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56 Cards in this Set
- Front
- Back
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pemphigus vulgaris etiology
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antibodies against desmosomes of epidermal cells; mostly idiopathic but also ACEIs and penicillamine
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pemphigus vulgaris presentation
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young patient with skin erosions and thin bullae that are painful
mouth erosions are prominent Nikolsky sign |
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pemphigus vulgaris diagnosis
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skin biopsy with immunofluorescence shows deposits of IgG and C3 in the epidermis
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pemphigus vulgaris treatment
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systemic glucocorticoids
if not effective --> azathioprine, mycophenolate or clyclophosphamide, rituximab, IVIG |
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Nikolsky sign
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removal of skin like a sheet with slight pressure
seen in pemphigus vulgaris, staph scalded syndrome, toxic epidermal necrolysis |
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blistering diseases
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pemphigus vulgaris
bullous pemphigoid pemphigus foliaceous porphyria cutanea tarda |
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pemphigus foliaceous
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more superficial than vulgaris with no oral lesions or intact bullae; same diagnosis and treatment as vulgaris
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bullous pemphigoid presentation
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autoantibodies against hemidesmosome at dermo-epidermal junction/basement membrane result in tense bullae that don't rupture easily in elderly; oral lesions are rare
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bullous pemphigoid diagnosis and treatment
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lesion biopsy with immunofluorescence shows depostis at basemanet membrane
systemic steroids alternative --> tetracycline or erythromycin combined with nicotinamide |
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porphyria cutanea tarda etiology
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deficiency of uroporphyrinogen decarboxulase results in accumulation of porphyrins and photosensitive reaction; there may be history of HIV, alcoholism, liver disease, chronic hepatitis C or oral contraceptives
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porphyria cutanea tarda presentation
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fragile, nonhealing blisters on sun-exposed areas with hyperpigmentation and hypertrichosis
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porphyria cutanea tarda diagnosis
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urinary uroporphyrins are elevated
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porphyria cutanea tarda treatment
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initial management is to stop alcohol and discontinue estrogens
barrier sun protection (not sunscreen) if insufficient --> phlebotomy, deferoxamine, chloroquine |
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urticaria etiology
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local skin anaphylaxis (IgE/mast cell mediated) without hypotension due to
drugs --> aspirin, NSAIDs, penicillins, morphine, codeine, quinolones foods --> peanuts, shellfish, tomatoes, strawberries insect bites and contact with latex |
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urticaria presentation
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acute --> wheals and hives and itching within 30 minutes last for <24h
chronic --> skin reactions last >6 weeks associated with pressure on skin, cold or vibration |
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urticaria treatment
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acute --> H1 antihistamines (diphenhydramine, cyproheptadine)
if life-threatening --> add H2 antihistamines + steroids chronic --> nonsedating antihistamines loratadine, desloratadine, fexofenadine, cetirizine most dangerous/avoid --> terfenadine, astemizole desensitization --> when trigger can't be avoided, beta blockers must be stopped before |
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morbilliform rash
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generalized maculo-papular rash that blanches with pressure (resembles measles), secondary to drug allergy; can appear days after exposure and after medication has been stopped; lymphocyt-mediated; treat antihistamines, steroids rarely necessary
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hypersensitivity rashes
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urticaria
morbilliform erythema nodosum erythema multiforme Stevens-Johnson toxic epidermal necrolysis fixed drug reaction |
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erythema multiforme
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most commonly due to herpes or mycoplasma infections
target-like lesions on palms and soles don't involve mucous membranes treat with antihistamines and underlying infection |
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Stevens-Johnson
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<10-15% of body surface area with mucous membrane involvement in 90% of cases
treat with early admission to burn unit and if needed, mechanical ventilation |
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toxic epidermal necrolysis
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involves 30-100% of body surface area; Nikolsky sign is present; clinical diagnosis; spesis is common cause of death but antibiotics are not used prophylactically; steroids not effective
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fixed drug reaction
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localized allergy to drugs; round, shaprly demarcated lesions that leave hyperpigmented spot after they resolve; treat with topical steroids
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erythema nodosum etiology
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localized skin reaction secondary to infections or inflammation
strep, coccidioides, histoplasma, syphilis, hepatitis Crohn, UC, sarcoidosis |
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erythema nodosum presentation, diagnosis and treatment
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multiple painful red raised nodules on anterior surface of lower limbs that do not ulcerate
ASO titers in case of strep treat underlying disease and give NSAIDs and analgesics |
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tinea presentation
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corporis: papulosquamous lesions with riased border in the body; pedis: macerated and scaling borders; unguium: thickened nails; capitis: small scaly semibold graysish patched on head; cruris: ringed lesions on crural folds and inner thighs; barbae: on face
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tinea diagnosis and treatment
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potassium hydroxide preparation
culture as definitive test capitis, corporis, unguium --> treat with oral terbinafine or itraconazole cruris, pedis, mild corporis --> topical clotrimazole/ketoconazole |
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oral and IV anti-staph drugs
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oral --> dicloxacillin, cefadroxil (preferred); IV --> cefazolin (preferred), oxacillin, nafcillin
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impetigo
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most commonly by staph or also by strep; affects only epidermis; lesions have purulent drainning material; treat with topical antibiotics (muciprocin, retapamulin) or oral if not effective (dicloxacillin, cephalexin)
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erysipelas
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most commonly by group A strep
involves dermis and epidermis with bright red swollen lesion, fever, chills and bacteremia treat with oral or IV penicillins or cephalosporins |
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cellulitis
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affects dermis and subcutaneous tissue; redness, swelling, warmth, tenderness without drainning lesions; treat with dicloxacillin or cefadroxil or if hypotension/sepsis --> IV oxacillin, nafcillin or cefazolin
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folliculitis, furuncles, carbuncles
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different stages of severity; carbucles are several confluent furuncles
furuncles and carbuncles are extremely tender treat with systemic antistaph drugs and surgical drainage of carbuncles |
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necrotizing fascitis
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by strep and clostridium
very high fever, portal of entry into skin, pain out of proportion, bullae and palpable crepitus diagnose with elevated CPK and image that shows air in the tissue and necrosis best initial step is surgery, then antistaph drugs |
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toxic shock syndrome presentation and diagnosis
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3 or more:
fever >102 systolic pressure <90 desquamative rash vomitting involvement of mucous membranes hyperbilirubinemia theombocytopenia there can also be increased CPK and liver enzymes, confusion and hypocalcemia |
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toxic shock syndrome treatment
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fluid resuscitation + dopamine
empiric --> clindamycin + vancomycin specific depending on methicillin resistance |
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staph scalded skin syndrome
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from staph toxin; Nikolsky sign is present; normal blood pressure and no involvement of viscera; treat with antistaph IV drugs
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anthrax
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woolsorters and bioterrorism
papule that becomes inflamed and develops central necrosis confirm with Gram and culture treat with penicillin V or doxycycline if terrorism treat with criprofloxacin |
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seborrheic keratosis
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hyperpigmented lesions with stuck-on appearance on face, shoulders, chest and back of elderly; no malignant potential; removed for cosmetic issues with liquid nitrogen or curettage
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actinic keratosis
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asymptomatic lesions on sun-exposed areas of elderly can progress to SCC
treat with sunscreen and remove with cryotherapy, 5FU, imiquimod, topical retinoic acid, curettage |
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melanoma
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malignant lesions grow in size, have irregular borders, uneven shape and incosistent coloring; full-thickness sample for biopsy; treat with excision
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squamous cell carcinoma of skin
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develops on sun-exposed areas of elderly
ulceration is common metastases rare diagnose with biopsy treat with surgery |
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basal cell carcinoma
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most common skin cancer
shiny or pearly lesion rare metastases diagnosis --> excisional biopsy treatment --> surgery |
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kaposi sarcoma
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purplish lesions on skin of HIV patients caused by HHV-8; treat with antiretrovirals; if CD4 doesn’t raise --> doxorubicin or vinblastine
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psoriasis presentation
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silvery scales on extensor surfaces, local or extensive, nail pitting, lesions with epidermal injury
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psoriasis treatment
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salicylic acid to remove scaly material
if localized --> topical steroids severe diseases --> add coal long-term --> calcipotriene (vitD) and tazarotene (vit A) if large area --> UV light if extensive and severe --> methotrexate new agents --> alefacept, efalizumab, etanercept, infliximab all patients should use emollients |
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atopic dermatitis presentation
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allergy with high levels of IgE result in extremely pruritic, red, plaques on flexor surfaces
children may have it on cheeks and scalp adults may have lichenification |
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atopic dermatitis treatment
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preventive --> moist skin, emollients, avoid drying sopas, cotton clothes
active diseae --> topical steroids, antihistamines, coal and phototherapy tacrolimus and pimecrolimus to decrease steroid use itching --> doxepin |
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seborrheic dermatitis
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scaly, greasy, flaky skin on scalp and face due to sebaceous secretion and pytirosporum ovale; treat with topical hydrocortisone or shampoos (ketoconazole, zinc pyrithione)
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stasis dermatitis
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hemosiderin hyperpigmentation from lower limb venous incompetence
prevent progression with elevation of legs |
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contact dermatitis
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hypersensitivity to soap, detergents, latex, sunscreen, jewelry, nickel
linear streaked vesicles confirm diagnosis with patch testing treat with topical steroids and antihistamines |
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pityriasis rosea
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pruritic, erythematous, salmon colored lesions spare palms and soles
clinical diagnosis, VDRL is negative treat with topical steroids |
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scaling diseases
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psoriasis, atopic dermatitis, seborrheic dermatitis, stasis dermatitis, contact dermatitis, pityriasis rosea
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decubitus pressure ulcers
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chronic sores where bone is close to skin in immobilized patients; stage I --> nonblanchable lesion; stage II --> superficial epidermis, partial dermis; stage III --> full skin thickness ecept fascia; stage IV --> all the way to bone; never culture or drain unless in surgery room for debridement; relieve pressure and if truly infected use antibiotics
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alopecia areata
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autoimmune destruction of hair follicles; treat with localized steroid injections
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telogen effluvium
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hair loss in response to big stress such as cancer or malnutrition
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acne presentation
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propionibacterium acne causes closed comedones, open comedones, pustules and cysts
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acne treatment
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mild --> topical clyndamycin, erythromycin, benzoyl peroxide, topical retinoids
moderate --> benzoyl peroxide with retinoids (tazarotene, tretinoin, adapalene) severe --> systemic tetracyclines and isotretinoin |
