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Derm non specific
Terms in this set (50)
Mucocutaneous blistering reactions often caused by drug reactions (just a few) Sulfonamides, aminopenicillins, cephalosporins, tetracyclines, phenobarbital, allopurinol, corticosteroids.Dangers; Secondary infection, fluid loss, e-lyte imbalance
Toxic erythema necrolysis (TEN), Steven Johnson syndrome
SJS is a severe variant of what?
progression to diffuse erythema, morbilliform lesions, necrotic epidermis, sheet like loss of epidermis is what? (nik is the gross kid in class who always eats his skin)
TEN and SJS present as what?
fever, photophobia, sore throat, mucosal inflammation, sore mouth the cutaneous lesions (pt. will c/o stinging sores) tend to be concentrated on the trunk initially.
What tests would you look at to diagnose SJS?
Lab studies/diagnostics look for anemia (CBC) and lymphopenia (CBC, Diff.) biopsy of lesions for diagnosis (pathology will demonstrate disruption in the dermal- epidermal junction).
You decide to give cortico steroids for a patient w/ SJS. When shold you administer them?
Early (within hours), or else it will exacerbate the illness.
How else should you treat SJS? Where should you send them?
immediate discontinuation of the causative agent. (getting a good HPI, PMH) transfer to the burn unit for skin care fluid resuscitation (IVF) electrolyte management
May be induced by drugs (similar to SJS and TEN)
Almost 50% of cases are patients less than 20 years old. Clinical features
Lesions start as macules>> become papular>> then vesicular >> bullae Hand and feet or generalized lesions Mucosal lesions (Hallmark of EM) are painful and erode Fever, weakness, malaise Treatment
1-3 mm flat, wingless with 3 pair of legs. The female can lay 300 nits in her lifetime
Nits are opalescent and found in the hair shafts
Transmission: person to person contact or contaminated clothing
Pruritus will cause the patient to what?
itch and cause excoriation
Will you always see the lice on the hair?
You see red-brown specs in the hair. What is this evidence of?
How to diagnose lice?
visualize under microscope
WHen someone is diagnosed as having head lice, who should be treated?
Everyone in the house
What are topical treatments for lice? (marathon on lyndale for meth)
What is the oral treatment for lice? (Eat some ivy)
What is a mechanical treatment for lice?
a lice removal comb
You should reccommend your lice patients should get what done in 7-10 days
Reapplication of treatment
Caused by Sarcoptes scabiei var. hominis One third mm in length Flat, oval body with 8 legs Any age but unusual for infants less than 3 months. Highly contagious. Itching worse at night. Live in the skin in web between toes and finger, axillary, belly, high temps. S shaped/straight lesions. Diagnose through scrapings, microscop finding. 1% lindane lotion. (I got scabies on lyndale)
What are the two common spiders in US that cause reaction?
Black Widow and Brown Recluse
Mild erythema or edema at the bite site. May have red-brown fang marks. Sever cramping abdominal pain, HTN, muscle complaints, irritability, agitation. Treat w/ Ice to the bite site
Antivenom for acute s/s
Local hive-like reaction followed by cyanosis and expanding necrosis. Systemic symptoms of fever, chills, vomiting, weakness and muscle/joint pain Treat extensive necrosis with local wound care ATB (molly the hot head recluse gets so drunk she pukes on you )
Thickened, velvety hyperpigmentation of the flexural skin. Primarily the posterior neck folds, axilla and antecubital fossa. Associated with obesity, insulin resistance and diabetes. Associated with adenocarcinoma of the GI/GU tract. Caused by medications like Estrogens andNicotinic acid. Treat w/ lactic acid to burn top layer of skin.
Inflammatory disorder of the apocrine gland-bearing skin; axillae and anogenital regions. Seen after puberty in females. Treat large cyst by cutting open and draining or for small cyst, broad term antibiotic. Topical clindamycin.
Can be mistaken for migratory melanoma. Located on trunk, soft symettrical and easily movable. May be removed for cosmetic reasoning.
Acquired brown pigmentation of the face and neck, More common in women with darker skin, In second and third trimester of pregnancy, On oral contraceptives, Extensive sun exposure, Genetically predisposed females (m' lady has dark skin, and she is on birth control w/ a nice tan). Treated w/ skin bleachers. avoid UV light
Less than 6 weeks, person has asthma, due to histamine (IgE). Hives (Ur tic gave me hives)
Lasts longer than 6 weeks, could be a chronic infection causing it such as thyroid, lupus, bacterial infect, drug inject, dusts, foods (ingestants, inhalants, injections infections internal disease)
Brief attacks of urticaria induced by physical stimuli. The event lasts for 1-6 hours. Produced by rubbing of the skin, pressure, overheating from exercise, sudden drop in temp, exposure to UV light
Physical causes of Utricaria
Pruritis, plaques are pink/red colored Non pitting, edamatous. few mm to several cm. Linear lesions.
Clinical manifestations of urticaria
When they don't respond to antihistamines, use what?
cortico steroids everywhere but Face due to thinning of the skin.
What is first drug used in anaphlyactic reaction?
Age 20 is onset, due to loss of pigmentation. Fairly symmetric pattern of white, depigmented, 0.5 to 5.0 cm macules and patches. Common location include dorsal hands, fingers, face, body folds, axillae and genitalia. In multiple places
Type A vitiligo
Vitiligo limited to 1 place
Vitiligo type B
1. Narrow band UVB
2. Psoralen plus phototherapy
Goals are repigmentation
Treatment for vitiligo
Prodrome of urticarial or papular lesions
Bullae are large, tense, oval and contain serous fluid or hemorrhagic fluid; rupture easily
Bullae collapse and crust
Axillae, thighs, groin, abdomen
Diagnose w/ skin biopsy, treat w/ systemic prednisone or azathiprine (immune suppressor)
Angular cheilitis is typical. Diagnose w/ KOH prep. Treat w/ clotrimazole, oral nystatin, clotrimazole. Swallow the mouth wash because it could be infecting the esophagus.
Can be due to cellulitis, erysipelas, impetigo, furuncles, carbuncles. Inflammation of the skin. Upon infectionm, need to perform a blood test in case the bacteria has gone systemic (would see elevated neutrophils). Treated w/ saline dressings, moist heat. May use surgery to incise necrotizing cellulitis. Treat w/ antibiotics for 10-30 days.
Cellulitis w/ superficial skin lymphatics. Uually GAS. Redness, in breach to skin. Usually on skin. Perform CBC, blood culture. Treat w/ penicillin for at least 10 days. Diagnose by palpating lymph
Honey crsted, staphylococci versus streptococci. Most frequent on face around mouth and nose, or at site of trauma. Slow, indolent. Tender red macule. Thin roofed pustule, weeping. bullae. Remove crusts, clean twice a day. Erythromycin, mupirocin, dicloxacillin
acute abscess of hair follicle which expands. Central pustule on lesion. Pus drains spontaneously. cloxacillin, dicloacillin. Erythromycin (has GI effects).
Furnuncles and Carbuncles.
Due to HPV, Single or multiple papular eruptions. pearly, filiform, fungating. verrucous or lobulated. Diagnose w/ acetowhitening (will turn white). Treat w/ cryotherapy, electro desiccation, cureettage, surgery.
Treat w/ valtrex, fluid filled blister, fever, headache, muscle ache, fatigue.
unilateral following of the dermatome.
Initially erythematous and maculopapular that evolves rapidly to grouped vesicles. Resolution of rash with crusts separating by 14 to 21 days
AcuteHerpes (varicella) zoster
Postherpetic neuralgia (15% overall; increases dramatically with age). A small percentage (1-5%) may affect the motor nerves causing weakness.
chronic H. Z
How to treat shingles?
Control pain, Acetaminophen, Acetaminophen with Codeine. Prevent w/ zostrix vaccine
Common virus due to poxvirus, common in children. In groin and lower extremities. Dome shaped and waxy. Get skin biopsy. Self limiting. Can appear in clusters.
Due to HPV, usually go away. cutaneous and mucosal epithelium. Treat w/ salicylate acid, TCA (burning chemical).
Incubation is 10-21 days. Cantagious 1-2 days before presentation of a rash until rash crusts over. fever, abdominal pain, rash, headache, malaise, anorexia. Leukopenia in first 3 days, Marked leukocytosis may indicate a secondary bacterial infection but is not a dependable sign. Draw ALT to check for hepatitis.
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