erythema, telangiectasias, papules, and pustules with redness, affecting face. Can involve increased vascularity in the eye. Rhinophyma in men (thickened and greasy skin on the nose).
How do you reduce roseacea sx?
avoid alcohol, hot beverages, extreme temperatures, and emotional stressors
Treatment of roseacea?
topical metronidazole, systemic abx for maintenance (tetracycline)
Epithelial tumors that look like Squamous Cell Carcinoma. They grow very very quickly. Dome with central crater containing keratinous material grows over the course of several weeks
Keratoacathoma: Tx: observation. Will likely regress spontaneously
Well demarcated lesions that are either hyper or hypopigmented and range in color from vrown to tan to white. Mostly on the trunk. From several species of malazie group. Part of normal skin flora.
What group does tinea versicolor affect?
Adolescents and young adults
What contributes to tinea versicolor?
Hot/humid weather, excessive sweating, and skin oils help it transform from normal skin to this.
How do you diagnose and treat tinea versicolor?
Dx: KOH prep (spaghetti and meatballs appearance) hyphae and yeast balls
Tx: Oral or topical antifungals. Selenium sulfide lotion can help
chronic, idiopathic inflammatory skin disorder in infants and adults. Seen in oily skin. Seen on scalp, hairline, behind ears, and skin folds. Scaly patches with moderate erythema. Can be mild and look like dandruff, or severe and be yellow oily flakes
Sevorrheic Dermatitis (cradle cap)
Sebhorric Dermatitis treatment
Sunlight, dandruff shampoo, topical ketoconazole, topical steroids
Delayed type IV hypersensitivity reaction?
skin is sensitized 1 to 2 weeks after first exposure. Will develop rash subsequently after the next exposure.
allergic contact dermatitis
contact dermatitis treatment
Topcial corticosteroids or oral steroids
Papulosquamous eruption - Initially "Herald Patches", taht resemble a ring worm (lots of oval/ round patches appear). Then a rash with multiple ovals appears. "Christmas Tree Appearance"
Pityriasis Rosea. commonly remits after 6-8 weeks with no treatment.
Painful, red, subcutaneous, elevated nodules on the front of the tibia. Self limited and resolves in a few weeks.
Erythema Nodosum. Caused by a lot of stuff so get a thorough workup - (strep, sarcoid, TB, syphilis, etc.) and treat the underlying condition.
erythematous macules/papules that resemble target lesions. Can become bullous. Prurtic and painful.
Erythema multiform is caused by what?
Drugs (pcn, or sulfa (MC)) or idiopathic, or HSV
SJS vs TEN
<10% = SJS >30% = TEN
Involves the mucus membranes. Sloughs off respiratory epithelium and may lead to respiratory failure. Nikolsky - But very very bad.
Tx of SJS
IVIG. steroids don't cut it
SJS and Nikolsky +
TEN (Toxic Epidermal Necrosis)
Tx of TEN
IVIG, don't try steroid. They don't work.
Half of all SJS and TEN cases are due to?
Pruritic, Polygonal, Purple, flat topped Papules
Lichen Planus tx with steroids
Subepthelial blisters. Dont rupture easily. Auto immune
AI blistering condition with loss of normal adhesion between cells (acantholysis). Starts in mouth. Blisters can rupture and are painful. Fatal if untreated
How do you treat pemphigus vulgaris?
Steroids, and make sure there's no cancer like non hodgkin lymphoma or CLL
HPV 6 and 11
Caused by pox virus and seen in sexually active young adults and in some kids
Molluscum Contagiosum (highly contagious). Extensive lesions seen if HIV positive
Small papules with central umbilication and relatively asymptomatic. Kids or sexually active young adults. Consider HIV infection.
Superficial Fungi that infect cutaneous epithelium, nails, and hair
Name the 3 dermatophytes
Trichophyton, Microsporum, and Epidermophyton
Examples of dermatophyte infections? and treatments?
Tinea corporis, Tinea capitis, Tinea unguium (nails), Tinea Pedis, Tinea cruris. Topical antifungals (use oral for capitis)
Dermatophyte (ring worm)
Human skin mite. Mites lay eggs in skin and then you develop type IV hypersensitivy to them
Permethrin cream (everywhere head to toe), Lindane (gama benze lotion, don't give to kids), Treat everyone (Scorch the Earth!)
Severe pururtis, linear marks with dark dot at one end, excoritaitons from scratching, and eczematous plaques, crusted papules. May develop secondary bacterial infection.
characteristic linear marks/ burrows, examine scraping under microscope for mites, ova, or scybala
Small, rough, scaly lesions due to prolonged and repeated sun exposure. May be horn like. Precursur to SCC
MC skin cancer
Pearly, smooth papule with rolled edges and surface telangiectasias
Crusting, ulcerated nodule or erosion
Numerous atypical moles with indistinct borders and variations in color.
Dysplastic Nevus Syndrome
If dsyplastic nevus syndrome and family history of melanoma, what's the risk for melanoma?
Dysplastic Nevus Syndrome
Most important indicator of prognosis with melanoma?
depth of invasion
Can melanoma lesions itch and bleed?
How do you diagnose melanoma?
excisional biopsy. Disect lymph nodes if they are involved
abnormal proliferation of skin cells. Trauma to skin can cause exacerbations. Associated with psoriatic arthritis
Well demarcated, erythematous papules or plaques that are covered by a thick silvery scaling on extensor surfaces of body
How do you treat psoriasis?
Topical: Steroids, Calcipotriene and Calcitrol (vit D derivatives)
Oral: Systemic - immune modulating (methotrexate etc),
AD - Hereditary, not malignant. Stuck on skin.
chronic depigmenting condition
What is vitiligo associated with?
DM, hypothyroidism, pernicious anemia, and Addison
caused by release of mediators from mast cells. Increase in vascular permeability. Will see edematous wheals (hives) that dissapear within hours. They blanch under pressure.
Caused by ACE inhibitors. Affects eyelids, lips, tongue, genetalia, hands, or feet. Localized edema causing puffy look. Can be life threatening if obstructs airway.
How do you treat angioedema?
Give eopinephrine for laryngeal edeam or bronchospasm and stop offending agent.
Chondyloma Accumulata - HPV 6 and 11