term Flashcards
seborrheic dermatitis treatment
- ketoconazole, selenium sulfide or zinc pyrithione shampoos for the scalp,
- topical antifungals (ketoconazole cream) and/or topical cor- ticosteroids for other areas.
- Cradle cap often resolves with routine bathing and application of emollients in infants.
drugs that worsen psoriasis
location
β-blockers, lithium, and ACE inhibitors (ACEIs), can worsen psoriatic lesions.
extensor surfaces
Kober phenemenon
Lesions initially appear small but may become confluent and can be provoked by local irritation or trauma
characteristic histology psoriasis
- Auspitz sign (pinpoint bleeding when scale is scraped) overlying well-demarcated, erythematous plaques with silvery “micaceous” scale.
Histology shows a
- thickened epidermis, (thickened hyperkeratosis)
- elongated rete ridges, Rete pegs are the epithelial extensions that project into the underlying connective tissue in both skin and mucous membranes.
- b an absent granular cell layer,
- preservation of nuclei in the stratum corneum (parakeratosis),
- sterile neutro philic infiltrate in the stratum corneum (Munro microabscesses).
treatment psoriasis
Local disease
- topical steroids,
- calcipotriene (vitamin D derivative)
- retinoids such as tazarotene or acitretin (vitamin A derivative).
Severe disease or psoriatic arthritis
1.methotrexate
2. anti– tumour necrosis factor (TNF) biologics
(etanercept, infliximab, adalim- umab).
3. Newer agents such as ustekinumab (anti-interleukin [IL]-12/23), secukinumab (anti-IL17),
4. UV light therapy can be used for extensive skin involvement (except in immunosuppressed patients who can develop skin cancer from UV light).
check what before starting methotrexate or TNF
before starting methotrexate or anti-TNF biologics, patients should at a minimum get a complete blood count (CBC), comprehensive metabolic panel (CMP), hepatitis panel, and a purified protein derivative (PPD).
urticaria dx , tx
anaphylaxis tx
- tryptase co- released with histamine
- dermatograph - formation of wheals where skin stroked
tx
anti histamines
anaphylaxis treatmnet
Anaphylaxis (rare) requires intra- muscular epinephrine, antihistamines, IV fluids, and airway support.
drug reaction
DRESS syndrome
- eosinophilia peripheral blood smear
- 7-14 days after drug therapy started
- unclear dx skin biopsy
- TSN/ SJS- dermal epidermal
- type IV reaction
- Nikolsky sign is
- drug reaction
erythema multiforme
- infection reaction HSV, Mycoplasma pneumonia - target lesion - Nikolsky sign is ⊝. Minor uncomplicated and localized to skin Major involves mucous membranes. It is a dis-tinct from SJS, no risk for progression to fever, myalgias, arthralgias, and headache. minor supportive, major treat as burns
SJS/TEN- biopsy
SJS/TEN: Biopsy shows full-thickness eosinophilic epidermal necrosis.
Treatment:
Patients have the same complications as burn victims—thermoregulatory and electrolyte disturbances and 2° infections, so cover the skin and man- age fluids and electrolytes.
phemigus bullus/ vulgaris
diagnosis
treatment
Most accurate test: skin biopsy with direct immunofluorescence, and/or ELISA
BULLUS - nickolsy Topical steroids can be sufficient Vulgaris \+ nick, mucous membranes involved acantholysis separation of keratinocytes High-dose steroids (prednisone) + immunomodulatory therapy (azathioprine, mycophenolate mofetil, IVIG, rituximab)
dermatitis heptiform
- Treat with dapsone and a gluten-free diet.
- lesions like HSV puritic
- papules, vesicles, bullae, and erosions on the elbows knees, buttocks, neck, and scalp, and it is associated with celiac disease
- Hyperkeratosis
- Parakeratosis
- Hypergranulosis
- Spongiosis
- Acantholysis
- Acanthosis
- thickness of stratum corneum
Psoriasis, calluses - Retention of nuclei in stratum corneum
Psoriasis
3. thickness of stratum granulosum
Lichen planus - Epidermal accumulation of edematous fluid in intercellular spaces
Eczematous dermatitis
5. Separation of epidermal cells Epidermal hyperplasia (spinosum)
Pemphigus vulgaris
6. epidermal hyperplasia - increase spinsum
Acanthosis nigricans
HSV dx
Most accurate test: Viral culture or polymerase chain reaction (PCR) test
of lesion. Direct fluorescent antigen is the most rapid test.
Classic multinucleated giant cells on Tzanck smear (Figure
port the diagnosis.
HSV treatment - FIRST EPISODE
FIRST episode:
A.
Immunocompetent patients: with small lesions only need: 2. acyclovir, famciclovir, or valacyclovir may be given to speed healing and reduce shedding.
B.
Immunocompromised patients or those with a severe painful outbreak
should receive an antiviral drug within 72 hours of the start of the outbreak
HSV treatment - REOCCURENCE
Recurrent episodes:
1. Minor lesions can be managed supportively.
Acyclovir, famciclovir, or valacyclovir given during the episode –> reduce healing time by ∼ 2 days.
- Severe frequent recurrences (> 6 outbreaks per year): Daily prophylaxis with acyclovir, famciclovir, or valacyclovir.
- 3. AIDS patients, HSV can persist, with ulcers remaining resistant to anti-viral therapy. Symptomatic HSV infection lasting > 1 month can be considered an AIDS-defining illness.
VZV treatment
child, adult, postexposure
- self limited child
- adult more serious IV acyclovir
If needed, immu- nocompromised individuals, pregnant women, and newborns should receive varicella-zoster immune globulin within 10 days of exposure. Immunocompetent adults should receive a varicella vaccine within 5 days of exposure.
giiant molluscum contagiosum
hink HIV or ↓ cellular immunity.
HPV viruses ? appearance infant HPV treatment
6 and 11
- cauliflower-like papules or plaques appearing on the penis, vulva, or perianal region
- mom passes it to child as laryngeal wart on aspiration
treated locally with
- cryotherapy, podophyllin, trichloroacetic acid, imiquimod, or 5-FU.
- Cervical lesions are monitored for evidence of malignancy (see Gynecology chapter).
Impetigo 1. layer skin infected?' 2. bacteria involved 3. complications of infection 4. appearance? treatment
- epidermis infection
- staph or strep
- strep infection –> glomerulnephritis
- Pustules and honey-colored crusts on an erythematous base, often on the face around the mouth, nose, or ears
- Bullous type: Characterized by bulla in addition to crusts that can involve the acral surfaces. Bullous impetigo is almost always caused by S aureus and can evolve into SSSS.
impetigo treatment
mild
- mupirocin
- bacitracin
Sever
- dicloxacillin or cephalexin
Community aquired MRSA
clindamycin
tetracyclin
tmp/smx
eczema treatment,
anatomic location
- topical steroids
- calcineurin inhibitors (eg, tacrolimus)
- H1 for itching 2nd generation
- Aggressive use of emollients, avoidance of harsh soaps, and limiting hot showers after resolution of acute flares will prevent future episodes.
- flexure
Pilonidal Cysts
- incision and drainage of the abscess followed by sterile packing of the wound.
- Good local hygiene and shaving of the sacrococcygeal skin can help pre- vent recurrence.
Treatment cellulite and all mild regular pencillin allergic MRSA
Sever
mild
- Dicloxacillin, cephalexin
- pencillin allergic - erythromycin, clarithromycin, clindamycin
- MRSA- doxycycline, clindamycin, tmp/smx
Sever- fever IV
- Oxacillin, nafcillin, cefazolin
- penicillin allergic- clindamycin, vancomycin
- MRSA- vancomycin, linzezolid, daptomycin, tigecylcin, ceftaroline
scaling patch pink or hypopigmented
best test
tx
topical ketoconazole or selenium sulfide.
Malassezia species,
KOH preparation of the scale revealing “spaghetti and
meatballs” pattern of hyphae and spores
candida
best initial test and findings
treatment
next best step
- Oral candidiasis: Oral fluconazole tablets; nystatin swish and swallow, clotrimazole troches.
- Superficial (skin) candidiasis: Topical antifungals; keep skin clean and dry.
- Diaper rash: Topical nystatin( only yeast infection
oral and vaginal candidas clear presentation then treat top ical antifungals
tinea capitis ( hair) and tinea unguium ( Nail) drug of choice
terbinafine otherwise itraconzole griseofulvin
Fungal infections without hair or nail involvement treatment best initial test KOH most accurate test fungal culture
topical anti fungal
- clotrimazole
- ketoconzole
- ciclopirox
topical antifungals; escalate to oral griseofulvin or terbinafine if infection is widespread or unresponsive to topicals. Treat tinea capitis with oral medications to penetrate into hair follicles; consider oral treatment for immunocompromised patients.
Sporothrix schenckii
itraconazole.
lice treatment
head lice
topical permethrin, pyrethrin, benzyl alcohol, and mechanical removal.
scabies treatment
Patients should be treated with 5% permethrin (nerve cell membrane to disrupt the sodium channel ) - from the neck down (head to toe for infants) for at least two treatments separated by 1 week, and their close contacts should be treated as well. Oral ivermectin is also effective. (high affinity to glutamate-gated chloride channels )
■ Pruritus can persist up to 2 weeks after treatment.
■ Clothes and bedding should be thoroughly washed as for lice.
acquired by walking barefoot on grass or sand. Treat with
Cutaneous Marva Migrans
Erythematous, serpentine, migratory rash due to infection with hookworm larvae, commonly
ivermectin.
debcubitus ulcer treatment and prevention
■ Prevention is key: Routinely reposition bedridden patients (at least once every 2 hours); special beds can distribute pressure.
■ If an ulcer develops, low-grade lesions can be treated with routine wound care, including hydrocolloid dressings. High-grade lesions require surgical debridement.
gangrene
dx
treatment
findings are enough + history
■ Hyperbaric oxygen (toxic to the anaerobic C perfringens) can be used after debridement to help with treatment.
exam findings and history are sufficient. Air in soft tissue on x-ray is very suggestive of necrosis
Emergency surgical debridement, with amputation if necessary, is the mainstay of treatment. Antibiotics alone do not suffice by virtue of inade- quate blood flow, but they should be given as an adjuvant to surgery.
■ Hyperbaric oxygen (toxic to the anaerobic C perfringens) can be used after debridement to help with treatment.
lichen
Tx: Mild cases are treated with topical corticosteroids. For severe disease, systemic corticosteroids and phototherapy may be used.
rosace
Topical metronidazole. For severe or ocular disease, use oral doxycycline.
Pityriasis rosea
dx treatment
Confirm with KOH exam to rule out fungus
self resolving , not on palms or soles
Vitilgo
autoimmune destruction of melanocytes
Bacillary angiomatosis, caused by Bartonella henselae and Bartonella quintana
can mimic Kaposi sarcoma (KS) and should be excluded in suspected KS patients; erythromycin is the treatment of choice.
