Term
|
Definition
Flat, circumscribed area. Change in skin color. <1cm in diameter.
Eg. Freckles, measles, scarlet fever |
|
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Term
|
Definition
Elevated, firm, solid circumscribed area. <1cm in diameter.
Eg. Verruca, Lichen planus, acne. |
|
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Term
|
Definition
Flat, non-palpable, irregular-shaped macule. >1cm in diameter.
Eg. Vitiligo, Port-Wine Stains, Cafe-au-lait spots, Mongolian Blue Spot |
|
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Term
|
Definition
Elevated, firm and rough lesion with flat top. >1cm in diameter.
Eg. Psoriasis, Seborrheic keratosis, Discoid lupus. |
|
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Term
|
Definition
Elevated, irregular-shaped area of cutaneous edema. Solid, transient. Variable size.
Eg. Bug bites, allergic reaction, urticaria. |
|
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Term
|
Definition
| Elevated, firm, solid, circumscribed. Deeper in dermis than papule. 1-2cm in diameter (larger than papule, smaller than tumor) |
|
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Term
|
Definition
Elevated, solid lesion. +/- clear demarcation, deeper in dermis. >2 cm.
Eg. Neoplasms |
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Term
|
Definition
Elevated, circumscribed, superficial (not into the dermis). Filled with serous fluid. <1cm in diameter.
Eg. Varicella, Herpes zoster |
|
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Term
|
Definition
| Vesicle >1cm in diameter. |
|
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Term
|
Definition
Elevated, superficial lesion. Filled with purulent fluid.
Eg. Impetigo, Acne |
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Term
|
Definition
Elevated, circumscribed encapsulated lesion. Dermis or Subcutaneous. Liquid filled or semi-solid.
Eg. Sebaceous cyst, cystic acne. |
|
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Term
|
Definition
Heaped up, keratinized cells, “flakey skin”. Irregular, thick/thin, dry/oily, Various sizes.
Eg. Seborrheic dermatitis, psoriasis |
|
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Term
|
Definition
Rough, thickened epidermis secondary to persistent rubbing, scratching, or skin irritation.
Eg. Atopic dermatitis, Lichen simplex chronicus |
|
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Term
|
Definition
| Irregular-shaped, elevated, progressively enlarging scar. Grows beyond wound boundaries. Due to excessive collagen formation during healing. More common in African-Americans. |
|
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Term
|
Definition
Loss of epidermis. Linear, hollowed-out.
Eg. Abrasion, scratches |
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Term
|
Definition
Linear crack/break from epidermis to the dermis.
Eg. Athlete's foot (tinea pedis) |
|
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Term
|
Definition
| Loss of part of the epidermis. Depressed, moist, glistening. Follows rupture of vesicle/bulla such as Herpes simplex. |
|
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Term
|
Definition
Loss of epidermis and dermis. Concave. Variable size.
Eg. Decubitus ulcers, primary syphilis, venous stasis ulcer |
|
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Term
|
Definition
Dried serum/blood/purulent fluids. Slightly elevated. Black/brown/red/straw-colored.
Eg. Impetigo, scabs |
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Term
|
Definition
Thinning of skin surface and loss of skin markings. Skin is translucent and paperlike. Aging, striae associated with obesity, scleroderma
Eg. Stretch marks |
|
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Term
| Morphologic Characteristics |
|
Definition
| Distribution, Shape/Arrangement, Border/Margin, Associated Change, Pigmentation |
|
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Term
|
Definition
Localized
Regional
Generalized |
|
|
Term
| Types of Basal Cell Carcinomas |
|
Definition
Nodular: 60%. Pink/Flesh colored. Pearly/Translucent, Telangectasia vessel, ulceration (rolled edge)
Superficial: 30%. More common in men and on trunk. Slightly scaly macules/patches light red to pink in color.
Morpheaform: 5-10%. Most aggressive form. Smooth flesh colored papules or plaques. |
|
|
Term
|
Definition
| Locally invasive, low metastases. Destructive to surrounding skin/structures. >40 yrs (increases w/ age). 30% more likely in men. More common in caucasians, and 70% occur on the face. |
|
|
Term
| Risk Factors for Basal Cell Carcinoma |
|
Definition
| Sun exposure (esp. childhood), tanning beds, therapeutic exposure to psoralen plus ultraviolet A light (PUVA), Photosensitizing drugs (Doxy, diuretics), Chronic arsenic exposure (water, fish, meds, moonshine), Ionizing radiation, Chronic immunosuppression (organ transplant, HIV), Genetic, fair-skinned people, albinos |
|
|
Term
| Treatment for Basal Cell Carcinoma |
|
Definition
Identify Tumor characteristics: Size, pathology, patient preferences.
Surgical Options: ED&C, Curettage or Excision, Mohs, Cryo.
Topical Therapy: 5-Fluorouracil (5-FU) cream (chemotherapeutic) |
|
|
Term
|
Definition
Circumscribed pigmented lesions, usually irregular and often maculopapular, w/ complex colors and patterns.
Mostly on trunk, seen in adolescence. Usually >5mm.
Usually brown but can be mottled with dark brown, pink, and tan colors. Marker for a propensity to develop melanoma
Familial dysplastic nevi syndromes. Need close follow-up after excision w/ narrow margins |
|
|
Term
|
Definition
| Most malignant tumor of the skin. Malignant transformation of melanocytes at the dermal-epidermal junction. Responsible for 80% of skin cancer deaths. Early recognition is key (prognosis is improving. 30% arise in preexisting melanocytic lesions, 70% occur in normal skin. Can occur in unusual places (hands, feet, vulva, fundi, scalp). |
|
|
Term
|
Definition
| Fair skin, family history of dysplastic nevi/melanoma, previous personal history of melanoma, UV irradiation esp. sunburn in childhood (intense and sporadic), large number (>50) or size (>5mm) of melanocytic nevi. Congenital nevi, more than 5 atypical (dysplastic) nevi, dysplastic melanocyte nevus syndrome. |
|
|
Term
|
Definition
Asymmetry
Border
Color
Diameter
Elevation (or Evolution) |
|
|
Term
|
Definition
Superficial Spreading: Most common (70%), Found anywhere. Elevated flat plaque, slow growing. Delayed vertical growth.
Nodular: More common in Japanese patients (15% of total cases), found anywhere. Vertical growth phase at onset, color usually uniform. Often a "new mole".
Lentigo Maligna: Least common (<5%), usually an older patient. On face and forearm. Slow growing. Vertical growth indicates a change in growth phase and increased invasiveness.
Acral Lentigionous: 5-10% of melanomas. Arise in palms, soles, or nail beds. Most often in Asians, Africans, or AAs. |
|
|
Term
|
Definition
| Excisional biopsy with narrow margins initially. Thickness (Breslow's Depth) is a better indicator of outcome. Prognosis can be predicted based on depth of invasion, ulceration, nodal status, patient's age, and extra-nodal extension. |
|
|
Term
|
Definition
Presentation: Very common in elderly (esp. caucasians), variety of appearances (yellow, brown, "stuck on"). Usually asymptomatic, but can be irritated by clothing and can itch and become inflamed. Unattractive and wart-like. Benign.
Treatment: Topical ammonium lactate and alpha hydroxyl acids can reduce the height, cryotherapy, ED&C, Laser Surgery |
|
|
Term
|
Definition
Precancerous lesions (Solar Keratosis). Can progress to Squamous Cell Carcinoma. Associated with sun exposure, more common in males/people who work outdoors. Crusty! Hyperkeratotic lesions on hands, face, scalp. Feel very rough.
Treatment: Cryo, curettage, 5-FU cream, topical imoquimod or retinoids.
Topical 5-FU is very effective but cause intense redness, ulceration and itching. Applied to the area BID until lesions peel (2-4 weeks) this is pricey! $$$
Imoquimod cream applied 2 times a week for 16 weeks, similar side effects. |
|
|
Term
| Cutaneous Squamous Cell Carcinoma |
|
Definition
| Malignant tumor of keratinocytes in the epidermis. Common sun exposed areas. Occurs in fair skinned people. Second most common skin cancer. Higher metastatic potential compared to BCC (esp. the lower lip and ear) Can cause local tissue destruction. |
|
|
Term
| Risk factors of Squamous Cell Carcinoma |
|
Definition
| UV exposure, fair skin, blond/red hair, albinism, immunosuppression, infections (hidradenitis suppurativa, chronic fungal infections, acne), sites of chronic inflammation (venous stasis ulcer, burn scars) |
|
|
Term
| Presentation of Squamous Cell Carcinoma |
|
Definition
| Crusting, scaly, eroded papule or plaque or non-healing ulcer. May be associated with cutaneous horn. May cause some peripheral nervous symptoms due to tumor involvement with nerve (numbness, twitching). |
|
|
Term
| Treatment of Squamous Cell Carcinoma |
|
Definition
| Surgical excision (tumor can be locally destructive and may require skin grafts), ED&C, Mohs for small lesions or where tissue preservation is needed (esp face), radiation (as adjuvant to surgery or primary radiation in patients unable to undergo surgery). |
|
|
Term
|
Definition
| Spindle cell tumor, endothelial cell origin. Varies from minimal mucocutaneous disease to systemic organ involvement. Mucocutaneous lesions are asymptomatic, usually a cosmetic issue. Organ involvement causes symptoms. |
|
|
Term
| Four Classifications of Kaposi's Sarcoma |
|
Definition
HIV/AIDS related
Classic (rare in US and Eastern Europeans)
Endemic (Africa)
Immunocompromised (organ transplant) |
|
|
Term
| Scabies: Sarcoptes scabies |
|
Definition
| Infestation, not infection. Gotten from contact with infested people/inanimate objects. 8 legged mite. Not visible unless magnified. Worldwide, across age ranges. (usually not in kids <3 mos) |
|
|
Term
|
Definition
| Entirely on humans. Female mite burrows into stratum corneum to stratum granulosum. Burrows up to 1cm length. Look at hands for burrows. |
|
|
Term
|
Definition
| Pruritis, characteristic lesions, epidemiological history. Excoriations/Eczematous dermatitis (web spaces, sides of fingers, volar wrists, lateral palms, elbows, axillary regions) Linear burrow is pathognomonic marking. Look at palms of hands. Crusted scabies along hairline. Infants may have diffuse scabies (fever, strep rash). |
|
|
Term
|
Definition
| Clinically diagnosed, but definitive dx by scraping and microscopy. Use mineral oil drop and scrape w/ #15 blade. Skin biopsy also diagnostic. |
|
|
Term
|
Definition
Impetiginization: Occurrence of impetigo by infection of a preexisting dermatitis.
Post-Strep: Scabies induced pyoderma? |
|
|
Term
|
Definition
Topical: Permethrin, Malathion, Crotamiton (less effective), Ivermectin (sometimes combined), Lindane (only used if others are not tolerated/ineffective.
Must treat household members!
Fomite Control: Wash clothes, sheets (hot heat). Dry clean. Put unwashables into plastic bags and leave in hot areas for 2 weeks. |
|
|
Term
| Pediculosis humanus capitis (Head Lice) |
|
Definition
| Size of sesame seed. Moves by grabbing hair laterally. Lays nits proximally (if nits are found on distal hair, it's an inactive infestation). Ova hatch over 1 week. Nymphs mature over 1 week. Female can produce 50-150 nits over 16 day lifetime. |
|
|
Term
| Pediculosis capitis Clinical Picture |
|
Definition
| Pruritis on scalp, back, sides. Secondary infection (scratching: likely staph aureus). Papular urticaria on back of neck! Eczema/Excoriations from scratching. Can be seen with naked eye. Nits (oval grayish-white) capsule. Creamy yellow if new. White means hatched. |
|
|
Term
| Pediculosis capitis Diagnosis/Treatment |
|
Definition
Diagnosed: Finding lice. Spread from head to head contact. Use louse comb. Active infestation is indicated by nits < or = 4mm above scalp.
Treatment: Permethrin, Malathion, Pyrethrin, Piperonyl, Butoxide, Ivermectin oral |
|
|
Term
| Pediculus humanus humanus (Body Lice) |
|
Definition
| Larger than head lice. Female produces 270-300 over over 18 day lifespan. Ova incubate 8-10 days, mature over 2 weeks. Live in seams of clothing. Feed on human host. Able to survive 3 days between blood meals. Attach to body hair. Transmit disease! |
|
|
Term
| Pediculus humanus humanus Transmittable Disease |
|
Definition
Bartonella quintana (Trench fever, endocarditis)
Rickettsia prowazekii (epidemic typhus)
Brill-Zinsser disease (louse-borne relapsing fever, after epidemic typhus) |
|
|
Term
| Pediculus humanus humanus clinical picture |
|
Definition
Similar to head lice (Eczema/Excoriation from trauma, staph aureus infection, post-inflammatory hyper pigmentation)
Diagnosis: Confirmed by finding lice/eggs on clothing seams. |
|
|
Term
| Pediculus humanus humanus treatment |
|
Definition
Decontamination of bed/clothes, hygiene measures, pyrethrin, permethrin, malathion
Infestations seen in war, homelessness, concentration camps, etc. |
|
|
Term
| Phthirus pubis (Pubic/crab lice) |
|
Definition
| 0.8-1.2mm (speck sized), 14 day life span, female produces 25 ova. Nits have 7 day incubation and 14 day maturation. Adults prefer humid area. Close contact for transmission (seen with STDs) |
|
|
Term
| Phthirus Pubis Clinical Picture |
|
Definition
Asymptomatic possibly, Pruritus sometimes for months, mild-moderate, Excoriation/Secondary infection possible (Staph aureus), Secondary impetiginization, regional lymphadenopathy, Pubic/crab lice may be stationary for days
Mouth embedded in skin, holding to hairs with claws
Nits (white-gray specks on hair), Pubic and Axillary areas most common, Children (eyelashes/eyebrows, no pubic involvement), Papular urticaria at sites of feeding, Maculae cerulea |
|
|
Term
| Phthirus Pubis Diagnosis/Treatment |
|
Definition
Diagnosis: Live lice, nymphs, or nits. Found in pubic region indicates active infestation.
Treatment: Similar to other pediculus. Decontaminate clothes, bed. Treat sexual partners. |
|
|
Term
|
Definition
Most spiders are venomous, but unable to penetrate the skin. Most skin infections are mistaken for spider bites.
US Spiders capable of penetrating the skin include: Loxosceles (brown spider)
Latrodectus (widow spider)
Tarantulas (common name, several large spider species) |
|
|
Term
| Brown Recluse (Loxosceles reclusa) |
|
Definition
| Central/Southeastern US (may be seen other places due to shipping), Nocturnal hunting. Bites likely defensive. |
|
|
Term
| Brown Recluse Bite Clinical Picture |
|
Definition
Pain/Burning usually around 10 minutes post bite
Mild/local/urticarial reaction. “Bull’s-Eye” type lesion over 1-12 hours (blanched ring surrounded by ring of ecchymosis)
Necrotic ulcer follows over 24-72 hours, Normally self-limiting but may be full thickness, Systemic symptoms (24-48 hours): Fever/chills, malaise, nausea, myalgias
RARE: intravascular hemolysis and DIC |
|
|
Term
| Brown Recluse Bite Treatment |
|
Definition
| Wound care, tetanus update, treat associated infection (cellulitis), admit patient if systemic symptoms (evaluate for and treat renal failure and hemolysis), No commercial anti-venom in the US. |
|
|
Term
| Latrodectus (Widow Spider) |
|
Definition
| Native to US. Female (significant invenomations, rare fatality), Disorganized web (garage, wood piles, etc), Shiny black, red hourglass shape on belly. |
|
|
Term
| Latrodectus (Widow Spider) clinical picture |
|
Definition
Localized mild erythema, target lesion, central puncture site, central blanching, erythematous ring. Pain at 30-120 minutes (most bites painful). Painful cramping/muscle fasciculations: at 3-4 hours, effected extremity, progress centrally, muscle rigidity/weakness, dyspnea, headache, parenthesias, HTN, regional diaphoresis, restlessness, N/V, tachycardia. Uncommon Symptoms: Leukocytosis, fever, delirium, arrhythmia, HTN crisis, respiratory arrest.
Differential: MI, Acute Surgical Abdomen. Symptoms for 12-72 hours. |
|
|
Term
| Latrodectus (Widow Spider) Treatment |
|
Definition
Monitor for >= 6-8 hours. ABCs? Treat HTN, pain, muscle cramps (relaxants, calcium IV).
Anti venom (latrodectus mactans): Effective, not widely used in US (seriously ill, elderly, peds not responding to supportive treatment) because anaphylaxis risk! Used in pregnancy to avoid pre-term labor (if sx of it).
Tetanus update, wound care, treat infection if present. |
|
|
Term
| Decubitus Ulcer (Pressure Ulcer) |
|
Definition
Incidence: 2.7-9% in acute care and 2.4-23% in long-term.
Pressure on skin over boney prominence causes capillary collapse. Factors to consider: immobility, malnutrition, altered mental status. |
|
|
Term
| Treatment for Decubitus Ulcer |
|
Definition
| PREVENT! Surgical debridement, enzymatic debridement, topical wound treatment, VAC, remove pressure. |
|
|
Term
|
Definition
Inflammation of pilosebaceous unit.
Affects 85% of adolescents. More severe in males.
Causes: Follicular keratinization and plugging prevents drainage of the sebum, Androgen stimulation of the sebaceous gland, Bacterial production of inflammatory factors (Propionibacterium acnes), Inflammation distends follicle walls which break and provoke an inflammatory response, Inflammation leads to scarring |
|
|
Term
|
Definition
| Cosmetics, mechanical trauma, sweating, clothing, humidity, familial factors, diet?, stress, HORMONAL FLUCTUATION. |
|
|
Term
|
Definition
Non-inflammatory: Comedones (Open=Blackheads. Closed=White heads)
Inflammatory: Pustules, Papules, cysts, nodules |
|
|
Term
|
Definition
Remove follicle plugging
Reduce sebum production
Treat bacterial colonization
Prevent scarring |
|
|
Term
|
Definition
Topical retinoids are most effective: retinoic acid, adapalene, tazarotene
Gradually increase the concentration
Patient education to avoid side effects is important: skin irritation, overdrying, deactivation by sunlight
“Surgical” extraction
Must be properly done
Best after treatment with retinoids |
|
|
Term
|
Definition
Topical antibiotics (clindamycin or erythromycin)
Benzoyl peroxide lotions, gels, creams, washes
Topical retinoids: retinoic acid, adapalene, tazarotene
Gradually increase the concentration
Patient education to avoid side effects is important: skin irritation, deactivation by sunlight |
|
|
Term
| Moderate Inflammatory Acne |
|
Definition
Topical antibiotics (clindamycin or erythromycin)
Benzoyl peroxide lotions, gels, creams, washes
Topical retinoids: retinoic acid, adapalene, tazarotene
Gradually increase the concentration
Patient education to avoid side effects is important: skin irritation, deactivation by sunlight
Oral Antibiotics: Tetracycline, doxycycline, minocycline |
|
|
Term
|
Definition
Nodulocystic or resistant acne, higher risk of scarring
Same topical treatments
Oral antibiotics
Oral isotretinoin
Highly effective
Highly teratogenic causing birth defects
Restricted to clinicians who register with the FDA
Serious side effects including depression, psychosis, elevated triglycerides, hearing loss, night vision loss, mucosal drying, arthragias |
|
|
Term
|
Definition
Common in fair skinned middle age patients
Presents with erythema, telangiectasias, acne-like lesions on the central face
More common in women, more severe in men
Differs from acne vulgaris, there are no comedones
Patients often flush to different stimuli: alcohol, stress, spicy foods
Can result in rubbery thickening of the nose, cheeks forehead or chin due to hyperplasia, edema and fibrosis |
|
|
Term
|
Definition
Avoidance of the triggers. Topical metronidazole most effective topical antibiotic
Oral antibiotics are even more effective
Minocycline or doxycycline
Telangectasias can be treated with laser surgery |
|
|
Term
|
Definition
Chronic suppurativa disease of the apocrine gland-bearing skin. Usually involves the axillae and anogenital regions
Begins in puberty. More common in females
Familial component. Smoking and obesity are predisposing factors |
|
|
Term
| Clinical Manifestations of Hydradenitis suppurativa |
|
Definition
Tender deep seated inflammatory nodules
Intermittent drainage of purulent to seropurulent material
Development of sinus tracts and abscesses
Most common in the axillary areas, usually bilateral but can be seen anywhere there are sebaceous glands
Upon drainage, multiple bacteria can be seen but usually are secondary colonizers |
|
|
Term
| Treatment of Hydradenitis suppurativa |
|
Definition
Must be guided by disease severity, not simply an infection
Early disease: topical antibiotic clindamycin and intralesional steroids, refer to dermatology for isotretinoin or TNF inhibitors
Acute infections treat with I & D and packing
Late disease is treated with oral antibiotics
Refractory disease can be treated surgically, excisional or laser
Patient education
Smoking cessation and weight loss counseling important
Avoidance of tight synthetic clothing
Avoid deodarants (antiperspirants are ok) |
|
|
Term
|
Definition
Microsporum, Epidermophyton, Trichophyton
Cause superficial fungal infections, infect keratinized epitheilium, hair follicles and nail apparatus
Named according to the site involved: Tinea capitis, Tinea corporis, Tinea cruris, Tinea unguium/onochomycosis, Tinea pedis
Clinical diagnosis, but can be confirmed with potassium hydroxide test (KOH) |
|
|
Term
|
Definition
Capitis: Most common in children. Affects African Americans more. Non scarrng alopecia from hair breakage
Corporis: Body
Cruris: Almost always associated with tinea pedis. Large, scaling well-demarcated. Often recurrent. To prevent reinfection recommend shower shoes and antifungal powders
Pedis: |
|
|
Term
| Treatment of Dermatophyte Infections |
|
Definition
Most can be controlled by topical anti fungal creams (Miconazole, clotrimazole, Terbinafine (LAMISIL))
Tinea capitis and tinea unguium must be treated with oral antifungals (Grisveofulvin (scalp), Terbinafine (both), Itraconazole (both), Fluconazole (nails)) |
|
|
Term
|
Definition
Most commonly caused by the yeast Candida albicans
Common cutaneous candidiasis clinical manifestations
Intertrigo, Diaper dermatitis, Follicular candidiasis, Interdigital
Risks for candida infections: Obesity, Diabetes, Any body part or situation that is moist |
|
|
Term
| Treatment for Candidiasis |
|
Definition
Keep intertrigionus areas dry. Topical antifungals are the mainstay of treatment. (Nystatin cream or powder, Imidazole cream or powder). Oral antifungals for recurrence
Oral nystatin, Fluconazole, ketoconazole |
|
|
Term
|
Definition
Bacterial infection of skin and subcutaneous tissues
Infection without formation of an abscess
Usually follows a breach in the skin or port of entry for bacteria (Insect bite, puncture wound, may not be obvious/microscopic)
Without draining wounds, streptococci are the likely etiology
Cellulitis surrounding an abscess is likely staphylococci, as are pus producing wounds |
|
|
Term
| Clinical Presentation of Cellulitis |
|
Definition
4 cardinal signs of a cellulite infection: Erythema, Pain, Swelling, Warmth
More severe infection shows the following findings: Malaise, chills, fever, Lymphangitic spread, Pain disproportionate to the exam, Bullae, skin sloughing, Gas in the tissue |
|
|
Term
| Risk Factors of Cellulitis |
|
Definition
Elderly and diabetics are at risk for more severe disease
Peripheral arterial and venous disease, Patients with immunodeficiency, cancer or chronic kidney disease
Postvenectomy, lymph node dissections, mastectomy, Obesity
IV drug users “skin popping”, Any break in the skin: pickers, rashes, infections (chicken pox or shingles) |
|
|
Term
|
Definition
For patient with mild local symptoms and no evidence of systemic disease, outpatient treatment with oral antibiotics is appropriate (treatment is 5-10 days depending on severity, pmh) Patients should be reassessed with a short-interval follow-up (2-3 days) Increase in erythema over first day of treatment is normal
Systemic symptoms warrant prompt reevaluation and IV antibiotic therapy (Escalating fever, Tachycardia, hypotension
Consideration of MRSA (Methicillin resistant staph aureus)
Other patients who may need IV treatment are immunosuppressed patients, patients with facial cellulitis, patients with chronic diseases like, cardiac, hepatic or renal failure |
|
|
Term
| Danger Sings for Cellulitis |
|
Definition
Crepitus (gas in the tissue), Circumferential cellulitis
Necrotic-appearing skin (bronzing), Evolving bullae
Rapidly evolving cellulitis, Pain on passive motion
All point to necrotizing fasciitis, gas gangrene or compartment syndromes CALL A SURGEON! |
|
|
Term
|
Definition
Deep soft tissue infection involving the subcutaneous fat and fascia. There is no distinct border and can be difficult to diagnose early on. Often polymicrobial including anaerobes and seen in immunocompromised patients
Can also be cause by group A strep or MRSA and affects healthy individuals. Surgical emergency
High mortality rate even with appropriate intervention |
|
|
Term
|
Definition
Methicillin resistant staph aureus. Initially seen in hospitalized patients, has moved into the community
Causative agent for many skin infections especially abscesses, furuncles, carbuncles
Complicates the management of cellulitis
Treatment is usually vancomycin IV or IV Linezolid for severe infections, bacteremia and hospitalized patients. For outpatients use oral linezolid, oral TMP-SMX, oral doxycycline |
|
|
Term
|
Definition
Group A Strep (B hemolytic strep) S. Pyogenes skin infections and pharyngitis
Group B Strep - S. agalactiae causes neonatal pneumonia and meningitis
Group D Strep - S. bovis GI bug causes bacteremia, endocarditis and is associated with colon cancer |
|
|
Term
|
Definition
Pasturella is the most common found organism (P. multiocida in cats). S. aureus, Bacteroides, Fusobacterium, Capnocytophaga, Porphyromonas. Assess severity and depth of wound
Drug of choice is amoxicillin-clavulante (AUGMENTIN), pen allergic patients get doxycycline or TMP-SMX or fluoroquinolone like ciprofloxacin plus clindamycin
Human bites are worse! Aerobic and anaerobic organisms
Aerobes: streptococci, S aureus, Eikenella corrodens, Anerobes: Fusobacterium, Peptostreptococcus, Prevotella, Porphyromonas
IV antibiotics is often necessary |
|
|
Term
|
Definition
Rare in the first 48 hours except group A strep (S. pyogenes) and Clostridial species, they hit early
Usual agents of infection are dependent on site of surgery
For GI or GU procedures it’s a mix of GP/GN organisms
Non-intestinal sites usually Staph including MRSA, and Strep are the causes
Aim therapy at the likely cause and adjust with cultures |
|
|
Term
| Immunocompromised Patient |
|
Definition
Patients with lymphoma, HIV, transplant patients,
Pseudomonas. Be aware in diabetics with leg infections
Unusual bacteria
Mycobacterium, nocardia, Viruses, Protozoa, Fungal infections |
|
|
Term
|
Definition
Starts as erythematous vesicular lesions that become pustular and crusty. Honey colored crusts. Staph aureus is the most common cause, Strep pyogenes also
Treat based on number of lesions and location and to limit continued infectivity
Topical mupirocin ointment TID to small areas
Oral antibiotics aimed at S. aureus and S. pyogenes for 7 days
Dicloxacillin, cephalexin, erythromycin, clindamycin, amoxicillin-clavulante |
|
|
Term
|
Definition
Explosive superficial infection
Most often caused by group A streptococcus (S. pyogenes)
Spreads quickly through the skin lymphatics
Usually a clearly demarcated area of redness that is palpable
Often starts from a superficial abrasion |
|
|
Term
|
Definition
First line treatment is either IV or PO penicillin depending on the severity
PCN allergic patients receive clindamycin or erythromycin
Refractory cases may be caused by:
Unusual organism
Resistance strep or staph
More sever underlying condition (necrotizing fasciitis or myonecrosis) |
|
|
Term
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Definition
Poxvirus. Common in children but can be seen in sexually active teens and adults, can be overwhelming in HIV patients
Clinical Presentation: Flesh colored papules and nodules with distinctive central umbilication. Often seen in groin, thighs, lower abdomen in adults
Treatment: Self-limiting but easily auto inoculated esp. in children, usually regress in 6 months
Benign neglect, ED&C, cryotherapy, topical imoquimod 1% |
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Term
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Definition
Causative agents are Human Papilloma viruses. Caused by skin to skin contact and minor trauma. Multiple locations
Papules, plaques, coalesce to from larger lesions
Widespread disease can be seen in immune compromised patients. Warts heal with out scarring |
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Term
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Definition
Verruca vulgaris (common wart). Seen on hands especially but can be anywhere, occur at sites of trauma (fingers, knees)
Papular, hyperkeratosis, clefted surfaces with vegetations
Inoculation by scratching
Verruca plantaris (plantar warts): Plaque like with rough surface and studded with brown-black thrombosed vessels
Painful if in a pressure area such as metatarsal head
Verruca plana (flat warts): Flat papules, flesh colored, oval or polygonal. Often on the surface of hands, shins, also face and beard area |
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Term
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Definition
Most resolve with no treatment spontaneously (patient reassurance). Treatment can cause scarring.
Patient initiated treatments: OTC salicylic acid 10-40%, $ and effective if used consistently, Imoqimod cream, Hot water therapy, home cryotherapy
Provider initiated treatments: Cryotherapy: usually requires repetitive treatments, Electosurgery: higher chance of scarring, Laser surgery: effective for more resistant warts, Surgical excision |
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Term
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Definition
Genital warts, most common areas: penis, vulva, vagina, cervix, perineum and perianal area. Human papilloma virus (HPV), 90% are types 6 and 11 (low neoplastic potential)
Most common STD with high prevalence in 17 to 33 year olds
Risk factors include smoking, multiple sexual partners, early age of sexual activity |
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Term
| Clinical Manifestations of Genital Warts |
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Definition
Single or multiple popular eruptions that can be filiform, fungating, plaque or cauliflower like
Flesh tone in color or erythematous or hyper pigmented
Important to examine multiple sites, external lesions in women often coincide with internal lesions on the cervix or urethra, perianal lesion are common in immunosuppression and patients who have anal intercourse
Treatment involves destruction
Topical podophyllum resin or trichloroacetic acid
Cryotherapy esp. for perianal lesions, also safe in pregnancy
Electrodessication, curettage, surgical excision
HPV vaccines |
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Term
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Definition
DNA virus. Acute skin infections and rarely serious illness, important in pregnant patients as it can affect the fetus
HSV type 1 = oral infection
HSV type 2 = genital infection
Infection occurs with contact between an infected person who is shedding virus and a susceptible host
Invades and replicates in neurons and epidermal/dermal cells, travels to sensory dorsal root ganglion and establishes a latent infection. Infection triggers: stress, UV radiation, extremes in temperatures, hormonal changes, immunosuppression, trauma |
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Term
| Orolabial Herpes: Cold Sores, Fever Blisters |
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Definition
Primary infection is typical viral infection: fever, sore throat and mouth, lymphadenopathy (viral prodrome)
Often asymptomatic in children. Gingivostomatitis with odynophagia can be observed. Painful vesicles develop on the lips, plate, gingiva, tongue and can be edematous
Lesions ulcerate and heal within 2-3 weeks.
Recurrences start as pain, burning, itching or paresthesia before the vesicles erupt, ulcerate and then crust
Usually occur in the vermillion border, symptoms last 1week, often recur at or near the same location within the distribution of a sensory nerve |
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Term
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Definition
Primary infection occurs 2 days to 2 weeks after exposure, viral prodrome
Men: painful erythematous, vesicular lesions that ulcerate, commonly on the penis but can occur on the anus and perineum, may be a penile discharge, inguinal adenopathy, severe dysuria!
Women: lesions occur on the cervix which are asymptomatic, but may cause a vaginal discharge, painful vesicles on the external genitalia, perineum, buttocks, sacral area, females may have lumbosacral radiculopathy, severe dysuria
Recurrences are milder and preceded by the prodrome of pain, itching, tingling, burning or paresthesia |
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Term
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Definition
Herpetic whitlow: Vesicular outbreak on the hands and digits, more common in children and dental and health care workers
Herpetic gladiatorum: Outbreaks on face, arms and torsos of athletes involved in close contact (wrestlers)
Eczema herpeticum: Variant infection seen in mostly children with inflammatory skin conditions like atopic dermatitis, burns
Neonatal HSV: Occurs in the first 2 weeks of life and is an HSV-2 infection transferred from the mother
Often a severe infection causing rash, eye infections, pneumonia, encephalitis and death |
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Term
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Definition
Most are self limiting, but antiviral treatment will shorten the course of symptoms and may prevent dissemination and transmission for both primary and recurrences
Acylovir, Valacycolvir, Famciclovir
Medications are most effective is started at the onset of symptoms
Oral meds can be used for chronic suppressive therapy for frequent recurrences
Topical treatments are less effective: topical acyclovir and penciclovir (DENAVIR)
Watch for secondary bacteria infection that can lead to cellulitis |
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Term
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Definition
Outbreak and transmission prevention is key
Viral shedding is greatest during a clinically evident outbreak but…
Transmission to uninfected partners usually occurs during asymptomatic virus shedding
Barrier methods can confer some protection against transmission but are more effective for women that men in regard to preventing infection
Long term suppressive therapy has been shown to decrease viral shedding during asymptomatic periods (acyclovir or valacyclovir)
Prevention of neonatal transmission is paramount
May require a Cesarean section if mother has an outbreak
Suppressive therapy in the third trimester has be proven to be safe and effective (acyclovir TID)
Avoidance of a primary infection while pregnant |
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Term
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Definition
Causative agent of chickenpox and herpes zoster (shingles)
Chickenpox (varicella) is the primary infection and is a mild, self-limiting childhood disease except in immune compromised patients
Zoster is a reactivation of the dormant virus and causes a dermatomal rash
Incidence of varicella is declining with the initiation of VZV vaccine (live attenuated)
Transmission is airborne and is highly contagious |
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Term
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Definition
Successive crops of pruritic vesicles that evolve into pustules then crusts and sometimes scars usually in children
Primary infection in adults can be complicated by pneumonia and encephalitis and the rash may be more severe
Crusted erosions heal in 1-3 weeks, some leave a punched out scar
Usually starts on the face and spreads inferiorly to trunk and extremities, palms and soles are spared, can see lesions on the palate
Immunization is 80% effective, some kids get a rash with the vaccine |
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Term
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Definition
Symptomatic
Treat itching with antihistamines, lotions,
Avoid aspirin because of the association with Reye’s syndrome??
Antiviral agents can decrease severity of course if started within 24hours, should be considered in neonates and immune compromised patients
Severe immunocompromised patients should get acyclovir IV |
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Term
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Definition
Acute dermatomal rash caused by the reactivation of dormant varicella-zoster virus
Starts with a prodrome: unilateral dysesthesia, pain, increased sensitivity, flu-like. Pain can mimic angina or an acute abdomen. Allodynia – heightened sensitivity to even mild stimuli, shirts, sheets. Progresses to a vesicular eruption along a sensory ganglion most common in the trunk
Vesicles rupture, erode then crust over a period of 2-4 weeks, can cover one or two dermatomes
Post herpetic neuralgia occurs in some patients which is severe, stabbing burning pain that can persists for months to years
Incidence will likely decline because of pediatric vaccination and now vaccination recommendation at age 60 for prevention in older patients |
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Term
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Definition
Prevention with vaccines is effective
Oral antiviral therapy for 7 to 10 days, acyclovir, valacyclovir, famciclovir
Decrease duration and prevent post herpetic neuralgia
Severely immune compromised patients or those with ophthalmologic involvement require IV acyclovir
Supportive treatment:
Pain management with narcotics is often necessary
Moist dressings for large areas of lesions, topical lotions like calamine
Treatment for Post herpetic neuralgia
Tricyclic antidepressants, gabapentin or pregabalin, capsaicin cream, lidocaine patches |
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