Lecture 4

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Questions and Answers

What typically triggers the spontaneous resolution of molluscum lesions?

  • Removal by scraping
  • Strengthening of the immune system (correct)
  • Exposure to liquid nitrogen
  • Application of topical treatments

Which HPV type is primarily associated with causing plantar warts?

  • HPV 3
  • HPV 1 (correct)
  • HPV 2
  • HPV 16

What is the hallmark characteristic of warts?

  • Rough, verrucous surface with black dots (correct)
  • Presence of clear fluid sacs
  • Smooth surface with no pigmentation
  • Large, scaly patches without pigmentation

Which treatment methods are effective for periungual warts?

<p>Salicylic acid and liquid nitrogen (A)</p> Signup and view all the answers

Which of the following HPV proteins is known to degrade p53?

<p>E6 (C)</p> Signup and view all the answers

What does the presence of black dots under a wart indicate?

<p>Thrombosed capillaries (B)</p> Signup and view all the answers

Why can treating periungual warts be particularly difficult?

<p>Potential to damage the fingernail (C)</p> Signup and view all the answers

What role do the early HPV proteins E6 and E7 play in the context of the virus?

<p>They promote excessive proliferation of keratinocytes (A)</p> Signup and view all the answers

What is the most common causative organism of tinea capitis?

<p>Trichophyton tonsurans (A)</p> Signup and view all the answers

Which of the following statements about tinea corporis is correct?

<p>It presents as a red, scaly ring with central clearing. (C)</p> Signup and view all the answers

Which of the following best describes the scaling seen in tinea infections?

<p>It serves as a defense mechanism against the infection. (A)</p> Signup and view all the answers

In darkly pigmented children, tinea corporis may show which of the following changes?

<p>Hypopigmentation or hyperpigmentation (D)</p> Signup and view all the answers

What type of fungi causes both tinea capitis and tinea corporis?

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

Which area of the body is typically NOT affected by tinea corporis?

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

What is the primary method used to diagnose tinea infections?

<p>Potassium hydroxide preparations (A)</p> Signup and view all the answers

The ring shape seen in tinea corporis is primarily due to which phenomenon?

<p>Shedding of the stratum corneum (B)</p> Signup and view all the answers

What is the primary cause of varicella?

<p>Varicella zoster virus (C)</p> Signup and view all the answers

What distinguishes varicella from smallpox regarding the appearance of lesions?

<p>Lesions in varicella appear in different stages of development. (A)</p> Signup and view all the answers

What is a common method of transmission for lice?

<p>Head-to-head contact (D)</p> Signup and view all the answers

Which treatment can significantly lessen the severity of varicella if administered early?

<p>Antiviral medications (C)</p> Signup and view all the answers

How long can it take for hypersensitivity to lice saliva to develop?

<p>Up to 6 weeks (D)</p> Signup and view all the answers

What is the characteristic feature of adult lice when identified?

<p>They are occasionally seen and mobile. (A)</p> Signup and view all the answers

Within how many hours must varicella immune-globulin be administered after exposure for it to be effective?

<p>96 hours (B)</p> Signup and view all the answers

What is a potential outcome for individuals immunized against varicella who still contract the disease?

<p>They will typically experience milder disease. (D)</p> Signup and view all the answers

What is the characteristic appearance of the rash associated with Fifth Disease?

<p>Bright red macular erythema on the cheeks (D)</p> Signup and view all the answers

Which virus is primarily responsible for causing Roseola?

<p>Human herpesvirus 6 (HHV6) (A)</p> Signup and view all the answers

What triggers the appearance of the rash in Fifth Disease?

<p>The immune response against the virus (D)</p> Signup and view all the answers

In what timeframe does the generalized rash of Fifth Disease typically last?

<p>1-4 weeks (D)</p> Signup and view all the answers

How does Varicella often begin before the rash appears?

<p>With a prodrome of low-grade fever and malaise (C)</p> Signup and view all the answers

Which group is primarily affected by Fifth Disease?

<p>School-aged children (C)</p> Signup and view all the answers

What precaution is important for individuals with compromised hematopoietic function when infected with parvovirus B19?

<p>They may develop significant anemia. (D)</p> Signup and view all the answers

What is a common treatment for managing high fevers in roseola?

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

What is the recommended strategy for treating nits after the initial treatment?

<p>Retreatment is recommended after one week. (A)</p> Signup and view all the answers

Which area is most commonly involved in atopic dermatitis in older children?

<p>Antecubital fossae (A)</p> Signup and view all the answers

What is a common finding associated with chronic rubbing in periocular areas due to atopic dermatitis?

<p>Periocular hyperpigmentation (B)</p> Signup and view all the answers

Which treatment is often avoided for periocular atopic dermatitis due to potential side effects?

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

What characteristic change is observed in the rash of atopic dermatitis as children age?

<p>It develops more scaling and skin thickening. (B)</p> Signup and view all the answers

What is keratosis pilaris, as described in the context of atopic dermatitis?

<p>Small hyperkeratotic papules at hair-follicle orifices (B)</p> Signup and view all the answers

What are the remnants that remain attached to the hairshaft after treatment for lice?

<p>Nits (shells) (C)</p> Signup and view all the answers

What is the typical appearance of atopic dermatitis lesions in older children?

<p>Dry and hyperpigmented (A)</p> Signup and view all the answers

What is the typical presentation of Henoch-Schonlein Purpura (HSP)?

<p>Purpuric papules on legs and buttocks (B)</p> Signup and view all the answers

Which of the following treatments is used for pityriasis alba?

<p>Moisturization and mild topical steroid (D)</p> Signup and view all the answers

Which complication can occur in cases of severe gastrointestinal manifestations of HSP?

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

What is the main finding observed in most cases of Henoch-Schonlein Purpura?

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

Which condition is most often treated with milder topical acids such as lactic acid?

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

What is the general duration of symptoms for Henoch-Schonlein Purpura?

<p>1-6 months (A)</p> Signup and view all the answers

Which of the following statements about Henoch-Schonlein Purpura is correct?

<p>It can be associated with respiratory infections. (B)</p> Signup and view all the answers

What long-term monitoring is recommended for patients after resolution of Henoch-Schonlein Purpura?

<p>Renal function tests every six months (B)</p> Signup and view all the answers

Flashcards

Tinea corporis

A fungal infection of the skin that typically presents as a red, scaly ring with central clearing.

Trichophyton rubrum

The most common causative organism of tinea corporis.

Tinea capitis

A fungal infection of the scalp that presents as areas of hair loss with scaling and possible erythema.

Trichophyton tonsurans

The most common causative organism of tinea capitis.

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Dermatophyte

A type of fungus that causes infections by digesting keratin.

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Scaling

A defense mechanism against dermatophyte infections, where the stratum corneum is shed faster than the fungus can proliferate.

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KOH preparation

A diagnostic test for tinea corporis and tinea capitis, where a sample of skin is treated with potassium hydroxide to dissolve keratin, leaving visible fungal elements.

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Fungal culture

A diagnostic test for tinea corporis and tinea capitis, where a sample of skin is grown in a culture medium to allow the fungus to multiply and identify the specific organism.

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Periungual Warts

A skin condition caused by a virus that affects the skin near the nail.

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Warts

The common name for the HPV (Human Papillomavirus) that causes warts, a group of over 70 viruses.

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Characteristics of Warts

Warts are rough, with brown or black dots on them, which are actually visible blood clots deep in the wart.

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E6 and E7 (Early 5, 6, and 7) protein.

A protein produced by HPV viruses, playing a crucial role in hijacking cell growth to replicate the virus.

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L1 and L2 (Late 1 and 2) proteins.

A type of protein that helps build the outer shell (capsid) of viruses, protecting the genetic material inside.

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Periungual Wart

A specific type of wart that grows near the nails. They are usually related to HPV 2.

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Plantar Warts

A type of wart that mainly affects the soles of the feet, commonly caused by HPV 1.

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Flat Warts (also called 'Plane Warts')

A common type of wart that typically grows on the face and legs, related to HPV 3.

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Atopic Dermatitis (Eczema)

A condition where the skin becomes itchy, red, and inflamed. It is common in children and can affect any area of the body, but often appears on the elbows and knees.

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Keratosis Pilaris

Tiny bumps that appear on the skin, especially on the arms. They are caused by thickened hair follicles and are common in people with atopic dermatitis.

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Morgan-Dennie Lines

Dark lines under the eyes that can be a sign of atopic dermatitis.

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Pityriasis Alba

Areas of lighter skin that can appear on the cheeks, often due to atopic dermatitis.

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Topical Permethrin

A treatment for head lice that involves applying a liquid insecticide to the scalp.

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No Nit Policies

These policies prohibit children with visible head lice from attending school. This can create a practical problem, as head lice are often difficult to eradicate completely.

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Topical Malathion

A common treatment option for head lice that can be used to kill live lice, when permethrin is ineffective.

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What is Keratosis Pilaris?

A skin condition characterized by small, rough bumps, typically on the upper arms, thighs, and cheeks.

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What is Pityriasis Alba?

A skin condition characterized by patches of lighter skin, often with a slightly scaly texture.

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What is Henoch-Schonlein Purpura (HSP)?

A rare disorder that causes inflammation of blood vessels (vasculitis), resulting in a purple rash, abdominal pain, and sometimes kidney problems.

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What is Palpable Purpura?

A symptom of HSP characterized by small, raised, purple spots on the skin, often on the legs and buttocks.

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What is Chronic Renal Failure in HSP?

A potential complication of HSP that can lead to kidney failure, sometimes months or years after the initial symptoms.

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What is Treatment for HSP?

A common treatment for HSP that aims to reduce inflammation and pain.

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How does HSP affect different organs?

HSP predominantly affects blood vessels, but can manifest with symptoms in different parts of the body. For example, a rash indicates skin vessel involvement, abdominal pain means digestive system vasculitis, and blood in urine signifies kidney vessel inflammation.

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What are the causes of HSP?

Although HSP can be triggered by infections or medications, many cases have no identifiable cause.

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Roseola

A viral illness characterized by a high fever followed by a rash that appears as the fever subsides. It is caused by human herpesviruses 6 and 7 (HHV6 and HHV7).

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Fifth Disease (Erythema Infectiosum)

A viral illness known for its distinctive "slapped cheek" rash, caused by parvovirus B19. The rash typically occurs on the cheeks and may spread to the body with a lacy appearance.

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Varicella (Chickenpox)

A viral disease caused by the varicella-zoster virus (VZV), characterized by itchy, fluid-filled blisters that appear in clusters. It is often called "chickenpox."

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Lymphotrophic Viruses

These viruses have a preference for attacking and infecting cells of the lymphatic system.

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Latent Viruses

This means that after the initial infection, the virus remains dormant but can reactivate later under certain circumstances.

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Immune Response to Parvovirus B19 (Fifth Disease)

The rash typically occurs when the body produces antibodies (IgG) against the virus. It's a sign of the immune system fighting back.

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Fifth Disease vs. Lupus

Fifth Disease can mimic the symptoms of lupus, a chronic autoimmune disorder, but blood tests will help distinguish between the two, as lupus patients will have a positive ANA (antinuclear antibody) test.

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Erythroid Progenitor Cell Tropism

This refers to the ability of a virus to have a preference for attacking a certain type of cell, in this case, the cells that produce red blood cells. This can lead to anemia in individuals with weakened bone marrow, such as those with sickle cell disease.

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Varicella zoster virus (VZV)

A type of virus that causes chickenpox and shingles.

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Incubation period for varicella

The period between exposure to the virus and the appearance of initial symptoms.

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Viremia

The spread of a virus from the initial infection site to other parts of the body through the bloodstream.

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Scalp pruritus (itching)

The primary symptom of head lice, due to hypersensitivity to their saliva or waste.

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Head-to-head contact

The primary mode of transmission for head lice, involving direct contact between heads.

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Fomites

Objects that can carry and transmit infectious organisms, such as combs, brushes, and hats.

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Study Notes

Tinea Capitis and Tinea Corporis

  • Tinea corporis (ringworm of the body) is common in all races, and presents as a red, scaly ring with central clearing, sometimes with hyper/hypopigmentation in darker skin tones. It is not typically itchy or painful.
  • Tinea capitis (ringworm of the scalp) is relatively common in African-American and Hispanic children, and is more common than in adults. It typically involves hair loss with scaling on the scalp, and may have some erythema and pustules. Some cases can be itchy or painful.
  • Causative organisms:
    • Tinea corporis: Trichophyton rubrum, Microsporum canis, and Trichophyton mentagrophytes.
    • Tinea capitis: Trichophyton tonsurans.
  • Both conditions are caused by dermatophytes, fungi that digest keratin, affecting stratum corneum, hair, and/or nails.
  • Infections can be anthropophilic (human reservoir), zoophilic (animal reservoir), or geophilic (soil reservoir).
  • The scaling of the rash is a defense mechanism. Stratum corneum sheds faster than the organism can proliferate, removing the infection from the skin. The clearing in the center of the rash shows this removal.
  • Diagnosis: Potassium hydroxide (KOH) preparations or fungal cultures.
  • Treatment: Azoles (ketoconazole, miconazole, etc) inhibit fungal growth; allylamine (e.g., terbinafine) inhibits squalene epoxidase, which is an alternative treatment.

Molluscum Contagiosum

  • Extremely common in children. More common in those with atopic dermatitis.
  • Presents as small (1-3 mm), shiny, skin-colored papules with a central dimple. Lesions can appear anywhere on the body, and can grow large in immunocompromised individuals.
  • Caused by a DNA virus (poxvirus).
  • Transmitted through contact with skin lesions, or through shared objects.
  • Usually resolves spontaneously, but treatment includes scraping, salicylic acid, liquid nitrogen, or imiquimod.

Warts

  • Caused by human papillomaviruses (HPVs).
  • Various types of HPV cause different types of warts (e.g., plantar, periungual, "flat").
  • HPV proteins (L1, L2, E5, E6, E7) hijack cellular proliferation, inactivating normal regulatory proteins (p53 and retinoblastoma). This allows for excessive proliferation of keratinocytes.
  • Diagnosis is generally visual.
  • Treatments include salicylic acid and liquid nitrogen.

Periungual Warts

  • Warts near fingernails are common in children.
  • Characterized by a rough, "verrucous" surface with black dots (thrombosed capillaries) beneath.
  • Treatment approaches are similar to warts in other locations.

Pyogenic Granuloma

  • Red, moist nodules that often result from minor trauma.
  • Characterized by excessive wound healing response.
  • Typically treated with surgical removal and cauterization to prevent recurrence.

Hand-Foot-Mouth Disease (HFMD) and Herpangina

  • Caused by picornaviruses (e.g., Coxsackievirus A16).
  • HFMD presents with vesicles or pustules (often on hands and feet) and oral erosions (typically in mouth).
  • Herpangina involves only oral erosions.
  • Typically resolves spontaneously.

Viral Exanthems

  • Viral rashes are common, typically non-specific, presenting as widespread erythematous papules/papules, and urticarial lesions, with fever and possible malaise (general unwell feelings).
  • Often caused by enteroviruses.
  • Diagnoses based on clinical presentation.
  • Treatment consists of supportive care for symptomatic relief.

Papular Acrodermatitis of Childhood (Gianotti-Crosti)

  • Symmetric, monomorphic pink papules (bumps).
  • Typically on face, buttocks, and extensor surfaces of extremities.
  • Often occurs in children during spring/summer.
  • May be associated with viral infections.
  • Typically resolves without treatment.

Roseola Infantum

  • Characterized by a high fever for several days, followed by a non-specific rash of pink macules and papules.
  • Caused by HHV6 and HHV7.
  • Typically resolves spontaneously.

Unilateral Thoracic Exanthem (UTE)

  • Non-specific rash localized to one axilla or flank, but often spreads to the opposite.
  • Etiology is believed to be viral but not yet isolated.
  • Self-limiting with resolution within 1-2 months.

Varicella (Chickenpox)

  • Characterized by a widespread eruption of small vesicles on erythematous bases.
  • Caused by varicella-zoster virus (VZV), transmitted via respiratory droplets.
  • Usually resolves spontaneously.

Pediculosis Capitis (Head Lice)

  • Infestation of parasites (lice) on the head, characterized by intense itching.
  • Female lice lay eggs (nits) that attach to hair shafts.
  • Diagnosed by visual inspection; may have mobile lice or nits.
  • Treated with topical permethrin, Malathion, or oral ivermectin.

Henoch-Schönlein Purpura (HSP)

  • A type of vasculitis characterized by palpable purpura (reddish/purple spots) on the legs and buttocks, often triggered by an upper respiratory infection.
  • Symptoms can range from mild (mild skin rash and/or GI distress) to potentially serious (kidney involvement or GI distress such as bloody stools or abdominal pain).
  • Treat with supportive care for mild cases. More serious cases, require potentially oral steroids.

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