DERM PEARLS

Created by rockwell66 

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Dermatology obj PHT2 hallmarks

Dyshidrosis/ Pompholyx

< 40 y/o (MC) in women
Triad-allergy, rhinitis, atopic
Eruptions follow stress or occur in hot humid weather
Early disease- Pruritic. Small VESICLES IN CLUSTERS W/ TAPIOCA APPEARANCE
Late- Ruptured vesicles
Hands and feet

Asteatotic Dermatitis

WINTER ITCH
CRACKED PORCELAIN OR DRY RIVER BED APPEARANCE
Deep fissures
Typically seen in lower legs progresses from red to fiery red to fissures to weeping
No fever - fever would indicate cellulitis
Excessive chapping and dryness of skin

Lichen simplex chronicus

Lichenification (thick skin w/ distinct borders) due to repetitive scratching and rubbing
Desensitized area MC in women
LOCALIZED ITCH-STRATCH lesions
Well circumscribed thick plaques that are highly pruritic
Nuchal (back of neck) areas and EASILY REACHED(genitals, scalp, ankles, lower legs) common
atopic dermatitis

Seborrheic Dermatitis

Infancy, puberty, young-middle aged adults
Scattered yellowish/brown or gray spots or scaly macules and papules w/ GREASY look
Sticky crusts and fissures behind ears in infancy (CRADLE CAP). Dandruff in adults
HIV/parkinsons

Nummular Eczema

Young adult and Elderly MEN DURING FALL AND WINTER
Small, grouped vesicles forming COIN-SHAPED PLAQUES w/ demarcation
Trunk or extensor surfaces

Atopic Dermatitis

TRIAD-CHILD, ALLERGY, RHINITIS
Pruritus (itchy) dry scaly or non scaly skin (paps and plaques)
MC on flexural surfaces, neck, eyelids, forehead, face, dorsum of hands and feet

Contact Dermatitis

IRRITANT OR ALLERGY CAUSED
Hx OF CONTACT W/ METALS, CHEMICALS, PLANTS
Itching and burning
Diaper rash
SHARPLY DEMARCATED AREA of dry, weeping, eczematous plaques
Chronic- plaques and scaling w/ lichenification. Satellite papules

Serum sickness

Reaction to foreign protein w/ meds
Aspirin, penicillin, streptomyacin, sulfanomides, thiourcils
TRIAD- fever, rash (hives), joint pain
Can have maculopapular eruptions
Late onset 7-10 days
Tx; none, will disappear in 24hrs

Photosensitivity

Increase sensitivity to UV rays brought on by meds
Amiodarone/ Tetracyclines/ Quinidine/ Ibuprofen
Arms and upper chest
Photo patch test (artificial light to different areas for reaction)
Tx; sunscreen/ removal of substance
48 hours after exposure

Environmental (dermitits)

Poison ivy/ oak- ITCH
Pruritic edematous streaks to localized area of exposure
Usually vesicles/ bullae
8-72 hours eruption- sensitized (previous exposure)
12 days-21 days eruption-non sensitized (first exposure)
Repeat exposures worse
Lasts 10-21 days
Tx; washing with soap 15 minutes post exposure
Calamine lotion/ cool wet dressings (burrows tx)- can use topical steroids

Industrial (dermitis)

Dry cracking, scaly, no vesicles to hands
Work related/ occupational incidences most likely
Tenderness and burning
KOH test- R/O tinea
Patch testing
Tx; removal of irritant, mild cleanser, medium topic steroid, vaseline

Cellulitis

Pinna and lower legs
Near wounds, surgical sites
Eyrthema, edema and pain
Full thickness/ stretched appearance
Immunocompromised, alcohol, dm pts
Red and hot to touch
Group A Streptocci
Oral antibiotic therapy

Ecthyma

Deep, untreated form of impetigo
Staphococcus aureus
Deeper erosion of skin
Thickened lesion form of impetigo
Buttocks to legs and feet
Tx; clean and soak, wipe crust/ Topical antiseptic and antibiotic

Impetigo

"Honey crusted" lesion
MC between nose and lip
Staph aureus
Immunosuppressed/ Young/ Poor hygiene
Contagious
Warm, moist climates
Tx; (Bactroban) Mupirocin, Cephalexin (kelfex) for widespread infection (oral antibiotic)

Erythrasma

ARMPITS/ folds (groin as well)
Pink and Brown
Red-pink colour under wood's light
Corynebacterium (swab or scraping)
Antiseptic or Oral antibiotic

Erysipelas

Type of cellulitis w/ lymphatic involvement (extending to nodes) w/ "streaking"
Superficial, raised w/ clearly demarcated margins
Intense, dark erythema/ painful
Acute, inflammatory
Athletes foot can predispose
Common in lower legs but can be in face to ear
Fever
Streptococci
Acute- Penicillin V

Folliculitis

Infected hair follicle, anywhere, shaving, blacks MC
Mechanical (pseudo)- trauma/ tight clothing
Bacterial-Staphylococcus aureus (follicular impetigo)
Pityrosporium- Back and chest. Pink pustules
Steroid folliculitis- multiple papules within 2 weeks of corticosteroid
Hot tub-pseudomonas (trunk)
Tx- avoid shaving, kelfex (extreme), bactroban, oral antibiotics

Furuncles

Uncommon in children
(BOIL) Walled-off firm deep collecting mass of pus afebrile
Tx; warm moist dressing- I&D (Iodoform gauze is used for packing) (drainage is critical)

Carbuncle

Uncommon in children
(Collection of furuncles) Deep abscessed aggregated follicle extremely painful
Multiple heads
febrile
Tx; warm moist dressing- I&D (Iodoform gauze is used for packing) (drainage is critical)

Hemangiomas

Of infancy (Strawberry)- infant/ raised red, purple, blue in first year
Single, firm and rubbery
If obstructing needs to be removed
Can ulcerate or bleed
Oral corticosteroids and laser therapy

Cherry Angioma

Older than 30y/o
Distinct, benign vascular neoplasm
Dome-shaped cherry red and deeper lesion are maroon
Trunk, head, neck
Sudden appearance, malignancy possible
Asymptomatic
Electrocautery, laser, cryosurgery

Port wine

Kool aid stain
Face head most common
Generally resolved after birth
Red purple flat
Tx; laser or cosmetics

Spider angioma

Liver disease/ pregnancy
Pinpoint central red or pink papule due to a dilated arteriole with fine radial branches
Easily blanches/ Pulsation
Shoulder/chest up
Tx; leave alone or laser

Nuchal hemangiomas

Redneck
No tx
Doesn't disappear with age

Venous Lake

Soft, compressible bluish red or dark blue to purple almost bruiselike to lips and ears
Slightly elevated, always to face
Sun damaged skin
Elderly whites
Lower lateral vermillion border
R/O melanoma- no rapid growth or induration
No pulsation-ddx to tortuous labial artery
Reassurance tx
Laser if cosmetically needed

Keloids

Arise from injury
MC in Blacks
Back, chest, trunk
Shiny firm smooth. Raised large pink recurring scarring
Always extend beyond borders of original injury
Tx; ineffective/ leave alone

Seborrhic Keratosis

Benign, common "STUCK ON" waxy appearance epidermal lesion anywhere except lips, palms and soles/ HORN PEARLS
Over 30 y/o
Aereolas common
Flat or raised and surface may be smooth, velvety, or verrucous (alligator)
Variable color/ can vary in color inside lesion
Dermatosis papulos nigra- common in African Americans (30-35%)
R/O melanoma- removals are 85% seborrhic Keratosis

Skin tags

PEDUNCULATED fleshy papules of skinfolds/ from back of neck, genitals, axilla, eyes
Short, broad, narrow stalk
Overweight people
Irritated by clothing-

Bullous Pemphigoid

Rash for several weeks that becomes Red Blistering/ NO NIKOLSKI/HANSON SIGNS
MC in elderly/ autoimmune
Tense fluid filled itchy blisters that burst in 1 week
IgG AB /T-lymphocytes attack basement membrane
Allergy to ones own skin/ autoimmune reaction
Itching- hydroxyzine (sedation in elderly)
Hospital Admission for skin protection (dressings)

Dermatitis Herpetiformis (MULTIPLE LESIONS)

Extremely Pruritic symmetrically distributed ITCHY Blistering
So itchy vesicles get scratched and ulcerate/crust over
Scalp, buttock, extensor surfaces (elbows, knees)
IgA ABGluten intolerance (rye, wheat, barley)
Chronic w/ spontaneous remission
Fatigue/ Abdominal discomfort (poor nutrition)
Biopsy
Tx; Gluten free diet
DAPSONE (itching and burning tx)

Erythema Multiforme Bullosum

Blistering that has progressed from Erythema Multiforme

Pemphigus vulgaris (VULGAR-DIRTY MOUTH)

Rare autoimmune reaction causing blistering and erosion of skin
MC inside mouth/ painful oral erosion (50-70%) blister
MC in Jewish people
NO ITCHING DDX from BULLOUS PEMPHIOGOID (also no nikolski's/hansons sign in bullous)
Easily ruptured/ Nikolski's sign (pulling of dermis causes blister)
Hanson's sign-fluid in blister disperses when pushed
Prednisone (ORAL CORTICOSTEROID) first/ Azathioprine

Chancroid

Painful papule or ulcers to genitals/ swollen lymph glands
One or more Inflamed painful swollen lumps around genital area if untreated (50%)
MC in men/ CHANCER OF PENIS foreskin MC
Traveled- Rare in US (prostitution abroad)
Gram negative clumped bacteria "school of fish pattern"
Haemophilus bacteria
Azithromycin / ANTIBIOTICS

Diabetes

MC for candida and impetigo
Also ulcers of feet and cellulitis
DERMOPATHY- MC/ SHIN SPOTS (scaly at firstred brownish lesion)
BULLAE- RARE Blisters
STIFF SKIN- Thickening, waxy, yellow

Gonrrhea

STD
Painful urethral green creamy discharge
MC no sx with women and anal
Neisseria bacteria
Oral Anitbiotic-Cephtriaxoine

Granuloma Inguinale

STI-genital lesions or perianal area
Start as raised nodules (granulomas)
Erode to form beefy-red velvety heaped-up ulcers
Gradually increase in size
MC in men/ traveled
Donovan bodies to dx
Oral antibiotics- Tetracycline

Sarcoidosis

Encompassing systemic microbacterium/ fungal disease
Plaques, papules, nodules, granulomas, lesions, scars
Black women
R/O keloids, rosacea, pulmonary infection (90% abnormal chest x-ray)
Lupus like presentation (nose bridge discoloration/redness, cheeks)
NO TX- CORTICOSTEROIDS HELP

Scarlet fever

Diffuse sandpaper rash/ Sunburn with goosebumps
Strawberry tongue (R/O KAWASAKI's Most likely Kawasaki with strawberry tongue) lips become dried crusted(ddx)
Circum-oral pallor (flushed face with white around mouth)
Face (red with circum-oral pallor) and trunk
Blanches/ Blotchy skin to trunk
Children over 3 y/o
Crowded conditions (boarding school)/ around people with "strep throat"
Throat swab to dx
PCN or Amoxicilline

Scleroderma (systemic sclerosis or crest syndrome)

Multisystem disease that results in fibrosis and vascular abnormalities
Autoimmune changes
Breakdown of skin, muscle, internal organs
Thickened and tightly bound skin to underlying structures
Crest- slow progression SHINY MASK (can't stop smiling) OR SHINY GLOVES
Diffuse- skin thickening rapid fatal visceral involvement
Ulcerated finger tips
30-40 year old women of child bearing age
ESOPHAGIAL involvement with limited and diffuse (80%)
Raynauds phenomenon- vasospasms (constricting) of fingertips (white to blue to red)
Elevated antinuclear antibodies (ANA)- 90%
No tx; cold avoidance/ topical corticosteroids for itching

Systemic Lupus

MC in young adult black women 20-50 y/o (childbearing)
Autoimmune/ Chronic and recurring inflammatory
Butterfly rash to cheeks
Sun exposure/ Photosensitivity
No cure- Use sunscreen
Tx; Corticosteroids/ Immunosupressants
Antinuclear Antibodies elevated (ANA)

Syphilis

Complex STI
IV drug use/ congenital
Trepineum Pallidium bacteria
Primary-small, firm, red, painless isolated ulcer/chancer to penis, inside vag and anus. Unnoticed
Secondary- Widespread rash. 6 weeks after chancer-Specifically red brownish spot to Palms and Soles w/ fever
Latent- No evidence of disease. Positive antibody test
Tx; PCN injection
RPR test- rapid plasma reaction

Tuberculosis

Lupus vugaris-apple jelly nodules
TB verrucos cutis- purpleish brown-red wart, persistent (years) to extremities and buttocks. Pus from lesion
Miliary TB- HIV/AIDS- small red spots on skin. Necrosis, abcess and ulcers to trunk
Myobacterium bacteria
Chest xray/ Skin biopsy
Tx; AntiTB with Antiobiotics

Stevens Johnson/ Toxic Epidermal Necrolysis

<10% of body surface- SJS
>30% of TEN
Between 10-20 = mixed
2 types
Drug induced-MC sulfa, NSAID (1-3 weeks after drug will have sx)
Infection caused- MC micoplasm (fungal) pneumonia or graft vs host disease
"Flu-like" illness prior; high fever, aches, runny nose, couch, sore throat
Abrupt onset of a tender/painful red skin rash starting on trunk spreading rapidly
Maximum spread by 4 days. The skin lesions may be;
Macules - flat, red and diffuse (measles-like) or purple (purpuric) spots
Targets - as in erythema multiforme
Blisters - flaccid (ie not tense)
Blisters merge to form sheets of SKIN DETACHMENT, exposing red, oozing dermis.
Nikolsky sign is positive in areas of skin redness
SCORTEN severity scale- mortality rate based on number of sx
Skin biopsy
Tx; remove drug causing
Burn pt tx; admission, fluid/nutrition replacement, skin care (antiseptics), sterility (infection), PAIN MGMT

Alopecia areata

Round bald patches spontaneously appearing
Autoimmune- lymphocytes at hair follicles release cytokines that reject the hair
Totalis- (5% of pt) all scalp hair loss
Universalis- (1%) all body hair
Nail disease- (10-50% of people with alopecia)-pitting and ridging
Common in Down Syndrome
No cure/ hair will regrow
Topical steroid/ Steroid site injection to help regrowth

Alopecia Adrogenic

Men- male patterned baldness
Women- balding to midline
Tx; Minoxidal (Rogaine), Propecia (men only)

Hirsutism

Female Glendale disorder
ADROGEN DEPENDENT
Increased hair growth in women (male pattern areas, chin and moustache/ thick on limbs)
Tx; antiandrogen medication or metformin
Removal of hair (bleaching, waxing)

Hypertrichosis

Werewolf disorder
ADROGEN INDEPENDENT/ genetic
DDX; Hirsutism (just in male patterns e.g. chin and cheeks)

Acne rosacea

Face flushing
Vascular- flushing/ redness/ blushing
Telengangiectasia- general thickening (rhynophyma common in men on nose)
Inflammatory- papules and pustules
Over 30y/o
Demodex mites- may play a role
Heat, alcohol, sunexposure
Celtic men
Tx; Avoid cause/ Metronitosol gel/cream

Acne Vulgaris

MC type of acne
Papules or pustular plugged follicles
Increased sebum production
Propiomibacterium acenis
Noninflammatory;
Closed comedones- whiteheads
Open comedomes- blackheads
Uninflamed nodules-cysts
Inflammatory lesions- papules, pustules, nodules (cysts)/ Rupture of cysts leads to scarring
Tx; keep area clean
Non inflamed blocked/blackheads- benzoperoxide
Inflamed nodules/cysts-Isotretinoin
Mild- clean, topical retinoid, azelyacid, salycic acid
Cystic acne-Oral prednisone/ Tetracycline

Perioral Dermititis

Scaly papular eruption around mouth, nose, eyes
MC in young-adult women
Fusom baterium
Routine use of moisturizers, petroleum products, sunscreens and foundation provoke
Wind and heat may worsen
VERMILIAN BORDER
Tx; removal of causing agent
Topical Metronitosol 4weeks laterif unresolved Tetracycline

Hidradenitis Suppurative

DOUBLE COMEDONE
A blackhead with two or more surface opening
Tombstone graveyard
Smelly BEEFY ARMPIT
MC in women-axilla MC site (suspect with women who complain of boil in groin)
Men- perianal and buttocks
Large painful draining mal-odoress abcesses (apocrine blockage)
Tx; large cysts-I&D
Long term oral antibiotics- Tetracycline

Actinomycosis

Chronic slow infection
Bacterial species found in mouth (mucosa), GI tract, female genital tract
Actinomyces genus
Mandibular dental source

Blastomycosis

Wood and soil
Blastomyces dermatidis fungus
Fungal inhalation- Spreads from lungs to other parts of body
Skin lesions common on face, neck, extremities
Raised wart like scars develop of years causing disfigurement

Candidiasis

SATELLITE PUSTULES
MC- C. albicans fungus of human GI tract (found in GI normally during infancy)
Red pustules denotate (peeling layers)cigarette paper like scaling
Balantis-penile/ red swelling, pinpoint red papulesoozing/ foreskin can be hard to retract/clean hygeine
Intertigo-overhanging large skin folds (obese and old saggy breasts). Poor-hygiene w/ warm climate. Macerated red papules with fringe moist scale at border (Ocean waves shape)/ wet dressing treatment w/ antifungal creams
Diaper dermatitis- diaper rash/ bright beefy red scaly plaques w/ inguinal folds/ keep dryHydrocortisone
Immunoseuppressed, infants, elderly
Tx; Antibiotic therapy
KOH culture

Sporotricosis

Sporothrix schenckii
Found in vegetation, twigs, hay, moss, soil that enters a cut
MC outdoor occupation
Lesion at cut site
Nodule along lymph node channels
1st sign is painless bump at site that becomes a pustule
Chronic w/o tx
Long term tx difficult
Potassium iodide tx

Tinea capitis (scalp)

Ringworm of scalp w/ hair loss
Stratum corneum affected
Granulomatous mass
Trichtophytun tonsuranis
MC in children and inner city
Contagious shared household
KOH and cultures might be neg
M.Canis greenwoods light
Types
MC seborrhic w/ patch fine white scales
Inferior Kerion= inferior boggy pustules (abcess)
BLACK DOTS; not inferior, hair broken off
Pustular; pustules and scabs w/o scaling
Brush culture dx
Tx; ORAL grisiofulvin and ketoconazole shampoo
Shampoo;Niboral, selsun

Tinea Corporis (body)

Starts as itchy papule, that becomes a lesion w/ erythematous borders and CENTRAL CLEARING
Warm climates
Wrestlers/ Kids who may have handled an animal/ Highly contagious
Types;
Ring worm; Flat scaly slowing, extended borders, CENTRAL CLEARING
Mild itch or asymptomatic
Deep inferior; intense inferior red, boggy pustular surface
Deeper infection
KOH for normal type
Bacterial/fungal culture for deep
Tx; ANTIFUNGAL CREAMS; clotzrhazole, micanzole/ NOTHING ORAL
Worse type; Griseofulvin

Tinea Cruris (groin)

MC in males (caused from other tineas) in folds of skin in moist conditions (football players)
Plaque like lesion w/ erythrematous borders w/ Central clearing
"jock itch" MC in summer
"HALF MOON SCALING"
Rarely travels to scrotum
Tx; decrease moisture environment/ DRY THE SKIN
Antifungal creams (zoles)

Tinea Pedis (foot)

Due to dermatophyte
"ATHLETES FOOT" MC in locker rooms or tight shoes
Scaling, emaciation, erythema, pruritic, occasional vesicular lesion
Toe webs 4th and 5th digits MC and soles/ yellowish discoloration of toenails
Types;
Interdigit; web spaces
Mocassin; sole, resists tx
Acute vesicular; High inflammation
Webs sole, allergic response
DX KOH, if sever culture
Tx; topical cream; butenafine and oral antifungal meds
Severe; diflucan, lammisil

Onchymosis (nails fungus- TINEA UNGUIUM)

Dermatophyte types
MC; yellow nail separation/ systemic infection-need to kill the root for tx
Nails soft powdery
Break off
DX KOH, culture
Tx; oral antifungal; Terbinafine

Tinea Versicolor (PITYRIASIS)

Young adult, asymptomatic
"small scaly circular papules"
MC in males and w/ upper trunk
Color uniform for individual but vary between people
MC "white color"
DX KOH; "spaghetti and meatballs"
Woods light; "Faint yellow green"
Recurrent/ WONT TAN in those area
Tx topical; selenium sulfide
Severe; Ketoconazole

Melanoma

Assymetrical irreglur borders (diameter greater than 6mm) and growing
Itching and bleeding/ varying colors
Grow from pre-existing moles/freckles
Basal layer (bottom layer produces melanin). Whites have less melanin to absorb UV radiation
MC in whites
Blacks less common
Most likely to develop in those with previous melanoma
Increase in age is ( >60 y/o= 51%) a high determining factor
Types;
(MC) superficial spreading (70-80% of all melanomas)
Nodular-extremities, raised (extend vertically) brown black, rapid appearance, rapid gro
Lentigo- MC males precursor to melanoma, Large flat irregular growing lesion, face and neck
Acral lentiginous- (7%) Males, hands feet and nails of people with (MC) dark skin
Biopsy and complete (full to fat layer) excision for labs
Palpate regional lymph nodes
Deeper the involvement the worse the prognosis

Kaposis sarcoma

Deep purple patches that can darken and thicken/ can become ulcerated
AIDS defining illness
20 times more likely with homosexual males
Types;
Indemic; African Americans and children
Classic-50-70 y/o men/ Eastern European mediteranean men/ slow progression
Immunosuppressive; Organ transplants; Eastern mediteranean men. Remove
immunosuppressive therapy. Radiation chemo for tx
AIDS associated; homosexual males/ head and feet
TX; chemo for all

Lichen planus

Pruritic planar purple patches crossed by fine white lines (wickham straie)
MC in women
Abnormal autoimmune inflammatory reaction (hep C or drugs)
Everywhere but trunk
Painless white streaking in areas other than skin
Tx; sedating antihistamines (pruritis), topical steroids for localized, prednisone for general
85% of cases clear on their own in 18 months

Pityriasis Rosea

Scaly patches or plaques that are oval and dry to chest and back
MC in teenagers and young adults
Herold patch- first lesion (largest) 21 days prior to outbreak
Lasts about 6 weeks may be viral caused
Follows URI (cough)
Trunk MC
Oriented around sagging skin lines (Langer lines) to resemble drooping pine tree
KOH to r/o ringworm (Herald patch can resemble ringworm)
Asymptomatic but if itches use topical steroid cream

Psoriasis

Silver scaly plaque
MC on elbows, knees and scalp
Genetic factor
Waxes and wanes (comes and goes)
Nail involvement with 1/3 of people
Auspitz sign (pinpoint bleed when plaque is removed)
Pustular type on palms and soles
Punch biopsy- thickening of dermis
Topical tar prep

Parisitic pediculosis

Infestation or infection of lice
Well camouflaged and reflect the color of the surroundings- difficult to see.
three types of lice that infest humans.
Pediculus humanus var. capitis - The head louse
Pediculus humanus var. humanus - The body louse.
Phthirus pubis - The pubic louse.
Lice are insects than live on rather than in the body.
Have strong claws, which they use to grasp on tightly to hair shafts or clothing fibers.
Head lice, the most common infestation in humans,
Eggs are called nits.
Pubic lice are smaller- short body resembling a crab.
Premethrin shampoo

Scabies

Tunneling or burrowing infestation
INTENSELY PRURITIC eruptions
MC seen in webs of fingers
Scrape test
Premethrin (lindane) topical
USE LINDANE CAUTIOUSLY FOR INFANTS (NEUROTOXICITY)
Malathion lotion effective in same manner

CHLOASMA (melasma)

Freckled face spots
MC seen in 2nd and 3rd trimester pregnant women
Mask of pregnancy
Tx; minimize sun exposure

Vitiligo

1% of population
Genetic
Destruction of melanocytes
First onset after emotional stress or sunburn
Type A- MC- systemic symmetric deep pigmentation pattern
Type B- limited to one area of body such as extremity
More noticeable in dark skin people
Woods light accentuates
Skin biopsy
LUPUS presents same but with scaling
Tinea versicolor as well (scaling)
Tx; cover up

Actinic Keratosis

Crusty yellow crap/horns on old people
Can progress to squamous cell carcinoma
Sun exposure
Actinic cheliatis- on lower lip/ cryotherapy-precursor to ca
Biopsy to r/o SCC
Tx; sun avoidance, cryotherapy

Dysplastic Nevi

Atypic naevi
Irregular shaped moles that can be mistaken for melanoma but are harmless
Light skinned ind
Show before age 15 y/o
Large 6-15mm
No labs
No tx; cosmetic

Leukoplakia

White patches or plaques in mucosa
Men MC over 40y/o
Can develop into cancer
80% of people who have use tobacco
One to multiple papules turn into plaques over time
Red speckled appearance
Not a diagnosis but a descriptive clinical term
Stop smoking
Biopsy SCC (can progress to SCC)

External otitis

Redness swelling and discharge from ear canal
MC in children "swimmers ear"
Deafness and pain
Pseudomonas bacteria
Can be fungal
Inlfamed auditory canal, Pinna red hot and edematous
Culture
Re-establish natural protective barrier
Gentle irrigation w/ acidic solution

Pruritis ani

Itchy anus above rectum
Wash ass/Stop itching ass/ Remove irritants
Scotch tape test to r/o pinworm

Senile pruritis

Itchy aging skin

Decubitus Ulcers

Reddened skin breakdown of skin (crater like necrosis)
Underlying fascia
Can damage bone, muscle and supporting structures
Osteomyelitis may occur
Tx like iceberg only superficial is seen
Cleanliness dryness wound care
Stage 3 and 4 debridement or surgery
Buttocks or heals

Venous stasis dermatitis

Lack of blood flow causing lesions and ulcers
"Gravitational eczema"
MC in lower legs

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