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Name 2 CLASS 1 STEROIDS
HERES 4>>

TEMOVATE

DPROLENE

ULTRAVATE

PSORCON
What is the generic name for temovate?
Clobetasol Dipropionate
What is the generic name for Diprolene?
Betamethasone Dipropionate
What is the generic name for Ultravate?
Halbetasol Propionate
What is the generic name for Psorcon?
Diflorasone diacetate
Raynaud's phenomenon is also known as constriction of small digital arteries., and is typically associated w/ connective tissue disorders. Persistent blue discoloration seen in those w/ Raynauds is known as ______________
Acryocyanosis.

Affects the entire hand/foot

The cause is unknown!
Raynaud's disease occurs in the absence of connective tiisue disorders. What are some of the tx for this?
Exposure to cold avoided

Vasodilators (nifedipine)

Topicals (nitroglycerin)
Erythromelalgia is rare It is associated with what condition?
Thrombocytopenia
In erythromelalgia the feet begin to burn, and the pt experiences local pain and redness. The pt has defective conduction C fibers.

What works to decrease the hotness?
Give aspirin daily!
Livedo reticularis has what kind of appearance?
Mottled-like net-like appearance.
Leukocyctoclastic, Henoch-Schonlein purpura, Erythema Nodosum, Wegener's Granulomatosis----- are indicative of _______ vessel vasculitis.
Small Vessel Vasculitis.

SMV=SMALL VESSEL VASCULITIS
Cutaneous Leukocytoclastic angiitis aka allergic vasculitis has necrosis in vessel walls. Below the knees, numerous lesions are present--- it may progress to ___________.
Hemorrhagic vessicles/bullae.

SMV
What is the tx for leukocytoclastic tx?
NSAIDS/ ORAL STEROIDS

SMV
This condition occurs in children after Strep pharyngitis.

HINT>>
H-appens to K -ids after S-trep
Henoch Schonlien Purpura
What is the tx for Henoch Schonlien Purpura?
IV/ORAL steroids

NSAIDs for joint pain
Erythema nodusum tx involved?

Occurs most commonly?
NSAIDS

Children & young adults

They experience an inflammatory process of fat (panniculitis)
Erythema Nodosum causes include ______________________
Strep infection, drugs, sarcoidosis, TB, inflamm BOWEL disease

Will resolve in a few days, but 77% infection related resolve in 7 weeks, 30% idiopathic
Erythema nodosum's diff dx should include _____________?
Bed BUG BITES MO FO!
Perniosis/Pernio (Chilblains) includes localized erythema and swelling. May progress to blisters in fingers and toes.

Happens to horse riders. (lateral aspects of thigs/ cold chapping)

What is the tx?
WEAR WARM CLOTHES.

thumbs up!
Wegner's granulomatosis is a rare disease. It is R-O-U-G-H on the body.

what do these letters indicate in wegners?
R-O-U-G-H

R- radiograph the chest
O- oral ulcers
U- urinary sediment
G- granulomas
H- hemoptysis
What is the circulating antibody we look for in dx wegners?
C-ANCA
What is the tx for wegners?
Systemic steroids/or Cyclophosphamide
How do you treat Wegner's pydoderma gangrenosum like lesion?
Oral Tacrolimus

SYSTEMIC STEROIDS!
Nodular vasculitis occurs in middle ages women---
they experience inflammatory nodules produced by a granulomatous vasculitis in deep dermis on posterior lower legs. It may be idiopathic or TB related.

What is the tx?
TX underlying TB, bed rest, bandages, no smoking!!
Polyartertis nodosa & kawasaki disease are both examples of what kind of vessel disease?
Medium sized vessel disease
Polyarteritis nodosa (PAN) is a rare, necrotizing vasculitis affecting small and medium sized arteries. It is painful.

It occurs more commonly in_____, ______, and ______.
PAN occurs more commonly in men.
4:1 ratio M/F.

It is a multi-system dx, involving the kidneys, heart, liver, and GI, but not the LUNGS!

Occurs more commonly in:
IV DRUG USERS, LUPUS PTS, HEP B & C PTS
TXing PAN consists of?
Systemic steroids
Kawasaki disease aka Mucocutaneous lymph node syndrome occurs in medium sized vessels. Most commonly seen in __________
Irritable, febrile infant or children under 5
Stomatitis or strawberry tongue is seen in Kawasaki Disease. What other disease is it seen in?
Wegners granulomatosis
The hallmark lesion of kawasaki disease is __________________
Erythematous desquamating perianal eruptions
Giant cell (Temporal) arteritis occurs in __________ vessels.
Large vessels.
Giant cell arteritis commonly affects which arteries?

If left untreated, it can lead to__________
The carotids

Blindness. Giant cell can lead to BLINDNESS!
Takayasu's arteritis is a progresive granulomatous inflammation of aorta and its major branches.

What is the tx?
Tx of takaysu's is: PREDNISONE

Occurs in pts <50yrs who are women.

Known as pulseless disease!
Schamberg's disease's presents how on the skin?
chronic pigmented purpura!!!


CAYENNE PEPPER SPOTS!
Buerger's disease aka thromboangitis obliterans occurs in the upper and lower extremities. commonly occurs in men 20-40.

What is the hallmark indication an individual has buergers?
PAIN PAIN PAIN & claudication
in the medial arch!
What is the tx for buergers?
Stop smoking!

continue to smoke, lose a limb
Lupus erythematous has 4 subtypes.

ACLE (acute cutaneous LE) hallmark lesion is?
the butterfly rash on the face.

99% will be positive for ANA.

ACLE lasts hours/weeks!
What is the tx for ACLE?
Steroids, oral steroids
Subacute cutaneous LE is more persistent than ACLE ---- last weeks or months.

It presents as scaly superficial inflammatory macules on the chest, arms, and neck.

What drugs do you want avoid b/c of their possible links to SCLE?
LAMISIL
NAPROXEN
GRISEOFULVIN
BONUS QUESTION:
What is griseofulvin and how does it work?
Anti-fungal.

The drug binds to tubulin, interfering with microtubule function, thus inhibiting mitosis.
Discoid LE is a common chronic form of cutaneous LE.

It involves fixed, indurated erythematous papules and plaques on head and neck.

W/O tx, it may persist for years and cause extensive scarring.

What is the tx?

WHAT FAMOUS SINGER HAS THIS?
Sunscreen, topical steroids, anti malarials, systemic steroids


seal- as in "kiss from a rose"
Schleroderma is a chronic disease that involves micro vasculature and connective tissues.

The cutaneous type is called____________
Localized morphea (can be seen on legs)
Systemic schleroderma is called ______________.
Progressive systemic sclerosis.
CREST is seen scleroderma pts.

CREST stands for
____________________
C- calcinosis cutis
R- raynauds phenomenon
E- esophageal dysfunction
S- sclerodactyly
T- teleangiectasias
Early symptoms of progressive systemic sclerosis.

Early symptoms include _______________.
Swelling of feet/hands

Develop raynauds

telangiectasias

May develop ulcerations on fingers & toes
Dermatomyositis is a disease of unknown etiology.

What is the hallmark sign you look for on the face?
Heliotrope eyes

*Looks as if you have purple eyeliner
How do you tx dermatomyositis?
Prednisone
Gottron's sign is ______________ AND is indicative of dermatomyositis.
Gottrons sign: pink to purple atrophic scaling lesions
Futcher's lines aka voight's lines are___________________
pigmentary lines of demarcation. symmetrical and bilateral.
Post inflammatory hyperpigmentation is darkening of the skin that results from injury.
(basal layer is interuppted, melanin escapes!)

How do you treat this?
Hydroquinone
Never use higher than 4%
What is the tx for vitilago?
It is by no means definite,
but UVB, light therapy.

Also, dermablend make up.
Subungual melanomas clues---- include........
solitary lesions
width>3cm
variable pigment
rapid increase in size
hutchinson's sign
yes it can happen to anyone.
thumb most comon!


DANGEROUS DX: more advanced by the time you diagnose, poorer survival 49% survival in 5 years