Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Dermatology 1st Year Handwritten Notes, 2nd Year Handwritten Notes, 3rd Year Handwritten Notes & Final Year Handwritten Notes (Lecture Notes)
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Eczema (Atopic Dermatitis) (1)
? Eczema is associated with asthma and al ergic
rhinitis
? Erythema, crusts, fissures, pruritis, excoriations,
lichenification
? Chronic pruritic skin condition
? Infants: Blisters, crusts, exfoliation (face, scalp,
extremities),1st few months. Resolves by age 2
? Adults: Dryness and thickening in antecubital and
popliteal fossae, neck
? Positive family history, worse in winter (dry
weather)
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Eczema (Atopic Dermatitis) (2)
? Treatment: corticosteroids, antipruritics
? Complications
?2? bacterial infection (treat with antibiotics)
?Eczema herpeticum: Widespread HSV infection
in patients with underlying atopic dermatitis
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Eczema (Atopic Dermatitis)
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Med-Chal enger ? EM
Eczema (Atopic Dermatitis)
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Eczema (Atopic Dermatitis)
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Eczema (Atopic Dermatitis)
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Med-Chal enger ? EM
Allergic Contact Dermatitis
? Delayed type hypersensitivity
? Poison ivy, poison oak, poison sumac (linear
extension)
? Contact with metal jewelry (nickel)
? Hair dyes, detergents
? Erythema, pruritus, vesicles, bul ae
? Blister fluid contains no antigen
? Corticosteroids for severe cases
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Contact Dermatitis
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Med-Chal enger ? EM
Contact Dermatitis
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Contact Dermatitis
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Contact Dermatitis
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Poison Ivy
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Exfoliative Dermatitis (1)
? Generalized dermatitis, diffuse, scaly, warm,
erythematous, non-tender, pruritic
? Leads to exfoliation
? Most are secondary to underlying disease
? Involves most or al of skin
? Flares of pre-existing skin disease (psoriasis,
atopic dermatitis etc.)
Differential: SSSS, EM, TEN ,TSS
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Exfoliative Dermatitis (2)
? Response to drugs, chemicals, systemic
disease or malignancy (lymphoma, leukemia)
? May be acute, subacute or chronic
? Typical y males over 40
? Complications are 2? to disruption of epidermis
?Hypothermia, volume loss, electrolyte
abnormalities, 2? skin infection
? Important to diagnose underlying cause
? Admit, IV, steroids for severe cases
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Exfoliative Dermatitis
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Psoriasis
? Chronic papulosquamous eruption
?Due to more rapid cel cycle
? Erythematous plaques with white (silver)
scales
? Extensor surfaces of elbows, knees, scalp,
palms, soles
? Pitting of the nails
? May be accompanied by psoriatic arthritis
? Treatment: steroids, tar, UV light, methotrexate
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Psoriasis
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Psoriasis
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Psoriasis
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Seborrheic Dermatitis (Dandruff)
? White, yel ow, waxy scales with erythema
? Localized to hairy skin areas
? Scalp, eyebrow, ear, axil a, groin (wherever
there are sebaceous glands)
? Malassezia furfur (a fungus) is associated
? Not contagious
? Frequent recurrences, worse in cold weather
? May be severe or generalized in HIV positive
patients
? Treatment: Rotating antidandruff shampoos,
ketoconazole shampoo or cream; steroids are
discouraged
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Seborrheic Dermatitis
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Seborrheic Dermatitis
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Pityriasis Rosea
? Children, young adults, spring and fal
? Etiology unknown
? No epidemics, not contagious
? Rash evolves over weeks
?Herald patch: Single salmon-colored lesion with
raised boarder on trunk, 1?5 cm
?1-2 weeks after herald patch: Widespread
eruption, pink maculopapular oval patches that
fol ow the ribs ("Christmas tree" pattern)
? Rule out syphilis (if clinical y indicated), drug
reaction
? Treatment: Symptomatic, antihistamines
? Resolution in 2-10 weeks
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Pityriasis Rosea
Christmas
Tree
Pattern
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Pityriasis Rosea
Herald Patch
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Med-Chal enger ? EM
Pityriasis Rosea
Herald Patch
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Petechiae / Purpura
? Deposits of blood under skin
? Non-blanching
? Petechiae <3 mm, purpura >3 mm
? Non-palpable: Platelet disorder,
thrombocytopenia
? Palpable purpura = Vasculitis
? Treatment: Antibiotics, steroids,
plasmapheresis (depends on etiology)
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Petechiae / Purpura
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Petechiae / Purpura
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Urticaria
? Diffuse pruritus, wheals, hives
(superficial dermis)
? Etiology is unknown most of time
? IgE mast cel s histamine release
? Usual y self-limited
? Treatment: Antihistamines, steroids,
antipruritics, H2 blockers, epinephrine
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Urticaria
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Urticaria
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Angioedema (1)
? Bradykinin-mediated
? Vasodilation
? Vascular permeability
? Edema of the deeper dermis
? Common cause: ACE inhibitors
?ACE inhibitors decrease metabolism of
bradykinins
?Can occur early or late
? 2/3 occur in hours
? 1/3 in months to years
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Angioedema (2)
? Familial - associated with C1 esterase inhibitor
deficiency
? C esterase inhibitor inhibits complement
1
cascade
?Deficiency leads to increased bradykinin
? Edema of face, extremities, bowel wal
? Responds to fresh frozen plasma and C1
esterase inhibitor concentrate
? Autosomal dominant (positive family history)
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Angioedema
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Erysipelas
? Infants, toddlers, elderly
? Usual y Group A Strep, occasional y Staph
? Superficial cel ulitis, lymphangitis
? Localized (face, legs, ear)
? Butterfly facial rash (warm and tender)
? Raised, well demarcated border
? Treatment: PCN, dicloxacil in, erythromycin
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Erysipelas
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Erythema Nodosum (EN)
? Painful, non-ulcerative, violaceous nodules
(localized vasculitis) on anterior tibia, arms,
trunk
?Looks like erythema, feels like nodes
? EN is often a marker for systemic disease
?Drug reaction (oral contraceptives, sulfa, PCN)
?Systemic infection (TB, fungal)
?Sarcoid
?Inflammatory bowel disease (ulcerative colitis)
?Malignancy (leukemia, lymphoma)
? Most common in women 30-50
? Resolves in 3-6 weeks
? Treatment is directed at underlying disease 39
Erythema Nodosum
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Erythema Nodosum
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Drug Eruption
? Consider in any acute, symmetrical eruption
? Common: PCN, cephalosporins, sulfa
? Usual y disappears within 1-2 weeks
? Immediate hypersensitivity: IgE (urticaria)
? Delayed hypersensitivity: IgM (serum sickness)
? Urticaria, morbil iform rash (discreet red-brown
papules coalesce to erythema), erythema
multiforme
? Treatment: Discontinue drug, antihistamines,
steroids
? Complications: Stevens-Johnson syndrome
(mucosal and cutaneous), Severe bul ous
(form can be fatal)
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Erythema Multiforme
? Minor (erythema multiforme) EM major
(Stevens-Johnson) EM maximum (TEN)
? Hypersensitivity reaction
?Infection (Mycoplasma, Herpes), malignancy,
drugs
?Sulfa, oral hypoglycemics, anticonvulsants, PCN
(memory aid: "SOAP")
? Palms, soles, extensor surfaces
? "Bull's eye" or "target" lesions
? Treatment: Remove offending agents;
symptomatic for minor forms; major forms may
need resuscitation, ICU admission
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Erythema Multiforme
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Erythema Multiforme
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Stevens-Johnson Syndrome
? Severe bul ous form of EM, 10-30% of BSA,
mucosal involvement, can be fatal
? Bul ous cutaneous lesions, mucositis,
stomatitis, conjunctivitis, crusted nares
? Children, adolescents, males
? Serious, potential y fatal form of E. multiforme
?Hypersensitivity reaction
?Severe reaction to medication: Sulfonamides
PCN, barbiturates, phenytoin, tetracycline,
thiazides
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Stevens - Johnson Syndrome
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Stevens - Johnson Syndrome
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Toxic Epidermal Necrolysis (TEN) 1
? Erythema multiforme, Stevens-Johnson
syndrome and TEN
?Probably variants of the same disease process.
The difference is in severity and body surface
area affected
?TEN affects >30% of BSA
? Exposure to drugs, chemical agents, infections
?Sulfa, PCN, barbiturates, phenytoin, al opurinol,
NSAIDs
?Mycoplasma, HSV
? Toxic patient, large bul ae, mucous membranes,
widespread systemic manifestations
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Toxic Epidermal Necrolysis (TEN) 2
? Separation of dermal-epidermal junction
? Nikolsky's sign: Skin peels off with light
pressure
? Older age group has high mortality
? Increased mortality from dehydration and 2?
infection
? Primary causes of death: Sepsis, pneumonia
? Treatment: Admit to ICU
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Toxic Epidermal Necrolysis
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Toxic Epidermal Necrolysis
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Toxic Epidermal Necrolysis
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Staphylococcal Scalded Skin Syndrome
? Usual y children <2 years old
? Staph aureus exotoxin
? Fever, scarlatiniform rash fol owed by
exfoliation
? Nikolsky's sign: Skin peels off with light
pressure
? Antibiotics (vancomycin) indicated, but do not
alter cutaneous disease
? More favorable prognosis than TEN
? Steroids are contraindicated
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Staphylococcal Scalded Skin Syndrome
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Med-Chal enger ? EM
Staphylococcal Scalded Skin Syndrome
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Pemphigus Vulgaris
? Painful intradermal bul ae, 40-60 years old,
possible autoimmune etiology
? Associated with penicil amine, captopril,
phenobarbital
? Bul ae appear on normal skin, often start in mouth
? Blisters are fragile, break easily, leave red or
crusted erosions
? Mucus membranes are frequently involved
? Smal flaccid bul ae erosions, ulcerations
? Nikolsky sign positive (like TEN)
? Can be lethal: Mortality due to secondary
infection, dehydration
? Treatment: Steroids, admission, biopsy
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Pemphigus Vulgaris
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Pemphigus Vulgaris
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Bullous Pemphigoid
? Chronic benign bul ous eruption. Autoimmune
disease
? Risk factors: Age > 60, female, malignancy,
furosemide (Lasix)
? Begins with urticarial lesions, then tense blisters
up to 10 cm
? Large bul ae (2-5 cm) arise from erythematous skin
? Mucus membranes infrequently involved
? Nikolsky sign negative
? IgE deposited on basement membrane
? Course is usual y benign. Mortality much less than
in pemphigus
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Bullous Pemphigoid
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Pemphigus Vulgaris
Bullous Pemphigoid
? Fragile, smal er blisters
? Tense, larger blisters
? Painful
? Chronic
? Can be lethal
? Benign
? Positive Nikolsky's
? Negative Nikolsky's
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Basal Cell Carcinoma
? Most common skin malignancy
? Pearly, rolled border with central ulceration
? Not a metastasizing tumor
? Slow growing, usual y head and neck
? Seen only where hair fol icles exist
? Cure rate 100% if found early
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Basal Cell Carcinoma
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Basal Cell Carcinoma
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Malignant Melanoma
? Increasing incidence
? Ages 30-50
? Risk factors: Adulthood, dysplastic nevi, family
history of melanoma, fair skin, UV exposure,
congenital nevi
? Account for majority of deaths due to skin
cancer
? Sun exposed areas (head, neck, trunk)
? The greater the depth, the worse the prognosis
? Metastases are common
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Malignant Melanoma
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Malignant Melanoma
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Squamous Cell Carcinoma
? Second most common cutaneous malignancy
? Common in elderly males, fair skin, sun
exposure
? Face, lips, ears, tongue, hands
? Rapid growth, central ulcer, raised and
indurated border
? Metastases occur early
? Treatment: Excisional surgery, radiation
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Squamous Cell Carcinoma
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Squamous Cell Carcinoma
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Tinea (Dermatophytosis) (1)
? Tinea capitis (scalp) and tinea barbae (beard)
?Bald, broken hair
?Scaly patch
?Edematous nodules and pustules (kerion)
? Tinea corporis (ringworm)
?Non-hairy parts of the body, outward
spreading, annular lesion, clear center
? Tinea pedis (athlete's foot)
? Tinea cruris (jock itch)
?Groin and inner thigh (sharp demarcation)
?Scrotum not involved
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Tinea (Dermatophytosis) (2)
? Causes: Trichophyton, Microsporum,
Epidermophyton
? Treatment: Antifungal (topical or oral)
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Tinea
Capitis
Corporus
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Tinea Cruris
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Tinea Versicolor
? Hypopigmented or
hyperpigmented
circular, scaly patches
? Poor hygiene, moisture
? Malassezia furfur
? Treatment: Selenium
shampoo,
ketoconazole shampoo
or cream
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Spirochetes
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Leptospirosis
? Pathogenic spirochete
? Reservoirs: Rats, cattle, pigs, dogs
? Skin contact with urine of infected animal
? Contaminated water
? Hepatitis, nephritis, meningitis, coagulopathy
? Weil's disease (severe form): Jaundice,
subconjunctival hemorrhage, hepatitis, DIC
? Risk of death from hepatorenal failure
? Diagnosis by serology
? Treatment: Pen G, tetracycline, doxycycline 78
Lyme Disease (1)
? Borrelia burgdorferi (spirochete)
? Transmitted by bites of Ixodes ticks
? Tick reservoirs: Rodents, rabbits, deer
? Most do not recal tick bite
? Fever, myalgias, arthralgias, headache
? 3 stages
? Localized (rash)
? Disseminated (neurologic and cardiac)
? Persistent (arthritis)
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Lyme Disease (2)
? Erythema migrans: Annular, expanding
erythematous lesion with central clearing
(spares palms, soles)
? Neuro: CN VII palsy, meningitis, peripheral
neuropathy
? Cardiac: Myocarditis, pericarditis, heart block
? Diagnosis: ELISA (screening); Western blot
? Treatment: Doxycycline, amoxicil in,
cefuroxime; macrolides if others not tolerated
? Probable risk = Test
? Probable disease = Treat
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Lyme Disease
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Lyme Disease
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Lyme Disease
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Meningococcemia (1)
? N. meningitidis (encapsulated Gram
negative diplococcus)
? Broad spectrum of disease
?Bacteremia, sepsis, meningitis
? Fever, myalgias, headache, rash
? 1-2 mm petechiae purpura
? Poor prognosis if petechiae, hypotension,
T> 40 ?C, decreased platelets, no
meningismus or leukocytosis
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Meningococcemia (2)
? Prophylaxis: Close contacts, nursing home,
dormitory, family
?Prophylaxis is not indicated for brief hospital
encounter (ER patient, no close contact)
? Rifampin, Cipro for prophylaxis
? Diagnosis: CSF and blood serology, cultures
? Treatment: PCN, chloramphenicol, isolation
Waterhouse-Friderichsen syndrome:
shock, petechiae, adrenal infarction
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Meningococcemia
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Meningococcemia
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Necrotizing Soft Tissue Infections(1)
? Virulent, toxin-producing bacteria
? Often seen with IVDU
? Widespread fascial and muscle necrosis,
sparing of skin
? Crepitant anaerobic cel ulitis (necrotic soft
tissues, subcutaneous gas)
? Myonecrosis (clostridial, non-clostridial)
? Necrotizing fasciitis (rapid dissection and
necrosis in superficial and deep fascial
planes)
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Necrotizing Soft Tissue Infections(2)
? Necrotizing fasciitis
?"Flesh-eating" bacteria
?Strep, clostridia, polymicrobial
?"Pain out of proportion" is hal mark
?Surgical emergency
?Pen G + imipenem, or amp + gent + clinda
?Fournier's gangrene: Necrotizing fasciitis
involving scrotum, vulvar or perianal skin
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Necrotizing Soft Tissue Infections
Subcutaneous Air
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Necrotizing Soft Tissue Infections
Necrotizing Soft Tissue Infections
Subcutaneous Air
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Methicillin Resistant
Staph aureus (MRSA) (1)
? Hospital acquired MRSA
?Hospitalized, dialysis, IVDU, nursing home
? Community acquired MRSA
?Skin and soft tissue infections
?High prevalence in many areas
?Resistant to beta-lactam antibiotics
?Milder infections: Trimethoprim/
sulfamethoxazole or clindamycin
?Serious infections: Vancomycin or linezolid
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Methicillin Resistant
Staph aureus (MRSA) (2)
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Toxic Shock Syndrome
? Staph aureus exotoxin
? Prolonged tampon use, packed surgical
wounds, nasal packing
? Menstruating females, postpartum, also in
males
? Fever, hypotension
? Rash: Diffuse, erythematous, nonpruritic,
macular
? Involvement of at least three systems
?Renal, hepatic, hematologic, GI,
musculoskeletal, mucosal, CNS
? Treatment: Fluids, remove source, antibiotics
? Group A Strep variant (higher mortality)
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Tick-Borne Infections
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Rocky Mountain Spotted Fever (RMSF)(1)
? Rickettsia rickettsii (obligate intracel ular
bacterium)
? Bite from infected tick
? Most cases seen in April-September (tick
season)
? Commonly seen in children <15
? Endemic in Southeastern US
? Fever, headache, myalgias
? Smal pink macules petechiae, purpura
(from a vasculitis) / (wrists, ankles)
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Rocky Mountain Spotted Fever (RMSF)(2)
? Rash begins on extremities, wrists, ankles,
palms and soles
? Spreads up trunk, spares face
? Lab: WBC count normal, left shift, mild anemia,
moderate thrombocytopenia, hyponatremia
? Diagnosis: Clinical (don't wait for serology tests)
? Treatment: Doxycycline preferred, chloramphenicol
? Complications (due to vasculitis)
?DIC
?Loss of limbs
?CNS
?Lungs
?Kidneys
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Rocky Mountain Spotted Fever
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Rocky Mountain Spotted Fever
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Ehrlichiosis
? Clinical presentation similar to rocky mountain
spotted fever
? Transmission through tick bite
? Two types
?HME: human monocytic
?HGE: human granulocytic
? Fever, headache, myalgias
? Maculopapular rash
? Leukopenia, thrombocytopenia, hyponatremia,
anemia, LFTs
? Diagnosis: Clinical suspicion
? Treatment: Doxycycline, tetracycline,
chloramphenicol
? Complications: DIC, renal failure, coma, death 100
Babesiosis
? Tick-borne hemolytic disease, blood
transfusions
? Intra-erythrocyte protozoan parasite
? Endemic to northeastern USA
? Fever, chil s, fatigue, malaise
? Hepatosplenomegaly, jaundice
? Peripheral blood smear -- parasites in RBCs
? Usual y mild unless asplenic, elderly, or
immunosuppressed
? Treatment: Quinine plus clindamycin;
Atovaquone plus azithromycin
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Viral Infection
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Cytomegalovirus (CMV)
? A member of the herpes virus group (dormant
until reactivated)
? The most common of the TORCHES infections
? Congenital: Chorioretinitis, jaundice,
hepatosplenomegaly, deafness, rash
? Acquired: Asymptomatic or mono-like il ness
? Immunocompromised: CMV retinitis, nephritis,
pneumonitis, colitis. Carries high mortality
? Diagnosis: Atypical lymphocytosis, ELISA
? Treatment: IV ganciclovir or foscarnet
TORCHES
Toxoplasmosis, Rubella, CMV, Herpes, Epstein-Barr, Syphilis
Organisms associated with congenital transmission
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Congenital CMV
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Cytomegalovirus (CMV)
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Herpes Simplex
? HSV-1: Stomatitis, fever, decreased fluid intake,
oral lesions, corneal ulcers (steroids are
contraindicated)
? Herpetic whitlow: Vesicles grouped on digits,
non-surgical treatment, often misdiagnosed
? HSV-2: Painful vesicles of genitalia and anus
? Diagnosis: Viral culture, PCR
? Complications: Congenital transmission
(TORCHES), encephalitis
? Treatment: Acyclovir and analogs, vidarabine
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Herpes Simplex
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Herpetic Whitlow
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Herpes Simplex ? Genital
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Herpes Zoster (Shingles)
? Varicel a-zoster virus reactivation
? Painful vesicles in dermatome distribution
? Cranial nerve involvement
?HZ ophthalmicus: Opthalmic branch of CN V,
lesion seen on tip of nose (Hutchinson's sign),
vision- threatening
?Ramsay Hunt: CN VII, zoster presenting with
facial nerve palsy, ear pain
? Complications: Pneumonia, meningitis, post-
herpetic neuralgia, 2? infection, dissemination
? Treatment: Acyclovir and analogs, prednisone
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Herpes Zoster
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Herpes Zoster
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Herpes Zoster
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Acquired Immune Deficiency (1)
? HIV types 1, 2 (RNA retroviruses)
? Virus multiplication in CD4 lymphocytes
? CDC classification:
?Group l: Acute mono-like infection
seroconversion
?Group II: Asymptomatic infection
?Group III: Lymphadenopathy >3 months
?Group IV: AIDS (CD4 <200, opportunistic
infections)
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Acquired Immune Deficiency (2)
? Pneumocystis (PCP) is the most frequent
infection
?CXR: bilateral infiltrates, hypoxemia
?Treatment: TMP/SMX, steroids
? Cryptococcal meningitis
?Most common CNS fungal infection
?Diagnosis: CSF (India ink, cryptococcal antigen)
?Treatment: amphotericin B
? Toxoplasmosis
?Most common cause of encephalitis
?Diagnosis: CT (ring-enhancing lesions)
?Treatment: pyrimethamine, sulfadiazine
? Oral candida is most common GI tract infection
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Oral Candidiasis
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Kaposi's Sarcoma
? Second most common AIDS manifestation
? Seen in men who have sex with men (MSM)
? Not a cause of significant morbidity or mortality
? Purple, painless, non-pruritic areas, flush with
skin or raised strawberry-like plaques
? Persist, enlarge, coalesce, may bleed
? Extracutaneous involvement: GI tract, liver,
spleen, lungs, CNS
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Kaposi's Sarcoma
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Kaposi's Sarcoma
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Molluscum Contagiosum
? Viral infection of skin (poxvirus)
? 2-5 mm umbilicated, pink, dome-shaped
papules
? Autoinoculation: Common locations are face,
trunk, extremities (children), groin and genitalia
(adults). Usual y self-limited
? Transmission: Close personal contact,
swimming pools. Sexual transmission is
common in adults
? HIV/AIDS: Not uncommon, lesions can be
extensive and atypical
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Molluscum Contagiosum
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Infectious Mononucleosis
? Epstein-Barr virus (EBV)
? Common in adolescents. Usual y
asymptomatic in infants and children
? Fever, exudative pharyngitis, splenomegaly,
lymphadenopathy, atypical lymphocytosis
? Complications: Splenic rupture,
thrombocytopenia
? Diagnosis: Monospot, serology
? Amoxicillin almost always causes a
maculopapular rash (may be diagnostic)
? Treatment: Rest, supportive, no contact sports
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Mononucleosis
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Common Pediatric Rashes
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TORCHES
? A col ection of congenital infections that
can cause severe fetal abnormalities that
are associated with a variety of dermatologic
manifestations
?T = Toxoplamosis
?oR = Rubel a
?C = Cytomegalovirus (most common)
?H = Herpes simplex / HIV / Hepatitis
?E = Epstein-Barr
?S = Syphilis
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Erythema Infectiosum (Fifth Disease)
? Human Parvovirus B19
? Fever, myalgias, diarrhea, URI symptoms, flu
symptoms
? Rash: Abrupt onset, bright red cheeks
(slapped cheeks), tiny papules on
erythematous base, eyelids and chin spared
? "Lace-like" erythematous rash on limbs, trunk
? Complications: Arthritis, aplastic crisis
(especial y in sicklers)
? Can cause fetal anemia if acquired during
pregnancy
? Treatment: NSAIDs
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Erythema Infectiosum
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Hand-Foot-Mouth Disease
? Coxsackie virus (enterovirus)
? Occurs in outbreak
? Fecal-oral transmission
? Fever, sore throat, malaise, URI
? Oral lesions: Painful vesicles on anterior mouth
(buccal mucosa, tongue, soft palate, gingiva)
? Skin lesions: Red papules (change to gray
vesicles) on palms, soles, buttocks
? Vesicles on hands, feet, soles
? Avoid viscous lidocaine in young children
because of risk of seizures
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Hand Foot and Mouth Disease
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Hand Foot and Mouth Disease
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Hand Foot and Mouth Disease
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Herpangina
? Coxsackie virus
? Fecal-oral transmission, preschool age,
spreads to siblings
? Fever, dysphagia, drooling, vomiting,
headache
? Ulcerative lesions (vesicles rupture, leaving
painful ulcers on posterior pharynx, soft palate,
uvula)
? Complications are rare
? Resolves in 1 week
Anterior mouth spared
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Herpangina
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Henoch-Sch?nlein Purpura
? Most common acute vasculitis affecting children
? Preceding Strep or GI infection (Salmonel a,
Shigel a)
? Ages 2-10, abdominal pain, GI bleeding,
hematuria
? Palpable purpura (legs, buttocks)
? Thrombocytopenia is absent
? Complications: Arthritis, glomerulonephritis,
hematuria, GI bleeding, intussusception
? Renal consult
? Usual y resolves spontaneously
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Henoch-Sch?nlein Purpura
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Henoch-Sch?nlein Purpura
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Henoch-Sch?nlein Purpura
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Kawasaki's Disease (1)
? Mucocutaneous lymph node syndrome
? About 2,000 cases/yr in the U.S.
? Acute, febrile, exanthematous disease of
children (age 2-5, males, Asian)
? Self-limited vasculitis with predilection for
coronary arteries
? Cause unknown
? Possibly an immune response to bacterial
infection, since it occurs in outbreaks
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Kawasaki's Disease (2)
? Major criteria: Fever >5 days PLUS 4 of the
following
?Conjunctival injection (bilateral)
?Strawberry tongue, fissures, lips cracked
?Desquamation or swel ing of fingers and toes
?Erythematous rash (starts on palms and soles)
?Enlarged (15mm or greater) cervical lymph
nodes
? WBC, ESR, platelets
? Coronary artery aneurysms
? Treatment: Aspirin, IV immunoglobulin
139
Kawasaki's Disease
140
Med-Chal enger ? EM
Kawasaki's Disease
141
Impetigo
? Staph. aureus, Strep. pyogenes
? Superficial epidermis, no fever, highly contagious
? Preschool, young adults, poor hygiene
? Red, moist vesicles
? Painless, honey-crusted lesions
? Rarely causes glomerulonephritis (antibiotics do
not prevent this)
? Treatment: Dicloxacil in, cephalosporin,
erythromycin, mupirocin ointment
? Bul ous impetigo suggests Staph infection
142
Impetigo
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Med-Chal enger ? EM
Bullous Impetigo
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Impetigo
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Impetigo
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Impetigo
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Rubella (German Measles)
? Acute viral il ness (fever, sore throat, headache)
? "Three day measles"
? Rash (pink macules spread from head to feet)
Prominent lymphadenopathy:
posterior auricular, cervical, occipital
? Complications
?Arthritis (immune complex)
?Encephalitis
?1st trimester pregnancy (congenital defects)
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Rubella
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Rubella
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Rubeola (Measles)
? Fever, cough, conjunctivitis, coryza (3 "C"s)
? Koplik spots: Buccal mucosa (before rash),
non-tender, tiny white spots ("grains of salt")
? Maculopapular, red-brown "morbil iform" rash
spreads from head to feet
? Complications: Encephalitis, pneumonia,
otitis media, conjunctivitis
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Measles
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Measles
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Measles
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Koplik's Spots
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Med-Chal enger ? EM
Roseola Infantum
? Exanthem subitum
? Human herpes viruses (HHV) 6 and 7
? Common at ages 6-18 months
? High fever (3-4 days), then rash with
defervescence
? Febrile seizures are common
? Pink macules and papules on trunk
? May spread to neck, face, extremities
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Roseola
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Pediculosis (Lice)
? Head lice
?Scalp and neck (erythema, scaling)
?Nits (eggs) attached to the hair shaft
? Body lice
?Linear excoriations, nits in seams of clothing
? Pubic lice (crabs)
?Sexual y transmitted
?Intense pruritus, papular urticaria on thighs and
abdomen
? Treatment: Extensive cleaning of clothing and
bedding, pediculicide creams and shampoos
(pyrethrin, permethrin)
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Pediculosis (Lice)
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Scabies
? Severe pruritus (due to hypersensitivity reaction
to scabies mite)
? Web spaces, elbow, axil a, groin (favors thin
skin)
? Red papules, vesicles, crusts, linear burrows
? Treatment: Permethrin cream, ivermectin; may
consider using lindane lotion (>2 yrs)
? "Norwegian scabies" (severe disease) seen in
immunocompromised
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Scabies
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Scabies
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Scabies
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Scabies
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Scarlet Fever
? Group A beta hemolytic Strep toxin
? Sore throat, fever, headache, vomiting
? Sandpaper rash starts on flexor creases and
moves to trunk and extremities; circumoral
sparing
? "Strawberry" tongue
? Groin, axil a, antecubital areas (Pastia's lines)
? Skin peeling (palms and soles)
? Diagnosis: Throat swab, increasing ASO titer
? Treatment: Pen G
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Scarlet Fever
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Scarlet Fever
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Scarlet Fever
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Varicella (Chicken Pox)
? Varicel a zoster virus
? Fever, malaise, URI
? Macules, papules vesicles ("dewdrop on a
rose petal") that come in crops crusts
? Complications (mostly adults): Pneumonia,
encephalitis, otitis media, 2? infection
? Treatment: Acyclovir or analogues
? Avoid salicylates (Reye's syndrome)
? Prevention: Immune globulin if
immunocompromised or pregnant, vaccine in
kids and non-immune adults
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Chicken Pox
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Chicken Pox
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Varicella
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Varicella
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Varicella
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Six Childhood Infectious
Diseases Associated with Rashes
Infection
Characteristics
Measles
Rash begins at head and goes down
(Rubeola)
Cough, coryza, conjunctivitis (the 3 C's)
Chicken pox
Macules to papules to vesicles to crusted lesions
(Varicela)
Varying stages simultaneously
German measles
Rash begins at head and goes down
(Rubel a)
Three day measles
Prominent lymphadenopathy
Scarlet fever
Strep throat with sand paper truncal rash
Erythema infectosum Slapped cheeks
(Fifth Disease)
Roseola Infantum
Fever, then truncal rash when fever is gone
(Sixth Disease)
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Occupational Exposures (1)
Hepatitis B
? HB Surface antigen = Infectious
? HB Surface antibody = Protective
? HB e antigen = Highly infectious
? Per the CDC, a needle stick or cut exposure if
not successful y vaccinated = 6-30%
? Risk is at the high end of the range (25-30%) if
source is HBeAg-positive
176
Occupational Exposures (2)
Hepatitis B vaccination
? Very safe vaccine
? Three-dose series (0, 1, 6 months)
? Test for seroconversion (desired antibody level
>10 mIU/mL)
? Repeat series if non-responder
? No boosters if responder
Hepatitis B Immune Globulin (HBIG)
? Passive immunization (pooled antibodies)
? Effective within 1 week of exposure
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Occupational Exposures (3)
? Management of possible hepatitis B
exposure
?Test source for HB surface antigen
?Test exposed patient for HB surface antibody
? Exposure to HBsAg-positive source
? If the healthcare worker is unvaccinated, give HBIG
and start the vaccine series
? If the healthcare worker has protective levels of
antibody (>10 mIU/mL), no treatment is needed
? Special circumstances (known non-responders,
partial y vaccinated) -- look it up!
178
Occupational Exposures (4)
Hepatitis C
? Percutaneous transmission is common
? Sexual transmission is rare
? Per the CDC, after a cut or needle stick
exposure the seroconversion risk about 2%
? Test source for anti-HCV
? No effective post-exposure prophylaxis
? If positive do serial tests of the healthcare
worker for anti-HCV and liver enzymes
179
Occupational Exposures (5)
HIV exposure
? Transmission after percutaneous exposure
0.3%
? Risk of transmission is increased when
?Contaminating device is visibly contaminated
with blood
?A needle is placed directly into a blood vessel
?Injury is deep
?Contamination is with a hol ow bore needle
?Source is likely to have a heavy viral load (as
occurs in terminal HIV)
? Post-exposure prophylaxis recommended for
significant HIV exposures
180
Occupational Exposures (6)
HIV Post-Exposure Prophylaxis
? For HIV-positive exposures
? HIV test source and healthcare worker
? Start medications within 1-2 hours of
exposure
? Multi-drug protocols are standard
? Reverse transcriptase inhibitors (e.g.,
zidovudine, lamivudine) and protease
inhibitors are used
? Side effects often limit treatment
? PEP is continued for 4 weeks
? Consult ID for most cases
181
DERMATOLOGY
QUESTIONS
Review the picture on the slide and then answer the
question on the slide that follows.
182
DE 1 183 1
Which of the following is TRUE
about the above slide?
A.It is usual y fol ows a benign course
B.Mucus membranes are rarely involved
C.Nikolsky sign is negative
D.The lesions are painless
E.The vesicles a fragile and break easily
DE 1 184 1
DE 2 185 2
Which of the following is TRUE
about the above slide?
A.It is a type of acute hypersensitivity
B.Linear pattern helps make the
diagnosis
C.Steroids are contraindicated
D.The blister fluid contains antigen
E.The rash does not itch
DE 2 186
DE 3 187
Med-Chal enger ? EM 3
Which of the following is TRUE
about the above slide?
A.Aplastic crisis may be a complication
B.No other symptoms are associated
with this rash
C.NSAIDs should be avoided
D.The rash starts after the patient
defervesces
E.The chin and eyelids are usual y
involved
DE 3 188 1
DE 4 189 5
Which of the following is TRUE
about the above slide?
A.It does not require antibiotic treatment
B.It is cause by Staph
C.Skin peeling is uncommon
D.The circumoral area is spared
E.The rash is seen on extensor surfaces
DE 4 190 1
DE 5 191 6
Which of the following is TRUE
about the above slide?
A.Antibiotics are indicated
B.It is caused by a virus
C.It is contagious
D.It is seen more often in children and
young adults
E.It wil resolve within a week
DE 5 192 1
DE 6 193 7
Med-Chal enger ? EM
Which of the following is TRUE
about the above slide?
A.It is not tender
B.It is not warm
C.It is seen only in the elderly
D.The rash tends to be generalized
E.Treatment is with penicil in or
doxycycline
DE 6 194 1
DE 7 195 8
Which of the following is TRUE
about the above slide?
A.It is a marker for systemic disease
B.It is more common in men
C.It resolves quickly (in a couple of
days)
D.Lesions are most commonly found on
the anterior forearms
E.The lesions are painless
DE 7 196 1
DE 8 197
19
Which of the following is TRUE
about the above slide?
A.Diagnosis is made by culturing the
offending organism
B.It is acquired by a mosquito bite
C.It is treated with antiviral agents
D.Patients may have cranial nerve
palsies
E.The rash involves the palms and
soles
DE 8 198 1
DE 9 199 9
Which of the following is TRUE
about the above slide?
A.It is the most serious form in a
spectrum of disease
B.Lesions are asymmetric
C.Target lesions are rare
D.The lesions al desquamate
E.The patient may be taking phenytoin
DE 9 200 1
DE 10
201
12
Which of the following is TRUE
about the above slide?
A.Affects less than 25% of the body
surface area
B.ICU admission is recommended
C.Is unrelated to Stevens Johnson
syndrome
D.Nikolsky's sign is negative
E.Rarely associated with exposure to
drugs
DE 10
202
1
DE 11
203
13
Which of the following is TRUE
about the above slide?
A.Aspirin should be avoided
B.Cerebral artery vasculitis and
aneurysms are a complication
C.Desquamation is uncommon
D.Fever duration of over 5 days is a
diagnostic criterion
E.Seen in patients up to age 18 years
DE 11
204
1
DE 12
205
30
Which of the following is TRUE
about the above slide?
A.Cough is rare
B.It is one of the "TORCH" infections
C.Koplik's spots may be found in the
mouth
D.Posterior lymphadenopathy is
characteristic
E.The rash typical y lasts three days
DE 12
206
1
DE 13
207
29
Med-Chal enger ? EM
Which of the following is TRUE
about the above slide?
A.Complications are common in children
B.It may be accompanied by fever and
malaise
C.Salicylates are indicated
D.There is no vaccine for this infection
E.The lesions al develop
simultaneously
DE 13
208
1
DE 14
209
Which of the following is TRUE
about the above slide?
A.Blisters can be large and tense
B.It has a high mortality rate
C.Mucus membranes are frequently
involved
D.Nikolsky sign is positive
E.This rash is usual y an acute process
DE 14
210
1
DE 15
211
26
Which of the following is TRUE
about the above slide?
A.It is caused by a bacteria
B.It is spread by respiratory
transmission
C.Lesions are also seen on the torso
D.Mouth lesions spare the anterior
mouth
E.Sore throat and URI symptoms may
be seen
DE 15
212
1
DE 16
213
20
Med-Chal enger ? EM
Which of the following is TRUE
about the above slide?
A.It is caused by a virus
B.It is seen most commonly in the winter
C.It is transmitted by a tick bite
D.The rash begins on the trunk and
spreads to the extremities
E.The rash often involved the face
DE 16
214
1
DE 17
215
27
Which of the following is TRUE
about the above slide?
A.Immunocompromised patients are not
at increased risk of severe disease
B.The axil a and groin tend to be spared
C.The rash is due to a hypersensitivity
reaction
D.The rash is not itchy
E.Treatment is to wash the skin off
DE 17
216
1
DE 18
217
23
Which of the following is TRUE
about the above slide?
A.Does not resolve without intervention
B.GI bleeding is a complication
C.It is the most common acute vasculitis
affecting adults
D.The rash associated with a viral
infection
E.Thrombocytopenia is common
DE 18
218
1
DE 19
219
24
Which of the following is TRUE
about the above slide?
A.Bul ous lesions suggest a Staph
infection
B.Fever is common
C.It is a deep skin infection
D.It is not contagious
E.It is painful
DE 19
220
1
DE 20
221
21
Which of the following is TRUE
about the above slide?
A.Antibiotics are indicated
B.Diagnosis is made by wound culture
C.The causative organism is not one
of the TORCH infections
D.The causative organism may also
cause oral lesions
E.The lesions should be incised and
drained
DE 20
222
1
Dermatology Answer Key
1. E
11. D
2. B
12. C
3. A
13. B
4. D
14. A
5. D
15. E
6. E
16. C
7. A
17. C
8. D
18. B
9. E
19. A
10. B
20. D
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Diseases Pictured
Question 1: Pemphigus Vulgaris
Question 2: Contact Dermatitis
Question 3: Fifth Disease (Erythema Infectiosum)
Question 4: Scarlet Fever
Question 5: Pityriasis Rosea
Question 6: Erysipelas
Question 7: Erythema Nodosum
Question 8: Lyme Disease
Question 9: Erythema Multiforme
Question 10: Toxic Epidermal Necrolysis (TEN)
224
Diseases Pictured
Question 11: Kawasaki's Disease
Question 12: Measles
Question 13: Varicel a
Question 14: Bul ous Pemphigoid
Question 15: Hand, Foot and Mouth Disease
Question 16: Rocky Mountain Spotted Fever
Question 17: Scabies
Question 18: Henoch-Schonlein Purpura
Question 19: Impetigo
Question 20: Herpetic Whitlow
225
This post was last modified on 24 July 2021