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?

<p>Skin folds where skin touches skin (C)</p> Signup and view all the answers

What is a classic sign of scabies?

<p>Burrows in the skin (D)</p> Signup and view all the answers

What is the most important aspect of treating intertrigo?

<p>Drying the affected skin (D)</p> Signup and view all the answers

Which population is most likely to develop scabies?

<p>Children and nursing home residents (C)</p> Signup and view all the answers

What laboratory test is recommended before starting treatment for cellulitis?

<p>Blood cultures (D)</p> Signup and view all the answers

What is the primary purpose of ligating an incompetent vessel?

<p>To promote blood flow into competent vessels (D)</p> Signup and view all the answers

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

<p>Application of Unna boots (C)</p> Signup and view all the answers

What skin condition is typically associated with chronic lymphedema?

<p>Thick and hardened skin (D)</p> Signup and view all the answers

What is an appropriate management strategy for chronic lymphedema?

<p>Addressing causative factors such as obesity (C)</p> Signup and view all the answers

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

<p>Applying if ulcers are infected (B)</p> Signup and view all the answers

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

<p>Recurrent infections and ulcerations (A)</p> Signup and view all the answers

How does chronic lymphedema initially develop?

<p>From accumulated lymphatic tissue (A)</p> Signup and view all the answers

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

<p>To inflate balloons sequentially to promote fluid movement (C)</p> Signup and view all the answers

What is a characteristic feature of crusted scabies?

<p>Thick crusting primarily on the hands, feet, and scalp. (C)</p> Signup and view all the answers

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

<p>Allergic reaction to mite feces and saliva. (A)</p> Signup and view all the answers

What is the first line treatment for standard scabies?

<p>Topical permethrin. (C)</p> Signup and view all the answers

Which statement about Zoster is correct?

<p>The eruption is often preceded by tingling, burning, or itch. (D)</p> Signup and view all the answers

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

<p>Refer the patient to ophthalmology to evaluate for ophthalmic involvement. (D)</p> Signup and view all the answers

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

<p>Post-herpetic neuralgia. (A)</p> Signup and view all the answers

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

<p>Two doses, one week apart, at 200 mcg/kg each. (A)</p> Signup and view all the answers

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

<p>2-8 weeks. (B)</p> Signup and view all the answers

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

<p>Acyclovir (D)</p> Signup and view all the answers

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

<p>Adults aged 60 and above (C)</p> 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?

<p>Advanced stage (C)</p> Signup and view all the answers

What characterizes the blisters associated with Bullous Pemphigoid?

<p>Tense and tough (C)</p> Signup and view all the answers

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

<p>CD4+ T-cells (C)</p> Signup and view all the answers

What is a common initial presentation of Mycosis Fungoides?

<p>Red-brown scaly patches (A)</p> Signup and view all the answers

Which treatment is typically used for patch-stage CTCL?

<p>Topical treatments (C)</p> Signup and view all the answers

What triggers the autoimmune response in Bullous Pemphigoid?

<p>Antibodies against dermal proteins (D)</p> Signup and view all the answers

What are the common symptoms associated with stasis dermatitis?

<p>Erythema, scaling, and possibly weeping (B)</p> Signup and view all the answers

What is the primary cause of stasis dermatitis?

<p>Venous hypertension (A)</p> Signup and view all the answers

How does stasis dermatitis typically progress if left untreated?

<p>It leads to permanent hyperpigmentation and potential ulcers. (B)</p> Signup and view all the answers

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

<p>Proximal to the medial malleolus (D)</p> Signup and view all the answers

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

<p>Generalized pruritic eruption of small, pink papules and vesicles (B)</p> Signup and view all the answers

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

<p>Enhanced physical activity (C)</p> Signup and view all the answers

What is the first step in managing stasis dermatitis?

<p>Making the correct diagnosis (A)</p> Signup and view all the answers

In which patient demographic is stasis dermatitis most common?

<p>Elderly individuals, especially if obese (B)</p> 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?

<p>Stasis dermatitis (B)</p> Signup and view all the answers

What is the primary treatment for stasis dermatitis?

<p>Topical steroids, leg elevation, and compression (B)</p> Signup and view all the answers

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

<p>To rule out deep vein thrombosis (D)</p> Signup and view all the answers

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

<p>They promote fluid movement proximally by having greater compression distally. (D)</p> Signup and view all the answers

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

<p>Triamcinolone 0.1% ointment (A)</p> Signup and view all the answers

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

<p>They can experience contact dermatitis from these products. (A)</p> Signup and view all the answers

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

<p>Compression should only be used if arterial circulation is confirmed to be healthy. (A)</p> Signup and view all the answers

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

<p>Refer them to a vascular surgeon for evaluation. (D)</p> Signup and view all the answers

Flashcards

Stasis Dermatitis

A skin condition primarily affecting the lower legs, caused by poor blood flow back to the heart.

Venous Hypertension

Increased pressure within the veins, often due to impaired blood flow out of the legs.

Id Reaction

A generalized, pruritic eruption of small, pink papules and vesicles that can occur with severe stasis dermatitis.

Erythema

A common symptom of stasis dermatitis, characterized by redness, warmth, and tenderness.

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Scaling

The formation of scales on the skin, often seen in stasis dermatitis.

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Extravasation

The leakage of fluid from blood vessels into surrounding tissues, contributing to stasis dermatitis.

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Proteases and Lysosomes

The release of proteins and enzymes from white blood cells, contributing to inflammation and tissue damage in stasis dermatitis.

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Diagnosis

The primary focus of treatment for stasis dermatitis.

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Cellulitis

A bacterial infection of the skin that causes redness, swelling, pain, and warmth.

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Leg Compression Therapy

The use of compression stockings or bandages to improve blood flow in the legs, especially for conditions like stasis dermatitis.

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Graduated Compression Stockings

A type of compression stocking that applies more pressure to the ankles and less pressure to the thighs, promoting blood flow upwards.

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Allergic Contact Dermatitis

A common complication of stasis dermatitis, occurring when patients are allergic to topical creams, ointments, soaps, or even moisturizers.

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Triamcinolone 0.1% Ointment

A topical steroid commonly used to treat stasis dermatitis due to its minimal ingredients and low allergy risk.

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Doppler Studies

A type of medical study that uses sound waves to assess blood flow in the legs.

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Deep Vein Thrombosis (DVT)

A condition characterized by the formation of blood clots in the deep veins of the legs, potentially leading to swelling, pain, and redness.

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Chronic Lymphedema

A condition where lymphatic fluid accumulates in the extremities, often resulting from chronic stasis dermatitis or lymphatic system damage.

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Chronic Lymphedema: Skin Appearance

A thick, hardened appearance of the skin in the affected limb, often with a pebbly or nodular surface.

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Compression Garments for Lymphedema

Compression garments that exert significant pressure to reduce swelling and improve lymphatic flow.

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Sequential Compression Devices (SCDs)

Devices that inflate and deflate sequential balloons on a garment worn on the limb, mimicking the natural pumping action of muscles.

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Chronic Lymphedema: Inflammation and Fibrosis

Inflammation associated with fluid and protein leakage in the affected limb, leading to fibrosis (scarring) of the skin and subcutaneous tissue.

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Chronic Lymphedema: Cause

A condition that develops after chronic stasis dermatitis and edema, caused by accumulation of lymphatic fluid in the limb.

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Chronic Lymphedema: Complications

Recurrent infections, ulcerations, pain, and loss of function are potential complications of chronic lymphedema.

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Chronic Lymphedema: Weight Management

Weight loss is crucial in managing chronic lymphedema, especially for obese individuals.

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Intertrigo

A rash that occurs in skin folds, often in elderly or overweight individuals. It is caused by excessive moisture and Candida albicans overgrowth.

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Silver sulfadiazine cream

A type of broad-spectrum antibiotic cream used to prevent infection in skin breakdown.

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Beta-lactamase resistant antibiotics

Antibiotics that can kill bacteria that produce beta-lactamase, an enzyme that breaks down many antibiotics.

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Elevated WBC count

High levels of white blood cells in the blood, often indicating infection.

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Nystatin

A type of antifungal medication used to treat Candida infections.

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Topical azoles

A type of antifungal medication used to treat Candida infections.

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Crusted Scabies

A severe form of scabies that occurs in people with weakened immune systems or neurological disorders. It involves thick crusting, especially on the hands, feet, and scalp, and can harbor thousands or millions of mites.

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How to treat scabies

Treatment for scabies typically involves topical permethrin cream applied from neck to toe, left on overnight, and washed off in the morning. The process should be repeated a week later. Sheets and clothes worn within the past five days should be washed in hot water.

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Shingles (Herpes Zoster)

A viral infection caused by the varicella-zoster virus, often presenting with painful, blistering rash that follows a nerve pathway (dermatome) on one side of the body. It's more common in older adults and those with weakened immune systems.

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Dermatomal Distribution

The most useful sign for diagnosing shingles is a clear, sharp cut-off along a specific nerve pathway, called a dermatome, on one side of the body.

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Ophthalmic Zoster

A complication of shingles that can occur when the virus affects the V1 dermatome near the eye. It can lead to serious eye problems, even permanent vision loss, if untreated.

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Post-Herpetic Neuralgia

Persistent pain that can continue for months after a shingles rash has healed. It's caused by damage to the nerve fibers from the virus.

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Postherpetic neuralgia

A common complication of shingles where the pain can persist for months after the rash has cleared. This pain is often described as burning, stabbing, or tingling.

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Mycosis Fungoides/Cutaneous T-Cell Lymphoma (CTCL)

A rare type of skin cancer that affects T-cells, the immune cells that help fight infection.

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Bullous Pemphigoid (BP)

An autoimmune disease that causes blistering on the skin. It's more common in older adults and often causes intense itching.

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Disseminated Zoster

A common complication of shingles, where the virus reactivates and spreads to a new area of the skin. This can cause a new rash, even years after the initial infection.

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Antiviral Treatment for Shingles

The use of antiviral medications, such as acyclovir or valacyclovir, to treat shingles. This can help reduce the duration and severity of the infection, and may reduce the risk of post-herpetic neuralgia.

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Treatment for Post-herpetic Neuralgia

The use of medications like gabapentin or tricyclic antidepressants to manage the pain of post-herpetic neuralgia. These medications can help reduce the pain and improve quality of life.

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Zoster Vaccine

A vaccine that helps protect against shingles. It's recommended for adults over 60 years old. This vaccine can also help reduce the severity of shingles if a person does develop it.

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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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Lecture 10 Part 2 PDF

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.

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