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102 Cards in this Set

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what is HAIR-AN syndrome?
Acanthosis Nigrans: Velvety hyperpigmentation of the skin associated with insulin resistance,
endocrine disorders
HyperAndrogenism
Insulin Resistance
Acanthosis Nigricans
Causes of generalized
hyperpigmentation—
“None of the skin is SPARED”
Sunlight
Pregnancy
Addison’s disease
Renal failure
Excess iron
(hemochromatosis)
Drugs (e.g., busulfan)
Dx and treatment:
>>Velvety hyperpigmentation of the skin
>>may develop type 2 diabetes, dirty-appearing, prominent skin lines
Dx: acanthosis nigrans
Tx: weight reduction for obesity
and insulin resistance or search for occult malignancy.
>>rule out DM.
Histology shows hyperkeratosis and proliferation of melanocytes. what should be ruled out and tx
Tx: weight reduction for obesity
and insulin resistance or search for occult malignancy.
Dx: acanthosis nigrans
Common drugs causing
hyperpigmentation
minocycline, amiodarone,
chloroquine, gold,
chlorpromazine, bleomycin,
5-FU, and daunorubicin.
>>A slowly enlarging area of pink or brown macular patches is seen,predominantly affecting the flexor surfaces.
Erythrasma
pathogen that cause erythrasma?
predominant in what group of people?
Corynebacterium minutissimum and other corneybacterium species.
predominant in diabetics
what would be seen in wood's light and KOH prep in erythrasma?
>>Wood’s light causes lesions to fluoresce coral pink or red
>>KOH prep is -
treatment of erythrasma?
Rx: Topical or oral erythromycin
hypersensitivities
Anaphylactic—type I
Cytotoxic—type II
Immune complex—type III
Delayedhypersensitivity— type IV
skin disorder characterized by pruritus. Persistent scratching → lichenification
Atopic Dermatitis/Eczema
allergic triad
atopic dermatitis, asthma, and
hay fever
Macule
Flat area of skin discoloration < 1 cm in diameter.



.
.
Papule
Elevated area of skin < 1 cm in diameter.
Plaque
Elevated area of skin > 1 cm in diameter.
Nodule
Elevated and deep (continues beneath skin) area of skin > 0.5 cm in
diameter.
Cyst
Nodule containing fluid
Vesicle
Fluid-containing skin elevation < 0.5 cm in diameter
Wheal
Transient, pruritic, edematous papule or plaque.
Bulla
Fluid collection in elevated skin > 0.5 cm in diameter.
Pustule
Papule containing purulent fluid.



.
Petechiae
Nonblanching, flat, red/purple lesions caused by thrombocytopenia associated
microhemorrhages.
Purpura
Visible collection of extravasated RBCs.
Telangiectasia
Visible dilated capillaries on the surface of the skin.
Hyperkeratosis
Thickening of the stratum corneum
Keloid
Scar tissue hypertrophy.
Scale
Thick, detached areas of stratum corneum.
Crust
Dried exudate.
Excoriation
Shallow abrasion caused by scratching.
Erosion
Loss of epidermis above the basal layer.
Ulcer
Loss of epidermis and part or all of the dermis.
Nevus
Benign growth, such as a mole, that is a cluster of melanocytes.
atopic dermatitis viral associations
impetigo
cellulitis
HSV-1 skin infection (eczema herpeticum)Molluscum contagiosum.
Bullous Pemphigoid autoantibodies
BP1 and BP2 found in the basement membrane of the skin.
tx pemphiguds vulgaris
Oral steroids. Patients must continue steroids to prevent recurrence. Immunosuppressants
such as azathioprine can be used to ↓ steroid dose.
■ Severe cases may require plasmapheresis.
■ Lesions should be cared for as burns
how is contact dermatitis diagnosed? Tx for mild and severe cases
>> skin patch testing.
tx:
■ Mild cases: Cool compresses or oatmeal preparation; topical steroids 3–4 times a day to reduce pruritus.
■ Severe cases: An extended course of systemic corticosteroids may be required;
antihistamines to reduce pruritus
recurrent erythema multiforme
Think HSV infection with
what would an erythema multiforme show on skin biopsy.
Skin biopsy shows perivascular lymphocytes (mostly T cells) and necrotic keratinocytes
what medication both a precipitating factor and a treatment for erythema nodosum.
NSAIDs are both a precipitating factor and a treatment for erythema nodosum.
treatment for erythema nodosum
Supportive. Elevate leg, bed rest, potassium iodide, NSAIDs.
■ Systemic corticosteroids may be necessary for persistent cases
Lichen Planus is associated with?
Often induced by drugs and strongly associated with HCV
Dx:purple, polygonal pruritic papules with an overlying network of white lines (Wickham’s striae)
Lichen Planus
treatment Lichen Planus for itch and severe cases.
Topical steroids and oral antihistamines to reduce itch; severe cases require cyclosporine, oral prednisone, oral retinoids, and PUVA.
Munro microabscesses
(neutrophils in stratum corneum) seen in psoriasis
psoriasis: mild and severe
Topical steroids and topical calcipotriol for mild to moderate disease.
■ Phototherapy (PUVA/UVB) and immunosuppressants such as methotrexate for severe or generalized disease.
■ Biologic agents (e.g., infliximab, etanercept).
young person with severe seborrheic dermatitis
Suspect HIV
what yeast is Seborrheic Dermatitis
Pityrosporum yeast.
The leading cause of (SJS/TEN)
is sepsis from superimposed bacterial skin infections (S. aureus in the early stages; gram- rods such as Pseudomonas in later stages).
SJS skin biopsy:
Perivascular mononuclear infiltrate and degeneration of the basal layer.
TEN skin biopsy
Full-thickness, predominance of macrophages and
dendrocytes and a strong immunoreactivity for TNF-α.
tx: SJS/TEN
Early diagnosis and elimination of offending agents
Hospitalize in the burn ICU to manage skin and fluid losses.
With vitiligo, consider other
autoimmune diseases, name them
pernicious anemia, thyroid
disease, Addison’s disease,
and type I DM
tx .vitiligo
Topical artificial tanning creams, steroid/tretinoin creams, or phototherapy
can be used. Lesions can be refractory
what test should be done before administering isotretinoin
Isotretinoin is teratogenic, so
women must have pregnancy
testing before and during
therapy.
tx for mild moderate acne
Mild acne: Topical clindamycin or erythromycin; benzoyl peroxide; topical
retinoids.
■ Moderate acne: The above regimen plus oral antibiotics such as tetracycline.
■ Severe nodulocystic acne: Oral isotretinoin (Accutane
tx. for cellulitis/folliculitis
For mild to moderate cases, give oral antibiotics (cephalexin or dicloxacillin)
× 7–10 days.
■ Hospitalize and give IV antibiotics in the presence of any signs of systemic
toxicity,
Small, scaling, hyper- or hypopigmented macules that tend to enlarge and sometimes coalesce. (“spaghetti and
meatballs” on KOH prep
PITYRIASIS VERSICOLOR
treatment topical antifungal agents and selenium sulfide shampoo.
tx. for HSV erruptions: decrease viral shedding, recurrenc and have more than 6 out breaks per year
Acyclovir ointment reduces the duration of viral shedding
■ Oral or IV acyclovir frequency and severity of recurrences.
■ Daily acyclovir suppressive therapy = > 6 outbreaks per year.
Nonbullous impetigo
Characterized by superficial pustules with surrounding
erythema.
Bullous impetigo
Begins as small, erythematous macules → thin-walled vesicles or bullae on an erythematous base. Caused by coagulase- staphylococci that produce exfoliatin, a toxin.
lice treatments
Permethrin shampoo or cream; decontaminate sources of reinfection such as combs, bed sheets, and clothing.
describe scarlet fever
Sandpaper-like rash on the trunk; “strawberry” tongue;
circumoral pallor. The rash desquamates after a few .
days.
scarlet fever occurs in patients who has untreated disease and how to prevent rheumatic fever
Occurs in patients with untreated streptococcal pharyngitis treat with penicillin to prevent rheumatic fever.
If you see large molluscum
contagiosum lesions, think of?
HIV
what is Fournier’s gangrene?
is necrotizing fasciitis of the perineal region
treatment for necrotising fasciitis
■ Surgery to explore deep fascia and muscle and to remove necrotic tissue.
■ Gram stain and culture of tissue to determine appropriate antibiotic therapy
Necrotizing Fasciitis
rapidly developing infection of skin and fascia that has high mortality without emergent treatment.
>>Caused by group A streptococci, mixed aerobicanaerobic bacteria, or Clostridium perfringens.
tx. scabies for puritus, close contacts
TREATMENT
■ Treat with 5% permethrin cream; give antihistamines for pruritus.
■ Treat close contacts; wash bedding and clothing to prevent reinfestation.
Verrucae (Warts)
Caused by;
Hx/PE:
Rx:
■ Caused by HPV.
■ Hx/PE: Usually occurs in older children; commonly found on the hands.
■ Rx: Salicylic acid, liquid nitrogen, curettage.
lichen sclerous
cancer risk
diagnosis
tx
>>risk of squamous cell carcinoma in rare cases.
>>biopsy shows hyperkeratotic epidermis with follicular plugging, progressing to atrophy
>>Short-term, high-potency topical glucocorticoids or oral hydrochloroquine
Tuberous sclerosis
cutaneous manifestation
Shagreen patches (thickened areas of skin), ash leaf spots (hypopigmentation), angiofibromas (red papules around the nose).
Tuberous sclerosis: non dermatologic symptoms
Periventricular tubers, seizures, mental retardation,kidney or heart tumors.
Neurofibromatosis cutaneous manifestation
Café-au-lait spots, axillary
freckling. scoliosis, seizures.
Neurofibromatosis non dermatologic symptoms
neurofibromas,Meningiomas, acoustic neuromas, Lisch nodules (iris lesions), optic nerve gliomas, renovascular hypertension,
Sturge-Weber syndrome cutaneous manifestation
Port-wine stain on the face (hemangioma) over the distribution of CN V1.
Sturge-Weber syndrome cutaneous manifestation
Seizures, mental retardation, visual impairment.
von Hippel–Lindau cutaneous manifestation
Hemangiomas.
von Hippel–Lindau cutaneous manifestation
Retinal vascular hamartomas, renal cell cancer, syndrome pheochromocytomas, polycythemia.
When numerous seborrheic
keratoses acutely erupt, Dx
“sign of Leser- Trélat” and can be a sign of underlying malignancy (e.g., gastric cancer
tx for seboherric dermatitis
cryosurgery or curettage for cosmetic purposes
tx for basal cell carcinoma
curettage, surgical excision, Mohs’ micrographic surgery
(serial excisions with fresh-tissue microscopic examination to maximize
cosmesis), cryosurgery, and radiation.
■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun exposure.
tx: actinic keratosis
Rx:
■ Cryosurgery, topical 5-FU, curettage, or chemical peel.
■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun
exposure.
tx: SCC
Rx:
■ Surgical excision, Mohs’ micrographic surgery, or radiation.
■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun
exposure
tx. kaposi sarcoma
Rx: Antiretrovirals for HIV; chemotherapy for lesions (radiation, intralesional
vinblastine, liquid nitrogen cryotherapy
biopsy of kaposi sarcoma
proliferation of small vessels and slitlike intercellular spaces with extravasated RBCs.
Bx: SCC
Biopsy shows irregular masses of anaplastic epidermal cells proliferating down to the dermis
Bx: actinic keratosis
dysplastic squamous epithelium (hyperkeratosis,
with cells of the lower epidermis showing loss of polarity, pleomorphism,
and hyperchromatic nuclei) without invasion into the dermis
Bx: basal cell carcinoma
characteristic basophilic cells palisading with retraction
Bx: mycosis fungoides
Biopsy shows infiltrate of atypical lymphocytes with convoluted cerebriform
nuclei in the upper dermis and microabscesses in the epidermis (Pautrier’s microabscesses).
Tx:Mycosis fungoides.
PUVA photochemotherapy, topical nitrogen mustard, total-body electron
beam irradiation, ultra-high-potency topical steroids, systemic and topical
retinoids.
complication of mycosis fungoides
Sézary’s syndrome, secondary sepsis to high grade lymphoma
what is rhinophyma?
Men can develop (large, porous, lobulated nose) when they have roscea
treatment for rosacea
■ Avoid precipitating factors.
■ Topical metronidazole, sulfur lotions, and oral tetracycline or isotretinoin are options
histology of erythyma multiforme
Perivascular T lymphocytes;
histology of SJS
Perivascular mononuclear cells
with eosinophils in the
papillary dermis; degeneration
of the basal layer; subepidermal
blister formation.
histology of TEN
Full-thickness, eosinophilic
necrotickeratinocytes.epidermal necrosis; cell-poor infiltrate with predominance of macrophages and dendrocytes; strong immunoreactivity for TNF-α.
Location: pemphigous vulgaris vs. bullous pemphigoid
PV: Mucous membranes, skin.
BP: Only the skin; usually the arms and
thighs.
Autoantibody target: pemphigous vulgaris vs. bullous pemphigoid
PV: Desmocollins, desmogleins.
BP: BP1 and BP2
Location of Intercellular: pemphigous vulgaris vs. bullous pemphigoid
PV: Epidermal-dermal junction.
BP: autoantibodies
Location of blister: pemphigous vulgaris vs. bullous pemphigoid
PV: Intraepidermal, shallow.
BP: Subepidermal, deep.
Nikolsky’s sign: pemphigous vulgaris vs. bullous pemphigoid
PV: positive
BP: negative
Symptoms: pemphigous vulgaris vs. bullous pemphigoid
PV: Painful
BP: Itchy