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Derm Systemic 3


chronic skin disorder associated with celiac disease dermatitis herpetiformis
physiology of dermatitis herpetiformis IgA deposits in the skin, these are antibodies made in response to glutens
Symmetric, pruritic erythematous papules/plaques studded with vesicles (on extensor surfaces of elbows / knees; buttocks, scapular areas, scalp) = dermatitis herpetiformis
physiology of dermatitis herpetiformis IgA deposits in the skin; Ab response to glutens; assoc w/ celiac dz
dermatitis herpetiformis classic lesions erythematous papules/plaques w/vesicles (usu on extensor of elbows, knees, buttocks, scapula, scalp); symmetric and intensely pruritic
Pitting edema (dependant, improves overnight), varicose veins, stasis dermatitis, hyperpigmentation (mottled blue, purple), skin fibrosis, venous ulcers = venous insufficiency
Occurs on lower legs, ankles (+/- pitting edema). Erythematous papules, scale, erosions, excoriations = stasis dermatitis
often mistaken for cellulitis stasis dermatitis
treatment for stasis dermatitis compression, oral antibiotics, topical steroids
1/3 of patients with venous insufficiency will develop __ venous ulcers
venous ulcers are usually located __ above medial malleolus
venous ulcers classic lesions Assoc w/venous insuff; v painful, well demarcated, irreg shape, begin as a shallow erosion but can become deep (base often necrotic)
__ is always present with venous ulcers bacterial superinfection
chronic multisystem granulomatous disease (more common in AA females) sarcoidosis
with sarcoidosis skin involvement occures in __% of patients 25
most common lesions of sarcoidosis macules/papules-brown yellow or purple, occur mostly on face, extremities
lesions of sarcoidosis macules/papules-brown, yellow, or purple (face, extremities), nodules (brown purple, occur on face/trunk/extremities), plaques (annular or serpiginous, may be scaly. occur on buttocks/trunk/extremties) lupus pernio
classic sarcoid lesion, infiltrating violaceous plaque, occurs on nose, cheeks, ears, lips lupus pernio
lesions tend to occur on old scars (tattoos) sarcoid
3rd most common form of drug reaction (often 2/2 PCN, sulfonamide, phenobarbital, hydantoins) = erythema multiforme
mild erythema multiforme no bullae, lesions on upper extremities, face
major/severe erythema multiforme one or more mucous membranes involved, epidermal detachment of <10% of total body surface area
erythema multiforme classic lesions Macule => papule with vesicle or bulla in center [target (or iris) lesion]; on hands, forearms, feet, face, usually symmetric
treatment for mild erythema multiforme symptomatic analgesics, topical steroids
treatment for major erythema multiforme often associated with drugs. discontinue the offending agent
erythema multiforme etiology drugs (PCN, sulfonamides, phenytoin, allopurinol); infxn (HSV, mycoplasma); 50% idiopathic
considered dermatologic emergencies Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis
Widespread bullae on trunk, face, and mucous membrane; involvement with epidermal detachments = Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis
treatment for Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis medical emergency, monitor fluid/electrolytes, systemic steroids
Drug hypersensitivity classifications I: IgE mediated urticaria (2nd most common). II: cytotoxic rxn (cell lysis). III: vasculitis & serum sickness (immune complex in small vessels). IV: morbiliform rxn (most common)
SJS/TEN Sx/Sx: fever, photophobia, ST, mucosal inflammation; progress in 4 days: erythema, morbiliform lesions, necrotic epidermis & sheetlike loss; Nikolsky sx; poss ATN/ bronchitis
Procainamide, hydralazine & rash Lupus-type eruptions
Photosensitive rash may be due to which drugs: TCN, Sulfa drugs
Drug sensitivity reactions: clinical features & timing: Most common: examtematous / morbilliform rashes, red maculopapular often coalescing into plaques in 2-3 days post-exposure. Urticaria 2nd most common & resolve in 24h after med is stopped
Characteristic lesion of erythema multiforme is: macule -> papule with vesicle or bulla in center (target (or iris) lesion), on hands, forearms, feet, face, usually symmetric
HSV presentation: 24h prodrome (itching, burning); painful vesicles on erythematous base
HSV tx Acyclocir 5% ointment (6x/day x7d) vs pencyclovir cream 1% Q2h. Extensive genital erosions: silver nitrate vs burrow's
Varicella zoster tx Antivirals (acyclovir, valacyclovir, famciclovir; foscarnet for resistant VZV)
Created by: Adam Barnard Adam Barnard