macule
< 1cm
papule, vesicle
<1cm
bullae
> 1cm, clear, fluid filled
hyperkeratosis
Stratum corneum, e.g. warts, corns, calluses
parakeratosis
psoriasis, dandruff
acantholysis
loss of desmosomes/keratinocytes
acanthosis
diffuse epidermal hyperplasia
Seborrheic keratosis
stuck on
dermatofibroma
secondary to trauma
cryo
lipoma
subQ, movable
Actinic keratosis
electrocautery, 5-FU
Karposi sarcoma
HHV-8, round oval papules on legs and mucosa
BCC and SCC incidence increased with what exposure
arsenic
BCC
Telangectasia surround
only grow where hair grows
Less likely to MET
5-FU, radiation, remove
SCC
Fast growing, crusty
more likely to bleed
Excision, Mohs
Melanoma
> 6mm = worse prognosis
acral- most aggressive
sup spreading - most common
Erysipelas
strep ifxn of sup lymph
demarcated borders
Cellulitis
strep ifxn of dermis
cephalexin, TMP/SMX
Rubella
cranial–>caudal
CLAD
fever
Measles
cough, coryza, conjunctivitis, Koplik spots
cranial–>caudal
**subacute sclerosing panencephalitis
Tinea versicolor
gold hue on woods lamp
Vitiligo
Tx: copper, vit D, phenylalanine
Erythema multiforme
Herpes, Mycoplasma, drugs
Steven Johnson Syndrome
Bactrim, Cephalosporins, Anti-convulsants, NSAIDs, allopurinol
+ Nikolsky sign
Cell-mediated cytotoxic reaction against keratinocytes leading to massive apoptosis
paronychia
cephalexin, compresses
Felon
subQ abscess
antibiotics, may need to filet open, I&D
Pemphigus Vulgaris
+ Nikolsky sign
Anti-Desmoglein antibodies
DEADLY
Methotrex, Cyclosporine, steroids
Granuloma annulare
small flesh papules
Psoriasis
Nail pitting
Arthritis
Rosacea
oral doxycycline
metronidazole
Lichen planus
papules plaques pruritic purple polygonal planar Wickham Striae
Assoc with Hep C
steroids + methotrex/cyclosporine
Brown recluse bite
Necrotoxic
Painful
Erythema Nodosum
lesions of subQ fat (ant shins)
Sarcoid, TB, Leprosy, Histoplasmosis, Coccidiomycosis, Crohn’s Dz
Impetigo
staph or strep
mupirocin
pityriasis rosea
harold patch
post URI
Bullous pemphigoid
Bx: epidermal blisters and anti-basement membrane IgG
Hairy leukoplakia
white painless patches, cannot be scraped off
EBV (HIV pts)
2% glutaraldehyde
10 mins to disinfect
10 hrs to sterilize
Boiling sterilizes..
> 30 mins
Dry heat sterilizes
160C/320F x 1 hr
Autoclave sterilizes
15 psi at 121 C x 15 mins
Disinfect SKin
10% betadine x 3 or 0.4% chlorhexidine gluconate
Don’t suture wounds older than
8-12 hrs (24 on face)
Remodeling
30-40% strength by 3-4 weeks
80% at 1 year
Vertical mattress
easy to evert under tension, better for cosmesis
Horizontal mattress
high tension wounds and fragile tissue
palms/soles
Continuous running
rapid, not cosmetic, less secure; high risk of infection - poor eversion
Absorbable natural
catgut and chromic catgut
digested by enzymes
Absorbable synthetic
polyglactic/vicryl
polyglycolic/dexon
polydioxanone/PDS
hydrolyzed by body
Non-absorbable natural
silk
stainless steel
polyester/polybuster
Non-absorbable synthetic
nylon
polypropylene/prolene
Face/Neck sutures
5-0, 6-0; 3-5 days
Arm/Hands sutures
4-0, 5-0; 7-10 days
Trunk/Legs/Feet/Scalp
3-0, 4-0; 7-14 days
Post-op
keep dry/limit movement x 24-28 hrs
Infections most common
4-10 days post-op
Hematoma
arises after 24-72 hrs
Dehiscence
resuture in 48-72 hrs
Amides
metabolized in liver
Lidocaine
Bupivacaine/Marcaine
Mepivacaine/Carbocaine
Ester
metabolized in peripheral tissues by pseudocholinesterase Benzocaine Proparacaine Cocaine TAC Procaine/Novacaine
Adverse Rxn to anasthetics
bradycardia, cardiac arrest, heart block - treat with high dose 02
allergy/HSN - diphenhydramine if mild, epi + oxygen if severe
autonomic - self-limiting
Uses of Epi in anesthestics
decrease bleeding, oozing
prolongs duration by decr absorption
decreases risk of toxic rxn by decreasing amount of circulating anesthetic
epi dose
1:200,000, max = 0.2mg
antidote = Mag and B6 (for COMT)
Never use epi with…
TCAs, MAO-i, thyrotoxicosis, CVD
NDs cannot perform…
Location- eyes, nose, axilla, goin, po nech Large size/blood supply Deep Young children Pt on anti-coag/bleeding disorder Pulsating lesion Keloid formers Systemic illness/immunocomp
Liquid Nitro for cryo
freeze, thaw, refreeze with 2-3mm zone around lesion for 10-30 s
blister - scab
may depigment
C/I malignancy, Raynauds, sensitive skin
Electrosurgery
Sterile electrode with (+) destroys tissue and coagulates bv
C/I flammable ethanol, metal implants, jewelry
Electrocautery
indirect electrical current. precise. no blood loss
Hyfrecation
Direct, high frequency current. Precise, minimal blood loss
Excisional bx
3:1 elliptical, 30 angle, #15 blade
parallel to Langer’s lines
Incisional bx
narrow elliptic taken within a larger lesion to dx
Shave
diagnostic and therapeutic. healing is rapid with min scarring
Punch (aka trephine)
4mm most common. Full thickness of dermis with min scarring. Traction skin perpendicular to Langer’s lines. must go 1-2 mm beyond borders
11
Puncture abscess, incisions, stabbing, I and D
15
Blunt dissection, excision, trimming, elliptical excisions
10
Like #15 for thick skin
3
disposable
Toothed adson forceps
does not crush skin. for suturing
iris scissors
fine dissection, not for sutures
Metzenbaum scissors
blunt dissection
