GOOD MORNING! AUGUST 5, 2014
|
|
- Roderick Griffin
- 6 years ago
- Views:
Transcription
1 GOOD MORNING! AUGUST 5, 2014
2 PREP QUESTION During the health supervision visit of a term newborn boy, his mother relates that a cousins child died at age 4 months from sudden infant death syndrome. She asks what she can do to prevent such an occurrence in her son. Of the following, the single most important preventative measure is to: A. Avoid use of a pacifier B. Co-sleep in parental bed for close observation C. Ensure side-sleeping position to prevent aspiration D. Ensure supine sleep positioning E. Use home apnea and bradycardia monitoring
3 LET S HEAR FROM AND SEE THE PATIENT. WHAT ARE YOU THINKING?
4 WHAT S GOING ON?! Phototoxic Eruptions Bullous Impetigo Secondary Syphilis Stevens Johnson Syndrome Kawasaki Toxic Shock Syndrome Toxin Mediated Perineal Erythema Erythema Multiforme Serum Sickness Erythematous Drug Eruption Toxic Epidermal Necrolysis Urticarial Vasculitis Viral Exanthems Annular Urticarial Burns Pemphigus Vulgaris Herpetic Gingivostomatitis Aphthous Stomatitis Staph Scalded Skin Syndrome Linear Iga Bullous Dermatosis
5 A BLISTERING FAST RASH REVIEW (SAY THAT THREE TIMES FAST!)
6 WHAT S GOING ON?! Phototoxic Eruptions Bullous Impetigo Secondary Syphilis Stevens Johnson Syndrome Kawasaki Toxic Shock Syndrome Toxin Mediated Perineal Erythema Erythema Multiforme Serum Sickness Erythematous Drug Eruption Toxic Epidermal Necrolysis Urticarial Vasculitis Viral Exanthems Annular Urticarial Burns Pemphigus Vulgaris Herpetic Gingivostomatitis Aphthous Stomatitis Staph Scalded Skin Syndrome Linear Iga Bullous Dermatosis
7 STEVENS JOHNSON SYNDROME Immunologically mediated mucocutaneous reaction involving targetoid lesions and erosive mucositis Circulating immune complexes and pro-apoptotic factors Most commonly associated with medications: NSAIDs, PCN-related antibiotics, Allopurinol, Sulfonamides, Anticonvulsants (Phenobarbital, Phenytoin, Carbamazepine) Drug exposure precedes symptom onset by 1-3 weeks Re-exposure to meds may result in symptoms within 48 hours 2 commonly associated infections: Mycoplasma and HSV
8 STEVENS JOHNSON SYNDROME Lesion: atypical and targetoid Start as erythematous macules that develop bullous centers Central area often violaceous or blistered, surrounded by donut-shaped elevated area of pallor and peripheral rim of erythema May concentrate on torso + Nikolsky sign < 20% BSA
9 STEVENS JOHNSON SYNDROME Mucositis: Oropharyngeal, Conjunctival, Urethral, Rectal Includes 2 or more sites These areas are at risk for: scarring, adhesions, strictures, and blindness if conjunctival involvement Other symptoms may precede skin findings (usually by 1-3 days) Fever Influenza-like symptoms Skin tenderness Photophobia and conjunctival itching or burning
10 If you get labs: STEVENS JOHNSON SYNDROME Increased WBC, ESR Transaminitis Urogenital involvement Hematuria Proteinuria Pyuria Skin biopsy: Full-thickness epidermal necrosis and detachment with only slightly altered underlying dermis (aka at the dermalepidermal junction) Perivascular leukocytic infiltrates
11 STEVENS JOHNSON SYNDROME Diagnosis is CLINICAL BUT biopsy may help Treatment: Stop offending agent or treat etiology (ie Mycoplasma if PNA) Hospitalization for Fluid & Electrolyte management and pain control Diligent wound care and topical antibiotics (bacitracin, silver sulfadiazine) Consultation of subspecialists for any mucous membrane involvement IVIG?
12 WHAT S GOING ON?! Phototoxic Eruptions Bullous Impetigo Secondary Syphilis Stevens Johnson Syndrome Kawasaki Toxic Shock Syndrome Toxin Mediated Perineal Erythema Erythema Multiforme Serum Sickness Erythematous Drug Eruption Toxic Epidermal Necrolysis Urticarial Vasculitis Viral Exanthems Annular Urticarial Burns Pemphigus Vulgaris Herpetic Gingivostomatitis Aphthous Stomatitis Staph Scalded Skin Syndrome Linear Iga Bullous Dermatosis
13 STAPHYLOCOCCAL SCALED SKIN SYNDROME Bacterial toxin-mediated exfoliative eruption characterized by areas of red skin and superficial desquamation, resembling skin that has been scalded In children who lack neutralizing antibodies to staph toxins Seen in those <5 years of age, preterm, or older children and adults with renal impairment or immunosuppression Exfoliative toxins produced by staph act as proteases and bind to desmoglein-1 in epidermis to cause superficial separation
14 STAPHYLOCOCCAL SCALED SKIN SYNDROME Low grade fever, malaise, irritability precede rash Scarlatiniform rash: starts in intertriginous zones and perioral areas before generalizing Mild to moderately tender skin Nikolsky sign Denuded skin is moist red and resembles burns Involved areas desquamate without scarring days +/- conjuncitivis Hyperemic mucous membranes without oral lesions
15 STAPHYLOCOCCAL SCALED SKIN SYNDROME Identifying potential foci of infection is important! NP, conjunctivae, blood, urine, umbilicus, abnormal skin Toxin-induced blisters generally culture-negative Biopsy (if needed to differ from TEN): superficial split within granular layer compared to deeper, full-thickness epidermal involvement Supportive care Parenteral antibiotics for extensive skin involvement or systemic disease Oxacillin, Nafacillin, Clindamycin for 7-10 days Topical antibiotics and steroids are not indicated Excellent prognosis
16 WHAT S GOING ON?! Phototoxic Eruptions Bullous Impetigo Secondary Syphilis Stevens Johnson Syndrome Kawasaki Toxic Shock Syndrome Toxin Mediated Perineal Erythema Erythema Multiforme Serum Sickness Erythematous Drug Eruption Toxic Epidermal Necrolysis Urticarial Vasculitis Viral Exanthems Annular Urticarial Burns Pemphigus Vulgaris Herpetic Gingivostomatitis Aphthous Stomatitis Staph Scalded Skin Syndrome Linear Iga Bullous Dermatosis
17 TOXIC EPIDERMAL NECROLYSIS Life-threatening mucocutaneous reaction involving extensive skin sloughing, often in association with mucous membrane erosions. May evolve from pre-existing Stevens Johnson Syndrome Circulating immune complexes and elaboration of circulating propoptotic factors Most common drugs: PCN-related antibiotics, Sulfonamides, and Anticonvulsants (Phenobarbital, Phenytoin, Carbamazepine)
18 TOXIC EPIDERMAL NECROLYSIS Lesion: tender, red areas of skin often on dependent areas (lower back and butt) but can be anywhere May blister or simply slough and show + Nikolsky sign Widespread, involving >20% of BSA Mucositis may be as severe as SJS with similar sequelae Extensive full-thickness denudation of skin clinically resembles burned skin Predisposes patient to sepsis, fluid and electrolyte disturbances, and thermal instability
19 TOXIC EPIDERMAL NECROLYSIS Diagnosis: CLINICAL Biopsy with frozen section: full-thickness epidermal necrosis and subepidermal split Treatment: Stop offending agent or treat etiology Fluid and Electrolyte management in ICU or Burn Unit Diligent wound care and topical antibiotics (bacitracin, silver sulfadiazine) Systemic analgesia Consultation of subspecialists for mucous membrane involvement IVIG?
20 WHAT S GOING ON?! Phototoxic Eruptions Bullous Impetigo Secondary Syphilis Stevens Johnson Syndrome Kawasaki Toxic Shock Syndrome Toxin Mediated Perineal Erythema Erythema Multiforme Serum Sickness Erythematous Drug Eruption Toxic Epidermal Necrolysis Urticarial Vasculitis Viral Exanthems Annular Urticarial Burns Pemphigus Vulgaris Herpetic Gingivostomatitis Aphthous Stomatitis Staph Scalded Skin Syndrome Linear Iga Bullous Dermatosis
21 TOXIC SHOCK SYNDROME Acute streptococcal or staphylococcal exotoxin-mediated infection with perivascular infiltrates resulting in fever, diffuse erythroderma, hypotension and impairment of 3 or more organ systems Associations: foreign body (<50% due to tampons!), primary Staph infection, post-op wound infection, mucous membrane or skin disruption Streptococcal TSS is associated with Varicella, DM, HIV Exotoxins act as superantigens-> massive T cell activation, cytokine release Activation of coagulation cascade and thrombolytic enzymes-> hemolytic anemia and DIC
22 TOXIC SHOCK SYNDROME Fever, rash, hypotension, arthritis, with multi-organ involvement AND clinical course out of proportion to extent of local infection Initial erythroderma: diffuse, macular rash resembling sunburn which can include palms and soles; petechiae and bullae may develop 1-2 weeks after disease onset: pruritic, maculopapular rash, desquamation affects palms and soles Mucosal involvement: Hyperemia of the pharyngeal and GU mucosa, conjunctival-scleral hemorrhage
23 TOXIC SHOCK SYNDROME
24 Systemic symptoms: TOXIC SHOCK SYNDROME Fever (>102), hypotension Non-pitting edema of face and hands (secondary to capillary leak) Diarrhea and vomiting Myalgia Mental status changes Multi-organ failure/dic Lab findings: Blood, throat, CSF cultures typically negative Positive blood culture (more common with GAS) +/- Leukocytosis with a pronounced bandemia Increased CPK, Myoglobinuria/hemoglobinuria
25 TOXIC SHOCK SYNDROME
26 TOXIC SHOCK SYNDROME Treatment Anticipate shock and multisystem organ failure Remove or drain any loculated source of infection Empiric abx- beta-lactamase resistant anti-staph plus a protein-synthesis inhibitor (clindamycin). Strep pyogenes- PCN + Clindamycin Staph aureus- appropriate beta-lactam ABx based on susceptibility + Clindamycin Total course days IVIG? Patients with inaccessible focus or those with continued deterioration (400mg/kg once) Early admin may predispose to recurrence by blunting initial immune response
27 WHAT S GOING ON?! Phototoxic Eruptions Bullous Impetigo Secondary Syphilis Stevens Johnson Syndrome Kawasaki Toxic Shock Syndrome Toxin Mediated Perineal Erythema Erythema Multiforme Serum Sickness Erythematous Drug Eruption Toxic Epidermal Necrolysis Urticarial Vasculitis Viral Exanthems Annular Urticarial Burns Pemphigus Vulgaris Herpetic Gingivostomatitis Aphthous Stomatitis Staph Scalded Skin Syndrome Linear Iga Bullous Dermatosis
28 ERYTHEMA MULTIFORME (MINOR) Immunologically mediated mucocutaneous eruption characterized by targetoid lesions. Oral mucous membranes are commonly affected Older children and young adults Reactive phenomenon in response to multiple etiologies: infectious, medications, inflammatory conditions, environmental agents Infections > Medications Recurrent EM: strongly associated with HSV May occur a few days to a few weeks following an infection
29 ERYTHEMA MULTIFORME (MINOR) Lesion: targetoid and demonstrates triple color phenomenon of a central area that is violaceous and dusky, a surrounding pale ring of edema, and an erythematous peripheral rim Distribution: symmetric, acral predilection (spreads in centripetal manner) involving the arms and legs, palms and soles, with fewer lesions on the torso Typically asymptomatic HSV-associated lesions appear 2-17 days after outbreak
30 ERYTHEMA MULTIFORME (MINOR) TYPICALLY INVOLVES ONLY ONE MUCOUS MEMBRANE ORAL 70% CAN EXTEND TO PHARYNX AND URT GENITAL 25% OCULAR 17%
31 ERYTHEMA MULTIFORME (MINOR) If you get labs: Non-specific: Elevated ESR, WBC Transaminitis If any suspicion: Skin biopsy? HSV (DFA, Viral Cx, PCR) M. Pneumoniae (serology) If diagnosis is in question Epidermal cell apoptosis, basal cell vacuolar degeneration, lymphocytic exocytosis, and dermal lymphocytic infiltrate
32 ERYTHEMA MULTIFORME (MINOR) Diagnosis is CLINICAL Self-limited Lesions appear over 3-5 days and disappear over ~2 weeks Usually no scarring, but may leave area of post-inflammatory hyperpigmentation that can remain for months Requires supportive care Poor oral intake from mucositis may require IV rehydration Antihistamines for pruritus Ophtho consult if eye involvement
33 WHAT WOULD YOU LIKE TO DO? WHAT WE DID Skin biopsy: extensive full thickness epidermal necrosis, very mild inflammation in dermis FINAL DIAGNOSIS? Stevens Johnson Syndrome
34 BOARD SPECS AT A GLANCE Recognize that the spectrum of severity of erythema multiforme ranges from targetoid lesions to stevens-johnson syndrome Recognize the major clinical syndromes of staphylococcus aureus: scalded skin syndrome, toxic shock syndrome Recognize the appearance of staphylococcal scalded skin syndrome, know it is mediated by a toxin Understand the management of a patient with staphylococcal toxic shock syndrome Know that Group A Streptococcus can cause a toxic shock syndrome
35 NOON CONFERENCE: DR HESCOCK INTRO TO QI PROJECTS (STUDENTS OFF)
Pediatric Dermatology
Pediatric Dermatology --------- Emergencies & Urgencies Nicholas V. Nguyen, M.D. Director, Pediatric Dermatology Disclosures In the past 12 months, I have had the following financial relationships with
More informationEmergency Dermatology Dr Melissa Barkham
Emergency Dermatology Dr Melissa Barkham Spotlight Seminar 30 th September 2010 Why is this important? Urgent recognition and treatment of dermatologic emergencies can be life saving and prevent long term
More informationDERMATOLOGIC EMERGENCIES. Mary Evers D.O., F.A.O.C.D. Georgetown, Texas
DERMATOLOGIC EMERGENCIES Mary Evers D.O., F.A.O.C.D. Georgetown, Texas SKIN EMERGENCIES??? Subclassifications: Autoimmune (Anaphylaxis, Vasculitis, Pemphigus) Erythroderma (AGEP, DRESS, SJS, TEN) Infectious
More informationA. Erythema multiforme and related diseases
Go Back to the Top To Order, Visit the Purchasing Page for Details Chapter Erythema, Erythroderma (Exfoliative Dermatitis) Erythema is caused by telangiectasia or hyperemia in the papillary and reticular
More informationCutaneous Drug Reactions
Cutaneous Drug Reactions Andrei Metelitsa, MD, FRCPC, FAAD Co-Director, Institute for Skin Advancement Clinical Associate Professor, Dermatology University of Calgary, Canada Copyright 2017 by Sea Courses
More informationFive things not to miss in Dermatology. Dr Judy Wismer Associate Clinical Professor Michael G DeGroote School of Medicine
Five things not to miss in Dermatology Dr Judy Wismer Associate Clinical Professor Michael G DeGroote School of Medicine Key Descriptives Fever, skin pain Purpura, necrosis Bullae, Mucosal, Skin sloughing
More informationBacterial Infections in Pediatric Dermatology. Patrick McMahon, MD Children s Hospital of Philadelphia
Bacterial Infections in Pediatric Dermatology Patrick McMahon, MD Children s Hospital of Philadelphia Fill In The Blank When you see on the skin, you think of a bacterial skin infection SEND SWABS VIRAL
More informationDermergency! An Approach to Identification and Management of Life-Threatening Rashes
Dermergency! An Approach to Identification and Management of Life-Threatening Rashes Gabby Anderson, PharmD PGY2 Emergency Medicine Pharmacy Resident anderson.gabrielle@mayo.edu Pharmacy Grand Rounds January
More informationFuture of Pediatrics: Blisters, Hives and Other Tales from the Emergency Room June 14 th, 2016
A. Yasmine Kirkorian MD Assistant Professor of Dermatology & Pediatrics Children s National Health System George Washington University School of Medicine & Health Sciences Future of Pediatrics: Blisters,
More informationConcentrate on Descriptors. An Approach to Skin Diseases in the ER
Concentrate on Descriptors An Approach to Skin Diseases in the ER Toby Maurer, MD University of California, San Francisco Vasculitis-leaky blood vessels Targetoid lesions-round lesions with blue or red
More informationTo update the use of IVIG and CORTICOIDS IN management of SJS/ TEN To remind Doctors being careful when giving
Present : Dr Pham Thi Minh Rang Internal Department No2-Hospital for children No2 AIMS To update the use of IVIG and CORTICOIDS IN management of SJS/ TEN To remind Doctors being careful when giving To
More informationDERMATOLOGICAL EMERGENCIES. DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA (UK),FRACGP,FACRRM,DIP DERM(Wales) TASMANIAN SKIN AND BODY CENTRE
DERMATOLOGICAL EMERGENCIES DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA (UK),FRACGP,FACRRM,DIP DERM(Wales) TASMANIAN SKIN AND BODY CENTRE Dermatological Emergencies INFECTIONS ERYTHRODERMA DRUG ERUPTIONS STEVENS-JOHNSON
More informationMark A. Bechtel, MD Clinical Associate Professor Division Director, Dermatology Ohio State University Medical Center
Dermatologic Emergencies Mark A. Bechtel, MD Clinical Associate Professor Division Director, Dermatology Ohio State University Medical Center Clinical Features of SJS/TEN Initial symptoms Fever, stinging
More informationAuthor(s): C. James Holliman, M.D., F.A.E.C.P., Pennsylvania State University (Hershey)
Project: Ghana Emergency Medicine Collaborative Document Title: Toxic Shock Syndrome, 2012 Author(s): C. James Holliman, M.D., F.A.E.C.P., Pennsylvania State University (Hershey) License: Unless otherwise
More informationHerbal and homeopathic products, often considered natural and non-toxic, can also cause adverse drug reactions.
Idiosyncratic and potentially serious cutaneous adverse drug reactions (CADRs), although relatively rare, account for significant morbidity and mortality. RANNAKOE J LEHLOENYA, BSc, MB ChB, FCDerm (SA)
More informationSkin Manifestations of Drug Reactions
Skin Manifestations of Drug Reactions Dr Carol Hlela, Division of Dermatology Department of Medicine, University of Cape Town and Red Cross Children s Hospital What are the Skin Manifestations of Drug
More information건강한성인에서의오진하기쉬운포도구균성열상피부증후군의치험례. Staphylococcal Scalded Skin Syndrome in a Healthy Adult: Easy to Misdiagnose
Archives of Hand and Microsurgery Arch Hand Microsurg 2018;23(4):271-276. https://doi.org/10.12790/ahm.2018.23.4.271 pissn 2586-3290 eissn 2586-3533 Case Report 건강한성인에서의오진하기쉬운포도구균성열상피부증후군의치험례 김홍일ㆍ곽찬이ㆍ박언주
More informationCutaneous Conditions Associated with Systemic Disease
Cutaneous Conditions Associated with Systemic Disease Johnnie M Woodson, M.D., F.A.A.D. Assistant Professor of Dermatology University of Nevada School of Medicine Director of J. Woodson Dermatology & Associates,
More informationEmergency Dermatology. Emergency Dermatology
Emergency Dermatology These are rapidly progressive skin conditions and some are potentially lifethreatening. Early recognition is important to implement prompt supportive care and therapy. Some are drug
More informationObjectives. Terminology. Recognize common pediatric dermatologic conditions. Review treatment plans Identify skin manifestations of systemic disease
Pediatric Visual Dermatological Diagnosis Fernando Vega, M.D. Objectives Recognize common pediatric dermatologic conditions Expand differential diagnosis Review treatment plans Identify skin manifestations
More informationLESIONS OF THE ORAL CAVITY ORAL CAVITY. Oral Cavity Subsites 4/10/2013 LIPS TEETH GINGIVA ORAL MUCOUS MEMBRANES PALATE TONGUE ORAL LYMPHOID TISSUES
LESIONS OF THE ORAL CAVITY David I. Kutler, MD, FACS Associate Professor Division of Head and Neck Surgery Department of Otolaryngology HNS Weill Cornell Medical Center ORAL CAVITY LIPS TEETH GINGIVA ORAL
More informationDiagnosis and Management of Drug-induced Stevens-Johnson Syndrome: Report of Two Cases
10.5005/jp-journals-10011-1189 CASE REPORT JIAOMR Diagnosis and Management of Drug-induced Stevens-Johnson Syndrome: Report of Two Cases 1 M Venkateshwarlu, 2 B Radhika 1 Professor and Head, Department
More informationPedsCases Podcast Scripts
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Drug Allergy. These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio
More informationBacteria: Scarlet fever, Staph infection (sepsis, 4S,toxic shock syndrome), Meningococcemia, typhoid Mycoplasma Rickettsial infection
Exanthematous Fever objectives FEVER WITH RASH 1 Determine the feature of skin rashes 2 Enumerate the most common causes of skin rashes in children (measles, chicken pox, rubella,erythema infectiosum,
More informationObjectives. Routine to Rare: Complex Wound and Skin Conditions 8/29/2017
Routine to Rare: Complex Wound and Skin Conditions Debbie Harrell RN, MSN Objectives Describe various pediatric complex wound and skin conditions. Identify the root causes of complex wound and skin conditions
More informationREGISTRY OF SEVERE CUTANEOUS ADVERSE REACTIONS TO DRUGS AND COLLECTION OF BIOLOGICAL SAMPLES. R e g i S C A R PATIENT'S DATA. Age country of birth
REGISTRY OF SEVERE CUTANEOUS ADVERSE REACTIONS TO DRUGS AND COLLECTION OF BIOLOGICAL SAMPLES R e g i S C A R PATIENT'S DATA Initials of the patient date of birth Age country of birth Gender male female
More information-> Education -> Excellence
Quality Conference 5/2557 Extravasations: Event -> Education -> Excellence รศ.นพ. รว ศ เร องตระก ล สาขาว ชาก มารศ ลยศาสตร ภาควชาศลยศาสตร Extravasations: Event 1. Thrombophlebitis - superficial vein 2.
More informationCutaneous Adverse Drug Reactions in Domestic Animals. Katherine Doerr, DVM, Dip. ACVD. Veterinary Dermatology Center
Cutaneous Adverse Drug Reactions in Domestic Animals Katherine Doerr, DVM, Dip. ACVD Veterinary Dermatology Center Maitland, Rockledge, Waterford Lakes, FL Not highly studied in veterinary medicine Unknown
More informationCases of Non-Infectious Vulvovaginitis
Cases of Non-Infectious Vulvovaginitis 2 nd PANHELLANIC CONGRESS on Lower Genital Tract Disorders December 14-16 Grand Hyatt Athens Lynette J. Margesson MD FRCPC Assistant Professor of Obstetrics & Gynecology
More informationDisclaimer. This is a broad survey and cannot cover all differential diagnoses or each condition in thorough detail
Objectives Pediatric Infections: Differentiating Benign from Serious Eileen Klein, MD, MPH Rashes Infectious vs non-infectious Viral vs bacterial Respiratory and GI illnesses When do you treat When do
More informationVARICELLA. Infectious and Tropical Pediatric Division, Department of Child Health, Medical Faculty, University of Sumatera Utara
VARICELLA (Chicken pox) Infectious and Tropical Pediatric Division, Department of Child Health, Medical Faculty, University of Sumatera Utara Definition : Varicella is a common contagious disease caused
More informationCUTANEOUS DRUG REACTIONS OR I WOULDN T HAVE SEEN IT, IF I HADN T BELIEVED IT Edmund J. Rosser Jr., DVM, DACVD
CUTANEOUS DRUG REACTIONS OR I WOULDN T HAVE SEEN IT, IF I HADN T BELIEVED IT Edmund J. Rosser Jr., DVM, DACVD DERMATOLOGY Pathogenesis Immunologic: can involve Type I, II, III, IV hypersensitivity reactions.
More informationGram Positive Coccus Staphylococci Dr. Hala Al Daghistani
Medical bacteriology Gram Positive Coccus Staphylococci Dr. Hala Al Daghistani The Staphylococci are gram-positive spherical cells, nonmotile, usually arranged in grapelike irregular clusters. Some are
More informationKawasaki Disease. 1:45 2:30 p.m. James Nocton, MD Benjamin Goot, MD. Children s Specialty Group. All rights reserved.
Kawasaki Disease 1:45 2:30 p.m. James Nocton, MD Benjamin Goot, MD Disclosures We have no relevant financial relationships to disclose. Objectives Describe the characteristic signs and symptoms of Kawasaki
More informationAn Approach to Common and not so Common Rashes in the Office FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc
An Approach to Common and not so Common Rashes in the Office FMF 2014 Christie Freeman MD, CCFP, DipPDerm, MSc 1 Common Rashes Tinea Corporis: Annular- this is not the only criteria Advancing erythematous
More informationCASE 5 - Toy et al. CASE FILES: Obstetrics & Gynecology
z CASE 5 - Toy et al. CASE FILES: Obstetrics & Gynecology A 28-year-old woman is brought into the emergency room with a blood pressure of 60/40. The patient s husband states that she had 2 days of nausea
More informationOXCARBAZEPINE-INDUCED STEVENS-JOHNSON SYNDROME: A CASE REPORT
OXCARBAZEPINE-INDUCED STEVENS-JOHNSON SYNDROME: A CASE REPORT Lung-Chang Lin, 1,2 Ping-Chin Lai, 3 Sheau-Fang Yang, 4 and Rei-Cheng Yang 1,5 Departments of 1 Pediatrics and 4 Pathology, Kaohsiung Medical
More information=ﻰﻤاﻤﺤﻠا ﺔﻴﻘﻠﺤﻠا ﺔذﺒاﻨﻠا
1 / 15 Erythema Annulare Centrifugum and Other Figurate Erythemas The figurate erythemas include a variety of eruptions characterized by annular and polycyclic lesions. Classification of this group has
More informationAOU Ospedali Riuniti - Ancona
AOU Ospedali Riuniti - Ancona Ospedale Materno-Infantile di Alta Specializzazione G. Salesi UOC Pediatria Allergia a farmaci e infezioni: tra coesistenza e casualità fabrizio franceschini Drug Hypersensitivity
More informationEXANTHEMATOUS ILLNESS. IAP UG Teaching slides
EXANTHEMATOUS ILLNESS 1 DEFINITIONS Exanthema eruption of the skin Exanthema eruption of mucosae Macule flat nonpalpable lesion Papule small palpable lesion Nodule large palpable lesion Vesicle small fluid
More informationSkin Manifestations of Systemic Disease. Approach to Dermatalogic Diagnosis 9/6/2016. Go Ahead---Judge a Book by its Cover!
Go Ahead---Judge a Book by its Cover! Skin Manifestations of Systemic Disease Amelie Hollier, DNP, FNP-BC, FAANP Lafayette, LA President, APEA Objectives Compare diseases of the skin with reactions of
More informationPatricia A. Treadwell, M.D. Professor of Pediatrics
EXANTHEMS Patricia A. Treadwell, M.D. Professor of Pediatrics Indiana University School of Medicine FACULTY DISCLOSURE I have the following financial relationships with the manufacturer(s) of any commercial
More informationHEMORRHAGIC BULLOUS HENOCH- SCHONLEIN PURPURA: A CASE REPORT
HEMORRHAGIC BULLOUS HENOCH- SCHONLEIN PURPURA: A CASE REPORT Nirmala Ponnuthurai, Sabeera Begum, Lee Bang Rom Paediatric Dermatology Unit, Institute of Paediatric, Hospital Kuala Lumpur, Malaysia Abstract
More informationStevens-Johnson s Syndrome / Toxic Epidermal Necrolysis: An update
Stevens-Johnson s Syndrome / Toxic Epidermal Necrolysis: An update Robert G. Micheletti, MD Assistant Professor of Dermatology and Medicine Director, Cutaneous Vasculitis Clinic, Penn Vasculitis Center
More informationClassification: 1. Infective: 2. Traumatic: 3. Idiopathic: Recurrent Aphthous Stomatitis (RAS) 4. Associated with systemic disease:
Classification: 1. Infective: 2. Traumatic: 3. Idiopathic: Recurrent Aphthous Stomatitis (RAS) 4. Associated with systemic disease: Hematological GIT Behcet s HIV 5. Associated with dermatological diseases:
More informationLearning Objectives. History 8/1/2016. An Approach to Pediatric Rashes
An Approach to Pediatric Rashes Neethi Patel, D.O. Learning Objectives 1.To identify common features of rashes seen in the pediatric population as well as pathognomonic features of certain pathologies
More informationPimples and Boils!! Dr Nathan Harvey Anatomical Pathology, PathWest
Pimples and Boils!! Dr Nathan Harvey Anatomical Pathology, PathWest Overview & Learning Objectives Review the cardinal signs/symptoms of acute inflammation Review the histological features of acute inflammation
More informationFever and rash in children. Haider Arishi MD Consultant, pediatrics and infectious diseases Director, infection control program
Fever and rash in children Haider Arishi MD Consultant, pediatrics and infectious diseases Director, infection control program objectives To understand importance of fever and rash. To discuss the clinical
More informationA Retrospective Study of Spectrum of Nevirapine Induced Cutaneous Drug Reactions in HIV Positive Patients
Journal of US-China Medical Science 12 (2015) 85-89 doi: 10.17265/1548-6648/2015.02.008 D DAVID PUBLISHING A Retrospective Study of Spectrum of Nevirapine Induced Cutaneous Drug Reactions in HIV Positive
More informationCorrespondence should be addressed to Wanjarus Roongpisuthipong; rr
Dermatology Research and Practice, Article ID 237821, 5 pages http://dx.doi.org/10.1155/2014/237821 Research Article Retrospective Analysis of Corticosteroid Treatment in Stevens-Johnson Syndrome and/or
More informationPYOGENIC INFECTIONS. Dr. Kenéz Éva - Anna Division of Infectious Diseases
PYOGENIC INFECTIONS Dr. Kenéz Éva - Anna Division of Infectious Diseases 2015.11.10 KEY POINTS The virulence factors of streptococcus and staphylococcus Disease caused by streptococcus and staphylococcus
More informationSyndrome de Lyell Approche diagnostique. seminaires iris. Veronique del Marmol Alexandre Chamoun Service de Dermatologie Hôpital Erasme.
Syndrome de Lyell Approche diagnostique Veronique del Marmol Alexandre Chamoun Service de Dermatologie Hôpital Erasme Serge Jennes Hôpital Militaire Rash benign Pustulose exanthematique Aigue et généralisée
More informationVisual Diagnosis. Q-PEM: Jan Dr. Rafah F. Sayyed PEC - Al Sadd, Doha
Visual Diagnosis Q-PEM: Jan 2017 Dr. Rafah F. Sayyed PEC - Al Sadd, Doha DISCLOSURE I do not have any relevant financial relationship with commercial interest to disclose. Introduction Speed and Accuracy
More informationDEFINITION Impetigo vulgaris is a highly contagious, superficial bacterial infection of the skin.
DEFINITION Impetigo vulgaris is a highly contagious, superficial bacterial infection of the skin. Nonbullous impetigo Formation of vesiculopustules that ruptures, leading to crusting with a characteristic
More informationAutoimmune Diseases with Oral Manifestations
Autoimmune Diseases with Oral Manifestations Martin S. Greenberg DDS, FDS RCSEd Professor Emeritus Department of Oral Medicine University of Pennsylvania Disclosure Statement I have no actual or potential
More informationEndocarditis. By : Mehrnoush. dianatkhah
Endocarditis By : Mehrnoush. dianatkhah Case 5.31, 31 years old woman CC : Fever, dyspnea, 3 days postpartum PMH : Mitral prolapse Fever 38.5 WBC : 8900 ESR : 84 CRP : 10.4 Cr : 0.6 NT Pro BNP: 5469 Physical
More informationEducational Session: Life-Threatening Pediatric Rashes
Educational Session: Life-Threatening Pediatric Rashes Richard M. Cantor, MD, FAAP, FACEP 3/22/2010 4:30 PM - 5:30 PM Cutaneous Signs of Serious Illness Richard Cantor MD FAAP/FACEP Associate Professor
More informationDermatology. Chapter 34
Dermatology Chapter 34 Dermatology Introduction Most pediatric dermatological conditions are not acute and may be managed through telemedicine specialty consultation if dermatological expertise is needed.
More informationDrug Allergy A Guide to Diagnosis and Management
Drug Allergy A Guide to Diagnosis and Management (Version 1 April 2015 updated April 2018) Author: Jed Hewitt Chief Pharmacist, Governance & Professional Practice Date of Preparation: April 2015 Updated:
More informationProf Dr Najlaa Fawzi
1 Prof Dr Najlaa Fawzi is an acute highly infectious disease, characterized by vesicular rash, mild fever and mild constitutional symptoms. is a local manifestation of reactivation of latent varicella
More informationRetrospective 10 years review of 100 patients with psoriasis in the Kingdom of Saudi Arabia (KSA)
Retrospective 10 years review of 100 patients with psoriasis in the Kingdom of Saudi Arabia (KSA) Ahmed Abdullah Alhumidi King saud university, Riyadh, kingdom of Saudi Arabia Abstract Background: This
More informationin Pediatric Medicine
in Pediatric Medicine Martin Belson, MD Pediatric Emergency Medicine Associates, LLC Pediatric Sedation Services, LLC Children s Healthcare of Atlanta, Scottish Rite and Egleston Wellstar Hospital Systems
More informationDilantin (phenytoin) ROBERT A. SCHWARTZ
Dilantin (phenytoin) ROBERT A. SCHWARTZ Bailey & Galyen Attorney in Charge, Mass Tort Litigation Managing Attorney, Houston 18333 Egret Bay Blvd., Suite 120 Houston, Texas 77058 Toll Free: (866) 715-1529
More informationBugs and Drugs: What s New in Hypersensitivity Reactions?
Bugs and Drugs: What s New in Hypersensitivity Reactions? Erin Mathes, MD Associate Professor of Dermatology and Pediatrics University of California, San Francisco DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY
More informationAlphaherpesvirinae. Simplexvirus (HHV1&2/ HSV1&2) Varicellovirus (HHV3/VZV)
Alphaherpesvirinae Simplexvirus (HHV1&2/ HSV1&2) Varicellovirus (HHV3/VZV) HERPES SIMPLEX VIRUS First human herpesvirus discovered (1922) Two serotypes recognised HSV-1 & HSV-2 (1962) HSV polymorphism
More informationManaging Penicillin Allergy
Managing Penicillin Allergy Brian T. Kelly, MD MA April 12, 2019 Objectives Review penicillin allergy prevalence, morbidity, and management Describe the penicillin testing and oral challenge process Provide
More informationACUTE ANNULAR URTICARIA IN A CHILD
The West London Medical Journal 2013 Vol 5 No 2 pp 1-5 ACUTE ANNULAR URTICARIA IN A CHILD Aaron Yon Dayse Fernandes Michelle Pike Jodi Newcombe Colin Michie 1. ABSTRACT Urticarial skin rashes have a range
More informationUpper Respiratory Tract Infections / 42
Upper Respiratory Tract Infections 1 Upper Respiratory Tract Infections Acute tonsillitispharyngitis Acute otitis media Acute sinusitis Common cold Acute laryngitis Otitis externa Mastoiditis Acute apiglottis
More informationFever Without a Source Age: 0-28 Day Pathway - Emergency Department Evidence Based Outcome Center
Age: 0-28 Day Pathway - Emergency Department EXCLUSION CRITERIA Toxic appearing No fever Born < 37 weeks gestational age INCLUSION CRITERIA Non-toxic with temperature > 38 C (100.4 F) < 36 C (96.5 F) measured
More informationGeneral surgery department of SGMU Lecturer ass. Khilgiyaev R.H. Anaerobic infection. Gas gangrene
Anaerobic infection Gas gangrene Anaerobic bacteria Anaerobic bacteria are the most numerous inhabitants of the normal gastrointestinal tract, including the mouth Bacteroides fragilis and Clostridium The
More informationAnother New HIV Diagnosis
Another New HIV Diagnosis P. Young, RPAC Shelley A Gilroy, MD Albany Medical College June 3, 2014 The Patient 21-year-old male college student with rash x 1 month, beginning on his face Non-tender & non-pruritic
More informationAbscess. A abscess is a localized collection of pus in the skin and may occur on any skin surface and be formed in any part of body.
Abscess A abscess is a localized collection of pus in the skin and may occur on any skin surface and be formed in any part of body. Ethyology Bacteria causing cutaneous abscesses are typically indigenous
More informationB. Autoimmune blistering diseases
Go Back to the Top To Order, Visit the Purchasing Page for Details formation immediately above the basal layer. The dermal papillae, which are covered by basal cells in the single layer that is left in
More informationInfectious diseases Dr n. med. Agnieszka Topczewska-Cabanek
Infectious diseases Dr n. med. Agnieszka Topczewska-Cabanek Viral: Exanthema subitum (Roseaola infantum) Herpetic stomatitis Measles Rubella Chickenpox Erythema infectious (5th Disease, Slapped cheec disease)
More informationA case of bullous pemphigoid following pemphigus foliaceus
#2228 A case of bullous pemphigoid following pemphigus foliaceus Priyanka Vedak MD 1, Danielle Levine MD 1,3, Lyn Duncan MD 2,3, Hensin Tsao 1,3, Daniela Kroshinsky MD MPH 1,3 1. Department of Dermatology,
More informationBig rashes in little patients:
! Big rashes in little patients: Severe drug eruptions and cutaneous infections!! Marcia Hogeling, MD, FAAD Assistant Clinical Professor Director, Pediatric Dermatology Division of Dermatology David Geffen
More informationToxic Epidermal Necrolysis and SJS : Case Reports & Brief Review
Case Report Toxic Epidermal Necrolysis and SJS : Case Reports & Brief Review Deepali P. Mohite*, Satyajitraje Tekade*, Amol Gadbail*, M. S. Chaudhary** Abstract : Toxic epidermal necrolysis (TEN) and Stevens
More informationHow is it transferred?
STI s What is a STI? It is a contagious infection that is transferred from one person to another through sexual intercourse or other sexually- related behaviors. How is it transferred? The organisms live
More informationCore Content: Toxic Shock, Necrotizing Fasciitis, Erysipelas, Cellulitis, Tetanus Keith Conover, M.D., FACEP /11/2008 Tetanus 78-year old
Core Content: Toxic Shock, Necrotizing Fasciitis, Erysipelas, Cellulitis, Tetanus Keith Conover, M.D., FACEP 1.01 11/11/2008 Tetanus 78-year old Russian man, speaks fair English, smoker, no past medical
More informationPEDIATRIC LIFE- THREATENING RASHES
PEDIATRIC LIFE- THREATENING RASHES Ghazala Q. Sharieff MD, MBA What makes you think that a rash may be lifethreatening? 1.Mucous membrane involvement 2.Extensive blisters or peeling of skin 3.Extensive
More informationPAEDIATRIC ACUTE CARE GUIDELINE. Impetigo. This document should be read in conjunction with this DISCLAIMER
Princess Margaret Hospital for Children PAEDIATRIC ACUTE CARE GUIDELINE Impetigo Scope (Staff): Scope (Area): All Emergency Department Clinicians Emergency Department This document should be read in conjunction
More informationChapter 19. Pathogenic Gram-Positive Bacteria. Staphylococcus & Streptococcus
Chapter 19 Pathogenic Gram-Positive Bacteria Staphylococcus & Streptococcus Staphylococcus Normal members of every human's microbiota Can be opportunistic pathogens Facultative anaerobes Cells occur in
More informationStreptococcus pyogenes
Streptococcus pyogenes From Wikipedia, the free encyclopedia Streptococcus pyogenes S. pyogenes bacteria at 900x magnification. Scientific classification Kingdom: Eubacteria Phylum: Firmicutes Class: Cocci
More informationThe Streptococci. Diverse collection of cocci. Gram-positive Chains or pairs significant pathogens
The Streptococci Diverse collection of cocci. Gram-positive Chains or pairs significant pathogens Strong fermenters Facultative anaerobes Non-motile Catalase Negative 1 Classification 1 2 Classification
More informationBacterial infections Diphtheria, Pertussis and Enteric fever. Dr Mubarak Abdelrahman Assistant Professor Jazan University
Bacterial infections Diphtheria, Pertussis and Enteric fever Dr Mubarak Abdelrahman Assistant Professor Jazan University Gram negative: Diplococci Bacilli Coccobacilli Gram Positive: Diplococci Chains
More informationInfection Control Manual Residential Care Part 3 Infection Control Standards IC6: Additional Precautions
IC6: 0110 Appendix I Selection Table Infection Control Manual esidential Care IC6: Additional Legend: outine Practice * reportable to Public Health C - Contact ** reportable by Lab D - Droplet A - Airborne
More informationFEVER. What is fever?
FEVER What is fever? Fever is defined as a rectal temperature 38 C (100.4 F), and a value >40 C (104 F) is called hyperpyrexia. Body temperature fluctuates in a defined normal range (36.6-37.9 C [97.9-100.2
More informationOral Medicine. Dr. Qianming Ian CHEN
Oral Medicine Dr. Qianming Ian CHEN ORAL MEDICINE Oral medicine is the specialty of dentistry that is concerned with the oral health care of medically compromised patients and with the diagnosis and nonsurgical
More informationSJS/TEN spectrum. Stevens-Johnson syndrome (SJS) /Toxic Epidermal Necrolysis (TEN) 10/7/2016
Jesse Keller MD Assistant Professor Oregon Health & Science University Stevens-Johnson syndrome (SJS) /Toxic Epidermal Necrolysis (TEN) Drug induced dermemergencies that exist on a spectrum Delayed reaction:
More informationAn unpredictable, dose-independent adverse drug reaction which is immunologically or IgEmediated.
R H E U M A T I S M D I S O R D E R S A N D A L L E R G I E S APPROACH TO DRUG ALLERGY Dr Bernard Thong DEFINITION OF DRUG ALLERGY An unpredictable, dose-independent adverse drug reaction which is immunologically
More informationRapid and progressive necrosis of the tissue underlying epidermis (cellulitis)
Table 1. Infections of the Skin, Eyes and Ears Folliculitis Furuncles (boils) & Carbuncles Staphylococcus aureus (G+) Scald Skin Syndrome Peeling skin on infants Staphylococcus aureus (G+) Impetigo Lesions
More informationVasculitis local: systemic
Vasculitis Inflammation of the vessel wall. Signs and symptoms: 1- local: according to the involved tissue 2- systemic:(fever, myalgia, arthralgias, and malaise) Pathogenesis 1- immune-mediated 2- infectious
More informationGROUP A STREPTOCOCCUS (GAS) INVASIVE
GROUP A STREPTOCOCCUS (GAS) INVASIVE Case definition CONFIRMED CASE Laboratory confirmation of infection with or without clinical evidence of invasive disease: isolation of group A streptococcus (Streptococcus
More informationCase Presentation. By Eman El Sharkawy Ass. Professor of cardiology Alexandria University
Case Presentation By Eman El Sharkawy Ass. Professor of cardiology Alexandria University 6m old baby girl Past history : - At the age of 2m attack of fever, diarrhea, mouth ulcers, difficult breast feeding
More informationBacterial infections Diphtheria, Pertussis and Enteric fever. Dr Mubarak Abdelrahman Assistant Professor Jazan University
Bacterial infections Diphtheria, Pertussis and Enteric fever Dr Mubarak Abdelrahman Assistant Professor Jazan University Gram negative: Diplococci Bacilli Coccobacilli Gram Positive: Diplococci Chains
More informationINVESTIGATION OF ADVERSE TRANSFUSION REACTIONS TABLE OF RECOMMENDED TESTS. Type of Reaction Presentation Recommended Tests Follow-up Tests
Minor Allergic (Urticarial) Urticaria, pruritis, flushing, rash If skin reaction only and mild hives/ rash
More informationObjectives. Define classes of uncomplicated skin and soft tissue infection (SSTI) that drive empiric antimicrobial selection
Objectives Define classes of uncomplicated skin and soft tissue infection (SSTI) that drive empiric antimicrobial selection Purulent SSTI Non-purulent SSTI Recognize conditions that suggest complications
More informationPersonalized Medical Care:Recognition, Management, and Maybe Prevention of Cutaneous Hypersensitivity Reactions
Personalized Medical Care:Recognition, Management, and Maybe Prevention of Cutaneous Hypersensitivity Reactions Bernard A. Cohen, M.D. Johns Hopkins Children s Center Baltimore, Maryland (NO disclosures)
More informationEarly View Article: Online published version of an accepted article before publication in the final form.
: Online published version of an accepted article before publication in the final form. Journal Name: International Journal of Case Reports and Images (IJCRI) Type of Article: Case Report Title: A Case
More informationBSD Self Assessment Workshop 7 th July 2013 CASE 27 RAC6123
BSD Self Assessment Workshop 7 th July 2013 CASE 27 RAC6123 M55. 4/7 tender lesions on knee, legs and arms. Also iritis/ weight loss/headache, synovitis.?vasculitis. Sarcoidosis. Biopsy from left elbow
More information