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Derm Systemic 3
Derm
| Question | Answer |
|---|---|
| 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:
Abarnard
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