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66 Cards in this Set

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Four Subtypes of Rosacea
Erythematotelangiectatic (Vascular) Rosacea
Papulopustular (inflammatory) Rosacea
Phymatous
Ocular
Variants of Rosacea
1. Granulomatous - histo shows perifollicular, noncaseating epitheliod granulomas (Lupus Miliaris Disseminatus Faciei overlaps w/ this except it has central caseation)
2. Periorificial dermatitis - histo and rx similar to rosacea
3. Pyoderma faciale - in young females, no prior hx. may rx with prednisone & accutane
4. Steroid rosacea -- Rx is d/c steroid... rx flare with TCNs, accutane, or topical tacrolimus
Four Variants of rhinophyma
glandular
fibrous
fibroangiomatous
actinic
% of rosacea pts with ocular sx?
50%
Severity is NOT proportional to facial dz, may show up years before cutaneous dz
Proposed pathogenesis of ocular rosacea?
Meibomian gland impaction leads to decreased lipids in tear film which increases evaporation and leads to irritability of eye
Medications that can induce flares of rosacea or cause rosacea-like eruptions?
Amiodarone
Topical Steroids
Nicotinic Acid
Vitamins B6 and B12
EGFR Antagonists
Treatment options for Roseacea
Avoidance of triggers
Topicals: Metrogel, Azelaic Acid, Benzoyl Peroxide, Sodium sulfacetamide, Topical tretinoin, oral ABx - TCNs, Accutane, LASERs
Most common fungi in Tinea Barbae? Majocchi's granuloma?
T. mentagrophytes or T. verrucosum (male farm workers)
T. rubrum (women from shaving legs)
Causes of Drug-induced Folliculitis
(Morphology: Monomorphic Follicular Papules, neg comedones)
Corticosteroids
androgenic hormones
iodides
bromides
lithium
isoniazid
anticonvulsants
ACTH
Bugs assoc with Gram-Neg Folliculitis
Klebsiella, Enterobacter, Proteus. TOC: accutane
Name the three types of Eosinophilic folliculitis
Eosinophilic pustular folliculitis
AIDS-associated eosinophilic folliculitis
Eosinophilic pustular folliculitis in infancy
Eponym for Eosinophilic pustular folliculitis
Ofuji's Disease
Main assoc w/ Ofuji's Dz?
- explosive crops of follicular papulopustules
- annular and serpiginous plaques
- Japanese Men
- Peripheral eosinophilia
NO systemic symptoms
involutes in 7-10 days, relapse in a month
Treatment of Ofuji's?
UVB & Oral Indomethacin
What level CD4 is assoc with AIDs assoc eos folliculitis?
CD4<300
Improves with HAART
How is AIDS assoc different than Ofuji's?
no large pustules and/or figurate lesions
Eosinophilic pustular folliculitis in infancy: common? boys vs girls? onset? course?
Rare and self-limited; boys > girls
Onset as early as first 24 hours
Cyclical course for 3mo - 5 yrs
What is similar to Eosinophilic pustular folliculitis in infancy? How do you differentiate?
Must consider: Erythema Toxicum Neonatorum
Similar histo, but ETN is onset in 1st 48 hours, resolves in a week
Eponym for "goose bumps"
Hitch & Lund Disease
aka disseminate & recurrent infundibulofolliculitis
Tx for Hitch & Lund?
topical steroids, lactic acid/urea, PUVA, accutane
Describe Keratosis Circumscripta rash. onset? histo? overlap? from what country?
groups of folliculocentric papules: knees, elbows, nape of neck, hips, sacrum w/ assoc palmoplantar thickening.
Onset: 3-5 years
similar to psoriasis, overlaps with juvenile PRP & lichen spinulosus
Tx: keratolytics, peels, ablative laser
from AFRICA
Rash from Vit A deficiency?
Phrynoderma -- follicular papules w/ conical keratotic plugs -- extensor surfaces of extremities (thighs and forearms)
Level of Vit A seen in Phrynoderma
Serum level < 20mg/100mL
Risk group for Phrynoderma
in Asia & Africa
Bariatric Surgery
Assoc findings w/ Phrynoderma
Ocular (night blindness, xerophthalmia, Bitot spots)
Mucosal (erythematous glazed tongue)
Systemic (muscle weakness, neuritis, diarrhea)
Rx: Vit A, lesions clear in 1-4 months
Follicular Ichthyosis more common in boys or girls?
MC in Boys (XLR?), seen on head and neck, appears in early infancy and early childhood
Generic name for Vaniqa
Eflornithine
(alpha-difluoromethylornithine)
hair growth inhibitor
Follicular Occlusion Tetrad?
Acne Conglobata
Hidradenitis Suppurativa
Dissecting Cellulitis of the scalp
Pilonidal Sinus (added later)
What drug can cause hidradenitis suppurativa? is this condition androgen sensitive?
Lithium
No - apocrine glands are not androgen sensitive
Describe Acne fulminans
eruptive cystic acne
fever
leukocytosis
myalgias
constitutional symptoms
osteolytic bone lesions
Where are eccrine glands absent?
Clitoris, glans penis, labia minora, external auditory canal and lips
What fibers innervate eccrine glands?
Sympathetic cholinergic fibers
Sources of Neural hyperhidrosis? Non-Neural?
Neural:
Cortical, Hypothalamic, Medullary, Spinal, Axon reflex
Non-neural:
Local heat, drugs, changes in blood flow or sweat glands
Prevalence of Axillary Hyperhidrosis? % of those with Family History in Cortical Hyperhidrosis?
25% axillary hyperhidrosis, appears post-puberty
75-80% with Fmily Hx --> AD likely
Medical Treatment Options for Hyperhidrosis?
Aluminum Chloride
Anticholinergics: Probanthine, Robinol, Ditropan
Treatment Options for Hyperhidrosis besides medication
Iontophoresis
Botox Injections (50U per axillae)
Mechanism of action of Botulinum toxin? What is the specific protein invoved?
Binds to proteins responsible for ACH receptors; specifically, light chain of BTX-A cleaves SNAP-25 (synaptosome-associated Protein)
What level Endoscopic Transthoracic Sympathemectomy for Palmar vs Axillary?
Palmar = T2-T3
Axillary = T4-T5
Skoog-Thyresson Surgery
No secretory mapping
Plastic surgeons dissect out axillary sweat glands
Hurley-Shelley Surgery
sweat mapping
surgical ablation of active loci
Name other Cortical Hyperhidrosis
Unna-Thost keratoderma
Vorner's (diffuse epidermolytic keratoderma)
Progressive diffuse keratoderma (Greither)
Howel-Evans Keratoderma
Mutilating keratoderma of Vohwinkel
Mal de Meleda
Olmstead (Diffuse keratoderma c keratosis periorificialis)
Acrokeratoelastoidosis
Pachyonychia congenita
Localized EB Simplex
What is Pel-Ebstein?
Night sweats assoc with Lymphoma
MC Cause of Hypothalamic (thermal) Hyperhidrosis
defervescence of fever
How do CNS lesions causes hyperhidrosis?
a Hypothalamic cause:
release of cortical inhibitory influence on the hypothalamus (contralateral hyperhidrosis)
Pathogenesis of Medullary (gustatory) hyperhidrosis? Types? Demographics?
MOA: Taste receptors in mouth afferent input --> glossopharyngial nerve and/or vagal nerve --> nuclei in medulla oblongata
Physiologic: foods, alcohol; seen in children/young adults/warm climate; familial tendency
MOA: transposition of the postganglionic sympathetic and parasympathetic nerve fibers (except for CNS)
Pathologic: disease or injury to PAROTID GLAND, also in CNS d/o like syringomelia or encephalitis, also in alteration or trauma of THORACIC SYMPATHETIC TRUNK
Frey's Syndrome
aka auriculotemporal syndrome;
salivary stimulation that leads to sweating on the cheek and adjacent neck;
seen in 40% of pts who undergo parotid surgery
Chorda tympani syndrome
gustatory hyperhidrosis involving the submandibular gland;
sweat over chin and lower jawline
What is "crocodile tear" syndrome?
Injury to facial nerve, gustatory lacrimation
Name some conditions with increased sweating due to increased blood flow to the affected areas?
Nevoid angiomatous lesions
Mafucci's syndrome
Congenital AV fistulas
Glomus tumors (pain or blood flow)
Blue rubber bleb nevus syndrome (pain or blood flow)
What is Shy-Drager?
Progressive Autonomic Failure (PAF) with multiple system atrophy
What is Ross' syndrome?
Holmes-Adie syndrome (tonic pupils) , absent DTRs w/ Anhidrosis
Horner's syndome
unilateral anhidrosis, miosis, ptosis of eyelid
Atarabine (quinacrine) dermatitis
damage of sweat glands; infiltrated by fluorochrome atarabine (fluoresce a bright orange-yellow w/ wood's light)
Angiokeratoma corporis diffusum eponym?
Fabry's disease
Franschetti-Jadassohn syndrome?
Reticulated hyperpigmentation plus ectodermal dysplasia
Helwig-Larssen syndrome
Familial anihidrosis w/ labyrinthitis
What are the three types of miliaria (sweat retention vesicle)?
Crystallina - stratum corneum
Rubra - stratum corneum to DEJ, miliaria pustulosa variant w/ sterile pustules, most common*

Profunda - upper dermis, asymptomatic b/c below itch receptors, rare
Trimethylaminuria?
Defect in Flavin-containing monooxygenase 3 (demethylating enzyme) can cause this syndrome. Get "fishy odor" sweat after ingesting foods with choline & lecithin (fish, egs, kidney, liver)
Chromhidrosis?
Eccrine chromhidrosis (exogenous):
Piedra or corynebaterium
Copper miners = blue-green sweat
Clofazamine = red sweat
Apocrine Chromhidrosis
Intrinsic cause of colored sweat due to excretion of lipofuscin in large amounts
Granulosis rubra nasi
pinhead sized erythematous papules of nose, cheeks, upper lip, chin; begins in infacny, associated with cortical/emotional hyperhidrosis of palms and soles, cyanosis, and chilblains; rare & resolves spontaneously
Keratolysis exfoliativa
superficial desquamative process, scaling in annular or circinate patterns, occurs in healthy pts
Who is at risk for Neutrophilic Eccrine Hiradenitis?
Cancer patients (90% of pts with this condition have a malignancy!)
Assoc with Chemotherapy, esp cytarabine (also w/ MTX, Cyclophos, 5FU, AZT, GCSF)
Palmoplantar Eccrine Hiradenitis
Young, healthy children or young adults
clinically like E.N. of the palms
Triggers: wet shoes, cold/damp weather
Papular-purpuric gloves and socks syndrome
partially blanchable, erythematous, purpuric patches -- assoc with prior URI
What is Fox-Fordyce Disease?
Apocrine Miliaria, rare, in females; most commonly in Axilla & Areola; very pruritic; remission after menopause; Rx - topical or intralesional steroids; topical tretinoin may reduce pruritus but not appearance; clinda bid, OCPs may help