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Erythrasma
-predisposition
- Caused by Corynebacterium minutissim in mostly older adults
- -Predisposition: DM, hyperhidrosis, obesity, and inadequent hygiene
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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
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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
-
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
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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
-
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
-
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
-
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
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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
-
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**
-
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
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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
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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
-
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
-
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
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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)
-
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
-
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)
-
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!
-
Retapamulin Ointment 1% (Altabax)
- -New class of topical antibacterial
- -for impetigo caused by S.aureus or S.pyogenes
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