Flashcards in this deck (82)

• What is the peak age for Erythema annulare centrifugum (EAC)?

  Fifth decade
  dermatology erythema
• What is the pathogenesis of EAC?

  Unknown; may be immune reaction to antigens like infections, drugs, pregnancy, and neoplasms.
  pathogenesis erythema
• What are the clinical features of EAC?

  Starts as firm pink papule > erythematous annular lesions that migrate centrifugally (up to 6 cm in 2 weeks).
  clinical erythema
• Where do EAC lesions commonly occur?

  Thighs/hips, but can generalize.
  anatomy erythema
• What is the histopathology of superficial EAC?

  Mild spongiosis, focal parakeratosis, perivascular lymphohistiocytic infiltration (tight and dense).
  histopathology erythema
• What is the treatment for EAC?

  Treat underlying disorder; otherwise, use topical steroids.
  treatment erythema
• What is the prognosis for EAC lesions?

  Lesions last days to months.
  prognosis erythema
• Who is primarily affected by Erythema marginatum?

  Children 5-15 years old not treated for group A Streptococcus infections.
  epidemiology erythema
• What is the pathogenesis of Erythema marginatum?

  Associated with rheumatic fever; immune response to group A Streptococcus infection.
  pathogenesis erythema
• What are the major criteria for rheumatic fever?

  Carditis, migratory polyarthritis, erythema marginatum, subcutaneous nodules, Sydenham’s chorea.
  criteria rheumatic_fever
• What are the minor criteria for rheumatic fever?

  Fever, arthralgias, abnormal lab findings (TESR, TCRP, TPR interval).
  criteria rheumatic_fever
• What are the clinical features of Erythema marginatum?

  Migratory expanding annular/polycyclic patches/plaques starting as macules, usually on trunk and axillae.
  clinical erythema
• What is the treatment for Erythema marginatum?

  No treatment shown to alter natural disease course.
  treatment erythema
• What is the epidemiology of Erythema migrans?

  Most common in US (southern New England, SE NY, NJ) and Europe (central Europe).
  epidemiology erythema
• What is the pathogenesis of Erythema migrans?

  Caused by Borrelia burgdorferi from Ixodes tick bites; tick must be attached for >1 day.
  pathogenesis erythema
• What are the clinical features of Erythema migrans?

  Large annular red expanding patch at tick bite site 7-15 days after tick detachment.
  clinical erythema
• What are the symptoms of early localized Lyme disease?

  Flu-like symptoms and lymphadenopathy.
  symptoms lyme_disease
• What is required for a confirmed diagnosis of Erythema migrans?

  Erythema migrans + known exposure or lab evidence (culture, PCR, anti-Borrelia antibodies).
  diagnosis erythema
• What is the treatment for Lyme disease?

  • Depends on stage of disease
  • Doxycycline for early localized and mild disseminated disease (non-pregnant adults)
  • Amoxicillin for children <8 years or pregnant women
  • Ceftriaxone for Lyme meningitis (IV treatment)
  medicine treatment lyme_disease
• What happens if Lyme disease is left untreated?

  • Erythema migrans lesions self-resolve in 6 weeks
  • 60% develop arthritis (usually knee)
  • 10% develop neurologic issues (usually Bell's palsy)
  • 5% develop cardiac issues (usually AV block)
  medicine lyme_disease prognosis
• What is Erythema gyratum repens?

  • Paraneoplastic disorder
  • Immune reaction against tumor-associated antigens
  • Most common malignancies: lung > breast and GI
  medicine dermatology erythema_gyratum_repens
• What are the characteristics of Erythema gyratum repens lesions?

  • Multiple lesions with 'wood grain' appearance
  • Rapid expansion (1 cm/day)
  • Itch and trailing scale
  • Hands and feet are spared
  medicine dermatology erythema_gyratum_repens
• What is flushing?

  • Change in skin color due to dilation of blood vessels in dermis
  • Not figurate erythema
  medicine dermatology flushing
• What are common causes of flushing?

  • Emotion
  • Temperature
  • Food or beverage
  • Rosacea
  • Climacteric flushing
  • Fever
  • Alcohol
  medicine flushing causes
• What are uncommon serious causes of flushing?

  • Carcinoid
  • Pheochromocytoma
  • Mastocytosis
  • Anaphylaxis
  medicine flushing serious_causes
• What are some other causes of flushing?

  • Medullary thyroid carcinoma
  • Pancreatic cell tumor (VIP tumor)
  • Renal cell carcinoma
  • Fish ingestion
  • Psychiatric or anxiety disorders
  medicine flushing other_causes
• What are some very rare causes of flushing?

  • Sarcoid
  • Mitral stenosis
  • Dumping syndrome
  • Male androgen deficiency
  • Arsenic intoxication
  medicine flushing very_rare_causes
• What is the peak age for Erythema annulare centrifugum (EAC)?

  Third decade

  Second decade

  Fourth decade

  Fifth decade
  dermatology erythema
• What is a possible cause of Erythema annulare centrifugum (EAC)?

  Genetic disorder

  Allergic reaction

  Immune reaction to an antigen

  Bacterial infection
  dermatology pathogenesis
• What is a common clinical feature of Erythema annulare centrifugum (EAC)?

  Blistering lesions

  Firm pink papule that migrates centrifugally

  Dark brown spots

  Itchy red rash
  dermatology clinical_features
• How do lesions of Erythema annulare centrifugum (EAC) typically appear?

  Scattered small bumps

  Single large patch

  Linear streaks

  Annular lesions up to 6 cm in diameter
  dermatology clinical_features
• What is the recommended treatment for Erythema annulare centrifugum (EAC)?

  Antihistamines

  Surgery

  Topical steroids

  Antibiotics
  dermatology treatment
• Who is primarily affected by Erythema marginatum?

  Children aged 5-15 years

  Teenagers aged 16-19

  Infants under 1 year

  Adults over 50
  dermatology epidemiology
• What condition is Erythema marginatum associated with?

  Psoriasis

  Eczema

  Rheumatic fever

  Lupus
  dermatology pathogenesis
• What is the typical resolution time for Erythema marginatum?

  A few weeks

  Several months

  Over a year

  A few days
  dermatology clinical_course
• What is the primary cause of Erythema migrans?

  Borrelia burgdorferi

  E. coli

  Staphylococcus aureus

  Candida albicans
  dermatology pathogenesis
• Where is Erythema migrans most commonly seen in the US?

  Texas

  Florida

  Southern New England

  California
  dermatology epidemiology
• What is a characteristic clinical feature of Erythema migrans?

  Large annular red expanding patch

  Small red dots

  White patches

  Blistering lesions
  dermatology clinical_features
• What is required for the confirmed diagnosis of Erythema migrans?

  Skin biopsy

  Blood test only

  X-ray

  Erythema migrans + known exposure
  dermatology diagnosis
• What is the typical treatment for early localized Lyme disease in non-pregnant adults?

  Ceftriaxone

  Amoxicillin

  Doxycycline

  Azithromycin
  lyme_disease treatment
• What is the best IV treatment for Lyme meningitis?

  Doxycycline

  Amoxicillin

  Ceftriaxone

  Penicillin
  lyme_disease treatment
• What percentage of untreated Lyme disease patients develop arthritis?

  60%

  10%

  30%

  5%
  lyme_disease prognosis
• Which neurologic issue is most commonly associated with untreated Lyme disease?

  Seizures

  Stroke

  Meningitis

  Bell's palsy
  lyme_disease neurology
• What is the most common malignancy associated with Erythema gyratum repens?

  Lung cancer

  Renal cancer

  Stomach cancer

  Breast cancer
  erythema_gyratum malignancy
• What is a characteristic appearance of lesions in Erythema gyratum repens?

  Ringworm

  Plaque formation

  Bulla formation

  Wood grain appearance
  erythema_gyratum symptoms
• What is a common cause of flushing?

  Carcinoid

  Emotion

  Mastocytosis

  Anaphylaxis
  flushing causes
• Which serious condition can cause flushing?

  Rosacea

  Alcohol

  Fever

  Pheochromocytoma
  flushing serious_conditions
• What is the differential diagnosis of flushing NOT include?

  Mastocytosis

  Benign cutaneous flushing

  Carcinoid

  Anaphylaxis
  flushing differential_diagnosis
• Which of the following is a very rare cause of flushing?

  Emotion

  Alcohol

  Food

  Sarcoid
  flushing rare_causes
• Erythema annulare centrifugum (EAC) peaks in the fifth decade of life.
  dermatology erythema epidemiology
• The pathogenesis of EAC is unknown, but may be an immune reaction to an antigen such as infection or drugs.
  dermatology erythema pathogenesis
• EAC lesions start as firm pink papules and become erythematous annular lesions that migrate centrifugally.
  dermatology clinical_features erythema
• EAC lesions can reach up to 6 cm in diameter in 2 weeks.
  dermatology clinical_features erythema
• In EAC, a trailing scale is common in superficial lesions but not in deep lesions.
  dermatology clinical_features erythema
• Histopathology of superficial EAC shows mild spongiosis, focal parakeratosis, and perivascular lymphohistiocytic infiltration.
  dermatology histopathology erythema
• Treatment for EAC involves treating the underlying disorder if present, otherwise using topical steroids.
  dermatology treatment erythema
• Erythema marginatum is primarily seen in children aged 5-15 years who are NOT treated for group A B-hemolytic Streptococcus infections.
  dermatology erythema epidemiology
• Erythema marginatum is associated with rheumatic fever, starting 2-5 weeks after infection, with major and minor criteria.
  dermatology pathogenesis erythema
• Jones major criteria for rheumatic fever include carditis, migratory polyarthritis, and erythema marginatum.
  dermatology criteria rheumatic_fever
• Erythema marginatum lesions are migratory and can expand 2-12 mm in half a day, usually resolving in a few weeks.
  dermatology clinical_features erythema
• Erythema migrans is most commonly seen in the US and Europe, particularly in central Europe.
  dermatology erythema epidemiology
• Erythema migrans is caused by Borrelia burgdorferi, transmitted by Ixodes ticks that must be attached for >1 day.
  dermatology pathogenesis erythema
• The clinical feature of erythema migrans is a large annular red expanding patch at the tick bite site occurring 7-15 days after tick detachment.
  dermatology clinical_features erythema
• Early localized Lyme disease symptoms include flu-like symptoms and lymphadenopathy.
  dermatology clinical_features lyme_disease
• Chronic Lyme disease may present as chronic arthritis, encephalopathy, and acrodermatitis chronica atrophicans.
  dermatology clinical_features lyme_disease
• Diagnosis of erythema migrans requires the presence of erythema migrans and either known exposure or laboratory evidence of exposure.
  dermatology diagnosis erythema
• Treatment for Lyme disease depends on the stage of disease, age, and pregnancy status.
  treatment lyme_disease medical
• Typically, doxycycline is used in early localized disease and mild early disseminated or chronic disease for non-pregnant adults and children 28 years.
  treatment lyme_disease doxycycline
• For children under 8 years or pregnant women, amoxicillin is typically used for Lyme disease treatment.
  treatment lyme_disease amoxicillin
• The best IV treatment for Lyme meningitis is ceftriaxone.
  treatment lyme_disease ceftriaxone
• If left untreated, Erythema migrans lesions self-resolve in 6 weeks.
  prognosis lyme_disease erythema_migrans
• 60% of untreated Lyme disease patients develop arthritis, usually in the knee.
  prognosis lyme_disease arthritis
• 10% of untreated Lyme disease patients develop neurologic issues, usually Bell's palsy.
  prognosis lyme_disease neurologic_issues
• 5% of untreated Lyme disease patients develop cardiac issues, usually AV block.
  prognosis lyme_disease cardiac_issues
• The Agar for Borrelia is Barbour-Stoenner-Kelly medium.
  microbiology borrelia agar
• Erythema gyratum repens is a paraneoplastic disorder likely due to an immune reaction against tumor-associated antigens.
  disorder erythema_gyratum_repens immune_reaction
• The most common malignancies associated with Erythema gyratum repens are lung, breast, and GI (especially esophagus/stomach).
  malignancies erythema_gyratum_repens cancer
• Lesions of Erythema gyratum repens have a wood grain appearance and can expand rapidly at 1 cm/day.
  symptoms erythema_gyratum_repens lesions
• Flushing is a change in skin color due to dilation of blood vessels in the dermis.
  symptoms flushing skin
• Common causes of flushing include emotion, temperature, food or beverage, rosacea, and alcohol.
  causes flushing medical
• Uncommon serious causes of flushing include carcinoid, pheochromocytoma, and anaphylaxis.
  causes flushing serious
• Very rare causes of flushing include sarcoid, mitral stenosis, and dumping syndrome.
  causes flushing rare