Dermatology

Front 1

Rosacea stages

Back 1

-Blood flow is higher than in normal skin.
-1: Pre-rosacea: episodic flushing of the central portion of the face.
-2: Vascular rosacea: Recurrent, maybe painful blush on nasal ala/cheeks.
-3: Inflammatory rosacea: Small papules and pustules, deeper red than acne, persistent inflammation.
-4: Sebaceous hyperplasia and phymatous rosacea: Overgrowth of sebaceous glands.

Front 2

Pemphigus vulgaris

Back 2

Lethal, peaks at 30-50
Painful blistering
MHC Class II genes associated: DR4 in Ashkenazi Jews, DQ1 in others.
No real inflammation
Desmoglein 3 and 1 are targeted.
Treat with prednisone and human immunoglobulins.

Front 3

Bullous pemphigoid

Back 3

Non-lethal, peaks at 60-80 years.
Painless, pruritic blisters.
ABs against BP180 epitope of hemidesmosome
Inflammatory
Treat with anti-inflammatory drugs

Front 4

Psoriasis

Back 4

Th1 cytokines (autoimmunity): TNFa, IFNgamma, IL-2
HLA subtype Cw13 confers increased RR.
White, silvery scales.
Treat with topical treatments, phototherapy, immunosuppressives.

Front 5

Atopic dermatitis

Back 5

Th2 cytokines: IL-4,5,6,9,10,13
Goes with allergies
Patients have pruritis and eczema.
Can lead to cutaneous infections like impetigo and s. aureus.

Front 6

Moles:
Junctional:
Compound:
Intradermal:

Back 6

Junctional: Symmetric, flat, no melanocytes within dermis.
Compound: Raised, maybe hairy, melanocytic nests within dermis.
Intradermal: Raised, skin-colored, with no melanocytes in epidermis.

Front 7

ABCDEs of evaluating melanoma

Back 7

Asymmetry
Border (irregular?)
Color (uneven?)
Diameter (>5mm?)
Evolution (changing?)

Front 8

Rates and deaths from melanomas and basal cell carcinomas

Back 8

BCC: 80% of new skin cancers.
Melanomas: 80% of skin cancer deaths.

Front 9

Basal cell carcinomas

Back 9

Mutations in hedgehog pathways.
Tend not to metastasize, but aggressive locally.
Waxy, pearly.

Front 10

Squamous cell carcinomas

Back 10

Mutations in p53 suppressor gene.
Erythmatous, scaly.
More metastases than BCCs, but still relatively low risk.
Actinic keratosis is a precursor lesion.

Front 11

Order corticosteroids from weakest to strongest

Back 11

Hydrocortisone < triamcinalone < fluocinonide (Lidex) < Clobetasol (Tmeovate, strongest).

Front 12

Differences between "pigmented" skin and "unpigmented" skin

Back 12

Black skin is = SPF 13.
More dilated blood and lymphatic vessels in black skin.
Multinucleate fibroblasts in black skin.
Black hair tends to be elliptical and small on x-section with a curved follicle.
White hair tends to be round, medium diameter, and straight or curled follicle.

Front 13

Brown birthmark in baby
Diagnostic criteria

Back 13

Example: Neurofibromatosis Type I
>2 Neurofibromas
Freckling in axilla or groin.
> 6 Cafe au lait spots
Optic glioma
>2 Lisch nodules
Sphenoid or long bone dysplasia
Relative with NF1.

Front 14

White birthmark in baby
Diagnostic criteria

Back 14

Example: Tuberous sclerosis.
Neurologic impairment (seizures), multisystem hamartomas, hypopigmented macules and angiofibromas.
In _neonates_ or _fetuses_ you see cardiac rhabdomyomas.
In _infants_ you see hypomelanotic macules.
In _teenagers_ you see angiofibromas, etc.
Renal disease most common cause of death.

Front 15

Red birthmark in baby

Back 15

Example: Infantile hemangioma.
4-10% of white infants, female preponderance, prematurity is a risk factor.
watch out for PHACE(S) syndrome.
Treat with systemic steroids or propanolol.

Front 16

Yellow birthmark in baby

Back 16

Example: Nevus sebaceous.
1/300 newborns, present with small immature sebaceous glands.
Small risk of tumors arising.

Front 17

Retinoid nomenclature:

Back 17

Vitamin A = all-trans retinol, an alcohol.
Beta carotene is cleaved into 2 Vitamin A's.
All-trans retinaldehyde is formed by oxidation of Vitamin A.
All-trans retinoic acid = Tretinoin, binds RAR receptor (86%).
An isomer of retinoic acid binds RXR (14%).
All retinoids increase collagen synthesis.
CYP450 hydroxylates retinoic acid to eliminate it.

Front 18

Non-blistering drug eruptions
Exanthematous/morbilliform:
Erythema:
Urticarial:

Back 18

Exanthematous/morbilliform: Most common, pink, red, macules or papules. Sometimes begins > 1 week post-exposure. Drug-induced hyerpensitivity CAN BE FATAL! (Bactrim)!
Erythema: Hypersensitivity reaction to rapidly infused Vancomycin.
Urticarial: Wheal, type 1 IgE mediated hypersensitivity reaction. PCN and derivatives, ACE inhibitors, aminoglycosides, etc.

Front 19

Blistering drug eruptions
Fixed drug eruption:
Stevens-Johnson Syndrome:
Toxic epidermal necrolysis:
Acute Generalized Exanthematous Pustulosis:

Back 19

Fixed drug eruption: Sharply demarcated, round, dusky erythematous plaques. Recur at same anatomic site with repeat exposure.
Stevens-Johnson Syndrome: Fever, mucous membrane erosions, "target" shaped lesions. Less than 10% of body and 5% mortality.
Toxic epidermal necrolysis: Like SJS but > 30% of body surface and 30-50% mortality.
Acute Generalized Exanthematous Pustulosis: Acute pustular eruption, comes on quickly and resolves quickly. Macrolides, PCN, etc.

Front 20

Cutaneous manifestations of internal diseases:
Paraneoplastic pemphigus (PNP):
Neutrophilic dermatosis:

Back 20

Paraneoplastic pemphigus (PNP): Severe mucosal ulceration. Similar to pemphigus vulgaris but with different immunoprecipitation charateristics.
Neutrophilic dermatosis: Rapidly expanding painful, ulcerative lesions. Can get worse after debridement!

Front 21

Cutaneous manifestations of internal diseases (GI disorders):
Peutz Jeghers:
Acrodermatitis enteropathica:
Glucagonoma syndrome (migratory necrolytic anemia):

Back 21

Peutz Jeghers: Hereditary polyposis with hyperpigmented macules.
Acrodermatitis enteropathica: Zinc absorption disorder, presents at infancy with dermatitis, alopecia, diarrhea.
Glucagonoma syndrome (migratory necrolytic anemia):Due to excessive glucagon production by pancreatic tumor.

Front 22

Cutaneous manifestations of internal diseases (endocrine/metabolic):
Necrobiosis Lipoidica diabeticorum:
Pretibial myxedema:
Acanthosis Nigricans:

Back 22

Necrobiosis Lipoidica diabeticorum: Well-demarcated plaques on front of lower legs in diabetics or patients with poor glucose tolerance.
Pretibial myxedema:Indurated flesh-colored plaques seen in hyperthyroidism of Grave's disease.
Acanthosis Nigricans: Velvety thickening and hyperpigmentation in diabetics/glucose intolerants.

Front 23

Common skin infections:
Bacterial diseases:
Viral diseases:
Fungal diseases:

Back 23

Bacterial diseases:Strep (impetigo, erysipelas, cellulitis), staph (folliculitis, furuncles, carbuncles)
Viral diseases: DNA viruses (papova, poxviridae (molluscum), herpesvirus.
Fungal diseases: Malessezia furfur (tinea versicolor), candida albicans (thrush, antertrigo, angular cheilitis).