description flat-topped, polygonal, violaceous papules and plaques wickham’s striae: fine lacy...
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Lichenoid eruptions
DescriptionFlat-topped, polygonal, violaceous papules and
plaquesWickham’s striae: fine lacy patternDorsal surface of extremitiesKoebner phenomenon at sites of traumaNail dystrophyOral mucosa: lacy white plaques
Lichen Planus
TreatmentTopical steroids
CourseProlonged period of
hyperpigmentation can be expected
Lichen Planus
DescriptionFlat-topped papules appear abruptlyErythematous or hypopigmented
Surfaces with fine scaleLinear or swirled distribution
(along skin lines of Blaschko)Nail dystrophy
LocationExtremeties, neck, upper back
Lichen Striatus
TimingPeak in school-age children
CourseSpontaneous resolution 1-2yrs
Lichen Striatus
Vesiculopustular disorders
Tells you that it’s a viral lesionMultinucleated giant
cellNot specific to type of
virusOutdatedUse DFA, PCR, or Viral
culture
Tzanck Smear
Superficial bacterial skin infection
Cause: GAS, GBS, S.aureusLocation
Tips of pads of fingers/toesDescription
Tense blisters, 5-10mmFilled with thin, purulent
fluidNarrow erythematous rimThick crust upon rupture
Blistering Distal Dactylitis
Which is true of the condition pictured?A Use of systemic steroids
may improve survivalB Systemic antibiotics with
G+ coverage are the mainstay of treatment
C Permanent sequelae may include visual impairment
D Nikolsky’s sign is negative
Question 3
Reactive erythemas
Description Symmetrical, red, tender
nodules 1-5cm
Location Pretibial
Hypersensitivity reaction, associated with: Strep Sarcoid Ulcerative colitis TB Other bacterial/fungal infxn Oral contraceptives and other
meds
Erythema Nodosum
Timing/Course>10y/oLasts 2-6wksOften recurs
DescriptionRed, tender, slightly elevated
nodules Indurated SQ plaquesBrownish-red or purplish-red hueShins most common site
TreatmentTx underlying causePain: NSAIDS and rest
Erythema Nodosum
Aka “Hives” “Welts”Course
Sudden onsetTransientLasts 1-24hrs
DescriptionWell-demarcated intensely pruriticAppear to migrateMay coalesceWhite/red “halo”
Urticaria
Cause: can be IgE or complement mediatedAcute (<6wks)
IgEAcute infections (strep, mono)FoodsDrugsInsect bitesContact or inhaled allergen
Chronic (>6wks)Occult infectionHep BConnective tissue dz
Urticaria
This child has mild edema of hand/feet and painful migratory periarticular swelling of wrists and ankles. The most likely etiology is:
Question 4
A Staph Scalded Skin SyndromeB Henoch-Schonlein PurpuraC Hemolytic Uremic SyndromeD Interstitial nephritis as part of a reaction to medicationsE Serum Sickness-Like Reaction
Type III reaction: Immune-Complex DepositionSymptoms
Urticarial lesionsRelatively nonpruriticTarget or serpiginous
Periarticular swellingMigratory
Stocking-glove angioedemaPainful
Facial edemaFever
Serum Sickness-Like Reaction
TriggersURIMeds
SulfaCefaclorMinocyclinePCN
CourseWax and wane over 1-3wks
Serum Sickness-Like Reaction
Hypersensitivity syndromeCauses
Drugs, viruses, bacteria, foods, immunizations
Connective tissue dzRecurrent EM
Recurrent HSV infxnLocation
Any part of bodyCommonly: palms/soles,
arms/legs
Erythema Multiforme
DescriptionSymmetricalDusky red macules – evolve into iris or target-
shaped lesionsCenter of target may be blue, violaceous, or
whiteVescicles or bullae may develop
Center or ring of targetMay appear as diffuse urticaria initiallyNon-pruritic, may be painful
Erythema Multiforme
CourseCrops last 1-3 wksSelf limited?Mild systemic symptoms?
Low grade feverMalaiseMyalgia
Mucous membranes sparedOr mildly involved
Erythema Multiforme
Epidermal and mucous membrane necrosis and sloughingCleavage beneath basment membrane zoneFull-thickness sloughing
SJS: <30% BSATEN: >30% BSACause: hypersensitivity, viral infxn,
connective tissue dz, malignancy
SJS / TEN
Ophtho:Corneal scarringLid scarring: ectropion
FENDehydrationMalnutritionElectrolyte imbalance
IDSuperficial infectionSepsis
Death
SJS/TEN Complications
TreatmentIVIGSteroids relatively contraindicated
GI symptomsImmune suppression
Differentiate from SSSSSSSS
Bullae more thin-walledMucous membranes red, but do not slough
SJS / TEN
75% of all cutaneous drug reactionsDescription
Erythematous macules and papulesRange from fine to blotchyEruption 5-14days after starting medFace/Trunk extremitiesMay become confluentResolves over 1-2 wksMay see mild purpura, desquamation
Morbilliform Drug Eruption
Recur at same localized site following reexposure to offending drug
Target and bullous lesionsResemble erythema multiforme
Morphologically and histologically(only localized)
Fixed drug eruption
Vasculitis
Classic TetradPalpable purpura
Without thrombocytopenia or coagulopathyPresent in almost all patients
Arthritis/Arthralgia75%
Abdominal Pain (May have hematochezia)50%Intussussception (ileo-ileal)
Renal Disease (Mild)21-54%
Not all symptoms must be present for diagnosisTakes days to weeks to developMay present as abd pain or joint complaints*May recur
Henoch-Schonlein Purpura
Diffuse VasculitisHisto:
immune-complex deposition in capillariesLeukocytic vasculitis in skin
TreatmentSupportiveMay use steroids if severe
Henoch-Schonlein Purpura
DIFFERENTIATE FROM HUSHemolytic Uremic Syndrome
More toxicRenal involvement more severe (dialysis)Hemolytic: anemia, thrombocytopeniaMore severe neuro manifestations
Henoch-Schonlein Purpura