Professional Documents
Culture Documents
DERMATOLOGY
REVIEW
Danielle Kruger, PA-C, MS Ed
PATIENTS HISTORY
Pruritic
Crusting
Blistering
Painful
- Scaling
- Weeping
- Thickening
- Burning
PATIENTS HISTORY
History of contacts?
Sick contacts, pets or farm animals, travel, obvious irritant
(poison ivy, wool), environmental or occupational exposure
PATIENTS HISTORY
FOCUSED
Diabetes Mellitus
Atopy (eczema, asthma)
Previous skin cancers or other skin problems
History of STDs, HIV
Medications
Allergies
Any relevant family history?
Psoriasis, atopy
Melanoma, genetic conditions
Type
Cyst, macule, papule, pustule, ulcer, vesicle
Color
Erythematous or non-erythematous lesions or bases
Blue, brown, pink, white
Hyperpigmented vs. hypopigmented lesions
Surface features
Crusting, rough, smooth, scaly or verrucous
SKIN LESIONS
Arrangement
Single or multiple
Unilateral, bilateral, generalized or disseminated
Grouped, annular, dermatomal, linear
PSORIASIS
PSORIASIS
PSORIASIS...Most commons
Gender? FEMALE
Age?
MEDIAN AGE = 24
Race?
CAUCASIAN
ATOPIC DERMATITIS
ATOPIC DERMATITIS
ATOPIC DERMATITIS
List four characteristics...
ECZEMA HERPETICUM
Age? 95% diagnosed before 5 years-old
CONTACT DERMATITIS
CONTACT DERMATITIS
CONTACT DERMATITIS
Leading cause of contact dermatitis in the world?
NICKEL
PATCH TEST
TOPICAL STEROIDS
SEBORRHEIC DERMATITIS
SEBORRHEIC DERMATITIS
SEBORRHEIC DERMATITIS
In addition to sebum, this dermatitis is linked to
immunologic abnormalities and activation of
complement related to what agent?
MALASSEZIA
During what season do patients have remission?
SUMMER
LICHEN PLANUS
LICHEN PLANUS
LICHEN PLANUS
What infectious disease should be considered in
patients with widespread or unusual presentations?
HEPATITIS C
LP lesions in which location predispose to cancer?
PITYRIASIS ROSEA
PITYRIASIS ROSEA
PITYRIASIS...Most commons
Gender? FEMALE
Age?
MC = 10-35 years-old
TINEA VERSICOLOR
PITYRIASIS VERSICOLOR
IMPETIGO
IMPETIGO
H&P:
Single 2-4-mm erythematous macule rapidly evolves into
vesicle/pustule, and ruptures leaving honey-colored crusts
Lesions may be localized or extensive; self-inoculation common
Face and extremities are most commonly involved
Bullous impetigo: toxin-mediated erythroderma; top layer of
skin sloughs resulting in large areas of skin loss
Tx: Topical antibiotic (mupirocin) x 5 days for small lesions of nonbullous impetigo, removal of crusts with saline soaks, wound care
Oral Keflex or erythromycin for generalized infection or bullous
impetigo
IMPETIGO
MCC bullous impetigo? STAPH AUREUS
MC age for bullous impetigo?
90% cases in children <2 years
Complication of GABHS-impetigo?
POST-STREPTOCOCCAL GLOMERULONEPHRITIS
FOLLICULITIS
FOLLICULITIS
FURUNCLE/CARBUNCLE
FURUNCLE, CARBUNCLE
CELLULITIS
CELLULITIS
CELLULITIS
MC gender/age? MALES, age 45-64 years
Associated red streaking visible in the
skin proximal to the area of cellulitis is:
ASCENDING LYMPHANGITIS
Cellulitis in infants MCC by:
GROUP B STREPTOCOCCUS
VERRUCA PLANTARIS
VERRUCA VULGARIS
VERRUCA (non-genital)
VERRUCA (non-genital)
CONDYLOMA ACUMINATUM
CONDYLOMA ACUMINATUM
HERPES SIMPLEX
MC gender and race for HSV-2?
BLACK (45%), WHITE (17%)
FEMALE (25%), MALE (17%)
Chronic suppressive Tx
400mg PO BID x 1 year
VARICELLA ZOSTER
ZOSTER SHINGLES
Acute, self-limiting dermatomal vesicular eruption
Etiology: Varicella Zoster virus recrudescence
H&P:
Previous history of chicken pox (VZV)
Pain, tenderness and paresthesias in dermatome
Erythema, grouped vesicles, pustules and crusts
Usually unilateral, may involve adjacent dermatomes
Thoracic most common
In elderly ophthalmic of CN V MC
May cause contacts to develop chicken pox
VARICELLA ZOSTER
Involvement of cranial nerves V, IX and X with
peripheral facial nerve weakness and deafness:
RAMSEY HUNT SYNDROME
Pain that persists for >1 month following
resolution of the vesicular rash of Herpes Zoster:
POST-HERPETIC NEURALGIA
TINEA CAPITIS
TINEA CORPORIS
TINEA PEDIS
TINEA CRURIS
TINEA UNGUIM
ONYCHOMYCOSIS
DERMATOPHYTE INFECTIONS
FUNGAL INFECTIONS
DERMATOPHYTES
MC pediatric dermatophyte infection?
TINEA CAPITIS
MC dermatophyte infection in US and world?
TINEA PEDIS
Wood light (UV light) examination is performed
mainly for which dermatophyte diagnosis?
TINEA CAPITIS
CANDIDIASIS
CANDIDA
H&P:
Genital: pruritic, painful vulvovaginitis, adherent white
plaques and inflamed mucosa, dysuria, dyspareunia
Candida balanitits sexually transmitted to males
CANDIDA
Oropharyngeal: thrush = sore mouth or tongue, white
plaques on erythematous buccal mucosa and tongue
Angular cheilitis fissuring to corners of mouth
Esophageal candidiasis: dysphagia, odynophagia,
retrosternal and epigastric pain, N/V
Hx of chemotherapy, the use of broad-spectrum
antibiotics or inhaled steroids, the presence of HIV
infection or hematological or solid-organ malignancy
Generalized cutaneous candidiasis: diffuse pruritic
eruption over trunk and extremities, increased severity in
the genitocrural folds, anal region, axilla, hands and feet
PEDICULOSIS (LICE)
INFESTATIONS
HIDRADENITIS SUPPURATIVA
HIDRADENITIS SUPPURATIVA
PEMPHIGUS VULGARIS
PEMPHIGUS VULGARIS
PEMPHIGUS VULGARIS
BULLOUS PEMPHIGOID
BULLOUS PEMPHIGOID
BULLOUS PEMPHIGOID
MC age group affected?
Mean = age 65
MOLLUSCUM CONTAGIOSUM
MOLLUSCUM CONTAGIOSUM
MOLLUSCUM CONTAGIOSUM
ACNE
ACNE
H&P:
ACNE
ACNE
MC gender?
ACNE
ACNE ROSACEA
ROSACEA
H&P:
Persistent erythema of central face x 3 months with
associated flushing, inflammatory papulopustular
eruption resembling acne and telangiectasias
Other characteristics: burning and stinging, edema,
plaques, dry and coarse appearance, ocular manifestation
ROSACEA
TYPES:
1)
3)
4)
ROSACEA
What microbe plays a role in pathogenesis?
DEMODEX MITE
MC age group/gender?
30-50 YEARS-OLD
FEMALE
SEBORRHEIC KERATOSIS
SEBORRHEIC KERATOSIS
SKIN TAG
PARONYCHIA
PARONYCHIA
PARONYCHIA
Treatment for acute paronychia?
I + D as needed
PO AUGMENTION OR CLINDAMYCIN
(covers anaerobes)
ERYTHEMA MULTIFORME
ERYTHEMA MULTIFORME
HALLMARK:
Iris or target-shaped lesion: dull-red macule with papule or
vesicle in center, flattens and clears, intermediate pale
edematous ring develops; periphery becomes cyanotic or
violaceous
Rash starts on extremities with centripetal spreading
Negative Nikolsky sign
Symmetrical and acral distribution, affects palms/soles
ERYTHEMA MULTIFORME
MC age/gender?
MC MALES, 2nd-4th DECADES, and CHILDREN
ERYTHEMA MULTIFORME
Common medications causing EM?
ANTIBIOTICS and ANTICONVULSANTS
STEVENS-JOHNSON SYNDROME,
TOXIC EPIDERMAL NECROLYSIS
SKIN CANCER
SKIN CANCER
BASAL CELL
SKIN CANCER
SQUAMOUS CELL
Slow-growing, non-healing firm, indurated, scaly papule/nodule
MC on head, neck, dorsal hands and forearms
MELANOMA
Pigmented macule or plaque
MC superficial spreading malignant melanoma: 60-70%
Acral lentiginous melanoma: MC form in Africans, Asians and
Hispanics, palms and soles
Most important indicator of severity: DEPTH
SKIN CANCER
BASAL
ASYMMETRY, IRREGULAR
BORDERS, COLOR VARIATION,
DIAMETER >6mm,
EVOLUTIONAL CHANGE
ALOPECIA AREATA
ALOPECIA AREATA
ANDROGENIC ALOPECIA
ANDROGENIC ALOPECIA
FELON
Closed space infection of fingertip pulp
Thumb and index finger MC affected
Penetrating injury
MCC = Staph aureus
I+D, PO antibiotics
DYSHIDROSIS
Tapioca vesicles
Pruritus
50% Hx atopy
Tx: steroids
ERYTHEMA
NODOSUM
Anterior tibia
Septal panniculitis
R/O bacterial infection
and sarcoidosis
NEUROFIBROMATOSIS
Caf-au-lait spots
Crowe sign
Lisch nodules
Neurofibromas
PEUTZ-JEGHERS SYNDROME
PAGETS DISEASE
Unilateral
eczematous plaque
Intraductal papilloma
do mammogram!
Surgical removal
VITILIGO
Autoimmune
loss of
melanocytes
Well-defined
depigmentation
Adolescents
DISCOID
LUPUS
Head and Neck
Scarring
Photosensitivity
Tx: steroids
ERYTHEMA
MIGRANS
Annular macule
Lymes disease
Ixodid tick
Borrelia borgdorferi
ALBINISM
Oculocutaneous MC
Absence of tyrosinase
Normal melanocytes
THANK YOU