Beruflich Dokumente
Kultur Dokumente
Herpes
Simplex
Virus
(HSV)
Clinical
Tzanck smear of
vesicle base:
multinucleated giant
cells
*VSV has same
appearance on Tzanck,
so cx or direct IF Ab
staining needed for
definitive dx
Oral or IV Acyclovir
Frequency +
severity of
recurrences
Daily acyclovir,
famciclovir
suppressive therapy
Pts w/ >6
outbreaks per
year
Pts w/ EM
In AIDs pts HSV can
persist, ulcers
remaining resistant to
antiviral therapy
Dermatitis
Herpetifor
mis
Associated w/ celiac
disease (15-25% have it)
Dapsone
Varicella
(Chickenpo
x)
Transmission: respiratory
droplet or direct
clinical
Self-limited in healthy
children- Benadryl
In first trimester
Microcephaly
Chorioretinitis
IUGR
Cataracts
Herpes
Zoster
Infants, children,
adults: Vaccine
Adults: Acyclovir
Neonates:
VZIG if mom
contracted w/in 5
days of delivery
Gluten-free diet
clinical
Acyclovir
**Pain control most
important
Poxvirus infxn
Clinical
MC in young children +
AIDS pts
Confirmed by
expressing/staining
contents of papules
Giemsa or
Wrights stain
Large inclusion or
molluscum bodies
Verruca/co
ndyloma
(Warts)
Clinical
Acetowhitening
(mucosal lesions)
BACTERIAL INFECTIONS
Impetigo
Group A Strep
Clinical
Penicillin
S. pyogenes
Penicillin
Strawberry tongue
Salmonella
typhi
Erythrasma
Erythromycin (erythrasma =
erythromycin)
Clinical
Regional lymphadenopathy
Blood cx (when
bacteremia
suspected)
Necrotizing
fasciitis
factors:
Diabetes
IV drug use
Venous stasis
Immune compromise
Local radiographs or
CT : air in tissue
Biopsy (from edge of
lesion)
SURGICAL EMERGENCY!
Early + aggressive surgical
debridement
Strep: Penicillin G
Aerobic: metronidazole or 3rdgen cephalosporin
Clinical
Begins at puberty
Face, back, upper chest (greatest density of
sebaceous follicles)
Comedo:
Open comedones (blackheads)
Close comedones (whiteheads)
Inflammatory:
Comedo ruptures pustule (large/nodular)
Scar: picking at papules
Clinical
Tretinoin (retin-A) +
benzoyl peroxide
Mild popular or pustular acne
Topical Erythromycin/
clindamycin
Systemic: tetracycline
(photosensitivity),
erythromycin
**Severe acne or moderate
acne, primarily nodulocystic,
failing previous tx or have
scarring Isoretinoin
(Accutane)
Teratogen!!
Associated w/ depression
*Monthly blood tests (B-hcg,
LFTs, cholesterol, TGs)
Pilonidal
cysts
Clinical
Incision + Drainage
FUNGAL INFECTION
Tinea
versicolor
Candidasis
Clinical
KOH prep:
spaghetti and
metaballs pattern of
hyphae and spores
Clinical
KOH prep: hyphae +
pseudospores
Clinical
Head lice:
OTC pyrethrin (RID) +
mechanical removal of nits
PARASITIC
Lice
Scabies
Body lice:
Wash body, clothes, and
bedding thoroughly
Topical permethrin or
pyrethrin
Pubic: RID
Intense pruritis, especially at night + after hot
showers
MC sites: hands, axillae, genitals
Mite may be
identifiable by
scraping intact
tunnels and looking
under microscope
ISCHEMIC DISORDERS
Decubitus
ulcers
*Prevention is key!
Routinely move bedridden
pts (special beds)
MC in bedridden pts
Clinical
Arterial
insufficiency
Neuropathic
ulcers
Gangrene
Dry:
Early: dull ache, cold, and pallor of flesh
w/ necrosis (usually toe) becomes bluishblack, dry, and shriveled
Risk: Diabetes, vasculopathy, smoking
Clinical
Surgical debridement,
amputation if necessary
*Antibiotics alone do NOT
suffice (d/t inadequate blood
flow) but given as adjuvant to
surgery
Wet:
tissue appears bruised, swollen, or blistered
w/ pus
Gas gangrene:
Hyperbaric O2 (toxic to
anaerobic C. perfringens)
Susceptible pts should
maintain careful foot care
and avoid trauma
Gas:
At site of recent injury/surgery
Swelling around injury, skin turns pale then
dark red
Bacteria rapidly destructive of tissue gas
separates healthy tissue predisposes
to infxn
MEDICAL EMERGENCY!
Fasting glucose to
r/o insulin
resistance
Histology:
lichnoid pattern
band of T
lymphocytes at
epidermaldermal jxn w/
damage to basal
layer
Clinical
Associated w/
DM
Obesity
HAIR-AN Syndrome
Cushing disease
Gi adenocarcinoma
(paraneoplastic syndrome)
Lichen
planus
Rosacea
disease:
Planar, Polygonal, Purple
Pruritis, Persistent
Penile, Perioral, Koebners
phenomenon
Vitiligo
Disease of depigmentation
Chronic + Progressive
Serologic markers of
autoimmune dz
Anithyroid Abs, DM, pernicious
anemia
Pts w/ malignant melanoma may
develop antimelanocyte immune
Clinical
Differential:
Secondary
syphilis (RPR)
(Systemic sx)
Guttate
psoriasis
(smaller,
thicker scale)
Drug eruptions
Clinical
Histo: total
absence of
melanocytes
r/o:
postinflammatory
hypopigmentation,
scleroderma,
piebaldism, toxin
Topical/systemic psoralens
Exposure to sunlight or
PUVA
Must wear sunscreen
(depigmented skin lacks
protection)
DYSPLASIAS
Seborrheic
keratosis
Clinical diagnosis
Very
common,
in all pts >40
response
almost
vitiligo
>50 years
Histo:
hyperplasia of
exposure
benign,
basaloid epidermal
(phenolated
cells
w/
horn pseudocysts
cleaners
= toxic to
(prominent follicular
melanocytes)
openings)
NO malignant potential!
Actinic
keratosis
Pre-malignant lesion
Squamous cell
carcinoma
Clinical
Bx (r/o SCC):
intraepidermal atypia over
sun-damaged dermis
Clinical
Confirmation: Biopsy
MCC = UV light
Other:
If carcinoma suspected:
Excision/curettage
Advise pts to use sun
protection
Surgical excision or
radiation
Necessary for dx +
Intraepidermal
atypical
keratinocytes w/
penetration of BM by
malignant epidermal
cells growing into
dermis
sinuses (osteomyelitis)
Older adults w/ sun-damaged skin,
arising from actinic keratosis
Basal cell
carcinoma
therapy
Chemical carcinogens
prior radiation therapy
chronically draining infectious
Keratoacantho
ma
Sandpaper-like texture
No treatment necessary
d/t benign nature
Graded histologically
Similar to SCCs
Lupus
Multisystem autoimmune dz related
Nonspecific sx: fever, anorexia, weight
erytehmatos
totumor
Ab-mediated cellularVarying
attackdegrees
+
loss, symmetric
joint pain
MC Malignant skin
of pigmentation,
ulceration,
and
Clinical
depth
of
growth
us (discoid,
deposition of Ag-Ab complexes
Slow
growing,
locally
destructive,
Confirmation: biopsy
subacute,
*Have 4 criteria
virtually NO metastatic potential
SLE)
Risk: African AmericansUpper lip up
D Discoid rash
Islands of proliferating
O - border
Oral ulcers
MC Risk: Chronic UV light
Pearly nodule w/ rolled
epithelium resebling
Usually affects women of
P Photosensitivity
basal layer of
childbearing
age
A Arthritis
Multiple lesions on
non-sun-exposed
epidermis
areas more suggestive of arsenic
M Malar rash
exposure or inherited basal cell
Differential:
I Immunologic criteria
nevus syndrome
N Neuro sx (Lupus cerebritis, seizures)
Benign tumors
E Elevated ESR
Location: Face, other sun-exposed
Progressive refractory
cases:
Cure rates >95%
Corticosteroids
Hydroxychloroquine
Cyclophosphamide
azathioprine
Hypopigmented
areas
Pagets disease
Melanoma
Scleroder
ma
MC life-threatening dermatologic
dz
Inflammation excessive
Raynauds, dysphagia, mask-like face, tight skin
Risk:
deposition of type I and III
Later: vertical growth phase (dermal invasion)
Short,
intense bursts of sun
collagen
progressive
Symmetric thickening of skin face and/or distal
Pruritis = early sign of malignant change
tissueexposure
fibrosis (esp. in childhood +extremities
w/
intermittent exposure)
Characteristics:
CREST Syndrome (limited
Associated
w/ CREST Syndrome (limited
Congenital melanocytic nevi,
form)
form):
Irregular pigment
Calcinosis
# of nevi,
Diffuse form: skin, GI, GU,
Raynauds
phenomenon
Irregular
contour + border
renal,Dysplastic
pulmonary,
and
nevi,
Esophageal dysmotility
Nodule
and
ulcer formation
cardiovascular systemis
Sclerodactyly
Immunosuppression
Telangiectasias
Changes in size/shape/color/contour/surface
Risk:
Genetics:
Familial atypical mole,Diffuse form:
Female
Melanoma
(FAM-M) syndrome
Age 35-50
Pulmonary fibrosis
Kaposis
Sarcoma (KS)
Amyloido
sis
Cor pulmonale
Acute renal failure
Vascular proliferative dz attributed to Malignant
Classic variant:
HTN
herpesvirus, HHV-8, also called
Kaposis sarcoma-associated
herpesvirus (KSHV)
Extracellular deposition of
protein fibrils
Dz of elderly
Mycosis
Malignancy determined
RF
and ANA may be +
histologically
Anticentromere
Staged by Breslows Abs
(specific
CREST)
thickenessfor
and
tumornode-metastasis (TMN)
Anti-Scl-70
Clarks level = another
(antitopoisomerase
1)
classification system linking
Abs
associated
melanoma
depthw/
to
diffuse
dz and poor
prognosis
prognosis
Palliative is d/t
*Mortality
pulmonary HTN and
complications of
pulmonary HTN
PrimaryMore
systemic
(AL) and
Seconary systemic
disseminated
cases:
(AA): Kidneys, heart, liver
Bx (confirms):
Congo
cells
red stain apple
green birefringence
under polarized light
Excision w/
Acute flairs:
margins
Corticosteroids
D-penicillamine
LN dissection for
(for
skin changes
staging
inhibits collagen
Malignant:
cross-linking)
Ca2+
channel
Potential
to relapse
blockers
Dx: Clinical
Presence of viral
descent
Confined to skin:
Seizure control
Aggressive form of dz
Most common HIV-associated malignancy
Clinical + Histology
Porphyra
cutanea
tarda
Associated w/ Hep. C
NO abd pain
+ red urine
Vesicles on back of hand after drinking alcohol,
drugs, estrogens
Lyme
disease
Tick-borne
Pathogen: Borrelia
burgdorferi
Carrier: Ixodes ticks on
white-tailed deer and
white-footed mice
Summer months
Endemic to northeast
Primary (early-localized):
Erythema migrans (small erythematous
macule/papule at tick-biting site expands
slowly weeks-days)
Border macular or raised, central clearing
(bulls eye)
Secondary (early disseminated):
Migratory polyarthropathy
Neurologic phenomena (bells palsy)
Meningitis
Myocarditis
Conduction abnormalities (3rd deg. Block)
Tertiary (late disease):
Arthritis
Subacute encephalitis (memory loss +
mood change)
Stop EtOH
Then phlebotomy
Clinical dx of erythema
migrans:
ELISA (+ =
exposure)
Western Blot
(confirms)
Tissure cx + PCR
(not routinely done)
Early: Doxycycline
CNS + arthritic:
Ceftriaxone