Skin disorders 3.pdf

Johnson & Wales University Physician Assistant Program Dermatology Module Skin Based Disorders III 2024 Mark Trott, MBA, MHP, PA-C Diplomate Fellow-SDPA [email protected] Agenda Session 1 Session 3...

Johnson & Wales University Physician Assistant Program Dermatology Module Skin Based Disorders III 2024 Mark Trott, MBA, MHP, PA-C Diplomate Fellow-SDPA [email protected] Agenda Session 1 Session 3 Intro to Dermatology Skin Based Disorders III Approach to the Dermatology Nevi and Skin Cancer Patient Skin Based Disorders IV Common Skin Lesions Session 4 Session 2 Hair and Nail Disorders Skin Based Disorders I Derm Diagnostic Procedures Topical Steroids Skills Lab Skin Based Disorders II Session 5 Derm Cases/Review Skin Based Disorders III Molluscum Contagiosum Molluscum Contagious infection caused by a DNA Poxvirus Favors follicular epithelium Epidemiology Children Sexually active young adults Immunocompromised Molluscum Contagiosum Transmission Person to person Autoinoculation Fomites Molluscum Contagiosum Clinical Presentation Shiny skin colored umbilicated papules “Autoinoculation” “Molluscum Dermatitis” Most cases resolve spontaneously over several months up to 2 years Molluscum Contagiosum Molluscum Dermatitis Anogenital Molluscum Molluscum Contagiosum DX Clinical Labs Consider HIV in extensive/resistant cases Biopsy rarely necessary but will confirm diagnosis Molluscum Contagiosum RX Education Manage skin integrity/itch No treatment is most common approach in children STI Counseling/Testing recommended if sexually transmitted Cryosurgery Cantharidin- “Beetle Juice” Avoid use on face and anogenital area Imiquimod How are you going to treat this? Warts Warts Cutaneous HPV Infections >200 subtypes Clinical Variants Verruca Vulgaris Verruca Plana Palmar, Plantar and Periungual Condyloma Warts Pathogenesis HPV infection of Basal Keratinocytes Infected Keratinocytes then proliferate producing typical warty growths Warts Clinical Presentation Hyperkeratotic Rough or “Verrucous” Black Dots Thrombosed Capillaries Filiform Projections Thread-like Disruption of Skin Lines Palms and Soles Warts Hyperkeratotic Black Dots Warts Filiform Disruption of Skin Lines Warts Periungual Warts Verruca Plana Warts DX Clinical Biopsy Atypical lesions Treatment failure Warts RX Reality check! Warts are viral infections not just growths and can be very resistant to treatment Multiple treatments are often needed Treatment failure is common Warts RX No Treatment OTC Salicylic Acid Cryosurgery Other Topicals Retinoids Imiquimod 5-Fluorouracil Cantharidin- “Beetle-Juice” Lasers Immunotherapy Hypnotherapy Genital Warts Condyloma Acuminata HPV infection of skin or mucosal surfaces in the anogenital region Epidemiology Most common STD in the world 10-20% of unvaccinated adults Highest risk population Sexually active women 6 outbreaks per year What about topicals? Distribution? Herpes Zoster Shingles Skin eruption caused by reactivation of Varicella Zoster virus within sensory nerve ganglia Risk Factors Prior Varicella Infection Stress Advanced Age Immunocompromise Prevention Zoster Vaccine >50 Herpes Zoster Clinical Presentation Prodromal Phase Malaise or flu-like symptoms Pain without a rash lasting 1-10 days Active Infection One or more islands of grouped vesicles on a red base most commonly along a single dermatome Typical duration- 3-4 weeks Herpes Zoster Complications Post Herpetic Neuralgia Herpes Zoster Ophthalmicus Herpes Zoster Oticus Herpes Zoster Post Herpetic Neuralgia Pain > 1 month after lesions resolved Risk increases with age Can be severe and incapacitating lasting months to years for some Herpes Zoster Herpes Zoster Ophthalmicus Potentially sight threatening Involvement of the Ophthalmic Branch of the Trigeminal Nerve (V1) Dysesthesia of Forehead and Brow Conjunctivitis, Episcleritis, Keratitis, Uveitis or Iritis Hutchinson’s Sign Lesions on tip of nose Herpes Zoster Herpes Zoster Oticus Involvement of Facial Nerve- CN VII Some overlap with CN V, VI, VIII, IX Ramsay Hunt Syndrome Involvement of the ear, around the ear and down the auditory canal Vertigo, Ipsilateral Facial Weakness, Deafness Herpes Zoster DX Clinical Labs Tzanck Smear Viral Cultures PCR Testing >95 percent sensitivity Herpes Zoster RX Oral Antivirals- best if 24 hours Resolved lesions leave a mark Painful Urticaria Purpura Biopsy Urticaria RX Avoid triggers Antihistamines Diphenhydramine; Hydroxyzine Cetirizine; Loratadine; Fexofenadine Doxepin Systemic Steroids Short course while antihistamines kicking in Severe, Atypical or Recalcitrant Referral to Allergy-Immunology IgE antagonist Omalizumab- Xolair Erythema Multiforme (EM) Erythema Multiforme Self limited hypersensitivity reaction involving skin and mucous membranes EM Minor Skin only EM Major Skin and Mucous Membranes Systemic Sx Fever; Arthralgias Erythema Multiforme Triggers Infection HSV- 90% Drugs