Lecture 6 Part 2

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary manifestation of the first stage of Lyme disease?

Erythema multiforme

Erythema migrans (correct)

Blisters

Lesions on limbs

How long after a tick bite can Lyme disease symptoms typically appear?

24 hours to one week

Two days to two weeks (correct)

One week to two weeks

One month to two months

Which areas are primarily affected by hyperhidrosis?

Neck, face, and chest

Knees, elbows, and wrists

Back, abdomen, and thighs

Palms, soles, and axillae (correct)

What is the causative agent of Lyme disease?

Borrelia burgdorferi Signup and view all the answers

What is the main first-line treatment for hyperhidrosis?

Aluminum chloride Signup and view all the answers

Which treatment is commonly used for Lyme disease?

Doxycycline Signup and view all the answers

In patients with predominantly emotional hyperhidrosis, which part of the brain shows overactivity?

Cortical centers Signup and view all the answers

What condition is EM commonly associated with as an underlying disease?

Herpes simplex Signup and view all the answers

What characterizes the lesions of Erythema Multiforme?

Red papules that develop into target lesions Signup and view all the answers

What do keloids and hypertrophic scars have in common?

They are both examples of excessive scar formation. Signup and view all the answers

How is the diagnosis of Lyme disease primarily confirmed?

ELISA and Western blot Signup and view all the answers

What type of hyperhidrosis is characterized by sweating primarily due to emotional stress?

Emotional hyperhidrosis Signup and view all the answers

Which combination of treatments could be considered if aluminum chloride is ineffective?

Referral to a dermatologist and anxiety medication Signup and view all the answers

What is the best treatment for Erythema Multiforme once it appears?

Antihistamines and NSAIDs Signup and view all the answers

Which group of patients is more prone to developing keloids?

African-Americans Signup and view all the answers

What type of hyperhidrosis is characterized by continuous sweating regardless of emotional triggers?

Continuous axillary hyperhidrosis Signup and view all the answers

Which locations are most commonly affected by striae during puberty in males?

Thighs, lower back, and upper back/shoulders Signup and view all the answers

What is a key indicator that striae may be related to a pathologic state?

Striae in unusual locations occurs Signup and view all the answers

What is the most common type of herpes virus responsible for genital herpes?

HSV-2 Signup and view all the answers

Which of the following is a common symptom that precedes the appearance of herpes lesions?

Pain, burning, and tingling Signup and view all the answers

What is a limitation of treating striae effectively?

Lack of effective treatment options exists Signup and view all the answers

What percentage of the population has antibodies for HSV-1?

80-90% Signup and view all the answers

Which factor is NOT typically associated with stimulating herpes viral activation?

Medical intervention Signup and view all the answers

What characteristic distinguishes a keloid from a hypertrophic scar?

Keloids extend laterally beyond the borders of the initial wound. Signup and view all the answers

What typically happens to the lesions after vesicles from a herpes outbreak rupture?

A painful superficial ulcer often remains Signup and view all the answers

Which factor increases the likelihood of developing a keloid or hypertrophic scar?

Inflammation or infection at the wound site Signup and view all the answers

What is the primary treatment approach for both keloids and hypertrophic scars?

Massage therapy combined with steroid injections Signup and view all the answers

Where are keloids and hypertrophic scars more likely to occur?

On the earlobes and central chest Signup and view all the answers

What role does transforming growth factor beta (TGF-β) play in scar development?

It promotes production of extracellular matrix components. Signup and view all the answers

How do striae distensae typically progress in appearance over time?

Their color fades to a linear depression. Signup and view all the answers

During which life stage are striae most commonly observed in individuals?

Puberty and pregnancy Signup and view all the answers

What is a common symptom associated with striae distensae?

Mild itchiness Signup and view all the answers

What is the primary reason for using suppressive therapy with valacyclovir in patients with recurrent EM outbreaks?

To prevent HSV outbreaks. Signup and view all the answers

Which HPV types are most commonly associated with genital warts?

HPV types 6 and 11 Signup and view all the answers

What characteristic is least associated with the appearance of genital warts?

Presence of dark dots from dilated capillary loops Signup and view all the answers

Which patient population is at increased risk for developing genital or anal carcinoma associated with genital warts?

Transplant recipients with suppressed immunity Signup and view all the answers

In which age group is it least likely that genital warts in children are a sign of sexual abuse?

Under 3 years old Signup and view all the answers

What is a significant risk associated with perianal warts in individuals who engage in receptive anal intercourse?

Higher association with anal carcinoma Signup and view all the answers

Which of the following best describes the nature of HPV following the spontaneous resolution of genital warts?

HPV may enter a latent, subclinical state. Signup and view all the answers

What type of therapies can be used for the treatment of genital warts?

Both destructive and immunity-based therapies Signup and view all the answers

What is the primary cause of Tinea Versicolor?

Overgrowth of yeast Signup and view all the answers

Which area of the body is least affected by Tinea Versicolor lesions?

Lower arms Signup and view all the answers

What is a common treatment for Tinea Versicolor?

Ketoconazole shampoo Signup and view all the answers

Which population is most commonly affected by Tinea Versicolor?

Individuals of Mediterranean descent Signup and view all the answers

What symptom is most commonly associated with Pediculosis Pubis?

Severe pruritus in the genital region Signup and view all the answers

What is the primary characteristic of Phthirus pubis?

Short and wide body Signup and view all the answers

What should be avoided in the treatment of Tinea Versicolor due to poor effectiveness?

Allylamines Signup and view all the answers

How long can it take for pigmentation to return to normal after curing Tinea Versicolor?

Several months Signup and view all the answers

Study Notes

Hyperhidrosis

Affects up to several percent of the population
Primarily affects palms, soles, and armpits; sometimes only one area
Two main patterns: emotional stress-induced (predominantly palms/soles) and continuous (predominantly armpits)
Palm/sole sweating controlled by the cerebral cortex, responding to stress (increased grip) and not to core body temperature
Armpit sweating controlled by both cortical and hypothalamic centers, reacting to both emotional stimuli and core body temperature
Emotional hyperhidrosis involves overactive cortical centers
Continuous axillary hyperhidrosis involves overactive hypothalamic centers
First-line treatment is aluminum chloride (blocks sweat duct)
If aluminum chloride is ineffective, dermatological referral for surgical techniques, anticholinergics, or electrical stimulation is needed
Anxiolytics or psychological interventions are helpful for anxiety-related hyperhidrosis
Can be associated with rare neurologic conditions, spinal cord injuries, and endocrine disorders

Keloids and Hypertrophic Scars

Common, particularly in African Americans for keloids
Both involve excessive scar tissue formation
Keloids extend beyond the initial wound border
Hypertrophic scars remain within the original wound border
Both are raised, tender, and erythematous initially; remain raised permanently
Associated with familial (genetic) components
Increased risk in certain body areas (earlobes and central chest)
Inflammation, infection, foreign bodies, and tension increase risk of formation

Striae Distensae (Stretch Marks)

Affects up to 25% of people during puberty and upwards of 75% during pregnancy
Appear as pink to red-purple linear depressions; fade over time
Can be itchy; usually asymptomatic
Common locations in males: thighs, lower back, upper back/shoulders
Common locations in females: breasts, thighs, buttocks
Abdomen is most common location in pregnant women
Can be related to certain medical conditions (Cushing's disease, steroid abuse)
Cannot be prevented entirely, but retinoids and lasers may help with appearance improvements.

Oral and Genital Herpes Simplex Virus (HSV)

HSV-1 antibodies found in 80-90% of the population
HSV-2 antibodies in 15-25% of the population
HSV-1 is more common in oral herpes
HSV-2 is more common in genital herpes
Symptoms include pain, burning, tingling before blisters; often follow by sores
Symptoms can be asymptomatic, particularly in genital herpes;
Infection usually occurs through direct skin-to-skin contact
Treated with oral or IV antiviral medications (acyclovir, valacyclovir)
Latency in the nerve tissue; stress, trauma, infections can reactivate the virus
Some infections, like eczema herpeticum, can spread widely in immunocompromised patients

Erythema Migrans

Cutaneous manifestation of Lyme disease
Presents as expanding red plaque; central area often clears
Usually asymptomatic
Typically appears 2-14 days after tick bite
Treated with doxycycline
Diagnosis confirmed with ELISA and Western blot tests

Erythema Multiforme (EM)

Self-limited disorder, rare in young children and adults older than 40
Often triggered by herpes simplex infections
Characterized by skin lesions; "target lesions:" red with pale, edematous center, red ring
Can involve areas like hands, forearms, chest, palms, legs, and oral mucosa

Genital Warts

Common sexually transmitted infection (STI)
Caused by HPV types 6 and 11
Appear as rough, "pebbly" papules; may be hypo- or hyper-pigmented
Can lead to cervical or anal cancer, especially in immune-compromised patients
Treated with topical insecticides (e.g., permethrin) or oral ivermectin; some resolve spontaneously

Plantar Warts

Common, painful warts occurring on the soles of the feet
Often located on the ball or heel
Characterized by skin line disruptions and black dots (capillary bleeding)
Treated with a multimodal approach including chemical/physical debridement of the surrounding keratin to allow penetration of the medication, salicylic acid solutions/pads, or other anti-HPV medications

Tinea Versicolor (TV)

Yeast (Pityrosporum ovale) overgrowth
Hypo- or hyperpigmented macules (patches)
Commonly located on upper chest, upper back, and shoulders
More common in the warmer months
Topical antifungals (ketoconazole shampoo, creams) or oral medications are typically used for treatment

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Explore key clinical questions regarding Lyme disease and hyperhidrosis through this quiz. From symptoms to treatments, test your knowledge on these important medical conditions. Ideal for students and professionals in the medical field.