Skin conditions 3 and 4 Flashcards
molluscum contagiosum
- common pediatric virus
- replicates in epithelial cells
- usually affects young kids, sexually active adults and immunosuppressed
what causes molluscum contagiosum
- poxvirus MCV 1-4
how is molluscum contagiosum spread
- direct skin to skin contact
- gym equipment
- autoinnoculation
si/sx of molluscum contagiosum
- non pruritic
- flesh colored dome shaped papules
- has punctum in middle
- curd like material
- usually on face, trunk, extremities, groin
differential dx for molluscum contagiosum
- warts
- milia- epidermal like cyst
treatment of molluscum contagiosum
- usually not necessary
- self limited
- take months- yr to recover
- contagious the entire time there is a lesion
non genital verruca
- aka warts
- more than 100 human papillomaviruses
- can occur anywhere
verruca vulgaris
- aka common wart
- usually ages 5-20
- risk with frequent exposure to water
- hands and palms, periungunal, nail folds
- papules with rough gray surface
verruca planta
- aka flat wart
- usually kids and young adults
- flat topped flesh colored papules
- grouped together on face, neck, wrist, hands
verruca plantaris
- aka plantar wart
- appear on sole of feet
- usually at pressure points on ball of foot or heel
- can be grouped together- “mosaic wart”
diagnosis of verruca
- clinical exam
- punch biopsy
treatment for verruca
- 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
what causes tinea versicolor
- malassezia furfur (yeast)
- more common in humid climates
si/sx of tinea versicolor
- 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
dx of tinea versicolor
- KOH scraping -> hyphae and sports “spaghetti and meatballs”
- woods light -> orange mustard color
differential dx for tinea versicolor
- vitiligo
- difference= vitiligo is complete depigmentation with no scaling
treatment for tinea versicolor
- selenium sulfide shampoo daily
- topical ketoconazole cream
- PO ketoconazole- caution LFTs
tinea corporis
- aka ring worm
- aquired by contact with organism
- increased risk with wrestlers
si/sx of tinea corporis
- annular lesions with peripheral enlargement
- central clearing
- scaly active boarder
- asymmetrical distribution
- usually on face, trunk, extremities
- pruritic or asymptomatic
differential dx of tinea corporis
- acute lyme disease
- difference= no scaling
treatment for tinea corporis
- topical naftin or ketoconazole
tinea pedis
- common in young men d/t sweaty work boots
- moccasin distribution
si/sx of tinea pedis
- scale and maceration in toe web spaces
- moccasin distribution on plantar surface
- distinct boarder
- pruritic feet
- inflammation and fissures possible
diagnosis of tinea pedis
- KOH or fungal culture
treatment of tinea pedis
- keep feet dry
- zeasorb-AF powder- miconzaole
- topical antifungals
- if severe lostrisone cream
vitiligo
- autoimmune disease
- destruction of melanocytes
- mostly idiopathic
- can affect any age/race
si/sx of vitiligo
- 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
dx of vitiligo
- clinical
- punch biopsy
- woods light= milky white appearance
treatment for vitiligo
- sunscreens
- avoid sun exposure
- cosmetic cover up
- protopic/elidel
- eximer laser
varicella
- aka chickenpox
- 90% in kids <10
- incubation pd= 10-21 days
- usually self limiting in healthy kids
- adults= increased risk of pneumonia
how is varicella transmitted
- direct contact with lesion
- respiratory droplets
- infectious 4 days before and 5 days after rash
si/sx of varicella
- rash, malaise, low grade temp
- macules -> teardrop vesicles on erythematous base
- descending presentation - scalp -> face -> trunk -> extremities
- can be on palms and soles
changes of varicella lesions
- vesicles are pruritic -> pustular -> crusted
- crusted = not infectious
- can dev secondary staph or strep infection d/t itching
dx of varicella
- clinical
- tzank smear
treatment of varicella
- kids <13 = supportive
- oatmeal baths
- calamine lotion
- antihistamines
- AVOID ASPIRIN-> reyes syndrome
- in adults give PO acyclovir within 1st 24 hrs
what is reye syndrome
- acute encephalopathy
- hepatitis
- possible with ASA and chickenpox/ shingles
immunization for varicella
- single dose for kids 1-12
- over 13 should receive two vaccines 4-8 weeks apart
herpes zoster
- aka shingles
- reactivation of varicella zoster virus
- remains latent in sensory dorsal root ganglion
- increased risk > 50
- possible to have a reoccurance
how is damage caused by VZV
- 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
si/sx of VZV
- 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
how long does VZV last
- usually 2-3 weeks
- in elderly can last up to 6 weeks
- new lesions seen for 1-5 days
where is VZV typically found?
- 55% thoracic
- cranial (trigeminal)
- lumbar
- sacral
- if opthalmic division of trigeminal N must see opthalmologist
hutchinson’s sign
- VZV lesions on side and tip of nose
- MUST get opthalmologist consult
- tetinal necrosis
- glaucoma
- optic neuritis
differential dx for VZV
- angina pectoris
- plant dermatitis
- impetigo
- biliary or renal colic
- appendicitis
diagnosis of VZV
- clinical once lesions appear
- tzank smear
treatment for VZV
- 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
what is the name of the VZV vaccine
- zostervax
complications of VZV
- post herpetic neuralgia
- refer to neurologist for pain mgmt if pain continues after infection
- neurtontin, TCAs, gabapentin
herpes simplex virus
- most prevalent infection worldwide
- HSV-1 orolabial usually
- HSV-2 gential usually
- produces life long chronic latent infections
how are you initially exposed to HSV?
- direct contact with infected secretions
- sexual
- autoinnoculation -> herpetic whitlow
- vertical- mother -> baby
where does the HSV reside
- neurons
- HSV-1 trigeminal ganglia
- HSV-2 presacral ganglia
replication and shedding of HSV
- 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
what increases risk for HSV?
- increased number of sexual partners
- first intercourse at young age
si/sx of orolabial HSV
- tender grouped vesicles on erythematous base
- ulcerative
- exudative
- last 1-2 weeks
- recurrence has itching/tingling
si/sx of gential HSV
- grouped blisters and erosions
- usually on vagina, rectum, or penis
- blisters over in 1-2 weeks
si/sx of herpetic whitlow
- occurs on fingers or periungually
- tenderness
- erythema with deep seated blisters
dx of HSV
- fluorescent antibody test/ western blot to differentiate (not clinically necessary)
- tzank smear
- usually just clinical presentation
treatment of HSV
- doesnt cure
- decrease duration of sx, viral shedding, time to heal
- acyclovir/ valacyclovir
paryonychia
- inflammatory rxn in folds of skin around fingernails
- acute or chronic
- begin with break in eponychium or nail fold -> maceration of proximal nail fold
eponychium
cuticle
acte paronychia
- usually d/t aggressive manicure or nail biting
- usually staph aureus
chronic paronychia
- usually d/t frequent hand washing or water contact
- food handlers, dishwashers
- pseudomonas aerugionosa or candida albicans
si/sx of acute paronychia
- erythema
- swelling
- pain
- can extend into proximal nail fold
- can progress to pus that separates skin from nail
si/sx of chronic paronychia
- swollen
- erythematous
- tender without fluctuance
- nail may become thickened
- transverse ridges
- lasts 6 or more weeks
dx of paronychia
- r/o herpetic whitlow
- fluctuant paronychia usually bacterial
- KOH wet mount for chronic
- clinical hx and exam
treatment of acute paronychia
- warm water soaks 3-4 x a day
- PO abx for staph aureus (augmentin)
- topical steroid cream
- incision and drain if abscessed
treatment of chronic paronychia
- avoid inciting factors
- warm soaks
- topical steroid cream or antifungal
onychomycosis
- infection of finer or toe nail by yeast or fungi
- most common in people with other nail problems
causes of onychomycosis in hands
- t. mentagraphytes
cause of onychomycosis in feet
c albicans
si/sx of onychomycosis
- nail thickening and subungual hyperkeratosis
- nail distrophy or onycholysis
- usually asymptomatic
dx of onychomycosis
- KOH or fungal/ yeast culture
treatment of onychomycosis
- non-treatment is accetable
- topical agents usually ineffective (penlac and jublia)
- oral cure rate <40%
- monitor LFTs before and after PO tx with lamisil
eczema
- interchangable with dermatitis
- superficial
- pruritic
- erythematous
- red, blistering, oozing, or scaling/thickened skin
atopic dermatitis
- aka eczema
- atopic- lifelong tendency to allergic conditions like asthma and allergic rhinitis
- chronic and relapsing
- most common type
- IgE mediated hypersensitivity rxn
si/sx of atopic dermatitis
- “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
classic charatcteristics of atopic dermatitis
- pruritis
- flexural lichenification (less demarcated than psoriasis)
- personal/family hx of allergic rhinitis, asthma, or atopic dermatitis
- post inflammatory hyper/o pigmented changes
pathogenesis of atopic dermatitis
- IgE hypersensitivity rxn
- intense itching produced by mast cells and basophils
- is inflamed skin! not “fancy dry skin”
triggers for atopic dermatitis
- mites
- food
- alcohol
- hot/ cold/ humid weather
histology of atopic dermatitis
- varies with stage of lesion
- hyperkeratosis, acanthosis
- excoriation
- staph colonization is possible
- eosinophil deposition
infantile atopic dermatitis
- usually presents in 1st yr of life (after 2 mo)
- cheeks, chest, neck, flexor/extensor extremities
- red scaly and occasionally ooze
- usually symmetrical
dennie morgan lines
- infra-orbital folds
- associated with atopic dermatitis
differential dx for atopic dermatitis
- contact dermatitis
- scabies
- psoriasis- usually on extensor surfaces and less pruritic
treatment of atopic dermatitis
- 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
considerations for topical steroid use
- use for short term
- skin atrophy
- telangectasis
- acneform eruptions on the face
- can lead to tolerance (tachyphylaxis)
- consider cycled dosing
nummular eczema
- coin shaped pruritic patches and plaques
- occurs in clusters
- usually in atopic pts
- mainly seen on legs
- may clear centrally like tinea corporis
dx of nummular eczema
- clinical appearance
- negative KOH results
differential diagnosis for nummular eczema
- tinnea corporis
treatment for nummular eczema
- acute- intermediate strength topical steroids
- if severe can use high potency +/- occlusion
- long term- treat with less potent steroid
dyshydrosis
- inflammation and foci of intercellular edema in palms and soles
si/sx of dyshydrosis
- small vesicles on hands and feet
- very itchy
treatment for dyshydrosis
- mild cleansers
- emollient barrier creams
- protective gloves
- avoid irritants
- burows solution
- topical steroids**
- protopic and elidel for long term mgmt
contact dermatitis
- acute or chronic inflammatory reactions to substance that contacts skin
- irritant or allergic contact dermatitis
allergic contact dermatitis
- type IV delayed hypersensitivity rxn
- exposed to poison ivy, nickel, or chemicals
si/sx of allergic contact dermatitis
- well demarcated linear pruritic rash at site of contact
- itching, burning
- poison ivy- classic linear streaks of juicy papules and vesicles
differential dx for allergic contact dermatitis
- herpes zoster (usually painful and follows dermatome)
treatment of allergic contact dermatitis
- remove offending agent
- cool showers
- burow’s solution
- potent or super potent topical steroids
- severe cases- systemic steroids
irritant contact dermatitis
- direct toxic reaction to rubbing, friction, or maceration
- exposure to chem or thermal agent
irritants that cause irritant contact dermatitis
- alkalis
- acid
- soaps
- detergents
- diaper rash*
si/sx of irritant contact dermatitis
- erythematous
- scaly
- eczematous eruptions
- not caused by allergen
diagnosis of irritant contact dermatitis
- history
- rule out of allergic dermatitis
diaper dermatitis
- eruptions in area covered by diaper
- result of hydration of skin
- irritated by chafing, soaps, prolonged contact
si/sx of diaper dermatitis
- erythema
- scale papules and plaques
- can erode and ulcerate
- spares the creases
treatment of diaper dermatitis
- zinc oxide ointment
- frequent diaper changes
- OTC hydrocortisone
- if beefy red, c albicans is suspected -> topical ketoconazle with nystatin powder
perioral dermatitis
- usually in young women and children
- can be induced by topical steroids, hormone changes, cosmetics
si/sx of perioral dermatitis
- clustered papulopustules
- erythematous base
- can scale
- found around mouth
treatment of perioral dermatitis
- topical antibiotics - metronidazole or erythromycin
- severe cases- minocyclin or doxycycline
- avoid topical steroids**
stasis dermatitis
- eczematous eruption
- lower legs
- d/t venous insufficiency
- usually in women with genetic predispostion to vericosities
pathogenesis of stasis dermatitis
- incompetent valves -> decreased venous return -> increased hydrostatic pressure -> edema -> tissue hypoxia
si/sx of stasis dermatitis
- erythematous scale
- edema
- erosions
- crusts
- secondary infection possible
- chronic- hyperpigmented changes, thickened skin, “woody” appearance
- can dev ulcers
treatment for stasis dermatitis
- elastic compression stockings
- burrows solution
- mod topical steroids
- treat any secondary infections with abx
seborrheic dermatitis
- caused by yeast p.. ovale
- found in areas with high concentration of sebaceous glands
- scalp, face, body folds
si/sx of seborrheic dermatitis
- pruritic
- yellow gray scaley macules
- greasy
- cradle cap in infants
- dandruff in adults
- erythema and scaling on face
treatment for seborrheic dermatitis
- scalp- zinc shampoos, ketoconazole shampoo
- face/intertriginous areas- low pot topical steroids
lichen simplex chronicus
- aka neurodermatitis
- chronic
- solitary pruritic eruption
- d/t repetitive rubbing and scratching
- focal lichenified plaque or multiple plaques
distribution of lichen simplex chronicus
- found in areas easily reachable
- nape of neck
- vulvae
- scrotum
- wrists
- extensor forearms
- ankles
- pretibial areas
- groin
differential dx for lichen simplex chronicus
- tinea cruris
- candidiasis
- inverse psoriasis if in inguinal creases and perianal area
treatment for lichen simplex chronicus
- intermed strength topical steroid
- occlusion when able
- oral antihistamines
- protopic
- elidel
