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Skin Disease Review

skin conditions,skin rashes

What is Psoriasis? An inhertied skin disorder, rapid squamous cell divide and mature. Produces psoriatic plaques
What are the speacial findings in psoriasis? Koebner phenomenon:new palques over skin from truama. Auspitz sign: Pinpoint areas of bleeding in the area where plaques were removed.
What are the classic characteritics of Psoriasis? Puritic erythematous plaques covered with fine silvery white scales and pitted fingernails and toenails. Location: scalp,elbows,knees, sacrum,and intergluteal folds.
What is the management of Psoriasis? Topical steroids and tar preparations(Psoralen drugs). Sytemic antimetabolites(methrotrexate-for severe form. UV lights and tar derived topicals= induce remission.
What is the complication of Psoriasis? Guttate Psoriasis(drop shaped lesions); rare form of psoriasis from strep throat.
What is Actinic Keratosis? Precancerous lesion that are precursors to squamous cell carcinoma and caused by chronic sun exposure.
Actinic Keratosis is common in what race and gender? In older white patients with long-term sun exposure history
What are the classic characteristics of Actinic Keratosis? A dry red lesion with a rough texture. Present for several years and slowly enlarge and DO NOT HEAL. Locations: in sun-exposed areas of skin( cheeks,nose,face, neck, arms and back).
What is the managment of Actinic Keratosis? DX: by skin biopsy and clinical apperance. COmmon: more in light skinned persons. Meds: cyrotherapy=small lesions; fluorouracil cream 5%(5-FU cream)- topical antineoplastic agent used for several weeks.
What is Tinea Versicolor? A superficial skin infection caused by the yeast PITYROSPORUM ORBICULARE and pityrosporum ovale.
What labs are ordered for diagnosis of Tinea Versicolor? Potassium hydroxide(KOH) slide: hyphaea and spores(spaghetti and meatballs)
What is the management for Tinea Versicolor? Topical Selenium sulfide or ketoconazole(Nizoral) shampoo or cream to affected area BID x 2 weeks.
What are the characteristics of Tinea Versicolor? Lesion are round macules that vary in color from flesh tones. Common location: face, shoulders, chest, and back.
What is Eczema(atopic dermatitis)? A chronic inherited skin disorder marked by extremely pruritic rashes that are located on the handsm flexural folds, and the neck(older child to adults).
What exacerbates Eczema? stress, environmental factors(allergens, cold and dry climate)
What other conditions are associacted with Eczema? asthma, allergic rhinitis and positive family hx.
What are the classic characteristics of Eczema? Infants -age 2= larger area fo rash distribution. Rash on cheeks, entire trunk, knees and elbows. Older children and Adults=rash on hands, neck, antecubital fossa and popliteal spaces(flexural folds). Rash starts with small vesicles that rupture,weeping
What is the management for Eczema? Topical steroids, systemic oral antihistmines and skin lubricants(Eucerin,Keri). Avoid drying skin(hot baths, harsh detergents, chemicals).
What is Contact Dermatitis? An inflammatory skin reaction due to contact from irritating external substance. Location=localized lesions to genralized rashes. Common offenders= poision ivy, nickle, latex. Can occur in miutes to hours.
What are the classic characteristics of Contact Dermatitis? Bright red and prurtic rash starts bullous or vesicluar= bright red moist, weepy , tender areas, then dried and crusty. Linear shape rash.
What is the management for Contact Dermatitis? Topicals steroids Wet compress to dry weeping lesions. Calamine lotions and oatmeal baths. For Severe rash= oral prednisone for 12 to 14 days then wean.
What is Candidiasis? Superficial skin rash from yeast, promote growth in warm and humidity. Associated with decreased immunity or diabetes. In infants= diaper rash or oral thrush.
What is Acute Cellulitis? An acute skin infection caused by gram positive bacteria(staphylococcus aureus and streptococcus pyogens).Points of Entry=skin breaks, insects bites, abrasions.
What are the classis characteristics of Acute Cellulitis? Acute onset= difussed pink to red skin. Deeper infection= RED STREAKS radiating from infected area under skin secondary of infections of the lymphatic.
What labs are ordered for Acute Cellulitis? If discharge present order culture and senitivity(C &S). If fever is present order CBC.
What is the management for Acute Cellulitis? Dicloxacillin PO TID x 10 days. or Cephalexin(Keflex) PO x 10 days(not active against beta lactamase resistant bacteria). Tetanus(TD) booster if < 5 years ago. PCN allergic=macrolide(erythromycin, cephalosporin, clindamycin or quinolones, levaquin>18y/
What are the complications of Acute Cellulitis? Osteomyelitis, tendon and facial extension and sepsis.
What is Erysipelas? A subtype of cellulitis involving deeper tissue involvement caused by beta strep.
What are the classic characteristics for Erysipelas? Complaints of acne or insect bite that become infected. Lesions are raised, indurated bright pink plaque with raised edged. Plaque located on cheeks or lower legs.
Dog and Cat Bites Infected with Pasteurella multocida. CAT BITES more likely to be infected than dog bites.
Bat, Racoon,or Skunk Bites Rule out rabies in addtions to antibiotics, call local health dept and CDC.
Treatment of Bites(human or animal) 1. Amoxicillin/clavulanic(Augmentin) PO x 10 days(PCN allergy, use clindamycin plus fluoroquinolone). 2.wound C&S if suspect infection. 3.DOnt suture infected wounds or puncture wounds. 4. Tetanus prophylaxis(if booster > 5 years, needs booster.
What bites may require rabies immunoglobin plus rabies vaccine if animal is rabid? dog,cat,bat,racoon and skunk
When should you follow up on a bite? 12 to 24 hours after treatment
What is Hidradentis Suppurativa? A bacterial infection of the sebaceous glands of axilla or groin. can be one or both axilla. can leave sinus tract and heavy scarring if chronic.
What the classic characteristics of Hidradentis Suppurativa? c/o painful red nodules and pustules under one or both arms. Some lumps drain pus.
What are the objective findings of Hidradentis Suppurativa? affected axilla=large dark red pustules, rupture draining green purlent discharge(pus).
What labs are ordered for Hidradentis Suppurativa? A C&S of purlent drainage.
What is the management for Hidradentis Suppurativa? Augmentin PO BID or Dicloxacillin TID x 10 days. NO underarm deoderant. Muciprocin ointment to lower third nares and under fingernails BID x 2 wks to eliminate source of infection.
What is Impetigo? Acute bacterial superficial skin infection caused by gram positive bacteria. Very contagious and puritic.
What are the two types of Impetigo? bullous and nonbullous; common in children adn during warm and humid weather.
What are the classic characteritcis of Impetigo? Honey colored crust, fragile bulla.
What labs are ordered for Impetigo? C&S of skin lesions.
What is the management of Impetigo? Cephalexin(Keflex) QID, Dicloxacillin QID x 10 days. IF PCN allergic= Azithromycin 250mg x 5 days(macrolide) or Clindamycin x 10 days. Topical 2% Muciprocin oint(Bacitracin) x 10days. Frequent handwashing, hygiene to remove crust.
What is Meningococcemia? Life threanting infection caused by Neisseria meningitidis(gram negative), spread by respiratory droplets.
Who is more at risk for meningococcemia? college students living in dorms, needs to be treated early.
What are the classic signs of meningococcemia? PURPLE -colored painful skin lesions all over the body. sudden high fever, head ache and stiff neck, possible N&V
What are the prophypaxis for Meningococcemia? 1.Oral Antibiotic Rifampin 2.meningococcal vaccination per CDC if live in dorms.
What labs are order for Meningococcemia? 1.Lumbar puncture=CSF 2.Blood Cultures, throat cultures 3.CT or MRI of brain.
What is the management for Meningococcemia? 1.systemic pcn x 10days; ceftriaxone(Rocephin)x 5days if pcn allergic. 2.Hospital: high dose antibiotic and isolation precautions.
What are the complications for Meningococcemia? 1.tissue infarction and necrosis(toes,fingers, foot)= amputations. 2.death.
What is Early Lyme Disease? Erythrema Migrans; a skin lesion caused by a bite of ixodes TICK infected with Borrelia Burgdoferi. Untreated= systemic effect of organs.
What the the classic signs of Early Lyme round lesions with red target like expand and grow in size. Appear 3 to 30 days after bite, spontaneously resolve within a few weeks
What labs are ordered for Early Lyme Disease? Serum antibody titers immunoglobulin(IGM= early IgG- later.
What is the management for Early Lyme Disease? Doxycline BID or tetracyclinex 14days (amoxicillin if preganant).
What are the complications for Early Lyme Disease? Guillain-Barre syndrome, migratory arthritis, chronic fatigue
What is Rocky Mountain Spotted Fever? caused by a tick that is infected with Rickettisia rikettsii.High mortality rate if untreated.
What ar the classic signs of Rocky Mountain Spotted Fever? Round red rash with petechiae, maculopapular, headache and fever. 1. begin with high fever,myalgia and severe HA. 2.By day 2-3= petechial rash start on wrist-ankles-soles and palms, spread centrally. 2.
What labs that are ordered for RMSF? CBC with white cell count, liver funtion test, CSF,antibody titers,skin biopsy of lesion.
What is the managment for Rocky Mountain Spotted Fever? 1.REPORTABLE DISEASE 2.Doxycycline BID or Tetracycline four times daily x 21 days.
What is the complication of Rocky Moutain Spotted Fever? Death
What is Herpes Zoster(Shingles)? A reactivation of varicella zoster virus. Elderly and immunocompromised are at higher risk for shingle breakouts and postherpectic neuralgia.
What are the classic signs or Shingles? 1. group of small vesicles on a red base>rupture>crusty. ON ONE SIDE OF BODY. 2.c/o severe pain , itching or buring sensation at site of breakout.
What labs to order for shingles? Serum antibody titers IgM and IgG if not sure of diagnosis.
What is the management for shingles? Acyclovir(Zovirax) 5x a day or Valacyclovir(Valtrex) BID x 10days for intial breakout and 7 days for flare-ups.
What are the complications for shingles? Postheretic neuralgia>treat with tricyclic antidepressans(low dose amittriptyline(elavil) or anticonvulsant(depakote) at bedtime. Infection can cause corneal blindenss if on cranial nerveV(trigemnial). REFER TO OPTHALMOLOGIST OR ER.
What is Pityriasis Rosea? cause unknown.
What are the characteristics of Pityriasis Rosea? 1. c/o oval lesions with fine scales following skin lines(clevage lines). 2. on the trunk CHRISTMAS TREE pattern of papulosquamous lesions. 3. HERALDS PATCH= 1st lesion to appear and largest in size, appears 2 wks before full outbreak.
What is the management of Pityriasis Rosea? 1. NO Medications 2. lesions resolve about 4 wks 3. I high risk sexually active adolescents or adult= check rapid plasma reagin(RPR)= r/o secondary syphilis.
What is Scabies? infestation of skin by sacroptes scabiei mite; female mite burrows under skin and lay eggs. TRANSMITTED BY CLOSE CONTACT.
What is the classic signs of scabies? very pruritic, especally at night, in interdigital webs, axilla, buttocks, waist and penis.Other family menbers may have the same symptoms.
What is the objective findings of scabies? 1.rash appears as serpiginous(snakelike) or linear burrows. 2.papular, vesicular or crusted. 3.higher incidence in crowded conditions and homeless.
What labs are ordered for scabies? Scarpe burrow or scales with glass slide, use cover slip. look for mites or eggs.
What is the management for scabies? 1. Permethrin 5%(Elimite): appy cream to entire body and head; wash off after 8-14 hours. 2. Treat entire household, wash clothes and linen in hot water. 3. Kwell= not used neurotoxcity.
What is Tinea Infections(Dermatophytes)? An infection of superficial keratinized tissue(skin, by yeast.
What labs are ordered for Tinea Infections? KOH slide of scales, hair and nails; fungal cultures.
What is management for Tinea Infections? 1. Topical azoles:OTC clotrimazole,microconazole 2.systemic oral topical antifungal;diflucan weekly for 6mths. antifungals drug interaction(warfarin,anticonvulsants. Hepatoxic.
What is Tinea captis(scalp)? common in black kids,patchy alopecia with balck dots(broken hair shaft) Fine scales on scalp,itchy scalp.
What is the management of Tinea Captis? Treat only with oral systemic antifungals (griseofulvin(Fulvicin) for several wks.
What are complications for Tinea Captis? Kerion; inflammatory lesion, permanent damage to hair follicles; causing patch alopecia.
What is Tinea Pedis(athlete's foot)? Two types scaly and dry form or moist type(strong odor). Moist lesions between toe webs, white with strong unpleasant odor. Dry type fine scale only.
What is Tinea Corporis or Tinea Circinata(ringworm)? ringlike puritic rashes with fine scales that slowly enlarge; treated with antifungals.
what is Tinea Cruris(jock itch)? perineal and groin area with pruritic red rashes with fine scales.
What is Tinea Manuum(hands)? prutitic round rashes with fine scales on hands; usally infected from chronic scratching of foot infected with athletes foot.
What is Tinea Barbae(beard area)? beard affected,scaling with pruritic red rashes.
What is Onychomycosis(nails)? nails become yellow,thicked and opaque with debris; great toe common location. Need fungal cultures
What is the management of Onnychomycosis? Oral Itraconazole or terbinafine(Lamisil) for several wks. Mild cases; Ciclopirox 8% topical solution(penlac) nail lacquer.
What is Acne Vulgaris(common acne)? inflammation and infection of the sebaceous glands;highest incidence in puberty and adolescent; on face, shoulders, chest and back.
What is mild Acne? Open comedones(blackheads), close comedones wiht papules; use topical only retin A(photosensitvity).
What is Moderate Acne? same as mild plus large numbers fo papules and pustles; treat with topicals+ oral tetracycline or minocycline(Minocin). **Tetracycline cause permanent discoloratio fo growing enamel tooth. DON'T GIVE TO PATIENTS UNDER AGE 18. DECREASE ORAL CONTRACEPTIVE.
What is Severe Cystic Acne? All signs of moderate + painful indurated nodules adn cysts over face, shoulders and chest.
What is the management for Severe Cystic Acne? Accutane= category X drug extremely teratogenic 1.prescribed by MD only 2.sign special consent 3.females must use two forms of contraception and show two negative pregnacny test before startiing drug. 4.prescribe 1 mth supply only
What is Rosacea(Acne Rosacea)? cause unknown; c/o chronic small acnelike papules and pustules that erupt around nose, mouth and chin; exacerbated; seen in adults to elderly wiht Celtic background.
What is the management for Rosacea? Metronidazole gel and or oral tetracycline for several months.
What are the complications for Rosacea? Rhinophyma: hyperplasia of tissue at the tip of the nose from chronic severe disease.
What is Cheilosis? Skin fissures,cracks at corner of mouth; causes: iron deficiency anemia, bacterial infection, vitamin deficents.; treated with triple antibiotic ointment BID to TID until healed.
First degree burn(superficial thickness) Erythema only(no blisters); cleanse with mild soap, water or saline. Cold packs for 24-48 hrs; topical OTC anesthetics>benzocaine.
Second degree burn(partial thickness) Red skin with superficial blisters,painful; clean with saline, don't rupture blisters; treat with silver sulfadiazne cream(Slivadene)+ apply dressing.
Third degree burn(full thickness) Painless, entire skin layer, soft tissue is destroyed; medicate for pain before daily debridement; treat with Silvadne. REFER= FACIAL, ELECTRICAL, THIRD DEGREE BURNS, CARTILAGINOUS AREA(DOES NOT REGENERATE) AND BURNS OVER 10% OF BODY.
What is scarlet fever? "Sandpaper" rash with sore throat(strep throat)
What is a symptom in Measles? Koplik's spots
What is Stevens-Johnson Syndrome? Severe vesicular to bullous lesions all over teh body; range fron hives to blisters and hemorrhagic lesions; mucosal involvement. ** hx of recent antibiotic tx with sulfa, pcn or phenytoin.
What is Erythema Multiforme? milder form of Stevens-Johnson Syndrome; pink, targetlike lesions, wheals,blisters.NO mucosal involvement; HX antibiotic use and other drugs.
What is Melanoma? Dark colored moles with uneven texture,mixed colors, irregular borders. located anywhere on the body including retina' higher incidence with family hx of melanoma.
Created by: gmcghee
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