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Clin Med I > Skin conditions 3 and 4 > Flashcards

Skin conditions 3 and 4 Flashcards

1
Q

molluscum contagiosum

A
  • common pediatric virus
  • replicates in epithelial cells
  • usually affects young kids, sexually active adults and immunosuppressed
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2
Q

what causes molluscum contagiosum

A
  • poxvirus MCV 1-4
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3
Q

how is molluscum contagiosum spread

A
  • direct skin to skin contact
  • gym equipment
  • autoinnoculation
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4
Q

si/sx of molluscum contagiosum

A
  • non pruritic
  • flesh colored dome shaped papules
  • has punctum in middle
  • curd like material
  • usually on face, trunk, extremities, groin
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5
Q

differential dx for molluscum contagiosum

A
  • warts

- milia- epidermal like cyst

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6
Q

treatment of molluscum contagiosum

A
  • usually not necessary
  • self limited
  • take months- yr to recover
  • contagious the entire time there is a lesion
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7
Q

non genital verruca

A
  • aka warts
  • more than 100 human papillomaviruses
  • can occur anywhere
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8
Q

verruca vulgaris

A
  • aka common wart
  • usually ages 5-20
  • risk with frequent exposure to water
  • hands and palms, periungunal, nail folds
  • papules with rough gray surface
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9
Q

verruca planta

A
  • aka flat wart
  • usually kids and young adults
  • flat topped flesh colored papules
  • grouped together on face, neck, wrist, hands
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10
Q

verruca plantaris

A
  • aka plantar wart
  • appear on sole of feet
  • usually at pressure points on ball of foot or heel
  • can be grouped together- “mosaic wart”
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11
Q

diagnosis of verruca

A
  • clinical exam

- punch biopsy

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12
Q

treatment for verruca

A
  • no treatment
  • 65% regress spontaneously in 2 yrs
  • tx recommended for pts with extensive, spreading or symptomatic warts
  • cryotherapy
  • salicylic acid/ cantharidin
  • occlusive dressing
  • intralesional inj of bleomycin
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13
Q

what causes tinea versicolor

A
  • malassezia furfur (yeast)

- more common in humid climates

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14
Q

si/sx of tinea versicolor

A
  • hypo or hyperpigmented macules that do not tan
  • asymptomatic
  • usually noticed in summer bc of tan
  • well defined round macules with scaling on trunk, arms, face
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15
Q

dx of tinea versicolor

A
  • KOH scraping -> hyphae and sports “spaghetti and meatballs”
  • woods light -> orange mustard color
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16
Q

differential dx for tinea versicolor

A
  • vitiligo

- difference= vitiligo is complete depigmentation with no scaling

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17
Q

treatment for tinea versicolor

A
  • selenium sulfide shampoo daily
  • topical ketoconazole cream
  • PO ketoconazole- caution LFTs
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18
Q

tinea corporis

A
  • aka ring worm
  • aquired by contact with organism
  • increased risk with wrestlers
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19
Q

si/sx of tinea corporis

A
  • annular lesions with peripheral enlargement
  • central clearing
  • scaly active boarder
  • asymmetrical distribution
  • usually on face, trunk, extremities
  • pruritic or asymptomatic
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20
Q

differential dx of tinea corporis

A
  • acute lyme disease

- difference= no scaling

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21
Q

treatment for tinea corporis

A
  • topical naftin or ketoconazole
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22
Q

tinea pedis

A
  • common in young men d/t sweaty work boots

- moccasin distribution

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23
Q

si/sx of tinea pedis

A
  • scale and maceration in toe web spaces
  • moccasin distribution on plantar surface
  • distinct boarder
  • pruritic feet
  • inflammation and fissures possible
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24
Q

diagnosis of tinea pedis

A
  • KOH or fungal culture
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25
Q

treatment of tinea pedis

A
  • keep feet dry
  • zeasorb-AF powder- miconzaole
  • topical antifungals
  • if severe lostrisone cream
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26
Q

vitiligo

A
  • autoimmune disease
  • destruction of melanocytes
  • mostly idiopathic
  • can affect any age/race
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27
Q

si/sx of vitiligo

A
  • hypopigmentation macules
  • may occur focally or generalized in a pattern
  • hair can also become white
  • NO scales
  • often occurs at places where trauma occurs like knuckles and knees
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28
Q

dx of vitiligo

A
  • clinical
  • punch biopsy
  • woods light= milky white appearance
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29
Q

treatment for vitiligo

A
  • sunscreens
  • avoid sun exposure
  • cosmetic cover up
  • protopic/elidel
  • eximer laser
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30
Q

varicella

A
  • aka chickenpox
  • 90% in kids <10
  • incubation pd= 10-21 days
  • usually self limiting in healthy kids
  • adults= increased risk of pneumonia
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31
Q

how is varicella transmitted

A
  • direct contact with lesion
  • respiratory droplets
  • infectious 4 days before and 5 days after rash
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32
Q

si/sx of varicella

A
  • rash, malaise, low grade temp
  • macules -> teardrop vesicles on erythematous base
  • descending presentation - scalp -> face -> trunk -> extremities
  • can be on palms and soles
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33
Q

changes of varicella lesions

A
  • vesicles are pruritic -> pustular -> crusted
  • crusted = not infectious
  • can dev secondary staph or strep infection d/t itching
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34
Q

dx of varicella

A
  • clinical

- tzank smear

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35
Q

treatment of varicella

A
  • kids <13 = supportive
  • oatmeal baths
  • calamine lotion
  • antihistamines
  • AVOID ASPIRIN-> reyes syndrome
  • in adults give PO acyclovir within 1st 24 hrs
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36
Q

what is reye syndrome

A
  • acute encephalopathy
  • hepatitis
  • possible with ASA and chickenpox/ shingles
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37
Q

immunization for varicella

A
  • single dose for kids 1-12

- over 13 should receive two vaccines 4-8 weeks apart

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38
Q

herpes zoster

A
  • aka shingles
  • reactivation of varicella zoster virus
  • remains latent in sensory dorsal root ganglion
  • increased risk > 50
  • possible to have a reoccurance
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39
Q

how is damage caused by VZV

A
  • inflammation on dorsal root ganglion -> hemorrhagic necrosis of nerve cell
  • result = neuronal loss and fibrosis
  • rash distribution is associated with infected neurons in that specific ganglion
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40
Q

si/sx of VZV

A
  • prodrome of pain -> rash
  • burning, throbbing, electrical pain
  • severity varies
  • almost always unilateral (unless immunocompromised)
  • papules/plaques of erythema -> vesicles -> hemorrhagic or bullous
  • rare but can have pain and no lesions
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41
Q

how long does VZV last

A
  • usually 2-3 weeks
  • in elderly can last up to 6 weeks
  • new lesions seen for 1-5 days
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42
Q

where is VZV typically found?

A
  • 55% thoracic
  • cranial (trigeminal)
  • lumbar
  • sacral
  • if opthalmic division of trigeminal N must see opthalmologist
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43
Q

hutchinson’s sign

A
  • VZV lesions on side and tip of nose
  • MUST get opthalmologist consult
  • tetinal necrosis
  • glaucoma
  • optic neuritis
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44
Q

differential dx for VZV

A
  • angina pectoris
  • plant dermatitis
  • impetigo
  • biliary or renal colic
  • appendicitis
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45
Q

diagnosis of VZV

A
  • clinical once lesions appear

- tzank smear

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46
Q

treatment for VZV

A
  • antivirals for 1 week within first 3-4 days
  • helps limit severity
  • prednisone
  • domboro solution
  • pain mgmnt= APAP, NSAIDs, narcotics, lidoderm patch
  • NO ASA** reye sydrome
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47
Q

what is the name of the VZV vaccine

A
  • zostervax
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48
Q

complications of VZV

A
  • post herpetic neuralgia
  • refer to neurologist for pain mgmt if pain continues after infection
  • neurtontin, TCAs, gabapentin
49
Q

herpes simplex virus

A
  • most prevalent infection worldwide
  • HSV-1 orolabial usually
  • HSV-2 gential usually
  • produces life long chronic latent infections
50
Q

how are you initially exposed to HSV?

A
  • direct contact with infected secretions
  • sexual
  • autoinnoculation -> herpetic whitlow
  • vertical- mother -> baby
51
Q

where does the HSV reside

A
  • neurons
  • HSV-1 trigeminal ganglia
  • HSV-2 presacral ganglia
52
Q

replication and shedding of HSV

A
  • may be asymptomatic
  • begins before lesions appear and until they heal
  • incubation pd= 2-20 days after initial exposure
  • recurrence may correlate with number of neurons infected
53
Q

what increases risk for HSV?

A
  • increased number of sexual partners

- first intercourse at young age

54
Q

si/sx of orolabial HSV

A
  • tender grouped vesicles on erythematous base
  • ulcerative
  • exudative
  • last 1-2 weeks
  • recurrence has itching/tingling
55
Q

si/sx of gential HSV

A
  • grouped blisters and erosions
  • usually on vagina, rectum, or penis
  • blisters over in 1-2 weeks
56
Q

si/sx of herpetic whitlow

A
  • occurs on fingers or periungually
  • tenderness
  • erythema with deep seated blisters
57
Q

dx of HSV

A
  • fluorescent antibody test/ western blot to differentiate (not clinically necessary)
  • tzank smear
  • usually just clinical presentation
58
Q

treatment of HSV

A
  • doesnt cure
  • decrease duration of sx, viral shedding, time to heal
  • acyclovir/ valacyclovir
59
Q

paryonychia

A
  • inflammatory rxn in folds of skin around fingernails
  • acute or chronic
  • begin with break in eponychium or nail fold -> maceration of proximal nail fold
60
Q

eponychium

A

cuticle

61
Q

acte paronychia

A
  • usually d/t aggressive manicure or nail biting

- usually staph aureus

62
Q

chronic paronychia

A
  • usually d/t frequent hand washing or water contact
  • food handlers, dishwashers
  • pseudomonas aerugionosa or candida albicans
63
Q

si/sx of acute paronychia

A
  • erythema
  • swelling
  • pain
  • can extend into proximal nail fold
  • can progress to pus that separates skin from nail
64
Q

si/sx of chronic paronychia

A
  • swollen
  • erythematous
  • tender without fluctuance
  • nail may become thickened
  • transverse ridges
  • lasts 6 or more weeks
65
Q

dx of paronychia

A
  • r/o herpetic whitlow
  • fluctuant paronychia usually bacterial
  • KOH wet mount for chronic
  • clinical hx and exam
66
Q

treatment of acute paronychia

A
  • warm water soaks 3-4 x a day
  • PO abx for staph aureus (augmentin)
  • topical steroid cream
  • incision and drain if abscessed
67
Q

treatment of chronic paronychia

A
  • avoid inciting factors
  • warm soaks
  • topical steroid cream or antifungal
68
Q

onychomycosis

A
  • infection of finer or toe nail by yeast or fungi

- most common in people with other nail problems

69
Q

causes of onychomycosis in hands

A
  • t. mentagraphytes
70
Q

cause of onychomycosis in feet

A

c albicans

71
Q

si/sx of onychomycosis

A
  • nail thickening and subungual hyperkeratosis
  • nail distrophy or onycholysis
  • usually asymptomatic
72
Q

dx of onychomycosis

A
  • KOH or fungal/ yeast culture
73
Q

treatment of onychomycosis

A
  • non-treatment is accetable
  • topical agents usually ineffective (penlac and jublia)
  • oral cure rate <40%
  • monitor LFTs before and after PO tx with lamisil
74
Q

eczema

A
  • interchangable with dermatitis
  • superficial
  • pruritic
  • erythematous
  • red, blistering, oozing, or scaling/thickened skin
75
Q

atopic dermatitis

A
  • aka eczema
  • atopic- lifelong tendency to allergic conditions like asthma and allergic rhinitis
  • chronic and relapsing
  • most common type
  • IgE mediated hypersensitivity rxn
76
Q

si/sx of atopic dermatitis

A
  • “itch that rashes” secondary to scratching
  • flexor surfaces
  • neck
  • eyelides and face
  • dorsum of hands and feet
  • papules or plaques, edema, erosion
  • +/- scales or crusting
  • persistant xerosis
  • dennie morgan lines
  • hyperlinear palmar creases
77
Q

classic charatcteristics of atopic dermatitis

A
  • pruritis
  • flexural lichenification (less demarcated than psoriasis)
  • personal/family hx of allergic rhinitis, asthma, or atopic dermatitis
  • post inflammatory hyper/o pigmented changes
78
Q

pathogenesis of atopic dermatitis

A
  • IgE hypersensitivity rxn
  • intense itching produced by mast cells and basophils
  • is inflamed skin! not “fancy dry skin”
79
Q

triggers for atopic dermatitis

A
  • mites
  • food
  • alcohol
  • hot/ cold/ humid weather
80
Q

histology of atopic dermatitis

A
  • varies with stage of lesion
  • hyperkeratosis, acanthosis
  • excoriation
  • staph colonization is possible
  • eosinophil deposition
81
Q

infantile atopic dermatitis

A
  • usually presents in 1st yr of life (after 2 mo)
  • cheeks, chest, neck, flexor/extensor extremities
  • red scaly and occasionally ooze
  • usually symmetrical
82
Q

dennie morgan lines

A
  • infra-orbital folds

- associated with atopic dermatitis

83
Q

differential dx for atopic dermatitis

A
  • contact dermatitis
  • scabies
  • psoriasis- usually on extensor surfaces and less pruritic
84
Q

treatment of atopic dermatitis

A
  • topical steroids (short pd of time)= mainstay
  • antihistamines
  • topical immunomodulators- tacrolimus and pimecrolimus
  • crisaborole (eucrisa)
  • PO abx if secondary infection
  • avoid triggers
  • bath with moisturizing soaps and use emolients
85
Q

considerations for topical steroid use

A
  • use for short term
  • skin atrophy
  • telangectasis
  • acneform eruptions on the face
  • can lead to tolerance (tachyphylaxis)
  • consider cycled dosing
86
Q

nummular eczema

A
  • coin shaped pruritic patches and plaques
  • occurs in clusters
  • usually in atopic pts
  • mainly seen on legs
  • may clear centrally like tinea corporis
87
Q

dx of nummular eczema

A
  • clinical appearance

- negative KOH results

88
Q

differential diagnosis for nummular eczema

A
  • tinnea corporis
89
Q

treatment for nummular eczema

A
  • acute- intermediate strength topical steroids
  • if severe can use high potency +/- occlusion
  • long term- treat with less potent steroid
90
Q

dyshydrosis

A
  • inflammation and foci of intercellular edema in palms and soles
91
Q

si/sx of dyshydrosis

A
  • small vesicles on hands and feet

- very itchy

92
Q

treatment for dyshydrosis

A
  • mild cleansers
  • emollient barrier creams
  • protective gloves
  • avoid irritants
  • burows solution
  • topical steroids**
  • protopic and elidel for long term mgmt
93
Q

contact dermatitis

A
  • acute or chronic inflammatory reactions to substance that contacts skin
  • irritant or allergic contact dermatitis
94
Q

allergic contact dermatitis

A
  • type IV delayed hypersensitivity rxn

- exposed to poison ivy, nickel, or chemicals

95
Q

si/sx of allergic contact dermatitis

A
  • well demarcated linear pruritic rash at site of contact
  • itching, burning
  • poison ivy- classic linear streaks of juicy papules and vesicles
96
Q

differential dx for allergic contact dermatitis

A
  • herpes zoster (usually painful and follows dermatome)
97
Q

treatment of allergic contact dermatitis

A
  • remove offending agent
  • cool showers
  • burow’s solution
  • potent or super potent topical steroids
  • severe cases- systemic steroids
98
Q

irritant contact dermatitis

A
  • direct toxic reaction to rubbing, friction, or maceration

- exposure to chem or thermal agent

99
Q

irritants that cause irritant contact dermatitis

A
  • alkalis
  • acid
  • soaps
  • detergents
  • diaper rash*
100
Q

si/sx of irritant contact dermatitis

A
  • erythematous
  • scaly
  • eczematous eruptions
  • not caused by allergen
101
Q

diagnosis of irritant contact dermatitis

A
  • history

- rule out of allergic dermatitis

102
Q

diaper dermatitis

A
  • eruptions in area covered by diaper
  • result of hydration of skin
  • irritated by chafing, soaps, prolonged contact
103
Q

si/sx of diaper dermatitis

A
  • erythema
  • scale papules and plaques
  • can erode and ulcerate
  • spares the creases
104
Q

treatment of diaper dermatitis

A
  • zinc oxide ointment
  • frequent diaper changes
  • OTC hydrocortisone
  • if beefy red, c albicans is suspected -> topical ketoconazle with nystatin powder
105
Q

perioral dermatitis

A
  • usually in young women and children

- can be induced by topical steroids, hormone changes, cosmetics

106
Q

si/sx of perioral dermatitis

A
  • clustered papulopustules
  • erythematous base
  • can scale
  • found around mouth
107
Q

treatment of perioral dermatitis

A
  • topical antibiotics - metronidazole or erythromycin
  • severe cases- minocyclin or doxycycline
  • avoid topical steroids**
108
Q

stasis dermatitis

A
  • eczematous eruption
  • lower legs
  • d/t venous insufficiency
  • usually in women with genetic predispostion to vericosities
109
Q

pathogenesis of stasis dermatitis

A
  • incompetent valves -> decreased venous return -> increased hydrostatic pressure -> edema -> tissue hypoxia
110
Q

si/sx of stasis dermatitis

A
  • erythematous scale
  • edema
  • erosions
  • crusts
  • secondary infection possible
  • chronic- hyperpigmented changes, thickened skin, “woody” appearance
  • can dev ulcers
111
Q

treatment for stasis dermatitis

A
  • elastic compression stockings
  • burrows solution
  • mod topical steroids
  • treat any secondary infections with abx
112
Q

seborrheic dermatitis

A
  • caused by yeast p.. ovale
  • found in areas with high concentration of sebaceous glands
  • scalp, face, body folds
113
Q

si/sx of seborrheic dermatitis

A
  • pruritic
  • yellow gray scaley macules
  • greasy
  • cradle cap in infants
  • dandruff in adults
  • erythema and scaling on face
114
Q

treatment for seborrheic dermatitis

A
  • scalp- zinc shampoos, ketoconazole shampoo

- face/intertriginous areas- low pot topical steroids

115
Q

lichen simplex chronicus

A
  • aka neurodermatitis
  • chronic
  • solitary pruritic eruption
  • d/t repetitive rubbing and scratching
  • focal lichenified plaque or multiple plaques
116
Q

distribution of lichen simplex chronicus

A
  • found in areas easily reachable
  • nape of neck
  • vulvae
  • scrotum
  • wrists
  • extensor forearms
  • ankles
  • pretibial areas
  • groin
117
Q

differential dx for lichen simplex chronicus

A
  • tinea cruris
  • candidiasis
  • inverse psoriasis if in inguinal creases and perianal area
118
Q

treatment for lichen simplex chronicus

A
  • intermed strength topical steroid
  • occlusion when able
  • oral antihistamines
  • protopic
  • elidel

Clin Med I (16 decks)

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