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52 Cards in this Set
- Front
- Back
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What are dermatologic signs of cardiac disease?
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Cyanosis in nail beds
• Clubbing of digits • Edema of both LE • Livedo Reticularis (lacy pattern)- cholesterol and atherosclerosis • Cutaneous Bleeding from Coumadin Therapy |
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Describe Coumadin induced bleeding, where does it occur, what is the progression, what do you do about it
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Coumadin Necrosis”
• Breast, thigh, buttock • Pain to erythema to hemorrhage to necrosis • Within 2-5 days of starting therapy • Obese, female • Switch to heparin, lovenox |
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What are skin signs of endocarditis?
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Infective endocarditis, seen in IV drug users
Splinter Hemorrhages in Nails Osler’s Nodes: small, tender nodules that develop on the finger or toe pads. They persist for hours to days Janeway lesions: small purpuric hemorrhages with a slightly nodular appearance that occur on the palms and soles; seen in acute infective endo |
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Describe erythema multiforme, who does it affect?
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• Kids mostly
• HSV I and II comes out first, then skin lesions. These are target like lesions with 3 zones of color - central dark zone, immediate outside zoen, and then pale outline. • All lesions appear within 7 hrs • No necrosis or edema • No drug involvement; but drug eruptions can cause EM-like lesion, but these lesions are less well defined |
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What is Stevens Johnson Syndrome? who does it affect? what causes it?
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Respiratory illness
first, then 1-14 days later—red macule to bullous eruptions in mouth, due to drug reation also fever, difficulty swallowing, purulent conjunctivitis, stomatosis, lymphadenopathy, hepatosplenomaegaly, • Children • NSAIDs, tetracycline, anticonvulsants |
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How do you treat Steven Johnson Syndrome?
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• Hospitalize, burn unit
• Treat as burn from inside out • Electrolyte balanced • Mortality high if don’t discontinue drug • Systemic steroids and IVIG treatment, but controversial |
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Describe Toxic Epidermal Necrolysis, what is it, when does it start, how do you treat it?
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Toxic Epidermal Necrolysis
• TEN, a rare drug reaction that can be fatal (25- 35%) • NSAIDS, anticonvulsants • 7-21 days after initiation of drug • Not well defined red plaques, skin detachment by trauma or otherwise • May overlap with Stevens Johnson • Mouth, chest, back, elsewhere, >30% BSA • Admit, wound care, give IVIG |
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Pyoderma Gangrenosum
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• Ulcers with purple undermined
borders !!! • Women, 20-50 yrs • Name is misleading • Pustules on a red base scars • Inflammatory bowel disease!!! • Rheumatoid arthritis • 20-30% idiopathic cause, |
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What can help distinguish TEN and steven Jonhnson's syndrome?
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Steven Johnson syndrome is more on the mouth TEN is more on the whole body
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Treatment of Pyoderma Gangrenosum
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• Prednisone
• Doxycycline • Cyclosporine • Infliximab*/Etanercept /Adalimumab • Topicals/Injections |
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Describe calciphylaxis
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Red plaques in livedo pattern, become
black gangrenous plaques • Bilateral and symmetrical Rare and fatal (80%) • Female (3:1) • ESRD (1%), diabetes? Obesity?, post renal transplant (30%), liver dx, HIV • Secondary hyperparathyroidism – Parathyroidectomy, no proof |
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Calciphylaxis
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• Rare and fatal (80%)
• Female (3:1) • ESRD (1%), diabetes? Obesity?, post renal transplant (30%), liver dx, HIV • Secondary hyperparathyroidism – Parathyroidectomy? Proof? • Red plaques in livedo pattern, become black gangrenous plaques • Bilateral and symmetrical |
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treatment for calciphylaxis
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Treatment: debridement, HBOT,
parathyroidectomy, bisphosphonates, IV sodium thiosulfate (antioxidant that reduces pain) |
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What is a nevi
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a mole
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What is ajunctional nevus
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proliferation melantocytes along dermal/epidermal junction - flat
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compound nevus
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raised nevus
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juntional nevus
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nevus that lost it's color
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congenital melanocytic nevus
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nevus that apperas during your first year of life
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What are the charateristics of an atypical nevi
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marked varigation in color
loss of normal symmetry larger than > 6mm |
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what is solar lentigo
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sun spots
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What are ephelides
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freckles
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What is a Dermatofibroma
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small, firm, flat, or paule on lower exttremities
skin colore do r borwon "dimple sing" when lateral pressure applied |
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What is hemangioma
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benign tumor of blood vessels
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What are types of hemangioma?
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angiokeratoma of mibelli: blue black hyperkeratotic vascualr papule over hand sor feet in kids
cherry angiomas: very common acquired trunk upper extremity, middle age elderly people |
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How do you treat stucco keratoses
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freeze or just leave them alone
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ACtinic keratoses
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Actinic keratoses are sun induced pre cancerous lesions of skin.
diffuse scale on red base |
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Bowen's disease
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skin cancer in situ, happens on any sikin surface, persistent ertheamtous lsighly indurate plaques with scale
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What are signs a lesion is malignat
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has it change recently
did it happen over age 40 does it itch is it non-heal |
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What are risk factor for all skin cansers
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exposure to cacinogenic agents: UV, PUVA, radiation, HPV, cigaretttes
Genetic syndromes: xeroderma pigmentosum, basa cel nevus syndrom, family hx of melanoma Predisposing clinical scenario - non- healing wound immuno suprresion |
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Basal cell carcinoma, what is it, what kind are there
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most comon skin cancer
sun damage rarely metatstasize nodular : peraly papule with telangiectasias superficial spreading: erythematous slow growing plaques on trungk morpheaform: resemples scars or normal skin |
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treatment of basal cell skin cancer
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excision,
cryotherapy electrodessication adn curretage moh's surgery topicals like aldara - maybe |
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Squamosu cell carcionma
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ill defined, red lesio with rough patchy surface and scale, may even produce a cutaneuos horn
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ABC's of melanoma
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Assymetry
Border and Bleeding Color Diameter Elevation Family history |
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Types of Melanoma
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Superficial spreading - most common, on body slow to enlarge, macular and papular
nodular - pigmented papule that enlarges and ulcerates, looks likenon healing skin ulcer Acral lentiginou most common of nfeet, is on non hair bearing skin (palms, soles Lentigo maligna - irregular shaped on sun exposed skin (only face) Amelanotic - non pgmented may look like pyogenic granuloma, |
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ABC's of subungual melanoma
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Age (5th to 7th decace of life)
Brown to Black Band with breadth of 3mm or greater with variegated borders Change in the nail band or lack of change with treatment Digit most commonly involved is thumb or hallux Extension of pigment into proximal nail forld or lateral nail fold Family or personal history of melanoma |
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What does Kaposi's sarcom look like
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early erythematous macules with a bruise liek halo
enalarges with line sof skin cleavage can be pink, red, pruple, brown, mimics many skin disease has Koebner's phenomenom |
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Clark's Level I
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tumor cells in epidermis only
100% cured with adwquate excision |
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Clark level II
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tumor cells int dermis (but does not fill papillary dermis)
95-99% 5 year survival rate with Breslow depth < 0.75 mm |
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Clark Level III
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tumor cells go into and fill paplillary dermis
90% 5 yr survival rate depth of 0.76 - 1.49 mm |
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Clark Leve IV
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tumor cells go into reticular dermis
75% 5 year survival rate depth of 1.5 -4.00 mm |
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Clar level V
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tumor cells through dermis and into subcutaneous fat
<50% 5 year survival rate depth > 4.0mm |
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How much margin should you leave when excising skin cancer with depth of
< 1mm 1-2 mm 2-4 mm > 4 mm |
< 1mm : 1 cm margin
1-2 mm:1-2 cm margin 2-4 mm: 2 cm margin > 4 mm: 3 cm margin |
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skin signs of hepatic problems
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Color: Jaundice—deposition of bilirubin in
skin, greater than 2.5 mg/dl Pruritus: bile salts in skin Koilonychia (spoon nails) Terry’s Nails (aka leukonychia on all of nail except for 1-2 mm area) Hepatitis C infection: cryoglobulinemia/palpable purpura |
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skin signs of thyroid problems
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• Pretibial myxedema
(Thyroid dermopathy): in Graves dx; shiny, waxy indurated plaques on anterior tibia. Peau d’orange appearance • Dry, xerotic skin and decreased hair in hypOthyroidism • Hyperhidrosis in hypErthyroidism |
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Dermatological manifestations of Diabetes Mellitus
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• Prayer sign
• Necrobiosis Lipoidica Diabeticorum • Bullous Diabeticorum • Acanthosis Nigricans • Diabetic Dermopathy • Granuloma Annulare • Infections: Tinea, Onychomycosis, Skin • Yellowish nails • Ulcers • Xerosis |
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what is prayer sign
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• “Diabetic Hand
Syndrome” • Inability to appose palmar surfaces when pressing hands together • Waxy thickening of dorsal aspect of hands and fingers • NIDDM and IDDM |
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what is necrobiosis lipodica diabeticorum
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• Slightly elevated irregular plaque on the
pre-tibial region • Becomes yellowbrown looking and atrophic in center • 1/3 lesions ulcerate spontaneously 10 year delay in those who have Diabetes • More common in women |
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Treatment of necrobiosis lipodica diabeticorum
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• Topical steroids under
occlusion • Intralesional Kenalog 10 • Short term oral steroids in nonulcerated • Prevent secondary infection if open • Only 11-65% have diabetes, but sending for lab eval is useful |
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What is bullosis diabeticorum
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• Tense blisters appearing on feet, plantar
aspect, legs • Self-limiting • No scars, negative Nikolsky’s sign • Chronic and recurring |
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What is acanthosis nigricans
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• Velvety hyperpigmented plaques on the
neck and axilla • Dirty skin that can’t be washed off • Insulin resistance: often high levels of insulin are present in the plasma |
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What is diabetic dermopathy
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• Brown atrophic spots on legs
• Most common sign of diabetes • Shown that this correlates with high HgA1c • More common in men |
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most common fungal skin infection in a diabetic is…
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CANDIDA ALBICANS
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