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Bites and Stings.

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Presentation on theme: "Bites and Stings."— Presentation transcript:

1 Bites and Stings

2 Question 5 The most effective treatment to eliminate the lesions seen here: A Topical steroids B Oral antibiotics C Treatment of home for fleas D 5% Permethrin cream to all household members E Oral antihistamines Answer: D Papular urticaria

3 Bites and Stings Think about distribution (exposure)
Bites on face may be atypical Red Pruritic Soft and nontender Intense, hemorrhagic reaction possible Fleas: some members of household “spared” Clusters of 3 Grass or sand mites: localized blisters

4 Spider Bite More intense reaction Erythema and induration Vesciculate
Ecchymotic Painful Pruritic Vesciculate Central necrosis with eschar Brown Recluse

5 Hymenoptera Stings Local pain, erythema, edema within 2hrs Honey Bee
Stinger in skin Releases venom for an hour Scrape horizontally with fingernail or card

6 Hymenoptera Stings Late onset edema Treatment Risk of anaphylaxis
Peak 48-72hrs Delayed hypersensitivity Pruritic, painful Treatment Paste of meat tenderizer and water Symptomatic treatment Risk of anaphylaxis Known history Mastocytosis Education on avoidance EpiPen

7 Papular Urticaria Timing Description Young children Chronic/recurrent
Highly pruritic papules and wheals Central punctum Vesiculate centrally 3-10mm diameter Resolution: central crust with collarette of scale After 4-6wks: target-shaped macule Linear or triangular clusters Exposed areas

8 Papular Urticaria Cause Only youngest child in family may be affected
Hypersensitivity to fleas, bedbugs, mosquitoes Fleas and bedbugs are not seasonal Only youngest child in family may be affected >1y/o May experience “reactivation” New bites incite delayed hypersensitivity at old sites

9 Papular Urticaria Treatment Identification and avoidance of insect
Repellent Topical steroids Oral antihistamines Good hygiene (secondary infections)

10 Infestations

11 Scabies Cause Timing Description Mite: Acarus scabiei
Burrows beneath skin Hypersensitivity reaction Timing 4-6 wks after initial contact Description Intensely pruritic papules, vesicles, pustules, linear burrows fingers/ webs of toes, flexor regions, nipples, waist, groin/buttocks, palms/soles Infants: intense and persistent nodular reaction

12 Scabies Excoriation and secondary infection Diagnosis Treatment
Clinical Skin scrapings: mite, eggs, feces From linear burrow (black speck) Treatment 5% permethrin (Elimite) All household members Wash all linens Repeat 1 wk later

13 Lice Crab lice (Phthirus pubis) Sexually transmitted
Eyelashes and pubic hair Bites Bluish, pruritic papules: lower abd and upper thighs Intense pruritis Children Scalp or eyelashes

14 Lice Body lice (pediculus humanus corporis) Bedding or clothing Bites
Urticarial papules Waist, neck, shoulders, axillae Excoriations/ secondary infection

15 Lice Head Lice (pediculus humanus capitis)
Most common Excoriations of scalp and neck Occipital adenopathy Nits: oval, white 0.5mm dot glued to hairshaft Above and behind ears Nonviable shells may remain attached after treatment

16 Lice Treatment: Pediculicide topically (all household members)
Permethrin cream Malathion lotion (second line…flammable) Lindane: contraindicated in young… neurotoxic Cleaning of linens/clothing Nits: Diluted vinegar rinse Fine-toothed comb

17 Acne Acne vulgaris Cause: Unknown Treatment
Disorder of pilosebaceous apparatus Cause: Unknown Abnormal follicular keratinization Driven by androgens Propionibacterium acnes Treatment Topical retinoic acid, benzoyl peroxide, abx Severe: oral abx with topical agents Beware retinoic acid in preganancy

18 Other Lesions

19 Question 6 The most reliable way to distinguish these lesions from other lesions frequently seen on the sole of the foot: A Black dots indicate corns that have received trauma B Interruption of dermatoglyphics indicate plantar warts C Superficial scaling indicates callus formation D Boggy texture indicates plantar warts Answer: B Plantar Wart

20 Warts HPV Fingers, hands, feet Plantar wart: Larger than appearance
Painful w walking Interrupts dermatoglyphics Incubation 1-6mos Disappear spontaneously over 5yrs Local trauma: inoculation of virus Periungual common Calluses and corns do NOT interrupt dermatoglyphics

21 Warts Characteristic appearance Condylomata acuminata Treatment
Black dots (thrombosed capillaries) Condylomata acuminata Anogenital warts Consider sexual abuse Controversial <age 3 (vertically acquired) Treatment Duct tape Salicylic acid

22 Molluscum Contagiosum
Pox virus Description: Dome-shaped papules with waxy surface Single or multiple May be pruritic 5mm Location: trunk, face, axillae, genital area Spread by scratching (linear)

23 Molluscum Contagiosum
Curdlike core can be expressed from center Course: spontaneous remission 2-3yrs Treatment Watchful waiting Curetting after topical anesthetic Especially in poorly controlled eczema

24 Congenital Lesions

25 Cutaneous mastocytosis
Pathological proliferation of mast cells in skin Other organs involved as well Darier sign When lesion (or skin) rubbed, urticaria develops Histamine release following trauma to superficial mast cells May form blisters 75% identified by age 2

26 Cutaneous mastocytosis
Urticaria pigmentosa (most common form) Oval or round red-brown Macules, papules, plaques Solitary or innumerable Resemble Nevi, pigmentary alteration, CALMs May be associated with GI symptoms Hypotension in severe cases

27 Cutaneous mastocytosis
Other organ systems can be affected Treatment Usually resolves in childhood Symptomatic treatment Antihistamines Immunosuppresants in severe cases Extensive workup rarely needed

28 Juvenile Xanthogranuloma
AKA: Nevoxanthoendothelioma Present at birth (w/in 1st year) Grow slowly and become more yellow Benign proliferation of non-Langerhans cell histiocytes Brown to yellow color: lipid-laden histiocytes Benign

29 Juvenile Xanthogranuloma
Primarily in whites Usually solitary nodular lesion Multiple small papular lesions possible 4% extracutaneous Iris Other locations Associations/Complications Glaucoma Myelomonocytic leukemia Nontraumatic Hyphema

30 Juvenile Xanthogranuloma
No specific gene defect NF-1 Urticaria pigmentosa Niemann-Pick Treatment Watchful waiting Resolve 5y/o Surgical excision Steroids +/- chemo

31 Job Syndrome Abnormal immunity Chromosome q4 T-Cells, Neutrophils
High IgE and eosinophils Chromosome q4 AD Variable expressivity

32 Job Syndrome Description Timing Pruritic S. aureus superinfection
Weeping, crusting, cutaneous abscesses Abscesses (little pain and inflammation) Mucocutaneous candidiasis Timing Shortly after birth

33 Job Syndrome Course Treatment Recurrent focal bacterial infections
Decreased bone density with multiple fractures Little pain With age: scoliosis and coarsening of facial features Treatment Control infections

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