Case 32: Rash

Front 1

What is acute urticaria (hives)

Back 1

rash that comes and goes

changing

caused by histamine release and triggered by drugs, foods, or pollen

Front 2

Uritcaria family history?

Back 2

atopic dermatitis

asthma

allergic rhinitis (hayfever)

Front 3

Diagnosis of urticaria?

Back 3

blood testing to determine allergins

Front 4

How to treat acute urticaria

Back 4

1. avoid suspected allergens

2. symptomatic treatment (antihistamines, oral prednisone, keep patient cool and calm)

Front 5

What is seborrheic dermatitis?

Back 5

very common condition

caused by fungus

Front 6

Treatment of seborrheic dermatitis?

Back 6

for infants: baby oil frequent shampooing with gentle baby shampoo

low potency topical steroid cream

Front 7

Stages of acne?

Back 7

starts as comedones, become inflamed, erythematous lesions called papules and pustules

Front 8

Triggers of acne

Back 8

• make up
  
• mechanical factors
  
• occlusion, as occurs with some sports gear
  
• overzealous cleaning
  

Front 9

What is chronic nickel contact dermatitis?

Back 9

• common
  
• requires sensitization
  
• occur despite prior tolerance to exposure
  
• development depends on whether skin barrier intact or damaged
  
• ofter resolves after avoidance
  
• if allergy difficult to control, can do patch testing
  

Front 10

Treatment of nickel contact dermatitis?

Back 10

• avoid nickel
  
• apply good emoliant or quality skin lubricating cream
  
• medium potency topical steroid ointment
  

Front 11

What is the most common site for impetigo?

Back 11

nares (because of rubbing and colonization)

can be anywhere

Front 12

What is infectious organism?

Back 12

Staphy aureus

Strep pyogenes (GAS)

Front 13

Treatment of impetigo?

Back 13

• topical antibiotics such as mupirocin
  
• careful to watch for abscesses
  
• more aggressive therapy and systemic antibiotics
  

Front 14

Features of acute contact dermatitis?

Back 14

vesicles, edema, erythema, pruritic lesions

Front 15

Common plant causes of acute contact dermatitis?

Back 15

poison ivy

poison oak

poison sumac

Front 16

What else can cause contact allergy?

Back 16

almost everything

Front 17

Potencies of topical steroids?

Back 17

• mild
  
• intermediate
  
• potent
  
• super potent
  

Front 18

Name a mild potency topical steroid?

Back 18

hydrocortison acetate, 1%

Front 19

Name a potent topical steroid?

Back 19

betamethasonedipropionate

Front 20

Vehicle for topical steroids?

Back 20

e.g. cream

Front 21

Other factors?

Back 21

chemical formulation

Front 22

What to keep in mind when prescribing steroids for children?

Back 22

infants absorb significantly moremeds through skin than adults

occlusive dressing will increase absorption

Front 23

Side effects of steroids?

Back 23

• skin atrophy
  
• telengectiasis
  
• hypopigmentation
  
• suppression of hypothalamic pituitary axis
  

Front 24

Treatment of pediculosis capitis (head lice)

Back 24

• easy for school kids to get lice, spread by sharing belongings
  
• no need to treat head lice prophylactically
  
• no healthy child should miss school time because of head lice
  

Front 25

pharm treatments for head lice?

Back 25

• 1% permethrin lotion,
  
• Benzyl alcohol 5%,

Front 26

non-pharm treatments for head lice?

Back 26

• vinegar hair treatments
  
• wet heair with fine toothed comb
  
• Bedding, stuffed animals, hats, combs and brushes, and other contaminated items should bewashed in hot water or dried in high heat in the dryer.
  

Front 27

Scabies skin infestation

Back 27

skin infestations

nothing to do with clinliness

Front 28

what causes scabies?

Back 28

sarcoptes scabiei

Front 29

Presentation of scabies?

Back 29

scabies mite

intense itch at night

wrists, elbows, fingers, toes common distribution sites

curivlinear thread like lesion

Front 30

Complications of scabies?

Back 30

impetigo

cellulitis

secondary eczematous dermatitis

Front 31

How to diagnose scabies?

Back 31

• look for mites, eggs, eggshell fragments, fecal pellets
  
• scrape
  
• exam with mineral oil using light microscope
  

Front 32

Treatment of scabies?

Back 32

permethrin 5% cream

Front 33

Appearance of ringworm?

Back 33

• annular, well circumscribed, scaly plaque with raised border and brown/hypopigmented center
  
• lesions gradually enlarge
  
• may coalesce with surrounding lesions
  
• pruritic or asymptomatic
  

Front 34

Diagnosis of ring worm?

Back 34

KOH wet mount exam of scrapings

Front 35

What is ringworm?

Back 35

isn't a worm!

superficial and easy to treat fungus (TINEA CORPORIS)

Front 36

Tinea pedis?

Back 36

athlete's foot

Front 37

Tinea versicolour?

Back 37

• infection with yeast from fungus
  
• rash pink, brown, or white lesions depending on the background color of theskin, and it has a fine scale.
  
• can be contagious
  
• heat/humidity predispose to the infection
  

Front 38

First line treatment of tinea versicolour?

Back 38

selenium sulfide lotion

Front 39

Tinea capitis?

Back 39

• ringworm of scalp
  
• grisofulvin treatment
  
• Tinea may be misdiagnosed as an eczematous condition and treated with steroidcreams. This can actually make all tinea infections worse and also cause the appearance to beatypical.
  

Front 40

Warts vs molluscum?

Back 40

• warts - HPV
  
• molloscum contagiosum - small, smoother than common warts, central dimple, making them "umbilicated"
  

Front 41

Common causes of diaper rash?

Back 41

• irritant dermatitis
  
• diaper candidiasis
  
• bacterial infection
  

Front 42

Irritant dermatitis?

Back 42

• most common cause of diaper rash
  
• prolonged exposure to moisten friction and digestive enzymes
  
• presents as irregular areas of erythema
  
• spares intertriginous creases
  

Front 43

Treatment of irritant dermatitis?

Back 43

keep diaper area as clean and dry as possible

use zinc oxide

Front 44

Diaper candidiasis

Back 44

erythematous papules, become confluent bright red plaques

Front 45

Treatment of diaper candidiasis

Back 45

antifungal, e.g. nystatin

Front 46

Bacterial infection for diaper rash?

Back 46

GAS

potentially serious

Front 47

Treatment of diaper rash?

Back 47

antibiotics, oral

Front 48

Alarming features of diaper rash?

Back 48

irritability

growth problems

fevers

other systemic symptoms

Front 49

zinc deficiency

Back 49

An infrequent cause of diaper rash.Nutritional deficiencies, such as acrodermatitis enteropathica, or malabsorption (due tocystic fibrosis, for example) can cause significant diaper rash.

Front 50

Langerhans cell histocytosis

Back 50

is another possible cause of diaper rash.These lesions tend to be crusty and weepy and may bleed.If there is no change or progression of a diaper rash with treatment, then the child should bereferred to a dermatologist.

Front 51

Focused questions for a rash?

Back 51

• duration
  
• rate of onset
  
• location
  
• associated symptoms
  
• family history of similar symptoms
  
• whether patient has any allergies
  
• any new exposures
  
• any previous treatments, such a benadryl, as this can change the way lesion looks
  

Front 52

Key findings of an allergic reaction

Back 52

family history of atopy

recurrent rapid onset and resolution of rash

pruritis

history of a therapetic response

Front 53

DDx of rash?

Back 53

• Urticaria due to type 1 hypersensitivity
  
• Papular urticaria
  
• Streptococcalinfection
  
• Erythema multiforme
  
• Drug eruption
  
• Roseola
  
• Erythema infectiosum (Fifth disease)
• Erythema migrans

Front 54

urticaria

Back 54

Classic lesion is an intensely pruritic, circumscribed, raised, erythematous wheal, often withcentral pallor.

Front 55

Papular urticaria

Back 55

Common pediatric condition.Lesions are papular and 3 mm to 10 mm in diameter.Caused by insect bites.Can be recurrent or chronic.Pruritic.

Front 56

strep infection?

Back 56

Most commonly associated with the rash of scarlet fever, which is a fine, erythematous,sandpaper-like rash accentuated at skin creases.

Front 57

erythemia multiform

Back 57

Associated with a symmetrical rash that starts as a dusky red macules and evolves intosharply demarcated wheals and then into target-like lesions.

Front 58

Drug eruption

Back 58

Commonly urticarial.May be Type 1 hypersensitivity reactions or may result from non-immunologic triggers ofmast cell release (such as from opiates or NSAID

Front 59

Roseola

Back 59

A viral exanthem that classically follows 3-5 days of a febrile illness.As the fever resolves, patients develop a pink, maculopapular rash that starts on the trunkand may spread to the face and extremities.Caused by human herpes virus-6 (HHV-6).

Front 60

erythema infectiosum

Back 60

Rash starts on the face with a "slapped"-cheek appearance followed by a reticular (lacy)erythematous rash on the trunk and extremities.Caused by parvovirus B19.

Front 61

erythema migrans

Back 61

Lesion associated with early localized Lyme disease.Starts as a red papule at the site of a tick bite.Expands to form a large erythematous, annular patch.

Front 62

Treatment of seborrheic dermatitis (cradle cap)

Back 62

Seborrheic dermatitis is common.Consists of erythematous plaques with fine to thick, greasy yellow scale.Typically seen on the scalp, but may spread to the ears, neck, and diaper area of infants

Front 63

Treatment of eczema, or atopic dermatitis

Back 63

May involve the posterior scalp.A positive history of atopic diathesis would support this diagnosis.Look for pruritic, erythematous, scaling plaques on extensor surfaces as evidence of atopicdermatitis on other areas of the body.

Front 64

Treatment of candidal rash

Back 64

Commonly manifests as a diaper dermatitis peaking between 7-10 months of age.Characterized by an area of erythema in the inguinal region, as well as erythematouspapules and plaques with satellite lesions.

Front 65

Treatment of psoriasis

Back 65

More erythematous, with a thicker, non-waxy scale and more defined borders thanseborrheic dermatitis.May or may not be pruritic.A family history of psoriasis is present in 40% of patients.

Front 66

staph folliculitis

Back 66

similar to nodular or cystic acne, often below waist or groin

Front 67

Hidradenitis supprativa

Back 67

Distribution markedly different from acne.Areas most likely affected in women:AxillaeGroinInframammary regionsIn men:Perineal and perianal areas morecommonly affected.

Front 68

Rosacea

Back 68

malar and nasal surfaces

Front 69

Perioral roseola

Back 69

may be around mouth, nose, or eyes

Front 70

Ddx of ringworm

Back 70

• Nummular eczema
  
• Psoriasis
  
• Pityriasis alba
• Pityriasis rosea