Integumentary High-Yield Clinical Sciences Flashcards

Clinical Sciences, Sourced from emma_dip on Quizlet

What is albinism? symptoms, diagnosis

-congential recessive

-mutation in any enzyme needed or produce melanin or in proteins responsible for transport (ex. tyrosine or melanosomes)

Symptoms

-little or no colour in hair, eyes and skin

-eyes: light blue or translucent (look light blue or red), causes vision problems (focusing, depth perception, nystagmus, amblyopia - lazy eye)

-skin: can cause freckles, moles, lentigines and an icnreased risk of skin cancer

Diagnosis

-via clinical observations

-skin biopsy or hair bulb extraction showing decreased melanin

-definitive with genetic testing

What condition is albinsim related to?

Chediak higashi

What is pemphigus?

-autoimmune disease

-epidermal cells and mucous membranes attacked

-antibodies against desmogleins (bind skin cells)

-skin becomes fragile and fluid can collect between its layers which forms blisters

2 main types:

Pemphigus vulgaris

-m/c in US

-blisters in mouth, other mucosal surfaces, and skin

-develop within a deep layer of the epidermis

-often painful

*subtype of the disease called pemphigus vegetans = blisters form mainly in the groin and under the arms.

Pemphigus foliaceus

-less common

-only affects the skin

-blisters form in upper layers of the epidermis and may be itchy or painful

What causes ehlers danlos syndrome?

-defective collagen synthesis

-results in stretchy skin, easy bruising and flexible joints

1. Gene mutation

-in any gene that codes for collagen type (type of collagen affected determines type of EDS)

2. Protein mutation

-in TNXB which causes a defect in tenascin x protein which regulates production and assembly of certain collagen types, also controls flexibility

-results in classical like EDS

3. Enzyme mutation

-actaully in gene that codes for enzyme that assists in synthesis of collagen

Describe the 5 types of ehlers danlos

1. Classical (cEDS)

-mutation in COL5A1 and COL5A2 (codes for collagen type 5)

-autosomal dominant

-results in stretchy skin, easy bruising and flexible joints

2. Vascular (vEDS)

-mutation in COL31A (codes for type 3 collagen)

-weakens blood vessels

3. Classical Like (clEDS)

-defect in tenascin x protein

-hyperflexible joints

4. Kyphoscoliotic (ksEDS)

-defect in gene that codes for lysyl hydrolyase that assists in synthesis of collagen

-autosomal recessive

-classic symptoms plus early kyphoscoliosis

5. Musculocontractural (mcEDS)

-mutation that blocks proteolytic processing

-autosomal recessive

-classic symptoms plus scoliosis, slender features

What is epidermolysis bullosa? causes, symptoms

-inhereted

Causes

-decreased or dysfunctional hemidesmosomes (hold epidermis to dermis)

-keratin also lack mechanical stiffness (causing proteolysis, cellular stress, and cytolysis)

Symptoms

-fragile (thin and painful) skin and mucous membranes that blister easily

-minor mechanical friction results in blisters and wounds

-sx usually start in childhood (sometimes in adults)

-lesions often in high friction areas

-lesions can occur on internal tissues like GI

-lesions start as blisters -> erosions -> ulcers -> crusts -> scar

-damage can cause muscles and tendons to harden and shorten

-can also cause joint contractures and deformities

-can also have nail defects or no nails

-tooth decay and alopecia common

*increased risk of skin cancer

How is epidermolysis bullosa diagnosed? treated?

Diagnosis

-history, PE

-skin biopsy = immunofluorescense to see if decrease or missing hemidesmosomes // electron microscopy to identify structural defects

-genetic testing

Treatment

-no cure

-prevention by keeping skin cool and moist

-treat complications = wound care to prevent infections

-surgery to correct deformities if needed

What is alopecia areata?

-autoimmune -> attacks hair follicle

Risk factors

-AI = celiac, T1DM, RA

-family history

Symptoms

-patchy hair loss (usually circular or oval) on scalp

-rarely can affect hair on whole body

-amount of hair loss varies person to person

-thinning hair + hair loss

-may itch or burn

-white spots, thin, splitting and/or rough nails

Diagnosis

-scalp biopsy

-presentation

-bloodwork

What is bullous pemphigoid? causes, symptoms, testing, treatment

-m/c 60-80yo

-autoimmune

-likely result of genetics + meds - furosamide, captopril, penicillamine, NSAIDs, abx)

Causes

-IgG abs against dermal-epidermal basement membrane proteins (hemidesmosomes)

-Fab region on ab binds to dystonin (BPAG1) and type 17 collagen (BPAG2) on hemidesmosome and activates complement

-type 2 hypersensitivity

Symptoms

-pruritis, tense, subepidermal bullae formed when basement membrane splits from hemidesmosome (dermis and epidermis separate)

-Bullous pemphigoiD = Deep

-negative nikolskys sign = no bullae form when lateral pressure applied (dif than p. vulgaris which ruptures easy)

-often in flexors of forearms, axillar, med thighs, groin, abdo (often spares oral mucosa)

Testing

-immunofluorescense = linear deposition of IgG and C3 along basement membrane

-IgG anti basement membrane detectable in serum

-biopsy shows ab and complement

Treatment

-systemic corticosteriods

-topical steroids

-stop offending meds

What is psoriasis? causes, symptoms, diagnosis, treatment

-strong HLA association

-1-3% of world pop

-onset during adolescence or >60yrs

Causes

-excessive inflammation after immune response (following strep pharyngitis, HIV) causes chronic skin damage

-blood vessels dilate in dermis bringing more immune cells in

-neutrophils collect in stratum corneum

-keratinocyte production increases -> dont stick together properly and easily break

-results in thin basal layer and thicker rest of epiderm

-cell growth > sloughing off

-can also be caused by scratching the skin (keobners) or drugs like lithium, NSAIDs, alc or beta blockers

Symptoms

-well demarcated, flat, elevated erythematous papules that are salmon coloured

-plaques with silvery white scales (acanthosis)

-rash common in areas of trauma (elbows, knees, lower back)

-positive auspitz sign (pin point bleeding under scales)

-nail pitting

-may itch

* symptoms vary depending on type of psoriasis (plaque, gluttate, inverse, pustular, erythrodermic)*

Diagnosis

-biopsy

Treatment

-natural sunlight, UVB

-avoid offending drugs

-potent corticosteriods

-retinoids

-systemic treatment -> methotrexate, cyclosporine

-moisurizers and emollients

What is pemphigus vulgaris? causes, symptoms, testing, treatment

-40-60yo; m/c in jewish, med, asian

-likely result of genetics + herpes or captopril or certain abx

Causes

-IgG against epidermal desmoglein-1 (epithelial) AND/OR -3 (epithelial and mucosal)

-IgG binding causes protease release = desmosome breakdown

-breakdown results in acantholysis = cells let go of each other and form INTRAEPIDERMAL bullae

-basal cells adhered to membrane but rest of epidermis separates -> TOMBSTONING

-type 2 hypersensitivity

Symptoms

-vesicles and bullae develop on oral mucosa (90%), scalp, face, chest, axillae, groin, umbillicus

-positive nikolskys sign = bulla formation with rubbing over skin

-pemphigus vulgariS = Superficial

-asboe-hansen sign = pressure applied to bulla causes lateral extension

Testing

-immunofluorescebce shows IgG and C3 deposition intraepidermally = fish net appearance

-serum anti-desmoglein IgG antibodies

-skin biopsy = tombstone appearance

Treatment

-corticosteriods

-may be fatal unless treated with immunosuppress (methotrexate, cyclosporine)

-rituximab (prevents ab production)

What is vitiligo? causes, symptoms, diagnosis, treatment

-pigmentation disorder causing hypo or depigmentation

Causes

-autoimmune destruction or loss of function of melanocytes (ranges from local to extensive)

-associated with other AI disorders

-likely result of genetics and enviro triggers

-can also develop after skin trauma (keobner)

Symptoms

-streaks of depigmented hair, possibly eyes

-sections of hypopigmentation over extensor surfaces and periorificial areas (mouth, eyes, genitalia)

-2 types:

1. non-segmental

-often on hands, forearms, feet, neck, scalp, face

-m/c; any age

-symmetrical (both sides of body) distribution over multiple body sites

3. segmental

-often on skin near dorsal spinal cord roots and face (esp near trigeminal)

-m/c in kids

-along single spinal nerve

Diagnosis

-r/o other AI conditions (thyroid, addisons, T1DM)

-woods lamp to detect lesions

Treatment

-sun avoidance and protection

-topical steriods

-narrow band UVB phototherapy

What is lichen planus? causes, symptoms, diagnosis, treatment

-AI, antigen unknown

-30-60yo; m/c women

-acute or chronic inflammation in mucous membranes (oral LP if only here) AND/OR skin (cutaneous LP) (usually both)

Causes

-healthy keratinocytes present ag's on MHC1 = killed by CD8 T cells

-release cytokines which attract more CD8 to the area

-causes damage to surrounding cells (stratum basale and dermis)

-causes melanocytes to release melanin = hyperpigmentation

-damage eventually reaches stratum granulosum keratinocytes and causes them to increase in numbers and size = hypergranulosis

-can also be triggered by medication (lichenoid reaction)

Symptoms

-commonly affects wrists, ankles, nails scalp, mouth, vulva, glans)

-lesions develop in areas of scratching (koebners phenomenon)

-fine whitish reticular network visible in oral musoca 50% of time

-increased risk of developing squamous cell carcinoma

-6 P's: Pruritic, Polygonal, Planar (flat topped), Purple, Papules, Plaques

Diagnosis

-skin scrape or biopsy showing sawtooth dermal-epidermal junction

Treatment

-topical corticosteriods

-immunosuppressants (cyclosporin, methotrexate)

-retinoids for lichen planus in mouth

-phytotherapy for resistant cases

What is lichen sclerosis? symptoms, diagnosis, treatment

-likely AI bc associated with thyroid issues, pernicious anemia, diabetes; actual cause unknown

-m/c postmenopausal ,women 40-60yo, prepubescent girls

Symptoms

-discoloured, thin, itchy skin with scaly patch

-scratching can form blisters and sores

-small, white, shiny, slightly raised spots

-often affects neck, chest, upper back, torso, wrists, mouth

-ulcers, sores, inflammation, scarring, cracking

-dysuria, dyspareunia, tight foreskin, phimosis, penile discharge

Diagnosis

-symptoms

-biopsy

Treatment

-topical corticosteriods

-phytotherapy

-immunosuppressants

-surgery if needed

What is a pressure ulcer? risks, symptoms, diagnosis, treatment

-blood flow diminishes to an area = pressure -> ischemia -> necrosis

-localized skin, underlying tissue injury caused by unrelieved pressure +/- friction, shearing forces

-m/c affects bony prominences like sacrum, hips, heels, ankles

Risks

-reduced mobility (d/t disease, nerve damage, altered consciousness, old age)

-reduced perfusion (atherosclerosis, periph vasc dx, hypotens, smoking)

-factors affecting skin structure (malnutrition, protein def, skin moisture)

-diabetes

Symptoms

-ulceration

-fever, foul odor

-may be painful

-complications if biofilm formation on wound, infection, sepsis, fistulas, gangrene, malignant transformation (rare)

Diagnosis

-swab culture to determine tx in healing resistant ulcers

Treatment

-topical sulfadiazine creame

-debridement of biofilm

-dressing replacement

-negative pressure therapy

Differentiate scorpion, bedbug, snake and spider bites

Scorpion

-usually not life threatening

-may tingle/burn in area

-can cause serious sx like impaired swallowing, breathing, seizures, hypertension, drooling, etc -> hospital

-non urgent = clean site, apply ice or cold, elevate area, use antihistamines or steriods

Bedbug

-small, itchy, inflamed spots with dark middle in a line or cluster

-m/c on face, neck, arms, hands

-prevent and eliminate

-hosp if severe rxn

Snake

-puncture marks, red, swelling, bruising, bleeding, N/V/D, severe pain, decreased vision, low bp, inc hr, dec breathing, numbness and tingling

-hospital asap incase poisonous

-remove rings, watches, etc before swelling starts

-mark areas of injury

-NO ice or pain killers

-cover with clean, dry dressing

Spider

-usually harmless except for few species

-if poisonous like black widow = dec breathing, itching skin rash, sweating, muscle cramps, N/V, inc saliva, headache, droopy/swollen eyes

-blister or bulls eye wound, swelling, ulcer over site

-hospital if severe

-diagnose based on skin sx unless know the spider (no test)

-antivenom, sedatives, muscle relaxants

what should be done in the case of skin trauma?

Refer to ER

-open = bone, muscle or subcutaneous fat exposed

-labs done to determine severity of injury (CBC, CMP, ABG, UA)

How are pressure ulcers staged?

1. Stage 1

-nonblanchable erythema

-skin intact, localized

2. Stage 2

-partial thickness dermis loss

-red wound, serum filled blister, no skin sloughing

3. Stage 3

-full thickness tissue loss

-visible subcutaneous fat

-raised wound edges

-skin sloughs

4. Stage 4

-full thickness tissue loss

-bone, muscle, tendon esposed

-raised wound edges

-skin sloughs/eschar formation (dead tissue that forms over healthy skin before falling off)

Unstageable: filled with sloughed skin, scabs, diagnosis difficult

Deep tissue injury: nonblanchable erythema, skin separation, no skin disruption

How are burn injuries graded?

1. Stage 1

-limited to epidermis

-mild erythema

2. Stage 2

-partial thickness with dermal involvement

-red, moist injuries with blisters

3. Stage 3

-full thickness, extends to subdermal soft tissues

-white/brown-black, dry, leathery apperance

4. Stage 4

-extends to bone

-dark like charred tissue

What needs to be looked out for in skin trauma?

-if injury circumferential around limb = limb at risk

-infection = fever, localized pain, edema, erythema, crepitus, warmth, fluid collection

-fournier gangrene = perianal, retroperitoneal lesion or UTIs can cause -> spreads to skin, soft tissue of external genitalia and perineum = massive ulcer and tissue death/necrosis

refer to hosp

What is stasis dermatitis/varicose eczema? How is it managed?

-decreased bloodflow to an area (unhealthy valves, venous reflux, DVT) resulting in skin inflammation

-lighter skin appears itchy, dry, flaky, scaly

-darker skin appears dark brown/grey

-m/c in legs but can spread

**can progress to ulcer

-if weepy or discharges = emergency

Management

-stay active, elevate leg

-compression socks

-keep skin moisturized

-steriod creams if bad itch

-refer to MD if needed

What is seborrheic dermatitis? symptoms, treatment

dandruff

-possibly associated with Malassezia spp. (yeast)

-common in infants and puberty

-inc incidence and severity in immunocomp

Symptoms

-adults = yellow-white flakes, pruritis on scalp and underlying erythema

-children = generalized with flexural and scalp involvement

-newborn = cradle cap

-m/c on scalp, eyebrown, eyelashes, beard, body folds, trunk, genitalia

Treatment

-selenium sulfide or zinc pyrithione shampoo (head and shoulders)

What is actinic keratosis? causes, symptoms, diagnosis, treatment

-m/c in fair skinned in areas with long term sun exposure

-40-60% in adults >40

-HPV, immunocomp and/or disorders that decreased DNA repair increase risk

Causes

-prolonged UV radiation exposure damages the keratinocytes

-characteristic UV induced mutations in TP53 gene and deletion of gene coding for p16 tumor suppressor protein

-precursor to squamous cell carcinoma (2-5% of cases)

Symptoms

-begin as small, rough spots of various colours (pearly, grey-white, pink, flesh toned, dark tan or some combo)

-hyperkeratotic, easier felt than seen

-feels like sandpaper

-3-20mm in size but can enlarge to several centimeters

-m/con face, back of neck, scalp if bald, lips, sun exposed limbs

-recurs if scraped off

Diagnosis

-biopsy if resistant to treatment

Treatment

-excision always recommended

-liquid nitrogen, electrodessication and curettage

-topical therapy with 5-fluorouracil cream for 2-3 weeks

-phytodynamic therapy

What is basal cell carcinoma? causes, symptoms, testing, treatment

-m/c malignancy in humans

-M>F; m/c in elderly

Causes

-chronic exposure to UVB light (so >80% on face)

-occurs in sun exposed areas like face, upper lip

-locally aggressive (tangential growth), rarely metastasizes

-arises from basal cell layer of epidermis and infiltrates the underlying dermis

-increased risk of reoccurance if >20mm or any size on head, neck, hands, feet, genitals; poorly defined; recurrent; micronodular, morpheaform, sclerosing, mixed infiltrative, etc

Symptoms

-usually presents with lesion that chanegs in size and colour or wont heal

-skin coloured papule or nodule with rolled, pearly, telangiectatic boarder and depressed/eroded/ulcerated centre

-sides of the crater have telangiectatic vessels

-late stages = large, fungating -> local invasion

Testing

-biopsy (shave if shallow, punch or excisional if deep) showing fibrosis, clefting, inc mitotic activity, peripheral palisading, ulceration or deep invasion

Treatment

-shave excision with curettage and electrodessication

-cryotherapy

-topical therapy with 5-fluorouracil cream to inc immune response

-radiation (esp w elderly)

**most are slow growing and dont metastasize

Describe the 3 main types of basal cell carcinoma

1. Nodular

-m/c subtype (60%)

-classic, raised, pearly or waxy with rolled edges

-may have central ulceration

2. Superficial

-2nd m/c

-red and scaly

-looks like squamous cell, eczema, psoriasis

3. Infiltrative

-flat, white, scar like

-most aggressive subtype

*many other rare forms

What condition can increase the risk of developing basal cell carcinoma?

Xeroderma pigmentosum

-rare, autosomal recessive

-decreases the ability of body to repair DNA damage

-increases risk for many cancers

Albinism can also inc risk for skin cancer

What is a dysplastic nevi?

atypical mole

-acquired proliferation of atypical melanocytes

-may be hereditary

-can turn into melanoma, but melanoma can arise denovo

-having lots increases risk of melanoma

-result of combo genetics + family history + environmental factors like UV light

-ABCDE exam and monitoring

What is the ABCDE exam for moles?

1. A = Asymmetry

-melanoma often asymmetrical

-non-cancerous typically uniform and symmetrical in shape

2. B = Border

-melanoma often has undefined or irregular boarders

-non-cancerous moles usually have smooth, well-defined borders

3. C = Color

-melanoma often more than one color or shade

-benign are typically one color

4. D = Diameter

-melanoma growths normally larger than 6mm in diameter

5. E = Evolution

-melanoma often changes over time (in size, shape, colour)

Sens = 92%, spec = 100%

What skin cancer type favours the upper lip?

Basal cell carcinoma

B higher in alphabet than S

What is formed via UV radiation and damages keratinocytes?

Pyrimidine dimers

-DNA usually repaired but can leave transcriptional errors and mutations

-if errors/mutations in proto-onco or tumor suppressor genes = risk of skin cancer

What is the #1 risk factor for skin cancer?

UV radiation exposure

What skin cancer type favours the lower lip?

Squamous cell carcinoma

S lower in alphabet than B

What is a keratoacanthoma?

an umbilicated skin nodule that mimics basal cell carcinoma but appears over a short period of weeks

-regresses spontaneously

What are the 4 major subtypes of melanoma?

1. Superficial spreading

-prolonged horizontal growth phase

-good prognosis

2. Nodular

-nodule or lump

-early vertical growth phase

-worst prognosis

3. Lentigo maligna

-slow and lentiginous horizontal growth

-good prognosis

4. Acral lentiginous

-palms, soles, nailbeds

-darker skinned individuals

What is melanoma? causes, symptoms, diagnosis, treatment

-malignant tumor of melanocytes with an increased risk of metastasis

-leading cause of death d/t skin cancer

-median age diagnosis = 53

-m/c site = back in males, calves in females

Causes

-malignant neoplasm of melanocytes and nevus cells (pigment forming)

-mutation in BRAF V600E gene (codes for BRAF kinase) = proto-onco gene = uncontrolled growth signals

-mutation in CDKN2A tumor suppressor gene

Symptoms

-often asymmetrical with undefined or irregular boarders

-often more than one color or shade

-normally larger than 6mm in diameter

-often changes over time (in size, shape, colour)

-ABCDE mnemonic

-4 subtypes

Diagnosis

-excision biposy (including surrounding normal tissue, full depth of dermis) stains positive for S100

-tumor usually deeper than anticipated

Treatment

-excisional biopsy to remove (include surrounding normal tissue and full depth of dermis to prevent regression)

-chemotherapeutic, gene therapies, vaccines in metastatic

-radiotherapy as adjunct

-vemurafenib if BRAF mutation

Describe the risk factors and growth of melanoma

Risk factors

-numerous moles, family history, use of tanning booths

-blue eyes, fair/red hair, pale complexion, freckles, inc incidence of sunburn

Growth

-initial = radial, melanocytes proliferate within epidermis (low risk metastasis)

-secondary = vertical growth phase, malignant cells penetrate underlying reticular dermis (inc risk of metastasis)

*Breslows thickness (thickness of lesion) = most important prognostic factor for predicting metastasis*

What is squamous cell carcinoma? risks, symptoms, treatment

-primarily in elderly on sun exposed skin

Risks

-chronic sun exposure

-actinic keratosis

-arsenic exposure

-m/c complication during immunosuppressive therapy

-M>F

Symptoms

-usually present with chronic, non healing wound or abnormal growth

-indurated erythematous nodule/plaque with surface scale/crust +/- ulceration

-70% on head (forehead, scalp) and neck

-favours lower lip

-also often on external ear, periauricular region

*more rapid enlargement than BCC*

Treatment

-surgical excision (+ biopsy to diagnose)

-Mohs surgery (thin layers of cancer containing skin progressively removed and examined until only cancer free tissue remains)

-lifelong follow up bc more aggressive than BCC

*Bowen disease - SCC in situ*

What is merkel cell carcinoma? causes, symptoms, diagnosis, treatment

-rare and aggressive type of skin cancer

-merkel cells are neuroendocrine cells with nervous and endocrine system function (sit near nerve endings)

Causes

-develops in merkel cells in epidermis

-spreads quickly and commonly reoccurs

-inc risk with UV radiation exposure

-8/10 people have merkel cell polyomavirus (but most people with mcp dont develop merkel cell carcinoma)

Symptoms

-shiny or pearly lump on area of skin that commonly gets sun exposure (face, neck, arms, eyelids; can occur on legs or torso too)

-lump commonly size of dime

-dome shaped, raised

-firm, itchy, skin coloured or red, pruple, bluish-red

-tender or sore

-similar to pimple or insect bite

-commonly spreads to lymph nodes first

Diagnosis

-biopsy

Treatment

-Mohs surgery (thin layers of cancer containing skin progressively removed and examined until only cancer free tissue remains)

-wide local excision

-lymph node dissection

-chemo, radiation, immunotherapy if needed

What is an acrochordon? symptoms, treatment

-skin tag

-often in middle age or elderly

-typically in obese; F > M

Symptoms

-benign outgrowth of skin

-forms in areas where skin forms crease (eyelids, neck, axillae, groin)

-fibroepithelial polyp

-ranges from 1-10mm in size

-generally harmless and painless

-dont grow or change over time

Treatment

-removal by excision, electodessication or cryosurgery

What is a benign melanocytic nevus (nevocellular nevus)?

-benign neoplasms of melanocytes in contact with each other

-form small collections of cells known as nests

-commonly form during early childhood

-formation may be result of UV exposure

-very small percentage develop into melanoma

What is lichenification?

-thick, leathery skin with a bark like appearance

-usually result of constant scratching and rubbing

-with prolonged rubbing, epidermis hypertrophies resulting in thickening of skin and exaggeration of normal skin markings

-common consequence of atopic dermatitis and other pruritic disorders

What are sebaceous cysts? symptoms, treatment

-derived from epidermis of hair follicle that becomes filled with keratin and lipid debris

Symptoms

-round, yellow coloured

-mobile, slow growing

-firm and fluctuant nodule

-may rupture and produce a foul cheesy odor with creamy colour consistency

Treatment

-none

-surgical excision if infected

What is a lipoma? symptoms, diagnosis, treatment

-benign, fatty, soft tissue tumors that are slow growing

-lobulated masses enclosed by thin, fibrous capsule

-occur in 1% in population

-m/c in females than males

-being overweight does not increase risk

Symptoms

-rarely symptomatic

-no overall health impact

-small (1-3cm)

-felt just under skin

-moveable, painless

-soft, rubbery consistency

-remain same size or grow very slowly

-m/c on trunk and extremities but can be anywhere

Diagnosis

-clinical

-biopsy if atypical (painful, rapid growth, firm)

Treatment

-surgical removal if problematic

What is a xanthalasma? risk factors, symptoms, causes, diagnosis, treatment

-harmless, yellow growth that appears on or by the corners of your eyelids next to your nose

-formed by cholesterol deposits under skin

-can be sign of another condition (diabetes, hyperlipidemia, thyroid issues)

Risk factors

-overweight, smokers

-high cholesterol, diabetes

-high bp

-family history

**increases risk for heart disease, heart attack, atherosclerosis, high cholesterol

Symptoms

-yellow skin around eyes

-appearance varies, can be flat, bumpy, soft, firm

-may be uncomfortable

Causes

-high cholesterol (can be familial)

-diabetes

-weight gain

-thyroid issues (hypo)

-inflammation

-drinking too much alcohol

Diagnosis

-clinical

-bloodwork showing high cholesterol

Treatment

-doesnt go away on its own

-liquid nitrogen

-reduce cholesterol levels

What is seborrheic keratosis?

-m/c benign tumor in older individuals

Symptoms

-has 'stuck on' appearance

-initially = sharply defined, light brown flat macules

-evolves into uneven warty surface with waxy papule appearance

-colour can vary fom bown to dark brown or black

-slow enlargement with increasing thickness and pigmentation

-m/c on face, trunk, upper extremities (can occur anywhere except for palms or soles)

Diagnosis

-biopsy needed if diagnosis uncertain

Treatment

-none

-curettage or liquid nitrogen if needed

What is acanthosis nigricans? What should patients who present with this be screened for?

A brown to black, poorly defined, velvety hyperpigmentation of the skin

-m/c in fexural skin (neck, armpits, skin folds)

-associated with DM, obesity and other endocrine disorders and malignancy

-cutaneous marker of tissue insulin resistance

-must screen pt for diabetes

What is allergic contact dermatitis? symptoms, treatment

-type 4 hypersensitivity (cell mediated, delayed)

-ex. poison ivy, other allergens

Symptoms

-erythema with papulovesicular eruption

-swelling and pruritus

Treatment

-avoid allergen

-topical or oral steriods

What is irritant contact dermatitis? symptoms, treatment

-skin reaction to irritant

-non immune mediated

-ex. laundrydetergent, soap, acid/alkaline solvents, alcohols, oils

Symptoms

-erythema, dryness, burning, oozing

-acute: quick reaction with sharp margins (ex. acid/alkaline burns)

-chronic: slow to appear, poorly defined margins

Treatment

-avoid allergen

-topical or oral steriods

What is acne vulgaris? symptoms, treatment

-chronic inflammation of pilosebaceous glands

-usually around puberty, severity increases in teenage years and decreases in adulthood

-family history of severe, cystic acne inc risk

Symptoms

-inflammatory papules, pustules, nodules, cysts (pimples)

Noninflamed comedones:

-plugging of hair follicle by keratin debris

-open comedone = blackhead

-closed comedone = whitehead

Inflammatory type:

-d/t bacterial infection by P. acnes

-increased sebum production

-bacterial lipase produces irritating fatty acids causing inflammatory reaction

Treatment

Systemic antibiotics:

-mild = clindamycin (inhibits protein synth)

-moderate = doxycycline (inhibits protein synth)

-severe = isotretinoin (inhibits sebaceous gland function and regulates keratinization)

Hormonal therapy:

-oral contraceptives (reduce free testosterone levels in women)

What is urticaria? causes, symptoms, treatment

-hives

-pruritic elevations of the skin

Causes

-mast cell release of histamine

-type 1 hypersensitivity (IgE mediated)

-reaction to exposures to food/additives, insectstings, drugs, aeroallergens, physical contact

Symptoms

-transient, red, pruritic, edema, well demarcated wheals

-involving the dermis and epidermis

-last >24 hours

Treatment

-discontinue offending drugs, food, etc

-avoid asprin and other NSAIDs

-ER if signs of angioedema or anaphylaxis

-0.3-.05ml IM epinepherine if needed

-25ml IV or 50ml IM diphenhydramine

-oxygen

What is atopic dermatitis?

-eczema

-inflammation of skin, characterized by pruritis

-often affects kids, young adults

-1/3 have symptoms into adulthood

-family or personal history

Causes

-type 1 IgE mediated hypersensitivity

-epidermal barrier dysfunction

-triggers include irritants, sweating, stress, microbes (s. aureus)

Symptoms

-acute: erythematous rash w vesicles

-chronic: dry, thickened skin (hyperkeratosis), d/t chronic itching

-dry skin, prolonged severe pruritis

-inflammation, excoriations, lichenification secondary to continued scratching

-infants: face, scalp, extensor surfaces forearms

-children (>18months): flexural surfaces (back of knees, elbows, neck)

-adults: hands, feet, flexures, wrists, face, eyelids, neck

Diagnosis

-clinical

-can do skin biopsy or check serum IgE levels

Treatment

-avoid triggers

-enhance barrier function of skin with moisturizers to hydrate and decrease itching

-topical corticosteriods to decrease inflammation

What is a chalazion?

-retined sebaceous secretions leak into tissue causing chronic granulomatous inflammation of meibomian gland eventually leading to stye

-forms d/t blocked oil gland

-m/c on underside of upper eyelid but can occur on lower

Risk factors

-previous chalazion

-chronic blepharitis (eyelid inflammation)

-certain skin conditions, like dandruff (seborrheic dermatitis) or rosacea

-dry skin

-hormonal changes.

Causes

-gland obstruction = impissination (dec flow of secretions) = granulomatous inflammatory response = lipogranuloma inflammation = lesion forms on eyelid

Symptoms

-bump on eyelid (m/c upper)

-single, non tender firm nodule deep within lid

-mild irritation causing eye to water

-blurred vision

-swollen eyelid, erythema

-slow growing, may persist for months

Diagnosis

-clinical

Treatment

-warm compress

-good hygiene

-draining and steriods if needed

What is the difference between a chalazion and a stye?

chalazion = blocked oil gland, deeper than stye

stye = bacterial infection of oil gland

What is dyshidrotic eczema (dyshidrosis)? symptoms, diagnosis, treatment

-recurrent dermatitis

-m/c 20-40yo; F > M

-personal and/or family history of eczema or contact dermatitis

-people who recieve immunoglobulin infusions

-cause unknown but likely result of immune system, allergies and/or excessive moisture (ex. excessive hand sweating)

-not contagious

*cant find source confirming if IgE related but assume so?

Symptoms

-intensely pruritic

-small, firm, painful blisters

-typically involves palms and soles

-itchy, scaly skin on or around blisters

-increased sweat around blisters

-dry, cracked skin

Diagnosis

-allergy test

-biopsy

-blood test

Treatment similar to atopic dermatitis

-treat and prevent flares

-steriods

What is nummular eczema? causes, symptoms, diagnosis

-discoid eczema

-chronic, can last for weeks-months

-m/c in young females and older men

*cant find source confirming if IgE related but assume so?

Causes

-allergies

-bacterial infection

-exposure to rough fabrics

-dry skin or dry environments

-frequent bathing or showering with hot water

-skin trauma or injury (burn, scrape, bug bite)

-irritating and drying soaps

Symptoms

-circular, raised spots (coined shaped)

-itchy, ooze clear fluid

-crusty on top

-very itchy

-may burn or sting

Diagnosis

-clinical

-skin scrape

Treatment similar to atopic dermatitis

-treat and prevent flares

-steriods

What is pterygium? causes, symptoms, diagnosis, treatment

-surfer's eye

-rapidly growing fibrovascular lesion that can distort the cornea

Causes

-long-term exposure to UV light (m/c cause)

-eye irritation from hot and dry weather, wind and dust

Symptoms

-raised, fleshy growth

-can be unilateral or bilateral

-typically grows on the medial -> lateral side of the sclerae

-redness, swelling, itching of eye

-blurry vision or double vision (if grows onto cornea)

Early:

-slightly raised pink growth on eye

-red, irritated, swollen, dry, itchy or burning eyes

-feels like sand or grit in eye

-teary eyes

Late:

-increase in size and spread of lesion

-unpleasant appearance of eye (d/t size of the lesion)

Diagnosis

-slit lamp eye exam, visual acuity test, corneal topography

Treatment

-lubricating eye drops

-steroid eye drops

-surgery if vision is blocked, symptoms are not being relieved or cosmetic issues

What is dacryocystitis? causes, symptoms, diagnosis, treatment

-inflammation or infection of the lacrimal sac (tear sack)

-pathogens may differ between acute and chronic

-often in >40yo

Causes

-trauma (fractures or surgery on nose)

-medical conditions involving immune system/inflammation/infection

-unusual nasal structure

-tumors

-certain drugs (timolol, dorzolamide, pilocarpine, trifluridine, fluorouracil, docetaxel or radioactive iodine)

-retained punctal plugs (devices to help drain tear ducts)

Symptoms

-acute: starts and reolves quickly (<3 months)

-chronic: lasts >3months; linked to systemic and autoimmune conditions (granulomatosis with polyangiitis, sarcoidosis and SLE); often cormorbid with chronic conjunctivitis

-eye pain

-swelling around eye

-redness or skin darkening

-abscess or sore that may have pus in the inner corner of eyelids

-fever

Diagnosis

-eye exam

-testing discharge

-yellow dye in eye (see how long it takes to dissapate)

-imaging

-bloodwork

Treatment

-warm compress

-abx if bacterial

What is acne rosacea? causes, symptoms, treatment

-chronic, inflammatory reaction of pilosebaceous units of skin on the face

-hyperplasia of sebaceous gland

-m/c in fair skinned, 30-5yo, sources vary on which gender more commonly affected

-genetic predisposition

-triggered by warm weather, alcohol, spicy foods, stress, heat, cold, wind, sun

Causes

-unknown

-may be innate immune system dysfunction in response to bacteria or UV light = chronic inflammation

Symptoms

-pustules and flushing with burning sensation

-flushing, non-transient erythema and telangiectasia (can sometimes see vessels)

-m/c on cheeks, forehead, nose and chin

-causes ruddy complexion (persistant central facial erythema)

-intensity intermittent (remits and exacerbates)

-phymatous changes (irregular, nodular skin)

-hyperactive vascular response (may extend to eyes)

Treatment

-trigger avoidance

-avoid topical corticosteriods and makeup

-1st line = oral tetracycline and topical metronidazole, topical azelic acid

-oral retinoids, topical sulfur

What are the complications of acne rosacea?

-skin thickening

-scarring

-rhinophyma (enlarged, red, bumpy, bulbus nose)

-ocular rosacea (blepharitis)

What are the 6 types of acne rosacea?

1. Papulopustular

-similar to acne

-no comedones

2. Phymatous

-thick, oily skin

-mostly on nose

-m/c in males

3. Ocular

-common

-conjunctivitis, keratitis

-tearing, burning

-telangiactasias

4. Granulomatous

-papules around eyes, cheeks

5. Pediatric

-rare

-never phymatous

6. Neurogenic

-pain

-neurologic symptoms

What is erythema multiforme? causes, symptoms, dignosis, treatment

-immunologic reaction of skin

-type 4 hypersensitivity -> body attacks basale cells

Causes

-infection by mycoplasma pneumonia, HSV

-rarely triggered by drugs (sulfonamides, penicillin, phenytoin)

Symptoms

-vesicles, bullae (sometimes macules and papules) that have classic bulls eye pattern of concentric light and dark rings (typical target)

-bullseye: erythema surrounding central necrosis

-targeted lesions 2mm-2cm big

-located on palms, soles, extensor membranes of hands and forearms, mucosa

-bilateral and symmetric

-lesions last 2 weeks and heal w/o complications

-mild or major type

Diagnosis

-clinical

Treatment

-systemic with oral anti-histamines, antacids

-treat triggering infection

-eliminate offending meds

-oral acyclovir for 6-12 months if recurring HSV infection

-maintain hydration

What is iritis/keratitis? causes, risk factors, symptoms, diagnosis, treatment

-corneal inflammation causing corneal tissue destruction

-inflammatory response causing stromal damage from infection resulting in edema, infiltrates, necrotic ulceration, focal thinning, perforation

Causes

-infectious: bacteria, virus, fungus, parasites

-non infectious: inflammation

Risk factors

-contact lenses, recent keratoplasty

-immunocop

-occular steroid use

-often comorbid with sicca (dye eye), neurotrophic keratitis (lesion on CN V), certain AI conditions

Symptoms

-erythema

-periauricular lymphadenopathy

-discharge = watery (viral), mucopurulent (bacterial)

-corneal opacity, stromal infiltrate (yellow = bacterial; white = fungal)

-feels like something in your eye

Diagnosis

-fundoscopy

-corneal scrapings

-penlight

-physical exam (snellen)

-fluorescein dye (in cornea)

Treatment

-topical antimicrobials for offending agent

-control comorbidities

What is the most common cause of infectious blindness in western countries?

-herpes simplex keratitis

-usually HSV type 1

-triggered by stress, immunosuppression, fever

Symptoms

-pain, photophobia, blurred vision

-tearing, redness, eyelid edema

Diagnosis

-via observation of corneal lesion

Complications

-corneal scarring

Treatment

-refer

What is conjunctivitis? causes, symptoms, treatment

-inflammation of conjunctiva

-infection, inflamatoin = dilation of conjunctival tissue = conjunctival hyperemia = edema = inflammatory discharge

Causes

-infectious: bacterial, viral, chlamydial

-non-infectious: allergic, toxic (irritants, dust, smoke, etc)

Symptoms

-red eye

-itching, tearing, discharge

-crusting of lashes in the morning

-lid edema

-palpable preauricular, submandubular nodes

Treatment

-cool compress

-antibiotics if bacterial

Distinguish the types of conjunctivitis (4) and treatment for each

1. Allergic

-airbourne allergens (seasonal,etc)

-IgE mediated, local mast cell degranulation

-associated with asthma, hay fever, rhinitis, seasonal

-treatment = avoiding allergens, cool compress, antihistamine, mast cell stabilizers (cromolyn)

2. Viral

-very contagious (via direct contact)

-occular manifestationof systemic infection

-serious discharge, lid swelling, enlarged lymph nodes

-usually caused by adenovirus, HSV, VZV

-treatment = cool compress, self limiting (7-10 days)

3. Bacterial

-very contagious (via direct contact)

-purulent discharge, lid swelling, moderate tearing

-usually caused by s. aureus, s. pneumonia, h. influenze

-if sexually active, consider n. gonorrhea

-**c. trichomatis is m/c cause in neonates (can cause blindness in child)

-threatens vision

-treatment = broad spectrum abx (doxy)

4. Non-infectious

-mechanical, chemical insult

-treatment = remove/avoid agent

What is dermatitis herpetiformis? risks, symptoms, testing, treatment

-chronic condition

-manifested by pruritic papules, vesicles over the elbows, knees, buttocks, posterior neck, scalp and hairline

-result of celiac disease or gluten sensitivity

-m/c in 30-40yo w celiac disease

-M > F

Risks

-celiac disease/gluten sensitivity

-relative with dermatitis herpetiformis or celiac disease

-fam history of autoimmune like anemia, thyroid, vitiligo, Type 1 DM, alopecia areata, Addison’s

Symptoms

-skin rash: pruritic papules, vesicles over the elbows, knees, buttocks, posterior neck, scalp and hairline

-oral: pitting, discoloration or horizontal grooves on teeth; canker sores

-GI: gluten sensitivity or celiac disease and associated GI symptoms

Testing

-skin biopsy, blood test

-Immunofluorescence: granular IgA deposits along dermal papillae

-circulating anti-endomysial antibodies can be detected in all pts (gluten-sensitive enteropathy)

Treatment

-gluten free diet

-antibiotic (dapsone)

What is Toxic Epidermal Necrolysis (TEN)? causes, symptoms, diagnosis, treatment

-rare, immune mediated

-type 4 hypersensitivity

-epidermal detachment

Causes

1. medications

-anticonvulsants (phenytoin, carbamazapine)

-antibiotics (sulfanamides)

-anti-inflammatories (sulfasalazine)

-certain NSAIDs

2. infections

-mycoplasma pneumonia

-HIV

-CMV

-herpes

Symptoms

-rapid onset pain and rashes

-flu like symptoms (cough, sore throat, fever)

-usually starts as atypical flat, dusky target lesions on palms and soles

-later will progress to erythema, ulcers and blisters over skin and mucosa

- >30% epidermal detachment (vs. steven johnson syndrome <10%; 10-30% detachment = overlap)

-extensive skin damage resulting in severe dehydration, electrolyte imbalance, and inc risk of infection

Diagnosis

-positive nikolsky sign

-CBC may show signs of infections

-blood culture

-CXR

-lung crackles if lung involvement

-definitive with biopsy

Treatment

-refer

-dicontinue offending meds

-wound care

-hydration

-pain management

-steroids, IV IG, abx if needed

Distinguish minor and major erythema multiforme

Minor

-mild

-triggered by infection

-targeted lesions on palms and soles

-symmetric spread to trunk

-NO or mild mucosal involvement

Major

-involves >2 mucosal sites (oral, ocular, genital m/c)

-usually triggered by mycoplasma, HSV or meds

-more severe than minor; rarely life threatening

-painful ulcers than can bleed

-lip crusting

Differentiate between oral candidiasis and oral squamous cell carcinoma

What is candidal paronychia? treatment?

-m/c C. albicans

-affects periungual (toenail,fingernail) skin

-painful, red, swollen

Treatment

-topical agents

-if not effective, oral antifungals

Differentiate between folliculitis, carbuncles and furuncles

What are carbuncles? symptoms, treatment

-collection of furuncles that coalesce to form a large infected mass

-larger than a boil, may have multiple openings to drain pus onto skin

-m/c S. aureus

Symptoms

-deep seated abscess from multiple coalescing furuncles

-mass may not be able to drain bc so deep

-red, irritated and may be painful when touched

Treatment

-incise and drain to relieve pressure and pain

What is cellulitis? Risks, symptoms, testing, treatment

-inflammation of dermis and subcutaneous fat

-d/t bacterial infection; m/c Group A strep, B hemolytic strep, S. aureus, S. lagdunensis

Risks

-animal bites/trauma

-recent surgery

-peripheral vascular disease

-diabetes

-lymphedema

-cracked skin in feet/toes

Symptoms

-involves lower dermis and subcuteneous fat

-erythema with poorly elevated, indistinct boarders

-warmth, swelling, pain

-m/c in legs

-may have systemic symptoms (fever, chills, malaise)

-regional lymphadenopathy may be present; can lead to lymphangitis

Testing

-clinical

-bacterial culture to confirm

Treatment

-antibiotics (cephalexin 1st line)

-trimethoprim sulfamethoxazole if diabetic

What is folliculitis? symptoms, treatment

-superficial infection of fair follicle causing inflammation

-normal, non pathogenic bacteria (S. aureus m/c)

Symptoms

-dome shaped pustule at hair follicle

-pustule will rupture to form a small crust

Treatment

-topical antibacterial meds (mupironcin)

-antiseptic

What are furuncles?

-boils

-deep folliculitis, infection of hair follicle

-m/c caused by S. aureus

Symptoms

-painful, swollen area on skin d/t accumulation of pus and dead tissue

-m/c in areas with hair (thighs, neck, face, axillae, groin, buttox)

-red, hot, tender, inflammatory nodules

-yellow or white point at center of lump can rupture and drain pus

**can coalesce and turn into carbuncle**

Treatment

-topical antibiotics

-incise and drain to relieve pressure and pain

What is impetigo? Differentiate causes, symptoms, testing, treatment in nonbullous and bullour impetigo

-bacterial infection of superficial epidermis

-m/c bacterial skin infection

-3rd m/c skin disease in children

-highly contagious

Impetigo Vulgaris (NONbullous)

Causes

-group A strep, S. aureus, S. pyogenes

-m/c in preschool and young adults

-often d/t poor hygiene or neglected minor trauma

Symptoms

-acute purulent infection

-vesicle or pustule that ruputures and becomes yellow honey crusted exudate

-exudate covers erosion and is surrounded by erythema

-m/c on face, arms, legs, butt

-rapid spread follows by contiguous extensionor to distal areas through inoculation of other wounds from scratching

Testing

-gram stain

-culture lesion fluid

Treatment

-saline compress and topical antiseptic soak to remove crusts

-topical antibacterial (mupirocin)

-topical antibiotic (cephalexin)

Bullous Impetigo

Causes

-S. aureus

-m/c in neonates and older children

Symptoms

-small or large, superficial fragile thin walled bullae

-appear quicly and sponteneously rupture

-drain clear, yellow turbid fluid with no surrounding erythema

-lesions spread on face, trunk, extremeties, butt, groin

Testing

-gram stain and culture of lesion fluid

Treatment

-topical antibacterial (mupirocin)

-oral antibiotics

What is necrotizing fasciitis? causes, symptoms, testing, treatment

-rapidly progressive inflammatory infection of the fascia with secondary necrosis of subcutaneous tissues

-limb and life threatening = REFER TO ER ASAP

Causes

-surgical procedures, insect bites, IM injections, local ischemia in diabetics

-Type 1 = polymicrobial (aerobes and anaerobes - S. aureus, Bacteroides, Enterobacteriaceae)

-Type 2 = monomicrobial (m/c B hemolytic strep)

Symptoms

-pain out of proportion to clinical findings

-pain reaches past the boarder of erythema

-crepitus can be heard as anaerobes produce gas

-edema

-rapid spread of infection

-may appear well initially but will get very sick quickly

-skin turns blue and black (2ndary to thrombosis and necrosis)

-gangrene

Testing

-clinically = start treatment ASAP (dont wait for cultures)

-blood and tissue culture and sensitivity (C&S)

-Xray to visualize soft tissue gas

-serum creatine kinase may be extremely elevated = late sign of myonecrosis

Treatment

-IV fluids and abx (penicillin and clindamycin)

-Emerg surgical debridement to confirm diagnosis and remove necrotic tissue

-may require amputation

What is onychomycosis? symptoms, ddx, testing, treatment

-tinea unguium

-T. rubrum (90%) and T. mentagrophytes are m/c causes

-associated with HIV, DM, peripheral arterial disease

Symptoms

-crumbling, dystrophic nails

-yellowish, opaque with subungual hyperkeratotic debris

-nail raised and plate is white or yellow, tick and crumbly

-toenail usually precedes fingernail infections

DDx

-psoriasis, lichen planus, contact derm, traumatic onychodystrophy, bacterial infection

Testing

-microscopic exam of nail scrapings with KOH prep shows hyphae

-culture of scraping or clippings on sabourauds agar

-periodic acid schiff (PAS) stain of cliping

Treatment

-terbinafine antifungal most effective

-itraconazole

What is paronychia? causes, symptoms, treatment

-local infection and inflamamtion of soft tissue around fingernail (nail fold)

Causes

-commonly caused by injury to the area (ex. biting, picking hangnaill, trimming back cuticles, sucking fingers)

-acute infection usually = Staph

-chronic infection usually = Candida (also usually diabetic and w constant hand exposure to water)

Symptoms

-painful, red, swollen area around nail

-often at cuticle or site of hangnail/other injury

-nail may look detached, abnormally shaped or have unusual colour

Treatment

-warm compress 2-3x/day

-acute = warm compress and cephalexin; drain abscess if present

-chronic = antifungals

What is pediculosis? types, symptoms, testing, treatment

-lice

-can transmit infectious agents like Bartonella quintana and Rickettsia prowazekii

-m/c 3-11yo

Types

-Phthirius pubis = pubic

-Pediculus humanus capitis = scalp

-Pediculus humanus humanus = body (found in poverty, war; uncommon in most people)

Symptoms

-intense pruritic excoritations

-secondary bacterial infection and lymphadenopathy (d/t constant scratching)

-nits (louse eggs) can be seen on hair and clothing seams

-itching occurs when lice feed on blood (>1/day) via piercing skin with tiny needle like mouthparts (saliva excretion during this causes itching)

-cannot burrow in skin

Testing

-comb scalp thoroughly with a louse comb and examine for presence of living lice

-most effective method to detect

Treatment

-no product that assures 100% destruction of lice and nits after single treatment

-need combination of products to remove:

-Permethrin cream

-combing hair using dilute vinegar solution (removes nits)

-shaving hair so they have no place to hide

-wash clothing with detergent in hot water and machine dry

Name 7 different types of Tinea and what they cause

1. Tinea capitis

-round, scaly patches of alopecia

-ringworm of scalp

2. Tinea corporis

-ringworm (of body)

3. Tinea cruris

-jock itch

4. Tinea pedis

-Athletes foot

5. Tinea manuum

-uncommon

-blisters or dry scaly patch of infection on hand

6. Tinea unguium

-onychomycosis

7. Tinea barbae

-superficial inflammed annular lesions, pustules and crusting around hairs

What is Tinea capitis? symptoms, ddx, testing, treatment

-ringworm of the scalp

-infection involves hair shaft and follicles

-m/c in kids (mainly black), immunocompromised adults

-highly contagious

-often transmitted from barber, hats, theatre seats, pets

Symptoms

-round, scaly patches of alopecia

-hairs may be broken

-itchy scalp, eyelashes and eyebrows

-may have occipital lymphadenopathy

-Kerion (boggy, elevated, purulent, inflammed nodule/plaque) may form secondary to infection and result in scarring

DDx

-alopecia, psoriasis, seborrheic dermatitis, trichotillomania

Testing

-woods light exam of hair = green fluorescence

-culture of scales/hair shaft

-KOH prep of scales or hair shafts

Treatment

-terbinafline for 4 weeks

-oral antifungals to penetrate hair root

-adjunctive antifungal shampoos or lotions to prevent spread

What is Tinea corporis? symptoms, ddx, testing, treatment

-ringworm

Symptoms

-pruritic, scaly, round/oval plaque with active erythematous margin

-may have central clearing

-m/c on trunk, limbs, face

DDx

-granuloma annulare, pityriasis rosea, psoriasis, seborrheic dermatitis

Testing

-KOH prep of scales show hyphae

-culture of scales

Treatment

-topical clotrimazole, ketoconazole, miconazole, terinafline or ciclopiroxolaime cream BID 2-4 weeks

What is Tinea cruris? symptoms, ddx, testing, treatment

-jock itch

Symptoms

-scaly patch/plaque with well defined, curved border and central clearing

-pruritic, erythematous, dry/marcated

-starts medial thigh then spreads centrigulally to perineum, gluteal cleft, butt

DDx

-candidiasis (will involve scrotum and have satellite lesions)

-contact dermatitis

-erythresma

Testing

-culture of scales

Treatment

-terbinafline, itraconazole, fluconazole, ketoconazole if extensive

What is Tinea pedis? symptoms, ddx, testing, treatment

-athletes foot

-predisposing factors = heat, humidity, occlusive footwear

Symptoms

-pruritic scaling and/maceration of web spaces

-powdery scaling of soles

-acute = interdigital (esp 4th web space); red/white scales, vesicles, bullae, often with maceration

-chronic = non pruritic, pink, scaling keratosis on soles and sides of feet

-acute on chronic possible

DDx

-atopic dermatitis, contact dermatitis, dyshidrotic dermatitis, erythrasma, intertrigo, inverse psoriasis

Testing

-culture scales

Treatment

-terbinafline, itraconazole, fluconazole, ketoconazole if extensive

What is Tinea manuum? symptoms, ddx, testing, treatment

-usually associated with tinea pedis (primary infection of hand is rare)

Symptoms

-acute = blisters at edge of red areas on hands

-chronic = single, dry scaly patch

DDx

-atopic derm, contact derm, granuloma annulare, psoriasis

Testing

-culture scales

Treatment

-terbinafline, itraconazole, fluconazole, ketoconazole if extensive

What is Tinea unguium? symptoms, ddx, testing, treatment

onychomycosis

-associated with HIV, DM, peripheral arterial disease

Symptoms

-crumbling, dystrophic nails

-yellowish, opaque with subungual hyperkeratotic debris

-nail raised and plate is white or yellow, tick and crumbly

-toenail usually precedes fingernail infections

DDx

-psoriasis, lichen planus, contact derm, traumatic onychodystrophy, bacterial infection

Testing

-microscopic exam of nail scrapings with KOH prep shows hyphae

-culture of scraping or clippings on sabourauds agar

-periodic acid schiff (PAS) stain of cliping

Treatment

-terbinafine antifungal most effective

-itraconazole

What is Tinea barbae? symptoms, ddx, testing, treatment

Symptoms

-superficial, inflammed annular lesions

-pustules and crusting around hairs

-inflammatory kerion may occur and result in scarring hair loss

-predom affects men who work with animals

-m/c in beard area

DDx

-folliculitis, malignant lymphoma, sporotrichosis

Testing

-KOH prep of scales show hyphae

-culture of scales

Treatment

-terbinafline or itracanozole

What organism is the leading cause of skin and soft tissue infections? Name 5 that affect the skin

-S. aureus

1. Folliculitis

-least serious

-hair root follicle infection

2. Impetigo

-shallow, fluid-filled blisters that rupture, leaving honey-colored crusts

-may itch or hurt.

3. Abscesses (boils or furuncles)

-warm, painful collections of pus just below the skin

4. Cellulitis

-infection of skin and the tissue under it

-pain and redness

5. Toxic epidermal necrolysis (TEN)/SJS + scalded skin syndrome in newborns

-serious infections

-large-scale peeling of skin

What is rubella? causes, symptoms, testing, treatment

-german measles (milder than rubeola/measles)

Causes

-RNA togavirus (3 day measles)

-incubation = 14-21 days

-transmission = droplets

-MMR vaccine to protect

Symptoms

-Forchheimers spots = red spots on posterior soft/hard palate, develop at onset of rash

-appearance of pink, discrete, maculopapular rash lasting 1-5 days

-rash starts on hairline, rapidly spreads to neck, trunk and rest of body

-pruritic but disappears by the 3rd day

-painful postauricular lymphadenopathy

-polyarthritis in adults

Testing

-ELISA serology for IgM

-may not be detected for 4-5 days after rash onset

Treatment

-symptoms

-self resolves

What happens when a pregnant woman contracts rubella? What symptoms will be seen in mom? Baby when born? Testing? Treatment?

-contracted via respiratory droplets (highly contagious)

-transmitted transplacentally in 1st trimester

Symptoms for mom

-rash (exanthema) on face which spreads to trunk and extremities

-disappears after 3 days (3 day measles)

-low grade fever, post auricular or occipital lymphadenopathy

-joint pain

Symptoms for fetus/baby when born

-deafness (sensorineural)

-cataracts

-thrombocytopenia (blueberry muffin baby)

-hepatomegaly

-patent ductus arteriosus

Testing

-ELISA IgM that is 4x greater than IgG in acute

Treatment

-MMR vaccine after pregnancy (CANNOT give during preg bc live attenuated)

What is scarlet fever? causes, symptoms, testing, treatment

-scarletina

Causes

-toxin producing group A beta hemolytic strep (GABHS)

-GABHS found in secretions and discharge from nose, ears, throat and skin

-toxin causes pathognomonic rash d/t inflmmatory mediators leading to scarlet coloured rash

-GABHS replicates in tonsils and pharynx

-m/c in 5-15yo

Symptoms

-acute onset fever, sore throat

-24-48 hours after pharyngitis, erythematous rash develops on face and neck, then spreads to other parts of body

Rash

-sandpaper quality, non pruritic, non painful

-spares mouth but tongue has white exudate with studded prominent red papillae

-fades after 6 days, starts peeling (can last up to 10 days)

-white exudate on tongue disappears, tongue turns beefy red = strawberry tongue

Testing

-rapid strep test

-throat culture

Treatment

-penicillin, amoxicillin

What acronym is useful to remember the features of scarlet fever?

SCARLET

S = Sore throat

C = Circumoral pallor (white around lips)

A = group A strep

R = Rash

L = Lymphadenopathy

E = Erythrogenic toxin

T = strawberry Tongue

What is erythema infectiosum? symptoms, testing, treatment

-fifths disease

-d/t parvovirus B19 (erythrovirus)

-occurs in epidemics

Symptoms

-mild prodromal symptoms begin 1 week post exposure to parvoB19, last 2-3 days

-prodromal sx = fever, headache, sore throat, pruritis, arthralgias (flu like)

-classic slapped cheek appearance which typically fades over 2-4 days

-1-4 days after slepped cheek fades, erythematous maculopapular rash extends to trunk and proximal extremities

Testing

-diagnosis via clinical presentation alone

-ELISA = increased IgM

-western blot hybridization, PCR assay

Treatment

-self limiting

-symptom relief w NSAIDs

Describe the differences seen in rashes associated with roseola, rubeola, rubella, erythema infectiosum, scarlet fever, varicella, hand-foot-mouth disease

Roseola (human herpes virus 6 (DNA virus)

-non pruritic

-starts at neck, trunk then spreads out to face and extremities

-pink/rose colorued macules and maculopapules

-1-5mm in diameter

Rubeola (measles; paramyxovirus)

-non pruritic

-starts at hairline or mucous membranes (white spots on cheeks) and spreads down to face/neck/trunk

-no palm or sole involvement with rash

-erythematous, blotchy rash

-Koplik spots = grey/white papules on buccal mucosa

Rubella (german measles; RNA togavirus)

-pruritic but disappears by the 3rd day

-rash starts on hairline, rapidly spreads down to neck, trunk and rest of body

-Forchheimers spots = red spots on posterior soft/hard palate

-pink, discrete, maculopapular rash

Erythema infectiosum (fifths disease; parvoB19)

-possibly pruritic

-classic slapped cheek appearance

-after cheek fades, erythematous maculopapular rash spreads down to trunk and proximal extremities

Scarlet fever (toxin producing group A beta hemolytic strep)

-sandpaper quality, non pruritic, non painful

-erythematous rash on face and neck, then spreads down to other parts of body (fades and peels)

-spares mouth but tongue has white exudate with studded prominent red papillae -> strawberry tongue after

Varicella (chicken pox; VZV)

-pruritic

-often starts on trunk, then spreads out to face, scalp, conjunctivae, oral mucosa, extremities (inc palms and soles)

-progresses from macules to vesicles to pustules that burst

-lesions crust over

Hand-foot-mouth disease (coxsackievirus)

-possibly pruritic, painful

-erythematous lesions found on hands, feet, buttocks and genitalia

-lesions progress to vesicles that erode and become surrounded by erythematous halo

Herpangina (coxsackievirus A16, enterovirus 71)

-non pruritic

-multiple vesicles (grey with red base) or ulcers on soft palate and pharynx, surrounded by erythema

What is hand-foot-mouth disease? symptoms, testing, treatment

-acute viral illness

-via Coxsackievirus

-m/c in young children

-infection via fecal oral OR contact with skin lesions and oral secretions

-incubation 1 week

Symptoms

-sore mouth, throat, malaise

-macular lesions appear on buccal mucosa, tongue and/or hard palate = may be painful

-lesions progress to vesicles that erode and become surrounded by erythematous halo

-lesions = erythematous, tender macules or vesicles found on hands, feet, buttocks and genitalia

-fever within first 24-48 hours

Testing

-clinically

Treatment

-self limiting

-no meds generally needed

What is herpangina? symptoms, testing, treatment

-acute febrile illness

-arises from various enterovirus infections (coxsackievirus A16, enterovirus 71)

-spreads via fecal oral; can spread via respiratory or fomites

-m/c in newborns-young adults in summertime

-incubation 4-14 days

Symptoms

-50% asymptomatic

-fever (101-104), malaise

-multiple vesicles or ulcers on soft palate and pharynx, surrounded by erythema

-vesicles = gray papulovesicles with erythematous base

-sore throat and pain on swallowing

Testing

-diagnosis = clinical

Treatment

-none effective

-self resolves

What is roseola? symptoms, treatment, complications

-human herpes virus 6 (DNA virus)

-unclear transmission; incubation = 5-15 days

-m/c viral exanthema in kids <2yo

Symptoms

-high fever (>39.5/103) lasting 3-5 days

-fever may cause febrile convulsion/seizures**

-cough, nasal congestion

-fever resolves abruptly, then rash appears

Rash

-pink/rose colorued, non-pruritic macules and maculopapules

-starts at neck and trunk

-spreads to face and extremities

-1-5mm in diameter, may last 2 days

Treatment

-no effective pharmaceutical

-supportive w acetominophen

Complications

-febrile seizures

-encephalitis

What is Rubeola? symptoms, complications, treatment

-measles

-paramyxovirus

-incubation 8-13 days

-communicable via 4 day pre and post rash

Symptoms

-morbilliform rash = starts at hairline or mucous membranes (white spots on cheeks) and spreads down to face/neck/trunk

-no palm or sole involvement with rash

-rash preceded by Cough, Coryza, Conjunctivitis (3 C's)

-enanthem = Koplik spots = grey/white papules on buccal mucosa

Complications

-d/t suppression of immune system for 6 weeks

-otitis media

-pneumonia

-encephalitis

-SJS

-glomerular nephritis

-myocarditis/pericarditis

Treatment

-vitamin A

-immunoglobulin

-MMR vaccine for others in the house/people at risk

What is the difference between an enanthem and an exanthem?

Enanthem

-or enanthema

-rash inside the body

-ex. Koplik's spots (measles) inside the mouth that look like tiny grains of white sand surrounded by a red ring

Exanthem

-rash on the outside of the body

-ex. rubella, roseola rash