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What are 3 types of topical treatments that can be given to patients w/ acne vulgaris?

1. Retinoids
2. Benzoyl Peroxide
3. Topical antibiotics

If you prescribe antibiotics for a person w/ acne vulgaris, what else should you give them in combination?

B. Peroxide

What are some negatives to using B. Peroxide?

Can be irritating

What is the first line systemic treatment for acne vulgaris?

Tetracyclines (doxycycline, minocycline)

Name two forms of hormonal therapy that can be used to treat acne vulgaris.

Sprinolactone (androgen antagonist)
Orthotricycline (Yaz)

What does rosacea look like, and how is it different from acne vulgaris?

Erythematous papules, pustules and telangiectasias on face (cheeks, nose, chin)- "Flushing and blushing"

Does not have comedones and no relationship to androgenic activity

What age group does rosacea usually affect? Males or females?

30-50 year olds
Females 3 x more likely than males

What are the 3 stages of rosacea?

1. Flushing and blushing
2. Papules and pustules
3. Edema, phymatous changes (swelling, "bulb")

Name 3 non-skin findings of rosacea.

1. Blepharitis
2. Conjunctivitis
3. Grittiness and dry eyes

What can be done to treat rosacea?

1. Topical antibiotics- first line; ex. MetroGel
2. Oral antibiotics- help w/ papules/pustules; ex. Tetracycline
3. Azelaic acid- kills bacteria and reduces inflammation
4. Pulsed dye laser- destroys telangiectasias

What is the cause of rosacea?

Unknown. May be some connection w/ Demodex mites or H. Pylori. May also be genetic or hormonal.

What is folliculitis and how is it spread?

Superficial inflammation of hair follicle; abrupt
Spread by scratching, shaving

Other than shaving (mechanical cause), what can cause folliculitis?

Fungus
Bacteria (Staph A)

What does folliculitis look like?

Dome shaped pustules with small erythematous halos arising in follicle
Can be tender

What is Majocchi's granuloma?

Deep folliculitis due to dermatophyte (fungal) infection. Usually caused by an introduction of tinea into hair follicle in women who shave their legs.

Why should you do a nasal culture in a patient that has folliculitis?

Because patients w/ nasal carriage of Staph A are at an increased risk of infection w/ the bacteria

In what population do you see eosinophilic folliculitis?

HIV/AIDS

What are 3 treatments for folliculitis?

1. Antifungal
2. Antibiotic (antistaphylococcal, mupirocin)
3. Antibacterial cleanser

Also avoid heat, friction, occlusion

A child w/ eczema herpeticum is at risk of superinfection w/ what?

Staph A--> can end up getting impetigo on top of all of that

What's the first line treatment for eczema herpeticum (w/ secondary impetigo)?

Mupirocin ointment 3 x day 10 days

What does generalized acute pustular psoriasis look like?

Fiery red erythema
Lakes of pus
Burning
Itching

Why is generalized acute pustular psoriasis worrisome?

Comes on all of a sudden- might have fever and respiratory distress

What population generally experiences generalized acute pustular psoriasis?

Uncommon
Mostly 50s
Have hx of plaque psoriasis

What are 3 drug-related causes of generalized acute pustular psoriasis?

1. Withdrawl of systemic steroids
2. PCN
3. NSAIDs, salicylates
4. Lithium

What is the treatment for gen. acute pust. psor.?

Get back to normal, prevent infection

What is palmoplantar pustulosis and what age group does it affect?

Localized form of pustular psoriasis (hands and feet); numerous pustules
Affects 50-60 y/os, not common

What does tinea manuum look like?

Eczema- dry skin, fissures, can be itchy

What is one hand, two feet syndrome?

Also known as tinea manuum- usually tinea pedis precedes the tinea manuum b/c of scratching of feet

What is tinea cruris and who does it mostly affect?

Jock itch, males

Spares scrotum

Who is more likely to have tinea facei?

Children, wrestlers

What is the infectious agent of syphilis?

Treponema pallidum

What are the stages of syphilis?

Primary, Secondary, Latent, Tertiary

What are 3 characteristics of primary syphilis?

Painless chancre that resolves w/ regional lymphadenopathy

How soon after the chancre does secondary syphilis appear and how long does it last? and how does it appear? (5)

6 weeks, lasts 2-10 weeks
1. Flu-like sx
2. Asymptomatic Rash
3. Mucocutaneous lesions
4. Hepatosplenomegaly
5. Generalized adenopathy

What is a classic sign of secondary syphilis?

Copper colored macules on palms and soles
CONTAGIOUS

In tertiary syphilis, what forms on organs?

Gummas (nodules)

What is the most common diagnostic test for syphilis?

RDR- Rapid Plasma Reagin (serologic test)

What other tests can be done to Dx syphilis?

Direct Fluroescent Antibody test
Dark Field Microscopy
Treponemal serologic test

usually confirmatory

What is the treatment for syphilis?

Penicillin 2.4 Million units IM
Doxycycline 100mg bid x 2 weeks

What is Hutchinson's triad?

Hutchinson's teeth
Interstitial keratitis (inflammation of the cornea)
Eighth nerve deafness

For congenital syphilis

What are some signs of congenital syphilis?

Still birth, failure to thrive, snuffles, deafness
Alopecia
Desquamation of palms and soles

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