vesicular dermatoses/pustular disorders Flashcards
HSV1
Clin Man
primary & recurrent
Primary infection: most commonly asymptomatic, but may cause tonsil pharyngitis or gingivostomatitis
Recurrent infection: prodromal symptoms within 24 hours of reactivation of virus followed by the development of
grouped vesicles on an erythematous base that crossed over prior to healing
HSV1
Dx and Tx
▸ Diagnosis : PCR (most sensitive and specific)
▸ Treatment: Valacyclovir 2g bid x 1 day
HSV2
Clin Med
▸ Painful genital ulcers often preceded by prodromal symptoms
▸ Multiple, shallow, tender grouped 2–4 mm vesicles on an erythematous base that progressed to vesicle pustules, erosions, and
alterations +/- inguinal lymphadenopathy
HSV2
Dx and Tx
Diagnosis : PCR (most sensitive and specific)
Tzanck smear: multinucleated giant cells - classic but not specific
▸ Treatment: Valacyclovir, acyclovir, famciclovir
Herpes Zoster
Clin Man
▸ Prodrome: fever, malaise, sensory changes followed by rash
▸ Rash: unilateral, the secular dermatomal eruption of painful, grouped vesicles or bola on an
erythematous base that does not cross midline
▸ Boards: thoracic and lumbar roots are most commonly affected
HSV1
HSV2
herpes zoster
zoster
Tx, prevention
Treatment: Valacyclovir, acyclovir, famciclovir within 72 hours of onset
▸ Topical analgesics
▸ Education: no longer infectious once lesions crust over
▸ Immunocompromised: VZV immune globulin to exposed individuals
Prevention : Shingrix vaccine - reduces the risk of postherpetic neuralgia
Atopic dermatitis
atopic dermatitis
general
Triad
Rash due to defective skin barrier susceptible to drying, leading to pruritus and inflammation
▸ Atopic triad: Eczema + Allergic Rhinitis + Asthma
atopic dermatitis
triggers
heat, perspiration, allergens, contact irritants
atopic dermatitis
Dx
clinical
atopic dermatitis
clin man
Hallmark
▸ Hallmark: pruritus, xerosis
▸ Erythematous, scaly, ill-defined papules or plaques. Most common flexor creases in older children
and adults.
▸ Nummular: sharply-defined discoid or circular coin-shaped lesions especially on hands, feet,
extensor surfaces
atopic dermatitis
Tx 3- and severe
First-line: topical corticosteroids with emollient use. Antihistamines for itching
Moderate-Severe: dupilumab
contact dermatitis
general
Inflammation of the epidermis and dermis from Direct contact between a substance in the surface
of the skin – either irritant or allergic
contact dermatitis
irritant
most common type – caused by chemical, alcohol, or cream exposure
▸ Pathophysiology: Nonimmunologic reaction – immediate
contact dermatitis
Allergen
nickel most common, poison ivy, metal, chemicals, detergent, cleaners, prolonged water
exposure
contact dermatitis
Dx
clinical. Patch testing may identify potential allergens to prevent future exposures
contact dermatitis
contact dermatitis
contact dermatitis
clin man
Erythematous papules or vesicles with linear or geometric distribution. often associated
with localized intense pruritus, stinging, or burning
contact dermatitis
Tx
If extensive?
Identification and avoidance of irritants is the most important aspect
▸ First line: topical corticosteroids + General measures
▸ General measures: Cool compresses, oatmeal baths, skin emollients
▸ Severe/extensive: oral corticosteroids – 10 day prednisone taper recommended
DYSHIDROTIC ECZEMA / POMPHOLYX
general
Recurrent, pruritic, vesicular rash affecting the palms and our soles most commonly affecting young adults
DYSHIDROTIC ECZEMA / POMPHOLYX
triggers
sweating, emotional stress, warm and humid weather, metals
DYSHIDROTIC ECZEMA / POMPHOLYX
Clin Man
Sudden onset of the development of pruritic “tapioca like “small tense vesicles on the soles, palms,
and/or fingers
Followed by desiccation, desquamation, papules, scaling, lichenification, and erosions may occur
DYSHIDROTIC ECZEMA / POMPHOLYX
Dx and Tx
Mild\mod and severe
Treatment:
▸ Mild-moderate: topical corticosteroid ointment preferred
▸ Severe: oral corticosteroids, potent topical corticosteroid
▸ General measures: use of lukewarm water, fragrance free & sensitive skin
products, frequent use of emollients, wearing gloves during household
chores
DYSHIDROTIC ECZEMA / POMPHOLYX
IMPETIGO
general
Highly contagious superficial vesicopustular skin infection most commonly found in children
Impetigo
impetigo
risk factors
Poor personal hygiene, poverty, crowding, warm and humid weather, skin trauma
impetigo
classification
Nonbullous - most common type, typically caused by staphylococcus aureus, group a streptococcus. Presents as papules,
vesicles, and pustules with weeping and later development of honey color, golden crust, primarily on exposed surfaces of
the face and arms
▸ Bullous - most commonly caused by staphylococcus aureus. Vesicles form large bulla rapidly that rupture and develop a
thin, varnish-like crust
▸ Ecthyma - ulcerative pyoderma caused by group a strep – rare
impetigo
Dx and Tx
Mild and extensive
Diagnosis: clinical
▸ Treatment:
▸ Mild: mupirocin TID x 10days + good skin hygiene
▸ Treat household members, make sure to treat nasal cavities
▸ Extensive disease: cephalexin, dicloxacillin
impetigo
complications
Complications
▸ Common cause of cellulitis – 10%
▸ Acute glomerulonephritis – 1-5%
Acne Vulgaris
general
Inflammatory skin condition associated with papules, pustules involving the pilosebaceous
unit
acne vulgaris
4 main factors
four main factors – follicular hyperkeratinization, increased sebum production,
Cutibacterium acnes overgrowth, inflammatory response
acne vulgaris
Rosacea
Rosacea
General
Chronic acneiform skin condition most commonly affecting adults, typically lighter skin phototypes
▸ Etiology is unclear – persistent vasomotor instability, capillary vasodilation, and abnormal pilosebaceous activity
rosacea
triggers
alcohol, changes in weather, spicy foods, sun exposure (chocolate, and citrus)
rosacea
clin man
Macular erythema, telangiectasia, possible papules and or pustules – there are no comedones
Some patients develop rhinophyma – overgrowth of the dermis and sebaceous glands on the nose
Ocular – ocular erythema, tearing, foreign body sensation, burning, itching
rosacea
Dx and Tx
SIM + severe
Diagnosis: clinical
Treatment:
▸ Mild-Moderate: topical metronidazole, topical ivermectin cream, topical
sulfacetamide
▸ Moderate-Severe: oral antibiotics (doxycycline) + topical agent
▸ Facial erythema : topical brimonidine
▸ Telangiectasia: laser therapy
Milia
general
Skin eruption due to keratin retention and sebaceous material in the pilosebaceous follicles
within the dermis
Milia
Clin man
▸ 1–3 mm pearly, white – yellow papules especially seen on cheeks, forehead, chin and nose
Milia
Tx
▸ Treatment: Observation
▸ Can be manually extracted or treated with liquid nitrogen if desired for cosmetic reasons
milia
milia
folliculitis
general
▸ Superficial hair follicle infection or inflammation
▸ Staphylococcus aureus most common, other gram positive organisms
▸ Recent hot tub use? Think Psuedomonas aeruginosa
folliculitis
folliculitis
risk factors
More common in men, prolonged use of antibiotics, topical steroids
folliculitis
clin man
Solitary or clusters of perifollicular papules/pustules with surrounding erythema on hair bearing skin
folliculitis
Tx
First line and severe
▸ First Line: topical mupirocin, clindamycin +benzoyl peroxide, erythromycin
▸ Severe: oral cephalexin or dicloxacillin
perioral dermatitis
age group affected
20-45 females
perioral dermatitis
risk factors
History of topical corticosteroid use or fluoridated toothpaste
perioral dermatitis
clin man
▸ Erythematous group papules or pustules which may become confluence into plaques with scales
▸ Spares the vermilion border
▸ May affect the periorbital or paranasal skin
perioral dermatitis
Tx
PEM
If extensive?
▸ First line: Topical pimecrolimus, metronidazole, or erythromycin + elimination of topical corticosteroids, irritants
▸ Oral: tetracyclines if extensive or refractory
