Derm part 2

NIKOLSKY SIGN

easily ruptured bullae associated with pemphigus vulgaris

pemphigus vulgaris

gross serious vesiculobullous disorder, burning and painful, begins in oral mucosa NIKOLSKY SIGN-easily ruptured bullae tx-prednisone and immunosuppression

herpes zoster

grouped herpetiform vesicles on a erythematous base usually unilateral stopping abruptly at midline tx-antivirals and varicella vaccine

hyper pigmented hormonally related symmetric macules most common on cheeks, etc

melasma

small round areas of hair loss, exclamation point hairs

alopecia areata

tinea manuum

"one hand, two feet syndrome?" blisters on palms and fingers that progress to scale and can infect nails

TEN

30% or more of body affected secondary infection and sepsis common belongs in burn unit death sometimes

lichen planus

4 Ps: purple, polygonal, pruritic, papule found on flexor surfaces of upper extremities, genitalia and mucous membranes

pityriasis rosea s/s

HERALD PATCH and CHRISTMAS TREE PATTERN eruption of rosy, oval papules following cleavage lines and can be itchy

lichen simplex

Lichen simplex chronicus is a response to persistent, vigorous rubbing, and results entirely from rubbing what at first was normal skin. tx. topical steroids

hidradenitis suppurativa

acne inversa, clusters of abscesses mostly on underarms, under breast, inner thighs, etc no cure

large, atypical tagetoid lesions, sloughing of 10% of skin

SJS

rosacea tx

avoid triggers, put on sunscreen vascular lasers are mainstay topical-Metronidazole

bullae that start urticarial and then become tense, oval and round

bullous pemphigoid

Erysipelas

infections of the dermis and subcutaneous layers of the skin that are rapidly progressive and are often accompanied by systemic signs, such as fever, leukocytosis, and elevated markers of systemic inflammation. tx. requires systemic antibiotic therapy.

cellulitis

infections of the dermis and subcutaneous layers of the skin that are rapidly progressive and are often accompanied by systemic signs, such as fever, leukocytosis, and elevated markers of systemic inflammation. tx. systemic abx

intertrigo

inflammation of the body folds. Appears red and raw looking tx. remove the moisture, lose weight

tinea pedis

interdigital presentation most common erythema, fissuring, scaling on foot moccasin distribution over sole and heel

folliculitis

itching and burning in hairy areas pustules in the hair follicles tx. topical abx like mupirocin/ bacitracin

Steven johnson syndrome

large, atypical tagetoid lesions, sloughing of 10% of skin you can die

purple, polygonal, pruritic, papule

lichen planus

warts tx

lots of different kinds of warts but I think you will be able to figure it out tx-do nothing or topical meds like salicylic acid cryosurgery or five thousand other things

multiple dome-shaped waxy UMBILICATED papules

molluscum contagiosum

looks like measles, spares palms and soles

morbilliform drug rash

morbilliform drug rash

most common, looks like measles spares palms and soles

dermatitis medicamentosa

need a good hx usually med related

erythema nodosum

nodular inflammatory eruption mainly on extensor surfaces of legs systemic cause so comes with flu-like symptoms, etc usually self limiting

alopecia

nonscarring-telogen effluvium, due to systemic cause scarring-follicles destroyed by inflammation

if you have systemic tinea corporis

oral griseofulvin or systemic azoles

molluscum contagiosum s/s tx

peaks in early childhood multiple dome-shaped waxy UMBILICATED papules tx-do nothing, cryotherapy

lichen planus tx

self limiting if not, topical steroids or if really bad, oral steroids

candida albicans

severe pruritis, beefy-red budding cells and pseudohyphae under microscope tx-clotrimizole (skin and nails), single dose fluconazole (genitals)

herald patch

solitary salmon colored macule

pityriasis rosea tx

suck it up steroids for itching and UVB to speed it up

acne tx

topical retinoids (for comedolytic and anti-inflammatory)-adapalene, tazarotene topical antibiotics- goes after pro. acnes and has anti-inflammatory properties (clindamycin) oral antibx-tetracycline birth control isotretinoin- NO BABIES

erythema multiforme

usually mild like picture but can be bad bad bad SJS, TEN

vitiligo

well circumscribed depigmented macules dx. wood lamp tx. topical and oral prednisone, phototherapy

perioral dermatitis s/s and tx

younger females tiny papulopustules on erythematous base in premolar area, nose folds, lateral eyes tx: topical antibiotics-metronidazole, erythromycin/ oral antibx-minocycline or doxy

hyperhidrosis

abnormally increased sweating tx. a super deodorant w/ lots of aluminum chloride

dyshidrosis

hand eczema A pruritic papular and vesicular inflammatory process of unknown cause that tends to affect the sides of fingers and toes, as well as palms and soles.

severe pruritis, beefy-red

candida

tinea corporis s/s and dx

centrifugal pattern w. active border, scaling and shedding infected skin, itchy KOH of skin scraping

bullous pemphigoid s/s, tx

chronic autoimmune, subepidermal blistering skin disease elderly bullae that start urticarial and then become tense, oval and round tx-prednisone at high doses

necrobiosis lipoidica diabeticorum

collagen degeneration w. granulomatous response, thickening of bv and fat deposition red brown irregular or oval patches, shiny pale thin, telangecatic, mostly in pretibial area tx difficult

acne vulgaris different kinds

comedonal acne (not inflamed) inflammatory acne nodulocystic acne-comedones, inflammatory lesions and large nodules that can cause scarring

scabies dx and tx

confirmed w/ skin scraping, will see the scabies and poop tx: scabicidal agent like permethrin cream or ivermectin (oral), antihistamines, wash clothes and bedding

granuloma annulare

dermal papules and annular plaques on dorsum of feet, ankles, lower limbs DM1 dx. punch biopsy tx. topcial steroids, cryotherapy

what is lichen planus associated with?

hep C

melasma

hyper pigmented hormonally related symmetric macules most common on cheeks, etc dx. your eyes or the wood lamp tx. fading creams

tinea versicolor s/s, dx, tx

hypo and hyper pigmented macules and patches on chest and back dx-KOH, spaghetti and meatballs tx-topical therapy-selenium sulfide

alopecia areata

maybe autoimmune (non-scarring) small round areas of hair loss, exclamation point hairs tx. difficult, intralesional kenalog

REVEIW TIME! tiny papulopustules on erythematous base in premolar area, nose folds, lateral eyes

perioral dermatitis

rosacea s/s

persistent erythema on central portion of face x 3 months flushing, papules, pustules, telangiectasias, can burn and sting

eruption of rosy, oval papules following cleavage lines and can be itchy

pityriasis rosea

tinea cruris s/s and tx

pruritic fungal infection of groin but "spares scrotum" tx: topical imidazole or allylamine

Scabies s/s

pruritic papules and vesicles primarily on the flexor aspects of wrists, webs of fingers, dorsal feet, axillae, etc. itching is worse at night

tinea unguium (onychomycosis) s/s, dx, tx

thickening, deformity and yellow discoloration dx. KOH stain, nail biopsy tx. difficult, systemic terinafine

centrifugal pattern w. active border, scaling and shedding infected skin, itchy

tinea coporis

pruritic fungal infection of groin but "spares scrotum"

tinea cruris

blisters on palms and fingers that progress to scale and can infect nails

tinea manuum

tinea corporis tx

topical azoles (ketoconazole) or allylamines DONT USE STEROIDS- will cause majocchi granuloma- fungus borrows deeper

treatment of tinea pedis/man

topical or oral antifungals (imidazoles)