Derm packet 4- viral and fungal skin infections

intro to medicine 1

salicylic acid

first line of treatment for warts (Compound W)

OTC and inexpensive

salicylic acid is___ (refering to type of drug and expense)

liquid nitrogen

common wart treatment: two freeze-thaw cycles are administeres every 2-4 weeks for several visits

surgical removal or laser therapy

if warts are recurrent, you can do this (2)

laser therapy

this form of treatment is good if you have a lot of warts

“Benign Neglect”

a option for wart treatment where you just let the wart go

plantar warts

these are found on the plantar surfaces of the feet

plantar warts; they are calloused because of the forces on the feet from walking

calloused warts; what are they called and why are they calloused

spontaneously without therapy

how might plantar warts resolve

may be widespread and intractable (hard to treat)

what might happen to plantar warts in immunocompromised patients (2)

solitary and mosaic

two primary types of plantar warts

blood and nerves

what does each wart have its own supply of (2)

cut duct tape size of lesion and leave in place for 6 days, remove, wash skin, gently debride

plantar wart treatment you can do yourself

OTC topical salicylic acid preparations for 8-12 weeks

medication used for plantar warts and duration

OTC topical salicylic acid preparations

cure rate is 75% for plantar warts

OTC topical salicylic acid preparations

you can not use this medication for plantar warts for diabetic patients

cryotherapy ablation with liquid nitrogen

plantar warts treatment with 50% cure rate

surgical removal/ laser treatment

treatment for plantar warts but recurrence may occur (2)

deep palmoplantar warts/myrmecia, flat warts, Heck disease

other types of warts (3)

Heck disease

this may be on buccal mucosa (inside of cheeks and lips) and gingival mucosa (gums)

Heck disease

HPV strands 13 and 32

condyloma acuminata

commonly called “genital warts”

condyloma acuminata

infection of the genital or anal skin by HPV

condyloma acuminata

HPV Serotypes (distinct variations of HPV) 6 and 11 are responsible for >90% for ____

condyloma acuminata

these lesions spread rapidly over moist areas

condyloma acuminata

these lesions also spread rapidly on symmetric surfaces of the labia and rectum

condyloma acuminata

pale pink to white, warty-like raised papules

condyloma acuminata

may coalesce (come together) to form large cauliflower like masses

use white vinegar (acetic acid) to bathe suspected lesion; if it turns white, it is acuminata

what can you do to test for acuminata

condyloma acuminata

identificaiton of this lesion may be difficult

pap smear (specimen retrieval from cervix), biopsy, colposcopy (look at cervix with a magnifying glass)

these methods might be used to make the diagnosis of condyloma acuminata

podofilox (condylox) and imiquimod (aldara)

treatments for condyloma acuminata (2)

twice daily for 3 days a week for cycles of 4-6 weeks

podofilox (condylox) plan

5% cream once daily for 3 alternate days per week for 8-12 weeks

imiquimod (aldara); what is it and plan

surgical removal

incase there is resistant to other treatments, what might be used to treat condyloma acuminata

human papilloma virus

what does HPV stand for

HPV

what is the etiologic agent (agent that causes warts) with over 100 different serotypes (distinct variations)

hands/feet and periungual (around fingernails and toenails)

where are non-genital warts found (3)

flat, filiform (long, threadlike), plantar

types of warts by appearance (3)

strands 6 and 11

what strains are genital warts

genital warts

serotypes 6 and 11 are responsible for >90% of what

12 high risk cancer strians

warts can cause what

strains 16 and 18

what strains cause 70% of high risk cancer strains in warts

verruca vulgaris

what is the other word for warts

hands and knees

where are warts most common

dome shaped with irregular surfaces

general apperance of warts

children

warts are common in what kind of person

skin to skin contact, contact with contaminated surfaces, autoinoculation

how are warts spread (3)

deep palmoplantar wart/myrmecia

deep palmoplantar wart/myrmecia

flat warts

Heck disease

vaccination against HPV

what is the prevention against condylomata acuminata

vaccination against HPV

what vaccine is recommened for children starting at age 9

cancer

the HPV vaccine can be prevention of what

herpes simplex

viral infection, primary or recurrent (this is common), characterized by grouped vesicles on an erythematous (red and irritated) base on skin or mucous membrane (in mouth)

type 1 (HSV1) or type 2 (HSV2)

what are the types of herpes simplex lesions

skin to skin, skin to mucosa, or mucosa to mucosa

types of transmission for herpes simplex (3)

condyloma acuminata

cauliflower appearance

what is the appearance of this

occurs with multiple, painful lesions, fever, lymphadenopathy, and general malaise (feel bad)

herpes simplex primary infections (4 main points)

typically 2-4 weeks

how long does herpes simplex primary infections last

infancy or early childhood

when is HSV1 (type 1) most common

similar lesions and symptoms but less severe and shorter duration (1-2 weeks)

herpes simplex secondary lesions

herpes simplex

herpes simplex

acyclovir 400mg 1 tab po TID x 7-10 days

first line of treatment for herpes simplex: with strength, dose route, frquency, and duration

valacyclovir and famcyclovir

other treatments for herpes simplex (2)

shingles

other name for herpes zoster

herpes zoster

actual name for shingles

herpes zoster

T cells decline in their immunity of VZV which causes what virus

varicella virus

what does VZV stand for

caused by recativation of varicella virus due to cold, stress, age, or medical conditions

how is herpes zoster caused (4 factors)

unilateral pain, vesicular lesions limited to a dermatome

symptoms of herpes zoster (2)

pain/burning/itching

after 1-5 days of the herpes zoster rash, what will occur (3)

clustered vesicles of varying sizes

how does herpes zoster present

lesions do not cross the midline of body

what is specific about the alginement of herpes zoster

lesions continue to develop for 3-5 days and scab over in approx 10 days

process of herpes zoster

level of the nipples

where is the T4 dermatome

level of the bellybutton

where is the T10 dermatome

herpes zoster

acyclovir, valacylovir, famcyclovir: 800 mg 5x per day x 7 days

treatment for herpes zoster: with strength, frequency, duration

prevents post herpetic neuralgia and shortens course

if medication is given for herpes zoster within 72 hours of symptoms, what? (2)

topical cream, Tylenol, Advil, narcotics

pain management for herpes zoster (4)

herpes zoster ophthalmicus, Ramsay-Hunt Syndrome, post herpectic neuralgia, encephalitis

complications of herpes zoster (4)

herpes zoster ophthalmicus

shingles that happens in or around the eye→ dermatome affected invovles the eye

Ramsay-Hunt disease

facial nerve affected and can cause paralysis of the face (herpes zoster)

pain lasting >3 months after lesions resolve

what is post herpetic neuralgia

post herpetic neuralgia

most common complication of herpes zoster where risk increases with age

herpes zoster ophthalmicus

shingrix

prevention for herpes zoster

60

shingles vacicne recommended by CDC for patients over ____ for routine immunization

shingrix

helps to rpevent the risk of developing shingles nad post herpetic neuralgia

chickepox

what is varicella

vaccination against varicella

what is another way of prevention for herpes zoster

superficial fungal infections

most common mucocutaneous (skin meets mucous membrane) infections

dermatophytes and candida

two common groups of fungal skin diseases

dermatophytes

unique fungi that infect nonviable (not living) keratinized cutenour structures

tinea

what are dermatophytes also called

by their site of infection

how are dermatophytes classified