Derm-3b

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Author:
atmu
ID:
174486
Filename:
Derm-3b
Updated:
2012-10-01 00:47:18
Tags:
Derm
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Description:
Derm-3b
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  1. Erythrasma
    -predisposition
    • Caused by Corynebacterium minutissim in mostly older adults
    • -Predisposition: DM, hyperhidrosis, obesity, and inadequent hygiene
  2. Erythrasma
    -PE
    -Dx
    -Tx
    • -PE: sharply delineated dry brown scaling patches
    •    *usually asymptomatic
    •    *occurs in axillary regions, groin, between toes
    • -Dx: Wodds lamp - coral red fluorescence
    • -Tx: topical Abx - erythromycin, PO Abx
  3. Syphilis
    -Clinical stages
    • caused by Treponema pallidum -- spirochete; STD
    • -Clinical stages 
    • 1. Primary - painless ulcer on genitalia (can be found on perianal, rectum, pharynx, tongue, or lip; 2-6 weeks after exposure); Tests: STS and Darkfield microscopy
    • 2. Secondary - generalized maculopapular rash, mucosmembrane lesions, patches on palms and soles
    •    *Condyloma lata - moist skin areas
    • 3. Tertiary
    •     a) systemic destruction of aorta and brain
    •     b) skin lesions -- infiltrates--tumors of skin
    •     c) gummas -- ulcerated lesions
  4. Herpes Simplex Virus facts
    • 1. occurs mostly in young adults
    • 2. incubation period 2-20 days (avg=6) for primary infection
    • 3. virus ascends regional nerve ganglia and remains for life
  5. Non-Genital HSV
    -Primary
    -Recurrent
    -Labs
    -Tx
    • -Primary: most asymptomatic; symptomatic w/ vesicles, crusing, lymphadenopathy; vesicles, erosions at oral mucosa
    • -Recurrent: prodrome of tinging, burning, or itching before skin lesions by 24 hrs; can be triggered by sunlight, irritation, fever, altered immune states
    • -Labs: Tzanck Smear -- giant cell
    • -Tx: antiviral (acyclovir), topical drying agents, Serology, Dermatopathology
  6. Genital HSV
    - same durations as non-genital
    -Dx (primary and recurrent)
    -Labs
    -Tx
    • HSV-2 > HSV-1
    • -Primary:
    • *Dx: erythematous plaque w/ vesicles, pustules (males on dicks, girls on vag)
    • -Recurrent:
    • *Dx: lesions are similar to primary but less severe
    • -Labs: Tzanck Smear, Antigen Detection, Serology, Dermatophathology
    • -Tx: antivirals (acyclovir); for recurrent-systemic antivirals
  7. Molluscum Contagiosum
    -Sx
    -Dx
    -Tx
    • -Comes from Molluscum Contagiosum virus (MCV) poxvirus
    • -Seen in children and sexually active adults
    • -HIV infected ppl may have hundred of lesions
    • -Sx: waxy dome shaped papules w/ dimple in middle
    • -Dx: smear of keratotic plug--Giemsa stain; dermatopathology
    • -Tx: curettage, cryosurgery, electrodiseccation, avoid contact
  8. Human Papilloma Virus (HPV)
    -Types of warts (4)
    • -double stranded DNA, transmitted by skin to skin contact
    • Types of warts:
    • 1. Common Warts (Verruca vulgaris) (you know these!) -- palmar ones are "red dots"
    • 2. Plantar warts (Verruca Plantaris)- small shiny papule, later plaque w/ rough hyperkeratotic surface; black dots-thrombosed vessels
    • 3. Flat warts (Verruca Plana) - sharply defined, flat, round papules
    • 4. Genital (Condyloma Accuminata) - sexually transmitted; small papules 
  9. HPV treatments
    -Non-genital
    -Genital
    • -Non-genital
    • 1. keratolytics
    • 2. liquid nitrogen
    • 3. electrodissecation
    • -Genital
    • 1. podophylum-podophilox
    • 2. BCA,TCA
    • 3. electrodissecation
    • 4. cryosurgery
    • 5. immunqoid
    • 6. laser
  10. Types of acne:
    -Tx
    • 1. Comedonal
    • 2. Nodulocystic
    • 3. Papulopustular
    • -Tx
    • 1. antibacterial soaps
    • 2. cleansers (salicyclic acid/BPO)
    • 3. retinoids (topical/oral)
    • 4. antibiotics (topical/oral)
    • **combination therapy is the most effective**
  11. Rosacea
    -Sx
    -Tx
    • -vascular disorder characterized by papules that occur in the T-zone
    • -Sx: flushing, inflammatory papules, erythema, sebacious hyperplasia (Rhinophyma=tommy lee jones)
    • -Tx: Abx, pulse dye laser (erythema), Accutane, Ocular Rosacea
  12. Hidradenitis Suppuritva
    -Sx
    -
    Tx
    • Chronic suppurative disease of apocine gland bearing skin (axilla, anogenital region)
    • -Sx: red, tender nodule or abcess w/ purelent drainage; "Double comedones"; can develop tracts with fibrosis
    • -Tx: systemic Abx, steroids, surgery, isotretinoin
  13. Alopecia Areata
    -Types (2)
    • -Autoimmune disease
    • -rapid onset, total hair loss (no follicles) that's well demarcated (usually round)
    • Types:
    • 1. Alopecia totalis - loss of all head hair
    • 2. Alopecia universalis - loss of all body hair
  14. Vitiligo
    -Labs
    -Tx
    • MJ disease
    • -Labs: thyroid antibodies, CBC, ANA, fasting BS
    • -Tx:
    •     *repigmentation: (1) NBUVB - narrow band UVB; (2) topical steroids / Tacrolimus
    •     *depigmentation: Monobenzone
  15. Melasma
    -Tx
    • Symmetrical hyperpigmentation of sun exposed areas
    • -Tx: 
    • 1. Hydroquinon cream - bleachiing agent
    • 2. Tretinoin cream - acne medicine; hope to flake off pigmentation
    • 3. Kojic and ascorbic acid - lightening gels/creams
    • azelaic acid, chemical peels, laser
  16. Wet Dressings
    -Uses for
    -Action
    • -Uses
    • 1. poison ivy
    • 2. herpes zoster
    • 3. herpes simplex
    • 4. bullous impetigo
    • 5. eczema
    • -Action
    • 1. antibacterial solution (aluminum acetate, acetic acid)
    • 2. woud debridement (compress and remove crusts/vesicles)
    • 3. inflammation suppression (cooling effect)
    • 4. drying effect (cycles of weetnig and rying make it weep)
  17. Clobex bold points (5)
    • 1. Adverse reactions (burning pruritis, dryiness, pain, hyperpigmentation, irritation, atrophy)
    • 2. Do not use on pts under 18
    • 3. Do not use longer than 4 consecutive weeks
    • 4. Should not be used on face, groin, axillae
    • 5. Use with caution in pregnant women
  18. Adverse effects of topical steroids (5)
    • 1. Local reactions (infection, irritation, atrophy, thinning)
    • 2. Striae
    • 3. Purpura (red spots from local hemorrhage)
    • 4. Telangectasia (red lesions from dilation of capillaries)
    • 5. Systemic toxicity w/ prolonged therapy (growth retardation in children, adrenal suppression)
  19. Calcineurin Inhibitors (2)
    • 1. Tacrolimus -reduce inflammation by reducing mast cell and basophilc; low systemic absorption, well tolerated
    •     *sensitizes skin to UV light; must avoid light and use suncreen!
    • 2. Pimecrolimus - same action

    • -interfere w/ activation of T-cells which trigger immune response to atopic dermatitis and eczema
    • -risk for skin cancer and lymphoma
    • -only for patients that have no responded to other therapies; not for pregnancy!
  20. Retapamulin Ointment 1% (Altabax)
    • -New class of topical antibacterial
    • -for impetigo caused by S.aureus or S.pyogenes

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