A set of skin findings that can occur with or without systemic lupus 10% of patients with cutaneous lupus go on to develop SLE, after an average of 8 years Malar "butterfly rash": erythema sparing the nasolabial folds Erythematous popular rash on the arms Photosensitivity Annular scaly plaques on the upper back, chest, upper arms Discoid lupus: red, scaly plaques with scarring most commonly on the scalp, face Diffuse hair thinning Urticaria Raynaud phenomenon & digital ulcers Vasculitis Livedo reticularis
What is the presentation of Cutaneous Lupus?
Autoimmune disease Runs in families Exacerbated by sun exposure More common in young females,African Americans Drug induced form
What is the etiology of cutaneous lupus?
Diagnosis: Skin biopsy and screening for systemic disease using ROS,ANA panel. Treatment: Depends on the extent Topical and/or oral steroids NSAIDS, hydroxychloroquine, retinoids, immune modulators, plasmapheresis Psychosocial support Sun protection
How do we diagnose and treat Cutaneous Lupus?
Asymptomatic palpable purpura Legs, buttocks, & back are most common sites May have systemic symptoms
What is the presentation of Purpura/Vasculitis?
Immunoglobulins form in response to infections, drugs, allergens, etc. They then circulate and deposit in small blood vessels
What is the etiology of Purpura/Vasculitis?
Diagnosis: Diascopy, +/- skin biopsy, testing for blood immunoglobulins. Treatment: Remove the causative agent Topical or oral steroids Systemic immunosuppressants in more severe/chronic cases
What is the diagnosis and treatment of Purpura/Vasculitis?
Periodic outbreaks of painful vesicles on an erythematous base Oral and genital variants are most common Can also occur on the body (gladiatorum), fingertips (whitlow)
What is the presentation of Herpex Simplex?
Infection with HSV1 or 2 Spreads by direct contact (including sexual)
What is the etiology of Herpes Simplex?
Diagnosis: Clinical; antigen/antibody testing Treatment: Antivirals such as acyclovir and valacyclovir.
What is the diagnosis and treatment of Herpes Simplex?
Extremely painful, grouped vesicles on a red base in a dermatomal distribution Prodrome rash neuralgia
What is the presentation of Herpes Zoster (Shingles)
Reactivation of VZV after lying dormant in the DRG following primary exposure Most common after age 60
How do we diagnose and treat Herpes Zoster (Shingles)?
Flesh-colored, hyperkeratotic, verrucous papules
What is the presentation of Warts?
Benign epidermal proliferation caused by HPV infection Spread by direct contact
What is the etiology of Warts?
Diagnosis: Clinical Treatment: Many regress without treatment Topical salicylic acid or imiquimod Cryotherapy Intralesional candida or bleomycin
What is the diagnosis and treatment of Warts?
Firm, smooth, pearly flesh-colored papules with central umbilication Anywhere on the body except palms/soles
What is the presentation of Molluscum Contagiosum?
Poxvirus infection Spread by direct contact (including sexual) & fomites Risk factors: kids, immunosuppressed adults
What is the etiology of Molluscum Contagiosum?
Diagnosis: Clinical Treatment: Imiquimod, tretinoin, catharidin Curettage, cryotherapy, laser Fish oil, vitamin E, vitamin C, zinc, Echinacea, goldenseal
What is the diagnosis and treatment of Molluscum Contagiosum?
Paramyxovirus infection Highly contagious Morbilliform rash which spreads from the head down Koplik spots, fever, cough, conjunctivitis
What is the presentation and etiology of measles?
Measles (Showing koplik spots)
Varicella (VZV) infection Highly contagious, and is more severe in the older & immunocompromised Papules vesicles crusted erosions Fever, conjunctivitis, GI symptoms
What is the presentation and etiology of Chicken Pox?
Contagious Confluent pink macules and fine papules that start on the face & spread to the trunks/extremities Fever, malaise, runny nose, joint pain, & swollen lymph nodes Complications include encephalitis, blindness, birth defects
What is the presentation and etiology of Rubella?
Kids infected w/coxsackie virus Small, painful red vesicles on the palms, soles, and oral mucosa Fever, sore throat, headache, loss of appetite
What is the presentation and etiology of Hand and Mouth Disease?
AKA erythema infectiosum Parvovirus B19 infection Red, maculopapular rash on the trunk and extremities, and "slapped-cheeks" Fever, malaise, arthritis in adults
What is the presentation and etiology of Fifth Disease?
Diagnosis: Clinical Treatment: Rest, fluids, acetaminophen Calamine, capsaicin, antihistamines if itchy Lysine, chamomile, peppermint, aloe, burdock root, lemon balm, licorice, Madonna lily, vitamin A Prevent spread of infection
What is the diagnosis and treatment of VIral Exanthems?
Recurrent dermatitis in photo- distribution 2 hours-5 days following sun exposure Polymorphous rash, huge variety of morphologies Burning, itching, & discomfort May also have chills and headache
What is the presentation of Polymorphous Light Eruption?
Delayed hypersensitivity reaction to a compound in the skin that is altered by UV light (especially UVA) Runs in families Most common in 20-40 y/o females
What is the etiology of Polymorphous Light Eruption?
Diagnosis: Clinical Treatment: Sun protection and avoidance Topical steroids, antihistamines Hydroxychloroquine in severe cases
What is the diagnosis and treatment of Polymorphous Light Eruption?
Excessive, uncontrollable sweating Can be localized (i.e. palms, soles, axillae) or generalized May result in scaling, maceration, cracks/fissures
What is the presentation of Hyperhidrosis?
Overactivity of the hypothalamic thermoregulatory center
What is the etiology of Hyperhidrosis?
Diagnosis: Clinical Treatment: Topical aluminum chloride, oral glycopyrrolate Iontophoresis, botox injections Surgery for very severe cases (sympathectomy)
What is the diagnosis and treatment of Hyperhidrosis?
Health and the Older Person Midterm and Final104 terms