Six Derm topics in sixty minutes

Question 1

Topics included in 6-lectures in 60minutes of derm

Answer 1

1. tropical and travel dermatology
2. urticaria (hives)
3. pyoderma gangrenosum
4. black and ethnic skin
5. mycosis fungoides (cutaneous t-cell lymphoma)
6. drug rashes

Question 2

Topics under tropical and travel dermatology

Answer 2

1. bot fly miasis
2. cutanea larva migrans
3. leishmaniasis

Question 3

Etiology of bot fly miasis

Answer 3

• dermatobia hominis
• central and south america
• female bot flu uses mosquitoes to transmit eggs

Question 4

Presentation of bot fly miasis

Answer 4

• tender red nodule with 2-3mm opening
• scalp, face and upper body
• enlarges, drains, more painful, necrotic
• 1 to 1.5cm soft white larvae with spicules

Question 5

Etiology of Leishmaniasis

Answer 5

Parasite, many leshmaniasis species

• transmitted by sandflies
• can be cutaneous, mucocutaneous, systemic
• in the old world, was common in europe, asia and africa
• new world, common in americas = l. mexicana, l. brazilensis, l. peruviana

Question 6

Presentation and treatment of leishmaniasis

Answer 6

• asymptomatic, red-violaceous ulcer with raised edges

- tx –> complicated in US –> CDC typing

Question 7

Etiology of cutanea larva migrans

Answer 7

• creeping eruption
• ancyclostomia braziliense hookworm
• beach, sandy soils, sandbox, children
• hookworm eggs passed from anima feces
• larvae penetrate skin

Question 8

presentation of cutanea larva migrans

Answer 8

• red winding serpigenous tract

- 2 to 4 weeks after returning from a beach vacation

Question 9

Appearance cutaneau larva migrans

Answer 9

Serpiginous lesion usually on the feet

Question 10

Characteristics of Urticaria

Answer 10

Can be acute or chronic

- triggered by foods, medications or other allergens

Question 11

Appearance of urticaria

Answer 11

pruritic, red-pink, polycyclic wheals

• coalesce, migrate, recur
• variations: physical, cold, solar, cholinergic

Question 12

Urticaria associated with:

Answer 12

Thyroid disease, viral infections, occult abscess

Question 13

Urticaria Pigmentosa

Answer 13

.

Question 14

Characteristics of Pruritic Urticarial Papules and Plaques of Pregnancy

Answer 14

Appear on the belly

- look like stretch marks

Question 15

Characteristics of Pyoderma gangrenosum

Answer 15

• inflammatory skin disease, results in ulceration, necrosis
• starts with mild trauma, rapidly expands
• ulcer with undermined border; neutrophilic inflammatory pattern; pathergic response
• Assoc. with inflammatory bowel disease (30%)

Question 16

Appearance of pyoderma gangrenosum

Answer 16

lesions are multiple, ulcerations, necrotic, on the legs, very painful
- can ulcer straight to the bone

Question 17

Treatment of pyoderma gangrenosum

Answer 17

Immunosuppression (steroids, cyclosporine, infliximab)

Question 18

Diagnosis of Pyoderma gangrenosum

Answer 18

Often misdiagnosed as an infection, vasculitis, sweet’s syndrome –> often expensive with surgical debridement

Question 19

How are appearances on ethnic skin different?

Answer 19

Varying clinical appearances, same diseases

• epidemiology is different in different races and ethnicity
• skin types 1-6

Question 20

Skin color and pigmentation changes in black skin color

Answer 20

Epidermis is thicker
More melanin in cells at BM
Hair follicles at acute angle
Larger and more number of melanosomes 
Same number of melanocytes

Question 21

Black or ethnic skin problems

Answer 21

Keloids
Pomade acne
Skin cancers
Traction alopecia
Sarcoidosis - look like anything
Lung involvement

Question 22

Skin Cancer types in ethnic skin

Answer 22

Melanoma
- 10 times greater in whites
- more common in acral sites, looks really dark
Basal Cell Carcinoma
- uncommon in African-Am.
- similar distribution to whites
- most likely pigmented BCC type 
- looks pearly
Squamous Cell Carcinoma
- Most common skin cancer in black skin

Question 23

Mycosis Fungoides (CTCL)

Answer 23

• variant of CTC lymphoma
• systemic lymphoma, presents in the skin
• Sezary syndrome is the systemic erythroderma variant of CTCL, in which the entire body is warm, inflamed and exfoliative.
• Many stages: MF, patch, plaque, tumor

Question 24

Appearance of Mycosis Fungoides

Answer 24

• presents as thin, pink, scaly patches, over the trunk, resemble eczema and psoriasis.
• Sometimes termed “parapsoriasis.”
• Patch and plaque stage CTCL may show annular, round, oval, arcuate, serpiginous elevated plaques, which migrate and expand and ulcerate. Can also be nodules
• appear anywhere and behind legs, face, back of head, ears

Question 25

List of drugs rashes

Answer 25

- Urticarial - morbilliform - fixed drug eruption - acute generalized exanthematous pustulosis - coumadin/warfarin necrosis - pigmentary drug rashes - erythema multiforme minor or major - toxic epidermal necrolysis - photo-toxic drug eruption

Question 26

Appearance of urticarial drug rash and morbilliform drug rash

Answer 26

``` urticarial = polycyclic rings morbilliform = small blotches all over body. Can be pruritic ```

Question 27

Appearance of fixed drug eruption

Answer 27

can look like small blisters, can scar, can look erythematous

Question 28

Locations of Photo-allergic/toxic/induced drug eruption

Answer 28

Areas exposed to the sun - face, hands, feet, above the lip

Question 29

Locations of acute generalized exanthematous pustulosis

Answer 29

Usually in folds of the skin like the neck

Question 30

Warfarin or coumadin necrosis appearance

Answer 30

looks like a big ecchymosis | black and blue

Question 31

Pigmentary drug eruptions appearance

Answer 31

usually above the lips, face and nails

Question 32

appearance of erytherma multiforme

Answer 32

- circular red macules with central darker red lesions - hands and lips, can be on arms - can be big or small - can ulcerate a little - can also look like dark - blisters on the mouth

Question 33

Appearance of steven-johnson syndrome

Answer 33

SJS --> there is sheet like skin and mucosal loss - nearly always caused by medications - starts as high persistent fever, cough, sore throat, conjunctivitis - then rash spreads from body to face and limbs - rash is either macules, targets (like in erythema multiforme) or flaccid blisters - at least two mucosal surfaces are affected

Question 34

What is erythroderma?

Answer 34

Intense reddening of the skin that is preceded by or associated with exfoliation (exfoliative dermatitis) Sezary syndrome is a systemic erythroderma variant of CTCL, in which the entire body is warm, inflamed and exfoliative.

Question 35

Characteristics of toxic epidermal necrolysis

Answer 35

can be wide pruritic macules or flat atypical targets OR it can appear as large epidermal sheets and no pruritic macules - healing without scarring

Question 36

Staphylococcus Scalded Skin Syndrome

Answer 36

Need to exclude this to diagnose SJS and TEN - Need to biopsy to diagnose - Sheets of skin peel off, large blisters/bullae appear - starts around eyes and mouth then spread to other areas of the body