Derm
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| chronic skin disorder associated with celiac disease | dermatitis herpetiformis
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| physiology of dermatitis herpetiformis | IgA deposits in the skin, these are antibodies made in response to glutens
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| Symmetric, pruritic erythematous papules/plaques studded with vesicles (on extensor surfaces of elbows / knees; buttocks, scapular areas, scalp) = | dermatitis herpetiformis
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| physiology of dermatitis herpetiformis | IgA deposits in the skin; Ab response to glutens; assoc w/ celiac dz
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| dermatitis herpetiformis classic lesions | erythematous papules/plaques w/vesicles (usu on extensor of elbows, knees, buttocks, scapula, scalp); symmetric and intensely pruritic
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| Pitting edema (dependant, improves overnight), varicose veins, stasis dermatitis, hyperpigmentation (mottled blue, purple), skin fibrosis, venous ulcers = | venous insufficiency
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| Occurs on lower legs, ankles (+/- pitting edema). Erythematous papules, scale, erosions, excoriations = | stasis dermatitis
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| often mistaken for cellulitis | stasis dermatitis
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| treatment for stasis dermatitis | compression, oral antibiotics, topical steroids
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| 1/3 of patients with venous insufficiency will develop __ | venous ulcers
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| venous ulcers are usually located __ | above medial malleolus
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| 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)
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| __ is always present with venous ulcers | bacterial superinfection
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| chronic multisystem granulomatous disease (more common in AA females) | sarcoidosis
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| with sarcoidosis skin involvement occures in __% of patients | 25
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| most common lesions of sarcoidosis | macules/papules-brown yellow or purple, occur mostly on face, extremities
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| 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
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| classic sarcoid lesion, infiltrating violaceous plaque, occurs on nose, cheeks, ears, lips | lupus pernio
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| lesions tend to occur on old scars (tattoos) | sarcoid
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| 3rd most common form of drug reaction (often 2/2 PCN, sulfonamide, phenobarbital, hydantoins) = | erythema multiforme
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| mild erythema multiforme | no bullae, lesions on upper extremities, face
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| major/severe erythema multiforme | one or more mucous membranes involved, epidermal detachment of <10% of total body surface area
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| erythema multiforme classic lesions | Macule => papule with vesicle or bulla in center [target (or iris) lesion]; on hands, forearms, feet, face, usually symmetric
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| treatment for mild erythema multiforme | symptomatic analgesics, topical steroids
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| treatment for major erythema multiforme | often associated with drugs. discontinue the offending agent
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| erythema multiforme etiology | drugs (PCN, sulfonamides, phenytoin, allopurinol); infxn (HSV, mycoplasma); 50% idiopathic
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| considered dermatologic emergencies | Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis
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| Widespread bullae on trunk, face, and mucous membrane; involvement with epidermal detachments = | Steven-Jonhnson Syndrome, Toxic Epidermal Necrolysis
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| treatment for Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis | medical emergency, monitor fluid/electrolytes, systemic steroids
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| 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)
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| 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
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| Procainamide, hydralazine & rash | Lupus-type eruptions
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| Photosensitive rash may be due to which drugs: | TCN, Sulfa drugs
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| 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
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| 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
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| HSV presentation: | 24h prodrome (itching, burning); painful vesicles on erythematous base
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| HSV tx | Acyclocir 5% ointment (6x/day x7d) vs pencyclovir cream 1% Q2h. Extensive genital erosions: silver nitrate vs burrow's
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| Varicella zoster tx | Antivirals (acyclovir, valacyclovir, famciclovir; foscarnet for resistant VZV)
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