Dermatology Final Set 2

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Epidermolysis Bullosa (EB) simplex - EPIDERMAL lesion; easy blistering of hands/feet; genetic defect for keratins 5 + 14

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Epidermolysis Bullosa (EB) simplex - EPIDERMAL lesion; easy blistering of hands/feet; genetic defect for keratins 5 + 14

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Junctional EB - decreased laminin 5 in DEJ; in areas of trauma, oral lesions, facial erosions, nail, tracheal lesions

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Junctional EB - decreased laminin 5 in DEJ; in areas of trauma, oral lesions, facial erosions, nail, tracheal lesions

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DYSTROPHIC EB - Autosomal Dominant form: less severe; DERMAL Lesion

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DYSTROPHIC EB - Autosomal Recessive form: heals with severe scarring at digits; pseudosyndactly; DERMAL lesion

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Vesiculobullous Genetic - Hailey-Hailey Dz (aka Benign familial pemphigus): defects in ATP2C1; non-trauma induced; erosions + crusts in intertriginous areas; can get secondary bacterial infxns

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Vesiculobullous Genetic - Hailey-Hailey Dz (aka Benign familial pemphigus): defects in ATP2C1; non-trauma induced; erosions + crusts in intertriginous areas; can get secondary bacterial infxns

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Vesiculobullous Genetic - Acrodermatitis Enteropathica: deficiency of Zinc; Alopecia + diarrhea

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Vesiculobullous Metabolic - Diabetic bulla: chronic + recurring; tense bullae on Lower Extremity; heals 2-6wks

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Vesiculobullous Metabolic - Pellagra: deficiency of Niacin; also in alcoholics + isoniazid therapy

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Vesiculobullous Metabolic - Porphyria cutanea tarda: decrease in uroporphyrinogen decarboxylase; tense bullae on sunexposed skin (esp. hands); from alcohol, drugs, estrogen + iron

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Vesiculobullous Inflammatory - Bullous Pemphigoid: uticarial plaques - tense bullae, no nikolsky sign; SUBEPIDERMAL

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VB Inflammatory - Bullous Pemphigoid: uticarial plaques - tense bullae, no nikolsky sign; SUBEPIDERMAL

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Pemphigus vulgaris: chronic + affects adults; begins at mouth and spreads distal; Sx - tender, +Nikolsky sign; Tx - oral prednisone, immunosuppressive agents.

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Dermatitis Herpetiformis - from gluten sensitivity: erythema w/ vesicles, pruritic; symmetrical on knees, butt, arms; Tx - Dapsone, gluten free diet

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Dermatitis Herpetiformis - from gluten sensitivity: erythema w/ vesicles, pruritic; symmetrical on knees, butt, arms; Tx - Dapsone, gluten free diet

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VB Inflammatory - Herpes gestationis: Sx - pruritic, begins PERI-UMBILICAL, miscarriage (No HSV)

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Edema Blisters - pts w/ acute exacerbation of lymphadema in leg; Sx - non-inflammed, tense, asymptomatic; Tx - resolves w/ edema Tx; DDx - bullosis diabeticorum

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(Genodermatoses)Ichthyosis vulgaris: Tx - Urea

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Ichthyosis vulgaris

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X­linked recessive ichthyoses - Neck looks dirty, SIGN OF DIABETES

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Congenital Ichthyosiform erythroderma (CIE)

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Lamellar Ichthyosis: Tx - 40% urea

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Lamellar Ichthyosis: Tx - 40% Urea

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Lamellar Ichthyosis: Tx - 40% Urea

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Collodion Baby

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Collodion Baby

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Darier’s Disease - Mutations of Ca2+/ATPase pump; Tx - soothing emollients, oral retinoids (same as Tx for Ichthyosis)

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Darier’s Disease - Mutations of Ca2+/ATPase pump; Tx - soothing emollients, oral retinoids (same as Tx for Ichthyosis)

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Palmoplantar Keratodermas (PPK) - Unna Thost Type: non-epidermolytic; +hyperhidrosis; mutated K1 gene; Tx - urea

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Diffuse PPK - epidermolytic; less hyperhidrosis

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Vohwinkel’s syndrome: mutilating PPK; no hyperhidrosis; HONEYCOMB PALMS; pseudo aihnum

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Papillon-­Leferve: psoriaform lesions on extremities; PPK w/ periodontitis

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Focal PPK - local hyperkeratosis over pressure points

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Stirate palm (keratoderma)

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Punctate PPK - biopsy coranoid lamella; Tx - urea

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Venous Ulcers - atrophy blanch in 38% pts; medial mal. most common; Tx - 1) elevate legs above heart, 2) compression therapy, 3) promogran, 4) silver dressing, 5) topical steroids around ulcer if needed, 6) grafts, 7)oral/TV Abx

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Venous Ulcers - atrophy blanch in 38% pts; medial mal. most common; Tx - 1) elevate legs above heart, 2) compression therapy, 3) promogran, 4) silver dressing, 5) topical steroids around ulcer if needed, 6) grafts, 7)oral/TV Abx

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Venous Ulcers - atrophy blanch in 38% pts; medial mal. most common; Tx - 1) elevate legs above heart, 2) compression therapy, 3) promogran, 4) silver dressing, 5) topical steroids around ulcer if needed, 6) grafts, 7)oral/TV Abx

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Arterial Ulcers - over bony prominences (toes/ankles) or minor trauma (ill-fitting shoes); Sx - atrophy surrounds, shiny skin, round sharply demarcated borders, PAINFUL; also caused by - cholesterol emboli, Raynauds, Frostbite

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Arterial Ulcers - over bony prominences (toes/ankles) or minor trauma (ill-fitting shoes); Sx - atrophy surrounds, shiny skin, round sharply demarcated borders, PAINFUL; also caused by - cholesterol emboli, Raynauds, Frostbite

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Diabetic/Neuropathic ulcer - looks puched out with HPK rim; trauma is major cause; looks granular/fibrotic; check for infxn (OM); Tx - debride, wound dressing, education, bypass/ revascularize

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Pressure Ulcers - Long standing disease/ hospital stays; tissue necrosis on heels/ sacrum; from shear forces, friction, moisture + pressure