Wolfpacc Dermatology

Front 1

Pityriasis versicolor

("tinea versicolor")

Back 1

• Cause: Malassessia/Pityrosporum globosa fungus
  
• Dx: microscope KOH "spaghetti and meatball"
  
• S/S: superficial pale/tan/pink scales;
  
• hypopigment dark skin; hyper- light skin
  
• Treat: ketoconazole (pulse treat w/ oral and then exercise to sweat and coat the body OR just do topical), nizoral shampoo

Front 2

Pityriasis Rosea

Back 2

• Cause: viral infection (HSV-6, etc)
  
• RF: recent URTI, idiopathic
• Pink oval macules resolving over 6 wks
  

- large (can be 1 in+)
- initial itchy herald patch
- moves to "christmas tree" generalized over chest and body

• Treat: Symptomatic Antihistamines

Front 3

Rubella
("German Measles")

Back 3

• Cause: Togaviridae Rubivirus Rubella
• Dx: Rubella IgM Ab
  
• "rash spreads face to body"
• S/S: coryza, low fever, joint pain, cervical lymphadenopathy
• Complications: risk of encephalitis, MANY complications if Congenital Rubella Syndrome

Front 4

Define coryza

Back 4

cold-like symptoms; stuffed, runny nose w/ post-nasal drip

Front 5

Define petechiae

Back 5

pinpoint, round bleeding spots that don't lose color upon pressing

Front 6

Herpes

Back 6

• fluid-filled vesicles
  
• Travel along sensory nerves & reside latent in nerve bodies
• Dx: Clinical; PCR if unsure
  

Front 7

Acanthosis Nigricans

Back 7

• velvety hyperpigmentation
• Reflects possible disease-state:
  
• insulin-resistance (e.g. DM, PCOD),
  
• obesity
  
• Endocrine dysfunction (e.g. hypothyroidism, Cushing's, Addison's, acromegaly)

Front 8

Addison's Disease

Back 8

• Generalized darkening of skin due to ACTH activating melanocytes; darkened gums and buccal membranes.
• Insufficient mineralocorticoid and glucocorticoid production
• 1' - adrenal destruction (autoimmune, cancer, Waterhouse-Friedrichsen hemorrhage, tumor)
• 2' - Impaired steroidgenesis (Congenital Adrenal Hyperplasia, ketoconazole) or increased steroid breakdown (rifampicin)
• 3' - corticosteroid withdrawl
• Hyperkalemia, Hypercalcemia, Hypoglycemia, hyponatremia
• Metabolic ACIDosis
  

Front 9

UV Rays

Back 9

• UVA

- 320-400nm
- more cancer risk -> melanoma and basal

• UVB

- 290-320 nm
- sunburn risk
o Squamous Cell Carinoma risk after a sunburn

• Pyrimidine dimers nick DNA damaging it
  

Front 10

Squamous Cell Carcinoma

(non-ulcerated and Risk Factors)

Back 10

• red area esp. on vermillon border
• sunburn
• smoking
• radiation

Front 11

Squamous Cell Carcinoma
(ulcerated)

Back 11

Front 12

Squamous Cell Carcinoma
(biopsy)

Back 12

• Invasive squamous epithelium
• "keratin pearls"
  

Front 13

Atopic Dermatitis - "eczema"

Back 13

• Itchy macules with erythematous, oozing vesicles
• Spongiosis - histological (microscope) intercellular edema
  
• Can be in response to numerous antigens.
• recurring episodes
• Cause: Type I hypersensitivity (IgE) rxn
• RF: Asthma and allergic rhinitis
  

Front 14

Psoriasis

Back 14

• "silver scales"

- Auspitz sign - bleeding when scale falls off

• Recurrent, genetic susceptibility
• Triggers: stress, trauma, infection, meds (ACEI, NSAIDS, B-blockers, lithium)
• Treat: topical steroids -> Infliximab (r/o TB first & check liver function) -> methotrexate (check liver function

Front 15

psoriatic arthritis

Back 15

• 30% of psoriasis pts
• Sx: similar to RA
• Dx: psoriasis pt with RA sx but (-) RF
  

Front 16

Seborrheic Dermatits

Back 16

• Red, splotches esp. on scalp
• Cradle cap
• Cause: Malassesia/Pityrosporum ovale
• Treat: sunlight -> antifungals/dandruff shampoos
  

Front 17

Skin layer organization

Back 17

basement membrane btwn epidermis and dermis

Front 18

Acne Progression

Back 18

• Propionibacterium acnes
• Treat: clean, dry, benzoyl peroxides (OTC)
• Severe: Vit A (retinoic acid) - birth defects
  

- check for pregnancy and prescribe contraceptive

Front 19

Hidradenitis Suppurativa

Back 19

• Pilosebaceous - follicle and sebbaceous glands clog causing:
  
• Abcess-like structures
  
• Axilla, groin, perineum
• Treat: warm compress & stop deodorant
  
• Severe: Drain with needle

- Don't Incise and Drain (I&D)

Front 20

Impetigo

Back 20

• red/yellow, crusty sores near nose & mouth
• "honey colored crusted lesions"
• "fluid filled vesicles" - R/O herpes & varicella
• Cause: S. aureus/pyogenes
• Treat: Abx (topical & oral)

Front 21

Erysipelas

Back 21

• swollen red plaques w/ fever and chills
  
• S. pyogenes
• Treat: oral Abx -> IV Abx
  

Front 22

Cellulitis

Back 22

• deep subcutaneous (dermis & subQ fat) infection usually secondary to a cut
  
• Treat: Abx
  

Front 23

Folliculitis

Back 23

• Hair follicle inflammation
  

Front 24

Furuncle

Back 24

• a "boil"
  
• deep foliculitis with infection & pus
• commonly S. aureus
• Treat: warm compress -> lance -> Abx
  

Front 25

Carbuncle

Back 25

• furuncle involving many hair follicles
  

Front 26

Scarlet Fever Info

Back 26

• GAS erythrogenic toxin
• Can progress to glomerulonephritis and endocarditis (which can lead to mitral prolapse)
• Linear petechiae that blanch, red cheeks, strawberry tongue, and sandpaper skin.
• Sore throat, fever, hallucinations
• Treat: Abx
  

Front 27

Scarlet Fever Rash

Back 27

red cheeks and rash ("sandpaper skin")

Front 28

Scarlet Fever Tongue

Back 28

"Strawberry Tongue"

Front 29

petechiae

Back 29

pinpoint, round bleeding spots

Front 30

Erythema Nodosum

Back 30

• Inflammation of fat cells under skin - "red lumps on shins"
• Acute - occur w/ fever and illness
• Immunologic/Granulomatous
  - treat underlying disease

- Behcet's, Inflammatory Bowel Disease, Sarcoidosis

Front 31

Lyme Disease

Back 31

• Borrelia Burgdorferi
• Ixodes scapularis
• Early erythema migrans (pic)
  

- fever, fatigue

• Mid: CN 7 - Facial palsy's; meningitis; encephalitis (mood)
  
• Late: cognitive, mental dx, gait abn, numbness, tingling,
• Treat: Amoxicillin or doxycycline (avoid sun/inactivates estrogen birth control)
  

Front 32

Varicella

Back 32

• Chicken pox
• Herpes Zoster (shingles) - dermatomal rash, burning pain
  
• Dx: Vesicle microscopy (keratin inclusions and multinucleated giant cells)
  
• Treat: acyclovir (mupirocin for secondary bacterial skin infection if needed)
  
• Pregabalin (newer gabapentin/neurontin) to treat post-shingles' neuralgia
  

Front 33

Rubeola

"Measles"

Back 33

• Highly contagious
• coryza
  
• conjunctivitis
  
• cough
  

Front 34

Molluscum Contagiosum

Back 34

• Dome shaped w/ white spot in middle

• Usually children
  
• pox from direct/sexual contact
• Treat: often go away with age or removal (salicylic acid, cryo, electrosurg, needle curettage)
  

Front 35

Pemphigus Vulgaris

Back 35

• Usually child; include mouth
  
• Autoantibodies against Desmosomes
  

- Nikolsky + - slough/rupture epidermis at with rub
- Dx: C3 and IgG to desmosomes in epithelium

Front 36

Bullous Pemphigoid

Back 36

• Usually elderly; usually no mouth involvement
  
• Intact blisters
• Antibodies to deeperhemidesmosomes of basement membrane
• Dx: C3/IgG to hemidesmosomes in basal membrane
  

Front 37

Scabies

Back 37

• Contagious - bedding
• Sarcoptes scabiei
• Commonly interdigital
• Treat 5% permethrin cream
  

Front 38

Seborrheic Keratosis

Back 38

• Benign epidermal
• Often elderly
  
• "Pasted to skin"
  

Front 39

Actinic Keratosis

Back 39

• Scaly pink macules
• Cause: sun exposure
• premalignant -> Squamous Cell Carcinoma
  
• always biopsy
• Treat: 5-fluorouracil cream
  

Front 40

Basal Skin Cancer

Back 40

• Most common
  
• Pearly pink papule
• "invasive spindle cells surrounded by pallisadal basal cells"
  

Front 41

Squamous Skin Cancer

Back 41

• See other
• Actinic Keratosis -> Squamous Cell Carcinoma
• Often Ulcerate
  

Front 42

Melanoma

Back 42

• From melanocytes - dark coloration
  
• SNAL

- Superficial melanoma
- Nodular melanoma
- Acral Lentiginous melanoma
- Lentig maligna melanoma

• 60% BRAF600 mutation (to Glutamic acid from Val)
  

Front 43

Melanoma Signs pic

Back 43

• assym - 1/2s don't match
• ragged border
• color varies
• diameter larger than eraser
• evolve bigger
  

Front 44

Male pattern baldness

Back 44

• Cause: high dihydrotestosterone
• Sx: loss of hair at vertex and anterior scalp
• Rx: finasteride - block dihydrotestosterone by inhibiting 5 alpha reductase
  

- see also prostate cancer

Front 45

vitiligo

Back 45

• Cause: unknown - RF is other autoimmune
  
• Sx: linear loss of epidermal melanocytes
  

Front 46

cherry hemangioma

Back 46

• benign proliferation of blood cells
• older = more cherry hemangiomas
  

Front 47

strawberry hemangioma

Back 47

• Raised red lumpy area in infants and young children
  
• fade on their own
  

Front 48

hemangioma

Back 48

Benign neoplasm (overgrowth bundle) of blood vessels found in children <2 y.o

• EX: cavernous hemangioma (non-superficial/deep hemangioma)
  
• exception: cherry hemangiomas are more common the older you get
  

Front 49

spider angioma

Back 49

• bright red central papule with branching vessels
• Cause: increased estrogen - cirrhosis, pregnancy, birth control, hormone replacement
• often associated with liver damage
  

Front 50

glomangioma (benign glomus tumor)

Back 50

• Rare, benign tumor found under the nail bed
• From dermal glomus bodies (thermoregulators shunt blood )
  

Front 51

angiosarcoma

Back 51

• Malignant
• Endothelial overgrowth (originating from endothelial cells from vessel walls of lymph and blood vessels)
• Sx: firm violet nodules
• RF: lymph resection (e.g. former mastectomy patient)
  

Front 52

Xanthelasmas

Back 52

• cutaneous lesion with lipids (on microscopy)
• commonly on eyelid
• associated with primary hyperlipidemia and secondary hyperlipidemia (biliary cirrhosis, cholecystitis)
  

Front 53

tendinous xanthoma

Back 53

• white plaques on tendons (usually fingers and Achilles)
• Sign of hypercholesterolemia - primary or 2 (biliary cirrhosis, cholecystitis
  

Front 54

Dermatitis herpetiformis

Back 54

• itchy, burning skin rash that looks like HSV/varicella (herpetiformis) with filled vesicles
• Associated with celiac disease/gluten sensitivity (HLADQ2)
• Dx: IgA Ab (blood) or DFA IgA deposits (skin)
  

Front 55

tinea corporis

Back 55

• "ringworm" - branching hyphae itchy circular area with raised edges - don't confuse with Lyme diseases bullseye

• Rx: terbinafine, griseofulvin
  

Front 56

leprosy

Back 56

• Cause: genetic susceptibility to mycobacterium leprae which is in many animals esp. rodents. These are trapped in nodules and killed, but the immune system overreacts causing damage to skin and nerves
  
• Sx: hypopigmented lesions with sensory loss
• Mech: CD4+ TH1 makes IL2 and IFN-g
• Types: tuberculoid (small, defined nodules--can go away common); lepromatous (pic-many areas)
  
• Dx: lepromin test - mycobacterium leprae antigens injected under skin - nodule formation is a positive test