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Skin Disease Review
skin conditions,skin rashes
| Question | Answer |
|---|---|
| What is Psoriasis? | An inhertied skin disorder, rapid squamous cell divide and mature. Produces psoriatic plaques |
| What are the speacial findings in psoriasis? | Koebner phenomenon:new palques over skin from truama. Auspitz sign: Pinpoint areas of bleeding in the area where plaques were removed. |
| What are the classic characteritics of Psoriasis? | Puritic erythematous plaques covered with fine silvery white scales and pitted fingernails and toenails. Location: scalp,elbows,knees, sacrum,and intergluteal folds. |
| What is the management of Psoriasis? | Topical steroids and tar preparations(Psoralen drugs). Sytemic antimetabolites(methrotrexate-for severe form. UV lights and tar derived topicals= induce remission. |
| What is the complication of Psoriasis? | Guttate Psoriasis(drop shaped lesions); rare form of psoriasis from strep throat. |
| What is Actinic Keratosis? | Precancerous lesion that are precursors to squamous cell carcinoma and caused by chronic sun exposure. |
| Actinic Keratosis is common in what race and gender? | In older white patients with long-term sun exposure history |
| What are the classic characteristics of Actinic Keratosis? | A dry red lesion with a rough texture. Present for several years and slowly enlarge and DO NOT HEAL. Locations: in sun-exposed areas of skin( cheeks,nose,face, neck, arms and back). |
| What is the managment of Actinic Keratosis? | DX: by skin biopsy and clinical apperance. COmmon: more in light skinned persons. Meds: cyrotherapy=small lesions; fluorouracil cream 5%(5-FU cream)- topical antineoplastic agent used for several weeks. |
| What is Tinea Versicolor? | A superficial skin infection caused by the yeast PITYROSPORUM ORBICULARE and pityrosporum ovale. |
| What labs are ordered for diagnosis of Tinea Versicolor? | Potassium hydroxide(KOH) slide: hyphaea and spores(spaghetti and meatballs) |
| What is the management for Tinea Versicolor? | Topical Selenium sulfide or ketoconazole(Nizoral) shampoo or cream to affected area BID x 2 weeks. |
| What are the characteristics of Tinea Versicolor? | Lesion are round macules that vary in color from flesh tones. Common location: face, shoulders, chest, and back. |
| What is Eczema(atopic dermatitis)? | A chronic inherited skin disorder marked by extremely pruritic rashes that are located on the handsm flexural folds, and the neck(older child to adults). |
| What exacerbates Eczema? | stress, environmental factors(allergens, cold and dry climate) |
| What other conditions are associacted with Eczema? | asthma, allergic rhinitis and positive family hx. |
| What are the classic characteristics of Eczema? | Infants -age 2= larger area fo rash distribution. Rash on cheeks, entire trunk, knees and elbows. Older children and Adults=rash on hands, neck, antecubital fossa and popliteal spaces(flexural folds). Rash starts with small vesicles that rupture,weeping |
| What is the management for Eczema? | Topical steroids, systemic oral antihistmines and skin lubricants(Eucerin,Keri). Avoid drying skin(hot baths, harsh detergents, chemicals). |
| What is Contact Dermatitis? | An inflammatory skin reaction due to contact from irritating external substance. Location=localized lesions to genralized rashes. Common offenders= poision ivy, nickle, latex. Can occur in miutes to hours. |
| What are the classic characteristics of Contact Dermatitis? | Bright red and prurtic rash starts bullous or vesicluar= bright red moist, weepy , tender areas, then dried and crusty. Linear shape rash. |
| What is the management for Contact Dermatitis? | Topicals steroids Wet compress to dry weeping lesions. Calamine lotions and oatmeal baths. For Severe rash= oral prednisone for 12 to 14 days then wean. |
| What is Candidiasis? | Superficial skin rash from yeast, promote growth in warm and humidity. Associated with decreased immunity or diabetes. In infants= diaper rash or oral thrush. |
| What is Acute Cellulitis? | An acute skin infection caused by gram positive bacteria(staphylococcus aureus and streptococcus pyogens).Points of Entry=skin breaks, insects bites, abrasions. |
| What are the classis characteristics of Acute Cellulitis? | Acute onset= difussed pink to red skin. Deeper infection= RED STREAKS radiating from infected area under skin secondary of infections of the lymphatic. |
| What labs are ordered for Acute Cellulitis? | If discharge present order culture and senitivity(C &S). If fever is present order CBC. |
| What is the management for Acute Cellulitis? | Dicloxacillin PO TID x 10 days. or Cephalexin(Keflex) PO x 10 days(not active against beta lactamase resistant bacteria). Tetanus(TD) booster if < 5 years ago. PCN allergic=macrolide(erythromycin, cephalosporin, clindamycin or quinolones, levaquin>18y/ |
| What are the complications of Acute Cellulitis? | Osteomyelitis, tendon and facial extension and sepsis. |
| What is Erysipelas? | A subtype of cellulitis involving deeper tissue involvement caused by beta strep. |
| What are the classic characteristics for Erysipelas? | Complaints of acne or insect bite that become infected. Lesions are raised, indurated bright pink plaque with raised edged. Plaque located on cheeks or lower legs. |
| Human Bite | DIRTIEST BITE OF ALL. |
| Dog and Cat Bites | Infected with Pasteurella multocida. CAT BITES more likely to be infected than dog bites. |
| Bat, Racoon,or Skunk Bites | Rule out rabies in addtions to antibiotics, call local health dept and CDC. |
| Treatment of Bites(human or animal) | 1. Amoxicillin/clavulanic(Augmentin) PO x 10 days(PCN allergy, use clindamycin plus fluoroquinolone). 2.wound C&S if suspect infection. 3.DOnt suture infected wounds or puncture wounds. 4. Tetanus prophylaxis(if booster > 5 years, needs booster. |
| What bites may require rabies immunoglobin plus rabies vaccine if animal is rabid? | dog,cat,bat,racoon and skunk |
| When should you follow up on a bite? | 12 to 24 hours after treatment |
| What is Hidradentis Suppurativa? | A bacterial infection of the sebaceous glands of axilla or groin. can be one or both axilla. can leave sinus tract and heavy scarring if chronic. |
| What the classic characteristics of Hidradentis Suppurativa? | c/o painful red nodules and pustules under one or both arms. Some lumps drain pus. |
| What are the objective findings of Hidradentis Suppurativa? | affected axilla=large dark red pustules, rupture draining green purlent discharge(pus). |
| What labs are ordered for Hidradentis Suppurativa? | A C&S of purlent drainage. |
| What is the management for Hidradentis Suppurativa? | Augmentin PO BID or Dicloxacillin TID x 10 days. NO underarm deoderant. Muciprocin ointment to lower third nares and under fingernails BID x 2 wks to eliminate source of infection. |
| What is Impetigo? | Acute bacterial superficial skin infection caused by gram positive bacteria. Very contagious and puritic. |
| What are the two types of Impetigo? | bullous and nonbullous; common in children adn during warm and humid weather. |
| What are the classic characteritcis of Impetigo? | Honey colored crust, fragile bulla. |
| What labs are ordered for Impetigo? | C&S of skin lesions. |
| What is the management of Impetigo? | Cephalexin(Keflex) QID, Dicloxacillin QID x 10 days. IF PCN allergic= Azithromycin 250mg x 5 days(macrolide) or Clindamycin x 10 days. Topical 2% Muciprocin oint(Bacitracin) x 10days. Frequent handwashing, hygiene to remove crust. |
| What is Meningococcemia? | Life threanting infection caused by Neisseria meningitidis(gram negative), spread by respiratory droplets. |
| Who is more at risk for meningococcemia? | college students living in dorms, needs to be treated early. |
| What are the classic signs of meningococcemia? | PURPLE -colored painful skin lesions all over the body. sudden high fever, head ache and stiff neck, possible N&V |
| What are the prophypaxis for Meningococcemia? | 1.Oral Antibiotic Rifampin 2.meningococcal vaccination per CDC if live in dorms. |
| What labs are order for Meningococcemia? | 1.Lumbar puncture=CSF 2.Blood Cultures, throat cultures 3.CT or MRI of brain. |
| What is the management for Meningococcemia? | 1.systemic pcn x 10days; ceftriaxone(Rocephin)x 5days if pcn allergic. 2.Hospital: high dose antibiotic and isolation precautions. |
| What are the complications for Meningococcemia? | 1.tissue infarction and necrosis(toes,fingers, foot)= amputations. 2.death. |
| What is Early Lyme Disease? | Erythrema Migrans; a skin lesion caused by a bite of ixodes TICK infected with Borrelia Burgdoferi. Untreated= systemic effect of organs. |
| What the the classic signs of Early Lyme | round lesions with red target like expand and grow in size. Appear 3 to 30 days after bite, spontaneously resolve within a few weeks |
| What labs are ordered for Early Lyme Disease? | Serum antibody titers immunoglobulin(IGM= early IgG- later. |
| What is the management for Early Lyme Disease? | Doxycline BID or tetracyclinex 14days (amoxicillin if preganant). |
| What are the complications for Early Lyme Disease? | Guillain-Barre syndrome, migratory arthritis, chronic fatigue |
| What is Rocky Mountain Spotted Fever? | caused by a tick that is infected with Rickettisia rikettsii.High mortality rate if untreated. |
| What ar the classic signs of Rocky Mountain Spotted Fever? | Round red rash with petechiae, maculopapular, headache and fever. 1. begin with high fever,myalgia and severe HA. 2.By day 2-3= petechial rash start on wrist-ankles-soles and palms, spread centrally. 2. |
| What labs that are ordered for RMSF? | CBC with white cell count, liver funtion test, CSF,antibody titers,skin biopsy of lesion. |
| What is the managment for Rocky Mountain Spotted Fever? | 1.REPORTABLE DISEASE 2.Doxycycline BID or Tetracycline four times daily x 21 days. |
| What is the complication of Rocky Moutain Spotted Fever? | Death |
| What is Herpes Zoster(Shingles)? | A reactivation of varicella zoster virus. Elderly and immunocompromised are at higher risk for shingle breakouts and postherpectic neuralgia. |
| What are the classic signs or Shingles? | 1. group of small vesicles on a red base>rupture>crusty. ON ONE SIDE OF BODY. 2.c/o severe pain , itching or buring sensation at site of breakout. |
| What labs to order for shingles? | Serum antibody titers IgM and IgG if not sure of diagnosis. |
| What is the management for shingles? | Acyclovir(Zovirax) 5x a day or Valacyclovir(Valtrex) BID x 10days for intial breakout and 7 days for flare-ups. |
| What are the complications for shingles? | Postheretic neuralgia>treat with tricyclic antidepressans(low dose amittriptyline(elavil) or anticonvulsant(depakote) at bedtime. Infection can cause corneal blindenss if on cranial nerveV(trigemnial). REFER TO OPTHALMOLOGIST OR ER. |
| What is Pityriasis Rosea? | cause unknown. |
| What are the characteristics of Pityriasis Rosea? | 1. c/o oval lesions with fine scales following skin lines(clevage lines). 2. on the trunk CHRISTMAS TREE pattern of papulosquamous lesions. 3. HERALDS PATCH= 1st lesion to appear and largest in size, appears 2 wks before full outbreak. |
| What is the management of Pityriasis Rosea? | 1. NO Medications 2. lesions resolve about 4 wks 3. I high risk sexually active adolescents or adult= check rapid plasma reagin(RPR)= r/o secondary syphilis. |
| What is Scabies? | infestation of skin by sacroptes scabiei mite; female mite burrows under skin and lay eggs. TRANSMITTED BY CLOSE CONTACT. |
| What is the classic signs of scabies? | very pruritic, especally at night, in interdigital webs, axilla, buttocks, waist and penis.Other family menbers may have the same symptoms. |
| What is the objective findings of scabies? | 1.rash appears as serpiginous(snakelike) or linear burrows. 2.papular, vesicular or crusted. 3.higher incidence in crowded conditions and homeless. |
| What labs are ordered for scabies? | Scarpe burrow or scales with glass slide, use cover slip. look for mites or eggs. |
| What is the management for scabies? | 1. Permethrin 5%(Elimite): appy cream to entire body and head; wash off after 8-14 hours. 2. Treat entire household, wash clothes and linen in hot water. 3. Kwell= not used neurotoxcity. |
| What is Tinea Infections(Dermatophytes)? | An infection of superficial keratinized tissue(skin,nails.hair) by yeast. |
| What labs are ordered for Tinea Infections? | KOH slide of scales, hair and nails; fungal cultures. |
| What is management for Tinea Infections? | 1. Topical azoles:OTC clotrimazole,microconazole 2.systemic oral topical antifungal;diflucan weekly for 6mths. antifungals drug interaction(warfarin,anticonvulsants. Hepatoxic. |
| What is Tinea captis(scalp)? | common in black kids,patchy alopecia with balck dots(broken hair shaft) Fine scales on scalp,itchy scalp. |
| What is the management of Tinea Captis? | Treat only with oral systemic antifungals (griseofulvin(Fulvicin) for several wks. |
| What are complications for Tinea Captis? | Kerion; inflammatory lesion, permanent damage to hair follicles; causing patch alopecia. |
| What is Tinea Pedis(athlete's foot)? | Two types scaly and dry form or moist type(strong odor). Moist lesions between toe webs, white with strong unpleasant odor. Dry type fine scale only. |
| What is Tinea Corporis or Tinea Circinata(ringworm)? | ringlike puritic rashes with fine scales that slowly enlarge; treated with antifungals. |
| what is Tinea Cruris(jock itch)? | perineal and groin area with pruritic red rashes with fine scales. |
| What is Tinea Manuum(hands)? | prutitic round rashes with fine scales on hands; usally infected from chronic scratching of foot infected with athletes foot. |
| What is Tinea Barbae(beard area)? | beard affected,scaling with pruritic red rashes. |
| What is Onychomycosis(nails)? | nails become yellow,thicked and opaque with debris; great toe common location. Need fungal cultures |
| What is the management of Onnychomycosis? | Oral Itraconazole or terbinafine(Lamisil) for several wks. Mild cases; Ciclopirox 8% topical solution(penlac) nail lacquer. |
| What is Acne Vulgaris(common acne)? | inflammation and infection of the sebaceous glands;highest incidence in puberty and adolescent; on face, shoulders, chest and back. |
| What is mild Acne? | Open comedones(blackheads), close comedones wiht papules; use topical only retin A(photosensitvity). |
| What is Moderate Acne? | same as mild plus large numbers fo papules and pustles; treat with topicals+ oral tetracycline or minocycline(Minocin). **Tetracycline cause permanent discoloratio fo growing enamel tooth. DON'T GIVE TO PATIENTS UNDER AGE 18. DECREASE ORAL CONTRACEPTIVE. |
| What is Severe Cystic Acne? | All signs of moderate + painful indurated nodules adn cysts over face, shoulders and chest. |
| What is the management for Severe Cystic Acne? | Accutane= category X drug extremely teratogenic 1.prescribed by MD only 2.sign special consent 3.females must use two forms of contraception and show two negative pregnacny test before startiing drug. 4.prescribe 1 mth supply only |
| What is Rosacea(Acne Rosacea)? | cause unknown; c/o chronic small acnelike papules and pustules that erupt around nose, mouth and chin; exacerbated; seen in adults to elderly wiht Celtic background. |
| What is the management for Rosacea? | Metronidazole gel and or oral tetracycline for several months. |
| What are the complications for Rosacea? | Rhinophyma: hyperplasia of tissue at the tip of the nose from chronic severe disease. |
| What is Cheilosis? | Skin fissures,cracks at corner of mouth; causes: iron deficiency anemia, bacterial infection, vitamin deficents.; treated with triple antibiotic ointment BID to TID until healed. |
| First degree burn(superficial thickness) | Erythema only(no blisters); cleanse with mild soap, water or saline. Cold packs for 24-48 hrs; topical OTC anesthetics>benzocaine. |
| Second degree burn(partial thickness) | Red skin with superficial blisters,painful; clean with saline, don't rupture blisters; treat with silver sulfadiazne cream(Slivadene)+ apply dressing. |
| Third degree burn(full thickness) | Painless, entire skin layer, soft tissue is destroyed; medicate for pain before daily debridement; treat with Silvadne. REFER= FACIAL, ELECTRICAL, THIRD DEGREE BURNS, CARTILAGINOUS AREA(DOES NOT REGENERATE) AND BURNS OVER 10% OF BODY. |
| What is scarlet fever? | "Sandpaper" rash with sore throat(strep throat) |
| What is a symptom in Measles? | Koplik's spots |
| What is Stevens-Johnson Syndrome? | Severe vesicular to bullous lesions all over teh body; range fron hives to blisters and hemorrhagic lesions; mucosal involvement. ** hx of recent antibiotic tx with sulfa, pcn or phenytoin. |
| What is Erythema Multiforme? | milder form of Stevens-Johnson Syndrome; pink, targetlike lesions, wheals,blisters.NO mucosal involvement; HX antibiotic use and other drugs. |
| What is Melanoma? | Dark colored moles with uneven texture,mixed colors, irregular borders. located anywhere on the body including retina' higher incidence with family hx of melanoma. |
Created by:
gmcghee
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