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Rashes/Dermatology Jackie Weaver-Agostoni, DO, MPH UPMC Shadyside

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Presentation on theme: "Rashes/Dermatology Jackie Weaver-Agostoni, DO, MPH UPMC Shadyside"— Presentation transcript:

1 Rashes/Dermatology Jackie Weaver-Agostoni, DO, MPH UPMC Shadyside
Director, Osteopathic Family Medicine Residency 3/5/16

2 Pre-Test #1

3 Pre-Test #2

4 Pre-Test #3

5 Pre-Test #4

6 Pre-Test #5

7 Pre-Test #6

8 Pre-Test #7

9 History Length of symptoms Initial appearance and location
Changes/Spread Treatments tried and response Associated symptoms Sick contacts History of similar symptoms and treatment New exposures

10 History PMHx Medications Family history
Social history- occupation, hobbies

11 Lesion Morphology Macule – nonpalpable
Ex: vitiligo, cafe au lait, petechiae

12 Lesion Morphology Papule – palpable, </= 5 mm

13 Lesion Morphology Plaques - Large >/= 5 mm superficial flat lesions

14 Lesion Morphology Pustules – small purulent-filled papules
Vesicles – small < 5 mm papules containing serous material Bullae – large >/=6 mm vesicles

15 Lesion Morphology Nodules – palpable, discrete lesions >/= 6 mm
Tumors = large nodules

16 Lesion Morphology Cysts – enclosed lined cavities filled with liquid/semisolid material Telangiectasia – dilated superficial blood vessel Wheals - hives

17 Diagnostic Techniques
KOH Prep Fungal Tzanck smear HSV VZV Wood’s Lamp Tinea Erythrasma Vitiligo Melasma Porphyria

18 Melanoma Risk factors Prognosis Moles: Atypical, total # > 50
Red hair and freckling Severe sunburn, especially in childhood First degree relative Prognosis Breslow’s classification (tumor thickness) and lymph node spread No staging workup needed if lesion < 1 mm thickness as low risk

19

20 Irritant Contact Dermatitis
Xerosis, fissures, erythema, eczematous eruption Change frequently Increase air exposure Protective ointment Petroleum Jelly A and D ointment Desitin

21

22 Diaper Candidiasis Satellite lesions
Antifungal creams, frequent diaper changes Usually lasts about 10 days

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24

25 Rhus Dermatitis Lasts 1-2 weeks Linear Lesions
Blister fluid can NOT spread the inflammation Remove source, wet dressings (Burow’s solution), Class I topical glucocorticoid if non-bullous Blisters may require oral Prednisone (1-2 week taper). Do NOT remove the tops.

26

27 Miliaria Crystallina Miliaria- “Heat rash”
Eccrine sweat duct occlusion Vesicles filled with clear fluid Asymptomatic Cool water compress and proper ventilation

28

29 Pityriasis Rosea Benign and self-limiting
Herald patch- trunk or proximal extremities Christmas–tree distribution Reach their maximum number in 1-2 wks. Clears in 1-3 months More papular/vesicular in kids

30

31 Molluscum Contagiosum
Virus Umbilicated, flesh-colored, dome-shaped papules Autoinnoculation, scratching, touching Most self-limited in 6-9 months Curettage, cryosurgery, tretinoin (not very effective), salicylic acid, cantharidin Physical expression of lesion rather than tx with phenol worked just as well with less scarring

32

33 Primary Herpes Simplex
HSV-1 Kids- typically start around or in mouth Respiratory droplets, direct contact with active lesion, virus-containing fluid (saliva) Primary infection with more lesions than recurrence Uniform in size vs. herpes zoster Lasts 2-6 wks Acyclovir (Zovirax)

34

35 Erythema Multiforme Acute, immune-mediated Target-like lesions
Can have mucosal disease (erosions, bullae) Virus typical cause (HSV, mycoplasma pneumonia in kids) Medications, autoimmune dz, malignancy Usually self-limited over couple weeks Young adults Symmetrical, extensor surfaces, centripetal spread

36

37 Stevens-Johnson Syndrome
Commonly triggered by medications Allopurinol, antibiotics, antipsychotics and anti-epileptics, analgesics and NSAIDs Fever and mucocutaneous reaction followed by necrosis and sloughing of epidermis Starts as erythematous or purpuric macules and placques < 10% body surface (vs. Toxic Epidermal Necrolysis)

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40 Varicella Chicken Pox Contagious 2 days before rash, and until all lesions crust Trunk  face and extremities All phases present “Dew drop on a rose petal” March-May Complications: secondary infection, encephalitis, Reye’s syndrome, pneumonia Symptomatic tx, antivirals (Acyclovir approved)- within 24 hrs Immunization- 80% effective

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42 Measles Rubeola Droplets Cough, coryza, conjunctivitis
Koplik’s spots- blue-white spots with red halo on buccal mucosa Downward spread Morbilliform (confluent elevated maculopapules)

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44 Hand-Foot-and-Mouth Disease
Coxsakievirus A16 Oral-oral and fecal-oral routes Warmer months “Linear” vesicles on palms and soles Self-limited 7-10 days Symptomatic treatment 1st trimester may cause spontaneous abortion

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46 Scarlet Fever Strep pyogenes Downward spread
Circumoral pallor, pinpoint papules, sandpaper Pastia’s sign- linear petechiae in skin folds Desquamation of palms and soles Beau’s lines- transverse grooves on all nails several wks after rash gone PO abx- PCN, e-mycin

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48 Rubella German measles, 3-day measles Respiratory spread
1st trimester  congenital rubella synd. Cataracts, deafness, heart defects, bone damage, neurologic issues including mental retardation Immunization- do not get pregnant for at least 1 month following Downward spread Pinkish or rosy-red macules or maculopapules No treatment required- rash fades in 1-2 days

49

50 Erythema Infectiosum Parvovirus B19 Fifth disease “Slapped cheek”
Lacy eruption on trunk and extremities 2-day prodrome Respiratory spread Symptomatic treatment Rash lasts approx 10 days Risk to pregnant women- fetal death

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52 Roseola Infantum Exanthem subitum, sixth disease HHV-6 6 mo.- 4y/o
High fever ( degrees)  rash Pale-pink, almond shaped, macules Symptomatic tx.

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54 Kawasaki Syndrome Mucocutaneous lymph node syndrome
Multisystem vasculitis Fever plus at least 4: bilateral conjunctivitis, red lips/pharynx/”strawberry tongue”, erythema palms or soles, edema of hands or feet, desquamation, rash (erythematous exanthem), cervical lymphadenopathy Cardiovascular sequelae Tx: ASA, Gamma globulin

55 Rocky Mountain Spotted Fever
Palms and Soles Tick-borne disease Rickettsia rickettsii Southeastern and south central states Spring and early summer Rash typically between 3rd and 5th day Early treatment

56 Meningococcemia Petechial Rash- discrete 1-2 mm lesions can coalesce into larger purpuric/ecchymotic lesions Trunk and lower body Mucus membranes- hemorrhage

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59 Scabies Direct contact
Nocturnal itching Burrows, vesicles or pustules on palms/soles- highly characteristic in infants More widespread in kids- face and scalp involvement (vs adults) Permethrin, Lindane (?safety re: neurotoxicity, Ivermectin, sulfur (?safe), Crotamiton (60% cure vs 89% with permethrin) Launder contaminated items

60 Lupus Butterfly Rash- spares nasolabial fold
After sun exposure Can precede systemic symptoms Discoid lesions more inflammatory- scar If DLE alone, rarely anti-Ro ab and normal or low titer ANA Tx: Topical glucocorticoids, antimalatial drugs

61 Psoriasis Etiology- genetic, other (smoking, obesity, etc)
Arthritis, nail involvement Tx: Topical, Phototherapy, Systemic

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63 Henoch-Schonlein Purpura
2-10 y/o Palpable purpura of legs and buttocks, abdominal pain, GI bleed, arthralgia, hematuria Widespread vasculitis Prognosis based on renal involvement Usually benign and self-limited IgA deposition on biopsy Corticosteroids/dapsone

64 Tinea

65 Erythema migrans

66 Secondary Syphilis

67 References Habif, Thomas P. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. Mosby. Dermatology (Chapter 8) in Zitelli, Basil J. and Holly W. Davis. Atlas of Pediatric Physical Diagnosis, 4th edition, Philadelphia: Mosby Inc., Pp ONLINE Sites Ely JW, Stone MS. The Generalized Rash: Part I and Part II. Differential Diagnosis. AFP, March 2010. Free dermatology photo atlas for your PDA


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