Chapter 14 - Dermatology
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What are the layers of the skin?
- Stratum corneum
- Stratum Lucidum
- Stratum Spinosum
- Basement membrane
"Californians like girls in string bikinis"
How long does it take basal cells to reach the surface and be shed?
Patient got new custom shoes and presents with a irregular poorly demarcated patches of erythema superimposed with vesicles on distal big toe. What caused this?
Pt has possibly contact dermatitis from rubber found in toe box or cement used to bind shoe together.
Pt has history of migrains and asthma. He just moved to Flordia and developed poorly demarcated patches of erythema superimposed vesicles on dorsum of feet b/l.
- Atopic dermatitis
- -Usually a positive family history of allergic rhinitis, hay fever, asthma or migraines
- -Often exacerbated by sudden changes in temperature, humidity, stress/anxiety, and females may have eruption just before their mentrual period.
Pt developes an allergic reaction to eggs and breaks out into transient puritic wheals in minutes. The skin manifestations disipate in 24 hours. What do you call this skin presentation and what general anesthetic might you want to avoid?
- Avoid Propofol (don't give to pt with egg allergy)
70 year old during winter month develops skin rash that is itchy. What skin disorder?
- Nummular Eczema
- -Most common in older males during winter.
Pt has lichenification at dorsum of foot. Pt has history of schitzophrenia. What skin disorder?
Lichen Simplex Chronicum
Pt presents with small vesicles deep seated in clusters on plantar foot. Dr. asked about possible ingestion of metals and any recent emotional stress. What derm condition might the patient have?
- Dyshidrotic eczematous dermatitis
- -Emotional stress and ingestion of certain metals (nickel, cobalt, or chromium) have been suggested as possible precipitationg factors.
Patient has crohn's dz and presents with a large ulcer with purple overhanging edge on leg. What derm condition is present?
- Pyoderma gangrenosum
- -a rare disease frequently associated with GI diseases (UC, chrons dz.
5 year old has been attending preschool and developed a red rash with many small blisters on dorsal toes. What skin infection is present?
- -a common contagious superficial skin infection seen in preschool children and young adults
- -caused by staph
Pt presents with the soles of feet giving rise to a "moth-eaten" appearance. Pt has hyperhidrosis and bromhidrosis. What skin disorder? what is the causative organism?
- Pitted keratolysis
- -superficial pitting in the stratum corneum caused by corynebacterium or micrococcus sedentarius
Patient presents with a bacterial infection affecting the intertriginous areas of feet. What is the causative organism and what would be a good diagnostic modality?
- -Cornebacterium minutissimum
- -Use Wood's lamp and see "coral-red"
What organism is the most common cause of tinea capitus? Tinea pedis?
- Capitus: Trichophyton tonsurans and schoenleini
- Pedis: T rubrum
When would you use a tzanck smear?
To diagnose herpes simplex, herpes zoster, chickenpox (test with fluid from vescicle)
Patient develops an inflammatory eruption of the skin on flexor surfaces for the 4th time. He also has an oral lesion and develops ptergium What skin disorder?
- Lichen Planus
- -seen symmetrical in the flexor surfaes of wrists
Pt develops an extrememly painful blue-red lesion on distal digit. The pain comes very abruptly. What is the lesion?
- Glomus tumor
- -arise from glomus bodies in the nail bed, glomus bodies funtion in the blood shunting as an aid to temperature regulation in the nail bed.
Pt develops a bluish-red, purple to violaceous or dark brown macule on foot. Patient is of eastern europe descent and homosexual. What skin disorder?
- Kaposi's Sarcoma
- -Prior HIV was uncommon and seen in greatest frequency in Eastern Eruope and Jewish and Italian immigrants over 60 years of age.
- -Now occurs mainly in homosexual males with HIV.
What is the most common type of melanoma?
Superficial spreading melanoma
Which melanoma has the worst prognosis?
Which melanoma is aggressive and invades early, also found on nonwhite individuals?
Acral lentiginous melanoma
Patient has melanoma that invades through basement membrane to papillary dermis. What is the clarks classification?
- Stage 1: limited to epidermis
- Stage 2: Through basement membrane into papillary dermis
- Stage 3: Filling the papillary dermis
- Stage 4: into the reticular dermis
- Stage 5: into the subcutaneous fat
Pt has hyperpigmentation over the knuckles of the toes. What skin disorder does the pt have?
- Acanthosis Nigricans - may precede other symptoms of malignancy by 5 years
- - must r/o an underlying endocrine disorder and malignancies.
- Type 1 - hereditary, benign
- Type 2 - benign, associated with endocrine disorders (diabetes)
- Type 3 - pseudo, complication of obesity
- Type 4 - drug induced
- Type 5 - malignant
Pt presents with firm, pearly, white, well circumstribed papule on dorsum of foot. Pt is diabetic, what is the diagnosis?
Granuloma annulare: possibly a higher incident in diabetics. recurrences are common. Lesions are usually asymptomatic and self limiting.
Pt has hyperpigmented macule on the leg. This skin disorder is associated with a certain medical condition associated with nerves. What is the skin disorder called and what is the associated condition?
Cafe au lait spot, neurofibromatosis.
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