MORNING REPORT JULY 5, 2012 Good Morning!!!. Derm Terms Primary Lesions Maculeflat < 1 cm Patchflat...
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MORNING REPORT JULY 5, 2012 Good Morning!!!. Derm Terms Primary Lesions Maculeflat < 1 cm Patchflat > 1 cm Papuleelevated, solid < 1 cm Noduleelevated,
Derm Terms Primary Lesions Maculeflat < 1 cm Patchflat >
1 cm Papuleelevated, solid < 1 cm Noduleelevated, solid > 1
cm, deeper Plaqueelevated, flat top, solid > 1 cm
Vesicleelevated, filled with serous fluid < 1 cm Bullaelevated,
filled with serous fluid > 1 cm Pustuleelevated, filled with pus
< 1 cm WhealEdema in the upper dermis Secondary Lesions
Scaleflakes of stratum corneum Crustdried liquid debris Erosionloss
of epidermis, shallow Fissurelinear cleavage Ulcerationloss of
epidermis and dermis, deep Excoriationabraded skin
LichenificationThickening of epidermis Atrophythinning or absence
of epidermis/fat Scarpermanent fibrotic change
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Derm Terms Pattern/Distribution AnnularRing shaped
DiscreteRemain separated ClusteredGrouped together Confluent/
Coalescing Run together DermatomalFollow a dermatome GeneralizedMay
be scattered or diffuse AcralDistal portion of limbs
PolymorphicVaried shapes SerpiginousSnake-shaped
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Whats your final answer? Clusters of erythematous, eroded
papules with overlying hemorrhagic crust in a generalized
distribution
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Symptoms Acute /subacuteChronic LocalizedDiffuse SingleMultiple
StaticProgressive ConstantIntermittent Single EpisodeRecurrent
AbruptGradual SevereMild PainfulNonpainful BiliousNonbilious
Sharp/StabbingDull/Vague Problem Characteristics Ill-appearing/
Toxic Well-appearing/ Non-toxic Localized problemSystemic problem
AcquiredCongenital New problem Recurrence of old problem Semantic
Qualifiers
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Illness Script Predisposing Conditions Age, gender, preceding
events (trauma, viral illness, etc), medication use, past medical
history (diagnoses, surgeries, etc) Pathophysiological Insult What
is physically happening in the body Clinical Manifestations Signs
and symptoms that result from the pathophysiological insult
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Eczema Herpeticum
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Impetigo
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Varicella
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Tinea
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Erysipelas
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Folliculitis
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SSSS
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Drug Allergy
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Eczema Herpeticum
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Eczema Herpetcium Illness Script Predisposing Conditions
Eczematous skin disease: Atopic dermatitis Most common skin disease
in children (20% prevalence) More frequently in urban areas, higher
socioeconomic classes + family history of atopy Prone to infections
with S. aureus and HSV** Can occur at any age, most common 2-3
years old Exposure to caregiver with HSV Immunocompromised patient
HSV can be reactivated by fever, sunlight, trauma, stress
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Eczema Herpetcium Illness Script Pathophysiology Defective skin
barrier Most children, caused by primary HSV infection Incubation
period of 4-11 days after HSV infection, then eruption of lesions
Dysregulation of cell-mediated and humoral immunity in patients
with atopic dermatitis Allows HSV to proliferate Common
complication: Bacterial superinfection with staph or strep
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Eczema Herpetcium Illness Script Clinical Manifestations**
Eruption of multiple vesiculopustular lesions in disseminated
pattern Grouped fluid filled vesicles on an erythematous base After
several days, vesicles pustules rupture and become crusted, have
punched-out appearance May coalesce, erode and ooze hemorrhagic
exudate Irritability Pruritis Fever Anorexia, malaise, vomiting,
diarrhea, lymphadenopathy Systemic and CNS spread have been
reported
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Diagnosis** Clinical diagnosis Gold standard: viral culture
(not very sensitive) HSV DNA PCR from vesicle fluid Direct
fluorescent antibody testing of cells from vesicle scrapings Stain
with Giemsa or Wrights stain (Tzanck test) Very specific but not
very sensitive Can visualize multi-nucleated giant cells Can
indicate an HSV or Varicella-zoster infection
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Treatment Early treatment is essential to prevent fulminant
progression and possible mortality ALL children should receive
systemic acyclovir for 5- 7days MOST should have IV acyclovir If
patient appears well/limited disease, can do PO Can treat longer
for severely affected children Give until no new lesions appear
Local skin care, supportive care Treat with antibiotics for any
suspected bacterial infection Discontinue topical steroids
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NOON CONFERENCE: DR. CREEL STATUS ASTHMATICUS Thanks for your
attention!