Derm… ☠️ Let’s break it down starting with viral exanthems. Follow the 🧶
🚨Coxsackievirus:
1️⃣✋🏼,🦶🏼, & mouth disease - Coxsackie A > Coxsackie B or EV71
🔎 - 😣 ulcerative lesions on hard palate, 👅, buccal mucosa ➡️ vesicular rash on 🤲🏼 &🦶🏼
2️⃣ Atypical HFMD
🔎- vesiculobullous rash or crusted papules (Gianotti-Crosti syndrome). Associated with skin and 💅🏼 peeling. At sites of atopic eczema (eczema coxsackium)
2️⃣ Papular-purpuric (🧤&🧦) syndrome
🔎- pruritic erythema & edema of distal limbs (sharp demarcation at wrists/ankles ➡️ petechial or purpuric
🚨Measles:
1️⃣ Measles exanthem
🔎- starts behind the 👂🏼then spreads to face, trunk, limbs (🤲🏼🦶🏼)
2️⃣ Atypical
measles - seen in pts who received 💉 with killed measures virus (🛑 in 1967)
🔎- urticarial, vesicular, maculopapular, or hemorrhagic rash + peripheral or 🫁 edema
🔎- cluster of lesions that “crop” at different stages (papule ➡️ vesicle ➡️ pustule ➡️ crusted pustule), pruritic, not 😣 vs👇🏼
🚨Herpes Zoster: 😣 vesicular rash limited to dermatomal distribution
1️⃣ Disseminated - > or = 2 noncontiguous dermatomes or visceral/🧠 involvement
2️⃣ Herpes zoster ophthalmicus - vesicles around V1 distribution
🔎- 👁 (keratitis or retinal involvement), Hutchinson’s sign (vesicle on 👃🏼= involvement of nasociliary branch of V1 nerve)
💡EBV w/ Gianotti-Crosti syndrome & EM. What 💊 causes a rash w/ EBV? 🤔
🚨Human Herpes virus 6&7:
1️⃣ Exanthem subitum - sixth disease or
roseola infantum. Caused by HHV6B > HHV7
🔎- 🌹pink muculopapular blanching rash, non-pruritic, face & trunk
🚨Smallpox:
🔎- lesions that develop at the same stage (papule ➡️ vesicle ➡️ pustule ➡️ crusted pustule), deeper lesions, involve primarily face & extremities
💡👆🏼vs
what disease? 🤔
🚨HIV: acute HIV can cause a non-specific rash or
1️⃣ Kaposi sarcoma (cutaneous) - caused by HHV8
🔎- purple/brown macules in various sizes, generalized
2️⃣ Bacillary angiomatosis - caused by Bartonella quintana/henselae
🔎- papular vs plaque/nodular lesions
3️⃣ Eosinophilic pustular folliculitis
🔎- pruritic crops of papules/pustules
Post-exposure prophylaxis. As with all things, timing maters 😷
1️⃣ HAV:
Indications - close contacts, child care & school contacts, food handlers
⏲ 2 weeks - 💉
👉🏼 + Ig if > 60 YO or immunocompromised
⏲ 28 days - 💉
👉🏼 + Ig if chronic liver disease
or Hep B/C infection
⏲ 8 weeks - 💉 if there are > 1 close contacts in 🏠
2️⃣ HBV:
Indications - percutaneous or mucosal exposure, sex or needling sharing contact, victim of sexual assault
⏲- within 24 hrs, up to 7 days