Wright - Acne, Fungal, Viral Infections Flashcards

Question

What are the clinical manifestations of rosacea? Types?

Answer 1

- Redness, flushing, pimples - Four types: 1. Erythematotelangiectatic 2. Papulopustular 3. Phymatous: permanent swelling in the nose 4. Ocular

Answer 2

- Topical: usually a combo if severe 1. _Metronidazole_ (cream or gel) 2. Azelaic acid 3. Sodium sulfacetamide with sulfur - Systemic: if more moderate to severe disease 1. _Oral tetracyclines_ - Other: _IPL_ (intense pulse light therapy), laser, sx

Answer 3

- **Periorifical dermatitis**: women 20-45 yrs and prepubertal children (aka, periorbital dermatitis) - Suspected triggers: 1. Steroids, topical 2. OCP (oral contraceptives) 3. Menstruation, pregnancy 4. Fluorinated toothpaste 5. Stress 6. Candida, demodex mites

Answer 4

- _Rash or “pimples” around mouth_ 1. Nose, eyes, labia 2. Papules, pustules, vesicles - May be kind of eczematous - **Granulomatous variant**: longstanding in youth (top image)

Answer 5

- Discontinue all topical steroids - Mild: topical antibiotics - Severe: oral antibiotics - May need topical non-steroidal anti-inflam (like Tacrolimus)

Answer 6

- Very common in hair-bearing areas - Can usually determine cause via where it is occurring and PMH - _Most common causes are bacterial_: 1. **Staph aureus** 2. Streptococcus 3. Pseudomonas - Other Causes: 1. Fungal: pityrosporum orbiculare (yeast, fungus hybrid) 2. Mites: demodex folliculorum 3. _Mechanical_ (i.e., on buttocks) 4. **Eosinophilic folliculitis**: HIV, transplant pts

Answer 7

- Clinical manifestations of folliculitis -\> follicular based papules/pustules on hair-bearing areas - Caused often based on where it is occurring and past medical history (PMH) - TREATMENT: AB soaps/washes 1. Topical ABs: ok to use these by themselves in this context 2. Topical antifungals

Answer 8

- **Apocrine gland bearing areas**: axillary, inguinal, inframammary folds 1. Prevalence is 1-4%; mostly WOMEN - Risk factors: _obesity, cigarette smoking, and family history_

Answer 9

- Clinical manifestations: **recurrent, persistent painful abscesses** 1. Sinus tracts: chronic drainage 2. Scars 3. Also get comedones, a key to confirming the dx - Treatment: 1. Mild: topical and/or oral _antibiotics_ 2. Moderate to severe: intra-lesional _steroids_, TNF-α inhibitors, surgery

Answer 10

- dsDNA - **HSV-1**: peri-oral, lips, oral cavity 1. Abs in 85% of adults; can get initial outbreak when little, and not recurrences after that - **HSV-2**: genital -\> Abs in 20-25% of adults (can also infect the mouth)

Answer 11

- _Primary_: direct contact (vesicles) -\> 3-7 days after exposure 1. Pain, burning, tingling, fever, malaise, LAD - _Latent_: via sensory nerves to ganglion 1. Tends to be milder - _Recurrent_: viral shedding 1. Fever, sun exposure, stress

Answer 12

- Clusters of monomorphous (all look the same) vesicles with an erythematous base - "Punched out” erosions and crusted papules - Usually start out with clear contents that become cloudy over time

Answer 13

- HSV - Clusters of monomorphous (all look the same) vesicles with an erythematous base - "Punched out” erosions and crusted papules - Usually start out with clear contents that become cloudy over time

Answer 14

- **Tzanck smear**: look for multinucleated giant cells 1. Viral culture (48 hrs), PCR (faster, more $), direct fluorescent Ab -\> really just depends on the institution - Most of the time this is a clinical diagnosis - Can look like other conditions in children, however (like atopic dermatitis)

Answer 15

- Tzanck smear for HSV: note the multinucleated giant cells

Answer 16

- _Impetigo_: bacterial infection of skin with strep or staph (top image) - _Aphthous stomatitis_ (canker sore): tend to be larger and fewer in number (abscesses) -\> middle image - _Syphilitic chancre_: bottom image

Answer 17

- Mild: topical **antiviral** -\> not as effective as oral - Moderate to severe: systemic antiviral - Oral or IV for pts who may be immunosuppressed

Answer 18

- _Reactivation of latent VZV_ (in dorsal root ganglia; dsDNA) 1. 20-30% lifetime risk (if you had chicken pox as a child) - Incidence/severity INC: _after age 60_, and in ppl who are **immunosuppressed** - Triggers: trauma, stress, fever, radiation, immuno-suppression

Answer 19

- _Prodrome_: pain, pruritus, burning - **Grouped vesicles over a dermatome**: can get some additional lesions outside the dermatome too- 1. Trunk most common - Trigeminal nerve (_V1, ophthalmic_): 10 to 15% 1. Vesicles at tip/side of nose (**Hutchinson’s sign**) -\> nasociliary branch 1. _Eye_: blindness - _V2 and/or V3_: facial palsy 1. _Ear_: tinnitus, vertigo, deafness - Rash resolves within 3-5 weeks - _Postherpetic neuralgia_ (esp. common on the face, and in older patients) -\> 5-20% 1. Typically over 40 yrs old - Can get permanent scarring

Answer 20

- Shingles: VZV - Patients may think this is a bite at first

Answer 21

- Tzanck smear - Viral culture - PCR - Same as with HSV (which should also be in your differential -\> would not be as painful, or along the dermatome)

Answer 22

- Oral antiviral w/in 72 hrs and pain med, esp. with facial type - Vaccine (Zostavax) for people 60 yrs and older 1. Decreases risk of shingles by 51% and neuralgia by 67%

Answer 23

- Cutaneous infection caused by **Pox virus** (dsDNA) - Transmission: skin to skin, autoinoculation, fomites 1. _Risk factors: atopic dermatitis_, immuno-suppression, bathing/sleeping together 2. Children should not be kept out of school; casual contact should not spread disease - _Resolve spontaneously_ in months to years, but may leave depressed scar (that improves over time) 1. Discoloration common

Answer 24

- Small or lg pink to skin-colored 2-10 mm dome-shaped **waxy papules** 1. +/- central umbilication (can't rely on this for diagnosis) - May cause “_molluscum dermatitis_:” pruritis - Face, upper chest, extremities, other (_common in creases_: armpits, behind the knees, but really can be anywhere) - Parents worry about eyelids -\> conjunctivitis and keratitis are possible, but not common

Answer 25

Molluscum contagiosum

Answer 26

- Inflamed molluscum - True infection is rare -\> usually signals immune response and imminent resolution

Answer 27

- _Acne_ (left): comedones, no umbilication - _Folliculitis_ (right): papules or pustules, no umbilication

Answer 28

- Numerous methods, but **NO CLEAR EVIDENCE** to support any of them - _Active Nonintervention_: self-limited - _Physical Destruction_ 1. Curettage: more likely to leave scarring 2. Cryotherapy 3. **Cantharidin**: liquid that contains a vesicant (causes blister that dries up and falls off) - _Local Irritation_: topical retinoids, keratolytics - _Immunomodulators_: 1. Topical: Imiquimod -\> very expensive and irritating 2. Systemic: intralesional antigens, cimetidine

Answer 29

- **Chemical vesicant** extracted from the blister beetle that is used to _treat molluscum and warts_ - Research: _90% cleared after avg of 2 applications_; side effects -\> erythema, blistering, pain - High rate of parental and physician satisfaction - Superficial blisters, so NO SCARRING -\> some discoloration possible, but it will go away

Answer 30

- Common viral infection: **HPV** -\> certain types have predilection to infect certain locations - dsDNA - \>100 types - Anywhere: _hands, feet_ most common - _Benign_, involute -\> painful, embarrassing - Some oncogenic: **16, 18, 31, 33**

Answer 31

- _Contact_: 1. Direct: hetero or autoinoculation 2. Indirect: fomites -\> warm, moist surfaces, e.g., towels - Site of entry: _traumatized skin_ (can be subclinical abrasion or fissure) - Incubation period: 1-6 months - Duration variable: 2/3 _resolve within 2 years_ - Mechanism: **cell-mediated immunity** -\> production of cytokines that elicit immune response against the virus

Answer 32

- Verrucae Vulgaris: common warts - Verrucae Plantaris: plantar warts - Verrucae Plana: flat warts - Condylomata Acuminata: anogenital warts

Answer 33

- _Hands most common_: periungual, subungual 1. Can occur anywhere, including oral mucosa - Single or multiple _skin-colored_ hyperkeratotic papules and/or plaques 1. Dome shaped 2. Exophytic 3. Filiform (on a stalk) - Clues to diagnosis: paring surface reveals “**black dots**” -\> thrombosed capillaries 1. Disruption of normal skin lines

Answer 34

- Filiform warts: can be snipped off

Answer 35

- Face, neck, arms, legs most common - Smooth, skin-colored to slightly tan/pink _flat-topped thin papules_ (3-5 mm) and/or plaques - Few or many - _Shaving can facilitate spread_

Answer 36

Flat warts Note the Koebnerization in the bottom image (coalescing, linear lesion)

Answer 37

- Plantar foot, toes - Tend to be *_most symptomatic_* 1. Weight bearing surfaces 2. Develop **endophytic (grows inward) component**, painful - Coalesce into clusters 1. **Mosaic wart**: big one that causes a blister (top image) - Paring surface should reveal “_black dots_:” if you can’t tell what it is (bottom image -\> micro-thromboses) - Note the thrombosed capillaries in the bottom image

Answer 38

Endophytic warts

Answer 39

- Callus: left - Corn: top right - _Black heel_ (bottom right): common in athletes, and may sometimes be confused with warts

Answer 40

- Skin-colored to pink/tan soft papules: 1-5 mm 1. _Usually multiple_ 2. May form large masses (cauliflower-like) - _Usually asymptomatic_ 1. Irritation may cause pain, bleeding

Answer 41

- Transmission: 1. Sexual contact 2. Vertical (perinatal) 3. Benign (nonsexual) heteroinoculation (like a grandparent whiping a baby's bottom) 4. Autoinoculation: hands to genitalia or perianal area 4. Fomite (e.g., towels)

Answer 42

- No specific antiviral therapy for HPV infections -\> many txs, but **lack of evidence-based medicine** - Two broad categories: 1. _Destructive_ (physical or chemical): freezing, burning (may just grow back), cutting off, laser 2. _Immunomodulatory_: topical, oral, injections - Best evidence for topical salicylic acid, in a review

Answer 43

- Gardasil: 16, 18, 6, 11 - Cervarix: 16 and 18

Answer 44

- INDICATIONS: painful, extensive, enlarging, _subject to trauma_, cosmetically objectionable - Choice of tx depends on multiple factors: 1. Age/personality of child 2. Number 3. Size 4. Location 5. Previous therapy

Answer 45

- Tinea capitis: head - Tinea corporis: body - Tinea manuum: hand - Tinea cruris: groin creases - Tinea pedis: feet - Tinea unguium: onychomycosis

Answer 46

- Tinea or “ringworm” 1. Soil, on animals, on humans 2. **Digest keratin** and invade hair, skin, nails - 3 primary genera: 1. Trichophyton 2. Microsporum 3. Epidermophyton - Yeast: 1. Tinea versicolor 2. Candidiasis

Answer 47

- “Ringworm:" fungal infection of skin, hair of scalp - Most common in kids: 3-7 yrs old (M\>F), but freq in younger/older kids too (3-8% US prevalence) - Caused by: 1. _Trichophyton tonsurans_ (\>90% in US; AA) 2. Microsporum canis (Caucasian) - Tends to come from **cats**, and AA children more than Caucasian/Hispanic

Answer 48

- Transmission: _humans (via asymptomatic carriage_; most common), animals, soil 1. _Fomites_: brushes, combs, hats, hair clippers, etc. - Predisposing factors: large family size, _crowded_ living conditions, and _low SES_

Answer 49

- TINEA CAPITIS - **“Seb derm”-like** plaques (left): look more like dandruff -\> diffuse - **Localized** plaques (right) - Clinically, largely characterized by _scaling and patchy alopecia_, BUT variety of patterns/range of features may be seen 1. Doesn’t always look like rings, or what you see on the body

Answer 50

- **Patchy alopecia in tinea capitis**: can be subtle or quite severe - A lot of _hair breakage_, particularly at the surface of the skin

Answer 51

- **Patchy alopecia in tinea capitis**: can be subtle or quite severe - A lot of _hair breakage_, particularly at the surface of the skin

Answer 52

- **Broken hair shafts in tinea capitis** - If the child has dark hair, you may see a _“black dot” pattern_ (base of the hair is still in the follicle) - This is generally caused by **T. tonsurans**, which _grows on the inside of the hair shafts_, weakening them and causing them to break off at the scalp

Answer 53

- **Pustules in tinea capitis** - Sometimes just a few and sometimes many - When you see pustules, even in the absence of other significant findings, _you should have a high index of suspicion for a primary fungal infection_ and OBTAIN A FUNGAL CULTURE - Can also be superimposed bacterial infection

Answer 54

- **Kerions from tinea capitis**: may cause permanent scarring alopecia -\> esp likely if allowed to go on for a long time without proper treatment - May see severe inflam rxn on the scalp -\> follicles will recover and most of the hair will re-grow most of the time 1. Need to be taken seriously and treated to prevent permanent damage

Answer 55

- YES! - Studies show that presence of posterior cervical and sub-occipital LAD _correlate well with a + fungal culture in the setting of scaling and alopecia_

Answer 56

- **Gold standard is FUNGAL CULTURE** 1. Standard bacterial culturette 2. Moisten cotton tip of swab (tap water okay) 3. Rub vigorously over affected area - She reiterated how important this was multiple times - _M. Canis often takes even higher dose and longer course to clear_, especially if more severe infection, making CULTURE IMPORTANT (even though many physicians will not do this) - **KOH of scale** (attached image) & **broken hairs** may also be helpful

Answer 57

- Seborrheic dermatitis - Psoriasis - Alopecia areata

Answer 58

- **Seborrheic dermatitis**: usually more CHRONIC than tinea capitis - Unusual after infancy and before puberty 1. Infants with “_cradle cap_:" waxy yellow scale 2. Teens and adults with “dandruff:” diffuse dry or oily white to yellow scale - Diffuse dry or oily white/yellow scale - Thought that _Malasezia_ is involved

Answer 59

- **Psoriasis**: frequently affects the scalp - Erythematous plaques with silvery scale - Favors _postauricular and posterior hairline_

Answer 60

- **Alopecia areata**: well-circumscribed, smooth bald patches - Generally, you won’t see any scale or other skin changes - _Smooth bald patches_ that are very NON-INFLAM (may have pinkish-orange hue, but no scale or inflammatory pustules) - _No LAD or broken hairs_

Answer 61

- Requires _SYSTEMIC antifungal to penetrate hair follicle_ (can’t use a topical anti-fungal because can’t get inside the hair shaft) - **Griseofulvin is gold standard** - M.canis infections may require higher doses and longer course for clearance - Give with fatty food to enhance absorption; may divide bid if large volume of liquid - **Side effects rare**: headache, GI, photosensitivity, _morbilliform eruption_ 1. Heme and hepatic toxicity very uncommon - Routine lab monitoring NOT recommended 1. CBC, LFT’s for course longer than 8 wks

Answer 62

- _Antifungal shampoo_ 2-3 times per week (once per week if pt only washes hair once each week) 1. Ketoconazole 2% or Selenium sulfide 2.5% a. Aid in removal of scale b. Eradicate spores, which helps DEC transmission c. Helpful adjunctive therapy 2. _Consider use by all household members_ - _Fomite education_: don’t share combs, brushes, hats, etc.

Answer 63

- **Terbinafine**: approval for 4 and older (6-wk course) 1. Oral; have to draw _baseline LFTs and CBC_ (parents usually do NOT like this) 2. M. Canis doesn't respond well to this 3. AEs: headache, GI, dizziness, drug rxns, hepatotoxicity, rare hematologic - _Systemic azoles NOT routinely used_ -\> may give **Fluconazole to infants** (

1. More $, liver toxicity, drug interactions

Answer 64

- Marked inflam may cause scarring and permanent hair loss (e.g., the kid might wear a hat every day for awhile, making it harder to notice the damage) - _Rapid aggressive therapy_ indicated - Severe: **consider systemic steroids** (for 2 weeks) 1. Rapid resolution of inflammation 2. Decreased pain - If the patient has a kerion, you should think about whether you need medications in addition to the systemic anti-fungal

Answer 65

- Superficial fungal infection of skin - Transmission via contact with infected person or animal - Young children (M. Canis \> trichophyton) - Older child/adults (T. Rubrum and o/trichophyton) 1. Young child with T. rubrum likely has parent with tinea pedis and/or onychomycosis

Answer 66

- _Classic_: one or more well-defined **annular scaly erythematous plaques** with central clearing and a scaly, vesicular, papular, or pustular border 1. _Annular_: emphasized border, and central area that looks more like regular skin

Answer 67

Tinea corporis

Answer 68

- **Tinea incognito** (tinea corporis): use of topical steroids may alter appearance - Steroid can calm inflammation, but not clear it -\> ruins the appearance of the infection, leading to _difficult dx_ (incognito)

Answer 69

- **Majocchi's granuloma**: granulomatous folliculitis 1. Form of _tinea corporis_ (*Trichophyton rubrum*) - Erythematous plaques or patches studded with papules and/or nodules - Deeper infection of follicles - Usually _requires systemic therapy_ to penetrate follicles

Answer 70

- Clinical presentation: _history and PE_ - _KOH prep_: scrape active border - _Fungal culture_ - Most of the time, you’ll have to rely heavily on your presentation to make an educated guess -\> often don’t have time to do a KOH in prep

Answer 71

- Nummular atopic dermatitis - Psoriasis - Granuloma annulare

Answer 72

- **Nummular atopic dermatitis** - NOT ANNULAR (everything round is not annular) - Very pruritic: much more itchy than typical fungal infection would be

Answer 73

- **Psoriasis**: “dull pink” erythema - NOT tinea corporis because: 1. Silvery or white micaceous scale 2. Nummular lesions 3. Distribution -\> tends to favor scalp, behind ears, over elbows and knees

Answer 74

- **Granuloma annulare** - NOT tinea corporis because: 1. No scale 2. Raised, “rubbery” rim 3. Location: dorsal hands, wrists, feet, ankles

Answer 75

- Topical for superficial/localized: 1. BID for at least 2-4 weeks 2. Treat _affected area and rim of “normal” skin_ - If no improvement, reconsider diagnosis 2. If culture +, proceed to oral therapy - _Systemic therapy for_: disseminated/severe, immunocompromised host, Majocchi’s, tinea faciei (on the face)

Answer 76

- Combo antifungal/steroid often result in persistent, worsening infection - _Relatively strong topical steroids_: atrophy, striae, telangiectasias - _Fairly weak anti-fungal_ - Generally **NOT RECOMMENDED** - Pts use the product until they get atrophy of skin, and other effects of steroid use, but still have fungal infection -\> much better off doing the culture, and doing one or the other

Answer 77

- Skin of hands; most comm in MEN (Trichophyton) - Rare in children - Clinical manifestations: 1. Chronic _dryness_ of palms 2. _Redness_/scaling 3. Two patterns: a. _Palmar_: fine scale, may be unilateral b. _Dorsal_: annular, red, scaly

Answer 78

- **Tinea manuum** - Diagnosis via _KOH_ (branched septated hyphae) and _fungal culture_

Answer 79

- _Other dermatitis_: irritant, contact - _Psoriasis_ - Really important to GET CULTURE and see what this is

Answer 80

- Topical antifungal for dorsum, limited - Palms require oral antifungal

Answer 81

- Skin of groin, aka, "jock itch” -\> rare in children - MEN \> women - Risk factors: _obesity, heat, humidity_ - *Trichophyton*

Answer 82

- Pruritic - Red, annular, scaly plaques over groin and medial thighs - _Penis, scrotum not affected_

Answer 83

- Tinea cruris (jock itch) - KOH and fungal culture

Answer 84

- _Candidiasis_: NOT tinea bc much more irregular border satellite pustules - _Erythrasma_: NOT tinea bc no scale and coral red fluorescence (see attached image) - _Other_: psoriasis, seb derm

Answer 85

- Topical **anti-fungal** if it is pretty limited 1. Powders helpful (dry up the area) - Oral AF if refractory, severe (or have deeper follicular involvement) - Treat tinea pedis also -\> LOOK AT WHOLE BODY - _Recurrences are common_

Answer 86

- "Athlete’s foot” -\> 10% world population - Males - Risk factors: occlusive shoes, communal pools, showers

Answer 87

- Itching, scaling on soles, between toes 1. Blistering - _Moccasin_: fine dry scale over soles (T. rubrum) - _Vesiculobullous_: vesicles/bullae on soles, esp. insteps (T. mentagrophytes)

Answer 88

Tinea pedis: usually more concentrated on medial edge of the foot

Answer 89

KOH and fungal culture

Answer 90

- _Contact dermatitis_: dorsal feet affected - _Dyshidrotic eczema_: “tapioca vesicles” 1. Can be hard to differentiate between this and vesiculobullous type, but CULTURE is what helps here

Answer 91

Contact dermatitis: e.g., leather, etc. NOT tinea pedis

Answer 92

- **Dyshidrotic eczema** - Usually a lot itchier than tinea pedis, but this is a very subjective thing - CULTURE is the key

Answer 93

- Nail infection -\> _60% over age 70_ - Males - Tricophyton - Non-dermatophyte molds, yeasts - Risk factors: immunosuppressed, _diabetes_, HIV, _poor circulation_, trauma, _dystrophy_ (already abnormal and more susceptible)

Answer 94

- Discoloration, thickening, onycholysis - 4 patterns: 1. Distal subungual: most common 2. Proximal subungual 3. White superficial 4. Candida - Nails may separate from the nail bed

Answer 95

- **Distal subungual** = most common of the 4 types of _tinea unguium_ - Invasion of distal nail plate, onycholysis with thickening and discoloration

Answer 96

- **Proximal subungual** variation of tinea unguium - Uncommon - HIV positive patient: considered **pathognomonic for HIV**

Answer 97

- **Proximal subungual** variation of tinea unguium - Uncommon - HIV positive patient: considered **pathognomonic for HIV**

Answer 98

- **White superficial** variation of tinea - White plaques on dorsal nail plate: from top downward

Answer 99

- **Candida** - Distal fingertips red and swollen, and nails destroyed - Won’t see this in typical dermatophyte infections

Answer 100

- Nail dystrophy - **Candida albicans** 1. Confirm with stain and culture 2. Treatment a. _Topical ketoconazole if mild_ b. _Oral fluconazole if severe_ (3 mos for fingernails) -\> baseline CBC, LFT’s - Most of the time this has been going on for quite awhile, and you will give Fluconazole

Answer 101

- **Trachyonychia**: 20 nail dystrophy (may not affect all nails) 1. Ridging, grooves, pitting, discoloration, fragility 2. Pretty _rapidly progresses_ to involve all nails - _Causes_: idiopathic, lichen planus, psoriasis, other 1. Don’t really know what causes this (idiopathic), but can see in setting of psoriasis

Answer 102

- **Beau's lines**: transverse grooves or furrows - _Stress_ causes temporary arrest of nail matrix 1. Usually after some type of viral or febrile illness in kids 2. Plate stops growing, and re-starts, leaving a gap (totally _common, and nails grow back normally_) -\> **NOT fungus** - Nail may shed completely (_onychomadesis_)

Answer 103

- **Usually symmetrical**: often both great toes, 2nd toes, or 5th toes, e.g., pressure from ill-fitting shoes - Jamming will show breakage, splitting, hemorrhage 1. Smaller toes often times a little thicker (due to friction) - _NOT fungus_ -\> if symmetrical, less likely to be fungus

Answer 104

- Habit tic deformity - Habitual picking at the cuticle

Answer 105

- KOH prep: preferably from subungual debris - **Fungal culture** of nail clipping (couple pieces of nail) - Fungal stain of nail clipping: PAS = periodic acid-Schiff (see attached image; kind of old-fashioned)

Answer 106

- _Topicals generally not very effective_ bc they: 1. Do not penetrate nail plate well 2. Do not reach nail matrix 3. Penlac (Ciclopirox) for superficial infection not involving lunula (visible, crescent-shaped part of the root of the nail) -\> w/_softening agent_ (urea cream) - _Systemic therapy_: Griseofulvin in the past (but low cure rate and high recurrences) 1. **Terbinafine**: 6 wks for fingernails, and 12 wks for toenails -\> **baseline CBC and LFTs** (repeat in 2-4 weeks) 2. Other: itraconazole, fluconazole -\> tend to be more expensive and have more potential side effects

Answer 107

- Fingernails: 4 to 6 months - Toenails: 12 to 18 months

Answer 108

- Aka, pityriasis versicolor (_not a true infection_) - Common superficial fungal disorder of skin - Yeast forms of dimorphic fungus ***Malassezia furfur*** (_same as seb derm_); also pityrosporum orbiculare and pityrosporum ovale 1. Normal skin flora - **Usually presents in adolescence** (when oil and sebaceous glands are more active), but may be seen in younger children too

Answer 109

- Multiple scaling, **oval macules, patches and thin plaques** over upper trunk, prox arms, & sometimes face and neck - **Hyper- or hypopigmented**: azelaic acid production (diffuses down and impairs melanocyte function) 1. Depending on baseline complexion, level of sun exposure (may look lighter on dark skin and darker on light skin) - More prominent in **summer** when sun exposure intensifies pigmentation differences

Answer 110

- Multiple _scaling, oval macules, patches and thin plaques_ over upper trunk, prox arms, & sometimes face and neck - _Hyper- or hypopigmented_: azelaic acid production (diffuses down and impairs melanocyte function) 1. Depending on baseline complexion, level of sun exposure (may look lighter on dark skin and darker on light skin) - _More prominent in summer_ when sun exposure intensifies pigmentation differences

Answer 111

- **Pityriasis alba** - Most common on face (mostly children, and more M than F) - Usually atopic background - Less extensive than pityriasis versicolor - _Diagnosis_: KOH prep w/spaghetti and meatball appearance (hyphae and spores) 1. Usually don't culture, but **DIAGNOSE CLINICALLY**

Answer 112

- _Education_: course tends to be chronic, and recurrences common, esp. when weather gets hot - _Topical therapy_: selenium sulfide lotion/shampoo 2.5% OR ketoconazole shampoo 2% 1. Applied for 10 min. daily for 1-2 weeks, then 2-3 times per week for maintenance 2. May need maintenance tx, esp. in warmer months - _Severe, recurrent_, fails topical therapy -\> **systemic therapy** (adult dosing) 1. _Ketoconazole_ 400 mg po x 1: work up sweat, wait 10-12 hr to shower and repeat in 1 week 2. _Fluconazole_ 200-400 mg po x 1: may repeat in 1 week if severe 3. Should still use _topical for maintenance_

Answer 113

- Intertriginous - _Paronychia_ - **Angular Cheilitis**: oral commissures (increased moisture) -\> elderly, lip lickers, denture (see attached image) 1. _Clinical manifestations_: painful, erythematous fissures and small pustules 2. _Treatment_: topical anti-yeast cream -\> DEC moisture

Wright - Acne, Fungal, Viral Infections Flashcards

(137 cards)