[DERMA] ERYTHEMATOUS LESIONS 2 (NON-SCALY PAPULES and NODULES)

Acute, round, tender, circumscribed, perifollicular staphylococcal nodule

Furuncle

Ends in central suppuration

Furuncle

Two or more confluent furuncles with separate heads

Carbuncle

Several separate furuncles

Furunculosis

Only lesion with one head and has multiple furuncles

Furunculosis

Enumerate sites of predilection of Furuncles

• NAB

  • Nape

  • Axilla

  • Buttocks

Where do furuncles begin?

Hair follicles

Why do furuncles continue for a prolonged period of time?

Due to auto-inoculation

Nodule with central suppuration

Furuncles and Carbuncles

2 practices or ways to control furunculosis

• Handwashing

• Chlohexidine

Differentials for furuncles

Acne conglobata and severe cystic or nodular cystic acne vulgaris

True or False. Incise the furuncle when acutely inflamed

False. Administer warm compress and oral antibiotics

Antibiotic of choice for first time condition of furuncles

1st Gen Cephalosporins and Penicillinase-resistant penicillin

Antibiotic of choice for MRSA and Vancomycin resistant strains causing furuncles

• TMP-SMX

• Clinda

• Doxy and Minocycline

Ointment to anterior nares

Mupirocin

Indications for oral antibiotics in furuncles (Give 6)

• High Fever

• Lesion more than 5

• Lesion in critical region

• Lesion diff to drain

• Multiple

• Persistent even after drainage

Management of choice for furuncles or boils

Incision and Drainage

Critical area to perform Incision and Drainage in furuncles

Cavernous sinus

Chronic inflammatory disease of the pilosebaceous follicles

Acne vulgaris

Primary lesion of acne

Comedo

True or False. For light skinned patients with acne vulgaris, lesions become macular hyperpigmented

False.

Macular hyperpigmentation: dark skinned

Reddish-purple macule: light skinned

True or False. Acne scars are homogenous

False. Heterogenous

True or False. Neonatal acne have male predominance

True

Treatment for Acne vulgaris

• Topical benzoyl peroxide

• Erythromycin

• Retinoids

Principal abnormality of acne vulgaris

Comedo formation

Key hormone in the pathogenesis of acne vulgaris

Androgen

Screening tests to exclude virilizing tumor

DHEAS Levels

Caused by infantile production of androgens and usually wanes at 6-12 months

Acne neonatorum

Acne Treatment: first line for mild comedonal acne

Topical retinoid ± physical extraction

Second line: retinoid, benzoyl peroxide, salicylic acid, azelaic acid

Acne Treatment: first line for mild papular or pustular acne

First line: Benzoyl peroxide

If truncal lesions: Topical antimicrobial combination + topical retinoid, benzoyl peroxide wash

Acne Treatment: first line for moderate papular or pusutlar for men

First line: Oral antibiotic + benzoyl peroxide + topical retinoid

Acne Treatment: first line for moderate papular or pustular for women

First line: Topical retinoid ± Benzoyl peroxide + spironolactone and/or oral contraceptive

Acne Treatment: first line for severe nodular conglobate in acne

Isoretinoin

Oral antibiotic + topical retinoid + benzoyl peroxide

How many weeks is the recommended use of topical treatment for acne vulgaris?

8-12 weeks

Topical retinoid that is retinoid like compound with lower concentrations of tretinoin

Adapalene

Topical retinoid that is relatively irritating and helps lighten post-inflammatory hyperpigmentation

Tazarotene

Treatment for acne that is most effective for inflammatory acne

Benzoyl peroxide

Adverse effects of dapsone

Hemolytic anemia

Skin discoloration

What is used concomitantly with dapsone to increase its systemic absorption?

Treatment for acne: Mildly effective in both acne and rosacea

Azelaic acid

Drug that induces the potential for development of pseudomembrane colitis

Clindamycin

Drug that result o

Drug that is effective in severe cystic acne and AC

Corticosteroid

Acne treatment for severe cystic acne only

Isoretinoin oral retinoid therapy

Acne treatment: Severe resistant acne

Tumor necrosis inhibitors: Adalimumab, Etanercept, Infliximab

Difference between acne and rosacea

Acne: has comedone

Rosacea: no comedone

Prominent complication of acne vulgaris

Scarring

Small, firm, papules from long standing acne vulgaris

Osteoma cutis

Treatment for oestoma cutis

Corticosteroid and isoretinoin

Occlusion of eccrine glands

Miliaria

Miliaria is induced by

Staphylococcus epidermidis

Most superficial category of miliaria

Miliaria crystallina

Where do miliaria crystallina appear?

Bedridden patients

Bundled children

Medications for miliaria crystallina

Isoretinoin

Bethanechol

Doxorubicin

Prototype of non-scaly papules

Miliaria rubra (Prickly heat)

Site of injury and sweat escape in miliaria rubra

Prickle cell layer

Treatment for miliaria rubra

Corticosteroids for 1-2 weeks to decrease inflammation

Occlusion in the upper dermis

Miliaria Profunda

Non-pruritic, flesh-colored, deep-seated whitish papules

Miliaria profunda

Results from occlusion of sweat ducts and pores

Postmiliarial hypohidrosis

Rare form of miliaria

Tropical anhidrotic asthenia

Most effective treatment for miliaria

Cool environment

Multiple erythematous pruritic red papules with a central punctum and swelling over exposed areas of the body

Insect bites

Has a characteristic breakfast, lunch, dinner lesion forming linear distribution

Crawling insects

Common caterpillar that are dangerous to the eyes

European processionary caterpillar

Irritation through contact with caterpillar hairs with skin and egg covers and cocoons with stinging hairs

Caterpillar dermatitis

Also known as bed bugs

Cimicosis

Mimic urticaria

Bed bugs

Cimex species: Temperate regions and smaller

Cimex lectularius

Cimex hemipterus: tropical and longer

Also known as kissing bugs, assassin bugs, or conenose bugs

Reduviid bites

Cause of reduviid bites

Poor housing conditions

True or False. Bite of the reduviid is painless

True

Vector of onchocerciasis

Simuliidae (Black fly)

Transmits African trypanosomiasis

Tsetse fly

Area of predilection: Ked itch

Hips and abdomen

Infestation of human tissue by fly larvae

Myiasis

Itching pink papule with tortuous line extending 1-30 cm a day

Myiasis

Part of serum sickness

• Fever

• Urticaria

• Joint pain

Contents of Bee venom

• Histamine

• Hyaluronidase

• HMW

• Melittin

Has a zigzag pattern

Flea bites / Pulicosis

Infestation of Lice

Pediculosis

Nits are most common in what region

Retroauricular region

Differentiating factor of scabies from pediculosis corporis

Pediculosis affects entire body except hands and feet

Scabies: affects hands and feet

Blue or slate-colored macules located on the sides of the trunk and inner aspects of the thigh

Maculae cerulae

Oval, ventrally flattened mite with dorsal spines

Scabies

Primary lesion of scabies

Papulovesicular lesion

Area of predilection of Scabies

Circle of Hebra

• Axilla

• Elbow flexures

• Wrists and hands

• Crotch

Has burrows

Scabies

Classic clinical feature of scabies

Pruritus and worse at night

Type of scabies that persist in the scrotum, pelvis, vulva, axillary folds

Nodular scabies

Norwegian or hyperkeratotic scabies

Crusted Scabies

Difference of crusted scabies from classic scabies

Crusted scabies: has minimal pruritus

Most effective medication for scabies

Permethrin

Management for crusted type of scabies

Ivermectin and Topical Agent