Rosacea, Acne, Insects, Etc Flashcards
Acne vulgaris is a disease of the :
Pilosebaceous unit
What type of lesion is considered the precursor for the clinical lesions of acne vulgaris
Microcomedone
What converts a microcomedone into a closed comedone?
Accumulation of sebum and kertainous material
What areas of the body are affected by acne vulgaris
Areas with the largest, hormonally responsive sebaceous glands
(Face, neck chest, back, upper arms)
If a female pt has acne and addition signs of androgen excess, you should?
Work up for hyperandrogenism
Rapid appearance of acne in conjunction with virilization suggests..?
An underlying adrenal or ovary tumor
How do you treat comedonal (noninflammatory)acne?
Topical retinoid (Tretinoin)
How do you treat mild papulopustular and mixed acne?
Benzoyl peroxide
+/- TOPICAL antibiotic
topical retinoid
How do you treat moderate papulopustular and mixed acne?
Benzoyl peroxide
ORAL antibiotic
Topical retinoid
How do you treat severe acne?
Retinoid
ORAL antibiotic
Benzoyl Peroxide
OR
Oral isotretinoin (accutane)
+birth control for women
What is a safe regimen for pregnancy?
Oral erythromycin
Topical clindamycin
Topical azelaic acid
NO BP
NO RETINOIDS
Who most commonly gets rosacea
White ladies in 30’s
What are some things we think might cause rosacea?
bacteria on demodex mite
UV damage
Vascular dysfunction
Immunity abnormalities
What are the 4 types of rosacea
Erythematotelangiectatic
Papulopustular
Phymatous
Ocular
What type of rosacea: Chronic redness of central face Flushing Dry skin Telangiectasias
Erythematotelangiectatic
What type of rosacea:
Papules and pustules on central face
No comedones
Papules/pustules may coalesce
Papulopustular rosacea
What type of rosacea: Tissue hypertrophy causing irregular contours Mostly nose Cheeks, forehead, chin maybe Mostly men
Phymatous
What should you keep in mind if someone with a history of rosacea presents with bilateral eye problems?
Ocular rosacea
How is rosacea diagnosed
Clinical presentation
Treatment for erythematotelangiectatic rosacea
FIRST LINE -avoid triggers -sun protection -gentle skin care SECOND LINE -Laser/light therapy -topical brimonidine
Treatment of mild-moderate papulopustular rosacea
Metronidazole topical
Azelaic acid
(Ivermectin and sulfacetamide-sulfur as well)
Treatment of moderate-severe papulopustular rosacea
Oral antibiotics
Treatment of phymatous rosacea
Early: isotretinoin (accutane)
Advanced: surgical/laser debulking
Treatment of ocular rosacea
Refer to ophthalmologist
Topical/oral abx
When is scorpion venom depleted
After 1st sting
Subsequent stings don’t matter
What are the 2 worst types of scorpions
Bark and Mexican
Exilicauda and suffusus
What is a grade I envenomation?
Pain and paresthesias at site of sting
What is a grade II envenomation?
Pain and paresthesia beyond site of sting
-often radiating up affected extremity but sometimes even on other limb
What is a grade III envenomation
Produce EITHER:
Cranial nerve dysfunction
OR
neuromuscular dysfunction
What is a grade IV envenomation?
Produces BOTH:
cranial nerve dysfunction
AND
Neuromuscular dysfunction
How long does it take for scorpion sting symptoms to progress to maximum severity?
Within 5 hours
How long does it take for scorpjon sting symptoms to improve
9-30 hours for severe (III or IV) envenomation
How long does the pain and paresthesias from scorpion stings to go away
May persist for up to 2 weeks
How quickly can an infant progress to grade IV envenomation symptoms after being stung by scorpion
15-30 min
What is the tap sign
Tapping near site of scorpion sting and exacerbating pain
What are signs of cranial nerve dysfunction due to scorpion sting?
Hypersalivation Abnormal eye movements Blurred vision Slurred speech Tongue weird contractions
What are signs of somatic skeletal neuromuscular dysfunction due to Scorpion sting
Hot yoga: Fasciculations Shaking and jerking of extremities Opisthotonos Emprosthotonos Fever
What labs should you draw if a patient has a severe scorpion envenomation
every single one to be safe in case they crash
Treatment for mild scorpion envenomations
Pain management
Cleansing site
Tetanus shot
Observe for 4 hrs
What is the treatment for severe scorpion envenomations?
Monitor for major issues (ABC’s)
IV Fentanyl
IV benzos
Anti venom (BUT NOT if you gave benzos)
What percentage of bee stings cause anaphylaxis?
0.3-3%
What is the treatment for a large local reaction to a bee sting?
Cold compress
Prednisone
Antihistamine
NSAIDs
What two species of Hymenoptera usually cause secondary bacterial infections to their stings
Fire ants (super itchy get infected from scratching)
Yellow jackets (hang out near dumpsters and toilets)
What is the leading cause fo anaphylaxis
Insect stings
How do you treat anaphylactic rxn to bee sting
IM epinephrine
Refer to specialist
Where are widow spiders usually found
Outdoors near human habitats
What tupe of spider bite causes a blanched circular patch, surrounding red perimeter and a central punctum?
Widow
What does widow venom cause?
Catecholamine release
- radiating pain
- muscle spasm
- local diaphoresis** if pt is sweating in just one area, think widow spider
If a spider bite victim has local/regional diaphoresis, headache and N/V, what type of spider bit them?
Widow
How do you treat widow bite?
Local wound care Antiemetic Narcotic pain meds Tetanus shot Muscle relaxers Anti venom (with caution)
What type of bite is the recluse spider known for
Necrotic bite
Where do recluse bites usually happen
Indoors when spider is crushed in clothing or bedding
What type of spider bite: red plaque with central pallor +/- vesiculation
Recluse
Do recluse bites hurt at first?
No, progress to severe pain in 2-8 hrs
How long until recluse bites develop necrosis?
1-2 days (if they even do, it’s very rare)
How do you treat necrotic recluse bites?
Cleaning Cold compress Pain relief Antibiotics Surgical excision and reconstruction (maybe, after wound has stabilized)
Where is the hobo/ aggressive house spider usually found?
Fields and meadows
What causes vitiligo?
Autoimmune process that attacks melanocytes
Is there a family history to vitiligo?
Yes in 20-30% of pts
Is vitiligo associated with other autoimmune disorders?
Yes 20-30% of the time
How often does vitiligo spontanously repigment?
10-20% of the time
Does vitiligo get worse over time?
Yes, it is slowly progressive
What is the first line treatment for vitiligo
Topical and systemic corticosteroids
Average age of onset for hidradenitis suppurativa
23
How does hidradenitis suppurativa begin?
A single, deep-seated nodule
What types of lifestyle modification should a pt with hidradenitis suppurativa make
Avoiding skin trauma Hygiene (keep it clean and dry) Stop smoking Lose weight Change diet (high glycemic seems to make it worse)
Where do hidradenitis suppurativa lesions occur?
Armpits
Inguinal region
Anogenital region
What are the medical treatments for hidradenitis suppurativa?
Topical clindamycin Intralesional corticosteroids Oral antibiotics Anti-androgenic agents Surgery (cut top off or wide excision) Severe cases: TNF inhibitors and oral retinoids
