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21 Cards in this Set

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Erythema nodosum causes

localized inflammatory condition of skin (type of hypersensitivity rxn)




think anytime you have red nodules on anterior aspect of legs




assoc with preg




most common causes:


streptococcal infections


coccidioidomycoses


histoplasmosis


sarcoidosis


IBD


syphilis


hepatitis

Erythema nodosum presentation

multiple painful, red, raised, nodules on anterior surface of lower extremities


tender to palpation


do not ulcerate


can last ~6 weeks

multiple painful, red, raised, nodules on anterior surface of lower extremities




tender to palpation




do not ulcerate




can last ~6 weeks

Erythema nodosum next steps

Want to fig out cause:




CXR --> sarcoid, fungal infection




further w/u if CXR is negative

Fungal infection presentation

superficial fungal infections of skin, hair, and nails are dx with visual appearance and confirmed with KOH test




leading edge of lesion on skin or nail is scraped with scalpel to remove epithelial cells --> KOH dissolves epithelial cells but does not affect fungus

Tinea versicolor

occurs in humid climates or those who sweat perfusely


common in adolescents



dx with KOH with wood lamp

occurs in humid climates or those who sweat perfusely




common in adolescents




dx with KOH with wood lamp

Rx of fungal infection

Onychomycosis (nail infection):




oral terbinafine or itraconazole


6 weeks for fingernails & 12 weeks for toenails


monitor LFTs when on terbinafine




Griseofulvin for fingernails (6-12 months)


less efficasious than terbinafine & no longer rec for toenails




Tinea captitis (hair infection):


Oral terbinafine or itraconazole


Griseofulvin for 6-8 weeks

Tinea versicolor vs vitiligo appearence

Tinea versicolor:


lesions of different colors from tan to pink


lesions do not tan


KOH +




Vitiligo:


no pigmentation


KOH -

Vitiligo

chronic dz with idiopathic pathogenesis


assoc with autoimmune dz such as addison's dz, hashimoto thryoiditis, DM1



rx with topical steroids, calcineurin inhibitors, phototherapy

chronic dz with idiopathic pathogenesis




assoc with autoimmune dz such as addison's dz, hashimoto thryoiditis, DM1




rx with topical steroids, calcineurin inhibitors, phototherapy

Herpes simplex

Genital infection --> multiple painful vesicles (normally caused by HSV2 but can also be HSV1)




Many ppl infected are asympt




Oral infection --> vesicles are usually visible & rx should be started immediately (oral acyclovir, famciclovir, or valacyclovir) w/o test confirmation (usually caused by HSV1)

Herpes simplex diagnosis

dx is done with active lesions only




if dx not clear, best initial test is Tzanck smear of lesion --> detects multinucleated giant cells (technique is similar to pap smear)




most accurate diagnostic test is viral cx (takes 1-2 days)




serology NOT useful (just distinguishes acute vs chronic)

Herpes zoster

occurs in elderly or immunocompromised pts




vesicles follow dermatone distribution with erythematous base




pain occurs prior to vesicle appearance




Can dx with appearance but Tzanck prep is best initial test & viral cx is most accurate test




rx with oral acyclovir (800mg 5x/day for 10 days), valacyclovir, famciclovir




aluminum acetate soaks can be comforting for skin lesions




disseminated herpes zoster (multiple dermatones) --> IV acyclovir




postherpetic neuralgia --> analgesics (eg gabapentin, amitriptyline, lidocaine patch, pregabalin)

Ramsay hunt syndrome

Zoster affects geniculate ganglion of sensory branch of facial nerve




vesicles and pain appear on external auditory canal




pts lose their sense of taste in anterior 2/3 of tongue w/ipsilateral facial palsy




facial palsy + pain = zoster




facial palsy w/o pain --> something else (eg Lyme dz)

Syphilis presentation

primary syphilis --> chancre- an ulcertaion with heaped up indurated edges that is painless (but can also be in oral area)


secondary syphilis --> generalized copper-colored, maculopapular rash on palms and soles of feetcan also have mucous patch...

primary syphilis --> chancre- an ulcertaion with heaped up indurated edges that is painless (but can also be in oral area)




secondary syphilis --> generalized copper-colored, maculopapular rash on palms and soles of feetcan also have mucous patch, alopecia areata, or condylomata lata




secondary syphilis is infectious and VDRL & RPR is only positive in secondary syphilis

Syphilis dx & rx

Primary syphilis:


best initial test --> darkfield exam (false neg rate of 25% for both VDRL & RPR)




Secondary syphilis:


VDRL and RPR have ~100% sensitivity followed by treponemal specific testing (eg fluorescent treponemal antibody absorption (FTA-ABS)




rx with single IM dose of penicillin but if allergic, can give orally dox for 2 weeks




rx with pencillin causes rapid death of treponemal & can cause Jarisch-Herxheimer rxn (fever, chills, rigor, hypotension, headache, tachy, vasodilation, myalgia)

Lyme dz

caused by Borrelia burgdorferi transmitted by deer tick (Ixodes scapularis)




>85% develop a erythematous rash (erythema migrans) with central clearing that occurs 7-10 days AFTER tick bite --> if seen, can start treatment with no further w/u




rx with oral dox, amox, or cefuroxime once rash is seen




with no rx, rash goes away in a few days to weeks with 2/3 of pts eventually develop monoarthritis or rarely migratory arthritis & smaller number of pts develop neurologic or cardiac d/o




neurologic (b/l facial nerve palsy) or cardiac sxs (AV block, PR interval incr)--> IV ceftriaxone 2-4 weeks

Melanoma

L melanoma R normal


superficial spreading melanoma is most common type (2/3 of cases)

L melanoma R normal




superficial spreading melanoma is most common type (2/3 of cases)





Types of melanoma

Lentigo maligna melanoma --> sun exposed body parts in the elderly


Acral-lentiginous melanoma --> palms, soles of feet, and nail beds

Lentigo maligna melanoma --> sun exposed body parts in the elderly




Acral-lentiginous melanoma --> palms, soles of feet, and nail beds





Melanoma dx & rx

Bx is with full thickness sample bc tumor thickness is most important prognostic factor




rx with excision

Squamous cell carcinoma

develops on sun exposed skin in elderly




10-25% of skin cancers are squamous cell




common on lip (more common with tobacco use)




ulceration of lesion is common




dx with bx




rx with surgical removal and RT can be used for lesions that cannot be operated

Basal cell carcinoma

65-80% of all skin cancers


seen in sun exposed areas, particularily face



shiny or "pearly" appearance


dx with shave or punch bx



rx with surgical removal (Mohs microsurgery has greatest cure rate with instant frozens done to determine whe...

65-80% of all skin cancers




seen in sun exposed areas, particularily face




shiny or "pearly" appearance




dx with shave or punch bx




rx with surgical removal (Mohs microsurgery has greatest cure rate with instant frozens done to determine when enough tissue is removed)

Psoriasis

silvery scales develop on extensory surfaces




can be local or extensive




nail pitting is common




rx with salicyclic acid to remove heaped up collections of scaly material --> if localized, topical steroids




if severe --> coal tar or anthralin derivatives




to avoid long term use of steroids, can use topical vit D (calcipotriene) or topical vit A (tazarotene)