Vascular Skin Lesions Flashcards
What is Bacillary Angiomatosis?
A vascular skin lesion caused by Bartonella henselae or Bartonella quintana, seen in HIV patients with CD4 <100. It presents as friable red or purple papules or nodules that can ulcerate and bleed.
How is Bacillary Angiomatosis diagnosed?
Clinically suspected in HIV patients with vascular skin lesions, confirmed by biopsy showing neutrophilic infiltrate and Warthin-Starry silver stain for Bartonella.
What is the treatment for Bacillary Angiomatosis?
Doxycycline or erythromycin for at least 3-4 weeks. Antiretroviral therapy (ART) for underlying HIV is also important.
What is Kaposi Sarcoma?
A vascular tumor caused by human herpesvirus 8 (HHV-8), associated with HIV/AIDS. It presents as dark purple nodules, plaques, or macules on the skin, GI tract, and mucous membranes.
How is Kaposi Sarcoma diagnosed?
Clinically suspected in immunocompromised patients, confirmed by biopsy showing vascular proliferation with lymphocytic infiltrate.
When should Kaposi Sarcoma be treated?
If asymptomatic, observation is recommended. If symptomatic (pain, bleeding, GI obstruction, airway involvement), treatment includes local excision, chemotherapy (liposomal doxorubicin), and HAART for HIV.
What are Infantile Hemangiomas?
Common vascular tumors in infants, presenting as erythematous nodules that rapidly grow for months after birth, then spontaneously regress over time.
When should Infantile Hemangiomas be treated?
Most cases are monitored, but propranolol, laser therapy, or surgical excision are used for disfigurement, ulceration, or airway obstruction.
What are Cherry Hemangiomas?
Benign vascular proliferations in adults that appear as small, red papules. They do not regress and are only excised if bothersome or bleeding.
What is a Glomus Tumor?
A painful red-blue tumor arising from thermoregulatory glomus bodies in the fingernail bed. Glomus tumors are small but disproportionately painful lesions, commonly found under the nail bed, with cold sensitivity and point tenderness. Surgical excision is curative, providing immediate pain relief, they are benign but require surgical excision due to pain.
What is an Angiosarcoma?
A malignant vascular tumor associated with chronic lymphedema, radiation exposure, or arsenic exposure. Commonly occurs on the head, neck, or breast post-mastectomy. Angiosarcoma is an aggressive vascular malignancy with poor prognosis. Early recognition is critical, especially in patients with radiation history, chronic lymphedema, or chemical exposure. Treatment is challenging, requiring a combination of surgery, chemotherapy, and radiation, but outcomes remain poor due to early metastasis and recurrence.
How is Angiosarcoma treated?
Surgical excision, radiation therapy, and chemotherapy (doxorubicin-based regimens) for advanced disease.
What is Ecthyma Gangrenosum?
A necrotic skin lesion that presents as painless, black eschars surrounded by erythema, often in neutropenic or critically ill patients who have an increased risk of exposure to Pseudomonas.
Ecthyma Gangrenosum is most commonly associated with what bacteria?
Ecthyma Gangrenosum is most commonly caused by Pseudomonas aeruginosa, particularly in immunocompromised patients.
How is Ecthyma Gangrenosum diagnosed?
- Clinically suspected in immunocompromised patients with rapidly evolving necrotic skin lesions.
- Confirmed with blood cultures and biopsy showing gram-negative rods.
What is the treatment for Ecthyma Gangrenosum?
Empiric IV antipseudomonal antibiotics (piperacillin-tazobactam, cefepime, or meropenem).
What is Pyoderma Gangrenosum?
A neutrophilic dermatosis associated with inflammatory conditions (IBD, RA). It presents as a painful ulcer with a necrotic center and violaceous borders.
How is Pyoderma Gangrenosum diagnosed?
Clinical diagnosis, biopsy showing neutrophilic infiltration, and ruling out infection or vasculitis.
What is the treatment for Pyoderma Gangrenosum?
Systemic corticosteroids or cyclosporine. Avoid debridement as it may worsen the condition due to pathergy.
What are Pyogenic Granulomas?
Lobulated capillary hemangiomas that occur due to pregnancy or trauma. They are rapidly growing, friable nodules that risk ulceration and bleeding, requiring surgical excision.
