random Flashcards
paraneoplastic pemphigus
very rare, a/w malignancy, severe PV like mucus membrane lesions with dusky center like EM, Rapidly progressing. tx: find malignancy and treat
bp presentation
early prodrome, itchy non bullous rash, tense large bullae form bilaterally, symmetrical on flexural surfaces, heals with milia
mucous membrane pemphigoid
rare, 40-60 years old, chronic progressive and usually scars, painful mucosa erosions, tense blisters, sore throat, conjunctivitis. if severe or ocular need systemic rituximab and prednisone, ENT, gastro, optho consult.
MMF cellcept
immunosuppression, slow onset 2-3 mo, off label for inflam skin conditions, 500mg nightly to reduce GI distress and then slowly weekly increase in 500mg increments, mycophenolate rems teratogenic in 1st trimester for childbearing females
Azathioprine (Imuran)
immunosuppression, antiinflammatory, off label for AIBD. TPMT thiopurinemethyltranserase to measure activity in the RBCs, if low level do not use, if intermediate can start low at 1mg a day, if high start normal dose of 2-2.5mg/kg/day
pemphigoid genstationis
urticarial plaques and papules, vesicles, ocurrs in 2nd and 3rd trimsters, in belly button, associated with graves and thyroid, risk to fetus low birth weight, preterm, can have blisters, can occur in future pregnancy and menses and OCPs
polymorphous eruption of pregnancy
urticarial papules, late in 3rd, spares belly button, starts in striae, due to weight gain, no risk to fetus, resolves and 2 weeks after delivery and wont recur
DH presentation
intensely itchy, extensor surfaces, excoriations and papulovesicular, clustered and herpetiform, symmetrical, 8-12 hour prodrome burning before vesicles form. dx- need a dIF to show granular deposition of IgA autoantibodies to epidermal transflutaminase. screen- thyroid disease, family members, gi consult
DH mgmt
life long gluten free to control skin and gut and decrease lymphoma, no grains like wheat, barley, rye, spelt. Iodine and NSAIDs can induce eruptions. ROCs are OK. Dapsone.
Dapsone
myeloperoxidase enzyme inhibition for DH, off label for other AIBD, vasculitis. G6PD. increases with sulfa, mtx, chloroquine
hemolytic anemia in dapsone
can occur around 12 weeks, rbc and retic count drop,
methemolobinemia in dapsone
ha, fatigue, weakness, cyanosis, pale, s/s hypoxia
linear IgA
linear deposition of IgA in BMZ, antibodies to type 7 collagen, symptoms similar to BP, annular arcuate, may or may not look like MMF. Tx - dapsone
epidermolysis bullosa acquisita
20-30s, 80-90s, associated with chrons and SLE - screen. trauma induced bullae on hands, feet, fingers, toes, heals with mila and scarring, no mucus membranes need punch with DIF. tx dapsone, topical steroids. avoid trauma
ACLE
butterfly rash, patches and plaques, may be bullous or discound or erosions, waxes and wanes, photodistributed, duration: hours to days. risk of SLE > 90%. Multisystem, patients are sick. >90 percent progress to SLE
Subacute cutaneous LE
annular, polycyclic with central clearing, psoriasiform, persistent with flares, photodistrib NOT usually below waist, <50 Percent progress to SLE, limited and less severe than ACLE
first line for SLE
hydrocychloroquine or chloroquine - decreased efficacy in smokers, refer to rheum
first line for skin only
class 2 and 3 TCS, intermittent to butterfly, TCIs, antimalarials
hair with lupus
alopecia with non scarring, diffuse hair loss, broken frontal “lupus hairs” baby hairs in the frontal scalp
hands in lupus
telang, erythema BETWEEN dorsal IPs, dilated capillary loops proximal nail folds
DLE
AA, exacerbated by trauma and UVR. Discoid coin shaped thick dark plaques, carpet tack scale penetrating hair follicles, face, scalp, conchal bowl, Dx: h&e, ANA.
mgmt. DLE
prevent flares, sun protection, avoid scarring. treat with ILK and high potent topical steroids
chilblain lupus/perniosis
chronic, rare. risk for those who are thin, raynauds, in warm climates, PVD. tender itchy erythematous nodules when exposed to cold. dx h&e, cryoglobulins, ANA, anti-RO/SSA
mgmt. chilblain lupus
avoid cold, tight clothing, warm extremities, topical CCS,
lupus pernio
aka cutaneous sarcoid, acral locations, red yellow apple yellow urticarial papules and nodules, NOT temp induced (like perniosis/chiliblain)
mgmt. lupus pernio
h&e, if nose and mouth need pulm eval, CCS
antimalarials
hydroxycholorquine, chloroquine, quinacrine HCQ <6.5mg/day, CQ <3.0. Takes 4-6 weeks for effect, can exac pso, blue gray pigment if tx for more than 3 months - reversible. contraindicated in g6pd, MG, don’t use HCQ and CQ together, need eye exam first year at baseline
systemic scleroderma
sclerosis of visceral organs and skin, may have CREST (60%), rapid progressive, hardening fixed plaques, stiff hands and feet, raynauds, mgmt. by rheum
morphea
localized scleroderma, circumscribed ivory purple plaques that drop off at border can be linear, face
morphea mgmt
may burn out and no treatment, stays localized after 5 years, if over joints or cosmetically disfiguring, can do topical or oral CCS, antimalarials, UVB, all off label, maintain function and PT
raynauds phenomenon
intermittent vasoconstriction of small artiers, occurs with other CTD (scleroderma, lupus, RA, sjogrens) pale cold numn white blue increased in cold, refer to rhem, monitor for other symptoms of AID
sjogrens syndrome
primary - keratoconjunctivitis dry eyes, xerostomia - dry mouth, extraglandular: vasculitis, pruritic, annular erythema, vaginal dryness, refer to rheum, lubricants, avoid heat cant sweat, MMF or prednisone can help
DM
inflammation of muscle and skin, muscle weakness, idiopathic/genetic/environmental, children or 50 year olds, UVR exacerbate, risk for malignancy with ovarian cancer
polymyositis
no skin symptoms just muscle weakness on both sides of body
amyopathic
no muscle symptoms
DM clinical presentation
insidious onset of proximal muscle weakness, hair loss non scarring, heliotrope, gottrons papules, periungual erythema and telangiectasias, shawl sign - violet plaques on trunk, photosensitive
dx DM
muscle bx CT guided, h&e interface dermatitis
gottrons papules
erythema scaling and plaques OVER IP and MCP joints
HSV recurrence drugs
A 800 TID 2 DAYS
F 750 BID 1 DAY
V 2 BID 1 DAY
HSV PRIMARY
A 400 TID X 7-10 DAYS
V 1GM BID X 10 DAYS
hsv suppressive
valtrex 500mg once daily
or A 400mg BID
Shingles treatment
A 800 5X A DAY 7 DAYS
F 500 TID 7 DAYS
V 1G TID 7 DAYS
