obinno59's version from 2018-04-15 21:46


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A 45-year-old woman presents to the emergeny room with an infection on her hand that started with a bee sting on knuckle of her long finger and has spread to the distal wrist in two days. She is extremely concerned because her finger tips and the dorsal surface of her hand have started to turn purple and blackCharacterized by rapid progression to gangrene followed by sepsisNecrotizing cellulitis vs cellulitis
Necrotizing fasciitis •Most common pathogens include◦S. pyogenes (Group A strep)
Clostridium perfringens
■identifed by subsequent crepitus palpable at the surface along sites of infection
Necrotizing fasciitis tx•Operative

◦early IV antibiotics and surgical debridement
IV penicillin and clindamycin
■indicated in all cases as first-line therapy
■broad-spectrum systemic antibiotics are critical to slow or prevent further spread of infection
■sensitivity-guided antibiotic therapy
■implement as soon as culture results are reported
■surgical debridement
■indicated to prevent further spread along fascial planes
■must be immediate and extensive
Herpetic Whitlow
■cutaneous lesion on the hand that can be caused by HSV-1 or HSV-2
■most commonly seen in health care workers who come in contact with oral secretions (respiratory therapists, dentists)
Molluscum Contagiosum
•Diagnosis is primarily by clinical observation
Wright-Giemsa stain
◦show large inclusions, or "molluscum bodies"
◦confirms diagnosis
•Inquire about AIDS risk factors

Molluscum Contagiosum DDxMulluscum Contagiosum vs Warts, herpes, acne vulgaris, milia
Molluscum Contagiosum■curettage
■cryotherapy (freezing)
■trichloroacetic acid
Anaphylaxis tx•Initially treat with intramuscular epinephrine (Even if no Resp sx) 1:1000
◦this is repeated every 20 to 30 minutes
•If there is nor response, or the patient is in profound shock then give 1:10,000 epinephrine intravenously
•If the patient has extensive oral-facial swelling, then sedate and intubate
•Other options in less severe reactions include bronchodilators and IV corticosteroids
A young mother brings her 6-month-old child to the pediatrician complaining on a recurrent, erythematous, weeping rash that has appeared several times around the child's cheeks DDxAtopic dermitis: by pruritic scaling, hyperpigmentation, and lichenification in flexural areas of the body
•Contact dermatitis
•Seborrheic dermatitis
•Pityriasis rosea
•Drug eruption
•Cutaneous T cell lymphoma
•Ichthyosis vulgaris
Ichthyosis vulgaris: a autosomal dominant disorder that causes progressively dry, scaly skin with horny plates over the extensor surfaces of the limbs "lizard skin"
lichen planus picLichen planus is a pruritic inflammatory dermatosis, sometimes associated with HCV, that presents with violceous, flat-topped, polygonal papules. Lesions are often also present on mucosal membranes
Patient has a rash is consistent with contact dermatitis, secondary to either poison ivy or poison oak
pathology will show _____
Pathology will show spongiosis (intercellular edema in the epidermis).
Path: Langerhans giant cells are often found in ____(5)fungal infections, syphilis, sarcoidosis, leprosy, and tuberculosis
Path: Intraepidermal vesicles with keratinocytes are characteristic of ________herpes virus infections

Hx of hilking. Dx? How long did this take?
Poison ivy(24-48 hrs)
Erythema toxicum picThis child likely has erythema toxicum neonatorum, which is a benign skin finding in newborns. Observation is appropriate, as it resolves within hours to days of first appearing.
A 23-year-old male presents to his primary care physician complaining of the sudden-onset of rash on his back, chest and shoulders after beginning antibiotic therapy for a recent upper respiratory infection. DDx
uticaria pic
Uticaria vs Contact dermatitis, multiple insect bites, erythema multiforme
Uticaria txTreatment
•Medical management
systemic antihistamines
◦steroids and epinephrine in severe cases(anaphylaxis)

◦topical medications are of no benefit

◦discontinue medication if it is the cause
A 46-year-old patient with AIDS presents to the clinic complaining of a red rash that has appeared on his scalp


Cause? Type of pt?
Seborrhoeic dermatitis
•Chronic, superficial inflammatory disorder of the skin
•Caused by the normal flora yeast, Malassezia furfur (formerly Pityrosporum ovale), that commonly resides in sebum and hair follicles

•Also known as "cradle cap" in infants
- also sene in HIV and Parkinsons pt
Seborrhoeic dermatitis tx•Medical management
◦topical therapies
■1% hydrocortisone cream BID
■topical ketoconazole or imidazoles

■indicated for facial and bodily lesions

■selenium or tar shampoo
■indicated for scalp therapy
◦systemic therapy

■systemic steroids indicated in severe disease
Vitiligo Dx•Diagnosis is based primarily on clinical presentation and history
Fluorescence of lesions under Wood's lamp can help confirm diagnosis
DDx: ◦red, hot, swollen, tender "rash"Cellulitis vs Necrotizing fascilitis, osteomyelitis, abscess, urticaria, contact dermatitis, phlebitis, and compartment syndrome
Cellulitis txMedical Management
oral antibiotics
for mild to moderate cases
7-10 days of antistaphylococcal penicillin or vancomycin
oxacillin or Keflex
sometimes used

IV antibiotics
severe cases
evidence of systemic toxicity, comorbid conditions, diabetes, old age
hand or orbital involvement
usually requires hospitalization
for Pseudomonas spp, use broad spectrum penicillin plus aminoglycoside
nafcillin, oxacillin, cefazolin commonly used
Impetigo causes and variants(Caused by staphylococci > group A streptococci)
Two major variants as follows
bullous impetigo
caused by coagulase positive staphylococci that produce exfoliotin
characterized by large, stable blisters
can evolve into Staphylococcal scalded skin syndrome (SSSS)
common-type (Nonbulous) impetigo
caused by Group A streptococci, which produces superficial pustular lesions
features honey-colored crusts on an erythematous base and pustules commonly appears on the face
Impetigo tx=Non-operative
topical antibiotics for nonbullous impetigo
mupirocin, retapamulin, or fusidic acid
oral antibiotics for large bullous or diffuse nonbullous impetigo
antistaphylococcal agents preferred, including amoxicillin/clavulanate, dicloxacillin, cephalexin, doxycycline, trimethoprim/sulfamethoxazole, and macrolides
disinfectants as adjuvant therapy
there are currently no operative interventions for this disease
Erysipelas vs cellulitisErysipelas is a skin infection that is similar to cellulitis, and would most likely present without pruritus and with fever, swelling, and erythema.
A child is brought in to see the pediatrician. He has a new rash on his forearms and flank. The physician learns that the family has just adopted a new puppy, which has been sleeping with the child at night. Ddx
Tinea Corporis vs Pityriasis rosea, psoriasis, SLE, secondary syphilis
Causes of tinea corporisCausitive fungal organisms include
Microsporum (especially in pets)
Tinea Corporis txMedical Management
topical antifungal like Terbinafine
indicated as first-line therapy
usually taken BID for 30 days
systemic griseofulvin
indicated if topical antifungals are ineffective


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