Lecture 10 Part 2

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Questions and Answers

What is the primary factor contributing to intertrigo?

Infection by Staph aureus

Excessive skin moisture (correct)

Beta-lactamase resistance

Overgrowth of Candida albicans

Which characteristic symptoms are commonly associated with cellulitis?

Intense pruritus and a scaly rash

Dry, flaky skin and eczema

Erythema, edema, warmth, and tenderness (correct)

Flu-like symptoms without any visible lesions

What type of antibiotics should be used to treat cellulitis?

Broad-spectrum antibiotics only

Beta-lactamase resistant antibiotics (correct)

Topical antifungals

Narrow-spectrum antibiotics

In which areas of the body is intertrigo most commonly found?

Skin folds where skin touches skin Signup and view all the answers

What is a classic sign of scabies?

Burrows in the skin Signup and view all the answers

What is the most important aspect of treating intertrigo?

Drying the affected skin Signup and view all the answers

Which population is most likely to develop scabies?

Children and nursing home residents Signup and view all the answers

What laboratory test is recommended before starting treatment for cellulitis?

Blood cultures Signup and view all the answers

What is the primary purpose of ligating an incompetent vessel?

To promote blood flow into competent vessels Signup and view all the answers

What is a common treatment for ulcers as noted in the content?

Application of Unna boots Signup and view all the answers

What skin condition is typically associated with chronic lymphedema?

Thick and hardened skin Signup and view all the answers

What is an appropriate management strategy for chronic lymphedema?

Addressing causative factors such as obesity Signup and view all the answers

What should be avoided when using Unna boots for ulcer treatment?

Applying if ulcers are infected Signup and view all the answers

What is the primary long-term concern for a limb with chronic lymphedema?

Recurrent infections and ulcerations Signup and view all the answers

How does chronic lymphedema initially develop?

From accumulated lymphatic tissue Signup and view all the answers

What is a function of sequential compression devices (SCDs) in lymphedema treatment?

To inflate balloons sequentially to promote fluid movement Signup and view all the answers

What is a characteristic feature of crusted scabies?

Thick crusting primarily on the hands, feet, and scalp. Signup and view all the answers

What is the primary cause of itching and rash in scabies?

Allergic reaction to mite feces and saliva. Signup and view all the answers

What is the first line treatment for standard scabies?

Topical permethrin. Signup and view all the answers

Which statement about Zoster is correct?

The eruption is often preceded by tingling, burning, or itch. Signup and view all the answers

What is the recommended action if the V1 dermatome is involved in Zoster?

Refer the patient to ophthalmology to evaluate for ophthalmic involvement. Signup and view all the answers

What is a common complication of Zoster after the eruption resolves?

Post-herpetic neuralgia. Signup and view all the answers

What is the dosage regimen for oral ivermectin in severe scabies cases?

Two doses, one week apart, at 200 mcg/kg each. Signup and view all the answers

How long can itching and rash persist after successful treatment of scabies?

2-8 weeks. Signup and view all the answers

What is the primary treatment for zoster to reduce the risk of post-herpetic neuralgia?

Acyclovir Signup and view all the answers

Which age group shows the highest likelihood of developing post-herpetic neuralgia?

Adults aged 60 and above Signup and view all the answers

In which stage of Cutaneous T-Cell Lymphoma (CTCL) are malignant T-cells found in the blood and lymph nodes?

Advanced stage Signup and view all the answers

What characterizes the blisters associated with Bullous Pemphigoid?

Tense and tough Signup and view all the answers

What type of malignancy is Cutaneous T-Cell Lymphoma (CTCL) primarily associated with?

CD4+ T-cells Signup and view all the answers

What is a common initial presentation of Mycosis Fungoides?

Red-brown scaly patches Signup and view all the answers

Which treatment is typically used for patch-stage CTCL?

Topical treatments Signup and view all the answers

What triggers the autoimmune response in Bullous Pemphigoid?

Antibodies against dermal proteins Signup and view all the answers

What are the common symptoms associated with stasis dermatitis?

Erythema, scaling, and possibly weeping Signup and view all the answers

What is the primary cause of stasis dermatitis?

Venous hypertension Signup and view all the answers

How does stasis dermatitis typically progress if left untreated?

It leads to permanent hyperpigmentation and potential ulcers. Signup and view all the answers

Where are ulcers most likely to develop in cases of severe stasis dermatitis?

Proximal to the medial malleolus Signup and view all the answers

What characterizes the Id reaction associated with severely inflammatory stasis dermatitis?

Generalized pruritic eruption of small, pink papules and vesicles Signup and view all the answers

Which factor is NOT a possible cause of impaired blood flow leading to venous hypertension?

Enhanced physical activity Signup and view all the answers

What is the first step in managing stasis dermatitis?

Making the correct diagnosis Signup and view all the answers

In which patient demographic is stasis dermatitis most common?

Elderly individuals, especially if obese Signup and view all the answers

What condition should a patient with bilateral, red, swollen, painful calves be treated for, in the absence of fever and malaise?

Stasis dermatitis Signup and view all the answers

What is the primary treatment for stasis dermatitis?

Topical steroids, leg elevation, and compression Signup and view all the answers

Why should vascular studies be conducted in patients with sudden onset stasis dermatitis?

To rule out deep vein thrombosis Signup and view all the answers

How do graduated compression stockings specifically aid in treating stasis dermatitis?

They promote fluid movement proximally by having greater compression distally. Signup and view all the answers

What topical treatment is most commonly used for reducing inflammation in stasis dermatitis?

Triamcinolone 0.1% ointment Signup and view all the answers

Why should patients with chronic stasis dermatitis avoid using many topicals?

They can experience contact dermatitis from these products. Signup and view all the answers

What should be done if arterial insufficiency is suspected before applying compression?

Compression should only be used if arterial circulation is confirmed to be healthy. Signup and view all the answers

What is the appropriate course of action for patients with difficult-to-heal ulcers related to stasis dermatitis?

Refer them to a vascular surgeon for evaluation. Signup and view all the answers

Study Notes

Stasis Dermatitis/Id Reactions

Stasis dermatitis is common in older adults and those with leg trauma/surgery.
Affects lower legs, often associated with leg edema.
Initial symptoms include redness, warmth, and tenderness.
Progresses to scaling and weeping.
Long-term can cause brown discoloration.
Severe cases develop ulcers, typically proximal to the medial malleolus, which are moist and exude fluid.
Inflammatory stasis dermatitis can manifest as a generalized pruritic eruption (Id reaction).
Venous hypertension (impaired blood flow from legs), due to various factors (thrombosis, valves, obesity) is the primary issue.
Venous hypertension leads to fluid, protein, white blood cells, and red-blood-cells extravasation.
Extravasated substances cause inflammation and tissue damage.
Diagnosis is crucial; bilateral, red, swollen, painful calves without fever or high WBC counts suggest stasis dermatitis, not cellulitis.
Treatment involves topical steroids, leg elevation, and compression (graduated compression stockings).
Topical triamcinolone 0.1% ointment is preferred to minimize contact dermatitis risk.
Systemic steroids are sometimes necessary for severe cases (Id reactions).

Vascular Studies

Usually not needed unless stasis dermatitis develops suddenly.
Doppler studies should rule out deep vein thrombosis (DVT).

Compression Stockings

Graduated compression stockings are common treatment, with highest compression at the ankle.
Promotes fluid movement upwards, which is beneficial before arterial compromise is confirmed.

Topical Steroids

Applied twice daily to reduce inflammation.
Triamcinolone 0.1% ointment is often the preferred topical steroid.
Consider risk of contact dermatitis in patients receiving topical treatment, as the affected limb can become sensitive to other creams and oils.

Ulcer Treatment

Aggressive compression is important; Unna boots are a useful inexpensive option.
Topical steroids are usually effective
Avoid use in infected ulcers.

Chronic Lymphedema

Often follows chronic stasis dermatitis.
Characterized by thick, hardened skin.
Risk of infection, ulcerations, pain, and impairment from persistent buildup of lymph fluid in affected area.
Treatment aims to prevent progression, infection, and ulceration with compression garments, sequential compression devices (SCDs), and addressing any contributing factors (obesity).

Cellulitis

Common bacterial skin infection, presenting with erythema and tenderness; often accompanied by edema, malaise and elevated WBC counts.
Typically caused by Staphylococcus aureus or Streptococcus pyogenes.
Blood cultures should be checked before antibiotics are started.
Should be treated with antibiotics resistant to beta-lactamases

Intertrigo

Common in older, overweight individuals, occurring in skin folds.
Characterized by moist, erythematous skin, often in areas where skin touches skin.
Usually caused by excessive moisture and yeast overgrowth (Candida albicans)

Scabies

Common skin infestation, mainly causing intense pruritus (itching).
Characterized by burrows (small tunnels), often on finger webs, abdomen, breasts, groin.
Topicals like permethrin are preferred treatment; sometimes oral ivermectin may be necessary for severe cases.

Herpes Zoster

Often seen in the elderly and those with immunosuppression.
Characterized by a sharp, mid-line cutoff and dermatomal distribution, with painful vesicles developing in the affected area.
Pain may persist even after lesions have healed.
Early antiviral treatment (acyclovir or valacyclovir) is beneficial to reduce post-herpetic neuralgia risk.

Mycosis Fungoides/Cutaneous T-Cell Lymphoma (CTCL)

Rare type of skin cancer affecting T-cells.
Typically presents as red-brown, slightly scaly patches, progressing to plaques, then tumors.
Often develops on sun-protected areas, including the back, buttocks, and thighs.
Diagnosed based on clinical presentation and biopsy.
Treatment depends on the stage of the disease

Bullous Pemphigoid

Autoimmune disease, commonly in older adults leading to fluid-filled lesions on skin due to dermis-epidermis separation.
Characterized by intense pruritus and tense blisters developing in plaques.
Treatment involves topical steroids for mild cases, along with systemic steroid treatments and immunosuppressants for more severe cases.

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Description

This quiz covers stasis dermatitis, a common condition affecting older adults and those with leg injuries. Explore its symptoms, causes, and treatments, particularly focusing on the role of venous hypertension. Test your understanding of the diagnosis and management of this condition.