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108 Cards in this Set
- Front
- Back
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What is impetigo? |
Contagious skin infection contracted by direct contact. Characterized by vesiculopustular crusted erosions or ulcers. -Easily spread between family members and people with poor hygiene |
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What can cause impetigo? |
Break in the skin ex: abrasion, laceration, puncture, bite, burn, inflammation, psoriasis, ulcers |
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What is nonbullous impetigo? |
Vesiculopustular type Lesions are thick, yellow colored crusts that have erythematous margins Regional lymphadenopathy present |
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What are S/S of impetigo-nonbullous? |
Pruritis and burning (most common). Tender sores that continue to spread despite OTC treatment. Usually found on face or extremities.
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What is bullous impetigo? |
-Seen in newborns and young children-Large bilstering lesions that drain, leaving thin nonpurulent crust over the entire affected skin-Trunk more affected |
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What are S/S of impetigo bullous? |
A lesion that is pruritic and burning. Begins with a 1-2mm bullae that develops into a vesticularpustular lesion with a fragile rom that ruptures easily -honey crusuted lesions Usually on face, elbows, and knees |
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What is staphlococcal scalded skin syndrome? |
Exotoxins produced by staph bacteria that leads to bullous sheet like necrosis of the epidermic pieces -Mimics thermal burns -Usually starts in the intertriginous areas -Common type of impetigo |
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How do you diagnose impetigo? |
BY history and physical findings. Can do C&S on moist lesions **History, distribution, and morphologic features of the primary lesion provide the best information to help in the differential |
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What are the nonpharmacological ways of treating impetigo? |
1) Burrow's solution: Good for exudative lesions, removes thick crusts and dries out the lesions. Applied for 10-20min TID 2) Normal saline, tap water to debride and clean Improves appearance but will not treat underlying pathology |
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What are the pharmacological ways of treating impetigo? |
Wash lesions with chlorhexidine (hibiclens) TID before applying antibx cream. Can use Mupirocin (bactroban) 2% cream or ointment, TID for 14 days. Can also try Retapamulin (Altabax) BID for 5 days. Neomycin can cause contact dermatitis. can use systemic antibx for more lesions, face involvement, or cellulitis |
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If you are treating impetigo with a systemic antibiotic, which one do you use? |
Dicloxicillin 125-250mg every 6 hours for 10 days Can use cephalexin 5oomg BID for 10 days, or Clindamycin 250mg every 6 hours for 10 days |
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What is ecthyma? |
Ulcerative pyoderma of the skin usually caused by group A beta-hemolytic strep or staph |
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What does ecthyma look like? |
Round ulcerated lesion with a central adherent crust that started as a pustule with surrounding erythema Can have regional lymphadenopathy |
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What is folliculitis? |
***Hair at the center of the pustule sometimes perforating the lesion. Small pustules, surrounded by 1 to 2mm of erythema. Pustules resolve into red macules which fade to leave post inflammatory hyperpigmented scars. Nontender. May be pruritic and asymptomatic |
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What is staphylococcal folliculitis? |
Itchy, dome shaped pustules. Occurs anywhere there is hair |
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What is pseudomonas folliculitis? |
"Hot tub folliculitis." These are erythemic pustules, itchy, bathing suit area. Results from inadequate chlorination |
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What is yeast folliculitis? |
Malassezia furfur. These are itchy rounded pink pimples with an occasional whitehead. Mostly on the upper back, shoulders, and chest |
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What is sycosis barbae? |
Barber's itch. This is chronic recurrent staph infection of hair follicles on the beard of the face in men. Aggravated by shaving. |
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What is pseudofolliculitis barbae? |
Hair that curves back into the bearded area of the skin or the posterior scalp and neck causing inflammation. More common in black men. Can become chronic with bacterial infection |
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What is eosinophilic folliculitis? |
Caused by impaired immune system. See in advanced disease of HIV. Hair follicle is invaded with eosinophils and lymphocytes. Intensely itchy rash over the entire body |
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What is deep folliculitis? And what are S/S of deep folliculitis? |
Starts deeper in the skin surrounding the hair follicle and affects the entire hair follicle S/S: large, painful swollen bumps or mass, pus filled that break open and crust over |
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How do you treat folliculitis? |
Antibacterial soap cleansing of the skin BID and before applying ointment. Good hand washing with antibacterial soap. Can treat with mupirocin 2% TID for 10 days and topical clindamycin |
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What oral antibiotics can you use for folliculitis? |
(Staph) Cephalexin 250mg every 6 hours or 500mg for 10 days (MRSA) clindamycin 300mg to 450mg QID for 10 days |
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How can treat sycosis barbae and pseudofolliculitis barbae? |
-Benzoyl peroxide topical-apply to affected skin areas BID until lesion clears -Good shaving techniques -Tretinoin helps alleviate hyperkeratosis -Hydrocortisone 1% is helpful to reduce the inflammation of papular lesions |
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What is a furuncle? |
Deep bacterial infection of a hair follicle with abscess. Red, hot, tender nodule which will become fluctant and will drain pus. |
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What is a Carbuncle? |
Deeper infection c/b interconnecting furuncles. Large red painful lumps on the skin with multiple follicular openings. There are multiple furuncles
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What is the treatment for furuncles? |
-Warm compresses to promote localization and spontaneous drainage -Can consider at I & D if fluctant -Can treat with topical antibx (Mupirocin or Neosporin). Apply BID |
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What is the treatment for carbuncles? |
-I and D as well as systemic antibx -If MRSA: tx with Bactrim DS, Clinda -Otherwise: Dicloxacillin, keflex, augmentin |
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What is hidradenitis suppurativa? |
Chronic inflammatory follicular-occlusion disorder affecting area rich in apocrine glands (sweat glands) |
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How do you prevent hidradenitis suppurativa? |
Avoid constricting clothing like tight jeans Weight loss of needed Good hygiene |
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What are nonpharmacologic therapies for hidradenitis suppurativa? |
-Avoid antiperspirant and other irritants -Moist heat -Surgical excision for large persistent lesions |
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How can you treat hidradenitis suppurativa pharmacologically? |
-Systemic antibiotics which are not curative. -Initially treat with Keflex or Bactrim if MRSA -Can use topical clindamycin -Topical application to the nose is helpful in reducing the spread of bacteria |
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What is cellulitis? |
Deep bacterial infection of the skin that involves both the dermis and sub Q tissue -Usually caused by strep or staph |
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what is necrotizing fasciitis? |
"Flesh eating bacteria" |
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What does necrotizing fasciitis look like? |
-Rapid progression within hours -Bright red lesion spreading, purpuric changes and eventually gangrene. -Crepitus with palpation |
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What are the signs/symptoms of cellulitis? |
-Tender, warm erythematous area -Progressively increases in size -TEnder and enlarged lymph nodes in area -Usually edema in the affected limb -Later stages: fever, tachycardia, malaise, and lethargy |
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What medications can you use to treat mild to moderate cellulitis? |
Can use Dicloxicillin or Cephalexin 500mg QID for 10 days If there is a PCN allergy, can use Erythromycin Levofloxacin 500mg po Daily for 1-2 weeks |
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If a patient with cellulitis is due to an infected human or animal bite, or if the patient is diabetic, what antibiotic will you use? |
Augmentin 500-857mg BID for 10 days (Fresh bites: Augmentin 500mg for 5 days) |
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What are warts? |
Common skin tumors of the epidermis formed by infected keratinocytes -Usually caused by HPV |
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What are some cutaneous warts? |
Verrua vulgaris, plantar warts, and flat warts |
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How can you treat common warts? |
-Keratolytic therapy (salicylic acid plaster or solution) This will soften the skin layers that form on the wart so it can be rubbed off with a pumice stone or file |
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How do you treat flat warts? |
Tretinoin cream 0.025%, 0.05%, or 1% Apply at bedtime Disrupts the wart's skin cell growth |
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How do you treat genital warts? |
Podofilox %5 solution (works at an anti-mitotic agent that prevents cell division) Apply Q12H for 3 days then off for 4 days. Repeat this cycle every week for 1-4 weeks Imiquimod 5% cream 3x/week at bedtime for 16 weeks |
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What is condyloma acuminata? |
Genital warts
Heaped up warty papules forming a large confluent multiloculated (having many small cavities or cells) mass |
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What is the gold standard for diagnosing herpes? |
Viral culture Culture must be done within the first 72 hours of outbreak |
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What are some ORAL management measures for herpes? |
Ice to reduce swelling Blistex, lip ointments with SPF 30 or greater Lidocaine 2% Benadryl elixir to rinse mouth PRN Abreva (Docosanol 10% cream) 5times a day Penciclovir 1% Q2H when awake |
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What is the initial antibiotic therapy for primary herpes? |
Can try Acyclovir 200mg 5 times a day for 7-10days Acyclovir 400mg TID for 7-10days Valacyclovir 1gm daily for 5 days or 500mg BID for 3 days |
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If you have more than 6 outbreaks in a year, what can you use to treat herpes? |
Acyclovir 400mg BID Famciclovir 250mg BID Valcyclovir 500mg Daily |
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During recurrent episodes, what antibiotics should you start during prodrome or within one day of onset of lesion? |
Acyclovir 400mg TID for 5 days Famciclovir 125mg BID for 5 days Valcyclovir (Valtrex) 500mg BID for 5 days |
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If you have had chickenpox, what are you at risk for? |
Shingles, a reactivation of the varicella-zoster virus Physical or emotional stressors weaken the immune system, the virus can reactivate and spread along the nerve fibers to the particular areas of the skin supplied by the nerve |
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Explain the prodrome phase of shingles |
Burning or tingling pain Sometimes numbness or itch in 1 particular location of the body and on 1 side only (follows dermatone level) |
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Explain the acute phase |
After a few days, a rash appears Fever, malaise, headache Maculopapular rash progresses to grouped vesicles on an erythematous base, then pustules in 3-4 days |
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Explain the convalescent phase of shingles. |
Within 2-3 weeks, rash resolves Nerve pain (post herpetic neuralgia) can last anywhere from 30 days to months or years after the rash resolves |
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How do you treat shingles? |
Acyclovir 800g 5x a day for 7-10 days Famcyclovir 500mg Q8H for 7 days Valacyclovir 1000mg Q8H for 7 days (This will shorten the duration of viral shedding and stops the formation of new lesions and reduce pain severity) |
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What are other medications you can use besides an antibiotic to treat shingles? |
Capsaicin cream (OTC) Gabapentin 300mg daily then titrate to pain relief Amitriptyline Lyrica 75mg BID then titrate Lidoderm patch 5% |
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What are some characteristics that make up rosacea? |
Persistent erythema central face (telangiectasia) Recurrent erythematous papules and pustules Connective tissue hyperplasia with persistent yellow papules around the nose |
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What are signs and symptoms of rosacea? |
-Persistent burning, itching, or stinging sensation -Ocular rosacea: watery, irritated, or bloodshot eyes -Rosy hue on forehead, cheek, nose, chin, (symmetrical "flush/brush") |
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What is erythematotelangiectic rosacea? |
Flushing and persistent redness; may include visible blood vessels |
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What is papulopustular rosacea? |
Persistent redness with transient bumps and pimples |
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What is phymatous rosacea? |
Skin thickening usually with hyperplasia of the nose resulting in a large bumpy and bulbous appearance |
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What can you do to pharmacologically treat rosacea? |
Topical: Metronidazole cream (6-8 weeks of treatment) Can use Clindamycin 1% or Erythromycin 2% solution |
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What are nonpharmacological treatments for rosacea? |
Sunscreen, patients should stay cool on hot days, protect face from cold air and wind, exercise for shorter more frequent intervals, use a cool towel around the neck, frequent water breaks, and gentle cleansing with fragrance free facial cleaners |
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What is dermatitis? |
Group of medical conditions that cause the skin to become inflamed and irritated, itchy skin Ex: Atopic dermatitis |
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What is infantile eczema? |
A type of atopic dermatitis that presents as lesions on the cheeks, face, and upper extremities. The lesions are maculopapular, excoriated, and inflamed. May have oozing and crusts. |
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How does atopic dermatitis present in adults? |
Presents with symmetrical lesions that are crusting and excoriated. Early states: Erythematous, papulovesicular, edematous and weeping Later: crusted, scaly, thickened and lichenfied |
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How do you treat atopic dermatitis? |
There is no cure. Avoid precipitants, west lesions should be fried, dried lesions should be hydrated, and inflammation should be treated with corticosteroids. |
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What is xerotic eczema? |
Winter itch form dry skin that resembles a dry cracked river bed |
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What is contact dermatitis? |
Allergic reaction (poison ivy or nickel) Irritant (direct reaction to a detergent, soap) |
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What is seborrhoeic dermatitis? |
Related to dandruff, cradle cap in infants Dry or greasy peeling of the scalp, eyebrows, nose, hairline and sometimes the trunk |
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What is dyshidrosis? |
"Housewives eczema" Vesicular palmoplantar dermatitis on palms, soles, sides of fingers and toes Tiny vesicle bumps on hands and feet |
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What is discoid eczema? |
Nummular, exudate, round spots of oozing or dry rash with clear boundaries on lower legs, and is worse in winter |
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What are signs/symptoms of atopic dermatitis? |
Severe pruritis, sometimes history of asthma or allergic rhinitis, excoriated, erythematous maculopapular lesions. Later, the rash is crusty, scaly, and thickened |
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What are nonpharmacologic ways to manage atopic dermatitis? |
-Mild emollients (cetaphil), avoid soaps, or use dove soap in the axilla, groin and feet -Avoid excessive bathing -Take short lukewarm showers, no bubble baths -Apply moisturizer immediately after patting skin dry -Humidifiers during the cold and dry climates |
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What are pharmacological ways to manage atopic dermatitis? |
Burrows solution for wet lesions Topical steroids (Triamcinolone) or Hydrocortisone Antihistamines Montelukast 5-10mg/daily |
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What are Type IV hypersensitivity reactions? |
Non IgE mediated reaction are immunologic response to contact allergens in sensitized people -Plants, ragweed pollen, dust mites, dyes, nick, etc. |
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What are S/S of contact dermatitis? |
Inflammation of the epidermis Erythema, rough patches, weeping lesions with numerous tiny vesicles on an erythematous base that is pruritic, burning, stinging sensation |
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What is the treatment for contact dermatitis? |
Symptomatic relief while identify the underlying allergic precipitant. Identify and remove the irritant Can use topical potent steroids such as Betamethasone dipropionate 0.05% cream or Triamcinolone acetonide 0.1% cream Severe cases: Prednisone 20mg BID for 5 days |
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What is seborrheic dermatitis? |
Common skin condition that appears as a pink, scaling rash that is usually on the face and scalp. They may be slightly papular, surrounded by erythema. Scales may be greasy and appear yellow (Most common in infancy-cradle cap) |
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What are nonpharmacologic methods to treating seborrheic dermatitis? |
Exposure to sunlight Shampoo frequently for scalp lesions Apply warm peanut, olive or mineral oil in PM Wash off in AM with shampoo to remove thick scales |
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What are pharmacologic methods to treating seborrheic dermatitis? |
Face: Hydrocortisone 1% cream BID 1 weekScalp: Betamethasone 0.1% TID for 2 weeks. OTC dandruff shampoo. Can use Ketoconazole shampoo 2% BID for 2-4wks Eyelids: Hydrocortison 1% cream |
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What is psoriasis characteristics? |
Characterized by well circumscribed, raised, erythematous plaques. Covered with silvery white scales |
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What are the 5 types psoriasis? |
Plaque, guttate, inverse, pustular, and erythroderma |
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What is plaque psoriasis? |
Starts as small red bumps that are dry. Erythematous raised plaques, silver scales, usually in young adults |
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What is guttate "droplet" psoriasis? |
Acute eruption with multiple discrete small papules then scales. Starts on trunk, arms, and legs. Resembles a viral widespread rash May follow 2-3 weeks after strep throat, cold, tonsillitis, or chicken pox |
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What is inverse psoriasis? |
Can be found in the skin folds. Red, dry patches of thickened skin. Lesions are usually smooth shiny, erythema with well defined borders. Can be found in obese pts or with perspiration or frequent rubbing No scales Very tender |
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What is pustular psoriasis? |
Widespread with superficial pustules on a red base. Frequently localized on palms or soles Often from sunburn or meds There are several types: acute, chronic, and subacute, or generalized w fever |
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What is erythroderma psoriasis? |
Periodic, widespread, fiery redness that leads to desquamation. Severe itching and pain, tachycardia, and fevers Skin appears burned Loss of barrier to infection Life threatening |
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What are some triggers to erythroderma psoriasis? |
Aburpt withdrawal of systemic psoriasis treatment including cortisone, allergic reaction to a drug, severe sunburn, infection, antimalarial drugs, tar products, and low calcium |
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If you notice pitting in your nail beds, what can that be a sign for? |
May be the only presenting symptom for psoriasis |
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What are some diagnostic tests you could run for psoriasis? |
CBC with diff, CMP, hepatitis panel, and TB screening |
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What blood level is often elevated in pustular psoriasis? |
Uric acid |
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If your joints are involved what kinds of tests would you run for psoriasis? What psoriasis specifically |
Psoriatic arthritis. Tests: ANA, RF, and Xray |
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What is auspitz sign and what does it indicate? |
When the scales are removed and there are small droplets of blood that appear within a few seconds. Psoriasis |
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What are some nonpharmacologic methods of treatment in psoriasis? |
Phototherapy 3-5x/wk, moisturizers (to keep skin from cracking and becoming sore), salicyclic acid, stress reduction. U/V light Make sure to brush scales off after warm soaks to increase absorption |
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What is the first line of treatment for psoriasis? |
Can try Calcipotriene (Devonex) (Vitamin D) cream, which is better for plaques for 5days Steroids Topical steroids if <20% of the body involved High potency steroids x2wks then decrease potency to lower potency Refer if psoriasis covers >20% of the body Can try methotrexate 2-3 months |
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What can you educate the family and patient regarding psoriasis? |
-Not contagious -Avoid skin trauma (no scratching) -Keep skin dry and smooth -Avoid tetracycline, sulfa -Control your sun exposure -Rx for strep and skin infections -Avoid alcohol -Decrease stress |
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What other tests can you run when you see guttate psoriasis? |
Rapid strep test |
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What is lichen planus? |
An autoimmune inflammatory condition affecting the skin and mucous membranes (May be triggered by stress, Hep C, flu vaccine, and medication-Metformin, lasix, BB) |
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What are S/S of lichen planus? |
-Purplish, flat topped bumps (commonly found on the inner FA, wrist, and ankle) -Pruritis, blisters that may break to form scabs or crusts -White spots or patches in mouth, lips, tongue -Painful oral or vaginal ulcers -Hair loss, scalp discoloration, nail damage |
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How can you treat lichen planus and how long does it last? |
Tx: Oral antihistamines, steroid creams Usually resolves by itself after 18 months |
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What is pityriasis rosea? |
Benign skin condition that causes a rash Begins with a single round, scaly pink patch with raised border (herald patch) |
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What does pityriasis rosea look like? |
Within 1-2 weeks, smaller oval patches appear on teh back, chest, abd, arms and legs. Christmas tree pattern on skin |
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How do you manage pityriasis rosea? |
UV light may be helpful, Aveeno oatmeal bath for pruritis, Avoid taking hot showers |
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Describe a junction nevus. |
Color and shape of the black lesion are unifrom |
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Describe a compound nevus. |
Center is elevated and surrounding area is flat, still looking like the junction nevus (color and shape are uniform)
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Describe a dermal nevus. |
Papillomatous with soft, flabby, wrinkled surface |
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Explain the ABCDE mnemonic. |
Symmetry, border irregularity, color change, diameter >6mm, and elevation of evolving lesion |
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What is malignant melanoma and what do they look like? |
Typically a large mole on a sun-exposed area that has changed in appearance. Asymmetric, irregular border, >6mm, and raised lesion MUST BIOPSY ALL SUSPICIOUS LESIONS |
