Other Dermatoses

Question 1

How does acanthosis nigricans present?

Answer 1

• symmetrical
• hyperpigmented
• velvety, plaques

Question 2

Where does acanthosis nigricans typically present?

Answer 2

• skin folds

- i.e. posterior neck, axilla, under the breast, and groin

Question 3

What are the symptoms of acanthosis nigricans?

Answer 3

• usually asymptomatic

- mild pruritis possible

Question 4

What causes acanthosis nigricans?

Answer 4

• ? factors that stimulate epidermal proliferation, i.e. insulin
• ? friction and sweat

Question 5

What is the treatment for acanthosis nigricans?

Answer 5

• treat underlying dz (weight loss, DM dz)

- will not disappear, just prevent progression

Question 6

How is appearance improved in acanthosis nigricans?

Answer 6

• keratolytics

- topical retinoids

Question 7

What is malignancy associated acanthosis nigricans?

Answer 7

• acanthosis nigricans associated with GI malignancy

- underlying tumor is usually aggressive

Question 8

What is hidradenitis suppurativa?

Answer 8

• disorder of the terminal follicular epithelium in the apocrine gland bearing skin

Question 9

Who does hidradenitis suppurativa affect?

Answer 9

• females > males with family hx

Question 10

How does hidradenitis suppurativa present?

Answer 10

• erythema to painful papules/nodules to abscess formation to discharge to scarring
• patient presents with scarring resulting in dermal contractures
• open comedones
• recurrence

Question 11

How is the hidradenitis suppurativia diagnosed?

Answer 11

• clinical features

- typical lesion with progression, distribution, and reccurence

Question 12

What is the treatment for hidradenitis suppurativa?

Answer 12

• no cure
• surgical excision of glands
• abx
• intra-lesion steroid
• pain management

Question 13

What is a lipoma?

Answer 13

• benign subcutaneous fatty tumor

- discrete rubbery mass, 2-10cm

Question 14

What are lipomas composed of?

Answer 14

• fat cells

Question 15

What is the treatment for lipomas?

Answer 15

• none

- surgical excision

Question 16

What is an epidermal inclusion cyst?

Answer 16

• proliferation of epidermal cells within a circumscribed space in the dermis

Question 17

How does an epidermal inclusion cyst start?

Answer 17

• pimple or ingrown hair

Question 18

How does epidermal inclusion cyst present?

Answer 18

• asymptomatic
• may become inflamed
• cheesy, foul smelling contents when ruptured

Question 19

Describe the appearance of epidermal inclusion cyst

Answer 19

• flesh colored
• firm
• round
• nodule
• size varies

Question 20

What is the treatment for epidermal inclusion cyst?

Answer 20

• none necessary

- excision must get entire lining

Question 21

What is a melasma?

Answer 21

• hypermelanosis of sun exposed skin

Question 22

What is the patient population for melasma?

Answer 22

• females, hormonal influence

- OCP and pregnancy

Question 23

What causes melasma?

Answer 23

• sun exposure

Question 24

What are the symptoms of melasma?

Answer 24

• asymptomatic

- cosmetic concern

Question 25

What is a common distribution of melasma?

Answer 25

- mustache

Question 26

What is the treatment for melasma?

Answer 26

- difficult - sun avoidance - high SPF - avoid hormonal rx - hydroquinone - topical retinoid

Question 27

What is vitiligo?

Answer 27

- acquired pigmentary disorder of skin and mucous membranes | - melanocyte destruction

Question 28

How does vitiligo present?

Answer 28

- depigmented macules or patches - well demarcated - usually asymptomatic - progressive

Question 29

Where does vitiligo present?

Answer 29

- hands, arms, feet, and face | - perioral and periocular

Question 30

What is the issue with treatment of vitiligo?

Answer 30

- more distal lesions harder to tread

Question 31

What is the cause of vitiligo?

Answer 31

- idopathic - ? autoimmune - ? genetic - ? inherent defect in melanocytes

Question 32

How is vitiligo diagnosed?

Answer 32

- clinically, visual | - biopsy

Question 33

What is the common association with vitiligo?

Answer 33

- thyroid disorders | - check thyroid labs

Question 34

What is the treatment for vitiligo?

Answer 34

- no cure - difficult to treat - no standard tx - high SPF - systemic phototherapy - excimer laser - topical therapy - depigmentation therapy - surgical - mental health referal

Question 35

What is urticaria?

Answer 35

- fancy word for hives

Question 36

What is the most common derm presentation to the ED?

Answer 36

- urticaria

Question 37

Describe urticaria

Answer 37

- raised - well circumscribed lesion of erythema and edema - aka wheal - very pruritic

Question 38

Why does urticaria occur?

Answer 38

- release of histamine | - other vasoactive substances in the dermis

Question 39

What is the treatment for urticaria?

Answer 39

- ED for signs of lifethreatening rxn - antihistamines - no systemic steroids - biologic - remove offender - epipen + ED

Question 40

pilondial cyst

Answer 40

- cyst near tailbone at the top of the cleft of the buttocks

Question 41

How does a pilondial cyst start?

Answer 41

- hair punctures skin and becomes embedded (ingrown hair like EIC)

Question 42

What are the symptoms of a pilondial cyst?

Answer 42

- abscess - erythema - pain - discharge

Question 43

What is the treatment for pilondial cyst?

Answer 43

- I&D - abx - gen surg ref for surgical excision

Question 44

What type of reaction is urticaria?

Answer 44

- type I hypersensitivity