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24 Cards in this Set
- Front
- Back
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Name 9 serious skin diseases that may require hospitalization?
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Cellulitis
Community acquired MRSA Erythroderma Erythema Multiforme Pemphigus Vulgaris Bullous Pemphigoid Stevens Johnson Syndrome Toxic Eipdermal Necrolysis Vasculitis |
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What is the most common cause of skin related ER visits?
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Infections (52.1%) - cellulitis is most common of these (30.4% of skin related ER visits)
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What are some cellulitis mimickers?
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Erysipelas
Stasis dermatitis Lympedema Lipodermatosclerosis Panniculitis |
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How do you treat CA-MRSA skin infection?
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Incision and drainage (can be curative)
Antibiotics: septra +/- tetracycline, quinolone, clindamycin, etc. |
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How do you treat recurrent MRSA skin infections?
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Antibiotics
Bactroban in nares, axillae, perineum, lesions Antimicrobial soap |
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What is erythroderma?
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Generalized red scaly rash covering >90% of the body surface area
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What are clinical features of erythroderma? (8)
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Pruritis
Keratoderma Nail changes Alopecia Edema Seborrheic keratoses Infections Lympadenopathy |
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What are complications of erythroderma? (5)
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High output cardia failure
Hyper/hypothermia Fluid and electrolyte imbalances Anemia Malabsorption syndrome |
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What causes erythroderma? (5)
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Idiopathic - most common
Dermatitis Psoriasis Drug reaction Cutaneous T-cell lymphoma |
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How do you treat erythroderma?
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Treat complications
Treat underlying cause Oral antihistamine for itch Topical steroids and emollients Oral immunosuppressants as needed |
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What causes erythema multiforme?
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T-cell attack of keratinocytes expressing HSV antigens
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What is the natural history of erythema multiforme?
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Abrupt onset of wheal-like erythematous papules in centripetal pattern
Regression and relapse of inflammation in the centre causing targetoid lesions No associated symptoms Lasts 1-4 weeks |
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How do you treat erythema multiforme? (acute, recurrent)
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Acute: topical steroids, anesthetics, inhalers; oral antihistame, steroids, immunosuppresants
Recurrent: prophylactic treatment with acyclovir, valcyclovir, famcyclovir |
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What causes bullous erythema multiforme and who gets it?
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Mycoplasma
Children |
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What are the similarities and differences between pemphigus vulgaris and bullous pemphigoid? (location and target of antibodies, distribution, clinical features, treatment)
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Pemphigus vulgaris - antibodies more superficial in spinosum/granulosum and targeted against desmosomes, lots of oral involvement, positive Nikolsky and asboe hansen sign, balls of cells on histology due to loss of adhesion, prednisone + a steroid sparing agent (agent should be cyclophosphamide if severe)
Bullous pemphigous - antibody against deeper structures at the junction of the dermis and epidermis, itchy non-bullous phase followed by bullae, affects elderly more, little oral involvment, subepidermal blister and linear IgG at basement membrane on histology, topical steroids + antihistamines + tetracycline + prednisone + steroid sparing agent |
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What are 4 drug classes that can cause SJS-TEN?
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Allopurinol (most common)
Antibiotics Anti-inflammatories Anti-convulsants |
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Which skin layer is affected in SJS-TEN and by what molecular mechanism?
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Cells of basal layer undergo apoptosis due to interaction between Fas and FasL
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What are the clinical features of SJS-TEN?
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Prodome
Positive Nikolsky sign (shearing and Asboe Hansen sign (extension of blister) Mucosa involved usually |
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How do SJS and TEN differ? Which is worse?
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SJS <10% detachable skin
TEN >30% detachable skin - worse |
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How is mortality predicted for people with SJS-TEN?
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SCORTEN score
30% mortality if 30% involvement |
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How do you treat SJS-TEN? (5)
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Stop the drug!
Treat in burn unit Debride skin and dress wounds IVIg Supportive care |
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What diseases is leukocytoclastic vasculitis (small vessel vasculitis) caused by? (6)
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Churg-Strauss syndrome
Wegener's granulomatosis Microscopic polyangiitis Henoch-Schonlein purpura Essential cryoglobulinemic vasculitis Cutaneous leukocytoclastic angiitis |
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What are clinical features of Leukocytoclastic vasculitis (small vessel vasculitis)?
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Palpable purpura
Livedo - purple painful Urticaria Polymorphous papules, macules, nodules, vesicles, bullae Few systemic findings |
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What are the causes of leukocytoclastic vasculitis (small vessel vasculitis)? (know these!)
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V - viral
A - Autoimmune connective tissue disease S - strep and staph C - cryoglobulinemia U - urticarial vasculitis L - lymphoproliferative I - infections (RMSF, endocarditis, meningitis, gonnococal) T - thiazides I - immune serum S - septra and other antibiotics |
