Flashcards in Dermatology Deck (57)
"stuck on", verrucus appearance. Mots common benign tumor in the elderly. Brown or black.
chronic scratching causes skin growth (skin thickening)
Melanoma (always on the boards)
Most common in women, tumor marker S-100, METASTASIZES!
Risk: FHx, fair skin, actinic keratosis, outdoor work, sunburns
Superficial spreading: mc
Nodular: most aggressive
Lentigo: elderly, slow growing
Acral lentigious: most common in dark skin- palms, soles, nails- aggressive
Hyperkeratosis, pankeratosis, acantholysis, acanthosis
Hyperkeratosis: thickening of skin. Warts, corns, callouses.
Parakeratosis: thinning of the granular layer of the skin, like in psoriasis and dandruff
Acantholysis: cells lose their connections (desmosomes). Happens in pemphigus, not pemphigoid.
Acanthosis: diffuse epidermal hyperplasia, happens with insulin resistance
Assymetry, borders, color, diameter, elevation
10% can change to SCC; rough, scaling appearance
Rehydration in: hypovolemia, DKA, etc
Hypovolemia: normal saline (0.9%)
DKA: 5% dextrose in hypotonic solution (they lose glucose , which pulls water out with it; need to rehydrate with both)
Case #1: woman with a large, red bump in her armpit says it came on several days ago after shaving. Dx, tx?
Ddx: *abscess (soft fluctuant mass, comes on quickly); not a sebaceous cyst (sebum from the sebaceous duct builds up, slow)
Tx: I&D with a field block
Tools: #11 scalpel and hemostat
(11s are sharp and pokey, good for poking holes in things)
Field block= diamond-shaped pattern around the lesion you are trying to remove
Aftercare: pack with iodoform gauze
If draining continues, it’s possible that the lesion was multilocular and was not drained completely
Case #2: Postaural, round, 2 cm mass, nontender
Sebaceous cyst- soft & mobile, may feel like a marble
Tx: incision and removal of the entire mass
Most appropriate anesthesia: 1% lidocaine with epi
Remove entire capsule to prevent recurrence
Suture behind the ears, remove 7-10 days (scalp)
Case #3: brown lesion on bra line, 41yo gravid female; 3mm papule with erythematous border; she has a sulfa, penicillin allergy
How to remove? Shave biopsy (want to keep tissue intact for pathologist to examine)
Which anesthetic is safe for 1st trimester pregnancy? Lidocaine
(When in doubt, just use lidocaine)
secondary to trauma, increased fibroblasts, brown-firm like a BB
Epidermal inclusion cyst
Aka sebaceous cyst. Moveable capsule filled with keratin, sebum. Slow-growing.
SubQ nodules that recur. Small, moveable, rubbery.
Aka wen. An epidermal inclusion cyst on the scalp.
DONT CUT IT. Especially cavernous hemangiomas.
Benign cluster of blood vessels.
One of the MC tumor in infants. Many self-resolve.
Cradle cap in children, dandruff in adults. Mildly itchy. Greasy, clear or yellow with scales.
Tx: Se+ sulfide shampoo, Zn+pyrithione
Noninflammatory: open/closed comedones
Inflammatory: pustules, papules (<5mm), nodules (>5mm)
Avoid: B12, iodine
Tx: Zn, CU, Cr, Se, n3, VD, tea tree oil, retinoids, benzoyl peroxide, accurate (suicidality a risk, 2 forms of birth control). Clindamycin, doxycycline, OCPs
Vitaligo vs melasma
Melasma occurs during pregnancy and is hyperpigmentation
Vitaligo is an autoimmune disease that causes hypo pigmentation. Tx with Cu, vitamin D, phenylalanine
round/oval papules or plaques, pink/red/purple on the legs, which ulcerate. Associated with AIDS and HHV8. Excision.
"liver spots", benign, from sun exposure
Lesion of subQ fat, usually anterior shins. Caused by sarcoid, TB, leprosy, histoplasmosis, coccidiomycosis, Crohn's disease, cancer, NSAIDs, or idiopathic.
Elevate legs, compression, wet bandages
Most common HUMAN cancer. SLOW-growing. Mets are rare. May look pearly with a rolled border, teleangelectasia. Sun-exposed areas, upper lip. Highly curable when removed.
Arsenic exposure is a risk.
Nodular (mc), superficial, ulcerative, and pigmented
FAST-growing. May develop from actinic keratosis. Mets are common. Indurated, ulcerated, crusty, may bleed. Lower lip.
Arsenic exposure also a risk
GAS in the DERMIS. Can lead to necrotizing fasciitis, erysipelas (lymph involvement, skin looks like an orange peel).
Tx: Keflex, Trimethoprim-Sulfamethoxazole
red streaking along lymph nodes
strep infection of superficial lymphatics due to immunocompromised, trauma, ulceration or skin injury
chronic venous insufficiency due to DM or being bed-ridden
Genital warts and cervical cancer
Genital warts: HPV 6, 11
Cervical dysplasia: 16, 18, 31, 33
6th disease. HHV6/7. Maculopapular rash with high fever.