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33 Cards in this Set
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Atopic/Contact/Diaper Eczematous Eruption |
Atopic: type IV HS caused by irritants, solvents, oils, dust, nickel, poison ivy.... Diaper: "diaper rash" - prolonged contact with urine/feces Contact: cleaners, solvents, detergents. S/S: Itching, burning, vesicles, crusting, plaque formation. DX: patch test, culture/gram stain for infection TX: Wet dressing with Burrow's solution and topical corticosteroids. Diaper rash - use barrier of petrlatum. Severe cases - systemic steroids. |
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Seborrheic Dermatitis |
WHAT: common in infancy and puberty/ young adults and occurs in folds, face, scalp, genitalia (sebaceous glands). S/S: scattered yellowish/grey scaly macules and papules with greasy look. "Cradle cap" in infants and dandruff in adults. TX: UV radiation. Cradle cap - olive oil compresses and baby shampoo/ketoconazole shampoo or cream or hydrocortisone. Dandruff- shampoos with selenium or zinc and ketoconazole shampoo or topical steroids. |
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Stasis Dermatitis |
What: chronic venous insufficiency S/S: vericose veins, phlebitis, venous thrombosis, heaviness/aching in legs and feet. Aggravated by standing relieved by walking. Ulceration, inflammatory papules, scales and crusts with pigmentation. DX: DOppler, sonography, or venography and BX TX: Compression stockings. Vascular bypass, thermal ablation or angioplasty/stenting. |
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Dyshidrosis |
S/S: pts under 40. occur with stress or hot weather. Predominantly on hands and feet. Pruritis, pain if infected, small vesicles in clusters (tapioca like)and occasionally bullae on fingers, palms and soles. DX: culture and KOH to r/o other causes. TX: wet dressing with Burrow's soln. Topical/systemic steroids |
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Psoriasis |
Cause: genetic predisposition - chronic inflamm scaling condition due to fast cell rate turnover. S/S: patches that are raised, pink/red, and plaques with distinct margins and silvery scales. Peeling scale elicits bleeding (Auspitz sign). Found on scalp, extensor surface of elbows and knees. Pruritis and scratching creates more lesions - Koebner phenomenon. TX: topical corticosteroids and vit D if mild. Systemic steroid if widespread. Topical retinoids, UVB phototherapy, methotrexate |
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Tinea |
**Means fungal infection - pedis (foot), cruris (groin), Corporis ( trunk, legs, arms, or neck), Barbae ( beard), unguium (nails), manuum (hand), facialis (face) and capitus (head) S/S: annular erythematous patch with distinct borders and central clearing. Itches, stings, burns. Capitus has broken hair shafts DX: KOH prep TX: topicals BID x 4 wks. If chronic, resistant, nail - griseofulvin (dont drink ETOH), terbinafine for 3months |
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Tinea Versicolor |
**Jessie dz - fungal yeast infection of skin that does not tan in the summer. "spaghetti and meatballs" on KOH wet prep. TX: selenium sulfide shampoo. |
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Pityriasis Rosea |
S/S: herald patch (round solitary pink plaque with raised border) that precedes a symmetrical papular eruption. Common in teens/young adults. Have URI before rash that occurs on trunk and has "christmas tree" like distribution. TX: none- self limited |
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Acne Vulgaris |
S/S: comedones open/closed that can become papules, pustules, nodules, or cysts. DX: test, FSH, LH - look for endocrine d/o TX: Mild - keep clean and apply topical retinoids, azelaic acid, and salicyclic acid. If have inflammatory lesions - benzoyl perocide, trtinoin, ATB can be used. If cystic acne - use ATB(tetracyclines) + topicals. Oral isotretinoin (accutane ) is severe. |
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Acne Rosacea |
What: chronic d/o of F>M bw 30-50y/o S/S: flushing, nodules, and talengectasias - episodic and due to heat, ETOH, sun, spicy food, coffee/caffeine. Symmetric distribution. Can be disfiguring and occur on other areas of body. "-phyma" used to describe edematous areas. TX: reduce triggers, Topical metronidazole **. If fails, use oral ATB or isotretinoin. |
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Folliculitis |
What: inflammation of hair follicles by S. aureus. usually but can be pseudomonas if in hot tub S/S: NON-painful erythematous papules/pustules that burn. Abscesses may form. TX: cleansing, If mild - clinda/erythro-mycin. If hot tub related - no tx. |
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Herpes Simplex |
What: humans only reservoir- transmitted via close contacts of cracks in mucosal surface. Inactivated by crusting/drying. HSV1 - above waist. HSV2 - below waist. S/S: thin walled grouped vesicles with red base. DX: clinical, multinucleated giant cells on tzanck smear, antibodies on PCR TX: local wound car and supportive therapy. Acyclovir/valacyclovir. Foscarnet if immunocompromised. If have keratitis - trifluridine. |
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Herpes Zoster |
AKA SHINGLES What: highly contagious, even before rash. Incubates in 10-20 days. Can be lifethreatening in adults. S/S: "dewdrop of rose petal" vesicles with several morphologies that follow a dermatome (usually thoracic/lumbar region). Fever, malaise, arthralgias, HA. If severe - deeper lesions in lung, liver, pancreas, brain and can be fatal. If on tip of nose = hutchinson sign. DX: clinical TX: supportive. Prevent via Zostavax vaccine in pts >60 y/o, steroids if have nerve involvement, Varicella vaccine given at 1-2y/o and two doses 2months apart for adults without evidence of immunity. |
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Exanthems |
What: See table 17-2 pg 378 |
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Cellulitis |
What: acute spreading inflammation of dermis and subcu tissue S/S: swollen, red, hot, tender - may have fever and lymphadenopathy TX: oral PCN (Dicloxacillin or cephalosporin) - erythromycin if PCN allergic. IF severe - IV cephalosporin and maybe surgery to remove tissue |
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Impetigo |
What: "Streptococcus pyoderma" S/S: thick crusted "honey -colored" yellow lesions - can indicate malnutrition. If caused by staph = bullous impetigo DX : gram stain and culture TX: soaks and scrubbing, Topicals like bacitracin, Systemic ATB - cephalexin*. Bleach baths for all family members and do not share towels. |
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Erysipelas |
S/S: painful macular rash with well-defined margins - rapid onset and localized to face. It may go to extremities. TX: rash desquamates in 5-10 days. Either admit and give IV ATB or outpatient ATB- 7 day course of PCN QID. |
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Hidradenitis Suppurativa |
What: dz of apocrine glands (axilla, anogenital, and scalp) S/S: F>M between puberty and menopause. Tender inflammatory nodules/abscesses NOT related to hair follicles. Open comedones and sinus tracts may drain purulent material. Fibroses/scarring/contractures. DX: culture TX: Intraleisonal triamcinolone, I&D abscess and excise sinus tracts. Oral ATB. Add prednisone 2 wk taper if lesions are severe. |
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Lice |
What: Caused by louse. "Pediculosis" pubis = crabs, corporis -body, capitis - head. See them better at seams of clothing. S/S: itching, pyoderma TX: dispose infested clothing. Pubic - use permethrin rinse and cream. Wash and dry clothing at high temps and contact partner. Permethrin cream rinse (Nix) for head louse. Topical ivermectin and spinosad for topical application to body. |
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Scabies |
what: Infestation with Sarcoptes scabiei - mite S/S: infestation seen in webs of fingers/toes, belt line, edges of socks. DX: look for mites, eggs, or feces upon scraping with a drop of mineral oil. Positive microscopy is diagnostic. TX: 1% Lindane or 5%permethrin in a lotion/cream. antihistamines for itching. All bed/clothing should be washed and close physical contacts should receive tx too. |
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Spider Bites |
What: most often brown recluse (loxosceles reclusa) - occurs during sleep or in clothing. S/S: pain 3 hrs post bite and systemic s/s 4-6 hrs post bite. Shows as necrotic skin- pale grey in color with erosion in center and halo of tender inflammation and hemorrhage.. If a black widow - can cause neurologic overstimulation. TX: Local care and analgesics with NO debridement. If have neurologic manifestions - diazepam or calcium gluconate. Wound decreases significantly in 5-10 days. Antivenin rarely needed/available. |
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Bee Sting |
Tx: Cloth should be placed between the ice and skin to avoid freezing the skin. Consider taking an antihistamine such as diphenhydramine (Benadryl) for itching. Consider taking ibuprofen (Motrin) or acetaminophen (Tylenol) for pain relief as needed. Wash the sting site with soap and water. |
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Flea Bite |
What: blood suckers. S/S: saliva of flea produces urticaria in sensitive ppl. TX: quick-kill insecticides, residual insecticides and growth regulator. |
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Dog Bite/Human bite |
* Has less rate of infection than cat or human bite. Puncture wounds have higher rate of infection than lacerations. Cause of infection : Dog bites - Pasteurella. Human - strep and staph. Beware HIV! TX: vigorous cleaning and irrigation with debridement of necrotic skin = most important step. Radiographs to exclude fracture. Beware suturing. Hand bites of any animal and or have chronic dz (lower immune state) should receive Amox-clavulanate ATB prophylaxis. Consider tetanus and rabies vaccinations. |
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Basal Cell Carcinoma |
*MC S/S: pearly papule, erythematous patch >6mm or nonhealing ulcer in sun exposed area with hx of bleeding in fair skinner person. TX: excision and bx. Mohs surgery is most effective = removal followed by immediate freezing and re-excision of tumor pos. areas. |
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Squamous Cell Carcinoma |
S/S: arises from AK's and on sun-exposed areas of fair skinned ppl. Nonhealing ulcer or warty nodule. More likely to mets if appear de novo. TX: excision with bx and Mohs surgery.
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Melanoma |
*Leading cause of death due to skin dz S/S: irregular borders and any lesion that has changed in color. Can be flat or raised and occur ANYWHERE. Can bleed/ulcerate DX: tumor thickness determines survival rate** = best prognastic factor (thicker = worser). ABCDE (asymmetry, border, color, diameter >6mm, evolution* = most important), "ugly duckling sign" - mole that stand out from others. TX: excision and re-excision of margins. Sentinel LN biopsy for staging. Referral. Beta-blockers may reduce progression with high risk pts. |
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Alopecia areata |
What: Unknown cause - common with thyroiditis, pernicious anemia, SLE, or Addison dz. Could be associated with drugs - thallium , vit A, retinoids, antimitotic agent, anticoags, and oral contraceptives. S/S: exclamation point hairs, patchy or involve the scalp (alopecia totalis) or whole body (alopecia universalis) TX: may respond to steroids, but relapse is common. |
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Onychomycosis (Tinea Unguium) |
What: infection of nail with fungi or yeast S/S: Discolorations and crumbly nails. Paronychia - inflammation of nail fold with erythema, swelling, and throbbing pain. DX: KOH examination for hyphae TX; oral Griseofulvin for fingernails and terbinafine otherwise. |
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Lipoma |
What: adipose tumors and benign neoplasm of mature fat cells TX: Surgical excision for cosmetic/irritative reasons |
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Urticaria |
Cause: atopic - food, drugs or heat/cold and stress or infection. S/S; Hives or wheals- raised red areas due to His release. TX: antihistamine - diphenhydramine, hydroxyzine, fexofenadine or cetirizine. If recurrent or chronic- add steroid. Epipen if anaphylaxis expected. |
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Vitiligo |
What: destruction of melanocytes due to thyroid dz, pernicious anemia, DM, and addison. Can be idiopathic or genetic S/S: hypopigmentation TX: sunscreens, cosmetic cover-up, repigmentation therapies. |
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Burns |
1st degree - minor damage to epi (no blisters) 2nd degree - superficial partial-thickness (extend to papillary dermis and have THIN walled blisters) and deep superficial (extend into reticular dermis and have THICK walled blisters) 3rd degree - full thickness- epi and dermis. White/charred appearance. Dry with no sensation 4th degree - skin and subcu tissue to bone/muscle. Extensive charring and no feeling. ** if on upper airway/torso expect airway involvement. DX: hematocrit, electrolytes, BUN/creat, UA,chest CT. TX: maintain ABC's, estimate % via rule of 9's, stop burning via sterile water irrigation (except for chemical burns), fluid replenishment via Ringer's Lactate (Parkland formula = %of burn x body wt x 4mL/hr = amt of fluid needed for next 24 hrs), NG tube, foley, Sulfadiazine topical for burn, Excision on day 3 of dermal + burns. Complications: Curling ulcers, shock, infection |
