DERMPC2

Acute Dermatologic Conditions

• Five specific conditions are: Impetigo, Fifth disease, Hand-foot-mouth disease, Erysipelas, and MRSA/Staph.

Impetigo

• It’s a contagious superficial skin infection, found on exposed areas of the face and extremities
• It’s most commonly found in children; keep kids out of school for 48 hours
• Risks include sports, daycare, and warm/humid environments
• It appears as small, superficial vesicles that appear "honey crusted"
• To treat it, use topical mupirocin (Bactroban) three times daily, and wash with antibacterial soap or chlorhesidine (Hibiclens)

Fifth Disease

• It’s a common viral infection caused by parvovirus B19, characterized by an eruptive rash, sore throat, mild fever, runny nose, nausea, headache, and itching
• Once the rash develops, it’s no longer contagious, so patient may return to school
• Phase I: causes slapped cheek syndrome with circumoral pallor (2-4 days)
• Phase 2: Causes erythematous maculopapular rash on extremities and trunk. Fades into a centrally clear, lacy pattern in 1-6 weeks
• Phase 3: persistent, variable rash gets worse under heat, stress, and sunlight (lasts 1-3 weeks)
• It can pass from pregnant women to the fetus, prompting urgent referral to a specialist
• Supportive treatment is advised

Hand-Foot-and-Mouth Disease

• Highly contagious viral illness (Group A coxsackievirus) characterized by lesions on buccal mucosa, palate, palms of the hands, soles of the feet, and buttocks
• It’s common in children but can affect adults
• Self-limiting, resolving in 7-10 days
• Can cause prodrome of fever, URI symptoms, sore throat, and painful mouth lesions often precede skin lesions, and rash on hands and feet
• Remember to avoid aspirin in febrile illness! Reye's syndrome causes swelling in the liver and brain
• Symptomatic Care is advised

Erysipelas

• This is a distinct form of cellulitis with acute, well-demarcated, superficial bacterial skin infection, common on face, scalp, and extremities
• The most common pathogen is streptococcus pyogenes
• May result in fever, headache, vomiting, chills, and arthralgia
• Can be treated with penicillin, bactrim, or cefazolin
• A chronic form eksists

MRSA/Staph

• Presents as erythema, warmth, tenderness, swelling, indurated center, and possible abscess
• Tenderness, heat, pain, oozing, swelling, and redness are also symptoms
• Risk factors include athletes, history of MRSA, and "spider bites"
• If purulent lesion joins systemic signs of illness, wound culture
• Trimethoprim-sulfamethoxazole (Bactrim), Doxycycline, and Clindamycin can treat it

Cat Scratch Disease

• Subacute tender lymphadenitis develops upon contact with a cat, often from a scratch
• A red macule develops at contact site and evolves into fluid-filled vesicles and crusts, unilateral lymphadenopathy within occurs
• Lasts 1-2 weeks and may last for 2 to 8 weeks
• Self-limiting and resolves in 2 to 6 months
• Can be treated with analgesics and antibiotics in immunocompromised patients

Pityriasis Rosea

• Idiopathic, self-limited skin eruption; characterized by widespread papulosquamous lesions
• Common on the face, trunk, and distal extremities
• Hall-mark sign is 2-10cm salmon-colored oval patches or plaques known as herald patch, followed by generalized rash 1-2 weeks later; oval lesions appear parallel to each other as a "Christmas tree rash"
• Treat mild pruritus with oral or topical antihistamine; can also use a topical or oral steroid if itching is severe
• Resolves in 6–12 weeks

Herpangina

• Viral infection causes fever and multiple vesicles, followed by painful mouth ulcerations
• Involves the soft palate, uvula, and tonsils
• Transmitted usually by fecal-oral route but can be resp droplet
• Abrupt onset of fever, sore throat, yellowish/grey/white vesicles surrounded by red halo
• Treat symptoms with analgesics and topical anesthetics
• Resolves in 7-10 days, but viral shedding lasts 4 to 6 weeks

Oral Candidiasis

• This is a fungal infection of the membranes of the mouth that may involve the throat, esophagus, and trachea
• It appears as white oral plaques on an erythematous base
• Risks include being immunocompromised, the use of inhaled corticosteroids, antibiotics, dentures, and if the patient is an infant younger than 6 months
• Can be treated with oral antifungal agents (Nystatin oral suspension, fluconazole (Diflucan)
• Resolves within 2 weeks

Diaper Dermatitis

• Acute inflammation of skin occurs in the region of the perineum, buttocks, lower abdomen, and inner thighs, due to contact, atopic issues, candida or seborrheic causes
• Common in pediatric patients and adults with urinary or fecal incontinence caused by prolonged contact with a wet/soiled diaper
• Treat by allowing exposure to air, applying a skin barrier ointment (zinc oxide), and topical antifungal agents, and topical low-potency corticosteroid (as combo products on market)

Tinea Versicolor

• Fungal infection appearing as well-marginated lesions of varying color (white, red, brown)
• Common on shoulders, chest, back, and in axilla
• Risks include hot, humid climate

Tinea Pedis

• Fungal feet infection causing itching, odor, burning sensation, maceration in toe webs, scaling, or blistering on soles of feet
• Risks include athletes or being immunocompromised

Onychomycosis

• Also known as a fungal infection of the fingernails or toenails
• Risks being immunocompromised, tinea pedis, PVD, older adults, using a communal swimming pool

Tinea Capitis

• Fungal infection of the scalp
• Presents as round, patchy scales on scalp with or without alopecia
• Griseofulvin can be taken orally for 4-6 weeks. Take with high-fat food

Intertrigo

• Superficial fungal skin infection on intertigenous areas with increased warmth, humidity, or friction
• Classic case is obese patient complaining of bright-red and shiny skin fold

Paronychia

• Skin infection around the fingernails and toenails

Pediculosis

• Infestation of the body, head, or pubic area by lice; incubation is 1 month
• Head and body lice are common in children
• Risks include prolonged proximity to infected people and sharing personal items

Acne

• Skin type is important when it comes to acne treatment • For dry skin, use creams and lotions • For oily skin, use gels and solutions • On hairy areas, use lotions and foams

Acne treatment

• Treatment selection is based on acne severity, present treatment, and past treatment
• Systemic treatment is indicated for moderate to severe inflammatory acne resistant to topical therapy
• Systemic therapy should be used in conduction with a retinoid or benzoyl peroxide

Acne Topicals

• Benzoyl peroxide is a pregnancy Category C medication that may bleach hair or clothing and cause dryness, redness, or peeling
• Dapsone is a pregnancy Category C medication that may cause temporary yellow or orange skin and hair
• Clindamycin or Erythromycin is a pregnancy Category B medication. As a monotherapy, it is not recommended due to antibiotic resistance. It can be used with benzoyl peroxide or a retinoid
• Tretinoin or Adapalene is Pregnancy Category C. Each binds to a different set of retinoic acid, with slight differences in efficacy, tolerability, and activity, Will cause skin irritation, start 2-4X per week in advance. Use cautiously in people with fish allergies. Common SE: dry skin, peeling, scaling, burning sensation, erythema, pruritus, sunburn, change in pigmentation.

Combination Topicals

• Benzoyl peroxide + retinoid
• Benzoyl peroxide + antibiotic
• Retinoid + antibiotic

Systemic Acne Treatment

• Never give tetracyclines to children under 8 years of age or pregnant individuals to prevent permanent bone/teeth discoloration
• Do not use is as monotherapy; use in conjunction with topical benzoyl peroxide to prevent antibiotic resistance or topical retinoid to improve results
• Treatment may take 2 to 4 months

Combined Oral Contraceptives

• The FDA approves combined oral contraceptives for acne treatment in women who also desire contraception
• Not to be used as 1st line therapy
• Same screening guidelines as with patients seeking contraception
• Erythromycin is a second-line option if the patient cannot tolerate tetracycline
• use with topical retinoid to improve results but not with topical antibiotic.
• Resistance is up due to overuse

Shingles

• Treatment includes an antiviral, such as valacyclovir and acyclovir, the latter of which involves more frequent dosing but is less expensive
• Medication may be selected for pain control, such as NSAIDs and capsaicin cream
• Avoid use of topical antibiotics
• May take up to 3 weeks for the rash to resolve
• Pain may last for 3 months or more

Dermatitis and Corticosteroids

• Do not use oral steroids if a patient is diagnosed with diabetes or has a suspected infection
• Topical corticosteroids are the most common therapy
• Use for the shortest duration possible to prevent cutaneous atrophy
• Optimal vehicle (ointment, cream, lotion, solution, gel, or foam
• Type of steroid treatment includes Cortisone, Triamcinolone, and Betamethasone
• Use only mild potency for the face, neck, groin, and axilla
• Avoid use fluorinated topical steroids on the face
• To prescribe the appropriate amount: whole body coverage takes 30 gms, then estimate amount by calculating whole body x % needing the medication, using the Rule of 9's

Infestations

• To treat scabies or lice, consider Permethrin, Ivermectin, and Malathion
• To treat bedbug or flea bites, consider corticosteroid topicals
• May have to repeat in one week to kill eggs
• Treat all household members and sexual partners
• Malathion is highly flammable and poisonous

Common Derm terms

• Lesion: Any single area of altered skin; may be solitary or multiple
• Rash: A widespread eruption of lesions
• Dermatosis: Another name for skin disease
• Nummular Lesion: Round (coin-shaped) lesions; also known as discoid
• Linear Lesion: A linear shape to a lesion, often due to an external reason; also striate
• Iris Lesion: Concentric rings like a dartboard
• Gyrate rash: A rash that appears to be whirling in a circle
• Annular: Lesions grouped in a circle
• Erythroderma: a skin condition affects the whole body, which turns red all over
• Telangiectasia: A common term for describing prominent cutaneous blood vessels
• Purpura: Bleeding into the skin, appearing as petechiae (small red, purple or brown spots) or ecchymoses (bruises); purpura does not blanch with pressure (diascopy)
• Macule: An area of color change less than 1.5 cm diameter with a smooth surface
• Patch: A large area of color change with smooth surface
• Papule: Small palpable lesions; can be less than 0.5 cm diameter raised above the skin surface; may be solitary or multiple
• Vesicle: Small fluid-filled blisters less than 0.5cm diameter; may be single or multiple
• Pustule: a purulent vesicle; filled with neutrophils; may be white or yellow. Not all are infected, but they can be
• Bulla: A large fluid-filled blister. May be single compartment or multiloculated
• Abscess: A localized collection of pus
• Weal: An oedematous papule or plaque caused by swelling in the dermis; wealing often indicates urticaria

Distribution Terms

• Acral: Affects distal portions of limbs (hand, foot) and head (ears, nose)
• Blaschko lines: segmental pattern is indicative of somatic mosaicism
• Dermatomal: Corresponding with spinal nerve root distribution
• Extensor: Involving extensor surfaces of limbs; contrast with flexor surfaces
• Flexural: Involving skin flexures (body folds); also known as intertriginous
• Follicular: Arising from hair follicles; can be grouped into confluent plaques
• Generalised: Universal distribution; may be mild or severe, scattered or diffuse
• Herpetiform: Grouped umbilicated vesicles in herpes simplex & zoster infections
• Koebnerised: Arising in a wound or scar where it is subjected to an injury