51 terms

Dermatology: Lecture 2 (Chapter 5 and 6, Part 1)

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Psoriasis Vulgaris
Well-circumscribed papules and plaques with silver scale.

Lesions may itch and bleed and be anywhere. Scalp and extensor surfaces most common.

Nail changes can occur. If joint pain is present, it is psoriatic arthritis.
How will Psoriasis Vulargis present?
Chronic auto-inflammatory disease
T-cell and cytokine mediated
Excessive keratinocyte turnover
Runs in families
Koebner phenomenon
What is the Etiology of Psoriasis Vulgaris?
Clinical diagnosis. But can be confirmed with a biopsy.
How do we diagnose Psorias Vulgaris?
Topicals (emollients, steroids, tar, retinoids,
calcipotriene, salicylic acid)
Oral and injectable immunosuppressants
(retinoids, methotrexate, biologics)
Light therapy
Natural remedies (B12, primrose oil, herbs)
How do we treat Psoriasis Vulgaris?
Psoriasis Vulgaris
Psoriasis Vulgaris
Papules/plaques w/ "greasy" yellow scale
Infants → scalp (cradle cap), diaper area
Adults → scalp, ears, eyelids/brows, nasal
folds > upper back/chest, axillae, groin
Can feel dry/itchy or be asymptomatic
How does Seborrheic Dermatitis look?
Malassezia species proliferation & immune response
Tends to flare in the winter, and with
stress
Link to neurologic diseases, HIV
?Hormonal link
What is the etiology of Seborrheic Dermatitis?
Diagnosis: Clinical
Treatment:
Anti dandruff shampoos
Topical antifungals and steroids
Bath/mineral/peanut oil or Baker's P&S solution to soften scales; vitamin B2 supplement
How do we diagnose and treat Seborrheic Dermatitis?
Seborrheic Dermatitis
Onset in childhood
"Atopic march": eczema → allergies, asthma
"The itch that rashes"
Intensely itchy dry red papules & plaques with crusting, excoriations, and eventually lichenification
Can affect the entire body, but flexural surfaces common
Prone to superinfection
What is the presentation of Atopic Dermatitis like?
Itch-scratch cycle
Strong genetic & allergic component
Family h/o atopy is strongest RF
Aggravated by irritants, allergens, cold
weather, stress, infection
What is the etiology of Atopic Dermatitis?
Diagnosis: Clinical; further testing for allergy will be done.
Treatment:
Emollients, avoidance of allergens & irritants
Antihistamines
Leukotriene inhibitors
Topical steroids and calcineurin inhibitors
Light therapy
Oral/injectable
immunosuppressants
Zinc oxide, primrose oil, coal tar, herbal preparations (chick weed, chamomile etc.), vitamins
How do we diagnose and treat Atopic Dermatitis?
Atopic Dermatitis
Atopic Dermatitis
Atopic Dermatitis
6 P's: Pruritic, purple, planar, polygonal
papules & plaques w/fine scale
Flexor surfaces, back, lower legs, and neck common sites
Can also affect scalp, nails and mucous membranes
-Scalp: scarring alopecia
-Nails: splitting, ridging, thinning, nail loss
-Oral: white, reticular lesions and erosions
What is the presentation of Lichen Planus?
Lichen Planus
Lichen Planus
Exact cause unknown
Linked to Hepatitis C infection
Genetic predisposition, stress, and certain meds also
risk factors
What is the etiology of Lichen planus?
Diagnose: Skin biopsy and test for Hep C
Treatment:
Topical and/or oral steroids
Antihistamines
Retinoids
Light therapy
Homeopathic remedies including minerals and herbs
How do we diagnose and treat Lichen Planus?
Pruritic, hypo/erpigmented, lichenified plaques
Excoriated nodules (prurigo nodularis)
Location: anywhere accessible for scratching
What is the presentation of Lichen Simplex Chronicus?
Excessive rubbing, scratching, and picking
Often related to stress, compulsions
What is the etiology of Lichen Simplex Chronicus?
Diagnosis: Clinical
Treatment:
Stress reduction
Warm soaks & moisturizers
Topical/intralesional steroids
Antihistamines
Superficial X-ray therapy
How do we diagnose and treat Lichen Simplex Chronicus?
Lichen Simplex Chronicus
Pruritic vesicular dermatitis of the hands and feet
Vesicles rupture→ erosions/crust/scale →
hyperpigmentation
Often occurs alongside atopic dermatitis, hyperhidrosis, and/or contact dermatitis
What is the presentation and Etiology of Pompholyx?
Very common
Usually presents in childhood
Pink or hyperpigmented, scaly, pinpoint follicular papules affecting the extremities, buttocks, face
Asymptomatic or mildly itchy
What is the etiology and presentation of Keratosis Pilaris?
Keratosis Pilaris
Diagnosis: Clinical
Treatment:
Dry skin care
Moisturizers
Topical keratolytics (i.e. lactic acid)
Topical retinoids
What is the treatment and diagnosis for Keratosis Pilaris?
Itchy, red papules and plaques, +/- vesicles, erosions, excoriations, & lichenification in chronic cases
Rash is located in an area that has been in direct contact with a specific irritant or allergen
What does the presentation of contact dermatitis look like?
Skin inflammation caused by direct contact with an allergen or irritant
Allergic CD→ i.e. poison ivy, latex or nickel allergy, etc.
Irritant CD→ i.e. harsh soaps, chemicals, frequent hand washing
What is the etiology of contact dermatitis?
Diagnose: Clinical. Also, patch testing for allergen
Treatment:
Allergen/irritant avoidance
Cool compresses, calamine lotion, oatmeal baths
Topical and/or oral steroids
Antihistamines
How do you diagnose and treat contact dermatitis?
Type of mild eczema typically seen
in children in the summer months
Hypopigmented macules and
patches with fine scale affecting the cheeks, forehead
Asymptomatic or mildly itchy

NOTE: Etiology is unknown.
What is the presentation like for Pityriasis Alba?
Diagnosis: Clinical
Treatment:
Disease is self-limited
Dry skin care
1% hydrocortisone
Topical calcineurin inhibitors
What is the diagnosis and treatment like for Pityriasis alba?
Pityriasis Alba
Pityriasis Alba
Self-limited rash, most common in ages 10-35 in the spring & fall
"Herald patch" → smaller lesions erupt 1-2
weeks later (salmon colored papules & plaques w/fine scale primarily on the trunk)
"Christmas tree" distribution on the back
May be pruritic
What is the presentation like for Pityriasis Rosea?
Diagnosis: Clinical. Rule out tinea and secondary syphilis
Treatment:
Resolves without treatment in 4-12 weeks
Dry skin care
If pruritic: zinc oxide, calamine, topical steroids
Light therapy is effective but not really necessary
What is the diagnosis and treatment for Pityriasis and Rosea?
Pityriasis Rosea
Pityriasis Rosea
Pityriasis Rosea
Dry, fissured, scaly skin
May appear as "fish scales"
Severe forms → open fissures vulnerable to fluid/electrolyte losses & infection, which can limit life expectancy
What is the presentation like for Ichthyosis?
Several types; most are due to genetic defects.
What is the etiology of Ichthyosis?
Diagnosis: Can be made clinically. Biopsy and/or genetic testing are confirmatory.
Treatment:
Extreme dry skin care, soaks, wraps
Emollients, keratolytics
Topical retinoids
Camphor, menthol, eucalyptus oil, aloe
Treat fluid/electrolyte issues and infections
What is the diagnosis and treatment for Ichthyosis?
Ichthyosis
Tan to brown, warty, greasy, "stuck on" macules and papules
Very common in the middle aged and elderly
Can occur anywhere on the body except palms, soles, and mucous membranes
What is the presentation like Seborrheic Keratosis?
Benign epidermal tumors
Sign of Lesser-Trelat is concerning for an internal malignancy
What is the etiology of Seborrheic Keratosis?
Seborrheic Keratosis
Seborrheic Keratosis
Considered cosmetic

Options include shave, cryotherapy, electrodessication, laser, etc
What is the treatment like for Seborrheic Keratosis?