Y2S1B1

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Diagnosis

Features

DDx

Malignant melanoma

thickness defines survival rate

excise, refer to oncologist

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Amelanotic melanoma

dx delayed b/c presentation is pink/red

dermal nevus, BCC

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Acral lentiginous melanoma

most/least common in dark/light skin on hands/feet/nails of men

solar lentigo, nevus, pigmented actinic keratosis, Bowen's disease, longitudinal pigmented band

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Lentigo maligna and lentigo maligna melanoma

flat lesions w/irregular pigment; develops slowly into cancer over years in sun; drops into dermis

pigmented actinic keratosis, solar lentigo, Bowen's disease

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Nodular melanoma

extremities; evolve vertically over months-years

pigmented BCC, angiokeratoma, hemangioma, traumatized nevus, pyogenic granuloma

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Superficial spreading melanoma

most common subtype of melanoma; spreads laterally from a preexisting lesion before developing nodules; Men - back; Women - lower legs

nevi, atypical nevi, seborrheic keratosis, solar lentigo

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Melanoma: A, B, C, D E

asymmetry, border irregularity, color (red, blue, black, white), diameter (>6mm/pencil eraser), evolving (getting bigger?); If tender, bleeding or ulceration --> poor prognosis

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Melanoma: non-skin findings

regional lymph node adenopathy

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Melanoma: risk factors

fair skin, presence of atypical nevi, personal Hx, family Hx, Hx of severe burns (>3 blistering burns), large congenital nevus

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Melanoma: frequency

malignancy of melanocytes most commonly arising in skin; #8 cancer in US; #1 in women 25-29; #2 in women 30-35; 1 in 75 people

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Atypical mole syndrome

Auto dom w/variable penetrance, but inc risk of melanoma; new nevi after age 30 on sun/no sun surfaces! suspicious nevi; check for ocular melanoma

benign nevi and melanoma (use A, B, C, D, Es of melanoma)

photograph and watch nevi; education

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Nevi

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shave/excise for biopsy when >2 ABCDEs change

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Dermal melanocytosis (Mongolian spot)

blue/black baby sacral patch

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Becker's nevus

brown/tan patch that develops hair during puberty (hamartoma of smooth muscle)

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Congenital melanocytic nevus

dark brown raised plaques w/irregular surface and inc terminal hairs at birth/infancy; 6% develop malignant melanoma if >20cm

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Recurrent nevus

irregular pigment w/in a scar at any age

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Halo nevus

annular hypopigmented ring around pigmented papule/nodule/macule during adolescence

check family Hx for vitiligo

some will repigment

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Spitz nevus

preadolescent red-pink domed papule

dermatofibroma (dimple sign)

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Nevus spilus

pre-adult tan patch w/cafe au lait spots

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Blue nevi

birth/childhood solitary blue papule/nodule

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Intradermal nevi

post-puberty; elevated to pedunculated; fleshy

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Compound nevus

pigmented papules/nodules; get thicker in late childhood

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Junctional nevus

flat/slightly raised macule/patch in children

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Nevi

hamartoma/benign skin tumor composed of melanocytes; body doesn't make moles after age 35

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Seborrheic keratosis

benign epidermal proliferation; waxy stuck-on papules

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shave, cryo, curettage

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Sign of Leser Trelat

rapid eruption of multiple widespread seborrheic keratoses due to internal malignancy

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Acrochordans

skin tags; fleshy papules in neck/skin folds; associated w/ cancer; predisposing factors: fat

verruca, dermal nevus

cryo, snip, electrocautery

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Dermatofibroma

benign firm dermal papule on extremities; dimples when pinched laterally

nevus, epidermal inclusion cyst, scar, melanoma, dermatofibroma sarcoma protuberans

excision, shave epidermal portion

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Keloids

"scar" that extends beyond initial site of injury; upper body/chest

dermatofibroma, sarcoma protuberans, sarcoidosis, hypertrophic scar

steroids (topical/intralesional), Sx

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Nevus sebaceus

congenital lesion on scalp; orange/bubbly worsens during puberty; (possible triad: epilepsy, MR, nevus sebaceous); low incidence of skin cancers

linear epidermal nevus

excision; take annual pictures

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Chondrodermatitis nodularis helicis

tender, persistant papule on lateral helical rim in sunlovers

actinic keratosis, squamous cell/basal cell carcinoma

eliminate pressure; corticosteroids, removal

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Epidermal cyst

cystic papule filled w/keratin from hair follicle infundibulum d/t trauma or genetics; non-skin findings: Gardner's syndrome inclusion cyst and colon cancer

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incision, drainage, excision

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Pilar cyst

firm, Mobile, keratin-filled papule/nodule from outer root sheath of hair in scalp

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incise/drain/excise

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Sebaceous hyperplasia

common benign overgrowth of sebaceous gland on face w/central umilication and telangectasias

basal cell carcinoma, keratocanthoma, molluscum contagiosum

removal

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Syringoma

benign overgrowth of eccrine sweat glands on eyelids, upper chest, vulva; associated w/Down syndrome; can be blue from side angle

hair tumor, verruca plana, sebaceous hyperplasia, sarcoidosis, xanthelasma (cholesterol tumor)

leave it alone or removal

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Hemangiomas

benign neoplasm of vascular tissue in 1st year of life; most common vascular tumor in infancy; F>M; neck/head;

Resolution rule: 10% by 1yr, 30/3, 50/5, 70/7, 100/10; Non-skin findings: CHF, organ system failure, Kasabach-Merritt syndrome

Watch and wait; if hoarse/difficult to breath; send to surgery

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Strawberry/capillary hemangioma

true neoplasm of endothelial cells

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Cavernous hemangioma

venous malformation (dilitation of immune system)

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Hemangioma lesion progression

1. rapid growth (double/triple in wks), 2. stabilization (dormant for many years), 3. involution (gray center)

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Vascular malformations

classified by type of tissue affected (capillary, venous, arterial, lymphatic, combo)

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Nevus Flammeus (salmon patch)

pink midline patch/macule; "angel kiss" of "stork bite on 25-40% newborns; Port-wine stains; inc # of dilated capillaries/venules in dermis

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glabella fades, nuchal persists; laser

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Nevus anemicus

pale/irregular macule d/t catecholamines on chest (F>M)

vitiligo

none required

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Cavernous hemangioma

venous malform; blue

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Lymphangioma

frog-egg appearance; neoplasm of dilated lymph vessels; communicates w/ deeper structures and spreads

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excision d/t deep component

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Cherry angioma

benign neoplasm in adulthood of capillaries/PCV in papillary dermis; associated w/malignancy - sign of leser-trelat

pyogenic granuloma, angiokeratoma

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Angiokeratoma

benign hyperkeratotic vascular papule; 4 variants

kaposi's sarcoma, pyogenic granuloma, pigmented BCC, SCC

removal

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Angiokeratoma of Fordyce

most common type; scrotum/vulva in middle age; inc venous pressure

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Papular angiokeratoma

blue/black solitary lesion on legs of young adults; thrombosed vessels may be visible

melanoma

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Angiokeratoma corporis diffusum

rarest variant; bathing suit distribution at puberty; associated with underlying disease (metabolic); confluent purple papules/nodules in genital area, buttock, lower abs

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Venous lake

dark blue/purple soft cystic papule on mucosa of lip; partially blanchable w/pressure

herpes, cavernous hemangioma, Maffucci's syndrome, blue rubber bleb syndrome; melanoma (if it doesn't blanch out)

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Pyogenic granuloma

common in Children and Pregnant women; yellow-red friable vascular papule overgrowth w/scale or crust that BLEEDS

traumatized hemangioma, bacillary hemangiomatosis, kaposi's sarcoma, angiosarcoma

removal

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Kaposi's sarcoma

malignant tumor of lymphatic endothelial cells from herpes virus type 8;

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Classic Kaposi's

old jewish/greek/italian men; lesions on lower extremities progress to upper

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cancer therapy

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Endemic African Kaposi's

most common tumor in central Africa: Cutaneous (M >40 on limbs) and Lymphatic (aggressive in kids) forms

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cancer therapy

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Kaposi's associated w/immunosuppression

transplants; M>F; aggressive involving lymphatics, mucosa, viseral organs

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cancer therapy; withdraw immunosupressive drugs

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Kaposi's epidemic/AIDS related

most common tumor in HIV (20% of all AIDS pts); multifocal purple marks; generalized lymphadenopathy at presentation; progress to GI and lungs

stasis dermatitis, pyogenic granuloma, hemangioma

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Telangiectasias: Spider angiomas - nevus araneus

small dilated venules, capillaries, arterioles; signal of underlying disease (liver disease or pregnancy)

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Telangectasias - Heretidary Hemorrhagic (Olser-Rendu-Weber syndrome)

Auto dom; epistaxis, visceral arteriovenous malformations on lips, tongue, nasal mucosa, appendages

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Telangiectasias - Ataxia (Louis-Bar Syndrome)

Auto rec; defect in DNA repair of sister chromatids/inc sensitivity to ionizing radiation; ataxia, immune dysfxnl; telangiectasias on conjunctiva, face, neck, trunk; cafe au lait; death due to lymphoreticular malignancy/infection

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Unilateral nevoid telangiectasia syndrome

numerous and thread-like on unilateral dermatome (trigeminal, C3 or C4); Acquired form: elevated estrogen; Congenital form: M>F

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Telangiectasias: Scleroderma and CREST syndrome

mats on chest, face, hands, palms

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Generalized essential telangiectasias

widespread, idiopathic, F over 30yo; lower extremities progress to head; auto dom?

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Connective Tissue Diseases

Group of illnesses characterized by affecting multiple organ systems w/no typical pattern of onset, duration or progression, aka: Autoimmune diseases

Lupus erythematosus, dermatomyositis/polymyositis, scleroderma

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Lupus erythematosus

periods of exacerbations and remissions, W>M; common in African American and Hispanic pops

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Lupus erythematosus criteria (4 +)

malar rash, discoid rash, anti-dsDNA, anti-Sm, anti-phospholipid A/B, oral ulcers, arthritis (nonerosive >2 joints), serositis, +ANA, photosensitive, proteinuria/cellular casts, neurologic disorder, hematologic disorder

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Lupus erythematosus subsets

1. Chronic cutaneous (discoid) lupus (DLE), 2. Subacute cutaneous lupus (SCLE), 3. Acute cutaneous lupus erythematosus, 4. Neonatoal lupus erythematosus, 5. drug induced lupus

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Chronic Cutaneous LE

Face, ears (CONCHAL BOWL, scalp); SCARRING w/alopecia; limited to skin only; F in 30s; UV light/trauma exacerbate; carpet tack undersurface

sarcoidosis, lichen planopilaris (scalp); Jessner's lymphocytic infiltrate; rosacea; leukemia/lymphoma

Negative: ANA, anti-Sm and anti-dsDNA

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Subacute Cutaneous LE

No SCARRING; white females; sudden annular or papulosquamous appearance after sun; features of both chronic cutaneous and active LE; trunk, dorsal upper extremity (spares joints and volar surface); drugs induce (hydrochlorothiazide, Ca-channel blockers)

drug eruption, dermatomyositis, secondary syphilis, psoriasis, seborrheic dermatitis on face, tinea corporis

ANA negative; 30% anti-dsDNA+; Positive: anti-Ro or anti-La; can have babies with neonatal LE associated w/ heart block

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Acute Cutaneous LE

serious multisystem disease; W in 30s/40s; UV induces/exacerbates; systemic symptoms; drugs produce lupus-like syndrome (anticonvulsants, procainamide, hydralazine); butterfly; nail fold telangeictasias, alopecia, urticaria, Raynaud's phenom

contact dermatitis, rosacea, erytispelas, seborrheic cermatitis, tinea, polymorphous light eruption

Positive: ANA, anti-dsDNA, anti-Sm, anti-Ro, anti-La, anti-U1RNP; Negative: anti-histone ssDNA

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Positive anti-dsDNA

30-70% in nucleoplasmic or homogenous pattern; is diagnositic for LE; associated with nephritis

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Positive anti-Sm

15-30%; nucleoplasmic or speckled pattern; associated with U1RNP ab

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Positive histones

95% of drug induced LE; associated with anti-dsDNA

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Positive anti-Ro

24-60% of LE; SCLE, neonatal LE and LE with C2 and C4 def - 88-96% Sjogren's Syndrome

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Positive anti-La

9-34% of LE; in 90% of mother's of neonatal LE babies

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Positive U1RNP

30-40% of LE associated with anti-Sm; ~100% MCTD pts

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Drug Induced LE

cutaneous/systemic symptoms d/t medication (hydralazine, procainamide, isoniazid, methyldopa, monocycline, valproate, ca-channel blockers, Interferon, IL-2)

older pts after months of drug therapy; arthralgias/itis of sm joints and systemic probs; 25-50% have skin lesions; No CNS involvement, butferfly rash, alopecia, mucosal ulcers or discoid lesions

Lamisil and stop drug; Positive; anti-ssDNA/histone, possibly ANA; Negative: anti-dsDNA; acute hepatitis w/minocycline

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Treatments of Lupus Erythematosus

sunscreens (SPF45/50, UVA/B); topical/intralesional/oral corticosteroids; antimalarials; MTX azathioprine, thalidomide, acitretin, isoteinoin

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Neonatal lupus erythematosus

transfer of autoantibodies to fetus across placenta; SCLE-like cutaneous eruption; 3RD DEGREE CONGENITAL HEART BLOCK; cardiomyopathy, cholestatic hepatitis, thrombocytopenia

skin findings w/in 1st month; erythematous plaques w/central atrophy; "owl-eye" rash; heals w/o scarring w/in 6 months

Same as LE; Pacemaker

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Autoantibodies responsible for neonatal LE

maternal IgG anti-Ro (95%), anti-La, or anti-U1RNP

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Dermatomyositis/Polymyositis

rare inflammatory muscle disease w/ or w/o skin manifestations; children or adults >40

5 classifications (polymyositis, dermatomyositis, PM/DM w/malignancy; childhood PM/DM, PM or DM w/collagen vascular dx

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Polymyositis

insidious onset of proximal, symmetric muscel weakness of hips/thighs (can't get out of chair); distal strength and deep tendon reflexes are OK

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Dermatomyositis

proximal muscle weakness w/eruption on skin

4 courses (acute, chronic, recurrent, cyclic); associated w/malignancy (LOOK FOR CANCER in pts >40)

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Amyopathic Dermatomyosits

cutaneous changes ONLY

normal muscle enzymes in serum, but myositis on EMG or muscle biopsy

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Dermatomyositis Pathognomonic Skin Finding

Heliotrope rash; eyelid discoloration (look hard for it)

psoriasis (scaly scalp); Tcell lymphoma; lupus; polymorphous light eruption; contact dermatitis; atopic dermatitis

oral corticosteroids; MTX; Physical therapy; antimalarials (hydroxychloroquine); skin and muscle biopsy; evaluation for malignancy (6x greater risk of malignancy in 1st year)

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Gottron's Papules

60-80% of pts w/ dermatomyositis; rash on finger joints; differentiates from lupus

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Periungual telangectasias

dermatomyositis - proximal nailfold w/thick hyperkeratoic irregular cuticles

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Poikiloderma

dermatomyositis - mottled white/brown pigment on sun exposed skin w/dermal atrophy

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Scaly red scalp

dermatomyositis

confused w/ psoriasis or seborrheic dermatitis

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Childhood dermatomyositis

nonsupporative; symmetric weakness and rash, vasculitis of GI and myocardium

skin findings same as adult (gottron's papules, heliotrope rash, periungual erythema, poikolderma, scaly scalp, violacious patches)

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Scleroderma

progressive sclerosis of skin/visceral organs; vasculopathy; autoantibodies

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Scleroderma subtypes

systemic, localized, chemical-induced scleroderma-like condition; eosinophilic fascitis pseudoscleroderma

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Systemic Sclerosis

Diffuse scleroderma or CREST syndrome

Criteria: proximal sclerosis, nail pits and loss of digit fat pads; bibasalar pulmonary fibrosis

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Diffuse scleroderma

PRESENTATION: skin thickening (beak deformity) and/or Raynaud's phenomenon (white, blue, red); telangiectatic mats; 3 stages of disease

complications: GI tract and alveolar fibrosis/atrophy; renal disease and hypertension --> Major cause of death; myocardial fibrosis resulting in arrhythmias

No good Tx: manage infx and skin breakdowns; anti-Scl70 and anti-ACA (anti-centromere Ab)

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Edematous phase of scleroderma

skin thickened and swollen w/non-pitting edema

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Indurative phase of scleroderma

skin becoms hardened and thickened and motion is greatly restricted

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Atrophic phase of scleroderma

ulcerations, telangiectasias, atrophy w/smooth shiny appearance producing claw deformity and loss of terminal phalanges

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CREST

more benign, chronic and localized varient of scleroderma; calcinosis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia

CALCINOSIS is characteristic; DDx - telangiectasia hereditaria hemorrhagica

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Localized scleroderma (Morphea)

localized area of sclerosis on skin; NOT associated w/Raynaud's, organ involvement or acrosclerosis; common in F>30yo

violaceous - purple indurated plaques that progress to thick/white hairless flat plaques

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Linear Scleroderma

linear bands of sclerotic skin that affect joints F>>>>M; d/t surgery or trauma

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PT, MTX; eosinophils elevate in 50%; ANA, anti-ssDNA

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Linear scleroderma - en coup de sabre

frontoparietal face and scalp regions; follows Blaschko's lines

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Acute Eczematous Inflammation

Erythema, inflamed, edema, vesicles; itchy, often weeping/oozing

Allergic contact, irritant rxn, atopic aczema, dermatitis

If wet then dry …dry then wet

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Subacute Eczema

Mild – Mod Erythema,Scaling, itchy , excoriation; Eruption > 1 wk, if tender then possible 2nd infection

Fungal infx, Allergic contact, irritant rxn, atopic aczema, dermatitis

Topical & oral CCsteriods, moisturizers, AB’s

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Chronic Eczema

Red,scaly thicken skin; Habit scratching,

Lichen simplex chronicus, ddx from psoriasis wh/ has edema & thicken skin, stopic dermatitis

Topical CCCS – interalesional injections, antihistamines

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Lichen Simplex Chronicus ( Thicken skin)

Thicken skin due to habitual scratching; Located on limbs, wrist, ankles, posterior neck,

Rule out fungal infx, hand eczema from chemical,allergic exposure, genetic

Stop itching, put tape on it, Topical & oral CCsteriods, moisturizers, AB’s, eliminate antibacterial soap, use waxes to keep in moisture, superglue to seal lesion

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Asteatotic Eczema

Ill defined Erythema, proceeds to plaques (hands & legs), abnormal dryness; Dry, thin desquamation, progressing to weeping, crusting plaque, worse in winter

Subacute dermatitis, cellulites, contact, atopic, allergic dermatitis

Topical & oral CCsteriods, moisturizers, AB’s, wet dressings

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Chapped Fissured Feet

Erythema, scaling; tender feet, in kids most often, seasonal

Tinea pedis, psoriasis, allergic rxn

Keep feet dry, thick emollient, topical CCS

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Allergic Contact Dermatitis

Vesicles, redness, edema, extreme itch, Poison ivy; Delayed hypersensitivity rxn – Tcell rxn after 2nd exposure

Irritant contact, atopic dermatitis

Topical & oral CCsteriod,

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Irritant contact Dermatitis

Erythema, dryness, cracking, fissuring, juicy papules& vesicles on weeping patches; Tender and burning, lichen and excoriation of skin

Dryness & inflame by repeated exposure to mild irritant

Topical & oral CCsteriods, moisturizers

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Finger Eczema

Dry scaling, tender, fissued, stops at DIP joint; Limited to 1-2 fingers , seasonal

Psoriasis, allergy, candida infx, due to Allergic contact, chemical irritants, friction

Topical & oral CC.steriods, moisturizers, tar creams & lactic acid creams

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Keratolysis Exfoliativa

Simultaneous scaling from several pts. On palms & soles enlarging centrifugally;

Unknown cause, seasonal variation

None resolves in 1-3 wks

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Nummular Eczema

Sharply demarcated scaling round plaques on trunk & extremities, coin shaped red lesions, w/ imflammation; Pruritic, onset in older adults

Psoriasis, Tinea

Topical & oral CCsteriods, moisturizers, AB’s, oral antihistamines

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Pompholyx

Small deep seated, itchty , tender vesicles on palms, lateral fingers & plantar feet; A vesicular eruption occurs on hands & feet, scaling and peeling following vesicle eruption

Pustular Psoriasis, Tinea ( Id rxn), allergic contact

None

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Prurigo Nodularis

Numerous, hyperpigmented lichen nodules – highy pruritic; Idopathic nodular form of lichen simplex chronicus, lesion caused by chronic scratching, common in adults, diabetics, atopic people

Drug rxn, hypothyroidism, HIV, malignancy, liver dis.

Topical & tape CCsteriods, interalesional CCS injections, cryotherapy, excision, antihistamine, light therapy PUVA

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Stasis Dermatitis

Edema, thick, dry fissured , excoriated skin, brown leg discoloration, dilated tortuous vv; Inflam & scaling of legs due to impaired venous circulation, history of DVT

Contact dermatitis, cellulitis

Compression stockings, wet compresses, topical/oral CCsteriods, moisturizers, AB’s, oral antihistamines

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Venous Leg Ulcer

Pitting edema, sharp, sloping borders w/ crust on a moist base, woody texture of skin, varicose veins; Common in elderly females, after min. trauma, assoc. w/ venous insuficency, mildly painful

Arterial or neuropathic ulcer, pyoderma gengrenosum, infx,

Compression stockings, Topical & oral CCsteriods, moisturizers, surgical debridement, metronidazole gel, pentoxfylline, skin grafing, wet compresses

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Atopic Dermatitis – Lots of detail on this – these are the highlights – look over rest yourself

Abrupt onset w/ Erythema, severe pruritus, recurrent, symmetrical eruptions, infants: checks, scalp, perioral, kids – flexural, adults – hands, eyelids, patchy; High incidence in kids autosomal dominant – elevated T-cells hypersensitive langerhan cells

Contact dermatitis, scabies, tinea, immune deficiency & congenital

Topical CCsteriods, moisturizers, Oral AB’s, wet compresses, Topical immunomodulators, oral antihistamines

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Ichthyosis Vulgaris

Dry, small rectangular scales on the extensor extremities, lower legs effected, accentuated palmar creases; Autosomal dominant disorder, onset early-mid childhood – worsens in winter & dry climate – defect in filaggrin precursor to collagen

Dry skin, acquired ichthyosis & X-linked

Moisturizers/ emollients , increase environmental humidity

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Keratosis Pilaris

Pinpoint follicular papulars w/ red halo, sandpaper texture; Rough monomorphic follicular based papules on upper arms and lateral thighs, follicular plugging

Acne

Topical retinoids, urea and ammoniuym lactate creams , topical CCSteriods

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Pityriasis Alba

White round macules and patches w/ fine scaling; Common asymptomatic, scaly hypo-pigmented, indistinct patches, on faces & arms of kids & adolescent.

Tinea versicolor, vitiligo

Mild topical CCS,

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Psoriasis

Well demarcated erythemas based – silver white scaling plaques and papules, pitting, macules, onycholysis of nails , in web spaces axilla, grown – Pustules on erthyematous base; Papulosquamous disease effecting skin, nails & joints, immuno aberr of Tcells

Eczema, Seborrheic dermatitis, tinea capitis, lichen simplex complex, candida infx, syphilis, pityriasis rosea

Topical CCS, topical Vit D, Tar prep’s, anthralin, retinoids, salicyclic acid, topical immunomodulatory agents, Photo therapy, methotrexate, cyclosporine

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Seborrheic Drematitis

Greasy, yellowish scale on the scalp, erythematous, yellow-red macules & patches w/ scales; Common chronic inflame eruption on face, scalp & inter-triginous – in babies cradle cap – can be sign of other systemic disease – occurs over time from yeast in sk

Infants: atopic, zinc deficiency,histiocytosis

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Grover’s Disease

Red-brown papulopustules & keratotic papules, mild – mod itching; Acquired, uncommon persistent eruption effects chest, lower ribcage, upper back, lumbar area , itchy brown patches, gender predilection, self limiting

Acne, candidiasis, eczema, dermatitis, miliaria, impetigo, bites, pitryiasis rosacea

Diagnosis; biopsy, Avoid hot sweaty temp’s, topical moisturer, anti-itch med’s, topical CCS, Antihistamines, Vit A, Isotretinoin , CCS

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Pityriasis Rosea

Herald patch – well demarcated orange/red papules and Macules peripherally scaling annular or oval patch - many in skin lines of trunk/limbs; Common, benign asymptomatic viral eruption on trunk, possible viral infx, herald patch/dissemintes/resolves 1-2mo

Tinea corporis, 2nd syphilis , nummular eczema, psoriasis

Topical CCS, Antihistamine, UV light tx

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Lichen Planus – (patchy eruptions of small firm papules

Pruritic, flat topped, polygonal, purple papules-lacy; Wickham Striae; Itchy inflam eruption of flexural surfaces & mucous membranes; etiology : HIV, HCV, drugs. Forms; palmoplantar, hypertrophic, follicular, oral, nail

Lupus, pityriasis, popular eczema, Lichen simplex, stasis dermatitis, 2nd syphilis, pemphigus

Antihistamines, top CCS, intralesional CCS, retinoids, Griseofulvin – antifungal, Dapson – AB, Azathioprine – immune suppressant, hydroxycholorquine – immune suppress

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Lichen Sclerosus at Atrophicus

White atrophic plaques, w/ wrinkled cig. Paper appearance, purpura, contracted cicatrix; Chronic , uncommon painful thinning go the skin in genital area- post menopausal women. Symptoms; pruritus, dysuria, dyspareuria, assoc w/ cancer due to chronic infla

Leukoplakia

Top CCS, intralesional CCS, retinoids, emollients, surgery

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Pityriasis Lichenoides

PLC - Itchy brown/red papules w/ fine mica – like scales on trunk; PLEVA: Crops of red/brw pauples w/ violaceous ctr evolves into ulcerated pap/ pustules – crust over; Benign 2 forms; Varioliformis Acuta (PLEVA) - in kids & Chronica (PLC) – adults

Pityriasis rosea, syphilis, scabies, varicella, insect bites

Erthromycin, PUVA – light tx, tetracycline, Gold – IM inject, Methotrexate, CCS, Dapsone -

🗑

Acne Vulgaris

Inflam / nodules & noninflam lesions – closed pores; Etiology; microcomedome – gland at hair follicule – oils clog and gets inflam

Rosacea. Many types of acne; infantile, excoriated, senile comedomes, milia – little white bumps – plugged exocrine gland, steroid rxn, chem. Exposure, Gram – AB induced, neonatal

Determine type of lesion for tx; retinoids, top AB’s, top benzoyl peroxide, surgery , intralesional CCS. Oral AB’s , contraceptives, CCS, Isotretinoin – acutane for cystic scarring (regulated now)

🗑

Acne fulminans

Subtype of vulgaris

(blank)

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Acne conglobata

Subtype of vulgaris; Part of follicular triad – severe cyst that has 2 openings on face, back and chest

(blank)

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Pyoderma faciale

Subtype of vulgaris; Variant that is confined to face and is common in females – have very red face

(blank)

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Perioral Dermatitis

Pinpoint erythematous papules & pustules on eczematous plaque; Prurtic, red eruption around mouth, nose & eyes. Women> men, stress induced. Etiology; bacterial , top CCS, & moisturizers

Acne, seborrheic dermatitis, atopic

Oral & Top AB’s & CCS - avoid drying agents. Ab’s - tetracycline

🗑

Rosacea

Telang-eye lid, pap/pustules, cyst/nodules, Red, thick oily, ocular signs, Rhinoplima – nose thick/distorted; adult facial eruption w/ vascular & acne forms. No. European, stress exacerbates; blood shot eyes, flushing & red component to skin

Acne, pustular tinea, lupus erythematous, folliculitis, perioral dermatitis

Sunscreens, cover skin exposure, top AB’s , oral AB’s , Isotretinoin, CO2 surgery, Pulsed dye / laser

🗑

Hidradenitis Suppurativa

Double comedome, tracts, painful abscesses; Etiology; occlusion of follicle due to increased stickiness of keratinocytes, Chronic suppurative scarring eruption in axillae, anogenital, inframamillary regions – F>M; Familial clusters – puberty onset

Acne, furuncle, carbuncle – painful localized bacterial infx that has openings wh/ pus discharges

Intralesion CCS, AB’s contraceptives, Isotretinoin, surgical excision, plastic surgery – Incision & drainage.

🗑

Miliaria subtypes;

General: inflam papule due to occlusion of sweat ducts

(blank)

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Miliaria crystallina

Grouped or single clear vesicles; Occlusion of sweat duct at level of skin, red bumps can occur on baby from overheating

(blank)

Cool compresses & ventilation

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Miliaria rubra

Papules & vesicles w/ red halo or patch of red skin; Occlusion of intrepidermal section of eccrine sweat duct

(blank)

Anti-inflam lotion, keep cool

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Miliaria profunda

White papules on red base - Occlusion of dermal portion of eccrine sweat duct – occurs after multiple bouts of miliaria rubra

(blank)

Anhydrous lanolin, isotretinoin

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Verruca Vulgaris

flesh color (moist/velvety in genitals) hands face, legs are flat topped papules papules & plaques on feet , can be fingerlike hyperkeratotic on neck/face; – black pinpoints are bld vessals. Tranmission – direct contact - STD in adults

Acne, callus, corns, pearly penile papules

Duct tape, salicyclic acid, retinoids, liq nitrogen, 5-flurouracil cream, Electrodessication & curetting, laser & radiation

🗑

Molluscum Contagiosum

Domes/flesh color umbilicated papules w/ peripheral erythema – may progess to pustule; Self limited viral infx, on skin by poxvirus . Transmission – direct contact , STD in adults

Verruca, herpes, fungal infx, in HIV

Currettage – top salicyclic acid – liq nitro, tape, retinoids, immunomodulators, cantharidine

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Herpes Simplex

Grped vesicles on erythematous base b/f crusting; eruption lasts up to wks; Acute,recurrent infx by type 1 or II; direct contact; STD; Asymptomatic Vs systemic symptoms. Can be brought on by trauma, has prodromal symptoms

Disseminated zoster, herpes simplex, eczema herpeticum, impetigo, folliculitis

Topic antipruritic lotions, oral antiviral med’s – valtrex, IV viral med’s - Varicella zoster immune globulin vaccine

🗑

Herpes Zoster- Shingles

Grped vesicles on erythamatous base in 1-2 adjacent dermatomes, usually wont cross midline; Cut viral infx in dermatones d/t reactivation of the varicella zoster virus. Stress; elderly Prodomal symptoms - painful!

Herpes Simplex Complications; post herpetic neuralgia – have prolonged pain after outbreak – use Neurotin/ Elavil – med’s for pain

Cool compress, top. Capsaicin, CCS, Antiviral’s, Amitriptyline – pain, Neurtoin, Narcotics

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Hand, Foot & Mouth Disease

Painful erosions of oral cavity, Red macules that progress to pale oval vesicles, w/ red areolae on palms & soles, squared; Contagious viral infx, of skin hands, feet, moutn from coxsacky virus, prodromal symptoms

Herpangian, Aphthous stomatitis, herpetic gingivostomatitis,

Isolation, symptomatic tx’s, oral antiviral meds

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Impetigo

Thin roofed bullae/vesicles/pustules w/clear-cloudy fluid – thick honey colored crusts; Common contagious superficial sink infx, Staph Aureus, Steptococcus, occurs after minor skin injury – colonization of nose, warm climates, poor hygiene

Herpes Simplex

Topical AB ointment, oral AB’s – Keflex

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Cellulitis

Erythema, edema, indurated (hardened) plaque, vesicles/bullae; Infx of dermis & sub Q tissue w/ red, painful edema. May develop at sites of trauma, pt’s w/ renal problems, IDDM, immune compromised – predisposed. Recurrent episodes – skin integrity is gone

Stasis Dermatitis, Thrombophlebitis, DVT, erythema nodosum

Cool compress, elevation of limb, oral AB’s – levoquine or IV if needed

🗑

Erysipelas

Firm tender, red, well demarcated plaques; lower legs, face, ears. Streaked lymphangitis; Acute superfic infx of dermis, prodromal sympt’s; Group A strept, Staph Aureus, Pneumoccoccus, Klebselia, Yersinia & Haemophilus Influ.

Cellulites, usually from IDDM, Heart problems common

Oral AB’s

🗑

Folliculitis

Dome shaped pustules and erythematous papules centered over hair follicles; Inflam of hair follicle; abrupt onset itchy, spreads quickly, on hair bearing areas

Sub types; Eosinophilic folliculitis – HIV; Gram Neg- cause Hot tub – pseudomonas; Mechanical/occlusional – clothes rubbing; Steriod – 2nd to steroid use; Pityrosproium – fungi that is on face, scalp

Antibacterial soaps, Top AB’s, top antifungal/ yeast agents, AB’s and oral antifungal agents

🗑

Pseudofolliculitis Barbae

Many inflam pap/pustules around hair follicles; hypertropic/keloidal scarring may occur; Foreign body inflam rxn in hair bearing areas – hairs grows back into skin. Race predilection – blacks, get scarring from chronic outbreaks

Acne, folliculitis

Removal of hair, stop shaving, topical AB’s, oral AB’s, intralesional CCS, laser hair removal

🗑

Furuncle (boils) & Carbuncles

Subcut, erythema, tender nodule; multiple openings. On back of neck, upper back, lateral thighs; Furuncles – walled off, deep painful, firm fluctuant mass of pus; Carbuncles – painful, deep interconnected, aggregate of infxed follicles

Rupture EIC, cystic acne, hidrandenitis supprativa

Warm, moist compress, incision & drainage, oral & topical AB’s

🗑

Pseudomonas Folliculitis

Multiple red, round urticarial plaques w/ central papule or pustule; Acute infx of hair follicle w/ exposure to cont. water – hot tubs. Pseudomonas (bug) – children; appears 8hrs-5d after exposure

Staphylococcal folliculitis, hives, insect bite

Wet compresses, Oral AB’s

🗑

Otitis Externa

Erythema & edema of external auditory canal w/wo yellow crustin & debris. Pain maybe mild & dull to sharp & constant; Acute inflam of ext auditory canal w/ 2nd infx. Systemic symptoms. Malignant otitis externa – common in IDDM and may need IV AB’s

(blank)

Acetic acid soln – vinager & H2O after swimming, Topical CCS & AB’s solutions, IV AB’s if needed

🗑

Candidiasis (candida albicans; part of normal flora)

overgrowth on skin/mucosal areas w/depressed immune system (IDDM); primary lesion-pustule; red, denuded plaques w/satellite pustules; Commonly found btw fingers of bartenders

molluscum contagiosum, genital warts, psoriasis, eczema, herpes simplex

(blank)

🗑

Candidial balanitis

w/ or w/o sexual transmission; Phimosis-cannot withdraw foreskin; red pap/pustules rupture into erosions/ulcers/fissures

molluscum contagiosum, genital warts, psoriasis, eczema, herpes simplex (do a viral culture of KOH slide)

topical antifungal agents, topical corticosteroids, oral antifungals (clean behind foreskin)

🗑

Diaper dermatitis

acute candidial infx of superficial skin; contact irritant diaper dermatitis; candidiasis, atopic dermatitis, psoriasiform dermatitis, seborrheic dermatitis

streptococcal anal cellulitis, staphylococcyl impetigo

minimize exposure to wetness, barrier cream, topical antifungal/corticosteroid/antibacterial agent

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Candidial Intertrigo

infx of large skin fold w/overgrowth of candidial sp; pustules that denude/macerate on apposing surfaces with most/scaly border; painful fissures in skin crease

psoriasis, seborrheic dermatitis, intertrigo, erythrasma, eczema, bacterial folliculitis

moist compress, topical antifungals/corticosteroids; minimise moisture

🗑

Tinea Versicolor

d/t lipophilic yeast Pityrosporum orbiculare exposure in moist places (tanning beds/sports bras); multiple hypo-hyperpigmented circular scaling macules on upper trunk; looks like spaghetti/meatballs on KOH

malazma (pregnancy rash); vitiligo-turns white w/wood's light; pityriasis alba; seborrheic dermatitis, secondary syphilis, pityriasis rosea, nummular eczema, guttate psoriasis

selenium sulfide lotion, topical antifungals, salicylic acid soaps, oral antifungals

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Pityrosporum folliculitis

infx of hair follicle w/Pityrosporum orbiculare; multiple asymptomatic follicular domed pustules on upper back/chest (doesn't respond like acne)

acne, bacterial folliculitis, scabies

selenium sulfide shampoo, topical antifungals, oral antifungals

🗑

Onychomycosis

infx of nail plate w/fungal sp. d/t age, trauma, health conditions;

psoriais, leukonychia, habit-tick, trauma onycholysis (repeated water exposure - psuedomonas growth), eczema

Dx via nail culture or KOH; good local nail care; topical antifungals (not very effective); oral antifungals (lamisil/sporonax/diflucan/griseofulvin); remove nail plate

🗑

Distal subungual onychomycosis

trichophyton rubrum

(blank)

🗑

White superficial onychomycosis

trichophyton mentagrophytes

(blank)

🗑

Proximal subungual onychomycosis

trichophyton rubrum --> Get an HIV test

(blank)

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Candidal onychomycosis

candida albicans

(blank)

🗑

Other causes of onychomycosis

asperigillus, cephalosporium, fusarium, scopulariopsis

(blank)

🗑

Angular cheilitis (Perleche)

inflam of oral commissres d/t saliva irritation/maceration w/secondary yeast overgrowth; d/t mouth breathing, bad dentures, compulsive lip licking, aging, weight loss, loss of teeth; erythema/eczematous fissuring plaques w/ or w/o satellite pap/pustules

(blank)

avoid exacerbating factors; topical antifungals/corticosteroids/antibiotics

🗑

Cutaneous fungal infections

infx of stratum corneum w/ dermatophytes (microsporum, trichophyton, epidermophyton)

Origin of species (zoophilic, geophilic or less inflammatory anthropaphilic (humans); type of inflammation; type of hair invasion (endothrix-inside hair shaft, hair falls out; OR ectothrix-shredding of hair);

Dx - skin scrape for KOH, culture, wood's light

🗑

Tinea pedis

dermatophyte infx of foot d/t warmth/sweating; Subtypes: acute vesicular, Moccassin-type, Interdigital; maceration/fissureing of webs; dry scaly orange-red plaques at edge; hyperkeratotic palm or sole; vesicles/bullae on thick red scaly patch

Psoriasis, eczema, chapped-fissured feet

topical or oral antifungals, wet compresses, topical corticosteroids

🗑

Tinea Cruris

dermatophyte infx of crural folds d/t warm/moist environment; well-demarcated red-brown, scaly plaques extending out from crural fold

intertrigo, psoriasis, erythrasma

topical antifungals/corticosteroids, oral antifungals, absorbent powders

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Tinea Corpus and Tinea Faciei

dermatophyte infx of trunk/limbs and face; subtypes - Classic Ringworm and Majocchi's Granuloma (T. rubrum)-more inflammatory if from zoophilic sp.

nummular eczema, pityriasis rosea, psoriasis

Topical or oral antifungals; topical corticosteroids or antibiotics, oral antibiotics

🗑

Tinea manuum

dermatophyte infx of hands; subtypes: Classic Ringworm and Chronic Scaling

hand eczema, psoriasis, dyshidrosis, psoriasis, contact dermatitis

topical antifungals, topical keratolytic agents, oral antifungals

🗑

Tinea Incognito

dermatophyte infx of skin w/clinical presentation altered by use of topical corticosteroid products; infx waxes and wanes, but never clears completely; ill-defined red-pink plaques/patches w/ or w/o scaling and areas of clearing

eczema, folliculitis, pityriais rosea, rosacea, psoriasis, nummular eczema

stop offending corticosteroid, topical or oral antifungals, wet compress

🗑

Tinea capitus

dermatophyte infx of hair shaft or stratum corneum of scalp d/t wood's light negative endothrix Trichophyton tonsuran (90%); microsporum canis is wood's light positive; subtypes: Inflammatory, Seborrheic dermatitis, Non-inflammatory (blk dot), Pustular

Seborrheic dermatitis, psoriasis, eczema, tinea amaintacea

Dx: hair KOH, culture, Wood's light exam; Tx: oral antifungals

🗑

Tinea barbae

dermatophyte infx of hair on face d/t T. mentagrophytes and T. verrucosum; annular scaling, edematous boggy tender plaques

bacterial folliculitis, furunculosis, pseudofolliculitis barbae, rosacea, acne

topical or oral antifungals, oral antibiotics

🗑

Basal Cell Carcinoma

MOST COMMON skin cancer-Nodular, Superficial, Morpheaform, Pigmented, Micronodular; well-demarc, flesh-pink/red or multiclored pearly papule w/telangectasias, central ulcer, orange scale/crust flat-top plaque; ill-defined whitish waxy papule/plaque

(non-skin findings: basal cell nevus syndrome); DDx: Seborrheic keratosis, sebaceous hyperplasia, melanoma, scar, actinic keratosis, squamous cell carcinoma, chondrodermatitis nodularis helicis

Dx: skin biopsy; Tx: cryo (scar), dissection/excision; Moh's micrographic surgery --> USE for NOSES; radiation; topical immunomodulatory agents (aldera); photodynamic therapy

🗑

Actinic Keratosis (peels, "horns")

common, pre-cancerous hyperkeratotic, scaling plaque in sun-exposed areas on fair skin; face, ears, neck, scalp, forearms and dorsal hands; poorly-defined orange/red papules/plaques w/ yellow-white hyperkeratotic scale; Actinic kelitis-lips of smokers

seborrheic dermatitis, rosacea, psoriasis, seborrheic keratosis, squamous cell carcinoma, lentigo (sun freckles), lentigo maligna melanoma

cryo; topical 5-fluorouracil "ugly" cream; topical immunomodulators (aldera) - can cause untreated areas to erupt; topical diclofenac (popular); shave/dissection (difficult); CO2 laser-lips

🗑

Squamous cell carcinoma

2nd most common skin cancer; invasive cutaneous malignancy arising from keratinocytes of skin and mucous membranes; light skin; caused by sun, HPV and veruca; metastasis via ear and lip; orange hyperkeratotic scale, ill-defined papules/plaques, cut horns

actinic keratosis, superficial basal cell carcinoma, seborrheic keratosis, chrondromatitis nodularis helicis

electrodissection/excision (scars); Moh's micrographic surgery, radiation, cryo

🗑

Bowen's Disease

cutaneous malignancy arising from keratinocytes of skin/mucous membrane; Erythroplasia of Queyrat on penis; red, flat plaques w/adherent white/yellow scale

superficial basal cell carcinoma, actinic keratosis, inflammed seborrheic keratosis, psoriasis, chronic eczematous dermatitis

topical 5-fluorouracil, topical immunomodulators, electrodissection/excision

🗑

Leukoplakia

chronic condition of white patches/plaques that occur on oral mucosa w/o definitive Dx; association w/cancer; small, well-defined translucent-white papules that progress to plaques; often seen in dentist's office

candidiasis, oral hairy cell leukoplakia, frictional hyperkeratosis, lichen planus, white sponge nevus, squamous cell carcinoma

stop tobacco products, biopsy, topical 5-fluorouracil, cryo, electrosurgery

🗑

Paget's Disease

intraductal carcinomal of breast presenting on skin; MOST COMMON cutaneous presentation of breast cancer; red, sharply demarcated eczematous scaling plaque involving nipple, areola, and surrounding skin

nipple eczema, erosive adenomatosis of nipple, superficial basal cell carcinoma, tinea, candidal infx, atopic dermatitis, contact dermatitis

breast and node exam mammography, referral to surgeon to treat underlying cancer

🗑

Extramammary Paget's Disease

intraepidermal malignancy involving anogeital or axillary skin; adenocarcinoma w/in epidermal apocrine glands; associated w/urogenital, rectal carcinomas and transitional cell cancer of urethra and bladder; red-white/gray scale w/velvety surface, borders

eczematous dermatitis, lichen simplex chronicus, intertrigo, candidiasis, tinea, Bowen's disease, amelanotic melanoma

wide local excision, Moh's micrographic surgery, lymph node dissection, radiotherapy

🗑

Cutaneous metastasis

malignant tumor cells in cutaneous tissue which migrated from a malignancy in other organ system; may be primary presenting complaint; firm, sudden appearance of painless nodules that grow fast and can be flesh-black color;

(blank)

directed at primary tumor

🗑

lung cancer metastasis

chest wall

(blank)

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colon and rectal carcinoma metastasis

belly button (orange/red tumor in umbilicus); "Sister Mary Joseph's nodule"

(blank)

🗑

Melanoma metastasis

black nodule

(blank)

🗑

Renal cell carcinoma metastasis

head

(blank)

🗑

Oral squamous cell carcinoma metastasis

neck

(blank)

🗑

Neuroblastoma metastasis

anywhere on body; "Blueberry Muffin Baby"

(blank)

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Lymphoma metastasis

present on skin; poor prognosis

(blank)

🗑

Erythema Multiforme

common, acute, recurrent inflammatory disease d/t: infections (herpes simples or Mycoplasma pneumonia), contact allergens, drugs, CT disease, physical agents, pregnancy or malignancy;

preceded by fever, malaise, or irritation at site of erruption; evolution and resolution w/in 1month; target lesions on hands/feet, bullae/erosions on mucosal surfaces, urticarial plaques

topical or oral corticosteroids, prevention of infx/outbreaks

🗑

Stevens-Johnson Syndrome

erythema multiforme major; Symmetric, severe, vesicobullous eruption of 2 mucosal membranes; self-limiting w/resolutionin 4wks; infx d/t herpes simplex, mycoplasm, meds in children and young adults

Anticonvulsant hypersensitivity syndrome, paraneoplastic pemphigus, pemphigus vulgaris, TEN, herpetic gingivostomatitis

Dx: skin biopsy/immunofluorescence; Tx: supprotive (hydration and soft diet); viscous xylocain or benadryl (oral erosions), consult ophthalmology; cool, wet compress; underlying bacterial infx; oral corticosteroids

🗑

Drugs associated with SJS

phenytoin, phenobarbital, carbamazepine, sulfonamides, aminopenicillins

(blank)

🗑

Skin findings in SJS

erythematous papules/vesicles on purpuric macule "target lesions"; bullae w/gray-yellow fibrinous exudate and hemorrhagic crust on mucosal surfaces; ocular conjunctivitis w/ or w/o purulence

(blank)

🗑

Non-skin findings in SJS

fever, pneumonitis and bronchitis (mostly); renal failure (uncommon)

(blank)

🗑

Toxic Epidermal Necrolysis

Rare; life-threatening EXFOLIATIVE disease of skin and mucosal membranes (up to 100%); mortality rate is 25-50%; d/t drugs 80%, immunizations, viral, mycoplasmal infx, strep infx; Greater risk in AIDS and Lupus

staphylococcal scalded skin syndrome, graft-vs-host diease, staphylococcal toxic shoch syndrome, Kawasaki syndrome, acute paraneoplastic pemphigus, SJS

Dx:skin biopsy, liver fxn tests, CNC, urinalysis; Tx: stop all new meds, supportive care--burn center (IV fluids, pain control, nutrition, PT), oral corticosteroids, IVIG

🗑

Drugs associated with Toxic Epidermal Necrolysis

hydrantoins, barbituates, carbamezepine, sulfonamides, allopurinal, NSAIDs, cephalosporins, fluoroquinolines

(blank)

🗑

Skin findings in Toxic Epidermal Necrolysis

targetoid papules and bullae develop suddenly on erythematous skin; Nikolsky's sign is positive (if you pull the bullae, entire thickness of skin follows)

(blank)

🗑

Non-skin findings in Toxic Epidermal Necrolysis

fever, myalgias, malaise, ocular symptoms, upper airway damage, hypovolemia, wound infx/sepsis, urethritis, urinary retention, prerenal azotemia

(blank)

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Erythema Nodosum

nodular hypersensitivity eruption to antigenic stimuli found on extensor surfaces; d/t Nonmycobacterial infections (strep, coccidiodomycosis, chlamydia, mycoplasma, medications) and Noninfectious Inflammatory Diseases (sarcoidosis, enteropathies, HVB, TB)

F 5x> M; Prodrome-fevers, malaise, arthralgias, URI symptoms

(blank)

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Erythema Nodosum Disease Course

lesion lasts 2 wks, but new lesions appear up to 6wks with recurrence and remissions; red, ill-defined nodular swelling on SHINS w/edema of LOWER LEG; evolution into painful, hard, indurated plaques; plaques fade

cellulitis, infected insect bites, minor trauma, nodular vasculitis, Henoch-Schonlein pupura, Wever-Christian panniculitis, superficial and deep thrombophlebitis, panniculitis secondary to pancreatic cancer, erythema induratum

Dx: biopsy, ASO titer, Chest x-ray, PPD, ESR, stool culture, RF; Tx: symptomatic releif, NSAIDs, compression, potassium iodide, oral corticosteroids, dapsone

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Leukocytoclastic Vasculitis

inflammation of post-capillary venules mediated by immune complex deposition; d/t Meds (after 7-21days), Infections (strep, URI, hep A, B, C), CT Disease, Malignancy, or Systemic Illness; prodrome-malaise, fever, myalgias, joint pain

thrombocytopenia purpura, drug eruption, disseminated intravascular coagulation, purpura fulminans, septic vasculitis, septic emboli, bacteremia

ID and remove triggers, oral anti-histamines, NSAIDs, oral corticosteroids, colchicine, dapsone, cyclophosphamide, MTX, azathioprine

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Leukocytoclastic Vasculitis

lesions appear in crops and last 1-2wks; healing with SCARS; may involve other organ systems; orange non-blanchable hemorrhagic macules that progress to papules; purpura develops when macules coalesce, vesicles and bulla may develop and ulcerate

Dx: biopsy, throat culture, ASO titer, ESR, platelet count, CBC, serum creatinine, UA, ANA, c-ANCA, hepB core Ab, hep C ab, cryoglobulins, CH50, RF

(blank)

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Henoch-Schonlein Purpura

common vasculitic syndrome seen in childhood d/t strep or viral URI; prodrome-fever, malaise, anorexia; Classic Triad-1.purpuric rash, 2. abdominal cramps, 3. hematuria; palpable purpura on extensor surfaces of lower limbs/buttocks/scrotal swellling

entrapment of circulating immnune complexes in vessels of skin, GI, kidneys; runs a benign and self-limited course; DDx: leukocytoclastic vasculitis

Dx: biopsy, throat culture, UA, intestinal ultrasound, renal biopsy, serum IgG; Tx: stop offending antigen, oral corticosteroids, dapsone, plasmapheresis; Nephritis may require long-term care

🗑

Schamberg's Disease

lymph capillaritis; uknown etiology; lower limbs; M>F; develops slowly-years; drug-induced variant quick onset/may resolve (d/t acetominophen, ampicillin, diuretics, NSAIDs); irreg orang/brwn non-blanch macules; cayenne pepper spots; itch/scale/erythema

Chronic venous stasis, cutaneous Tcell lymphoma, nummular eczema, scurvy, senile purpura, trauma

Dx: skin biopsy, inflam/hemorrhage w/o necrosis of vessels; Tx: watch and wait, cosmetics, mild topical corticosteroids, pentoxifylline

🗑

Sweet's Syndrome

acute, idiopathic inflammatory response characterized by multiple discrete tender erythematous indurated papules; prodome-fever, malaise, Leukocytosis; Adults M 3.7x >F; d/t URI (viral or bacterial); malignancy in 15-20%; medications

erythema nodosum, erythema multiforme, adverse drug reaction, urticaria

oral corticosteroids, minocycline, oral potassium iodide, colchicine, dapsone, clofazimine, NSAIDs, cyclosporin

🗑

Sweet's syndrome systemic symptoms

fever, malaise, arthralgias/arthritis, oral aphthae, conjunctivitis/iridocyclitis

(blank)

Dx: biopsy, neutrophilic infiltrate in papillary and reticular dermis; CBC-elevated white count, elevated ESR,

🗑

Sweet's syndrome skin findings

sudden onset of painful, erythematous indurated papules/nodules with yellowish central discoloration; lesion may coalesce into plaques on head, neck, legs, hands

(blank)

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Acanthosis Nigricans

Divided into 2 Forms: Advanced intenral malignancy, and 2. DIABETICS (dark skin/bad diet)

thickened, velvety, hyperpigmented lesions

(blank)

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Pretibial Myxedema

manifestation of Grave's Disease (hypothyroidism); localized infiltrative scaly thick induration of skin; orange peel texture

(blank)

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Digital Clubbing

association with interstitial lung diease (COPD) and congenital heart diease; softening and periungual erythema of nail beds; buldge of distal phalanx and curvature of nails

(blank)

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Erythema Nodosum

associated with Infections, Drugs, Malignancies, and Inflammatory conditions; panniculitis pink-dusty red firm nodules on pretibial surfaces

(blank)

Tx: underlying cause, NSAIDs, potassium iodide

🗑

Systemic AIDS

Most commonly present with Kaposi sarcoma and yeast candidiasis on tongue

oral hairy leukoplakia - white growth on tongue d/t EBV

(blank)

🗑

Treatment of Lice Infestations

Pyrethrins with Piperonyl Butoxide Solution

(blank)

🗑

Treatment of Mite Bites

oral antihistamines (hydroxizine) 3-4x daily; topical steroids (fluocinonide) for itching; secondary bacterial infx-antibiotics

(blank)

🗑

Black widow toxin

neurotoxin

(blank)

🗑

Brown recluse toxin

hemolytic; necrolytic

(blank)

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Scabies

mite (sarcoptes scabiei) burrows into dermis between fingers, under breasts and on head of penis; tan linear ridges; very itchy

Nodular scabies can form keloids on infants

Kwell lotion, lindane

🗑

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Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.

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Created by: bscaryp