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Dermatology: Lecture 5 (Chapter 6, Part 4)

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Stage 1: flu-like symptoms, erythema migrans
Stage 2: carditis, meningitis, neuritis
Stage 3: arthritis, LAD, neurologic dysfunctio
What is the presentation of Lyme's disease?
Bacterial infection w/spirochete Borrelia burgdorferi
Transmitted by deer ticks
What is the etiology of Lyme's disease?
Lyme Disease
Erythema Migrans.

Looks like a small red macule or papule at the site of the tick bite -> it is an expanding red targetoid patch. It can be warm or tender.
What is a Lyme's disease rash called? What does it look like?
Antibody tests (ELISA, Western blot to confirm)
How do we diagnose Lyme's disease?
antibiotics (oral in early stages, IV in later).

Thiamin, massage, heat, ultrasound.
How do we treat Lyme's disease?
Red, edematous, intensely itchy papules or hives erupting up to 10 days after swimming in fresh water
Confined to exposed areas
What is the presentation of Swimmer's itch?
Allergic reaction to schistosomal parasites found in fresh-water lakes
What is the etiology of Swimmer's itch?
Diagnosis: Clinical
Treatment:
1. Self-limiting
2. Antihistamines and topical steroids.
What is the diagnosis and treatment of swimmer's itch?
Swimmer's Itch
Hyperpigmented macules or patches on the face and/or neck

Can be asymptomatic.
What is the presentation of Melasma?
Hormonal link (pregnancy, menopause, OCPs).

It is also aggravated by sunlight.
What is the etiology of Melasma?
Diagnosis: Clinical
Treatment:
May regress w/correction of the hormonal issue (i.e. post-pregnancy, after stopping OCPs)
Hydroquinone cream, azelaic acid, glycolic acid peels
Sun protection
How do we diagnose and treat Melasma?
Melasma
Symmetric, velvety, hyperpigmented plaques on skin folds & knuckles
Asymptomatic
What is the presentation of Acanthosis Nigricans?
Found in patients with obesity, diabetes, endocrine disorders, gastric or pineal gland tumors, +family history
What is the etiology of Acanthosis Nigricans?
Diagnosis: Clinical. Also, screen for diabetes and endocrine disorders.
Treatment:
Treat any underlying disorders
Retinoids, lactic acid cream, glycolic acid peels
How do we diagnose Acanthosis Nigricans? How do we treat it?
Acanthosis Nigricans
Acanthosis Nigricans
Symmetric depigmented macules and patches
Anywhere on body, but hands, feet, knees, face, scalp & genitals are common
What is the presentation of Vitiligo?
Autoimmune destruction of melanocytes
Affected areas may be preceded by trauma
Runs in families
What is the etiology of Vitiligo?
Diagnosis: Clinical, Wood's Lamp, screenf or autoimmune diseases
Treatment:
Topical steroids, calcineurin inhibitors, calcipotriene
Phototherapy/PUVA, laser, surgery, depigmentation
Psychosocial support, vitamins (B complex, C, E, D), ginkgo biloba
How do we diagnose and treat Vitiligo?
Vitiligo
This is hives.

Edematous pink wheals, various shapes and sizes
Individual lesions last <24 hours, but new ones can form until the trigger is removed
Angioedema in some patients
What is the presentation of Urticaria?
Allergic Reaction
What is the etiology of Urticaria?
Diagnosis: Clinical or allergy testing.
Treatment:
Allergen avoidance
Topical steroids
Antihistamines
What is the diagnosis and treatment of Urticaria?
Urticaria
Urticaria
Urticaria
A set of skin findings that can occur with or without systemic lupus
10% of patients with cutaneous lupus go on to develop SLE, after an
average of 8 years
Malar "butterfly rash": erythema sparing the nasolabial folds
Erythematous popular rash on the arms
Photosensitivity
Annular scaly plaques on the upper back, chest, upper arms
Discoid lupus: red, scaly plaques with scarring most commonly on the scalp, face
Diffuse hair thinning
Urticaria
Raynaud phenomenon & digital ulcers
Vasculitis
Livedo reticularis
What is the presentation of Cutaneous Lupus?
Autoimmune disease
Runs in families
Exacerbated by sun exposure
More common in young females,African Americans
Drug induced form
What is the etiology of cutaneous lupus?
Diagnosis: Skin biopsy and screening for systemic disease using ROS,ANA panel.
Treatment:
Depends on the extent
Topical and/or oral steroids
NSAIDS, hydroxychloroquine, retinoids, immune modulators, plasmapheresis
Psychosocial support
Sun protection
How do we diagnose and treat Cutaneous Lupus?
Cutaneous Lupus
Cutaneous Lupus
Cutaneous Lupus
Asymptomatic palpable purpura
Legs, buttocks, & back are most common sites
May have systemic symptoms
What is the presentation of Purpura/Vasculitis?
Immunoglobulins form
in response to infections, drugs, allergens, etc.
They then circulate and deposit in small blood vessels
What is the etiology of Purpura/Vasculitis?
Diagnosis: Diascopy, +/- skin biopsy, testing for blood immunoglobulins.
Treatment:
Remove the causative agent
Topical or oral steroids
Systemic immunosuppressants in more severe/chronic cases
What is the diagnosis and treatment of Purpura/Vasculitis?
Vasculitis
Periodic outbreaks of painful vesicles on an erythematous base
Oral and genital variants are most common
Can also occur on the body (gladiatorum), fingertips (whitlow)
What is the presentation of Herpex Simplex?
Infection with HSV1 or 2
Spreads by direct contact (including sexual)
What is the etiology of Herpes Simplex?
Diagnosis: Clinical; antigen/antibody testing
Treatment: Antivirals such as acyclovir and valacyclovir.
What is the diagnosis and treatment of Herpes Simplex?
Herpes Simplex
Herpes Simplex
Extremely painful, grouped vesicles on a red base in a dermatomal distribution
Prodrome rash neuralgia
What is the presentation of Herpes Zoster (Shingles)
Reactivation of VZV after lying dormant in the DRG following primary exposure
Most common after age 60
What is the etiology of Herpes Zoster (Shingles)?
Diagnosis: Clinical
Treatment:
Antivirals (i.e. acyclovir), steroids
Antidepressants or gabapentin for neuralgia
Spinal manipulation, supplements (lysine, vitamin C, zinc, thymus extract, lemon balm, licorice)
How do we diagnose and treat Herpes Zoster (Shingles)?
Herpes Zoster
Flesh-colored, hyperkeratotic, verrucous papules
What is the presentation of Warts?
Benign epidermal proliferation caused by HPV infection
Spread by direct contact
What is the etiology of Warts?
Diagnosis: Clinical
Treatment:
Many regress without treatment
Topical salicylic acid or imiquimod
Cryotherapy
Intralesional candida or bleomycin
What is the diagnosis and treatment of Warts?
Warts
Firm, smooth, pearly flesh-colored papules with central umbilication
Anywhere on the body except palms/soles
What is the presentation of Molluscum Contagiosum?
Poxvirus infection
Spread by direct contact (including sexual) & fomites
Risk factors: kids, immunosuppressed adults
What is the etiology of Molluscum Contagiosum?
Diagnosis: Clinical
Treatment:
Imiquimod, tretinoin, catharidin
Curettage, cryotherapy, laser
Fish oil, vitamin E, vitamin C, zinc, Echinacea, goldenseal
What is the diagnosis and treatment of Molluscum Contagiosum?
Molluscum Contagiosum
Paramyxovirus infection
Highly contagious
Morbilliform rash which spreads from the head down
Koplik spots, fever, cough, conjunctivitis
What is the presentation and etiology of measles?
Measles
Measles (Showing koplik spots)
Varicella (VZV) infection
Highly contagious, and is more severe in the older & immunocompromised
Papules vesicles crusted erosions
Fever, conjunctivitis, GI symptoms
What is the presentation and etiology of Chicken Pox?
Contagious
Confluent pink macules and fine papules that start on the face & spread to the trunks/extremities
Fever, malaise, runny nose, joint pain, & swollen lymph nodes
Complications include encephalitis, blindness, birth defects
What is the presentation and etiology of Rubella?
Kids infected w/coxsackie virus
Small, painful red vesicles on the palms, soles, and oral mucosa
Fever, sore throat, headache, loss of appetite
What is the presentation and etiology of Hand and Mouth Disease?
AKA erythema infectiosum
Parvovirus B19 infection
Red, maculopapular rash on the trunk and extremities, and
"slapped-cheeks"
Fever, malaise, arthritis in adults
What is the presentation and etiology of Fifth Disease?
Diagnosis: Clinical
Treatment:
Rest, fluids, acetaminophen
Calamine, capsaicin, antihistamines if itchy
Lysine, chamomile, peppermint, aloe, burdock root, lemon balm, licorice, Madonna lily, vitamin A
Prevent spread of infection
What is the diagnosis and treatment of VIral Exanthems?
Recurrent dermatitis in photo- distribution 2 hours-5 days following sun exposure
Polymorphous rash, huge variety of morphologies
Burning, itching, & discomfort
May also have chills and headache
What is the presentation of Polymorphous Light Eruption?
Delayed hypersensitivity reaction to a compound in the skin that is altered by UV light (especially UVA)
Runs in families
Most common in 20-40 y/o females
What is the etiology of Polymorphous Light Eruption?
Diagnosis: Clinical
Treatment:
Sun protection and avoidance
Topical steroids, antihistamines
Hydroxychloroquine in severe cases
What is the diagnosis and treatment of Polymorphous Light Eruption?
Excessive, uncontrollable sweating
Can be localized (i.e. palms, soles, axillae) or generalized
May result in scaling, maceration, cracks/fissures
What is the presentation of Hyperhidrosis?
Overactivity of the hypothalamic thermoregulatory center
What is the etiology of Hyperhidrosis?
Diagnosis: Clinical
Treatment:
Topical aluminum chloride, oral glycopyrrolate
Iontophoresis, botox injections
Surgery for very severe cases (sympathectomy)
What is the diagnosis and treatment of Hyperhidrosis?