Dermatology

What is gonococcemia?

"Dermatitis-arthritis" complex Characterized by painful, red vesiculopustules Occasionally hemorrhagic macules 2mm-2cm Seen on palms, soles, over joints - mylagias and arthralgias, poly arthritis Etiology: Dissemination of Neisseria gonorrhea Gonococci may be found in blood, skin lesions, joints and GU tract

What is atopic dermatitis?

"The itch that rashes" eczema Chronic, itching, relapsing skin disorder that leads to scaly excoriated erythematous patches. Often there is lichenification and secondary infection Pruritic inflammation of the epidermis and dermis Personal or family history asthma, or allergic rhinitis

What is a morbilliform rash?

"Typical" type of drug reaction to which the pt is allergic Milder version of urticaria Resembles measles Generalized maculopapular eruption that blanches w/pressure

What is irritant contact dermatitis?

-Non-immunologic inflammation of the skin -Causes: Detergent, Soap, Perfume, Latex Erythema, chapped skin, dryness and fissuring Pruritus - mild to extreme Pain is a common symptom with erosions and fissures Severe cases - edema, exudate, and tenderness Potent irritants produce painful bullae

What is piebaldism?

-an autosomal dominant congenital absence of melanocytes -there is a defect in migration or differentiation of melanoblasts -will have patchy areas of lighter skin and hair

What is erythema multiforme?

1. An acute ulcerative condition of skin and mucous membrane 2. An immunologic response to foods, chemicals, drugs (abx, anticonvulsants, antihypertensives, nsaids), or microbial infections 3. Recurrent HSV is a common trigger for recurrent EM 4. skin lesions: Bull's eye or target lesions in mucosa too 5. need biopsy to differentiate from Steve-Johnson syndrome and toxic epidermal necrolysis Acute, self-limited skin eruption Pruritic or painful EM Minor - No mucosal lesions, No prodromal symptoms, Tends to be recurrent and usually infection etiology, Major has mucosal lesions Target lesions

What is a pyogenic granuloma?

1. Exuberant tissue response to local irritation or trauma, develops over a dew days to weeks 2. Vascular appearance 3. Most common in kids and young adults on gingiva 4. Hormonal influence 5. "pregnancy tumor" often seen during pregnancy-gingiva

What is the treatment for andogenic alopecia?

2 - 5% minoxidil (topical) Finasteride (Propecia - oral) Inhibits 5 a-reductase Type II 6-12 months for results may cause sexual dysfunction Cannot be used in women who can get pregnant Used for Benign Prostatic hyperplasia (alpha blocker)

What is dermatosis papulosis nigra?

2-3mm, brown to black, hyperkeratotic, pedunculated or verrucous papules located on cheeks and around eyes bilaterally and are benign equivalent to seborrheic keratosis presents in Teens to middle age, Tend to be hereditary, More common in Blacks and Hispanics... Morgan Freeman

What is the treatment for scabies?

5% Permethrin (Elimite) Pruritis can continue up to 2-3 weeks Topical steroids Antihistamines ie Atarax, Benadryl Clothes, sheets, etc. wash normally the next morning Bedspread, coats, put in plastic bag for 4-7 days Treat all family members on the same night as patient

What organisms cause cellulitis?

80% of cases are caused by gram positive organisms Group A streptococcus and Staphylococcus aureus are the most common causal pathogens Think of other organisms if there have been unusual exposures: Pasteurella multocida (animal bites) Eikenella corrodens (human bites)

What are the clinical findings with alopecia atreata?

< 25 years of age Family history No inflammation, tenderness or adenopathy Minimal erythema if any Exclamation point hairs

What are the signs of melanoma in the nail?

A - Age B - Brown to Black, Breadth of 3 mm or more, variegated Borders C - Change in the nail band D - Digit most commonly involved (thumb, index finger or great toe) E - Extension of the pigment onto the proximal and/or lateral nailfold (ie, Hutchinson's sign) F - Family or personal history of dysplastic nevus or melanoma

Name the ABCDEs of moles

A - Asymmetry - in shape - one half unlike the other B - Borders - are irregular - edges irregular, scalloped C - Color - is mottled - haphazard display of colors - shades of brown, black, gray, red and white D - Diameter - is usually large - greater than the tip of a pencil eraser (6.0mm) E - Enlargement - a history of an increase in the size of a lesion is perhaps one of the most important signs of malignant melanoma

What is a bullae?

A circumscribed collection of free fluid more than .5cm. Similar to a vesicle but larger

What is a crust?

A collection of dried serum and cellular debris- a scab

What is nummular eczema?

A discrete coin shaped ring or annular lesion that coalesce to form patches which ooze and crust over, look at feet or groin for fungal infection, can be a hypersensitivity reaction

What is erosion?

A focal loss of epidermis. Do not penetrate below the dermoepidermal junction and therefore heal without scarring Circumscribed areas of epithelium defect

What is squamous cell carcinoma?

A malignant neoplasm Second most common skin cancer Usually occurs in patients >55 yrs Usually arises from actinc kera Rate of metastasis 0.5%-5% Predisposing risk factors: long-term sun exposure, exposure to industrial carcinogens, HPV, immunosuppression

What is basal cell carcinoma?

A malignant neoplasm The most common skin cancer (4-5x more than SCC) Occurs mostly in fair-skinned males starting at a younger age (20-40) Predisposing risk factor: cumulative sun exposure Limited potential for metastasis Half of patients with history of BCC will develop another within 3-5 years

What is the Fitzpatrick Scale?

A scale to measure the skins ability to tolerate sunlight

What is pruritus?

A sensation that leads to a desire to scratch Sensation of itch: Most likely due to C fibers (also responsible for pain production) Brainstem Control: Decreased threshold with: Increased stress Conditions of attention, anxiety and suggestion

What is seborrheic keratosis?

A wart-like lesion Common benign growths, onset 40-50 years old Oval, slightly raised, tan/light brown to black well-demarcated papules or plaques "Stuck-on" waxy greasy verrucous appearance on trunk, scalp, face, neck, extremities; usually multiples Treatment: none necessary, Cryotherapy or curettage if irritating or bleeding, Biopsy to r/o malignant lesion if suspicious

What is allergic contact dermatitis?

ACD occurs when contact with a particular substance elicits a delayed hypersensitivity reaction Sensitization process requires 10-14 days Upon re-exposure, dermatitis appears within 12-48 hrs Most common cause is Rhus dermatitis, from poison ivy, poison oak, or poison sumac (all contain the resin - urushiol)

What are Pastia's lines?

Accentuation of antecubital creases, axillary folds, groin by the rash seen in scarlet fever

What is nodular melanoma?

Account for 16% of all melanomas Median 50 years Evolves over 6 - 18 months

What is superficial spreading melanoma?

Account for 70% of all melanomas Age: 30 - 50 years Median 37 years Gender: Slightly higher in females Evolves over a period of 1 - 5 years May occur on an part of the body Slightly elevated, varied colored, palpable Can have vertical growth

What is a type I reaction?

Acute Immediate hypersensitivity IgE mediated Histamine release Vasoactive amine release Clinical presentation: Urticaria (Hives) Angioedema Anaphylaxis

What are the clinical features of lyme borreliosis?

Acute - erythema migrans Annular lesions at the site of tick bites Fever Chills Myalgia Weakness Headache Photophobia Fatigue Adenopathy Facial palsy Swollen knees Chronic: Carditis, arthritis, meningitis, encephalomyelitis

What is erythema nodosum?

Acute inflammatory/immunologic reaction caused by a number of etiologies Painful, tender nodules on the lower legs, fever, malaise, 50% with arthralgias Gender: Females 3x > Males Etiology: Infection - Group A ß-hemolytic Strep and others Drugs - Sulfa, OCP Others - Sarcoidosis, Ulcerative colitis, Idiopathic in 40% Treatment: Spontaneous resolution in 6 weeks depending on etiology Bed rest, Symptomatic treatment

What is lichen planus?

Acute or chronic inflammation of the skin and mucous membranes Age: 30-60 years Clinical findings: Pruritic Purple Papules Planar Polygonal

What is the vertical growth phase of melanoma?

After a variable time (2-3 years), the character of growth of the radial growth changes focally. Tumors that extend into the lower half of the reticular dermis are, by definition, in the vertical growth phase. All four types may exhibit this vertical growth phase.

What is the treatment for tinea capitis/kerion?

Always systemic! (topicals don't penetrate follicle root- can use as adjunct only) Griseofluvin (standard - but long duration 6 - 12 weeks) Take with fatty food - milk or yogurt Terbinafine, itraconazole, ketoconazole, fluconazole.

What is a fixed drug eruption?

An adverse drug reaction characterized by the formation of a solitary erythematous patch or plaque that will recur at the same site with re-exposure to the drug exact mechanism unknown, possible form of type IV Occurs at the same site each time drug is used.

What is Kawasaki disease?

An autoimmune disease involving the inflammation of blood vessels, lymph nodes, skin, and mucosa - initial symptom is a high fever, later symptoms include conjunctivitis, rash, peeling, and edema

What is candidiasis?

An infection of the skin, mucous membranes caused by yeast Most frequently Candida albicans 80% of population-normal oral, GI, vaginal flora Opportunistic infection-favorable environment Rarely colonize the skin unless there is some break, for example from dermatitis, cracks, or fissures THINK ABOUT DIABETES SATELLITE LESIONS are key******

What are the follicular stages of growth?

Anagen (active growth), about Grows 1 cm every 28 days. Catagen (resting/transitional) Hair follicle shrinks and detaches from dermal papilla , about 3 weeks Telogen (shedding and cessation), about 3 months. 6-8% of hairs are in this phase at all times

What is a type II reaction?

Antibody initiated cytotoxicity and complement activation IgM and IgG mediated, enhanced phagocytosis, complement mediated cell destruction Clinical presentation: Bullae Hemolysis Purpura Leukopenia Exanthem

What is a type III reaction?

Antigen-antibody immune complex formation Deposition in tissue with complement mediated tissue injury. Clinical presentation: Serum sickness Exanthems (macules, papules, urticaria, palpable purpura, vasculitis) Fever Arthritis Hepatitis Nephritis

What is urticarial vasculitis?

Appears as regular urticaria but lesions stay for more than 24 hours and when examined closely can see vasculitis. Associated with Systemic Lupus erythematous (SLE)

What are the skin lesions in sarcoidosis?

Apple-jelly" infiltrated plaques on the nose, cheeks, earlobes, arms Skin lesions are asymptomatic, Shape is annular or polycyclic Review of systems - fever, fatique, dyspnea, uveitis Non-caseating granulomas that involve any organ of the body. Lungs, lymph nodes (of thorax and neck) and liver. Granulomas of lacrimal glands and salivary glands in 1/3 of the patients. Subcutaneous nodules to erythematous plaque

What is psoriatic arthritis?

Arthritis in the presence of psoriasis Occurs in 10-25 percent of patients Any age, but mostly between the ages of 30 and 50 years Most common - oligoarthritis with swelling and tenosynovitis of one or a few hand joints Flares and remissions usually characterize the course of psoriatic arthritis

What is necrobiosis lipoidica diabeticorum?

Associated with Diabetes Mellitus Can be associated with rheumatoid arthritis Lesions can spontaneously resolve (no standard therapy) Compression stockings/rest Systemic steroids Nsaids

What is the treatment for chronic paronychia?

Avoid exposure to contact irritants Keep proximal nail fold dry Control inflammation with class 5 steroid Miconazole in ETOH placed on the proximal nail fold Fluconazole if it appears to have candidal overgrowth Wear rubber gloves with cotton liners/cotton socks when doing wet work

How should eczema be treated with topical corticosteroids?

Avoid using steriods on face - or use with low potency - compound Body and extremities often require medium potency Using stronger steroid for short periods and milder steroid for maintenance helps reduce risk of steroid atrophy and other side effects

What is the treatment for onycholysis?

Based on underlying etiology Psoriasis Class I or II topical steroid with Calcipotriene Intralesional steroids monthly injected into the matrix Tazarotene, Anthralin Biologic agents, Phototherapy, Oral retinoids Candidiasis Itraconazole, Terbinafine, fluconazole

What is a keloid?

Benign - raised scar When growing can be painful or itchy Any type of injury can lead to a keloid Treatment: cryotherapy, corticorsteriod shots, laser therapy or surgical removal

What is a dermatofibroma?

Benign neoplasm, very common, "button-like" firm, dermal nodule usually found on extremities Generally thought to be a consequence of an arthropod bite 3-10 mm diameter Can be domed up or depressed below surrounding skin Surface can be dull, shiny, or scaly Color can be skin-colored, pink, brown Dimple sign: lateral compression produces a dimple

What is a lipoma?

Benign subcutaneous tumors composed of fat cells Soft, rounded, movable Up to 6 cm diameter Occur most often on neck, trunk, extremities Can be left alone or surgically excised... good idea to ultrasound

What is a subungual hematoma?

Blood under the nail from Trauma Painful Hot paper clip or cautery needle on nail plate Biopsy if no history of trauma

What is a periungual wart?

Can be difficult to treat as virus gets under nail plate Treatment verruca vulgaris: Salicylic acid and/or lactic acid in collodion Imiquimod Cryosurgery Curettage Surgical or laser excision

What are other areas affected by bowen's disease and what causes it?

Caused by the HPV virus Called- Erythroplasia of Queyrat Glans of penis Cause ulcers, discharge, bleeding, pain, itch Vulvar Intraepithelial neoplasia (VIN) Bright red patches that itch or burn Prognosis -Good - easily treatable if caught early

What are other signs of kawasaki's disease?

Cervical lymph node enlargement Bilateral conjunctival injection Cardiac abnormalities- coronary artery Affects children <5 years old Males>Females Fever above 101 more than 5 days

What is varicella?

Chicken pox - Varicella-zoster virus Clinical Findings: initially papules/wheals Evolve to vesicles - (dewdrops on a rose petal) Vesicles evolve to pustules/crusts in 8 - 12hrs Crops at different stages Low-grade fever

What is systemic lupus erythematosus?

Chronic autoimmune , multisystemic - can affect any organ but usually affects kidneys, joints and skin Skin involvement is common Diagnostic: skin biopsy Treat with corticosteroids - oral and topical/ Plaquenil as well

How does rosacea present?

Chronic erythema of central facial areas Flushing and blushing triggered by stress, alcohol, heat, hot liquids, spicy foods, sun Telangiectasias, erythematous papules, pustules, rhinophyma More common in fair skinned adults Variant: ocular rosacea

What is the treatment for pilonidal cysts?

Chronic or recurrent needs to be surgically treated Chronic pilonidal cyst has a higher risk of squamous cell carcinoma. Recommend shaving the area and good hygiene and avoid prolonged sitting Soaking in warm water ease pain of pilonidal cysts Surgical opening and draining of the infected sinus May later be surgically removed if recurrent

What is hidradenitis suppirativa?

Chronic, suppurative inflammatory disease of apocrine sweat glands Areas most often affected are axilla and anogenital region Presents after puberty Associated with PCOS (hormonal and insulin resistance association??) Colonization with bacteria possible S. aureus, E. coli, Proteus mirabilis, P. aeruginosa Recurrent abscess formation, rupture, suppuration Leads to sinus tract formation and scarring Keratin plugging of hair follicles, dilation of follicle and apocrine duct, inflammation, bacterial growth, rupture, extension of tissue destruction, ulceration, fibrosis, sinus tract formation

What is a vesicle?

Circumscribed collection of free fluid up to 0.5cm. Small blister Contains fluid

What is a nodule?

Circumscribed, elevated, solid lesion more than .5cm. A large nodule is called a tumor. Can be solid or have some fluid component Example: dermatofibroma

What is the treatment for alopecia areata?

Class I topical or intralesional steroids Anthralin Topical immunomodulators: Tacrolimus, Pimecrolimus Topical or oral PUVA (psoralen and UV-A light therapy) IM/Oral steroids

What does hair look like with secondary syphillis?

Classic "moth-eaten" alopecia with irregular, patchy, non-scarring alopecia that may also affect the eyebrows and beard

What is acanthosis nigricans?

Clinical features: Hyperpigmentation and thickening of the skin of the neck and in body folds; appears "velvety" Increased production of keratin due to insulin sensitivity Most commonly associated with obesity and diabetes

What does squamous cell carcinoma look like?

Clinical findings: solitary, slowly evolving keratotic or eroded erythematous, yellowish, or skin-colored papule or plaque found on sun exposed areas

What does basal cell carcinoma look like?

Clinical findings: translucent, telangiectatic pearly papule/nodule with rolled border and often ulcerated center; 85% on head and neck,

What is melasma?

Common in women Hormonal factors: Oral contraceptive HRT Supplements with DHEA and other hormone-like ingredients Pregnancy Most common sun-exposed areas (need to use sunscreen) will fade with time, may lighten skin with Hydroquinone (alone or combo) & Tretinoin & Corticosteroid

What is a plantar wart?

Common plantar wart (verruca vulgaris) located in the thickened skin of the sole. Look for the small dark sports (stippled appearance)

What is a common melanocytic nevus?

Commonly called moles Appear in early childhood Reach a maximum in young adulthood Junctional: macular, brown, pigment is in the epidermis Compound: elevated, tan to brown color, pigment is epidermal and dermal

What is the workup for generalized pruritis?

Complete H&P CBC with differential Thyroid panel Stool for O&P and occult blood Hepatic function panel (AMA, viral hepatitis serology) Renal tests (BUN, Creatinine - CMP) HIV antibody

What are contributing factors to acne?

Contributing factors: stress, hormone changes, occlusion and pressure of skin, drugs (lithium, steroids, OCPs) NOT caused by food

What is Wilson's disease?

Copper storage disease Cirrhosis Kayser-Fleischer rings Azure lunula

What is a drug induced acneform eruption?

Corticosteriods, neuropsychotherapeutic drugs, antituberculosis drugs. Unusual location for acne (not just seborrheic areas) Resistance to conventional acne therapy

What is hand, foot, and mouth disease?

Coxsackievirus 16A Early symptoms: fever and sore throat, can have cold sore like blisters on mouth or tongue After about 2 days - rash on palm of hands and soles of feet Symptomatic treatment

What is perleche?

Cracking lesions in the corners of the mouth.

What is the treatment for seborrheic dermatitis?

Cradle Cap - Shampoo - warm water and mineral oil or petroleum jelly . Brush or rub off scales with fingers. Dandruff Topical ketoconazole BID - Reduces yeast counts Low-potency topical steroid (e.g. desonide) safe for flares on the face BID for 1-2 weeks for flares Antidandruff shampoo for scalp, chest Ketoconazole, selenium sulfide (SELSUN BLUE), zinc pyrithione, Salicylic acid, Tar preparation, ciclopirox shampoos Lather, leave on 10 minutes, rinse; repeat 3-5x/week Refer patients who fail these therapies

What meds can be tried when steroids are ineffective for eczema?

Crisaborole (Eucrisa) : non-steroidal topical cream Tacrolimus (Protopic), Pimecrolimus (Elidel)

What is the treatment for actinic keratosis?

Cryotherapy Topical fluorouracil (Efudex) Topical imiquimod (Aldara) Prevention - regular use of UVA/UVB sunscreens and sun protective clothing

What is the management for dematosis papulosis nigra?

Cryotherapy -hypopigmentation Small lesion electrocautery and curette Large lesion-anesthetize, excise Prognosis- will normally recur

What is vitiligo?

Decrease or absence of melanocytes Autoimmune disease - white patches devoid of melanin (pigment loss) Occurs in all skin types Peak incidence 10-30 years of age

What is a type IV reaction?

Delayed hypersensitivity Cell mediated immunity Clinical presentation: Classic contact dermatitis Localized reactions

What is atrophy?

Depression in the skin result from thinning of the epidermis or dermis Thin, translucenct, wrinkled, easy to see blood vessels

What is an epithelial inclusion cyst?

Derived from epithelium of the hair follicle Dermal or subcutaneous nodule that may have a connection to the surface of the skin via a pore (a central punctum) Cyst becomes enclosed and captures keratin and lipids Face, neck, trunk, scrotum 0.5 to 5 cm in diameter Content of cyst is keratinaceous - cream colored, pasty material with odor of rancid cheese If cyst wall ruptures, contents are irritating and cause inflammatory reaction - can become painful and erythematous Ruptured cysts are often inflamed, but not infected, must remove sac

What can happen from scratching?

Dermatographism Lichen Simplex Chronicus Excoriations Prurigo nodularis Pruritis scroti/ani

What are pilonidal cysts?

Develop when ingrown hair forms in the skin One-ended tunnel that becomes a sinus Most pockets become infected Hair and debris Cyst develops Occur in tailbone, common in people who sit alot

What is an osteosarcoma?

Develops in the long bones - arm and legs Average age of diagnosis 15 Bone pain or tenderness Hard mass Swelling or redness at site Broken bone with movement

What are the causes of stasis dermatitis?

Diabetes type 2 High blood pressure Varicose veins Morbid Obesity Congestive heart failure Hep C Medications (Nsaids) Renal failure Chronic DVT Pregnancy Previous vascular surgery in the area

What does the rash look like for SLE?

Discoid skin rash: patchy and can cause scarring Face: Butterfly Malar Rash Photosensitivity Alopecia (70% experience some form of hair loss) Livedo reticularis : normal and commonly seen in babies Raynaud's Phenomenon

What is leprosy?

Disease of the skin and peripheral nervous system (loss of sensation) Leads to nerve damage Clinical findings: hypomelanotic macules Etiology: Mycobacterium leprae Treatment (antibiotic combos) usually leads to repigmentation, phototherapy is effective

What is clubbing?

Distal finger enlarged nail convex May occur as a normal variant Normal angle 160o Clubbing > 180o 80% associated with lung disease Cardiac disease Cyanotic heart disease Cirrhosis Colitis Thyroid disease

What are the variants of onychomycosis?

Distal subungual onychomycosis - most common White superficial onychomycosis Proximal subungual onychomycosis Candida onychomycosis

What is the treatment for vitiligo?

Do TSH, FBS, ANA Treatment UVA light therapy Topical corticosteroids Cryotherapy for small areas Cosmetics Depigmenting - creams, Lasers, cryotherapy

What is a keratoacanthoma?

Dome shaped - low grade tumor Rapid onset of growth - and can spontaneously resolve Can progress to invasive or metastatic carcinoma. - SCC keratoacanthoma type

What labs should be drawn for androgenic alopecia?

Draw DHEAS levels (androgen in women) Total serum testosterone-normal in female thinning Serum prolactin CBC, serum ferritin TSH

What causes Stevens-Johnson syndrome?

Drug reaction - allopurinol, tylenol, ibuprofen, Naprosyn, PCN, anticonvulsants and antipsychotics Infections - HSV, pneumonia, HIV, Hep A Severe mucosal involvement in 2 or more areas, painful rash or blisters MOUTH INVOLVEMENT*** Prodrome of fever, malaise, sore throat, headache, cough Hospitalization (high chance for complications)

What are the diagnostic tests in henoch-schonlein purpura?

Elevated IgA Normal platelet count Normal coag studies Biopsy Skin, Renal Self-limited in most cases

What is a plaque?

Elevated, superficial, well circumscribed lesion more than > 1 cm. Often formed by the confluence of papules Most commonly seen in psoriasis

What is the treatment of felon?

Emergency incision and drainage with IV antibiotics Prevent osteomyelitis, permanent nail deformities, and ischemic necrosis of the fingertip

What are the clinical findings in eczema?

Erythema Papules Scaling Excoriations Crusting and lichenification Keratosis pilaris Ichthyosis vulgaris Dennie-Morgan sign Pityriasis alba Increased risk for secondary staph infection

What is familial atypical mole and malignant melanoma?

Essentially dysplastic nevus syndrome with 2 blood relatives with melanoma May cluster with other malignancies such as pancreas cancer

What is Lyme borreliosis?

Etiology: Borrelia burgdorferi, transmitted via tick bite (deer tick - Ixodes species) Diagnosis: Acute - based on characteristic clinical findings Chronic - specific serologic tests Treatment: Regimen based on extent of involvement and stage of disease

What is meningococcemia?

Etiology: Neisseria meningitides Headache/fever/ nuccal rigidity Local damage of cutaneous vessels by bacteria or endotoxin Cause thrombosis and infarction of overlying skin Labs: Blood cultures, CBC, plt count, BUN, Cr Cl, coag series, Lumbar puncture

What are the skin lesions in kawasakis disease?

Exanthem - non-specific macular or fine papules, perianal desquamation early Oral signs - red, fissured lips, "strawberry" tongue, diffuse oropharyngeal erythema Hand and foot lesions - indurated erythema of hands and feet, desquamation of digits 2 weeks after onset

What is measles?

Fever, cough, runny nose, watery eyes, tiny white spots on the inside of mouth - Koplik spots Rash is small red spots, slightly raised, tight clusters giving a splotchy appearance - FACE breaks out first Develops 10-14 days after exposure and lasts about a week Symptomatic treatment

What are dysplastic nevi?

Flat macules or slightly raised plaques with pebbly surface, larger than most nevi. Variability in pigmentation and irregular contour - can occur in both non-sun exposed areas as well as sun exposed Watch carefully!

What does invasive squamous cell carcinoma look like?

Fleshy, granulating, friable, crusted nodules Has the capacity to metastasize Any persistent nodule, plaque or ulcer, especially in areas of sun-exposure, radiation dermatitis, old burn scars or on the genitalia must be biopsied Treatment:Excision Prognosis - SCC has an overall remission rate after therapy of 90%

What is the clinical presentation for folliculitis?

Follicular pustules and papules on hair-bearing skin Can also be nodules Pruritis Tenderness

What is the treatment for cellulitis?

For outpatients with nonpurulent cellulitis: empirically treat for β-hemolytic streptococci (group A streptococcus) (Cephalaxin) For outpatients with cellulitis and high risk factors for infection empirically treat for community-associated MRSA (Bactrim) For unusual exposures: cover for additional bacterial species likely to be involved - Dog bite/ cat bite/ human bite Monitor patients closely and revise therapy if there is a poor response to initial treatment - Watch for ascending erythema Elevation of the involved area For hospitalized patients: empiric therapy for MRSA should be considered Cultures from abscesses and other purulent skin and soft tissue infections (SSTIs) are recommended in patients treated with antibiotic therapy

What is pseudomonas nail infection?

Frequent moist environments allows introduction of Pseudomonas Nail develops green-yellow or black color in areas of onycholysis No inflammation Little to no discomfort

What is a third degree burn?

Full Thickness (Third degree) All of epidermis and dermis Whitish or charred appearance, tough and leathery Sensation is lost Takes several weeks - months to heal Will result in scarring

What are the components to a nail?

Fully keratinized Cuticle maintains barrier to organisms Nail Bed highly vascular Parallel longitudinal ridges with small blood vessels Dilated capillary loops Splinter hemorrhages

What is the lifetime risks of developing melanoma with certain types of nevi?

General Population - 0.8% Dysplastic nevus syndrome - 18.0% Familial Melanoma - 100%

What are mongolion spots?

Gray to dark-blue, round patches on the lower back and buttocks in children with ethnic skin Harmless Represent melanocyte migration failure during fetal development Most resolve by adolescence

What are lisch nodules?

Growths affecting the iris of the eye

What systemic disorders commonly have seborrheic dermatitis?

HIV Neurological conditions: Parkinson's, ALS

What is a cutaneous horn?

Hard projections made of compact keratin Peak incidence between 60 and 70 50% benign and 50% pre-malignant or malignant

What is direct fluorescent antibodies used for?

Helps for accurate diagnosis of immune-mediated dermatological disorders. Especially helps with bullous disorders, Lupus, Zoster and vasculitis as well as other disorders

What are systemic causes of pruritis?

Hematological Lymphoma (Hodgkins) Polycythemia vera - RBC prompt histamine release Chronic renal disease (End stage) Uremia, dry skin, secondary hyperparathyroidism Endocrine disorders Thyroid, diabetes mellitus, postmenopausal pruritis Cholestatic liver disease Primary biliary cirrhosis Primary sclerosing cholangitis Increased bile salts accumulating cause itching Parasite infection Leads to elevated eosinophil count HIV/AIDs Infestations, infections, seborrheic dermatitis, eosinophilic folliculitis, pruritis of HIV

What is psoriasis?

Hereditary disorder with chronic scaling papules and plaques in areas of body related to repeated minor trauma. Positive Auspitz sign. ages 20-30 and ages 50-60, but can be seen at any age

What is tzanck prep used for?

Herpes, varicella, bullous pemphigus- sample from blister

What are Norwegian scabies?

Highly contagious Scaly lesions packed with mites Hands/face May also affect the scalp May be less itchy than usual scabies infection

What is verruca vulgaris?

Human Papilloma Virus warts Clinical findings: School children; decrease after 25 years Vulgaris: firm papules, hyperkeratotic, clefted surface, vegetations Plana: mesalike flat-topped papules Sites of trauma; linear (self inoculation from scratching) Diagnosis: Clinical findings, Biopsy, HPV subtyping

What is erythema infectiosum (fifth's disease)?

Human parvovirus B19 Slapped check Mild prodromal - fever, sore throat, coryza, arthralgias, headache Exanthem starts on face but then fades over 2-4 days - turns into a reticular pattern.

What is the treatment for tinea pedis?

Hygiene: Dry the area after bathing Tinea pedis: Change socks daily and alternate shoes worn Consider wearing open shoes such as sandals Use antifungal foot powder (available over the counter) to keep feet dry First-line therapy: Clotrimazole or miconazole cream apply to affected areas BID for 4-6 weeks Second-line therapy: allylamines (fungicidal) Terbinafine, naftifine, or butenafine cream or gel once or twice daily (product dependent) for 4-6 weeks

What is stasis dermatitis?

Hyperpigmentation from built-up hemosiderin Occurs from chronic LE-venous insufficiency Irreversible Typically middle aged- to elderly patients Pruritic and eczema-like in appearance Thickened skin/oozing/weeping skin

What is lichen simplex chronicus?

Hyperplasia of the vulvar squamous epithelium - Leukoplakia with thick, leathery vulvar skin - Associated with chronic irritation and scratching

What is pityriasis alba?

Hypopigmented macules on the cheeks, neck, and lateral arms white and scaly Can evolve from pink patch Treat underlying dermatitis, as lesions tend to resolve on their own Form of atopic dermatitis Common in kids

What is the treatment for kawasaki's disease?

IV gamma globulin Aspirin Dipyridamole (Persantine)

What is the treatment for a drug eruption?

Identify and remove the offending drug: Suspect more recent additions to medication list if on multiple medications. Don't assume that because a patient has been on a drug for a long time that it can't be responsible for the drug reaction that you are looking at! Antihistamines, systemic and topical steroids, bland emollients If in doubt, discontinue suspected drug and observe Sequenced removal and substitution 4-6 weeks is usually sufficient trial removal time H1 blockers - i.e. Benadryl (25 - 50mg IV/IM or 50mg PO) H2 blockers - i.e hydroxyzine, ranitidine, famotidine (antihistamine) Corticosteroids such as prednisone or methylprednisolone In severe allergic reactions or if any respiratory involvement administer subcutaneous epinephrine 0.3 - 0.5ml of 1:1000 solution Don't delay epi if respiratory involvement If angioedema is primary symptom, check for ACE-I use Prescribe epi-pen for pts who have a severe reaction

What is the treatment for toxic epidermal necrosis?

If drug-induced the offending drug must be stopped immediately Other medications that are unnecessary should be stopped as well Hospitalized with specialized nursing care often in an intensive care unit Patients should be transferred to a burn unit

What are the causes of urticaria?

IgE mediated - food, drugs, parasites, atopic history Complement-mediated - serum sickness, transfusions, radiocontrast media, salicylates, hereditary angioedema Physical stimuli - dermatographism, cold, sunlight, cholinergic, pressure Urticarial vasculitis

What is the treatment for erysipelas?

Immediate empiric antibiotic therapy should be started Monitor patients closely and revise therapy if there is a poor response to initial treatment Elevation of the involved area

What is impetigo?

Impetigo is a common superficial bacterial skin infection Most commonly children ages 2-5, but older children and adults can be affected Contagious, easily spread among individuals in close contact Most cases - S. aureus S. pyogenes or a combination of these two organisms Three clinical variants: Non-bullous impetigo Bullous impetigo Ecthyma (Ulcerative)

What are the causes of acne?

Increased sebum (oil) production Abnormal desquamation of follicular epithelium Propionibacterium acnes proliferation and colonization inside pilosebaceous follicles Inflammation and immune response

What is cellulitis?

Infection of the dermis that often begins with a portal of entry that is usually a wound or fungal infection Spreading erythematous, non-fluctuant tender plaque More commonly found on the lower leg Streaks of lymphangitis may spread from the area to the draining lymph nodes

What is felon?

Infection of the digital pulp with Severe pain and swelling and Erythema in the pad of the fingertip may be caused by cbg check, splinter, nail bitting

What is folliculitis?

Inflammation of hair follicle Can be infectious or non-infectious Bacterial is most common cause of infectious folliculitis S. aureus, MRSA - most common cause of bacterial folliculitis Pseudomonas aeruginosa - hot tub folliculitis: contact with water that is contaminated as a result of inadequate chlorine, bromine, or pH level in whirlpools, hot tubs, pools

What is rosacea?

Inflammatory disorder of facial pilosebaceous units Also associated with increased capillary involvement Associated with Demodex folliculorum Age of onset 30-50 years Fair-skinned individuals of Northern European or Celtic descent More common in women

What is xeroderma pigmentosum?

Inherited Extreme sensitivity to UV rays Freckles by age 2 High risk of developing cancer by age 10 30% develop neurological conditions - hearing loss, eye issues, difficulty walking, swallowing, seizures . Gets worse with time

What is the treatment for sarcoidosis?

Intralesional or topical steroids for skin disease, Systemic corticosteroids for ocular or active pulmonary disease

What is a 1st degree burn?

Involves only epidermis Skin is red Painful 7-10 days to heal Minimal or no residual scarring sunburn, scald

How ling does telogen effluvium last?

Lasts about 2-4 months with a recovery period of 4-9 months No scarring or inflammation

What is non-bullous impetigo?

Lesions begin as papules surrounded by erythema They progress to form pustules that enlarge and break down to form thick, adherent crusts with a characteristic golden appearance

What is a fissure?

Linear loss of epidermis and dermis and sharp definition and vertical walls, Linear split in the epidermis

What are other manifestations of neurofibromatosis?

Lisch Nodules: Growths affecting the iris of the eye Optic gliomas: , tumor of the optic nerve Pheochromocytoma Liver enlargement plexiform neuromas (variant of neuromas - NF1)

What is ichthyosis vulgaris?

Lizard skin! Dry, rough skin over extensor surfaces of arms/legs that progresses from normal skin to lizard skin over time.

What are the risk factors for cellulitis?

Local trauma (bug bites, laceration, abrasion, puncture wound) Underlying skin lesion (furuncle, ulcer) Inflammation (local dermatitis, radiation therapy) Edema and impaired lymphatics in the affected area Preexisting skin infection (impetigo, tinea pedis) Secondary cellulitis from blood-borne spread of infection, or from direct spread of subjacent infections (fistula from osteomyelitis) is rare

Where does melanoma metastasize to?

Local: Within 5cm of the primary site Intransit metastases/regional nodes: > 5cm from the primary site Distant metastases: Skin, subcutaneous tissue and distant lymph nodes (42-57%) Lungs (18-36%) Liver (14-20%) Brain (12-20%) Bone (11-17%) Small intestines (1-7%)

When is a shave or punch biopsy done?

Low suspicion of melanoma Large lesions Benign appearing lesions Persistent rash

What does a brown recluse spider bite look like?

Loxoscelidae reclusus - fiddle-back spider (1.5cm in length) Minor stinging and burning or sharp pain like a bee sting Most are mild with swelling and erythema Flag sign - rapid expansion of a blue-gray macular halo around the puncture site and necrosis causing a blue, red and white appearance Treatment - RICE, aspirin, antihistamine, tetanus prn, antibiotics, analgesics,, surgical debridement

What are the clinical findings in rocky mountain spotted fever?

Macules spread to palms/soles, then centrally Petechiae within the rash 2-4 days later + Rumpel-Leede test = sphygmomanometer pressure induces petechiae (Tournique test) Petechiae coalesce to become hemorrhagic and gangrenous lesions Treatment: doxycycline 100mg

What is androgenic alopecia?

Male Pattern baldness Genetic predisposition onset age 12-40 years Top-androgen sensitive Sides/back -androgen independent In the presence of androgens, terminal hairs are replaced by vellus hairs

What is Kaposi's sarcoma?

Malignancy of the vascular endothelial cells; non-AIDS form and AIDS-associated types Human herpes virus (HHV-8) Clinical findings: deep red, brown, or purple macules, plaques and nodules on lower legs Can also be present on face and trunk Diagnosis: biopsy, test for HIV if status unknown Treatment: AIDS-associated - treat underlying HIV Non-AIDS associated - Oncology consult, radiation/chemotherapy

What is a capillary hemangioma?

Mature capillary proliferations-Common in middle-aged and elderly patients Multiple lesions, most commonly on the trunk Bleed profusely with any traumatic rupture Dome-shaped, 0.1 to 0.4 cm in diameter, and always blanch with pressure Treatment is only necessary for patients who are bothered by the lesions but new lesions are likely to develop; no known way to prevent them

What is nail squamous cell carcinoma?

May present as verrucous lesion Onycholysis Suspect SCC in periungual warts that do not respond to appropriate therapy Refer for biopsy

What is the treatment for gram negative (pseudomonas) folliculitis?

May resolve without treatment Oral ciprofloxacin BID if severe or immunocompromised

What is acral lentigines melanoma?

Median age is 65years Male:Female ratio - 3:1 ALM is the principal melanoma in dark skinned people Accounts for 50 - 70% of melanomas in Japanese Evolves over 2.5years Prognosis: Survival rates for the volar type are less than 50% (palms and soles) Subungual type has a 5year survival rate of 80%

What is acral lentiginous melanoma?

Melanoma of palms/soles or distal fingers/toes or mucous membranes. Often nail beds

What is a myxoid cyst?

Middle age to elderly Treatment: Intralesional TAC High recurrence rate Repeated needle puncture Excision with removal of pedicle Cryotherapy - 75% RR CO2 laser

How is acne severity level determined?

Mild- <20 comedomes, no scarring Moderate- 20-100 comedomes, papules, pustules, mild scarring nodules severe nodulocystic- pustules, nodules, moderate scarring, pitted or hypertophic scarring, >5 pseudocysts

What education should you provide on acne treatment?

Minimize use of irritating products- ie exfoliating washes Apply acne medication to entire affected zone Avoid tanning and sun when using topical tretinoin products

What drugs cause pigmentary changes in skin?

Minocycline Amiodarone Hormones Psoralens Metals Silver Gold

What is the treatment for rhus dermatitis?

Minor supportive care Topical steroids for localized involvement Topical or oral antihistamines - pruritus Oatmeal soaks/calamine lotion - weeping erosions Severe involvement may require oral steroids Given for < 2-3 weeks, patients may relapse Avoid the plants Wash clothing, shoes, and objects after exposure Within 10 minutes if possible

What are the lab tests for kawasakis disease?

Moderate to marked elevated WBC count with a left shift.(day 1-11) ESR, CRP level, and serum alpha1-antitrypsin level are elevated Culture results are all negative Subacute stage, platelet count elevation.(day 11-21) Levels as high as 2 million Convalescent stage (day 21-60), platelets and other markers begin to return to normal Imaging Studies: ECHO to demonstrate coronary artery aneurysms Chest X-ray at baseline for congestive heart failure Other Tests: ECG - presence of various conduction abnormalities.

What is a nail nevus?

Monitor all pigmented lesions of nails for changes Look for extension on nail fold Refer for dermoscopy or biopsy

How does depigmentation work for vitiligo?

Monobenzyl ether of hydroquinone (MBEH) only FDA approved Imiquimod (genital warts), Phenol sol. (chemical peels) High cost of treatment and may take up to 12 months Repigmentation can be patchy and incomplete

What is an actinic keratosis?

Most common pre-cancerous skin lesion Etiology: chronic, cumulative sun exposure in susceptible individuals Can evolve into squamous cell carcinoma clinical findings: single or multiple, discreet, 3mm-1cm erythematous or brown scaly, keratotic papules and plaques found on sun exposed skin; scale is coarse, sandpaper-like Diagnosis: clinical, biopsy

What do abscesses require?

Most experts recommend irrigation, breaking of loculations, and packing following incision and drainage antibiotics

What is porphyria?

Multiple disorders based on enzyme defects in porphyrin metabolism (heme synthesis). Inherited Effect nervous system or skin or both Most common porphyrias with dermatologic manifestations: Porphyria cutanea tarda (most common), Variegate porphyria, Erythropoietic protoporphyria Rare - Erythropoietic porphyria

What is secondary syphilis?

Multiple oval, erythematous, scaling plaques of various sizes over the trunk, bilateral forearms, legs, palms and sole Lesions contain treponemes and are contagious Typically associated with malaise, myalgias, arthralagias, nasal discharge, low fever, headache, depression

What is nail psoriasis?

NAIL PITTING Pitting: punctate depressions of the nail plate surface Onycholysis: separation of the nail plate from the nail bed Subungual hyperkeratosis: abnormal keratinization of the distal nail bed Trachyonychia: rough nails as if scraped with sandpaper longitudinally

What is onychogryphosis?

Nail is severely distorted, thickened Opaque, brownish, spiraled and without attachment to the nail bed Nail of the great toe is most common Pressure from footwear in the elderly

What is the treatment for lichen planus?

No cure and typically self resolving Symptomatic treatment Antihistamines (hydroxyzine (Vistaril) Topical Steriod Oral Steriod or injection Phototherapy Retinoic acid Tacrolimus/pimecrolium cream

what is nevus anemicus?

No melanin defect Congenital (birthmark) Capillary vascular malformation

What is herpes simplex?

Nongenital or genital infection, primary or recurrent Clinical findings: Prodrome - tingling, itching, burning Grouped vesicles on an erythematous base Regional adenopathy Course - 7-10days Abreva (OTC) Vacyclovir, Acyclovir

What is the topical treatment for candidiasis?

Nystatin cream or ointment or powder Inexpensive and effective Imidazoles (miconazole, clotrimazole) Inflammation add hydrocortisone 1% cream or ointment Only for a limited time due to risk of skin atrophy and/or systemic absorption with prolonged use under occlusion Never prescribe combination therapies with high potency topical steroids (e.g. betamethasone/ clotrimazole combination)

What is the treatment for severe acne?

OTC products don't work well for severe cystic acne Topical combination antibiotics and/or oral antibiotics (benzoclin + doxycycline) Dapsone (Aczone) (anti-microbial and anti-inflammatory) Topical Azelaic Acid (Azelex , Finacea) Aldactone (Spironolactone) : for women only. Effects hormones/monitor renal Oral contraceptives Isotretinoin (Accutane): shrinks sebaceous glands reducing oil amount females - need proof of 2 forms of birth control Acne flare up prior to seeing improvement - generics available

What are the risk factors for folliculitis?

Occlusion- leggings Topical corticosteroids Long term oral antibiotic treatment for acne Shaving against the direction of hair growth Exposure to hot tubs

What are halo nevi?

Occur in 1% of the general population Etiology: due to circulating cytotoxic antibodies Associated with vitiligo Usually within the first three decades of life

What are neurofibromas?

One of the more common genetic disorders; 1 in 3,000 people. (not always genetic) NF1 - enlargement or deformation of bones and spine. Tumors can develop in the brain. 50-75% of people have learning disabilities NF2 - tumors on cranial and spinal nerves. Affects auditory nerve and hearing loss in teens/early 20's is common Tumors (neurofibromas) can become cancerous

What is bullous pemphigoid?

Onset >60 years of age Pruritic skin lesions Patients don't feel sick Oral mucous membrane lesions in 10-35% Self-limited in many cases Unlike Pemphigus Vulgaris bullae does not rupture easily Treat with: Corticosteroid (prednisone) Steriod-sparing: Cellcept, Imuran Methotrexate

What is granuloma annulare?

Onset generally prior to age 30 Lesions persist and then resolve with time Annular plaque Skin colored, erythematous Single or multiple indurated papules develop over wks. or mos. to annular configuration Assoc with diabetes, rheumatoid arthritis TreatmentClass I topical steroid

What are they types of candidiasis?

Oral (thrush) Angular chelitits Vulvovaginal Intertrigo Skin folds Diaper dermatitis Balanitis Balanoposthitis Paronychia Onychia

What is the treatment for impetigo?

Oral antibiotics used to treat impetigo include: Dicloxacillin Cephalexin Erythromycin Clindamycin Amoxicillin/clavulanate Topical therapy with mupirocin ointment may be equally effective to oral antibiotics if the lesions are localized in an otherwise healthy patient

What drugs commonly cause exanthems?

PCN Allopurinol Gold Sulfa Carbamazepine

What is idiopathic guttate hypomelanosis?

Part of the aging process - common over 40 Women>Men. Skin is thinner No predisposition to cancer - no treatment

What is a second degree burn?

Partial thickness (Second degree) Epidermis and part of the dermis Skin is red, blistered, swollen Painful May/may not heal in 2-3 weeks May/may not heal with scarring Silvadene cream Causes include: Flame Scald Chemical Contact

When should patients be referred to a dermatologist?

Patients have recurrent skin infections Patients have extensive and/or severe disease Symptoms are poorly controlled with topical steroids

When should onychomycosis be treated?

Patients with a history of cellulitis of the lower extremity Patients with diabetes especially with venous insufficiency or edema Patients with discomfort/pain associated with infected nails Patients who desire treatment for cosmetic reasons

What is pediculosis?

Pediculosis Capitis - Pediculosis humanus capitis (head lice) Pediculosis Pubis - Phthirus pubis (crabs) Head lice - pruritis of scalp and back of neck, visible lice, nits, excoriations on scalp Crabs - Same findings as head lice, but are harbored in pubic hair

What are the clinical findings in meningcoccemia?

Petechiae Irregularly shaped with central gray vesicle on trunk and extremities Variable presentation - suspect if fever, petechiae, sx of meningitis Petechiae coalesce to form ecchymotic areas

What are the systemic treatments for psoriasis?

Phototherapy: narrow-band ultraviolet B light (nbUVB), broad-band ultraviolet B light (bbUVB), or psoralen plus ultraviolet A light (PUVA) Oral medications: methotrexate, acitretin, cyclosporine Biologic Agents: T- cell blocker (alefacept), TNF-α inhibitors (infliximab, etanercept, adalumimab), IL 12/23 blocker (ustekinumab)

What is melanoychia?

Pigmented longitudinal bands in the nails Nail matrix melanocyte activation Caution when melanonychia is suddenly: Darker, Wider Develops blurred borders, Associated with nail dystrophy , Associated with periungual pigmentation can get melanoma!!!

What is keratosis pilaris?

Plugging of follicles with keratin= on the extensor surfaces of upper arm/thigh

What is Rhu's allergy?

Poison ivy...Initial episode 7-10 days after exposure Subsequent outbreaks may appear within hours of exposure usually 2 days Lasts 10-21 days depending on the severity Initial episode is the longest (up to 6 weeks!)

What is molluscum contagiosum?

Pox virus Clinical findings: Discrete, umbilicated, dome-shaped, pearly-white, waxy papules Children Adults (often STD or in HIV infected individual) Neck, trunk, anogenital area, eyelids Treatment: Children - spontaneous remission Adults - curettage, cryosurgery, electrocautery, Retin A

What are the precipitating stressors that cause telogen effluvium?

Precipitating stressor that leads to shift to up to 50% of telogen hairs or resting phase illness, operation, nutrition, childbirth, trauma, weight loss, oral contraceptives, beta blockers, anticonvulsants, antidepressants, thyroid disease, stress, hair dye

What are risk factors for melanoma?

Presence of precursor lesions Family history of melanoma in 1st degree relative Phenotype: Blonde or red hair Blue or green eyes Lighter skin type Freckling tendency History of blistering sunburns Increased sun exposure between 10 - 24 years of age

What is viral paronychia?

Prodrome - tingling, itching, burning Grouped vesicles on an erythematous base Children Regional adenopathy Course - 7-10 days

What is scleroderma?

Progressive sclerosis and tightening of the skin Hair follicles are lost in later stages of disease More common in women Hands have stiffness of the fingers due to the skin being hardened and tense. Face becomes mask like Prognosis is related to disease in organs, lungs, kidneys

What is traumatic or traction alopecia?

Prolonged tension from certain hair styles. Hair loss may be temporary or permanent, depending on follicle damage.

What are half and half nails?

Proximal white & distal red/brown Associated with renal disease Terry's nail-Liver disease

What is lichen planus in the nail?

Purple, polygonal, planar papules that are pruritic Wickham's striae on buccal mucosa Up to 25% of patients have nail involvement 5th and 6th decade of life Longitudinal ridging, grooving and pterygium formation: adhesion of proximal nail fold to nail matrix Treatment: Intralesional TAC Oral Prednisone Other immunosuppressive medications

What is pustular psoriasis?

Raised, non-infectious pustules, surrounding skin is red/tender/inflamed, localized and generalized

What is acute paronychia?

Rapid onset of painful red swelling of proximal and lateral nail folds following trauma or manipulation with Staphylococcus aureus and or Streptococcus pyogenes No abscess

What is anagen effluvium?

Rapid shedding of growing hairs- from entire body from infection, chemo, poisoning, radiation, autoimmune

What is albinism?

Rare Absence of melanin due to gene restriction- complete lack of pigmentation. High risk for sun damage/skin cancer. Can occur in any race

What is toxic epidermal necrolysis?

Rare but often fatal Same as Stevens-Johnson Syndrome but more severe Blistering and peeling of the epidermis Resembles severe burn Occurs in all ages - more common in elderly and AIDS patients Skin biopsy necessary to distinguish between SJS and TEN

What is the treatment for telogen effluvium?

Reassurance hair will regrow Ensure healthy diet to promote hair growth Cosmetic ways to make hair look thicker Minoxidil (Rogaine)- Hair growth stimulator

What are Osler's Nodes?

Red, tender spots seen under the skin of fingers. tender, purplish, subcutaneous nodules on fingers and toes. Indicates Endocarditis.

What is the treatment for rosacea?

Reduction of products that flare the flushing of rosacea Sunscreen daily to protect the skin from chronic UV rays Topical antibiotics Tetracyclines demonstrate both antibiotic and anti-inflammatory effects Oral isotretinoin (Accutane) Rhinophyma: Surgical - dermabrasion, planing with a scalpel or razor, electrocautery and ablation of tissue with a CO2 laser Telangiectasias: Electrocautery, or more commonly, with vascular lasers

What is the treatment for allergic contact dermatitis?

Remove etiologic agent Treatment of the acute phase depends on the severity of the dermatitis Mild to moderate cases: topical steroids - medium to strong potency Short course of systemic steroids for acute flares Oatmeal baths or soothing lotions - mild cases Wet dressings with extensive oozing and crusting Chronic cases or patients with dermatitis > 10% of the BSA should be referred to a dermatologist

What is an excisional biopsy?

Remove the entire lesion with margins Cysts or nodules If you know it looks like cancer - REFER

What is chronic paronychia?

Repeated nail fold trauma, irritants, allergens Moist local environments Cuticle separates from proximal nail fold, increasing risk of infection Redness, edema of nail fold Long term dystrophy of nail

What is the treatment for viral paronychia?

Rest, elevation, anti-inflammatory agents Acyclovir

What is scarlet fever?

Results from group A strep infection Sore throat and fever Sandpaper rash Bacteria makes a toxin causing a bright red bumpy rash, called scarlatina Strawberry tongue Swollen glands Pastia's lines - skin creases are brighter red than the rest of the rash

What is neurofibromatosis?

Rule of 5s: Cafe-au-lait macules >5 lesions, diameter ³ 0.5cm in kids <5 years of age Axillary or inguinal freckling

What is the treatment for verruca vulgaris?

Salicylic acid Cryosurgery Imiquimod Curettage Surgical or laser excision

What are the complications of steven's johnsons syndrome?

Secondary infection Fluid and electrolyte loss- dehydrtaion*** Sloughing of upper and lower respiratory tract Blindness due to corneal lesions Death

What is dyshidrotic eczema?

Seen in individuals who wear gloves or hands are wet frequently Also seen on feet Fluid filled blisters, peeling,

What are dilated capillary loops?

Seen in rheumatologic disorders Dermatomyositis Systemic lupus erythematosus

What type of sun protection should be used to prevent skin cancer?

Select broad-spectrum sunscreens that protect against the effect of UVB and UVA SPF of 15 or above that contain avobenzone ,titanium dioxide, and/or zinc oxide

What is the treatment for tinea versicolor?

Selenium sulfide (Selsun) blue shampoo Ketaconazole (Nizora) cream or shampoo Oral: Terbinafine, Fluconazole, Itraconazole

What is the treatment for pityriasis rosea?

Self-limiting 5 weeks > 80% resolve by 8 weeks without treatment Most patients only need to be reassured Soothing anti-itch lotions, topical steroids, and oral antihistamines may look like syphillis, consider that too

What is onycholysis?

Separation of nail plate from nail bed Potential space for infection may be caused by Psoriasis-pitting and oil spots, Atopic eczema, Candidiasis, Trauma

What labs should be drawn for alopecia atreata?

Serum iron, Thyroid profile, ANA, KOH prep to R/O other causes, biopsy for diagnosis in question

When are antibiotics recommended for abscess treatment?

Severe or extensive disease (e.g., involving multiple sites) Rapid progression in presence of associated cellulitis Signs and symptoms of systemic illness Associated comorbidities or immunosuppression Extremes of age Abscess in an area difficult to drain (e.g., face, hand, or genitalia) Associated septic phlebitis Lack of response to I&D alone

What is oral leukoplakia?

Sharply defined, white, macular, slightly raised area, cannot be rubbed off, remains after irritant removed Predisposing Factors:Tobacco, Alcohol, Human Papilloma Virus Types 11 and 16 pre malignant, may become squamous cell carcnioma

What is the Nikolsky sign?

Slippage of the epidermis from the dermis with slight rubbing/pressure (skin peeling)

What are lentigines?

Small < 5 mm, circumscribed, brown to dark brown, uniformly colored, macules, predominantly in sun-exposed areas Lentigo simplex - usually applied to an isolated lesion Senile lentigines - "Liver spots", "age spots" sun-induced freckling

What are Janeway lesions?

Small, erythematous or hemorrhage lesions usually seen on the palms or soles. nontender

What is chrondrodermatitis nodularis helicus?

Small, painful, inflammatory nodule attached to cartilage of the outer ear Most often seen in men >40 Pale or slightly reddish, covered by scale or a small ulcer 2 - 4mm in diameter May be related to increased sun-exposure, chronic trauma, or frostbite Treatment: excision, with importance of removing the inflamed cartilage under the skin to prevent recurrence Alternative: cortisone injection into the lesion every 2 to 4 weeks until clear or topical Class I-II steroid daily

What is a pilar cyst?

Smooth, firm dome-shaped nodules or masses Almost always on the scalp 0.5 mm to 5 cm diameter Does not have a central punctum - not connected to the epidermis Thick cyst wall, can be removed intact Contains keratin, sometimes calcified Runs in families and can be in multiples

What is koilonychia?

Spoon nails Central depression of nail plate Normal variant Iron deficiency (Plummer-Vinson syndrome) 50% of idiopathic hemochromotosis

What is the treatment for orbital cellulitis?

Stage 1: oral antibiotics Stage 2-4: can be progressively invasive causing proptosis, decrease visual acuity/ CT scan and IV antibiotics

What are the stages of melanoma?

Stage I - localized disease with no clinically palpable nodes Five year survival based on tumor thickness Stage II - palpable regional lymph nodes Five year survival rate is 30-40% Stage III - presence of distant metastasis 2% of newly diagnosed melanomas Median survival rate is six months All patients with melanoma should be followed by a dermatologist for life Common sites: males - back; females - lower extremities Patients with melanomas have a 10x risk of developing 2nd lesion- need aggressive and frequent skin exams

How does toxic epidermal necrosis present?

Starts with a fever, headache, myalgias then diffuse skin peeling, nails and hair can follow out. Huge loss of fluid and susceptible to organ system failure and sepsis Causes can include Sulfa drugs, Barbiturates, NSAIDS, and allopurinol

What is phymatous rosacea?

Subtype 3 - persistent erythema, numerous telangiectasias, papules, pustules, nodules and rhinophyma formation Development of rhinophyma, results from an increase in connective tissue with deep inflammation and sebaceous gland hyperplasia

What is erythematous rosacea?

Subtype I -intermittent flushing with few telangiectasias Repetitive cycles of small vessel dilatation and flushing lead to permanent telangiectasias

What drugs cause vasculitis?

Sulfa drugs and many others

What are the 4 types of malignant melanoma?

Superficial Spreading Melanoma Nodular Melanoma Lentigo Maligna Melanoma Acral Lentigious Melanoma

What is erysipelas?

Superficial cellulitis with marked dermal lymphatic involvement (causing the skin to be edematous or raised) Main pathogen is group A streptococcus Usually affects the lower extremities and the face Presents with pain, superficial erythema, and plaque-like edema with a sharply defined margin to normal tissue Plaques may develop overlying blisters (bullae) May be preceded by chills, fever, headache, vomiting, and joint pain

What are the components of acne vulgaris lesions?

Superficial lesions Open and closed Comedones, Papules Pustules (white or yellow "squeezable" spots) Deeper lesions Nodules (Large painful red lumps Pseudocysts (cyst-like swelling) Secondary lesions Excoriations (picked or scratched spots) Erythematous macules (red marks from recently healed spots, light skin) Pigmented macules (dark marks from old spots, mostly affecting dark skin) Scars

What is the treatment for a dysplastic nevi?

Surgical excision (do not laser or freeze), careful monitoring by patient monthly and provider annually, avoid sunbathing, tanning booths, use sunscreen

What are the clinical features of a drug eruption (exanthem)?

Symmetric red macules/papules Occasionally purpura Confluent on trunk, extremities - morbilliform -"measles-like" Can progress to generalized exfoliative dermatitis ± palm, mucosal involvement, fever Often pruritic

What is lentigo maligna?

Synonymous with melanoma in situ Flat, macular, intraepidermal neoplasm Precursor of Lentigo Maligna Melanoma (LMM) Median age is 65 Equal in males and females Older population with increased sun exposure Pigmented patch known at Hutchinson's Freckle Account for 5% of all melanomas Predominantly occur on the head and neck May take up to 20 years to evolve from a Lentigo Maligna

What is white superficial onychomycosis?

T. mentagrophytes White spots on the nail plate surface Spread centrifugally to involve the whole nail White areas are soft, chalky, powdery Can be scraped lightly with a dermal curette for KOH or culture

What is telogen effluvium?

Temporary thinning or hair loss Acute and chronic (>6 months) form Reactive to some type of stress

What is the treatment for onychomycosis?

Terbinafine (Lamisil) q d x 3 months to 6 months Check liver enzymes prior to administering and after 1 month. Terbinafine-induced hepatotoxicity/ RARE Itraconazole (Sporonox) BID x 1 week per month for 2-3 months OR q d x 6 weeks to 3 months Griseofulvin (takes up to 1 year for therapy) Ciclopirox (Penlac) nail laquer Use in children or to prevent recurrence/ not effective for bad infection Efinaconazole (Jublia) - topical solution $$$$$ Surgical removal

What is trichotillomainia?

The act of manually removing hair by manipulation. An obsessive-compulsive disorder seen in a 2.5:1 female to male ratio. May require lifelong psychotherapy and medication for control. May resolve after menopause onset

What are signs to look out for melanoma?

The color changes It gets smaller or bigger It changes in shape, texture, or height The skin on the surface becomes dry or scaly It becomes hard or feels lumpy It starts to itch It bleeds or oozes

What drugs cause a photosensitivity drug eruption?

Thiazides Phenothiazines Sulfa drugs (Bactrim) Tetracyclines

What are splinter hemorrhages?

Tiny lines of blood under the fingernails where clots have damaged the small capillaries under the nail... endocarditis

What is the treatment for mild acne?

Topical Anti-acne preparations: soap, cleansers, Benzoyl peroxide, salicylic acid Lasers, lights(photodynamic): series of treatments and results are variable

What is oral therapy for tinea infections?

Topical agents are ineffective in the management of tinea capitis Griseofulvin - drug of choice in the US Terbinafine granules* comparable in safety and efficacy to griseofulvin Shorter treatment course

What is the treatment for moderate acne?

Topical retinoids (tretinoin, adapalene, tazarotene) Topical antibiotics (clindamycin, erythromycin), combination products Oral antibiotics (minocycline, doxycycline, tetracycline) Antiandrogens - birth control (3 approved by FDA - combo of estrogen/progesterone)

What is alopecia totalis?

Total loss of hair on the head/face Seen primarily in younger patients with alopecia areata. Long term regrowth prognosis is poor.

What is urticaria?

Transient wheals, usually pruritic, can be recurrent and/or chronic Clinical features: wheals - 1.0mm to 8cm, pink with central white area, last only hours Acute urticaria: < 30days, generally IgE mediated Chronic urticaria: > 30days, etiology unknown in up to 90% of cases, stress, salicylate intolerance Urticarial wheals lasting longer than 3-4 days in one location should be biopsied

What are Beau's lines?

Transverse linear depressions Illness or extreme stress Nail changes due to internal disease will affect all nails simultaneously

What are endocarditis changes to nails?

Trauma to the nail or Acute and subacute bacterial endocarditis Clinical features: Fever, heart murmur and: 1) Janeway lesions - red or hemorrhagic macules on the palms and soles 2) Osler's nodes - tender, purplish, subcutaneous nodules on digits and palms 3) Subungual splinter hemorrhages - in the middle one-third of the nail Acute bacterial endocarditis - (1, 2) - result from septic embolism Subacute bacterial endocarditis - (2, 3) - from circulating immune complexes

What is the treatment for stasis dermatitis?

Treat underlying issues Recommend more physical activity/increase circulation to the area compression stockings Topical corticosteroid cream

What is the treatment for a psudomonal nail infection?

Treatment Dry area One part chlorine bleach/4 parts water under nail TID or vinegar Fluoroquinolone

What is the oral treatment for candidiasis?

Treatment (immunocompetent): Nystatin suspension Treatment Immunocompromised: Fluconazole Ketoconazole Itraconazole Often recurs and becomes resistant to therapy Refer to a dermatologist if the eruption is unusually severe, if it does not respond to standard therapies, or if the diagnosis is in question

What is the treatment for a pyogenic granuloma?

Treatment is indicated if: The patient desires it for cosmetic reasons The location is bothersome The lesion bleeds easily with minor trauma Excision If a punch excision not possible, a shave excision and/or curettage with cauterization is an option. Re-excision or dermatologic consultation is indicated if the original lesion or multiple satellite lesions recur after treatment.

What is the treatment for basal cell carcinoma?

Treatment: biopsy for diagnosis Surgical - Curettage, excision

What can trigger or worsen psoriasis?

Triggered by infections, especially streptococcal pharyngitis More severe in patients with HIV Up to 20% have psoriatic arthritis, which can lead to joint destruction Positive correlation between increased BMI and prevalence and severity of psoriasis

What is ecthyma?

Ulcerative form of impetigo Lesions extend through the epidermis and deep into the dermis. Most common area is on the legs and scarring occurs "Punched out" ulcers covered with yellow crust surrounded by raised margins

What is yellow nail syndrome?

Uncommon Elderly Pulmonary complaints: Pleural effusion, bronchiectasis bronchitis, COPD Facial or lower extremity edema Abnormal lymphatics Slow growth of nails without cuticle or lunula Light or deep yellow Thick and ridged Treatment: Vitamin E orally or topically has shown some improvement

What is proximal subungual onychomycosis?

Uncommon Begins proximal portion of the nail near cuticle and extends distally Usually occurs in severely compromised immune system Marker for AIDS May require biopsy of nail plate

What is Bowen's disease?

Usually a solitary lesion on exposed skin (squamous cell carcinoma In situ) Age >60 Slowly enlarging, erythematous macule, sharp border, little or no infiltration, usually slight scaling

What causes androgenic alopecia in females?

Usually begins at menopause Drop in estrogens-relative increase in androgens

What is herpes zoster?

Varicella-zoster virus - acute, localized infection Clinical findings: Age > 50 Prodrome - itching, burning, tingling over dermatome, pain 3-5 days later eruption Course lasts 7 - 10 days Unilateral Post-herpetic neuralgia Diagnosis: Clinical findings Treatment: Acyclovir, Ophthalmology consult if trigeminal nerve involvement Vaccine available (Zostavax) > 60 years of age

What is a pyogenic granuloma?

Vascular lesion that usually grows after minor trauma to the skin Rapidly growing Solitary eroded vascular nodule Bleeds spontaneously Color can be bright red, dusky red, violaceous, or black-brown Occurs on fingers, lips, mouth, trunk, toes

What are the two types of hair?

Vellous: "peach fuzz" Terminal: Pigmented, thicker All follicles can produce either type Follicular activity is intermittent (cyclical)

What is alopecia universalis?

Very rare complication of alopecia areata. Complete and total loss of all body hair.

How does hiradenitis suppurativa present?

Very tender, erythematous, inflammatory nodules or abscesses May drain purulent material Double comedones Old scars Distribution: Females - axillae, breasts Men- anogenital, groin May be a family history of nodulocystic acne

What is the treatment for acute paronychia?

Warm compress or soak Abscess Incise and Drain abscess Topical antibiotics - mupirocin Class II or III topical steroid Start antibiotics (low risk of MRSA) Dicloxacillin 250 mg four times daily, or Cephalexin 500 mg three to four times daily Start antibiotics (high risk of MRSA) TMP-SMX two double-strength tablets BID

What is characteristic of plaque psoriasis?

Well-demarcated plaques with overlying silvery scale and underlying erythema Chronic plaque psoriasis is typically symmetric and bilateral Plaques may exhibit: Auspitz sign (bleeding after removal of scale) Koebner phenomenon (lesions induced by trauma)

What is leukonychia punctata?

White spots on the nail, caused by microtrauma or cuticle manipulation

What is distal subungual onychomycosis?

Yellow to brown discoloration Most common Great toe generally affected first Distal hyperkeratosis with onychodystrophy Diagnosis with KOH or nail clipping culture

What is candidal onychomycosis?

Yellow, brown, dystrophic or onycholysis

What is bullous impetigo?

Young children Flaccid bullae with clear yellow fluid, later becomes purulent Ruptured bullae leave a thick brown crust

What is a macule?

a flat lesion that differs in color from surrounding skin (<1 cm in diameter)

What is an ulcer?

a focal loss of epidermis and dermis. Tend to heal with scarring Often the result of decrease vascular supply to the skin Common in peripheral arterial disease

What is contact dermatitis?

an inflammation caused by contact with a substance or chemical Pruritis or burning of the skin Irregular, well-demarcated patches of erythema and edema Non-umbilicated vesicles Punctate erosions exuding serum, and crusts Often linear arrangement

What should pruritus of eczema be treated with?

antihistamines-hydroxyzine skin infections with oral antibiotics

What is alopecia areata?

autoimmune disorder characterized by rapid onset of hair loss in well-circumscribed areas. If involvement is limited regrowth is typical. New hair may be finer and white.

What is a strawberry hemangioma?

benign capillary hemangioma of infancy, appearing in the first few weeks of life (1/200 births) and growing rapidly before regressing spontaneously between 5-8 years of age

What is the treatment for squamous cell carcincoma?

biopsy, excision, MOHS *** any isolated keratotic or eroded papule or plaque present >1 month is a SCC until proven otherwise

What is Auspitz sign?

bleeding after picking off scale

What is the treatment for Staph Aureus folliculitis?

can treat empirically Mild cases resolve spontaneously If more than one body area or many lesions, treat medically Topical mupriocin cream or topical clindamycin gel First line oral treatment: dicloxicillin (beta-lactam antibiotic) QID or cephalexin QID for 7-10 days If MRSA suspected: TMP/SMZ BID, clindamycin QID, or doxycycline BID for 7-10 days, sometimes longer tx needed

What is a pustule?

circumscribed collection of leukocytes and free fluid - various sizes Contains pus

What antibiotics are used to treat MRSA?

clinamycin: Excellent tissue and abscess penetration. Risk for C. difficile Inducible resistance in MRSA Bactrim: Unreliable for S. pyogenes (will need to combine with amoxicillin to cover for group A strep) doxycycline: Unreliable for S. pyogenes (will need to combine with amoxicillin to cover for group A strep). Do not use in children < 8 years old. linezolid: Expensive. No cross-resistance with other antibiotic classes vancomycin: Parenteral drug of choice for treatment of infections caused by MRSA

What is seborrheic dermatitis?

common disease caused by Pityrosporum ovale (harmless yeast) found in sebum and hair follicles, In areas with oily skin (scalp, eyebrows, nasolabial folds, midchest). Produces greasy yellowish scales in areas with hair. aka dandruff or cradle cap may be hypopigmented in darker skin tones

What is a furuncle?

deeper infectin at hair follicle aka hair follicle abscess multiple furuncles are carbuncles or abscess

What is the treatment for hiradenitis suppurativa?

difficult; use every modality possible as patients can be very depressed due to pain, draining pus, odor, area involved Antibiotics (tetracycline, minocycline, erythromycin) Important, but are only a part of complete treatment Often given for weeks to months Intralesional steroids Isotretinoin Surgical I&D of abscesses Excisions of recurrent nodules, sinus tracts Skin grafting after complete excision of axilla

What is rocky mountain spotted fever?

disease caused by Rickettsia rickettsii and carried by American dog tick. Organism invades the endothelial lining of capillaries and causes small vessel vasculitis Prodrome: Fever, chills, weakness, HA precede the rash Pink-red macules on wrists, ankles and forearms - appear on day 4 of fever (range 2-6 days)

What is exanthem?

drug induced Maculopapular rash Develops within 4 to 12 days and lasts up to 2 weeks after stopped med. Pencillins, Sulfonamides (Bactrim), Quinolones, Anticonvulsants, allopurinol (gout) and NSAIDS

What is demarcation?

easy to see a border, well defined

What is asteatotic eczema?

eczema that occurs when the skin becomes abnormally dry, itchy and cracked. It is often found in elderly people

What is a papule?

elevated solid lesion <1cm. If they become confluent they turn into plaques.

What is a compound melanocytic nevus?

elevated, tan to brown color, pigment is epidermal and dermal

What is a scale?

excess dead epidermal cells produced by abnormal keratinization and shedding. Accumulation of keratin Indicate inflammatory change and epidermis thickening Can be thin or thick. Pityriasis, psoriasis, ichthyosis

What is a wheal?

firm swollen plaque resulting from infiltration of the dermis with fluid. Transitory, compressible papule Red or white Usually in conjunction with urticaria (bug bite)

What is verruca plana?

flat warts treat with: Topical retinoids Cryosurgery Curettage Laser ablation Electrosurgery

What is a dermal nevus?

flesh-colored as pigment is in the dermis, elevated

What is tinea pedis?

fungal infection of the foot Maceration between toes Mocassin like scale

What is erythrodermic psoriasis?

generalized erythema covering nearly the entire body surface area with varying degrees of scaling

What is herpes simplex 2?

genital herpes Can give daily medication for suppression and prophylaxis

What is condylomata acuminata?

genital warts Treatment: Imiquimod, podophyllin, cryotherapy, trichloroacetic acid, laser or surgical excision, Recurrent anal lesions may warrant proctoscopy/sigmoidoscopy to visualize extent of lesions

What is trachyonychia?

grossly deformed nails Associated with: - Psoriasis - Lichen planus - Alopecia areata

What is the Ophiasis Pattern?

hair loss in the temporal and occipital areas in Alopecia Areata

What are itch producing chemicals or factors?

histamine, serotonin, opiates, higher temperatures, trypsin, papain, bradykinin, prostaglandins

What is KOH prep used for?

hyphae (fungus)

What is intertrigo?

inflammation of large skin folds Inframammary fold, gluteal cleft, inguinal creases, and folds under pannus (abdomen) Classic symptom: burns more than itches Classic sign: satellite lesions KOH exam may reveal pseudohyphae, but fungal culture may be more sensitive than KOH for Candida Prevention Keep intertriginous areas dry, clean, and cool Dry areas after bathing with hair dryer on cool setting; repeat twice daily Encourage weight loss for obese patients Wear loose clothing made of cotton

What is scabies?

intense, generalized, intractable pruritis, burrows, vesicles, nodules, excoriations Interdigital web spaces, axilla, wrists, flexor areas waist, groin Diagnosis: Clinical findings, skin scraping for mites

What is the dimple sign?

lateral compression produces a dimple

What is peutz-jeghers syndrome?

lentigines on the mucosa, lips, fingers, toes Associated with GI hamartomas (benign polyps) in stomach and intestines and occasionally carcinomas

What is inverse/flexural psoriasis?

lesions are located in the skin folds

What are names for primary lesions?

macule, papule, plaque, nodule, pustule, vesicle, bullae, wheal

What is blanching?

momentary turn to a lighter color because of pressure

What is the treatment for a benign pigmented nevi?

monitor, excision if cosmetically undesired, laser

What is pemphigus vulgaris?

mucocutaneous blistering disease that is characterized by flaccid bullae and intercellular IgG deposits in the epidermis Onset 50-60 years Rarely pruritic Sometimes painful flaccid bullae, erosions Positive Nikolsky's sign Majority of patients have painful mucosal membrane lesions Chronic blistering cause by the action of antibodies to surface antigens - autoimmune disease cause by IgG antibiodies Treatment: Corticosteriods. Without treatment - progressive and fatal

What is the erector pili muscle?

muscle below gland attached to outer sheath - makes hair stand up and causes sebaceous gland to secrete sebum

What shows on physical exam for telogen effluvium?

non-scarring alopecia on exam Hair density/part width Hair pull test (normal is < 6 hairs per pull) Daily counts of hairloss (between 100-250) Labs: CBC, serum ferritin, TSH, CMP (renal or liver failure)

What is the treatment for pyogenic granuloma?

not needed unless patient needs it, excision is treatment

What is longitudinal ridging or beading?

occurs in the presence of accelerated nail growth

What is an ingrown toenail?

occurs when the edge of the toenail grows deply into the nail groove & penetrates the surrounding tissue from Onychomycosis Small shoes Improper nail trimming soak in epsom salt

What is pityriasis rosea?

oval, fawn-colored plaques that measure up to 2cm in diameter and occur in a Christmas tree pattern. (secondary lesions) initial lesion (herald patch) that is followed by generalized eruption in 1-2 wks, peripheral scaling and central clearing Acute eruption - mainly occurs in young people, may be viral Usually asymptomatic, may have associated flu-like symptoms Malaise, nausea, loss of appetite, GI upset, upper respiratory symptoms Less commonly fever, swollen lymph nodes, pain, or sore throat are noted

What is papulopustular rosacea?

persistent flushing, increased telangiectasias, papules and pustules, absence of comedones

What is guttate psoriasis?

presents with drop lesions, 1-10mm salmon-pink papules with a fine scale (teardrop, diffuse, scattered) may occur after strept pharyngytis or viral infection or low immune system

What would you use to describe a lesion?

primary lesions, secondary lesions size demarcation color distribution (flexor, extensor surfaces, generalized, photodistributive) palpation (scale, texture, tempurature, induration, depth, solid or fluid filled)

What are the diagnostic tests for sarcoidosis?

radiographic studies - hilar lymphadenopathy, pulmonary infiltrates Laboratory: ACE elevated, Hypercalcemia Diagnostic: Biopsy

What is the management for skin tags?

removal-larger lesion will require anesthesia Chemical cautery, Drysol, AgNO3, Monsel's soln no recurrence but will get new lesions

What is tinea capitis?

ringworm fungal infection of the scalp has seborrheic variant and black dot variants

What is ocular rosacea?

rosacea with ocular involvement- conjunctivitis

What is Darier's sign?

rubbing causes dermographisim

What is the treatment for familial melanoma?

same as dysplastic nevi more aggressive at removing clinically atypical moles

What are names for secondary lesions?

scale, crust, erosion, ulcer, fissure, atrophy, scar

What is plaque psoriasis?

scaly, erythematous patches, papules, and plaques that are sometimes pruritic

What is a habit tic deformity?

sign of ocd or anxiety, marks on nails

What are achrochordon?

skin tags Skin colored to brown, Soft, Pedunculated, 1mm-1cm located i the areas of rubbing like eyelids, neck, groin, buttocks, axilla, waist

What are the topical treatments for plaque psoriasis?

steroids...may cause skin atrophy, hypopigmentation, striae calcipotriene (vitamin D analog)...skin irritation, photosensitivity tazarotene (retinoid)...skin irritation, photosensitivity salicylic or lactic acid (kerolytic agents) coal tar...skin irritation, odor, stains clothes calcineurin inhibitors...skin burning and itching

What are the side effects of topical steroids?

striae, telangiectasias, atrophy, and acne

What drug pigments teeth?

tetracyclines

What is a follicle?

the part of the hair in the skin the shaft is the part visible above the scalp

What is a kerion?

tinea infection accompanied by swollen, painful nodule; indurated, boggy, inflammatory plaque studded with pustules; most common w/ tinea capitus; tx w/ prednisone Can be associated with fever, adenopathy, and leukocytosis Has the potential to cause scarring and permanent alopecia

What is onychomycosis?

tinea unguium Etiology: Trichophyton rubrum Trichophyton mentagrophytes Thick nails are NOT always fungal KOH and culture

What is Henoch-Schonlein purpura?

vasculitis due to IgA immune complex deposition Tetrad: Palpable purpura in patients with neither thrombocytopenia nor coagulopathy Arthritis/arthralgia Abdominal pain Renal disease Age: 3 to 15 years, most common Purpura common on lower extremities

What is poliosis?

whitening of certain hairs and lashes due to genetics, autoimmune disease, or damage to hair folicles

What is tinea versicolor?

yeast infection of the skin that inhibits melanin production Malassezia species Clinical findings - sharply marginated off-white to brown "velvety" macule, fine scaling, round to oval on chest and back, occasionally pruritic Worse in hot humid weather Dark skin- light patches Light skin - dark patches More apparent with sun exposure Patches with some scaling Back, chest, neck, upper arms