Title: Definitions
1Definitions
- Macule color change, flat and smooth (large or
small) - Pustule small circumscribed elevation of skin
filled w/ cloudy white or yellow or green
material - Fissure linear cleft through the epidermis-
rarely into dermis - Cysts space occuping lesion, very sharply
circumscribed, movable and copressible- sac
containing liquid or semi-solid materials - Nodule larger than a papule in all three
dimesions - Agagen hair cycle growth phase lasts 3-4 years
- Vesicle fluid-filled lesion (clear) upto 0.5 cm
- Abrasion superficial skin loss not penetrating
the dermo-epidermal juncture - Urticaria evanescent, often pruritic, irregular
shaped lesions w/in 1hr of eating seafood
2Burns
- 4th degreeDestroys full thickness of skin and
underlying structures - 3rd degree split thickness skin graft- best long
term healing - 2nd degree epidermis and various layers of the
dermis
3Escharotomy
- No distal pulse
- Circumfrential burn full thickness
- Is a longitudinal incision to prevent blood flow
disruption
4Wound healing
- 1st phase Inflammatory phase
- Full- thickness wounds heal form edges
- Maturation phase no net colloagen productions ,
cross-linking occurs, flat more supple scar - Inflammatory phase no collagen, macrophages,
PMNs present - Clean wound less than 100,000 organisms/gram of
tissue - Proliferative phase raised, red scar, high
collogen production - Prevention of infection soft tissue adequated
debridement - Chemical spills must decontaminate first
- Edema beneath burn skin ivntravascular volume
loss death - Strength dermis-fascia
- Prophylactic antibiotics insertion of vascular
prosthesis - Short operation time low wound infections rate
5Malignant fibrous histiocytoma
- Histo atypical spindle cells storiform pattern
bizarre cells
6Superficial spreading melanoma
- Pigmented lesion grows rapidly and starts
vertically - 170 lifetime chance of getting
- ABCD
- Asymmetry of border
- Border (scalloped)
- Color (red, white, blue)
- Diameter (6mm)
7Breslow classification
- 1.51 to 3.99mm deep regional metastasis
incidence of 51
8Basal cell carcinoma
- Pearly, papule blood vessels over surface
- Histo nest of basaloid cellsw/ peripheral
palisading - Rarely metastasize
- Rodent ulcer nodular basal cell carcinoma
- Radiation non surgical candidate, and advanced
lesions - MCC type nodular
- MC skin cancer
- Skin growing pearly papule / nodule, rolled
raised border with central depression - () telangiectasia
- Bleed if scratch
- Lesion brown / black
- DDx SCC v . BCC with biopsy
- Tx imiquimod (aldara)
9Malignant melanoma
- Prognosis level and depth
- Found in skin and conjunctiva
- Dull red, central dork kerotoic plug, firm
10Squamous cell carcinoma
- Marjolins ulcer chronic unstable burn scars
- 2 MC
- Skin mucosal keratocytes
- Chronic sun exposure
- ORAL SCC
- Lower lip,
- Dome shaped crust, firm red nodule
- Watch for metastase
11Vitiligo
- Disfiguring disease of unknown origin
destruction of melanocytes - Woods light help diagnosis
12Senile purpura
- Purple patches, no blancheing
- Corticosteroid use
13Granuloma annulare
- Dorsum of hand
- Changed from discrete nodule to lesion w/
circumferentially raised border, same color as
adjacent skin antifungal does not work
14Seborrheic keratosis
- Uniform brown lesion
- stuck on appearance
- Sign of Leser-trelat
15Senile (actinic) Keratosis
- Premalignant lesion
- Histo hyperkeratosis, acanthois, celluar atypia-
lower dermis - Basophilic degeneration lymphocytic infiltration-
upper dermis - Finely scaly, read to tan, irregular surface
- 5 fluoro-uracil
- Tx chemical peels
- Progress to SCC (earliest stage)
- Burn itch sting
- Tx imiquimod (aldara)
16dermatomyositis
- Gottrons sign (papules over knuckles)
- Heliotrope eruptions and upper eyelid edema
- Poikiloderma
- Pt. has difficulty combing hair, climbing stairs,
getting up from chair
17Seborrheic Dermatitis
- Greasy yellow loose scaly
- Face scalp nasal, labial, eyebrows, glabella,
under arms, butt, groin - Tx
- Ketoconazole
- Green Tea Shampoos
- Scale removal
- Lopox gel / cream
- Seborrheic Blepharitis
- On eyelids
18Lichen Planus
- Saw-tooth patter of epithelium, liquefaction,
band of mononuclear cells - Flexor aspects of wrists and forearms pruritic
flat-topped, polygonal violaceous paules - () Auspitzs sign
- Puruitic
- Oral lesions painful
- Rx hydrochlorothiazide
- 5 Ps
- Pruritis
- Planar (flat topped)
- Polyangular
- Papule
- Pterygium (triangle deformity of nails)
- SSx
19Pityriasis Rosea
- Herald atch
- Collarette of scale with in border not on
outside
20Bullous pemphigoid
- Subepidermal non-acantholytic blister
- Immunofluorescence linear IgG basement membrane
- large tense bullae erythematous bse or normal
skin older pts. - Benign no scar
- Around umbilicus
- Itch and burn
- (-) Nikolsky sign
- DOC predenisone (ID)
21Pemphigus vulgaris
- Tx systemic steroids and steroid-sparing meds
- Intraeptithelial blister
- Immunofluorescence intercellular IgG and
complement - () nikolskys sign
22Mongolian spot
- Dark blueblack pigmented macularpathces
- Childern slate colored, resolve spontaeously
- Location butt and lower trunk
23Psoriasis
- Sharply defined silver-white plaques
- MC elbows / knees
- Histo acanthosis and elongations of the rete
ridges, parakeratosis - Munro abscesses
- Tx etretinate (tegison) - SQ
- Tx PUVA (psoralens-vua radiation)- moa
formation of DNA adduct decreased DNA
replication - Tx Goeckermann Regimen
- 90 effective for 9 months
- UVB old tar
- Tx Ingram regime
- Goeckermann Regimen with anthralen instead of tar
- Tx ethotrexate infiximab (Remicade) IV
infusion Amevive (alafacept) T-cells IV - Auspitz sign (), Koebner reaction ()
- Pustular psoriasis tx systemic retinoids
- Transmitted genetically
- Develop at sight of trauma
- Winter worse, 1-3 population
- Triggers strep / stress / Alcohol / Physical
Trauma (Koebner Rxn)
24Psoriasis
- Types
- Guttate
- Drop like lesions after strep infection
- Localized polymoplanar pustulosis
- Erythordermic
- Psomatic arthritis
- Dx KOH
- Poor self image 30 get arthiritis
- Topical creams make sure get under scaly skin
- Tachofolaxes atrophy, thinning of skin d/t long
term less potentcy - Underlying Cause T-cells mediators with TNF
25Koebner Rxn
- Psorasis
- Lichem planus
- Lichen nitidus
26Molluscum contagiousum
- Umbilicated papules dome shaped pink waxy
- Exhaggerated with ethyl-chloride
- Auto inoculation around the eyes
- Facial lesions in kids
- Poxvirus
- Sexual transmitted
- Spontaneously resolve except immunocompromised
- More common males
- NO significant skin symptoms
- Histo cup-like hyperplasia of epidermal cells
homogeneous ellipsoid inclusions - Usually self-limiting
- Tx aldara
27Erythema multiforme
- Herpes simplex episode multiple target lesions
(palms soles) - Result of hypersensitivity reaction to infection
or medications - Target lesions central necrosis perivenular
inflammation concentric rings with vesicles in
center uticarial plaques - Lesions on soles/palms
- Prodrome HSV outbreak
- Severe Steven Johnson Syndrome
- Even more severe Toxic Epidermal Necrolysis
(TEN)
28Measles (rubeola)
- Diffuse erythematous maculopapular rash face
and trunk - Fever, lethargic, viral ezanthemas
- Koplik spots- mouth
- Conjunctivitis (photophobia)
29Bullous impetigo contagiosa
- Honey-crusted
- Staphylococcus aureus
- Nonbullous impetigo B-hemolytic strep
30erysipelas
- St Anthonys fire
- Acute cellulitis
- Prodrome N/v, headache, fever, chills (24-48h)
31Onychomycosis
- Fungus of nail
- Types
- Superficial white
- Proximal subungual
- PATHOGNUMONIC for HIV
- Distal subungal
- MOST COMMON
32furuncle
- Abscess
- Boil
- Collection of pus
- Hair bearing area
- () scarring
- Pt is usually afebrile
- Tx ID
33Staph Scalded Skin Syndrome (SSSS)
- Ritters Disease
- () Nikolskys sign
34Nikolskys sign
- ()
- SSSS
- Toxic Epidermal Necrolysis (TEN)
- Plemphigus Vulgaris
- (-)
- Bullous pemphigoid
35Erythema infectiousum/ 5ths disease
- Malar rash on cheeks and arms leaves reticulated
pattern - parvovirus
36Hand, foot and mouth disease
- Rash on hands, feet and mouth
- Low grade fever, arthralgia
- Coxsackie virus
- () Tzanck
37Herpes simplex
- Small blisters on erythematous base (above lip)
- Tingling sensation overlying the area
- Recurrent episodes
- Oral acyclovir
- Cluster pustules / vesicles on eryth. Base
- Tzanck smear
- Giemsa Stain
- Giant multinucleated cells
38HZV
- Assoc with cancer and HIV
- HZ opthalimucius
- () Hutchinsons sign
- Lesion _at_ tip of nose
- Ramsey-Hunt syndrome
- CN V and CN VIII
- Ear and ear problems
- Bells palsy
39Varicella
- DDx small pox
- Varicella lesions all different stages all over
body that move from the central to the periphery
40Warts / Verrucae / HPV
- Verruca Vulgaris
- Black dots, common wart
- MCC kids
- Crusted lesion
- Filiform
- Singl soft
- Comlication esophogeal cancer
- Tx imiquimod (aldara)
- Parvovirus (5ths disease)
- Aplastic crises and anemia
41ORF
- Sheep pox
- Swelling fever pain lymphadenitis
- Eryth. With halo
42Roseola infantum
43scabies
- Sever pruritus _at_ night
- Papular lesions interdigitally hands and feet w/
linear burrow - DOC elamite
44Cutaneous Larva Migrans(Creeping Eruptions)
- anklystoma brasiliensis
- Walking barefoot
- Squiggly movement under skin
45Erythrasma
- Woods light coral red fluorescence
- Caused by corynebacterium minutissimum
46Acne
- Starts early in males on nose as micro-comedones
- Monobezone (benoquin) causes propionibacterium
acnes proliferation - Treatment topical- clindamycin
- Stages 1 -open/closed comedomes
- 2- papules/pustules
- 3- nodules / cysts
- 4- scars
- Male female
- Inflamm disease
- MCC microcomodones
47Acne vulgaris
- Nodules and cyst on face and chest
- Treat w/ accutane (is a retinoid)
48Acne keloidalis
- Hard nodules and papules, discrete and confluent
associated with hair loss in same area
49Acne conglobata
- Severe widespread, cicatrices (scars), drainning
sinuses and polyporous comedones
50Rosacea
- Severe flushing of face flushers and blushers
- increase reactivity of capillaries to heat
- telangiectasia
- Inflamed papules and pustules
- Coffee
- Tx tetracycline, sunscreens,, clindamycin green
based cosmetic foundations - Not tx red wine intake
51Hair cycle
- Agagen hair cycle growth phase lasts 3-4 years
52Alopecia Areata
- Oval /round patches of hair loss
- Spontaneously returns
- Family hz
- Exclamation point hairs
- Associated dz hashimotos dz, addisons dz,
vitiligo, hypOparathyroidism - Alopecia
- No new hair after birth
- Follicular plugging DISCOID LUPUS
- Moth-eaten hair loss SYPHILIS
- Trichofillomania
- Kids pulling out own hair
53Traction alopecia
- Braided hair
- Thinning and sparse hairs
54Hot comb alopecia
- Depigmentation and hyperpigmentation and scarring
alopecia vertex of scalp
55Telogen effluvium
- Large loss of scalp hair (clumps or most)
- Pulled out w/ little pressure
- Pervious serious infection (febrile)
56Sclerosis progressive systemic
- Aka scleroderma
- Prognosis not by Raynaunds Phenomenon
- Most common feature is Raynauds phenomenon
57Tuberous sclerosis
- Ash-leaf macules, periungual fibromas, shagreen
patch, adenoma sebaceum - Seizure risk
- Flat red discoloartion of right anterior and
lateral forehead involves the eylids and tip of
nose on the same side
58Seizures
- At risk ash-leaf spots, shagreen patches,
and adenoma sebaceum
59Toxic epidermal necrolysis (TEN)
- Due to drug reaction
- () Nikolsky sign
- Life threatening
- Moist large raw areas crusts then detachment of
skin - PLEMPHIGUS VULGARIS
60Bullous hemorragic cellulitis
- Mediated Tumor necrosis factor alpha
61Acrodermatitis enteropathica
- Serum zinc level
- Failure to thrive
- Malodorous pale, bulky stools
- Hair loss
62Sarcoptes scabiei
- Circumscribed alopecia w/ vesicles
- Hyphae and spores
63Tinea cruris
- Sites groin, thighs, butt, pubic region
- Not scrotum and penis
- Groin NOT genitals
64Tinea Manuum
- Dorsum of hand looks like ringworm
- Palmar hand increase creases
- 2-feet-1-hand syndrome
- () dermatophytid RXN
- DDx granuloma annularia
- (-) KOH
- (-) pruritis
65Tinea Pedis
- MCC dermatophytosis
- Patterns
- Interdigital
- Moccasin
- Acute vesicular
- ()dermatopytid RXN
66Miliaria rubra
- Beach
- Erythematous papulopustular rash on face, neck
and extremities
67Hemangioma
- Soft, raised strawberry colored lesion
- Appeared after birth and has enlarged
68Candidial diaper dermatitis
- Diaper rash- erythema of pernineal region
- creased of butt and proximal thighs
- Satellite papules peripherally
69Candidal intertrigo
- Ddx psoriasis, eczema, bacterial folliculitis,
seborrheic dermatitis - not herpetic eruption
70Miliaria crystalina
- Diffuse scaly rash scalp and eyebrows
71Granulation tissues
- Capillaries an inflammatory cells
72Dermatitis herpetiforms
- A gluten-free diet
- Immnofluorescence IgA dermal papillae
- Microabscesses at tips of dermal papillae
- Duhrings Disease
- Herpes-like
- Hallmark XXXX-pruritic itchy rash
- Assoc with HLA-BA
73Atopic Dermatitis
- Atopy (hayfever eczema)
- () Fam Hx
- Pruritic, recurrent, flexures
- All ages (MC children)
- Comorbid warts, virus, mollus. Contag.
- Stages
- Infantile 2mo-2y
- Childhood 2y-10y
- Adult 10y-adult (only 1 out of 3-4 of cases get
here) - INCREASED IgE
- S. aureus
- Tx muperacin or gentamycin (nostrils)
- HypO / hyperpigmentation inflamm with chronic
irritation - Allergies nickel, neomycin (neosporin)
- ATOPIC KERAToCONJUNctivitis chronic childhood
74Atopic Dermatitis
- Features
- Dennie Morgan Fold
- Keratosis
- HErtoghes sign
- Headlight Sign
- White dermopgraph
- Cataracts
- NOT triple response of Lewis
- Increase risk of
- Staph (Karposis Varicelliform)
- Wart eruption, Moll. Contag.
75Cowdens dz
- Features breast lesions, thyroid goiter, hand
keratosis , facial papules
76Keloids and Hypertophic scars
- Early scars are read and firm initially
- pruritus
- Smooth domed surface
- No cosmetic procedures
- Not usually hyper-pigmented in Afican americans
77UV hn
- Causes cutis rhomboidalis, squamuos cell
carinoma,, poikiloderma of Civatte
Favre-Racouchet syndrome - Does not cause seborrheic keratosis
78Favre-Racouchet Syndrome
- Zits around around eyes in old people raccoon
eyes - Nodular periorbital
- Leads to Ca
79Atopic dermatits
- FHx of asthma, hayfever, or allergic rhinitis
- Diagnosis- IgE levels
- Infantile stage starts _at_ 2mon
- Use cotton clothing
- Conolized by staph. Aureous
- Tx tacrolimus ointment
80Tinea versicolor
- Spaghetti and meatballs
- Hypopigmentation
- Commony recurs
- Repigmentation takes months
- Dx KOH (Spag meatballs)
- Onset scalp
- Tx ketoconazole
81Tinea corporis
- Dermatiophyte infection of body (glabrous skin)
- Ringworm of the body
- Scaly border, clear center that flattens as
border advances - XXX contagious
- Tx topical for 4 weeks
- Redo KOH to confirm
82Tinea Capitus
- MC organism tryophyte tonsorans
- Types
- Seborrheic dermatitis
- Diffuse patches
- Hair losses luster
- (-) KOH, need hair for Dx
- Inflamm type KERION
83Tinea facioli
- Tx topical only
- Flat scaly spots that extend peripherally
84Tinea Barbae
- Hair by fungi falls out
- Hair by bacteria DOES NOT fall out
- Tx systemic antifungals
85Candidal balanitis
- Ddx genital warts, psoriasis, eczema molluscum
contagiosum - A yeast infection frequently found in the
uncircumcised penis
86Candidiasis
- Marker for HIV
- Oral Thrush
- Superinfection d/t wide spectrum antibiotics
- Dx diflucan
87Perleche
- Angular chelitis
- Lip licking / drooling
88Mycosis fungoides
- Nodules neoplastic T-cells (nuclei cerebriform
pattern
89Keratoacoanthoma
- Nodular, central keratin-filled crater
- Fast appearance, rapid growing
- Elderly men leads to SCC
- Smmoth shiny lesion with telangiectasia
90Trichotillamania
- Oval irregular patch of hair loss frontal
scalp, enlarging - broken hairs w/in patch of hair loss
- No telogen hair roots
91Anagen effluvium
- Abrupt hair loss, cytotoxic drug treatment
- Thallium can cause similar problems
- Eventual complete regrowth
92vehicle
- Brings meds into contact w/ skin
- Benefits cooling, protective, emollient,
occlusive - Not subcutaneous atrophy
93Retinoids
- Isotretinoin- severe cystic acne
- Moa mediated via enhanced transcription via
receptors like thyroid/steroid super family - Helps reduce size of sebaceous gland
- Etretinate (tegison) and acitrein (soritane)
psoriasis - Teratogenic potential long term
94Glucocorticoids
- Topical Vasoconstriction, anti-proliferative,
immunosuppression, anti-inflammatory, atrophy of
hypertrophic scars - Bind DNA sequence glucocorticoid responsive
elements - Activation of expression of target gene
- Physiological responses anti-inflammatory
response - MOA in psoriasis- anti-mitotic effects
- Used to inhibit formation of prostaglandins
95Finasteride (propecia)
- Inhibits 5-alpha reductase controls production of
DHT
96Trioxsalen (trisoralen)
- Psoralen used for re-pigmentation (vitiligo)
97Hydroquinone
- Inhibition of tyrosinase enzyme thus inhibiting
melanin formation blocks oxidation of tyrosine
98Immunoflourescence
- Important in diagnosis of blistering disease
99Chemical peels
- Complications pigmentary changes, infection,
prolonged erythema, milia - For pigmentary dyschromias
100Lasers
- Light amplification by stimulated emission of
radiation - Monochromatic, highly collimated, controllable,
coherent - Used for vascular disorders through selective
thermolysis
101sclerotherapy
- For varicose and telangiectatic veins
- Complications cutaneous necrosis and ulceration,
pulmonary embolism, superficial thrombophlebitis,
post-sclerotherampy hyperpigmentation
102Tzanck test
- Air-dried
- Tzanck stain postivie for multinucleated giant
cells tx w/ intravenous acyclovir
103dermatomyositis
- Management Systemic gluco-corticosteroids,
methotrexate, plasmapheresis, rest and
physiotherapy - Internal malig of older patients
- () gorrrus papules
- Photosensitive violacema on knuckles, face, neck,
trunk - Lupus-like skin
104Carcinoid Syndrome
- Episodic intense flushing of face, neck and upper
chest - GLUCAGONOMA SYNDROME
- Alpha-cell tumor 80 malig
- Looks like eczema
- Ssx malaise, wgt loss, polyuria
- Tx excision and topical steroids
105Syndromes
- Sweet Syndrome
- Prodrome URIs
- FM
- Assoc with internal malig
- Gardners Syndrome
- Multiple epidermal cysts (scalp/face)
- Malig intestinal polyps
- Fibrous skin tumors
- Pigemnted ocular fundus
- Plapable osteomas
106Scleredema Diabeticorium
- Non-pitting eryth.
- Woody feeling
107Xanthomas
- Palmar
- Biliary sclerosis DM lipid accmulation
- Striated
- Palmar creases as yelow lines
- Tuberous
- Any age
- 1 hyperLIPID/CHOLESTEROLemia
108Discoid Lupus
- Butterfly rash
- Tests antinuclear antibodies
- Scarring alopecia
- Elevated read plaques w/ firmly-adherent scale
(butterfly rash) - Procainamide- cases a lupus like syndrome
- Systemic lupus false postive syphilis serology
109Chronic cutaneous lupus
- UV light precipitates attack
110Erythema nodosum
- Form of panniculitis (inflammation of
subcutaneous fat), lymphohistiocytic
infiltration, giant cells, eosinophils, NO
vasculitis - Back of leg () TB
- Self limiting
- Deep hot painful tender 1-5cm nodules on PRE
TIBIAL SKIN - Tx naproxsyn
111Lentigo
- Solar lentigo
- Freckle like blotchy
- Lentigo Maligna
- 10-20y exposure (chronic)
- Melanoma in situ
- Asymm irreg border macular lesions face, neck,
dorsal arms - Tx Mohs surgery
- Lentigo Maligna Melanoma (LMM)
- Vertical growth and metastases
112Cutais Rhomboidal Nuchae
- Thick tough skin leathery waxy exhaggeration of
normal skin markings - Pre-ca and Ca
113Compound nevus of spitz
- Children mistaken histologically w/ malignant
melanoma - Spitz nevus spindle-shaped and plump epithelioid
cells w/ irregularities
114Dysplastic nevi
- Multiple members of the family may be affected
115Post op fever
- Look to water, wound, walk, wind
116Erythema toxicum neonatorum
- 1st 3 days of life, resolves 2 weeks
- Firm yellow papule, irregular red base, no
therapy needed - Eosinophils present
117Mal perforans ulcer
- Pts. w/ diabets or leprosy, distal extremites
118Eczama herpeticum
- Multiple crops of vesicles over much of the body
119Rhus dermatitis
- Linear eczematious streaks
120Syphilis
- Secondary syphilis coin- shaped lesion
- Annular, concentric, arcuate coppy penny lesions
on palms/soles/head/neck - Dx FTA Antibodies
121Kerion
- Kerion boggy tender inflamed purulent lesion on
scalp, assoc. w/ posterior cervical adenopathy - Alopecia with pustules
- Scarring perm hair loss
- (-) KOH
- Tx griseofulvin, itraconzole, fluconazole
122Langerhans cell histiocytosis
- Seborrheic-like rash w/ petechial component
123Condyloma acuminatum
- Papillomatous epidermal hyperplasia w/
cytoplasmic vacuolation of superficial
keratinocytes
124CREST syndrome
125Fibroepithelial polyp
- Firobvascular core covered by benign squamous
epithelium
126Porphyria cutanea tarda
- Photosensitivity lease to vesicles and or bullae
may scar - MC porphyria
- Rfs Alcohol
- Tx phlebotomy (decrease iron stores)