3 patterns of melasma
solar elastosis: thickened wringled yellowish skin: forehead and back of the neck
wrinkles: cutis rhomboidalis nuchae: sun induced wrkinlig on back of neck
what do snow and ice do?
reflect UVB, ozone absorbs C
what are the parts of natural protection?
stratum corneum and melanin
patient malnourished on INH, long term 5fu, corn diet
what is short wave germicidal, absorbed by ozone and made by germicidal lamps?
tyalmost never burn, deeply pigmented; black
type VI, 15
who burns easily, tans slightly, fair skinned (blond hair)? spf and type?
type II spf 25-30
what are the disadvantages of sunscreen?
can't put on child <6 mos
irritant and allergic: oxybenzone
systemic toxicity: titanium and zinc
what is the treatment for photoaging?
retinoids (3-6 months): not good for wrinkling or telangectasia + wear sunscreen
resurfacing: peel, dermabrasion, laser: scarring/hypopig
tingling, erythema, then burning erythema, vesicles w/in hours, then bullae, linear streaking, and finally desqumation. the hyperpigmentation may last one year. occurs after useing perfumes, celery parsnip, limes, parsley, wild carrot, fig, hogweed, meadow grass. dx treatment?
find and avoid causative agent, sunscreen, PUVA if persists, top steroids
what light is not filtered out by car, how does physical protection work?
uva, scatters and filters light
burns rarely, tans deeply; middle east, asain, black
type V spf 15
fair skinned children w/ exposure to sun can get?
xeroderma pigmentosum: numerous lesions
type 2 oculocutaneous albinism: large jagged lesions
what is one of the difference in solar lentigo from ephelides (freckles)
freckles darkin in the sun, but solar lentigo does not
sometimes burns then gradualy tans moderatelly, mediteranean and hispanic?
type III spf 15
what is the treatment for pellagra?
PO niacin 50-100 mg TID/QID
premedicate w/ ASA prior to attenuate flushing
non scarring prurutic rash that is symmetric. papules coalesce into plaques and confluent edema. Papular type is MC (small papules disseminated), and plaque is 2nd MC, butther are 6 other types. Monomorphic recurrent lesion identical to those in previous eruptoins. typcially in v of chest, legs of women, back of hangs, extensor aspect of forearms. HAS PRODROME OF MALAISE CHILLS HA NAUSEA AND HEALS W/O SCARRING
polymorphous light eruption
treatment for solar lentigo?
none, cryo, topical retinoids, laser, combo
what are the sun induced damages?
texture, vascular, pigmentation, papular
what is the MC light induced skin disease? caused by UVA >UVB that typically occurs in first 3 decades in fair skinned females. it's inversely related to latitude?
polymorphous light eruption
what is a middle wave that produces harmful waves during summer, affects corneum and superficial layers: leads to sunburn, tan, erythema, pigmentation, and inflammation?
venous lake: round pruple ectatic vessels, lower lips and ears
poikiloderma of civatte: red brown reticulated pigmenation w/ telangectaisas and prominent hair follicles, chest and neck
what is a long wave, produced by black light, that constant, deeply penetrates dermis and subQ. Chronic exposure leads to CT degeneration and photoaging and photoallergies
distribution for pellagra?
glove/gauntlet, casal's necklace or cravat, spares the heel, butterfly, mucous membranes
most improant melasma factors?
genetic and UV, but also hormonal, thyroid cosmetic, phototoxic and antiseizure meds: phenytoin
asymptomatic white spots on arms and legs, has seborrheic keratosis, lentigines, and xerosis in same area
idiopathic guttate hypomelanosis
avoid sunlight, sunscreen
elective treatment: tretinoin, low potency roids, LN2, dermabrasion, make up
always burns, never tans, celtic/irish red head? what SPF and type?
type I spf 25-30
how to diagnose and treat polymorphous light eruption (areas covered in winter months vs exposed in sumer months)?
delayed onset, characteristic morphology, h/o disappearnace, bx and immunofluorescence studies to r/o SLE in plaque type
trx: corticosteroids (topical), protection, desensitization w/ phototherapy, Psoralen UVA, antimalarial drugs (hydroxychloroquine)
burns minimally, always tans well, darker hispanics and asians
type IV 15
rules for SPF use?
15-30 x daily
15-30 min before going out
q 2 hrs or after H2O exposure
wear dark loose clothing
CI to niacin treatment?
hypersensitivity, active hepatic dz, peptic ulcer disease, arterial hemorrhage, gout
photoaging papular changes?
favre racouchot: comedones and cysts around the eyes
treatment for melasma
sun protection, hypopigmenting: hydroquinone,
triluma cream (hydroquinone, tretinoin, fluocinolone): 8 weeks more effective than single agents:
chemical peel, later
tretinoin: slow, but good
medications that can cause photoallergic reaction?
celecoxib, doxy, dapsone, hydrochlorothiazide, itraconazole, oral contraceptives, phenothiazines, salicylates, quinidine, sulfonylureas
common in inuit and native americans, onset chilhood, fam hx, intensly itchy papules plaques, noduels that crust. may have actinic chelitis. mc on face. dx treatment
corticosteroids, protection, PUVA, antimalarial, desensitization w/ therapy
niacin deficiency, w/ dermatitis, diarrhea, dementia. begins w/ acute cutaneous phase: bilat, symmetric erythema, sunburn appearance then large bullae and brown scale and black crust. 2nd phase is late cutaneous. lesions are hard rough cracked, blackish and brittle. GOOSE SKIN, LICHENIFICATION, LESIONS HEAL CENTRIFUGALLY