Discard skin lesions. Mucous membrane peculiarities.
Discard skin lesions include:
I. Psoriasis
Psoriasis - Psoriasis is an erythematosquamos disease. Psoriasis can start at any age, but the disease begin between the ages 10 and 30. Histopathologically characterized by parakeratosis and capillary dilatation in dermal papilla. At present there is no evidence for a single etiology for psoriasis.
Clinical findings:
- Cutaneous lesions tend to locate on the extensor surfaces of the extremities, particularly the elbow and the knee, the sacrum and the scalp
- Psoriatic lesions begin as small erythemosquamous papules, which show centrifugal growth
- About 50% of the patients show small to large plaques with silver-white scale on the knee and elbow- this is plaque psoriasis
- Guttate form of psoriasis is ususally exanthematic occurrence of disseminated multiple small (up to 0,5 sm) eruptive round lesions on the trunk, limbs and face
II. Impetigo contagiosa
Impetigo is the most common bacterial skin infection in children two to five years of age. There are two principal types: non-bullous (70% of cases) and bullous (30% of cases).
- I. Non-bullous impetigo, or impetigo contagiosa, is caused by Staphylococcus aureus or Streptococcus pyogenes, and is characterized by honey-colored crusts on the face and extremities. Impetigo primarily affects the skin or secondarily infects insect bites, eczema, or herpetic lesions.
- II. Bullous impetigo, which is caused exclusively by S. aureus, results in large, flaccid bullae and is more likely to affect intertriginous areas.
Both types usually resolve within two to three weeks without scarring, and complications are rare, with the most serious being poststreptococcal glomerulonephritis.
Treatment includes:
- topical antibiotics such as mupirocin, retapamulin, and fusidic acid
- Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical. Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline,
III. Dry necrotic crusts due to herpes zoster
Herpes zoster is viral infection that occurs with reactivation of the varicella-zoster virus. It is usually a painful but self-limited dermatomal rash. Symptoms typically start with pain along the affected dermatome, which is followed in 2-3 days by a vesicular eruption.
Classic physical findings include painful grouped herpetiform vesicles on an erythematous base. Treatment includes antiviral medications such as acyclovir, famciclovir, and valacyclovir given within 72 hours of symptom onset.