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level: Level 1 of SKIN DISORDER AND CUTANEOUS DRUG REACTIONS

Questions and Answers List

level questions: Level 1 of SKIN DISORDER AND CUTANEOUS DRUG REACTIONS

QuestionAnswer
Skin consists of1 Outer Epidermis 2 Inner Epidermis
Epidermis parts1 stratum basale (basal layer), 2 stratum spinosum (prickle cell layer) 3 stratum granulosum (granular layer) 4 stratum corneum (horny layer)
1 provide resilience to mechanical stress 2 provide color and protect from UV penetration 3 consist of sweat, oils, corneocytes, protein decomposition products, and transepidermal water 4 a much thicker layer that contains nerve endings and blood vessels1 Keratinocytes 2 Melanocytes 3 Hydrolipid film 4 dermis
1 contains more water and is thinner for enhanced topical drug absorption 2 tends to be drier, thinner, and more friable (external insults) 3 Exposure to __ accelerates aging and skin cancer1 Pediatric skin 2 Aged skin 3 radiation
PATHOPHYSIOLOGY: 1 Localized DRUG-INDUCED REACTIONS 2 Allergic DRUG-INDUCED REACTIONS Depend on inducing an immune response from the host Classified as:1 Chemical vaginitis (vaginal douches, spermicides, and imidazoles) 2 Blistering Exanthematous Pustular eruptions Urticarial
Afebrile exanthematous eruption most commonly encountered. S/S: Erythematous macules and papules that may be pruritic. Lesions usually begin within 7-10 days after offending medication Resolution: 7-14 daysMaculopapular skin reaction
aka drug reaction with eosinophilia an exanthematous eruption accompanied by fever, lymphadenopathy, and multiorgan involvement S/S: begin 1–4 weeks after starting the offending drugDrug hypersensitivity syndrome (DRESS)
S/S: hives, extremely pruritic red raised wheals, angioedema, and mucous membrane swelling that typically occurs within minutes to hoursUrticaria and angioedema
complex urticarial eruptions S/S: fever, rash (usually urticarial), and arthralgias, usually within 1–3 weeks after starting the offending drug.Serum sickness-like reactions
Immune complex or cell-mediated allergic responses S/S: generalized tender/painful bullous formation with fever, headache, and respiratory symptoms, that rapidly deteriorate.Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN)
simple pustular eruptions caused by medications that induce acne (whiteheads or blackheads). onset is usually about one to three weeks.Acneiform drug reactions
complex pustular eruption S/S: acute onset (within days after starting the offending drug), fever, diffuse erythema, and many pustules.Acute generalized exanthematous pustulosis (AGEP)
may be related to increased melanin hydantoins direct deposition - silver, mercury, tetracyclines, antimalarials other mechanisms (some cytotoxic drugs)Hyperpigmentation
may be phototoxic or photoallergic. Drugs that induce phototoxic reactions absorb ultraviolet A (UVA) lightPhotosensitivity
COMMON SKIN DISORDER1 CONTACT DERMATITIS 2 DIAPER DERMATITIS 3 SKIN CANCER
Skin inflammation caused by irritants or allergic sensitizers Eczematous inflammation, with erythema, vesicles, papules, crusting, fissuring, or scalingCONTACT DERMATITIS
1 contact dermatitis that occur several days later, immunologic response 2 contact dermatitis that occur few hours, organic substance1 Allergic CD 2 Irritant CD
Acute, inflammatory dermatitis of the buttocks, genitalia, and perineal region Direct fecal and moisture contact with the skin Erythematous, and severe rashes may have vesicles or oozing erosionsDIAPER DERMATITIS / Diaper rash
1 causes red plaques, papules, and pustules in diaper rash1 Candida species
DRUG-INDUCED REACTIONS MANAGEMENT Management & Treatment 1 IF severe case: 2 IF w/ fever: 3 IF SJS/TEN:Termination of suspected drug 1 IF severe case: -- Corticosteroids 2 IF w/ fever: -- Acetaminophen 3 Broad spectrum antibiotics & vancomycin, IVIG
CONTACT DERMATITIS MANAGEMENT 1) 1st goal: 2) 2nd goal:. 1 identify, withdraw, avoid offending agent using Patch Test -> gold standard 2 provide symptomatic relief while decreasing skin lesions. -> cold compresses -> topical corticosteroids
DIAPER DERMATITIS MANAGEMENT 1 Non pharmacologic 2 Drugs 3 DOC for candidal rash:1) Frequent diaper changes Air drying Gentle cleansing 2) Zinc oxide (astringent) Petrolatum (moisture) 3 imidazole
SKIN CANCER MANAGEMENT 1 Squamous Cell Carcinoma (SCC) treatment 2 Basal Cell Carcinoma (BCC) 3 Malignant melanoma - give also drug for metastatic melanoma. 1 surgical excision 2 may involve surgical excision; topical agents (imiquimod or antineoplastic agents, such as 5-fluorouracil) 3 antineoplastic therapy, (temozolomide) or (dacarbazine for metastatic melanoma)