Test 3 - Derm Flashcards
Describe the stratum corneum
Top layer of skin
Contains keratin & fillagrin surrounded by lipid matrix that provides a water barrier
What is fillagrin?
A protein in the granular cell layer
Holds water
Found in stratum corneum
What are the types of skin cells?
- Keratinocytes
- Melanocytes
- Langerhans
Describe keratinocytes
90% of skin cells
Migrate from basal layer
Desquamation 40-56 days
Spiny layer, held together by desmosomes -stripes/spines
Defects in fillagrin causes?
atopic dermatitis
Defects in keratinocytes causes?
psoriasis
Describe melanocytesres
basal layer of skin
produce melanin which is transferred to the keratinocytes
Describe langerhans
mid-epidermis cells
Responsible for delayed hypersensitivity immune response reactions
What are the types of flat lesions?
- Macule
- Petechiae
- Ecchymosis
- Telangiectasia
What are the types of elevated lesions?
- Papule
- Plaque
- Nodule
- Wheal
- Papilloma
- Vesicle
- Bulla
- Abscess
- Cyst
- Scales
- Lichenification
Papule
raised, solid lesions <.5cm in daimeter
Nodule
raised, solid lesions >0.5 cm in diameter
Plaque
plateau-like elevation
confluence of papules
Lichnification
chronic, thickening of the epidermis leading to exaggerated, deep skin lines, usually due to chronic rubbing/scratching
Wheal
round of flat topped evanescent lesion,
changes rapidly in size & shape
urticaria
multiple wheals
“hives”
Vesicle
fluid filled lesion <0.5 cm
often thin walled
Bullae
fluid filled lesion >0.5 cm
Furuncle
abscess where hair follicle is involved
Carbuncle
multiple furuncles
What is cryotherapy?
liquid nitrogen
Warts, seborrheic keratoses, actinic keratoses
When do you perform an excisional biopsy?
Pigmented lesions >4mm
All lesions >6mm
Deep dermis/subQ involvement
Indications for Mohs surgery
- Incompletely excised BCC or SCC
- Primary BCC or SCC w/ indistinct borders
- Cosmetic areas
- Aggressive, rapidly growing lesions
Types of pigmented lesions
- Nevi
- melanocytic
- atypical
- blue - Lentigines
- Seborrheic keratoses
- Malignant melanoma
Evaluation of a pigmented lesion
A - Symmetry B - Borders; irregularly, poorly defined C - Color - inconsistent D - Diameter/size >6mm E - Evolving/changing (shape, size, color)
Risk Factors of melanoma
- Hx of melanoma
- Family Hx
- > 100 acquired nevi
- Any new lesion >50 y/o
- Fair skin, blue eyes, freckles (Fitzpatrick skin II)
- Big sunburn
Classification of atypical nevi
Meet 3/5
- Poorly defined borders
- Irregular borders
- Irregular pigment
- Background erythema
- > 5mm diameter
Seborrheic keratoses
Benign, may appear in 4th decade Not on palms & soles Pink, tan, dark brown Texture - velvety to warty Stuck on appearance
Tx - cryotherapy, curetted
Lentigo
Melanoma in elderly pts
Sun exposed areas
Slow growing
Horizontal growth
Clyde spots!
Acral lentiginous melanoma
Melanoma common in Asians/blacks
hands, feet, nails
Hutchinson sign - very aggressive w/ mets - line on nail
Amelanotic melanoma
Subtle w/o pigmentation
DDx:
diff. types of skin cancer
psoriasis
dermatitis
Atopic dermatitis
aka eczema
“itch that rashes”
Erythematous papules that coalesce into plaques
xerosis
What is the atopic triad?
50-80% of children will have another atopic disease
- Asthma
- Atopic dermatitis
- Allergic rhinitis
Risk factors of atopic dermatitis
- Hx/FH
- Hx asthma/allergic rhinitis
- Xerosis
- Repeated skin infections
- S. aureus
Tx atopic dermatitis
- Topical steroids
- Calcineurin inhibitors (Elidel, Protopic)
- Antihistamines
- Tx secondary bacterial infections
milds soaps, bath 1x/day, moisturizers, avoid wool & acrylics, sweat, heat & ointments
Lichen Simplex Chronicus & Tx
- Localized area of lichenification
- May be secondary to atopic dermatitis or other itchy conditions
- Hyperexcitability/abnormal itching
- Intense, may be unconscious habit
Tx - break the itch! Steroids, antihistamines, occlusive/hydrocolloidal dressing
Psoriasis & Risk Factors
Chronic inflammatory condition Bimodal peak 20-30 or 50-60 Familial, waxes & wanes Risk factors: 1. BMI 2. Smoking 3. EtOH 4. Medications
Types of psoriasis
- Plaque
- Guttate
- Inverse/flexural
- Erythrodermic
- Pustular
Plaque psoriasis
Most common type of psoriasis
Salmon colored plaques w/ silvery scales**
May itch
Hyperproliferative disease - immune response causes excess cytokine release
What is auspitz sign?
Psoriasis bleeds when plaques removed
Psoriatic arthritis
Considered seronegative spondyloarthropathies
OFten affects hands, feet & spine
Guttate psoriasis
Drop like lesions 1-10mm
Acute onset*
Often preceded by strep pharyngitis*
Erythrodermic & pustular psoriasis
Both rare but can be serious life threatening conditions
Inverse/flexural psoriasis
Found in body folds
Axilla common
Lacks scales due to moisture
May mimic candidiasis
Tx psoriasis
Mild: 1. Topical steroids 2. Vit D analogs 3. Keratolytic agents (salicylic/lactic acid) 4. Topical retinoids 5. Coal tar Moderate to sever: 1. PUVA (UV therapy) 2. Retinoids
Pityriasis rosea
Fawn/salmon colored plaques May be caused by herpes Peak age 10-35 more common in females Herald Patch** - 2-10cm patch w/ peripheral scaling, central clearing often located on the back 1-2 wks later, full blown rash on trunk & proximal extremities Xmas tree distribution* Spares the face, palms & soles of feet Neg KOH scraping no Tx
What causes a Herald patch?
Pityriasis rosea
2-10 cm patch w/ peripheral scaling, central clearing often located on the back
Which rash has a Christmas tree distribution?
Pityriasis rosea
spares the face, palms & soles of feet
Seborrheic dermatitis
Scaly, greasy looking rash
Beard, eyebrows, nasolabial fold, eyelids, under boobs, dandruff/cradle cap
Most likely caused by inflammatory rxn to fungus (Malassezia) or yeast
Tx Seborrheic dermatitis
- Antifungals & topical steroids
- Selenium sulfide shampoo or zinc pyrithione
- Salicylic acid
- Tx blepharitis by gently cleaning w/ soap
Chronic cutaneous lupus erythematosus
Discoid lupus - DLE chronic scarring lesions
Subacute cutaneous - SCLE nonscarring
Malar/butterfly rash -often pptd by sun exposure
Sharply marginated w/ irregular borders
Expansion peripherally w/ central regression leading to atrophy
Tx of lupus rash
Prevention - avoid sun
- Topical steroids
- Antimalarials
- Retinoids
- Thalidomide
Mycosis fungoides & Tx
aka cutaneous Tcell lymphoma Indolent Patches & plaques that may resemble psoriasis Sezary cells Tx - PUVA, retinoids
Actinic keratoses
Small lesions 0.2-0.6 cm Macular or papules Pinkish/flesh colored rough patches Often in sun-exposed areas Premalignant deformation of keratinocyte may develop into SCC
Tx actinic keratoses
- Liquid nitrogen
- Topical agents
- Fluorouracil cream
- Imiguimod 5%
Squamous Cell Carcinoma
Usually in sun exposed areas White fair skin Inc. mortality rate compared to BCC 1. Papule, plaque or nodule 2. Pink, red or flesh colored 3. Scaly 4. Grows outward 5. Firm 6. May have cutaneous form 7. Friable (bleed easily) 8. May be pruritic
Types of SCC
- In situ- Bowen: localized to intraepidermal layer
2. Invasive - involvement of dermis
Tx of SCC
- In situ - curette & desiccation, topical
2. Invasive - wide & local incision, MOHS
Mammary Paget disease
Unilateral red scaling plaque
Dx w/ Bx
Tx - mastectomy, chemo
Dishidrotic eczema & Tx
aka vesiculobullous hand eczema Tapioca vesicles affecting hands & feet Blisters, pruritic, may become scaly & fissured Tx - topical/oral corticosteroids keep dry - white cotton socks
Porphyria cutanea tarda & causes
Blisters on dorsal surface of hands Skin fragility Hypertrichosis (facial hair) Causes: 1. Sun exposure 2. Liver disease/alcoholism 3. Hep C 4. Hemosiderosis Dx - urinary uroporphyrins
Tx of porphyria cutanea tarda
- Avoid sun (suncreen doesn’t help)
- Avoid/remove other triggers
- Phlebotomy
- Antimalarials
Contact dermatitis causes
Exposure to chemicals or allergens
Irritant - additive, soaps, detergents
Allergic - plants, antimicrobials, adhesive tape, jewelry, rubber
Hypersensitivity rxn taking 10-14 days 1st time or 12-48 hrs repeated
Contact dermatitis presentation
Irritant - erythematous, flat, scaly
Allergic - vesicular, weepy, crusting
Itching & burning
Linear distribution
Rhus dermatitis causes
Uroshiol
- Poison ivy
- Poison oak
- Poison sumac
Type of contact dermatitis
Who gets Acne vulgaris?
May appear 8-12 y/o
Peaks 15-18 y/o
Often resolves by 25 y/o
Men>women
Pathophysiology acne vulgaris
- Production of sebum (androgen mediated)
- Keratinous obstruction of sebaceous outlet
- Baterial colonization - Propionionbacterium acnes
- Inflammatory rxn
What is an open comedone?
black head
seen w/ acne vulgaris
What is a closed comedone?
white head
seen w/ acne vulgaris
Tx acne vulgaris
- Topical antibiotics
- Benzoyl peroxide - helps open pores
- Topical retinoid
w/ severe - accutane - contraindicated in pregnancy
What worsens acne vulgaris?
- Androgenic steroids
- Corticosteroids
- Phenytoin (Dilantin)
- Isoniazid
- Oral contraceptives
Rosacea
Papules & pustules
Neurovascular component - flushing & telangiectasia
Glandular component - hyperplasia of the soft tissue of the nose (rhinophyma)
Tx of rosacea
- Metronidazole gel or clindamycin gel
- Oral antibiotics
- Benzoyl peroxide, topical retinoin
Milaria
aka heat rash
Keep cool w/ non-restrictive clothing
Clean skin w/ chlorhexadine
Topical steroids
Urticaria
Swelling of the upper dermis Angioedema - swelling of the deep dermis & subQ tissue Often involves face, tongue & larynx May be manifestations of anaphylaxis acute 6 wks
Types of urticaria
- Cholinergic - heat & emotion
- Solar
- Water - aquagenic
- Dermatographism - when skin is rubbed or scratched, leaves sharply localized edema or wheals
Causes of urticaria
Immunologic - IgE mediated activation of mast cells
Non-immunologic - Release of histamine through other pathways
1. Idiopathic
2. Food allergies
3. Infections
4. Drugs
5. IV contrast dye
What type of reaction do detergents cause?
contact dermatitis
Which drugs can cause urticaria?
- ACE
- PCN
- ASA
- NSAIDS
NSAIDS may not be cause but exacerbate it
Erythema multiforme Minor
Usually caused by Herpes or mycoplasma
Papules evolve into vesicles over ~10 days
Target lesions
Tx - acyclovir
What drugs can cause erythema multiforme major?
- Sulfa
- Allopurinol
- PCN
- Anticonvulsants
- NSAIDS
Tx erythema multiforme major
- Withdraw insulating agent
- Burn unit
- IV fluids
- IV immunoglobulins
- Corticosteroids maybe
- prone to infections
Pemphigus & causes
Rare Bullae - tender, painful & rupture Susceptible to secondary S aureus infection Nicholsky sign Causes: 1. Autoimmune 2. Drug induced 3. Paraneoplastic
What is the Nicholsky sign & when is it seen?
separation of epidermis w/ contact
Seen w/ pemphigus
What are the forms of pemphigus?
- Vulgaris
- Vegetans
- Foliaceus
- Erythematosus
Dx & Tx of pemphigus
Immunofluorescence - IgG deposits on keratinocytes & other inflammatory processes
Tx:
1. Corticosteroids, immunosuppressants, IVIG
2. Tx of secondary infection
3. Chronic, some remission
Bullous pemphigoid & Dx & Tx
Deep, tense bullae Common in flexural areas Age >60, men Autoimmune Course: exacerbations/remissions, remits 5-6 yrs Dx: Immunofluorescence Tx: Derm referral
Corns & Callosities
Hardened hyperkeratotic overgrowths
Protection from friction; pressure areas
Calluses are larger on the bottom/plantar surface
Types of corns
- Hard - thickened area w/ packed center
- Soft - thinner surface, nonweight bearing surfaces, more painful
- Seed - smaller, bottom foot, very tender, may be clogged sweat duct
Tx callus & corns
- Better fitting shoes
- Trimming
- Salicylic acid
- Soaking/pumice
- Urea/lactic acid
Refer if diabetic
Basal Cell Carcinoma
MCC of skin cancer Can occur in pale or dark skins Pink pearly papules*** rarely mets Locally invasive At risk for other types of skin cancer Follow up q 6mo-1yr
What is pathognomonic for pink pearly papules?
BCC
Tx BCC
- Curettage & dessication
- Cryotherapy
- Excision
- Mohs
- Imiquimod
- 5% Fluorouracil
- Radiation?
Violaceous purple plaques & nodules
- Lichen planus
- Kaposi sarcoma
- Purpura & vasculitis
- petechiae
- ecchymosis
- vasculitis
Lichen planus
Inflammatory pruritic condition 1. Purple 2. Papules 3. Pruritic 4. Polygonal (cells) Wickham's striae - fine white lacy lines Distribution - flexor surfaces, genitals
Causes & Tx of lichen planus
- Idiopathic
- Drugs
- Metals
- Infection (HCV)
if erosive/ulcerative - inc risk of SCC
Tx - PUVA & immunosuppression
Kaposi’s sarcoma
Vascular neoplastic condition caused by HHV8
Seen on face, trunk extremities & hard palate, GI tract & lungs
Refer!
Types of purpura
palpable - vasculitis (inflammatory)
non-palpable - petechiae 5mm
Does it blanch?
Blanch - secondary to vasodilation
non-blanch - extravasation of blood
hemorrhagic
Causes of petechiae
- Abnormal platelet function
- DIC & infection (meningitis)
3 Thrombocytopenia
-idiopathic
-drug induced
-thrombotic
Causes of ecchymosis
- Coagulation defects
- DIC & infection
- Trauma
Causes of vasculitis
- Henoch-Schonlein purpura
- Idiopathic
- Malignancy
- Infections
- Drug induced
- Polyarteritis nodosa
- Takayasu arteritis
- Giant cell arteritis
Anogenital pruritis & causes
- Hemorrhoids, fissures
- Infections
- Candidiasis
- Erythrasma
- Oxyuriasis (pinworms) - Contact dermatitis
- Irritating secretions
- diarrhea
- trichomoniasis - Psoriasis, seborrheic, dermatoses
Causes of vulvar pruritis
- Candidiasis
- Trichomoniasis
- Lichen conditions
Tx anogenital pruritis
- Hydrocortisone-pramoxine (pramasone)
- Topical doxepin
- Topical capsaicin
Erythema nodosum
Painful erythematous nodules** Bright red, brown-yellow & resemble contusions* Inflammation panniculus w/o ulcerations Anterior tibial surface Usually symmetric \+/- fever, fatigue & arthralgias 2-4th decade women>men
Causes of erythema nodosum
- Streptococcus
- Fungal (histoplasmosis, coccidiomycosis), TB, syphilis
- Drugs - oral contraceptives, sulfa
- Sarcoidosis
- IBD
- Diverticulitis
- Neoplasms
- Idiopathic
Tx erythema nodosum
Address underlying condition Usually resolves in 3-6 wks 1. NSAIDS 2. Oral KI 3. Steroids maybe
Epidermoid cysts
Epidermal inclusion cyst
Benign growths in the upper hair
Can become inflamed
Typically have a pore, punctate center
Epidermal inclusion cyst
Filled w/ cheesy, foul smelling material
May need I&D 1st then removal if infected/inflamed
Milia
Keratin filled cysts
benign, nonpainful, no Tx needed
Pilonidal cyst
Pit forms at gluteal cleft Blocked w/ hair & keratin Abscess may form High recurrence rate after Tx May need I&D, surgical referral
Causes of photodermatitis
- Solar urticaria
- Lupus
- Porphyria
- Photosensitization due to drugs
- Polymorphous Light Eruption (PMLE)
Drugs that cause photodermatitis
- Antibiotics
- sulfa, fluoroquinolones, tetracycline - NSAIDS
- Diuretics
- furosemide, HCTZ - Retinoids
Polymorphous Light Eruption
PMLE
~23 y/o
Occurs w/ sun exposure, spring/early summer
Probably a photoallergy type response
Appears w/in 18-24 hrs of exposure & resolves over 10 days
Tx of PMLE
- Sunscreen
- +/- antimalarials
- +/- PUVA (to inc. tolerance)
Venous ulcers
Signs of venous insufficiency Varicosities Dusky pigmentation (hemosiderin deposits) Discomfort relieved by elevation Medial ankle most common
Tx of venous ulcers
- Compression Tx (Unna boot)/compression stockings
- Carefully measure/document
- Keep moist (semipermeable dressings)
- Clean w/ saline
- Weekly dressing changes
- Systemic abx w/ infection
- If not healed w/in 6 wks - wound care referral
Arterial ulcer
Dependent rubor Diminished pulses Hx claudication Punched out appearance Well demarcated w/ pale base, minimal exudate
Diabetic ulcers
Neuropathy
Callus is considered pre-ulcerative condition in DM/neuropathy
Consider Xray to r/o osteomyelitis
Culture, abx
Pyoderma granulosum
Unknown cause
Minor trauma leads to development of pustule that quickly expands, inflammatory process
Multiple satellite lesions may form & coalesce
Violaceous border
Tx - steroids, immunosuppression
Vitiligo
Absence of melanocytes
Familial
Linked to autoimmune thyroid disease
White macules, can affect hair
Tx of vitiligo
- PUVA
- Steroids maybe
- Makeup
Albinism
Defect in tyrosinase - synthesis of melanin
1. Ocular - X linked
2. Oculocutaneous - autosomal recessive
Inc. risk of SCC & BCC but not melanoma
Melasma
Abnormal, irregular facial hyperpigmentation w/ sun exposure
Often assoc. w/ pregnancy, BC pills w/ estrogen & progesterone
Usually goes away after birth/stopping pills
Acanthosis nigricans & Tx
“Brown velvety thickening” in neck & axilla
assoc. w/ diabetes, insulin resistance
Tx underlying condition/wt loss
Addisons
Adrenal insufficiency & excess ACTH stimulates melanocytes
Types of aloe pecia
- Androgenetic
- Telogen effluvium
- Alepecia areata
- Trichotillomania
Androgenetic aloe pecia
Dec. anagen phase (growing phase)
Influenced by:
1. Inc. androgen levels
2. Inc. DHT levels (metabolite of testosterone)
3. Women w. inc. 5a reductase androgen receptors
Patterns in men - widows peak & crown
women - crown
Tx of androgenetic aloe pecia
- Minoxidil (Rogaine)
- Finasteride (Propecia) - males only
- Spironolactone (women)
Telogen effluvium aloe pecia & causes
Inc. # of hairs in telogen phase (resting) Inc. hair on pillows/shower Causes: 1. Pregnancy 2. Fever 3. Stress (inciting 2-4 mo prior) 4. Malnutrition 5. BC pills 6. Hyper/hypothyroidism 7. Anemia
Dx telogen effluvium aloe pecia
- Hair pluck test - 50 hairs & check for bulbs
- CBC (anemia)
- Iron studies
- Total testosterone, free testosterone, DHEA-5, prolactin
- Syphilis
Treat underlying cause
Aloe pecia areata
May be autoimmune disorder
Patchy hair loss but may become universal
Eyebrows & body hair affected
Tx - intralesional steroids
May resolve spontaneously, often recurs
Poor prognosis if: atopic dermatitis, FH, early onset
Exanthemeous eruptions & Tx
Caused by drugs, occuring 7-10 days later Only affects skin Symmetric macules & papules Resolves after ~1 wk Tx: 1. +/- Topical steroids 2. +/- Antihistamines
Fixed Drug Eruptions & causes
Solitary erythematous patch w/ bulla May involve mouth, face, genitalia, extremities Occurs in 30min-8hrs Lesion may erode, ulcerate Resolves over few weeks Causes: 1. Abx Sulfa, Tetracycline, Metronidazole 2. NSAIDS
Common causes of SJS/TEN
Sulfa Allopurinol Tetracyclines Anticonvulsants NSAIDs
& PCN
Dermatofibroma
More common in women & extremities
Reactive process usually at site of mild trauma/insect bite
~1 cm, pink-brown
Lesion tethered to dermis - pinch sign
What lesion has a pinch sign?
Dermatofibroma
Cherry Angioma
Benign, dilated capillaries, trunk
Appears in 30s
Pyogenic Granuloma
Rapidly developing hemangioma Smooth nodule, w/o crusting Age <30 y/o Often occurs at sites of minor trauma Benign but must Bx
Achrochordon
Skin tags Pedunculated polyp Frequently on neck, axilla, groin & chest Inc. w/ age Tx - snip w/ scissors
Pseudomonas folliculitis & Tx
Aka hot tun folliculitis
Papulopustular lesions, Pruritic
Tx - may resolve in few weeks
Quinolone if needed
Cellulitis
Acute spreading infection & inflammation of the dermis & hypodermis
Usually Staph/Strep
Erythema, warm, tender, swollen, possible lymphangitis w/ cellulitis streaking, adenopathy
Tx - demarcate, Abx, surgery if bad/necrotizing
Abscess & Tx
Localized pocket of infectious material - may have surrounding cellulitis Causes - IVs, IVDU MCC - Staph TX: 1. Warm soaks 2. I&D w/ wick 3. Culture 4. Oral/IV abx if >5cm in diameter
Impetigo
Strep pyoderma/staph
Crusted, golden & honey crusted yellow lesions
Tx - Bacitracin
If caused by GABHS - poststrep glomerulonephritis can occur
What usually causes bullous impetigo?
Staph
Erysipelas & Tx
Painful, macular, erythematous & well demarcated rash usually on the face
Desquamates in 10 days
Tx - admit, IV abx
Scarlet fever
Strep throat w/ rash
Fine red papular, sandpaper like rash on the cheeks, blansh, pastia lines
Assoc. w/ circumoral pallor & strawberry tongue
Fades in 2-5 fays w/ desquamation
Caused by GABHS
Necrotizing fasciitis & risk factors
Flesh eating bacteria severe swelling, warmth, pain, erythema, crepitus spreading rapidly along fascia lines, pain out of proportion to exam Risk Factors: 1. Age 2. DM 3. Immune issues 4. Renal failure 5. Chronic skin infections
Types of necrotizing fasciitis
- Polymicrobial - most common
- Monomicrobial - Group A Strep
- CA - MRSA
- Caused by Vibrio Vulnificus from seawater exposure
What should you suspect when someone has pain out of proportion to the exam?
necrotizing fasciitis
Fornier’s gangrene
Form of necrotizing fasciitis common in DM
Affects perianal area
Toxic Shock Syndrome
Bacteremia caused by Staph & Strep
Due to toxin mediated inflammatory response
Causes - tampons, nasal packing, wounds, rectal
Abrupt onset of fever, vomiting & diarrhea
Diffuse maculopapular rash & conjunctivitis
Multisystem organ failure
Cultures usually negative
Staphylococcal scalded skin syndrome
Exfoliative endotoxin - S. aureus
Children under 5 - URI Sx then tender red skin followed by exfoliation
+ Niklosky sign
Vibrio Vulnificus & Tx
Infection from contaminated seafood
Vomiting, diarrhea, abdominal pain & sepsis
Leads to necrotizing fasciitis, hemorrhagic bullae, HOTN/shock, purpura
CDC reportable
Tx - Abx, Debridement
Tinea infections
Red annular patch w/ central clearing & scale
Dx w/ KOH prep/clinical
Tx - antifungals
1. Dermatophytosis
2. Trichophyton
3. Microsporum
4. Tinea capitus, cruris, corporis, mnuum, unguium, barbae, pedis, cruris
Onycomycosis
Nails become white/brown/yellow & thicken
Caused by fungus - trichophyton rubrum
KOH prep
Tx w/ oral antifungals
Scabies
Sarcoptes scabiei - arthropod
Most common on hands, genitals, axillary
Secondary infection due to staph/strep
Lesions are pruritic burrows, pustules & nodules
Dx - clinical or explore for egg/mite
Tx - Lindane, Permethrin
Pediculosis
Pediculus capitis - Headlice, Rx - Permethrin
Pubic lice - crabs, STI
Body lice - can cause trench fever - Bartonella quintana
Molluscum Contagiosum
Cause - Poxvirus
STD, skin to skin
Common in AIDS w/ CD4 < 100
Single or multiple dome-shaped, waxy papules 2-5 mm in diameter that are umbilicated
Common on face, lower abdomen & genitals
Last 2 mo then remit
Tx - Curettage/liquid nitrogen, electrosurgery
Warts
Verrucous papules on skin/mucous membrane
Cause - HPV
Condyloma acuminata - genital warts types 6&11
Lyme Disease & Dx
Spirochete Borrelia burgorferi from ixodes scapularis tick that lives on deer mouse
Dx - serum Ab w/ ELISA, confirm w/ western blot, PCR
Leukocytosis, elevated ESR, hematuria, moderately elevated LFTs, LP, arthrocentesis PRN
Tx w/ abx - Doxycycline
Stages of Lyme Disease
Stage 1 - (7-10 days) early localized infection, erythema migrans on groin, thich of axilla, lesion w/ bulls eye, myalgias, fatigue, fever
Stage 2 - (wks-mo) early disseminated infection, bacteremia, secondary skin lesions, myocarditis, meningitis, keratitis, cranial neuropathies, ongoing flu-like Sx
Stage 3 - (mo-yrs) late persistent infection, large joint chronic arthritis, encephalopathy - memory loss, behavoiral changes, paresthesias, acrodermatitis chronicum atrophicans
Dew drops on a rose pedal?
Chicken pox! aka varicella
Lesions turn pustular then crust
Rubeola
aka measles
High fever, malaise, anorexia, conjuncitivis, cough, Koplik spots, exanthem rash spreading cephalocaudally
Rubella
TORCH infection
Aerosolized infection
Systematic maculopapular rash - malaise, ocular pain, low fever, HA
5th disease
Erythema infectiousum
Cause - Prvovirus B19
red slapped cheek fac & lacy pink macular rash on torso
Spread - droplet or bloodborne
Causes a polyarthropathy syndrome in adult females
Roseola infantum
Cause - HHV6
High fever, then goes away, then pink macular morbilliform rash
Tx - supportive
What is Darier’s sign?
Rubbing a lesion causes urticarial flare
What is Koebner’s phenomenon?
Minor trauma leads to new lesions at site of trauma
What is Shagreen skin?
An oval-shaped nevoid plauw
Skin is colored or pigmented on the trunk or back & is assoc. w/ tuberous sclerosis
When is cryotherapy typically used?
- Warts
- Seborrheic keratoses
- Actinic keratoses
1-6th diseases
- Measles
- Scarlet Fever
- Rubella
- -No 4th..
- Fifth’s disease - Erythema Infectiosum
- Roseola Infantum HHV-6
What is a big complication of measles?
Pansclerosing encephalitis
Scarlet Fever
Strep throat w/ sandpaper rash
Strawberry tongue
Erythema Multiforme Major
Usually from drug exposure 1-3 wks after exposure, erythematous coalescence sheet-like loss of epidermis, blisters resembles 2nd/3rd degree burns may cause renal dysfunction
