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Dermatology: Lecture 6

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Gritty, flesh-colored or pink scaly macules or papules
Photo-damaged sites
What is the presentation of Actinic keratosis?
Precancerous (can become SCC)
What is the etiology of Actinic Keratosis?
Diagnosis: Clinical
Treatment:
Cryotherapy
Topical chemotherapy (5-FU), PDT, curettage, chemical peels
What is the diagnosis and treatment of Actinic Keratosis?
Actinic Keratosis
Well-demarcated, round bald patches (non-scarring)
Universalis: involves whole body
What is the presentation of Alopecia Areata?
Autoimmune
What is the etiology of Alopecia Areata?
Diagnosis: Clinical
Treatment:
Topical or intralesional steroids
Minoxidil (Rogaine), anthralin
Systemic immunosuppressants in severe cases
How do we diagnose and treat Alopecia Areata?
Alopecia Areata
Localized pain, erythema, & swelling
Barbed end of stinger lodges in skin
Allergic patients may have anaphylaxis
What is the presentation of a bee sting?
Bee Sting
Diagnosis: Clinical
Treatment:
Remove stinger, apply ice
Aspirin, various folk remedies
Epipen if anaphylaxis occurs
How do we diagnose and treat a bee sting?
Red, scaly plaque
Photo-damaged sites, lower legs
What is the presentation of Bowen's disease?
SCC in situ
What is the etiology of Bowen's disease?
Diagnosis: Skin Biopsy
Treatment:
Excision, ED&C,
cryotherapy, topical
chemotherapy, or laser
What is the diagnosis and treatment for Bowen's disease?
Bowen's disease
Diffuse pruritus & large, tense
bullae
Age usually >50
What is the presentation of Bullous Pemphigoid?
Autoimmune (attack of the
epidermis basement membrane)
What is the etiology of Bullous Pemphigoid?
Diagnosis: Skin biopsy w/immunofluorescence. Monitor for superinfections.
Treatment:
Topical or oral steroids
Systemic immunosuppressants
What is the diagnosis and treatment of Bullous Pemphigoid?
Bullous Pemphigoid
Unilateral, tender, erythematous, scaly papule on helix or antihelix
Can mimic AK/SCC
What is the presentation of Chondrodermatitis Nodularis Helicis?
Repeated mechanical pressure, lack of SQ fat, poor vascularity
What is the etiology of Chondrodermatitis Nodularis Helicis?
Diagnosis: Biopsy to rule out cancer
Treatment:
Pressure off-loading
Topical/intralesional steroids
Excision
What is the diagnosis and treatment for Chondrodermatitis Nodularis Helicis?
Chondrodermatitis Nodularis Helicis
Hyperkeratotic, horn-like papule
What is the presentation of a cutaneous horn?
Can stem from a variety of lesions
(actinic keratosis, SCC, seborrheic
keratosis, wart)
~20% have malignant cells at base
What is the etiology of a cutaneous horn?
Diagnosis: Skin biopsy to rule out cancer
Treatment:
1. Depends on underlying lesion.
What how do diagnose and treat cutaneous horns?
Cutaneous Horn
Pruritic, serpiginous red plaques
Most commonly on the feet
What is the presentation of cutaneous larva migrans?
Hookworms
Spread by walking barefoot in
sand or soil with infected cat or
dog feces
What is the etiology of cutaneous larva migrans?
Diagnosis: Clinical
Treatment:
1. Oral anti-helminthics
2. Topical steroids, antihistamines for itch
What is the diagnosis and treatment of cutaneous larva migrans?
Cutaneous Migrans
Clustered, pruritic, superficial vesicles
which quickly rupture into erosions
Scalp, shoulders, buttocks, elbows, knees
What is the presentation of Dermatitis Herpetiormis?
Gluten allergy (>90% also have Celiac)
What is the etiology of dermatitis Herpetiformis?
Diagnosis: Skin biopsy and autoantibody test
Treatment:
1. Gluten free diet
2. Dapsone, steroids
What is the diagnosis and treatment for dermatitis herpetiformis?
Dermatitis Herpetiformis
Proximal muscle pain and weakness
Reddish-blue patches in
photodistribution, heliotrope eyelid
rash, Gottron's papules on knuckles
What is the presentation of dermatomyositis?
Autoimmune connective tissue disease
May be paraneoplastic
What is the etiology of Dermatomyositis?
Diagnosis:
CK, ANA
Skin and muscle biopsy
Cancer screening
Treatment:
Steroids, systemic immunosuppressants, IVIG
What is the diagnosis and treatment for dermatomyositis?
Dermatomyositis
Bullae and erosions on the skin and mucous
membranes, at sites of friction/minor trauma
Appears at birth or in early childhood
Can lead to severe scarring, contractures
What is the presentation of Epidermolysis Bullosa?
Genetic mutation in cell adhesion proteins
(AR and AD forms)
What is the etiology of epidermolysis Bullosa?
Diagnosis:
Skin biopsy
Genetic testing
Treatment:
Avoiding friction/trauma
Wound care
Managing super-infections
Future: gene therapy?
What is the diagnosis and treatment of epidermolysis Bullosa?
Epidermolysis Bullosa
Warm, tender, erythematous,
edematous plaque
Fever, chills, malaise
What is the presentation of Erysipelas?
Superficial cellulitis; infection of the upper dermis with Strep pyogenes
What is the etiology of erysipeas?
Diagnosis: Because S. pyogenes is difficult to culture, clinical is best.
Treatment:
1. Antibiotics
What is the diagnosis of erysipelas?
Erysipelas
Acute eruption of pink macules ->
papules/plaques -> target lesions with dusky purple centers
Usually starts on hands/feet then spreads; may involve mucous membranes
What is the presentation of erythema multiforme?
Hypersensitivity reaction to infection (HSV, mycoplasma pneumonia) or meds
What is the etiology of erythema multiforme?
Diagnosis: Clinical
Treatment:
Self-limited, no treatment required
aside from symptom support
Topical steroids, antihistamines,
analgesic mouthwash
How do we diagnose and treat erythema multiforme?
Erythema Multiforme
Tender, red, smooth, shiny nodules on the shins
May have fever, joint pain, malaise
What is the presentation of Erythema Nodosum?
Inflammation of the subcutaneous fat
Immune response to various triggers (pregnancy, sarcoidosis, TB, other infections, IBD, certain meds)
What is the etiology of erythema nodosum?
Diagnosis:
Clinical, skin biopsy
Test for underlying disorder
Treatment:
Treat underlying disease
Elevation, compression, NSAIDs
What is the diagnosis and treatment of Erythema Nodosum?
Erythema Nodosum
Smooth, pink or flesh colored,
annular papules and plaques
Usually asymptomatic
What is the presentation and granuloma annulare?
Delayed hypersensitivity reaction in the dermis for unknown reason
What is the etiology of Granuloma Annulare?
Diagnosis: Clinically, occasionally biopsied if unclear.
Treatment:
Self-limited, & tx is usually cosmetic
Topical or intralesional steroids, calcineurin inhibitors, imiquimod, cryotherapy or laser
What is the diagnosis and treatment of Granuloma Annulare?
Granuloma Annulare
Itchy, red, crusty/eroded papules on the
upper back and chest
Most common in elderly males
What is the presentation of Grover's disease?
Unknown, possibly related to
heat/sweat ducts
What is the etiology of Grover's disease?
Diagnosis: Clinical
Treatment:
Keep cool and dry
Topical steroids, menthol
or capsaicin cream
What is the diagnosis and treatment of Grover's disease?
Grover's disease
Asymptomatic 2-5 mm, tearshaped
("guttate") white
macules on the shins &
forearms
Common in women >40 y/o
What is the presentation of Idiopathic Guttate Hypomelanosis?
Unknown. Likely normal aging.
What is the etiology of idiopathic guttate hypomelanosis?
Diagnosis: Clinical
Treatment:
1. Cosmetic (cryo, dermabrasion, topical retintoids)
What is the diagnosis and treatment of idiopathic guttate hypomelanosis?
Idiopathic Guttate Hypomelanosis
Red, purple, or brown vascular
appearing nodules
Seen in HIV/AIDS patients
What is the presentation of Kaposi Sarcoma?
Vascular Neoplasm caused by HHV-8
What is the etiology of Kaposi Sarcoma?
Diagnosis: Biopsy
Treatment:
HAART
Cryosurgery, radiation, excision, laser, intralesional chemotherapy
High morbidity and mortality
What is the diagnosis and treatment of kaposi sarcoma?
Kaposi Sarcoma
Fever, cracked lips, strawberry tongue, conjunctivitis, polymorphous rash, erythema -> desquamation of hands/feet,
& cervical LAD in kids <5
What is the presentation of Kawasaki Disease?
Vasculitis affecting skin, oral mucosa, lymph nodes.

Cause is unknown.
What is the etiology of Kawasaki disease?
Diagnosis: Clinical. Echocardiogram to r/o coronary aneurysm
Treatment:
1. Low dose aspirin, IVIG
What is the diagnosis and treatment for Kawasaki disease?
Kawasaki Disease
Rapidly growing papule/nodule
with central crusted core
RF: elderly, sun damage
What is the presentation of keratoacanthoma?
"Low grade" variant of SCC
What is the etiology of Keratoacanthoma?
Diagnosis: Skin Biopsy
Treatment:
Often spontaneously regress
Surgical excision
What is the diagnosis and treatment of keratoacanthoma?
Keratoacanthoma
Small, darkly pigmented macules
What is the presentation of Lentigines?
Lentigo simplex unknown, usually present at birth
Solar lentigo sunburns, sun damage
Inherited variants (i.e. Peutz-Jeghers)
What is the etiology of Lentigines?
Diagnosis: Clinical
Treatment:
Considered cosmetic
Solar lentigines counsel
on sun protection, monitor
for skin cancers
What is the diagnosis and treatment of Lentigines?
Lentigines
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