilaterally
Sarcoidosis
*MC non-specific associated skin lesion is erythema nodosum
DX: Antinuclear antibody
___ causes folliculitis under areas of occlusion of bathing suit and improper cleaned hot tubs
__ causes folliculitis in areas of trauma such as shaving
__ causes folliculitis seen in febrile bedridden patients generally on the back due to occlusion
Pseudomonas aeruginosa
S. aureus
Candida albicans
hypopigmentation secondary to an inflammatory rash of eczema
pityriasis alba
f*ish-like scale most prominent on lower extremities that get progressively worse
*Associated w/ HIV, lymphoma, sarcoidosis and thyroid diseases
acquired ichthyosis
winter itch that occurs in high temp/low humidity environments (heated homes and desert climates)
-more common in older patients and presents as dry, cracked skin w pruritis
Eczema craquele
**Associated w/ inflammatory diseases: IBD, Crohn, UC, RA, spondyloarthropathies
Pyoderma gangrenosum
__ often manifests in the presence of iron overload, ethanol abuse, hep C and estrogen use
Porphyria cutanea tarda (PCT)
alopecia due to sensitivity to dihydrotestosterone (DHT)
androgenetic alopecia
TX: 5-alpha reductase inhibitor (finesteride)
redness, pruritus ad white discharge to the head of the penis w/o hx of STDs
*often in diabetic
Candida balanitits
TX: topical azoles (topical clotrimazole (Mycelex) or oral fluconazole)
young child w/ fussiness, decreased appetite, multiple lesions to kids face and mouth and ulcers to the hard palate and gingiva and redness lesions to right vermilion border
- vesicular lesions that quickly ulcerate*
- submandibular lymphadenopahty
Gingivostomatitis Herpes simplex
who is most likely to get MRSA
immunocompromised, those w/ chronic illness (ESRD, diabetes), inmates and athletes
Hib vaccination may help to prevent what skin disorder in children
cellulitis
Toxic shock syndrome is associated w/ many ___ species
staphylococcal and streptococcal species
yeast infection commonly in skin folds and is provoked by warm, moist environments
-pruritic red macerated patches
Intertrigo
*caused by C. albicans
Common signs of child abuse
- bruising to soft padded areas of body in multiple stages of healing
- burns that are uniform and bilateral in appearance
- in areas that can be covered
*facial lacerations and black eyes in kids are not considered suspicious for abuse
What skin lesion, if left untreated may progress to squamous cell carcinoma
Actinic keratosis
