RachaelDERMnoteQUIZ

Atopic Dermatitis

• Also known as eczema
• Can be caused by allergy or contact irritants
• Diagnostic criteria includes being pruritic, chronic, onset in childhood, and having a typical morphology and distribution
• Typical morphology and distribution of eczema include ill-defined patches on the face, neck, trunk, elbows, and knees
• Avoid irritants like soaps, sweat, and rough fabrics
• Treatments for flares include emollients, corticosteroids (taper up and down with strength), triamcinolone 1%, tacrolimus (Protopic 0.03% or 0.1%), and pimecrolimus (Elidel 1%)
• Tacrolimus and pimecrolimus are topical NSAIDs that can be applied twice daily to treat/prevent eczema, but have side effects of burning sensation and are expensive
• Chronic topical steroid use can cause atrophy (skin thinning) and striae (stretch marks)
• Systemic steroid use is only considered for severe eczema flares unresponsive to topical treatments

Rubeola

• Also known as measles
• Highly contagious virus with a 10-14 day incubation period
• Contagious from 4 days before until 4 days after rash onset
• Spread through respiratory droplets/airborne
• Symptoms include fever, conjunctivitis, runny nose, cough, Koplik spots, and maculopapular rash (3-7 days after onset of prodromal symptoms, begins on the face and becomes generalized, and lasts 4-7 days)
• Diagnosis includes a positive serologic test
• Treatment includes supportive care (WHO recommends vitamin A for all children with acute measles)
• CDC recommends two doses of MMR vaccine for all children, starting at 12-15 months and the second at 4-6 years
• Nearly eradicated in the US through vaccination
• Nationally notifiable disease

Diaper Dermatitis

• Acute inflammation of skin in the region of the perineum, buttocks, lower abdomen, and inner thighs
• Common in pediatric patients and adults with urinary or fecal incontinence due to prolonged contact with wet/soiled diaper
• Treatment involves leaving the area open to air if possible, using skin barrier ointment (zinc oxide), topical antifungal (clotrimazole = Lotrimin), and/or topical low-potency corticosteroid (hydrocortisone)
• Combo products include clotrimazole and betamethasone dipropionate cream (Lotrisole)

Hookworms

• Larvae penetrate skin and migrate through blood to lungs, are swallowed, and reach and attach to mucosa of small intestine to mature
• Suck blood from mucosa
• Symptoms include rash at site of larval penetration, respiratory symptoms (dry cough, wheezing, low-grade fever) during larval migration through lungs, GI symptoms (anorexia, epigastric pain, diarrhea) during larval attachment, and anemia (dependent on worm burden)
• Diagnosed based on eggs in feces
• Treatment involves abendazole 400mg x 1 or 100mg BID x 3 days

Bed bugs

• Live in crevices of furniture
• Bites tend to occur in lines or clusters
• May present as papular urticaria
• Treatment may need to be professional and involve extermination with heat

Scabies

• Infestation with sarcoptes scabiei
• Transmitted by close physical contact with infected person or their bed linens/clothing
• Itching is always present and can be severe
• Small pruritic vesicles, pustules, and “burrows” usually spare head and neck
• Diagnosed through scraping lesions and visualizing under microscope (organism, ova, or feces)
• Treatment involves application of permethrin 5% cream from neck down, leave on for 8-12 hours, repeat in 1 week

Tinea Versicolor

• Mild superficial infection of skin caused by Malassezia (type of yeast)
• Causes hypopigmentation
• Presents as velvety, tan/pink/white macules or thin papules on trunk, upper arms, neck, groin
• Treatment involves two doses of oral fluconazole 300mg 14 days apart
• Topical antifungals, selenium sulfide lotion, and ketoconazole shampoo can be used
• Recurrence is common, so continue to use lotions/shampoos as prevention

Tinea Barbae

• Fungal infection of the beard and mustache area
• Typically restricted to the jawline, cheeks, or neck
• Very rare, often connected to work with domesticated animals
• Presents with painless plaques, often misdiagnosed as bacterial folliculitis (which is painful)
• Treatment involves oral antifungals (ketoconazole 200 mg to 400 mg daily, fluconazole 200 mg once daily, itraconazole 100 mg once daily)

Tinea Unguium

• Also known as onychomycosis, fungal nail infection
• Characterized by nail dystrophy, discoloration, and thickening
• Treatment involves topical antifungals (efinaconazole, tavaborole, ciclopirox), oral antifungals (terbinafine, itraconazole), and laser treatments
• Recurrence is common
• Encourage patients to wear proper footwear and maintain hygiene
• Consider liver function with oral antifungals

Tinea Capitis

• Fungal infection of the scalp hair
• Occurs primarily in children between 3 and 14 years of age, but it might affect any age group
• Inflammatory type may result in a kerion (painful nodules with pus) as well as scarring alopecia
• First-line treatment is griseofulvin 20-25 mg/kg/day x 8 weeks (give with fatty meal to increase absorption)

Tinea Corporis

• Fungal infection of body
• Characterized by ring-shaped lesions with an advancing scaly border and central clearing
• Diagnosis confirmed with KOH prep or culture
• Treated with topical antifungals, most of which are available over the counter (ex. - clotrimazole [Lotrimin])
• Treatment should continue 1-2 weeks after clinical clearing

Tinea Cruris

• Also known as jock itch
• Confined to groin and gluteal cleft, typically spares scrotum
• Peripherally spreading, sharply demarcated, centrally clearing erythematous lesions
• Treated with topical antifungals or systemic medications (ex. Itraconazole 200mg daily or terbinafine 250mg daily x 7 days)
• Prevented using drying powder

Tinea Pedis

• Also known as athlete's foot
• Often presents with asymptomatic scaling, progresses to fissuring or maceration of toe web spaces that itches or burns
• Treatment involves aluminum subacetate (Burow's solution) soaks for 20 minutes twice daily, topical antifungals, and systemic measures (itraconazole 400mg daily x 1 week, terbinafine 250mg daily x 2-4 weeks)
• Recurrence is common

Oral Candidiasis

• Fungal infection of the membranes of the mouth that may involve the throat, esophagus, and trachea
• Appears as white oral plaques on erythematous base
• Risks factors include being immunocompromised, use of inhaled corticosteroids, antibiotics, dentures, infant < 6 months
• Treat with oral antifungal agents (Nystatin oral suspension) or fluconazole (Diflucan)
• Resolves within 2 weeks with treatment

Fifth Disease

• Common viral infection (Parvovirus B 19)
• Characterized by an eruptive rash, sore throat, mild fever, runny nose, nausea, headache, itching
• Not contagious once rash develops and may return to school
• Phase 1 includes slapped cheek syndrome with circumoral pallor (2-4 days)
• Phase 2 includes erythematous maculopapular rash on extremities and trunk (1-6 weeks)
• Phase 3 includes persistent rash worse with heat (1-3 weeks)
• Transmitted through respiratory secretions and saliva
• Pregnant women can pass virus to fetus (can cause premature labor, hydrops, fetal anemia, and fetal death-> infected mother should be referred to specialist)
• Treatment includes supportive care

Paronychia

• Localized superficial infection of the skin bordering the nail
• Causes pain, erythema, abscess
• Staph aureus most common pathogen
• Risk factors include nail-biting, ingrown nails, trauma
• Treatment involves warm compress, I&D, topical mupirocin (Bactroban)

Scarlet Fever

• Caused by pyrogenic toxins released by Streptococcus pyogenes during infection
• Starts with exudative pharyngitis followed by a blanching, erythematous, maculopapular rash, often described as "sandpaper-like”
• Can lead to complications such as rheumatic heart disease and glomerulonephritis, early recognition and treatment are crucial
• First-line treatment is penicillin/amoxicillin x 10 days or Bicillin IM x 1

Pediculosis

• Infection with lice of body (corporis), head (capitis), pubic hair (pubis)
• Intense itching may lead to deep excoriations that can become infected
• Nits (eggs) found at bottom of hair shaft
• Incubation period is one month
• Treatment involves permethrin 1% (Nix) rinse, topical ivermectin lotion, wash and dry clothing and bed linens at hot temperature

Impetigo

• Contagious superficial skin infection prominent on exposed areas of the face and extremities
• Most common in children
• Risk factors include sports, daycare, warm, humid environment
• Appears as small superficial (usually multiple) vesicles, “honey crusted"
• Treatment involves topical mupirocin (Bactroban) TID, wash with antibacterial soap or chlorhexidine (Hibiclens)

Roseola

• Also known as sixth disease
• Caused by infection with human herpesvirus 6 (HHV-6)
• Ninety percent of cases occur in children younger than two years
• Classically presents with acute onset high-grade fever (up to 104 degrees fahrenheit) lasting between three and five days followed by a nonpruritic, pink papular rash that begins on the trunk
• Clinically diagnosed, self-limited illness that can be treated symptomatically

Pityriasis Rosea

• Hallmark sign is 2-10cm salmon-colored oval patches or plaque known as herald patch followed by generalized rash 1-2 weeks
• Oval, fawn-colored, scaly plaques following cleavage lines of trunk (“Christmas tree pattern")
• Itching is common but mild
• Rule out other causes (i.e. secondary syphilis, tinea corporis)
• Usually self-limiting, resolves in about 6 weeks
• Can use topical antihistamines/corticosteroids or oral antihistamines/corticosteroids if itching is severe

Cat Scratch Disease

• Subacute tender lymphadenitis that develops after contact with a cat, scratch being most common
• Red macule develops at contact site and evolves into fluid-filled vesicles and crusts, unilateral lymphadenopathy within 1-2 weeks & may last 2 to 8 weeks
• Treatment is supportive care (usually self-limiting) and resolves in 2 to 6 months
• Prescribe prophylactic antibiotic if immunocompromised

Varicella

• Also known as chicken pox
• Caused by airborne varicella-zoster virus
• Characterized by small, itchy blisters that scabs over
• Typically starts on the chest, back, and face and then spreads
• Accompanied by fever, fatigue, pharyngitis, and headaches, usually lasting 5 to 7 days
• Vaccine prevents 70% to 90% of infections and 95% of severe disease
• Diagnosis is clinical
• Treatment is supportive, calamine lotion may relieve pruritus

Rubella

• Also known as German measles
• Rare (due to vaccine), mild viral disease that typically occurs in children
• In pregnant women can produce severe birth defects known as congenital rubella syndrome
• Long incubation period (14 to 21 days) followed by low-grade fever, malaise, anorexia, headaches, sore throat, and lymphadenopathy
• Exanthem could be the first manifestation in children and consists of pinpoint pink macules and papules that begin on the face and spread to trunk and extremities
• CDC recommends all children get two doses of MMR (measles-mumps-rubella) vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age

Herpangina

• Viral infection (coxsackievirus) that causes sudden, high fever, followed by painful mouth ulcerations involving the soft palate, uvula, and tonsils
• Transmitted usually by fecal-oral route but can be respiratory/droplet (coxsackie is an enterovirus)
• Treat symptoms with analgesics and topical anesthetics
• Resolves in 7-10 days but viral shedding lasts 4 to 6 weeks