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Good Morning!!!

Good Morning!!!. Morning Report July 5, 2012. Derm Terms. Derm Terms. What’s your final answer?. Clusters of erythematous , eroded papules with overlying hemorrhagic crust in a generalized distribution. Semantic Qualifiers. Illness Script. Predisposing Conditions

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Good Morning!!!

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  1. Good Morning!!! Morning Report July 5, 2012

  2. Derm Terms

  3. Derm Terms

  4. What’s your final answer? Clustersof erythematous, eroded papules with overlying hemorrhagic crust in a generalized distribution

  5. Semantic Qualifiers

  6. 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

  7. Eczema Herpeticum

  8. Impetigo

  9. Impetigo

  10. Varicella

  11. Tinea

  12. Erysipelas

  13. Folliculitis

  14. SSSS

  15. Drug Allergy

  16. Eczema Herpeticum

  17. 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

  18. 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 superinfectionwith staph or strep

  19. 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

  20. 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 Wright’s stain (Tzanck test) • Very specific but not very sensitive • Can visualize multi-nucleated giant cells • Can indicate an HSV or Varicella-zoster infection

  21. 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

  22. Thanks for your attention! Noon Conference: Dr. Creel – Status Asthmaticus

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