resolves spontaneously

warm soaks (50% water/50% antibacterial soap 3-4 x d)

abscess needling I & D

PO antiobiotics?

Seen in young sexually active adults

dormant for years

smal papular

cauliflower-floret lesions

keratotic warts

flat-topped papules/plaques

huge

acetic acid is helpful in visualizing lesions on the cervix and anus

condoms

no therapy eradiates HPV

vaccine

Imiquimod, 5% cream

Podofilox 0.5% solution and gel

TCA or BCA 80-90%

Cryosurgery with liquid nitrogen 

Laser removal

cryosurgery

TCA or BCA 80-90% 

Podophyllin 10-25%

viral, bacterial, rickettsial, parasitic

age < 20 

fever

malaise

N/V/D

coryza

HA

abd pain

diffuse erythema

macular morbilliform

vesicular eruptions

usually resolves < 10 days (reassurance)

antimicrobials if necessary

most commonly young adults 

HSV-1 (oral) HSV-2 (urogenital)

"shedding"

skin-skin

skin-mucosa

grouped small vesicles on erythematous base

superficial lesion- rupture early and erosion

crust and heal

Tzanck stain looking for "multinucleated giant cells"

Serology

pearly white or skin colored

round, oval, hemispherical, umbilicated

papules (1-2 mm), nodules (5-10 mm) (rarely giant)

supportive

5% imiquimod cream applied aHS 3 times/week for up to 1-3 months

Tretinoin (Retin-A) qHS

Curettage

Cryosurgery

verruca vulgaris (common warts)

verruca plantaris (plantar warts)

firm papules 

1-10 mm or rarely larger

hyperkeratotic, clefted surface with vegetations

characteristic "red or brown dots"

early small, shiny, sharply marginated papule

plaque w/ rough hyperkeratotic surface

studded w/ brown-black dots

erupts in a dermatomal pattern

(zoster, or shingles)

airbourne droplets

direct contact

children (uncommon)

adult - fever, malaise, HA, aches, & pains

crops of lesions

papule-vesicle-erosion-crust

face and scalp

spreads inferiorly to trunk and extremities

prodromal symptoms - burning, tingling

vesicular eruption

dermatome pattern

vaccine available (Varivax)

oral antihistamines

antivirals-cyclovirs 

if ophthalmic branch of trigeminal n. with eye inflammation consult w/ ophthalmologist

Condyloma acuminatum

Infetious exanthems

Herpes Simplex

Molluscum contagiosum

Verrucae

Varicella -Zoster

hard to palpation

extremely painful

painful

bright red

raised

edematous

indurated plaque w/ red borders

sharply  marginated

adults - S. aureus, GAS

children - Hib, GAS, S. aureus

less commonly - group B strep, pneumococci

opportunistic pathogens

dog, cat, or human bites

cellulitis/erysipelas lesions

may also see lymphangitis

supportive

antibiotics - Ceftriaxone, Augmentin, Doxy, Cipro

If MRSA, vancomycin or Linezolid

Surgery

superficial infections of the epidermis ( ______)

crusted erosions or ulcers ( _____)

impetigo

ecthyma

Epidermolytic toxin A-gene S aureus

(staphylococcal scalded-skin syndrome)

variable pruritis

especially associated with atopic dermatitis

scattered, discrete lesions

without therapy, lesions may become confluent

satellite lesions occur by autoinoculation

vesicles and bullae containing clear yellow or slightly turbid fluid

+- surround erythema

with rupture, ______ decompress

if roof of bulla is removed, shallow moist erosion forms

daily bath

benzoyl peroxide wash (bar)

check family members for signs of impetigo

ethanol or isopropyl gel for hands and/or involved sites

mupirocin ointment

apply 2x daily to involved skin and to nares for 7-10 days

cellulitis/erysipelas

impetigo

1. superficial of mucosal surface

healthy ind - oropharynx & genitalia

IC - esophagus & tracheobronchial tree

2. cutaneous - moist, occluded skin

3. disseminated - IC, invasion of GI tract

IC

DM

obesity

hyperhidrosis

steroid therapy

KOH prep

culture?

cutaneous

oropharyngeal

chronic mucocutaneous

genitalia

**multiple subtypes w/in each group

 cutaneous (erythema, pruritis)

 symptoms of cutaneous and oropharyngeal

erythema, pruritis, burning or pain, odynophagia

pruritis, white discharge, burning, erythema (F)

topical nystatin or imidazole

butoconazole or clotrimazole cream

"azole" suppository

Clotrimazole

Itraconazole

Ketoconazole

Fluconazole 

"conazoles"

high temperatures/relative humidity

oily skin

hyperhidrosis

hereditary factors

glucocorticoid treatment

immunodeficiency

usually known

mild pruritis

spaghetti and meatballs

can also do wood's lamp - blue/green fluorescence

Selenium fulfide (2.5%) / ketoconazole shampoo

• apply daily to affected areas for 10-15 min, followed by shower, for 1 week

Terbinafine (Lamisil) 1% solution - apply BID for 7 days

"azole" creams - apply QD or BID for 2 weeks

often asymptomatic

mild pruritis

"-azoles"

preparations is applied BID to involved area optimally for 4 weeks including @ least 1 week after lesions have cleared

apply @ last 3 cm beyond advancing margin of lesion

hot, humid weather

occlusive footwear

excessive sweating

walking barefoot on contaminated floors

arhrospores can survive in human scales for 12 months

months to years

often, prior history of tinea pedis, tinea unguium of toenails

may flare if in hot climate

Skin symptoms - asymptomatic frequently

pruritis. pain with secondary bacterial infection

interdigital type

moccasin type

inflammatory/bullous type

ulcerative type

tinea pedis

interdigital type

two patterns

1. dry scaling

2. maceration, peeling, fissuring of toe webs

hyperhidrosis common

most common site: between fourth and fifth toes

infection may spread to adjacent areas of feet

tinea pedis

Moccasin type

well demarcated erythema w/ minute papules on margin, fine white scaling, and hyperkeratosis 

(confined to heels, soles, lateral borders of feet)

Distribution of moccasin type

tinea pedis

sole, involving area covered by a ballet slipper

one or both feet may be involved with any pattern

bilateral involement more common

inflammatory/bullous type

tinea pedis

vesicles of bullae filled with clear fluid

pus usually indicates secondary S. aureus infection or group A streptococcus

ulcerative type

tinea pedis

extension of interdigital tinea pedis onto dorsal and plantar foot

usually complicated by bacterial infection

acute: burrow's

chronic: aluminum chloride hexahydrate 20% BID

most difficult

keratolytic agent 1st then topical

acutely, use cool compress

if severe, systemic glucocorticoids are indicated

topical - "azoles" apply to all affected sites twice daily. treat for 2-4 weeks

Take a look through slides 332 - 342 

(on burns, said it wouldn't be on test)

result of external compression of the skin, shear forces, and friction which produce ischemic tissue necrosis

(about 2 weeks to develop)

combinations of 

1. intralesional glucocorticoid

2. surgery

3. oral antibiotics

4 isotretinoin

excision

usually do not reoccur

avoid sun

sunscreen

may disappear spontaneously over a period of months after delivery or after cessation of contraceptive hormones

16-26, M>F

uncommon in asians and blacks

anywhere on skin

may be localized or generalized

(confined to site of trigger mechanism)

avoidance

antihistamines - H1 & H2 blockers, and/or mast cell-stabilizing agents (ketotifen)

prednisone

danazol (hereditary angioedema)

age of onset - 50% of cases it begins between the ages of 10 and 30 years

sunscreens

minigrafting

cosmetic coverup

repigmentation - topical glucocorticoids, topical photochemotherapy; employs topical 8-methoxypsoralen (8-MOP) and UVA

systemic photochemotherapy