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Derm - Vesicles and Bulla
Terms in this set (10)
Herpes zoster (shingles) is caused by an eruption of latent varicella zoster virus (VZV).
*Dermatomal (zosteriform) eruption on one side of the body
*Grouped vesicles on an erythematous base are typical of the herpes family of viruses, including VZV (chickenpox)
*Shingles appears most often on trunk but can be anywhere
-Usually preceded by pain or burning
-Generally shingles occurs only once in the immunocompetent, in contrast to herpes simplex virus (HSV), which frequently recurs
What is this? Hallmark features?
1) Narcotic Analgesics prn pain
2) Antiviral medications - Valtrex, Famvir, Zovirax. Valtrex 1000mg TID x 1 week.
3) Oral Corticosteroids — 1 mg/kg P0 qd for 1 week followed by tapering over 3 weeks for patients over 50 years old. Believed to decrease incidence of PHN.
4) Elavil 25 mg P0 tid coupled with oral analgesics appropriate for some patients.
5) Hydroxyzine (Atarax) 25-50 mg P0 tid for pruritus.
6)Topical agents include drying agents (Burow's solution) for weeping lesions and capsaicin cream (apply liberally 4- 5 times daily) for pain management.
Tx of shingles?
-Lesions are present on the tip or side of the nose, indicates involvement of the nasociliary branch and possible ophthalmic involvement. Refer to Ophthalmologist.
-Lesions are present on the external ear, ear canal, neck, jaw, or patient complains of ear pain (trigeminal nerve involvement - Ramsay Hunt Syndrome).
When do you want to refer shingles pt to Derm?
Herpes simplex viruses 1 and 2 cause painful, grouped vesicles on an erythematous base.
-Vesicles may appear pustular (white to yellow), reoccuring in same place
HSV 1 favors the mouth and nose
HSV 2 favors the genitalia, buttocks, thighs
-Perianal erosions or ulcerations in immunosuppressed patients are usually HSV
*Often don't see vesicles, just the erosions
-Look for bright red rim on erosion
**Pain and recurrence suggests HSV
What is this? Hallmark sign?
*Tzanck prep can be used to confirm herpes family viruses, but it does not differentiate them from one another. It requires scraping the base of an active vesicle or erosion. Results are immediate.
*Viral culture can be performed when there is fluid present, but it is less helpful once crusts have formed. Results in 1-3 weeks. Not as helpful for VZV. The gold standard for HSV.
-Direct fluorescent antibody (DFA) test can differentiate HSV 1 and 2, as well as VZV. Like Tzanck prep, scrape the base of a vesicle or erosion. Results in 48 hours.
-The HerpSelect test is a blood test, which uses IgG antibodies to differentiate past exposures to HSV 1 and 2 but not VZV. Results in days to weeks.
How to determine HSV?
Evidence shows PO antivirals work best:
Acyclovir 800 mg TID x 2 days
Famciclovir 1 gram BID x 1 day
Valacyclovir 2 grams BID x 1 day
Tx for HSV?
Allergic contact dermatitis (ACD) is a common source of vesicles
-The most common cause is rhus dermatitis, from poison ivy, poison oak, or poison sumac
*Rhus dermatitis often shows linear streaks of vesicles
*The main symptom of ACD is itching
This is a delayed hypersensitivity reaction so appears 24-72 hours after exposures
What is this? Main sx? Hallmark signs?
Dyshidrotic eczema presents as very pruritic vesiculopapules on the palms, soles, and sides of the fingers.
-After healing, they often leave behind a mark with a mahogany color, called post-inflammatory hyperpigmentation.
*Many patients have a history of atopic dermatitis, and many have coexisting tinea pedis.
*The mainstay of treatment is potent topical steroids
What is this? Clinical features? Tx?
The majority of lesions are crusted papules (impetigo contagiosa)
-Bullous impetigo (with vesicles or bullae) occurs more frequently in children
-Bullous impetigo is caused by a secreted exotoxin
-Generalized form of exotoxin-mediated disease results in Staphylococcal scalded skin syndrome
What is this?
Scalded Skin Syndrome
A focus of infection secretes toxin into the blood, leading to widespread superficial blisters
-Skin peels away in sheets
Wound cultures from erosions are negative
At risk: kids < 2 years and adults with renal disease
Consult dermatology immediately
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