SKIN Part 1

Lyme disease

• caused by tics

• Key words

  • tick bite

  • Bulsyeye or target like

    • called erythema migrans

• Treatment

  • Doxy

  • Or for pregnant amoxicillin

Rocky mountain spotted fever

• Spotted rash within 2-6 days of tick bite

• Fever, N/V and myalgia

• treatment

  • No matter what always Doxy even if pregnant

What if a patient felt a small sting then the spot became tender, deep blue centrally with a white halo followed by erythematous red ring

• known as the red white and blue sign

  • This is a brown recluse spider bite

    • treatment

      • cold packs and comfort management

Dog cat and human bites

• First steps

  • clean and assess

  • Consider tatanus or rabies prohylaxis

  • Do not suture a hand wound or any prone to infection

  • What ABX

    • A way to remember

      • if youre dog bitten treat with augmentin

      • A cat bite is usually more prone to infections

        • Both cat and dog bites typically are infected with the bacteria PAstuerella multicida

Cuteneous Anthrax

• Happens from contact with sheep, goat, cattle ,horses, and pigs

• KEy words

  • cattle farmer and painless

  • black and ulcered wound

• Treatment

  • phloloqinilons

    • ciprofoxacin or levofloxacin

    • Can also be treated with a tetracycline like doxycycline

Atopic dermatitis aka Echzema

• Keys

  • Intense pruritic, scaly, dry and lichenified, and leathery

  • mainly on flexor surfaces

  • Treatment

    • Emollients, topical steroids, and education on how to avoid triggers

  • ATOPY (AKA ATOPIC TRIAD) - the genetic tendency to have asthma, atopic dermatitis, and allergic rhinitis to appear together

Plaque psoriasis

• well-defined red plaques with silvery scale, also can see nail pitting and Onycholysis (nails pulling away from nail bed

• Signs to know for PP

  • Auspitz Sign - when plaques are scratched or removed, and pinpoint bleeding occurs

  • Koebner phenomenon - When there is trauma to the skin and plaques form, it may even be caused by scratching can cause a linear plaque to form

• Treatment

  • in primary care when the pt has limited disease

    • treat with topical steroids combined with vitamin D analogues

      • adjuncts use emooliont and koltor can

    • Refer out if more aggressive to derm

Herpes Zoster (Shingles)

• Keys

  • unilateral burning, stabbing, throbbing pain

  • followed by unilateral vesicular rash following a dermatome (Along the line where the area is innervated)

• Treatment

  • if close to the eye we need to refer to the emergency because it can cause blindness

  • If within 72 hours of symptom onset, we can get an antiviral like acylovir to help heal lesions and decrease pain

  • Immunocompromised patients

    • GIVE asyclovir regardless if its been more than 72 hours

• Prevention

  • Vaccines

    • 2 dose series given to adults over 50 or 18 and over with immuno compromised patients

    • Give vaccine regardless if they have already had shingles or not

    • No specific waiting period between when they have an outbreak and when we give the vaccine but just dont give it during active outbreak