Step III - Derm 1
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| What is the pathophys behind pemphigus vulgaris | Autoimmune attacking intracellular epidermal cells
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| What are the possible etio of pemphigus vulgaris | Idio / penicillamine / ACE (-)
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| Nokolsky’s sign is present in what dzs | pemphigus vulgaris / staph scaled skin / TEN
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| Most accurate test for pemphigus vulgaris | Skin bx
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| What is the best initial tx for pemphigus vulgaris | Steroids eg prednisone
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| Tx for pemphigus vulgaris when initial treatment fails | Azathioprine / mycophenolate / cyclophosphamide
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| Most accurate test for bullous pemphigoid | Skin bx w/ IF Abs
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| What is the best initial tx for bullous pemphigoid | Systemic steroids eg prednisone
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| Tx for bullous pemphigoid after initial tx fails | Erythromycin + nicotinamide OR tetracycline
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| Compare and contrast bullous pemphigoid and pemphigus vulgaris in terms of mouth involvement and age group | PV: 30-40s, mouth involved; BP: 70-80s, no mouth involvement
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| What is known etio of bullous pemphigoid | Drug induced eg sulfa
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| What makes pemphigus foliaceus different from BP and PV | More superficial skin surface
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| What are some causes of pemphigus foliaceus | ACEI and NSAIDs
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| Most accurate test for pemphigus foliaceus | Skin bx
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| What is the best initial tx for pemphigus foliaceus | Steroids
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| Pt has photosensitivity, alcoholic, DM, chr Hep C, hemochromatosis, OCP. Dx | Porphyria cutanea tarda
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| Pt has photosensitivity, non healing blisters on sun exposed areas, facial hypertrichosis, hyperpigmented skin | Porphyria cutanea tarda
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| Diagnostic study for Porphyria cutanea tarda | Urine uroporphyrin (higher than copro in urine)
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| Tx for Porphyria cutanea tarda | Lifestyle changes: stop EtOH, estrogen use; use sunblock, deferoxime to remove iron stores or phlebotomy, chloroquine to (+) excretion of porphyrins
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| MCC urticaria | Meds, insect bites, food, emotion, latex contact
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| MCC chr urticaria | Pressure on skin, cold, vibration
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| What is the best initial tx for urticaria | H1 antihistamine
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| Tx for severe urticaria | Add steroids
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| Chr Tx for urticaria | Non-sedating anti-histamine (Claritin, allegro, etc)
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| Tx for urticaria if trigger can’t be avoided | Desensitization
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| Generalized maculopapular rash that blanches with pressure a/w allergies to certain meds | Morbilliform rash
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| Tx for Morbilliform rash | Anti-histamines
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| Target like lesions found on palms and soles a/w drugs and infection | Erythema multiforme
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| Causes of EM | PCN, phenytoin, NSAIDs, sulfa, herpes simplex, mycoplasma
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| Tx for EM | Anti-histamines OR tx infection
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| Hypersensitivity response that involves mucous membranes, reaction covers <10-15% of body, a/w allergy to drugs, may cause respiratory compromise | SJS
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| Tx for SJS | Nothing has been proven; steroids will NOT work; move pt to burn unit
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| Hypersensitivity response that covers 30-100% of body, drug induced, high mortality, (+) Nikolsky sign | TEN
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| Most accurate test for TEN | Skin bx
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| What type of tx would not help and may actually aggravate TEN | Prophylactic antibx and steroids
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| Pt has dark sharply demarcated spots on body that don’t go away and a/w continued use/exposure of certain drugs | Fixed drug reaction
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| Tx for fixed drug reaction | Topical steroids
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| Painful red raised nodules in LE, tender to palpation, no ulceration, duration ~ 6wks | Erythema nodosum
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| Erythema nodosum is a result of what type of conditions | Secondary to infection or inflammatory conditions
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| Causes of Erythema nodosum | Recent strep, hepatitis, histo, IBD, pregnancy, coccidio, sarcoidosis, syphilis, enteritis (yersinia)
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| Tx for Erythema nodosum | Analgesic, NSAIDs; tx underlying condition
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| What is the best initial tx for fungal infx | KOH
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| Most accurate test for fungal infx | Fungal culture (up to 6wks)
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| In what cases would it be necessary to definitively isolate the fungus | Hair and nails
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| Most efficacious Rx for hair and nail infx | PO terbinafine or itraconazole; nails = 6wks; toes = 12wks
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| If pt is put on terbinafine what do you need to follow and why | LFTs; hepatotoxic
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| Alternative tx for fungal infx less efficacious and longer duration | Griseofulvan 6-12mos
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| AE of systemic use of ketoconazole | Hepatotoxic and gynecomastia
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| PO drugs for bacterial skin infections | Diclox, cephalexin, cefadroxyl
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| IV equivalent of PO drugs for bacterial skin infx | Ox/naf, cefazolin
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| Pts allergic to PCN and have only a RASH can safely use this class of drugs d/t <1% cross reactivity | Cephalosporins
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| Pts allergic to PCN and have ANAPHYLAXIS can safely use these classes of drugs | Macrolides and Fluoroquinolones
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| What is a sequelae of impetigo | Glomerulonephrx
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| What are the two bugs that cause impetigo | Staph and strep pyogenes
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| What skin layer is affected in impetigo | Epidermis only
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| What skin layer is affected in erysipelas | Epidermis and dermis
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| Etio of erysipelas | Strep pyo
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| Fever, chills, bacteremia, bright red angry swollen face | Erysipelas
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| Rx tx for erysipelas | Systemic PO or IV Antbx for strep; PCN G/ampicillin
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| Infection of dermis and SubQ +/- fever, HYPOtn, sepsis | Cellulitis
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Created by:
DrINFJ
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