Dermatology List of Commons

Terms in this set (63)

Acne often occurs during puberty but can start through 40's. Genetic and hormonal causes; activated by androgens in those who are genetically disposed. More severe and more common in males. Resistant case in females possibly due to hyperandrogenism with PCOS. Follicular plugging, sebum retention, overgrowth of bacteria (Propionibacterium acnes) with release of irritant fatty acids. Skin also regards extra sebum as a foreign body

S/S: open (blackheads) and closed comedones (whiteheads) are hallmark, papules, pustules over face, neck, upper chest/back, shoulders; may be inflammatory or cystic/nodular

D/Dx: rosacea has papules and pustules in middle of face but also has flushing, telangiectasias, and no comedones). Folliculitis causes pustular eruption on face in patients taking abx or with otitis externa but this is due to a gram (-) folliculitis. Miliaria (heat rash), tinea can cause facial pustules. Steroid reaction with systemic or topical facial use. In patients with HIV, folliculitis is common

Tx: do not scratch, reduce insulin resistance with low glycemic diet/weight loss. For comedonal try topical retinoids first such as tretinoin and adapalene (not in pregnancy). Then try benzoyl peroxide (water-based), and then try topical abx - macrolide class (clindamycin and erythromycin). For papular or cystic inflammatory acne (moderate) try topical abx with benzoyl peroxide. Oral abx - tetracycline class (also doxycycline or minocycline). In pregnancy use topicals only (clindamycin, erythromycin, azelaic acid). Steroid intralesional injections (triamcinolone) for papules and cysts. Laser dermabrasion

Complications/Side Effects: abx can cause contraceptive failure. Chronic, flares common with spontaneous remission, resistance can develop
Onset in adolescence or early adulthood. Common in families with atopy (genetic predisposition to allergic IgE mediated disorders such as asthma, allergic rhinitis, and atopic dermatits)

S/S: hyperirritable itchy, red, rough, exudative plaques on flexural surfaces and face, eyelids, neck, upper trunk, nipples, wrist, hands, antecubital/popliteal folds. Acute: vesicles or weeping (may have secondary staph infection). Chronic: lichenified and dry. Black patients lose skin color in lichenified areas. May be widespread. Tends to recur; most have onset in childhood. Onset uncommon after 30 y.o.

D/Dx: seborrheic dermatitis is less pruritic, has frequent scalp and face involvement, greasy and scaly lesions and responds quickly to treatment. Psoriasis has rough red plaques with discrete borders that are covered with white scales. There are no scales in eczema

Tx: use less/milder soap and take shorter/less showers to avoid drying of the skin. Avoid allergens and irritating fabrics. Emollients/lubricants: aquaphor, vaseline, eucerin. Topical corticosteroids: medication strength chosen according to severity but then taper steroid and add emollients as dermatitis clears. Use topicals when acute/subacute and taper to skin care and intermittent use; reserve systemic for severe cases. Start oral prednisone and taper over 2-4 weeks. Use oral antihistamines at night (hydroxazine- "atarax", diphenydramine "benadryl") at bedtime as they sedate. Use oral antibiotics if crusted, pustules, fissures (look behind ear): cefazolin or doxycycline unless MRSA is suspected. Phototherapy can help certain patients with recalcitrant disease with or without coal tar or psoralen with UVA light (PUVA). Use colloidal oatmeal and high potency steroids for weeping lesions. For chronic/dry lesions use high to ultra-high potency, tar preparations, nightly occlusion may help. Use moisturizers and intermittent topical preps for maintenance. Topical NSAIDs to prevent flares

Complications/Side Effects: eczema herpeticum (generalized herpes simplex infection), use acyclovir.
Do not give smallpox vaccincation to eczema patients due to risk of widespread vaccinia infection (skin and systemic manifestations of vaccine)

Prognosis: some resolve in adulthood, others chronic
Due to irritants or allergic response; skin contact. Most common causes are plant based, topical antimicrobials, anesthetics, nickel, rubber, oils/preservatives, and tapes. Location suggests cause

S/S: itching, burning, erythema, patterned/localized, edema/warmth. Allergic dermatitis presents as vesicles with weeping and crusting. Irritant cause redness and scaling but no weeping vesicles

D/Dx: impetigo: (staph or strep infection of skin) is ruled out by gram stain and culture. Atopic dermatitis does not have a history of contact with specific irritant agents. More easily seen as a chronic condition or one that waxes and wanes. Scabies has itchy burrows, especially on finger webs and in wrist creases. It affects penile glands and shaft. Mites, ova and brown dots of feces visible microscopically. Diagnose clinically based on exposure hx and pattern/location. Gram stain/culture if crusted, patch testing if chronic/recurrent

Tx: irritant: use topical corticosteroids. Allergic: high potency topical corticosteroids and taper to medium; calamine or sarna lotion given in between steroid dressing treatments. For subsiding dermatitis use medium potency topical steroids. For severe use prednisone p.o. and taper (12-21 days)

Complications/Side Effects: eczema herpeticum (generalized herpes simplex), use acyclovir. Do not give smallpox vaccincation to eczema patients due to risk of widespread vaccinia infection (skin & systemic manifestations of vaccine)

Prognosis: some resolve in adulthood, others chronic
Common, chronic inflammatory skin disease present mostly on extensor surfaces. Immune mediated (T-lymphocytes and dendritic cells). Obesity worsens psoriasis, genetic component, environmental triggers. Onset: age 20-30 and then 50-50 (bimodal). May occur after strep throat or with HIV. Koebner's Phenomenon: lesions develop at site of minor injury of irritation site. Guttate (many lesions after strep infection), Plaque (most common). May be associated with psoriatic arthritis

S/S: red, sharply defined plaques with silvery scales, scalp scaliness, extensor surfaces (knee/elbow), palms/soles, and nails (pitting on nails or oncholysis).
Distal joint arthritis of only a few sites. Itch may occur and be severe. Often have a pink or red intergluteal fold

D/Dx: atopic dermatitis, candidiasis/intertrigo (skin condition due to macerating effect of heat, moisture and friction, with itch, sting and burning). Cutaneous manifestations of reactive arthritis

Tx: treatment based on body surface area affected (BSA) and psychosocial impact of the disease on patient. Never use systemic corticosteroids to treat flares of arthritis. Phototherapy for patients with numerous small plaques. Tar shampoo or salicylic acid gel for scalp lesions. For larger plaques but less than 3% BSA involved: high/ultra-high potency steroids 2-3 weeks BID, then taper to mid-potency. Vitamin D analog ointments (calcipotriene/calcitriol). Occlusive hydrocolloidal dressings works in 30-40% when used alone. NSAID ointments for groin and facial psoriasis because calcipotriene can cause irritation to groin and face. Generalized Disease: >10% BSA, narrowband UVB phototherapy TID, photo chemotherapy, PUVA. Methotrexate 25 mg weekly for severe psoriasis (monitor liver for cirrhosis) and give with folic acid to prevent the nausea caused by MTX. Acitretin (synthetic retinoid but is a teratogen; wait 3 years to have children) is best for pustular psoriasis; cyclosporine for severe cases. But use with 2nd agent to prevent rebound Newer therapies include tumor necrosis factor (TNF) inhibitors such as infliximab, adalimumab, etanercept for pustular or chronic plaque type. IL-12/23 monoclonal antibodies: ustekinumab in place of TNF inhibitors

Prognosis: Chronic, may be refractory, may develop metabolic syndrome