phemigus vulgaris basics
antibodies to desmosomes (desmoglein)
(+) nikolsklys sign
(+) oral mucosa involvement
30-50 y/o
dx and tx of phemphigus vulgaris
dx - biopsy - thin walled blister, cells all over the place
—> IF - throughout slide
tx - steroids then mycophenolate or rituximab
bullous phemigoid
abs against hemidesmosomes
60-80 y/o
(-) nikolskys sign, (-) oral mucosa
dx and tx of bullous phemphigoid
dx - intact epithelium, IF - BM lights up
tx - steroids (systemic), topical (if local)
dermatitis herpetiformis
- path -
- celiac sprue
- IgA deposition in the dermis
every pt with this dz has celiacs disease
dermatitis herpetiformis presentation
vesicular lesions
extensor surfaces
especially the buttock
pt will have celiac symptoms
dx and tx of dermaitis herpetiformis
1st - antibodies to antitransglutaminase, anti endomyseal
2nd - EGD -> biopsy
neutrophilic abscess
tx - avoid gluten
Porphyria cutanea tarda
path - uroporphyrinogen
pt - blisters on sun exposed areas, hairy, easy blistering on the dorsum of the hand
dx and tx of porphyria cutanea tarda
dx - woodlamp - turns coral red
tx - avoid sun exposure
insults that can cause cutanea tarda
hep c
hemachromatosis
recent OCPs
seborrheic dermatitis
autoimmune dz, malazzi
rash, flakes, face - where there is hair = rash
areas without hair will not have rash
tx - selenium shampoo
psoriasis
pathophys
autoimmune T helper cells
abundance of keratinocytes
psoriasis
presentation
erythematous patch with silver scale that bleeds when picked
extensor surfaces, gluteal fold
nail pitting
onchymycosis
dx and tx of psoriasis
dx - clinical
tx - UV light first –> topical steroids
sketchy lymphoma kinda hx and new psoriasis always
biopsy to rule out lymphoma
pityriasis rosea
self limiting
herald patch - oval well demarcated
- white ppl - salmon colored
- dark ppl - hyperpigmented
spares - palms and soles
lichen planus
purple palpable raised
lacy white line network
tx - topical steroids
medications that cause lichen planus
ace- i
thiazides
diuretics
atopic dermatitis
allergies, asthma, atopy,
pt - symmetric licheniefication, AC fossa, popliteal fossa and extensors
tx of atopic dermatitis
avoid trigger –> emollients –> topical steroids
contact dermatitis
type IV HSR
poison ivy, nickel, latex
tx - avoid trigger, topical diphehydramine
stasis dermatitis
path - peripheral edema, skin stretched overtime
edema, erythema, darkens (treebarkish) - bilaterally
tx - diuretics, compression stockings, elevate legs
stasis dermaitis is associated with
malleolar ulcers (stasis ulcers)
hand dermatitis
too much hand washing - health care workers, food industry
tx - stop it dont use harsh soaps
urticaria
pathophys
type I HSR
mast cell degranulation
IgE cross links mat cells –> histamine release –> capillary dilates –> leaky fluid
pt presentation of urticaria
annular red papule that does blanche
dx of urticaria
anaphylaxis –> hypotension –> IM epi
no ^^^ –> steroids + H1 + H2 antihistamines
drug rxn rash
pink morebiliform rash that is symmetric and widespread
(7-14) days after medication
tx - stop offending drug - antihistamines (mild) steroids (mod-severe)
erythema multiforme
path and presentation
path - immune complex mediated
pt - targetoid lesion, acral sights - knees, palms, faces sights
MCC of erythema multiforme
HSV, Drug Rxn, Syphillis
tx of erythema multiforme
topical steroids
steven johnson syndrome
degeneration of basal layer
dusky
<10%
tx - stop all meds –> burn unit –> pray
TEN
same as SJS except >30%
F/U - oral and ophtho involvement
drugs that can cause SJS/TEN
sulfa drugs
PCN
cephalosporins
antiretrovirals
anticonvulsants
staph scalded skin syndrome
staph infection that attacks desmosomes
infant –> febrile illness –> sloughing of skin –> starts in the skin folds
tx of staph scalded skin syndrome
Naficillin
Mole
benign
from melanocytes
R/o - ABCDE
seborrheic keratosis
benign - kertinocytes
large greasy stuck on appearances
dx - if chronic - clinical vs if new - biopsy
keratocanthoma
SCC that spontaneously resolves after 6wks
Kaposi sarcoma
HHV 8
AIDs pt
Purple lesion
tx- treat aids its gets better
actinic keratosis
premalignant lesion of keratinocytes
erythematous lesion with sand paper like scale
yellow to brown color
hx of sun exposure
tx of actinic keratosis
biopsy –> cryoablation –> 5 FU
Squamous cell carcinoma
path - malignant lesion of keratinocytes
MC location - lower lip 90%
flesh colored lesion with ulceration
sun exposure hx
dx and tx of SCC
dx - biopsy
tx - resection - dont be shy as it can metastasize
tinea versicolor
fungus, malezzia
scaly macules of varying color
areas that dont tan
dx and tx of tinea versicolor
KOH prep (sphaghetti + meatballs)
tx - selenium shampoo or ketoconazole
vitelligo
path - AI distinction of melanocytes
pt - sharply demarcated patches that are completely white
dx and tx of vitilligo
dx - woodslamp - bx absence of melanocyte
tx - local high potency topical steroids
—> extensive –> UV light
albinism
path - AR, decrease tyrosinase activity, cant make melanin
pt - white fair hair eyes skin
tx - keep out of sun
prealbinism
melanocytic migration
or
white furlock
ash leaf spots
tuberous sclerosis
congenital defect
check for shagreen patches (blood vessels) or adenoma sebacaie
dx and tx of ash leaf spots
dx - woodslamp –> CT scan
tx - nothing they have MR szs and die young
kid thats albino and has funny smell and orange crystals in diaper
PKU
androgen alopecia
path - 5 Dihydrotestosterone
pt - circular patch that starts at back of head and circles and go forward
tx of androgen alopecia
minoxidil
finasteride
alopecia areata
path - AI destruction of hair follicle
pt - patch well circumscribed can be anywhere exclamation point (hair thins out as it goes down to follicle)
tx of alopecia areata
steroids
tinea capitis
path - fungal infection (trichophyton tonsurans)
pt - well circumscribed patch of hair loss with equal length
dx and tx tinea capitis
dx - KOH prep
tx - oral griseolfulvin
traction alopecia
path - pull hair too tight
pt - woman, braid, ponytail
dx - clinical
tx - none
trichotillomania
path - OCD, PTSD
pt - pulls hair out, compulsion, hair in different length s
dx - clinical
tx - OCD
stages of hair
1) anogen - growth
2) catogen - progression
3) telogen - resting
4) Exogen - shedding
5) back to anogen
Anogen effluvium
takes growing hair to shedding phase
Telogen effluvium
takes growing hair –> telogen phase
Impetigo
path - strep or staph
kid, honey, crusted lesion on face
dx - clinical
tx - amoxicillin (allergy –> clinda)
complication –> glomerulonephritis, No RF
Erisypelas
path - strep
pt - adults, infection of lymphatics, dark red well defined, indurated, climbing up the limb
dx - clinical
tx - Amoxicillin
Acne path
propronium bacteria
hyperkeratinoziation
sebaceous glands
acne ladder tx
1) topical retinoids - comedones
2) + benzyl peroxide - inflammed, pustules
3) + abx (doxy) - refractory, severe
4) Isotenion (teratogenic AF)
tinea pedis and tinea cruris tx
topical antifungals
tinea corporis
body
well described, circumscribed
moderate scaling with central clearing
tx - antifungall topical
onchymycosis (nails)
oral terbenafine
dx - via KOH first
acne vulgaris
pathogenesis
obstruction of sebaceous follicles by sebum –> leads to the proflieration of proprionbacterium
risk factors for acne vulgaris
young pubertal male
cushing syndrome
oily complexion
androgens
rosacea
reddening of face (forehead, nose, cheeks)
30-50 y/o
cacausian women
tx of rosacea
topical metro (gel form)
irritant contact dermatitis
ACUTE
rapid onset
more common
detergents, handwashing (chemical or physical)
allergic contact dermaitis
delayed type IV HSR
poison ivy, nickle, latex
rash appears 1-2 wks after med - 1st exposure
hours to days - subsequent exposures
acute stages of contact dermatitis appearance
erythematous papules and vesicles that are oozing
also maybe edema
chronic stages of contact dermaitis appearance
crusting
thickening
scaling
pityriasis rosea
xmas tree pattern
oval lesions
herald patches - papulosquamous eruption
spontaneously remits 6-8wks
causes of erythema mutiforme
meds (sulfa MCC) PCN
HSV - acyclovir - recurs
lichen planus
pruritic, poygonal, purple, flat toped papules
wrists shins oral mucosa, genitalia,
tx - glucorticoids
most common STD
codyloma acuminata (HPV) 6,11 strains
molloscum contagiosum
self limited viral infection - caused by poxvirus
small papules (2mm to 5mm) with central umbilication
highly contagious
tx of scabies
permethrin
scabies
interdigits of the fingers
extremely pruritic - worse at night
extremely contagious
basal cell carcinoma
most common skin cancer
sun exposure, fair skinned ppl
NOSE = most common site
pearly smooth, pink papule
tx - resection
marjoin ulcer
SCC arising from a chronic wound such as previous burn scar tends to be very aggressive
most important prognostic indicator for melanoma
depth of invasion
melanoma
ABCDE
changing mole MC presentation
MC site is BACK
advanced lesions present with itching and bleeding
vitiligo is associated with
DM
hypothyroidism
Addisons disease
pernicious anmeia
