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41 Cards in this Set
- Front
- Back
A young adult presents with a rash that started with 1 oval lesion, and 1 week later had many smaller oval salmon patches over their chest and back. What is this condition? |
Pityriasis rosea. |
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What are the main clinical features of this condition? |
Affects mainly young adults Herald patch/plaque, 1-2 weeks prior (can be mistaken for ringworm) Oval, salmon pink eruptions 0.5-2cm in size Coined shaped patches with scaly margins Follows cleavage lines of skin Itch varies from nil to severe Systemically well |
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What is the aetiology and prognosis of this condition? |
Pityriasis rosea is a viral rash. It is a mild self limiting disorder with spontaneous reemission in about 6–12 weeks. |
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Name 4 differential diagnosis for this condition? |
Seborrhoeic dermatitis Guttate psoriasis Drug eruption Secondary syphilis |
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Give 4 steps in management of this condition. |
Reassurance and explanation that its self limiting condition. Bathe or shower with plain water and bath oil, aqueous cream, or other soap substitute. Apply moisturizing creams to dry skin. Expose skin to sunlight cautiously (without burning). Calamine or topical steroids for itch |
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Are there any medications that may help speed up clearance? |
These medicines (used off-license) have been reported to speed up clearance of pityriasis rose: 7-day course of high-dose aciclovir 2-week course of oral erythromycin has also been reported to help, probably because of a nonspecific anti-inflammatory effect. Other studies have found that erythromycin and azithromycin are not effective in pityriasis rosea. |
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Following a strep throat infection, a child develops the sudden eruption of small, very dense, round, red papule on the trunk. What is this condition? |
Guttate psoriasis - multiple small scaly plaques that tend to affect most of the body. Lesions are usually concentrated around the trunk and upper arms and thighs. Face, ears and scalp are also commonly affected but the lesions may be very faint and quickly disappear in these areas. Often precipitated by a strep throat infection. |
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What is the natural course of this condition? |
It can persist for >6months It may undergo spontaneous resolution or enlarge to form plaques, which may become chronic |
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Name 3 treatment options for this condition? |
1. Treatment of an underlying streptococcal infection with antibiotics. 2. Phototherapy. 3. Topical agents including mild topical steroids, coal tar and calcipqotriol. Guttate psoriasis rarely requires treatment with oral medications. |
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A teenager presents with a sore throat, they are diagnosed as having tonsillitis and given penicillin, they then develop a maculopapular rash on the extensor surfaces of their limbs. What is this condition? |
EBV - epstein barr mononucleosis Primary rash - 5% only, non specific, pinkish and maculopapular. Secondary rash - extensive and sometimes purplish-brown tinge, precipitated by: Ampicillin/amoxycillin 90-100% Penicillin up to 50%. |
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7 days after starting allopurinol a patient has a maculopapular erythematous eruption, more pronounced on the trunk. What is this condition? |
Toxic erythema - most common type of drug eruption (45%). Drugs that typically cause toxic erythema = penicillin, cephalosporin, sulphonamides, thiazides, carbamazepine, barbiturates. Mx - recognise offending agent and withdraw it. |
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A young adult breaks out in a cold sore, 3days later an acute eruption of the skin and mucosal surfaces with erythematous plaques on the hand and forearms. What is this condition? |
Erythema multiforme. Hypersensitivity reaction triggered by infections. There is a minor and a major form. Skin eruption, target lesions, mucosal involvement. Young adults 20-40 years. Normally self limiting, up to 2 weeks. |
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A few days after starting an anticonvulsant, several days of fever, cough, conjunctivitis, then abrupt painful red painful skin rash starting on the trunk and rapidly spreads. |
Stevens Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN) - variants same condition. Very rare, acute, serious and potentially fatal skin reaction, skin and mucosal loss, caused by medications. Sudden onset fever, constitutional symptoms, then abrupt tender/painful red skin rash starts on trunk then spreads. |
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What is the management of SJS or TEN? |
Admit to an ICU unit for supportive care. The acute phase in which the patient is more unwell generally last 8 days. It may take weeks-months for symptoms and signs to settle. |
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A 25 year old female, who recently had a strep throat illness, presents with red lumps on the shins, and thighs and forearms. What is this condition? |
Erythema nodosum - sudden onset bright red, raised, tender nodules on the shins, knees and ankle. Acute inflammatory, immunological reaction in s/c fat. Affects 20-40 years, F>M. Appears to be a hypersensitivity reaction with a number of different causes - strep throat, TB, pregnancy. Mild cases subside in 3 to 6 weeks, can use compression bandages, NSAIDs. Occasionally chronic |
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An elderly patient, presents with localised blistering and painful rash on the left hand side of their back that does not cross the midline. What is this condition? |
Herpes zoster (shingles). Caused by reactivation of the varicella zoster virus, which isdormant in dorsal root ganglia nerve cells in the spine for years. Dermatomal distribution. More common in elderly, when low immunity. Anyone who has had chickenpox can get shingles. Once had shingles once, chance of recurrence is 1%. |
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What are the clinical features of shingles? |
The first sign is pain which may be severe. The patient feels unwell with fever and headache. The LNs draining the affected area are enlarged and tender.Within 1-3/7 of the onset of pain, a blistering rash starts as a crop of red papules. New lesions continue to appear for several days, each blistering or becoming pustular then crusting over. |
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What are the complications of shingles? |
Involvement of several dermatomes. Eye involvement - refer to ophthalmologist Deep blisters that destroy the skin, taking weeks to heal followed by scarring. Muscle weakness in about 1 in 20 patients. Infection internal organs, including the GIT, lungs and brain (encephalitis). In pregnancy can harm the fetus. Post herpetic neuralgia. |
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What is post herpetic neuralgia? |
Persistence or recurrence of pain, more than 1/12 after onset. Common with age, affecting 1/3 patients over 40. Increased if facial infection. It may be a continuous burning sensation with increased sensitivity or spasmodic shooting pain. The overlying skin is often numb or exquisitely sensitive to touch. Sometimes, instead of pain, the neuralgia results in a persistent itch. |
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Which agents can be used to manage post herpetic neuralgia? |
Paracetamol TENS as often as necessary TCA e.g. amitriptyline 10-25mg PO nocte OR Gabapentin 300mg nocte OR Pregablin 75mg nocte Topical medication: lignocaine 5% ointment or 10% gel OR lignocaine 5% patch to painful area Topical capsaicin |
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What is the treatment of shingles? |
Antiviral treatment reduces pain and duration of symptoms if started within 72hrs after onset. Aciclovir 800 mg 5 times daily for 7 days. Infectious if have not had chickenpox. Rest and pain relief. Oral abx if secondary infection. Protective ointment to rash e.g. petroleum jelly Educate about post herpetic neuralgia |
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Can anything be done to prevent shingles? |
Because the risk of severe complications from herpes zoster is more likely in older people, those aged >60 years might consider zoster vaccine, which can reduce the incidence of herpes zoster 50%. In people who do get herpes zoster despite being vaccinated, the symptoms are usually less severe and post-herpetic neuralgia is less likely to develop. |
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A 2yr old presents with a high fever, restlessness and excessive dribbling. Whitish vesicles evolve to yellowish ulcers on the tongue, throat, palate, cheeks. What is this condition? |
Primary herpes simplex virus type 1. HSV is a common viral infection that presents with localised blistering. It affects most people on one or more occasions during their lives.HSV is commonly referred to as cold sores or fever blisters, as recurrences are often triggered by a febrile illness, such as a cold. |
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What causes herpes simplex? |
Herpes is caused by 1 of 2 types HSV, members of the Herpesvirales family of double-stranded DNA viruses. Type 1 is mainly associated with oral/facial Type 2 is mainly associated with genital/rectal However, either virus can affect almost any area of skin or mucous membrane. |
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Who gets herpes? |
Primary type 1 - infants, children Type 2 - mainly after puberty, generally sexually transmitted. Transmitted by direct or indirect contact with active herpes simplex, which is infectious for 7-12 days. Incubation period is 2-12 days. During an attack the virus can be inoculated into new areas of skin which can develop blisters. |
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What are the clinical features of primary HSV? |
Can be mild, subclinical, but tends to be more severe than recurrences. T2 more symptomatic than T1. Primary T1 gingivostomatitis, fever, pain, swollen LNs, ulcers - subsides in 2 weeks. Primary T2 - genital, painful vesicles, ulcers, redness, swelling, fever, difficulty passing urine, lasts 2-3 weeks |
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What are the clinical features of recurrent HSV? |
There may be no further clinical manifestations throughout life. Where viral immunity is insufficient, recurrent infections are common, particularly with Type 2 genital herpes. The vesicles tend to be smaller, more closely grouped in recurrent herpes. They usually return to roughly the same site as the primary infection |
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How is herpes diagnosed? |
HSV can be confirmed by culture or PCR of a viral swab taken from fresh vesicles. HSV serology is not very informative, as it’s positive in most individuals and thus not specific for the lesion with which they present. |
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What are the possible complications of herpes? |
Eye infection - dendritic ulcer
Throat infection Eczema herpeticum Erythema multiforme Cranial/facial nerves - temporary paralysis Widespread infection - persistant ucleration esp in immunocompromised, HIV. |
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What is the treatment for oral mucocutaneous herpes simplex?
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Primary infection severe use antivirals: Famciclovir 500mg BD for 7 days. Analgesia - lignocaine 2% with or without chlorhexidine 0.05% gel topically, every 3 hours. Recurrent oral episodes: Aciclovir (adult and child) 5% cream topically, 5 times daily (every 4 hours) for 5 days. If severe: Famciclovir 1500mg stat. |
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For patients with frequent severe recurrences which medication can be used as suppressive therapy? |
valaciclovir 500 mg orally, once daily for 6 months, then review aciclovir 400 mg (child: 10 mg/kg up to 400 mg) orally, 12-hourly for 6 months, then review |
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What is the treatment of the first genital ulcer herpes outbreak? |
Antiviral treatment: aciclovir 400 mg orally, 8-hourly for 5 days OR famciclovir 250 mg orally, 8-hourly for 5 days OR valaciclovir 500 mg orally, 12-hourly for 5 days Up to 10 days treatment may be needed. |
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What is the treatment for recurrent outbreaks genital ulcer herpes? |
aciclovir 800 mg orally, 8-hourly for 2 days aciclovir 400 mg orally, 8-hourly for 5 days famciclovir 1 g orally, 12-hourly for 1 day valaciclovir 500 mg orally, 12-hourly for 3 days because viral replication is short lived, short courses of treatment are appropriate |
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What about suppressive treatment for severe recurrent gentile ulcer herpes? |
aciclovir 400 mg orally, 12-hourly; famciclovir 250 mg orally, 12-hourly; valaciclovir 500 mg orally, once daily reassess after 6 months treatment longterm suppressive therapy is considered safe it reduces recurrences by 70-80% but transmission can still occur |
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Can herpes be prevented? |
Avoid sun exposure - often triggers facial herpes. As its contagious - present in saliva, van be spread in a family by sharing cups/cutlery, toothbrushes, or by kissing. For genital herpes - sexual abstinence during an attack and then after an attack condoms can decrease transmission. |
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A patient living in the tropics presents with itchy pustules, in/around the hair of his leg. What is this condition? |
Folliculitis - a group of skin conditions in which there are inflamed hair follicles. The result is a tender red spot, often with a surface pustule.Folliculitis may be superficial or deep. It can affect anywhere there are hairs, including chest, back, buttocks, arms and legs. Folliculitis can be due to infection (bacteria, fungi, candida), blockage, irritation and various skin diseases. |
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What is this condition diagnosed, and managed? |
A skin swab is taken - commonly staph is the causative agent. Mx - removal of the cause and an antiseptic wash, such as triclosan 1%, chlorhexidine or povidone-iodine. Occasionally oral flucloxacillin is required. |
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Some patients present with folliculitis of the trunk after being in a hot tub, what organism causes this type of folliculitis? |
Pseudomonas - found in poorly chlorinated water maintained at temperatures 37-40. Mx - ciprofloxacin 500mg BD for 7 days. |
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How do we manage folliculitis of the groin? |
Pseudofolliculitis - common in women who shave. Use tea tree (melaleuca) lotion daily for folliculitis, change shaving habits, if persistent use antiseptic solution, if severe use bactroban ointment. |
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A patient presents with a deep tender and painful red nodule that is enlarging, fluctuant and has developed a necrotic centre. What is this condition? |
Boils (furuncles) are a deep bacterial infection of hair follicles. Take skin swab for MCS. Mx - flucloxacillin 500mg QID for 5-7 days If boils are recurrent - obtain swabs, use 3% hexachlorophene body wash daily, mupirocin 2% ointment to lesion and nose, antibiotics. |
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What is this lesion called? |
A carbuncle - a form of deep folliculitis, when there are multiple heads. A cluster of small abscesses involving a group of adjoining hair follicles. COmmon sites are the back of the neck, shoulders, buttocks or hips. Mx - as for boil. |
