ARNP Derm Cert

Card Set Information

ARNP Derm Cert
2012-09-15 14:22:20

ARNP Derm Cert
Show Answers:

  1. What are actinic keratosis?
    Discrete, dry, rough, adherent scaly lesions that occur on sun-exposed skin. Small portion can turn into squamous cell carcinoma.

    Treatment: Cryosurgery, 5-FU, Imiquimod, topical retinoids, facial peels, laser surgery, photodynamic therpay
  2. Basal Cell Carcinoma
    Most common cancer in the US

    Locally invasive, aggressive, and destructive with limited capacity to metastasize.

    Types: Nodular, cystic, ulcerating, sclerosing or morpheaform, superficial multicentric, pigmented, infiltrative

    Treatment: Excision (always in danger sites), cryosurgery, electrocautery, 5-FU, Imiquimod
  3. Squamous cell carcinoma
    Second most common form of skin cancer.

    Locally invasive with significant potential for metastases, esp in cancers occuring in scarring processes.

    Types: SCC I/S (Bowen's disease), highly differentiated, poorly differentiated

    Treatment:  Excision, consider 5-FU, cryosurgery for SCC I/S
  4. Keratoacanthoma
    Erythematous, dome-shaped tumor, firm but not hard, ranges from 1- 10 cm.

    Considered low-grade SCC.

    Rapidly growing papule typically on sun-exposed areas.

    Typically will spontaneously involute but may take up to a year.

    Treatment: Excision, 5-FU, Bleomycin, Methotrexate
  5. Dermatofibroma
    Asymptomatic papule or nodule, typically dome shaped and sharply circumscribed

    Etiology unknown; may occur as a result of trauma

    Range from 4-20 mm

    May be skin-colored, pink, tan, brown, dark brown.

    Dimple sign or button effect

    No treatment necessary, may excise or treat with cryosurgery
  6. Immunosupression- increased risk
    HIV, several diseases, and certain medicines used in treating organ transplants and other conditions all have something in common: they can weaken the immune system, leading to skin cancers.

    Organ transplant patients have 64 times as many squamous cell carcinoma as the general population. BCC presents a tenfold risk and melanoma a threefold risk, compared to the general population. Some rare skin cancers, such as Merkel cell carcinoma, also show up sometimes.
  7. Malignant Melanoma
    Damage and alteration to the melanocytes casing a mutation in the cell fom UV. 

    • Stage 0/melanoma insitu 99.9% curable
    • Stage I/II   40-80% curable
    • StaGe III  20-60%
    • Stage IV  9-15% survival rate
  8. Mastocytosis
    Rare disorder involving proliferation of mast cells in the skin. Mast calls are made by the bone marrow for the immune system.

    • Two types: cutaneous and systemic
    • Typically cutaneous in children and systemic in adults

    • Presents as:
    • Red rash
    • Rash with freckles
    • Hives
    • Lump on the skin
    • Urticate upon rubbing

    May cause flushing, urticaria, diarrhea, abd pain, headache, dyspnea, syncope, and palpitations, angioedema, asthma-like symptoms, syncope, anaphylaxis

    TX: H1, H2, and antiserotonins, avoid physical stimuli, PUVA, avoid opiates, aspirin, alcohol, quinine, scopolamine, gallamine, decamethonium, reserpine, amphotericin B, polymyxin B, and d-tubocurarine, epi pen
  9. Classifications of Mastocytosis
    Cutaneous and systemic mastocytosis 

    • 1. Indolent systemic mastocytosis (ISM) 
    • • Isolated bone marrow mastocytosis 

    • Smouldering systemic mastocytosis(SSM) 

    2. Systemic mastocytosis with associated hematopoietic disease (SM-AHD, AHNMD [associated hematological non mast cell disorder]): systemic mastocytosis with leukaemia, myelodysplastic syndrome/disease, or non-Hodgkin lymphoma 

    3. Aggressive systemic mastocytosis (ASM) 

    • 4. Mast cell leukemia 
    • 5. Mast cell sarcoma 
    • 6. Extracutaneous mastocytoma
  10. Describe squamous cell carcinoma
    SCCs represent about 20% of the non-melanoma skin cancers, but due to their more obvious nature and growth rates, they represent 90% of all head and neck cancers that are initially presented.[10] The vast majority of SCCs are those of the skin, and like all skin cancers, are the result of ultraviolet exposure. SCCs usually occur on portions of the body commonly exposed to the Sun; the face, ears,neck, hands, or arm. The main symptom is a growing bump that may have a rough, scaly surface and flat reddish patches. Unlike basal cell carcinomas, SCCs carry a significant risk of metastasis, often spreading to the lymph nodes,[11] and are thus more dangerous. During its earliest stages, it is sometimes known as Bowen's disease. Can be excised Scc insitu can be treated with Aldara, ed&c can be used with good efficacy.
  11. What are seborrheic keratosis
    Seborrheic keratosis (also known as "Seborrheic verruca," and "Senile wart"[1]:767[2]:637) is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age.[3] In fact, they are sometimes humorously referred to as the "barnacles of old age". Because the are isolated in the epidermis they can be easily removed via currette or cryosurgery.
  12. B cell lymphoma
    Develops from cutaneous lymphoid hyperplasia. Favors the face and is generally a solitary lesion. May be caused by Borrelia infections, tatoos, herpes zoster, antigen injecitons, acupuncture
  13. Cutaneous T cell lymphoma (CTCL)
    • Clonal proliferation of cells.
    • Most common types are Mycosis fungoides and Sezary syndrome.
    • Other types: Granulomatous slack skin, Lymphomatoid papulosis, Pagetoid reticulosis
  14. Mycosis fungoides
    Chronic patches, plaques and tumors on skin that progress slowly. Often have a long prodromal phase with non-diagnostic biopsies.

    TX: Topical steroids, topical nitrogen mustard or carmustine, ultraviolet therapy, radiation, retinoids, systemic chemo
  15. Sezary Syndrome
    Leukemic phase of mycosis fungoides.

    Erythroderma and abnormal T-cells in the blood and progresses rapidly. Erythoderma from onset of rash is characteristic.

    Assocaiated features: leonine facies, eyelid edema, ecotropion, diffuse alopecia, hyperkeratosis of palms and soles, dystrophic nails

    Poor prognosis, average survival < 5 years

    Histologically there is no difference in mycosis fungoides; need T-cell gene rearrangement and blood work

    TX: Methotrexate, Photophoresis, TSEB radiation, Zanolimumab
  16. Atopic dermatitis
    Chronically relapsing skin disease with pruritus, facial and extensor involvment in infancy, flexural in children and adults.

    Associated with asthma, allergies, xerosis/skin barrier dysfunction, IgE reactivity

    Denne-Morgan folds, allergic shiners, facial pallor, PA, KP, IV, white dermatographism, conjuctivitis

    TX: Cutaneous hydration, topical & systemic steroid, calcineurin inhibitors, TAR, phototherapy, cyclosporine, methotrexate, identify and treat allergens
  17. Contact Dermatitis
    Two types:  irritant and allergic

    Irritant: inflammtory reaction in skin as a result of exposure to a substance

    Allergic: acquired sensitivity to various substances that produces an inflammtory response
  18. Eosinophilia pustular folliculitis
    Three variants: classic eosinophilic pustular folliculitis, HIV-associated eosinophilic pustular folliculitis, and infantile eosinophilic pustular folliculitis.

    Puritic, follicular papulopustules 1 -2 mm; tend to be grouped and form plaques.

    Most frequently affects the cheeks, common on trunk and extremities, 20% have palmoplantar pustules

    Cause unknown; often seen in pts with Hep C, with Allopurinol, Demodex may be triggering agent

    Treatment: Indomethacin, topical and intralesional corticosteroids, minocycline, isotretinoin, UVB therapy, dapsone, cyclosporine
  19. Exfoliative dermatitis (Erythroderma)
    Most frequently the result of a pre-exisiting chronic dermatosis. May be related to a medication or internal malignacy (MF or Sezary). In children, consider immune defects.

    Entire body surface area (90%) dull scarlet and covered by small, laminated scales that exfoliate profusely; often have distinctly spared islands of skin.

    Severe pruritus and often have symptoms of general toxicity with fever and chills.

    Severe complications of ARDs, sepsis, cardiac failure, capillary leak syndrome; mortality rate 7%.

    TX: address underlying cause, steroids, cyclosporine, sauna suit, methotrexate, soriatane
  20. Grover's disease
    Pruritic, polymorphic, cutaneous papulovesicular eruption on the trunk.

    Most commonly seen in males over 40 with habitual sun exposure

    Exacerbated by heat and sweating

    TX: steroids, emoillients, urea, lactic acid, isotretinoin
  21. Intertrigo
    Superficial inflammation of opposing skin. Area becames emacerated and secondary infection of bacteria or fungus results.

    Well demarcated fiery red, moist, shiny surface, foul smell and absence of satellite lesions.

    Common in obese and children

    Inverses psoriasis and erythrasma should be considered.

    TX: low potency steroid or Protopic with antifungal or antimicrobial; separate opposing skin surfaces with gauze, etc.
  22. Keratosis Pilaris
    A skin condition in which the keratin forms hard plugs  within the hair follicles. Usually seen on the backs of arms and thighs. Worsens in winter, better in summer.

    • Treatment may include:
    • Moisturizing lotions to soothe the skin and help it look better

    Skin creams that contain urea, lactic acid, glycolic acid, salicylic acid, tretinoin, or vitamin D

    Steroid creams to reduce redness

    Improvement often takes months and the bumps are likely to come back.
  23. Lichen planus
    • an inflammatory condition that can affect your skin and mucous membranes.Purple Pruritic papules.
    • On the skin, lichen planus usually appears as purplish, often itchy, flat-topped bumps. When mucous membranes are affected — such as tissues inside the mouth or vagina — lichen planus appears as lacy white patches or sores that can be painful. Must rule out hep C
  24. Lichen simplex chronicus
    Skin disorder that is induced by the itch scratch cycle. Usually associated with eczema atopic derm, and psoriasis. Also called neurodermatitis. Treatment involves the patient to stop scratching . Can also be associated with psychiatric disorders.
  25. Nummular eczema
    Nummular eczema is characterized by round or oval erythematous plaques most commonly found in the arms and legs.Treatment is aimed at moisturizing the affected areas. 20 minute bath soaks with Petrolatum and topical steroids Are applied immediately after often relieves the symptoms. Occasionally antibiotics are used to treat secondary infection.
  26. Pityriasis alba 
    A common skin condition affecting children and occasionally adults. Several round or oval slightly scaly pink patches appear, leaving pale Marks when the redness has faded. There's no treatment needed.
  27. Pityriasis rubra pilaris
    A chronic skin condition in which pink, scaly patches and thick-skinned develop on the hands and feet. The pink scary areas covering the hands and feet. Small "islands" of normal,skin are seen within the areas of plink scaly skin. Treatment creams containing urea or lactic acid may help.m Oral isotretinoin also is used.
  28. Pityriasis rosea
    Is described as pink salmon colored with Collarette scale. Often can be diagnosed with the presence of a Harold, or "mother" patch that presents itself as the first lesion  1-20 days prior to the rash ranging 2 to 5 cm in diameter. Typically presents itself on the trunk of the body in a Christmas tree like pattern. Can be associated with the herpesvirus or syphilis. Soaps usually aggravate so have patient wash with normal water and use moisturizers. This is a self-limiting skin disorder.
  29. Pityriasis lichenoids chronicus
    is condition is characterized by the gradual development of symptomless, small, scaling papules that spontaneously flattened and regress over a period of weeks. Can be associated with Epstein bar virus or other viruses such as parvovirus b19. Treatment includes phototherapy corticosteroids and treatment for the itching usually affects adolescents. Must rule out hep,HIV,mono,strepolysin titter o.Rpr and throat cultures.
  30. .PLEVA
    Commonly misdiagnosis as chickenpox. is often misidentified as a form of staph infection. More severe than pityriasis lichenoid us, signs and symptoms usually begin with itching, burning skin lesions that ulcerate, break down and form open sores. May also be experience with a low-grade fever headache or malaise. Also called Mucha-Habermann disease. Usually seen on the arms legs trunk. Tetracycline erythromycin antibiotics are used along with Puva and corticosteroids.
  31. Pruritic urticarial papules & plaques of pregnancy (PUPPP)
    The most common Rashon pregnant women. It normally occurs in the first pregnancies during the third trimester. Does not usually affect subsequent pregnancies. Always begins in the stretch marks of the abdomen. Treatment includes corticosteroids.
  32. Psoriasis
    chronic skin disorder is characterized by Redskin covered with silvery scale and inflammation. Patches of circular two oval-shaped plaques usually occurring on the arms and legs elbows trunk and knees. Usually from an overactive immune system. Over excited tumor necrosis factor interleukins and cytokines. Can be suppressed by steroids puva   and the biologic agents. Frequently identified with kebnoers phenomenon
  33. Seborrheic dermatitis
    A papulosquamous disorder based on the oil-rich areas of the scalp face and trunk. It is linked to a yeast called Malassezia. Is commonly  associated by changes in humidity changes and seasons, or trauma or stress.topical steroids, although should be limited, cyclopriox, ketoconazole sulfur and dandruff shampoos containing zinc all help to contain his condition.
  34. Stasis dermatitis
    Stasis dermatitis occurs as a direct consequence of Venus insufficiency. Can be caused from deep vein thrombosis, surgical bypass, and diabetes.Treatment includes low potency topical steroids compression stockings. Treating with antibiotics if there are ulcers or open wounds.
  35. Xerosis cutis
    Excessive dryness of the epidermis. When the all-natural skin oils which lubricate the epidermis minimize and the amount of water is greatly diminished. This often occurs with the elderly.
  36. Drug eruption
    Drug eruptions can mimic a wide range of dermatoses. The morphologies include morbilliform, urticarial, papulosquamous pustular , and bollous. Most likely, if fixed drug eruption, the causing agents are anabiotic's antiepileptics  nonsteroidal anti-inflammatory agents and phenothiazines. The most common cause are sulfa drugs.
  37. Drug induced exanthems
    The most common cutaneous reactions to drugs, responsible for 75% of all drug rashes. The most commonly prescribed medication is antibiotics and soulful. Thrushes are referred to as xanthines or morbilliform and maculopapular ructions. Beginning the dependent areas and generalize, often associated with mucous membranes your theme. Two rightists is the most common symptom with low-grade fever.
  38. Neutrophil dermatosis
    Also called sweets syndrome it is a reactive process characterized by the abrupt onset of tender red to purple papules and nodules that coalesce to form plaques. The plaques usually occur on the upper extremities the face with a neck. Can often be precipitated after an upper respiratory illness. 11 to 54% of the cases are associated with some malignancy neoplasm,  Usually hematopoietic malignancies. Other bacteria such as coccidiomycosis and sporotrichosis are also associated with sweets syndrome. Lab work CBC CRP ESR. Hep panel. Prednisone is often very effective.dapsone and cyclosporine are also effective.
  39. Panniculitis
    Group of conditions that involved the  inflammation fat under the skin. Further classification of panniculitis is based on whether or not there's inflammation involving the blood vessels of the fat, which is vasculitis. Erythema nodosum,  The information occurs on the lower extremities as subcutaneous erythematous modules. Causes include sulfa drugs, birth control pills, strep throat, cat scratch disease, fungal disease, infectious mono, sarcoid, bechet's disease, and IBS like Crohn's and ulcerative colitis, hepatitis, syphilis, and is normal in pregnancy. Treatment involves Cortizone by mouth or local injection and anti-inflammatory drugs, potassium iodide.
  40. Erythema multiforme
    An acute self-limited and sometimes recurring skin condition that it considered to be hypersensitivity reaction associated with certain infections or medications. Characterized by small target or iris sign, lesions commonly found on hands body and sometimes oral mucosa, also oral mucosa is mildly affective. Most common cause by HSV herpes. Syphilis is also a factor. Medications that are commonly risk factors barbiturates penicillins phenytoin and  sulfa drugs. Often shows positive Nikolski sign. Erythema multiforme major, Also called Steven Johnson syndrome involves  widespread scaling heavily oral and Eye involvement. Important to note that these two disorders are completely different and do not progress into one another.
  41. Polymorphic light eruption
    Polymorphic light eruption is coming rash that occurs as a result of photosensitivity. Usually occurs in the sun exposed areas of the body. Arms chest face. Prevention is Endicotte apothecaries of clothing. Using SPF clothing. SPF lotion and stay in the shade.Interruption severe enough oral  steroids maybe prescribed.
  42. Porphyria Disorder
    Porphyrinogins of the building blocks of all hemoproteins. They're produced in bone marrow. There's an enzyme that is linked to the synthesis of these hemo proteins. When the hemoproteins are inadequate porphyrias are allowed to accumulate in the blood. The current group of porphyrias is based on the primary set of increased porphyrian  production, either in the liver or bone marrow. The hepatic  or erythropoietic porphyrias, respectively. Porphyria cutanae tarda is part of the hepatic porphyrians.
  43. Porphyria cutanae tarda
    Pct is the most common type of period. It is caused by a deficiency in the enzyme  uroporphyrinogen decarboxylase. The diseases characterized by photosensitivity resulting in bollous eruption especially on sun exposed part.This is caused by the porphyria in the blood reacting with the sun. The dorsal hands and forearms, ears and face are primarily affected. Liver disease frequently present in patients with PCT.There is also a history of alcoholism. Hepatitis should be ruled out. Diabetes is also associated with PTC. Hidalgos is a Tsidae Gibbstown suspected on the performance of urine test that will show a characteristic pink already florescence underwoods like examination phlebotomy is the treatment of choice.
  44. Pyoderma gangrenosum
    Painful ulcers would sharply marginated, undermine, blue to purple borders. Most commonly occurs in adults 40 to 60 years of age typically presents on the lower extremities in truck.lesions heal  with a characteristic thin atrophic scars. Colonoscopy should be done to rule out inflammatory bowel disease. Treatment includes systemic corticosteroids, dapsone,  tacrolimus, and TNF blockers biologic agents.
  45. Steven Johnson's syndrome
    And immune complex mediated hypersensitivity of the skin that typically involves the skin and the mucous membranes.While mild  presentations may occur, significant involvement oral, nasals, Eye, vaginal, urethral, gastrointestinal, and lower respiratory tract mucous membranes may develop over the course of the illness. There is full epidermal thickness loss through the basement membrane zone of the skin. The four common causes infectious, drug-induced, malignancy related, and idiopathic. Drug-induced causes include phenytoin carbamazepine valproic acids and barbiturates.
  46. Tens
    Life-threatening dermatological disorder characterized by widespread erythema necrosis and bolus detachment of the epidermis and mucous membranes resulting in exfoliation. Tens is most commonly drug related. Tens involves 30 % of the body, where Stevens Johnson syndrome involves less than 10%. Sulfa drugs are the most common drugs causing tens, with NSAIDS,a second. 100% destruction of the epidermis is seen in TENS.
  47. Vasculitis 
    Vasculitis is a process characterized by information in the process of blood vessels. Can be further classified into several different classifications of vasculitis. Small vessel vasculitis. Which includes idiopathic small vessel vasculitis, acute hemorrhagic edema of  infancy, urticarial vasculitis, cryoglobulinemic, erythema elevatum diutinum granuloma faciale and leukocytoclastic vasculitis. Medium vessel vasculitis includes polyarteritis nodosa. Mixed Size vasculitis includes connective tissue disease, septic vasculitis, ANCA associated vasculitis which include polyangiitis Wegener's granulomatosis allergic granulomatosis and drug-induced vasculitis. Large cell vasculitis includes Giant cell arteritis.
  48. Purpuras
    Purpura is the term used described extravasated of blood into the skin or mucous membrane. It presents as distinctive brownish red or purpleish macules. Family history or thrombotic disorders needs to be addressed. CBC and differential can be used to assessed for microangiopathic anemia. Can be classified into thrombocytopenic purpura, drug and food induced purpura, immune thrombocytopenia purpura, hyperglobulinemic purpura, Purpura fulminans, non-thrombocytopenic purpura.
  49. Thrombocytopenia purpura
    Maybe classified into two large categories, states resulting from Excelerated platelet destruction, and -states resulting from a deficiency of platelet production. Accelerated platelet thrombocytopenic purpura maybe caused by antibodies or autoimmune or drug-induced and DIC. Deficiency platelet production may be related to diseases such as aplastic anemia and leukemia.
  50. Anthrax dematosis
    Cutaneous anthrax is uncommon in the world. It results from contact with infected animals or the handling of hides or other animal products when the animal has died from splenic fever. Index is characterized by rapidly approaching, painless eschar with superlatives regional adenitis. Three forms of the disease occurring humans: cutaneous account for 95% of the cases, inhalation, and gastrointestinal. The first clinical manifestation of the cutaneous form is inflammatory papule, which begins about 3 to 7 days after inoculation, at the exposed site. Inflammation develops rapidly so there is a bulla surrounded by intense edema and infiltration within another 24 to 36 hours . It ruptures spontaneously a dark brown or black eschar is visible. Disease is produced bacillus  anthracis. Cipro needs to be given promptly for  adequate treatment
  51. Candidiasis
    Under the microscope candidiasis KOH prep may show spores and pseudo-hyphae oral thrush is involved with the mouth. In newborns the infection may be acquired by contact. Grayish white membrane plaques are found on the surface of the membranes. Perleche characterized by maceration and transverse fissuring of the oral commissures. Perleche is commonly related to Candida albicans. Intertrigo affects the areas of skin folds.
  52. Erysipelas
    Erysipelas, also known as St. Anthony's fire and ignis sacer, is an acute beta-hemolytic group a streptococcal infection of the skin involving the superficial dermal lymphatics. The onset is often preceded by prodromal symptoms of malaise for several hours accompanied by severe constitutional reaction chills high fever headache vomiting and joint pains. It is characterized by local redness almost violacious red, swelling and highly characteristic raised indurated order. In the early stages the affected skin is Scarlet, hot to touch, brawny and swollen. A distinctive feature of the inflammation is the advancing edge of the patch. This is raised in sharply demarcated, and feels like a wall to the palpating finger.  The legs and  face are the most common sites affected. Went on theface  inflammation generally begins on the cheek near the nose or frontal lobe of the ear and spreads upwards towards the scalp. When On the legs, Edema and bulbous  lesions are prominent features in many cases.
  53. Cellulitis
    Cellulitis is the inflammation involving the subcutaneous tissue, cause most frequently by staph pyogenes or staph aureus. Usually but not always, this follow some discernible wound. On the leg tinea pedis is most common portal of entry. Mild local erythema and tenderness sickness, malaise and chill sensations,may be present. The erythema rapidly becomes intense and spreads. The area becomes infiltrated and pits on pressure.
  54. Condylomata acuminata
    Condyloma on the skin surface appears as lobulated papules ranging from 2- 5 mm in size. Can appear anywhere on the penis or the anus.
  55. Cutaneous larvae migrans
    Also called creeping eruption , is applied to twisting, winding linear skin lesions produced by the burrowing Larva. Often affect people who go barefoot. There's a slight local itching and then the appearance of papules at the site of infection characterized by intermittent stinging and then A thin red tortuous line formed in skin . The culprit is often found in cat or dog feces. ivermectin 200 as a single dose, albendazole 400 mg for three days. Topical thiabendazole compounded as a 10% suspension or 15% cream use four times a day will result in relief.
  56. Furuncles
    A furunclenor boil is an acute, round, tender, circumscribed, periFollicular staphylococcal abscess that generally ends in central suppuration. The lesions beginning hair follicles and often for a prolonged period of inoculation. Warm compresses and antibiotics taken internally may arrest early furuncles. Methicillin-resistant and even vancomycin resistant strains to occur. Bactroban applied to the interior nares  daily for five days and bleach baths may help prevent recurrence. When the furuncle become localized and shows definite fluctuation, incision drainage is indicated.
  57. Carbuncles
    Carbuncles are just a group of furuncles.
  58. Gianotti  crosti  syndrome
    Gianotti-crosti syndrome is a characteristic viral exanthem. Most common cost by epstein bar virus. Deconditioned typically affects children between six months and 14 years of age. 90% of the cases occurring before the age of four, and may rarely be seen and adults. Features include mono Morphis flat topped, pink- Brown, papules or Papulovesticles 1 to 10 mm in diameter. Any three or all four sites involved-face, buttocks, forms, and extensor legs. Duration of at least 10 days. Early in the duration of eruption, the Keobner phenomenon will be present. No treatment is necessary. This is a virus that runs it's course usually tends to last many weeks to months. May also be associated wih hep b
  59. Hansen's disease
    Hansens, or leprosy disease has been committed by the World Health Organization to be eliminated in all countries. It has successfully reached that with the exception  As of 2008 three countries, Brazil, Nepal, Timor-Leste. This disease is endemic in the coastal South Eastern US and in Hawaii possibly due to exposure armadillos. It is from the mycobacterium leprae. Skin lesions are lighter than your normal skin color, had decreased sensation to touch or heat or pain and lesions do not heal after several weeks to months. Maybe muscle weakness and numbness. Treatment of different antibiotics include dapsone rifampin clofazimine fluoroquinolones macrolide and minocycline.
  60. Herpes simplex virus
    The herpes viruses contain double-stranded DNA and replicate in the cell nucleus. They're characterized by the ability to produce latent but lifelong infection by infecting the immunologically protected cells. Between 30 and 90% of adults have been seropositive for herpes simplex virus one. Most common diagnostic tool is a tzanck smear. It is nonspecific for HSV and VZV infections. The accuracy rate is between 60% and 90%. The direct fluorescent antibody or DEF a test is more accurate and will identify Marstown.
  61. Herpes gladiatorum
    Herpes infection of the neck from persons who wrestle. Occur on the lateral side of the neck or face in the form which is in direct contact with infected wrestler.
  62. Heretic whitlow
    Hsv of the finger
  63. Impetigo
    An infection caused by the Streptococcus or staphylococcus bacteria. Also can because methicillin-resistant staph aureus. It is most common children. It is contagious can be treated with Bactroban ointment.
  64. Cutaneous  Leishmaniasis
    There are several types of lesions, all to occur on expose parts and are transmitted by the sandfly. Caused from a protozoa, Lesions may present in two distinct types. One is the moist or rural type, a slowly growing, indurated, livid papule, which enlarges in a few months to form a nodule that ulcerated  in a few weeks. The dry or rural type has a longer incubation period develops much more slowly and heals more slowly than the Rural type. Rarely, after the initial lesion is healed, at the borders of the healed area, a few soft red papules may appear that are covered with a whitish scale and have the "Apple jelly "characteristics of the disease. The primary papule maybe come nodular, verrucas, or ulcerated with infiltrated red border. Most frequent site of infection is the ear. Mostly restricted to South Texas. Spontaneous healing of the primary cutaneous lesions occur usually within 12-18 months. Fluconazole and ketoconazole have been known to help treat lesions.
  65. Lyme disease
    Spirochetes of the genius borrelia is the cause of Lyme disease, commonly from a tick bite. The only skin finding the diagnostic early manifestation of erythema migrans. Treatment includes doxycycline hundred milligrams twice a day for 10 to 30 days.
  66. Molluscum contagiosum
    The diagnosis is easily established in most instances because the distinctive central umbilication and the dome shaped lesion. Canthardin, cryo, curetting, 5% sodium nitrate/5%salacytic acid, treatment not Aldara. Mostly childhood disease 
  67. Pediculosis capitis
    The head lice, more common in children but also adults. Premetherine 5%, ovide, nit combing are effective treatments.
  68. Pediculosis corporis
    Caused by body lice. Main difference between lice and scabies is there is no hand and foot involvement with lice. Permethrin spray or 1% malathion powder help control the lice in the clothes.
  69. Pediculosis pubis
    The crab Laos is found in the pubic region, as well as hairy areas of the legs adventurist actually in arms.
  70. Psychodermatosis
    Psycho dermatologic disorders can be broadly classified into three categories: psycho physiologic disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychophysiological disorders refer to disorders such as eczema or psoriasis, acne, alopecia areata,rosacea, seb derm that is worsened by emotional stress.
  71. Alopecia areata
    Characterized by rapid and complete loss of hair inone or more around patches. Complete loss of hair is called alopecia totalis. Can be associated with Lichen planus, atopic dermatitis and systemic lupus. Treatment high success rate with interlesional injection of triamcinalone 2-10mg 
  72. Primary psychiatric dermatosis
    Delusions of parasitosis Dysmorphophobia, delusions  of parasitosis, factitial dermatitis, neurotic excoriations and trichotillomania.
  73. Dysmorphophobia
    Body dystrophic disorder
  74. Bromidrosiphobia
    Fear that one sweat has a very pungent odor and keeps public away
  75. Small pox
    Eradicated worldwide in 1977, smallpox continues to be interest to dermatologist as a potential biological warfare agent incubation period is 7 to 17 days in the prodromal phase consists of 2 to 3 days of high fever severe headache and backaches . The fever subsides and the following day the rash covers the tongue, mouth and oropharynx. Followed in one day by appearance of skin lesions that are distributed in a centrifugal pattern on the face arms and legs. The lesions appear on the palms and soles of the feet and feel like permanent BBs under the skin. Patient is contagious from  day seven to day 10 after the rash presents.
  76. Staphylococcal scalded skin syndrome
    Staph  scalded skin is a febrile rapidly evolving generalized desquamative infectious disease, in which the skin exfoliates in sheets. It does not separate the dermal epidermal junction as in tens. The lesion MUCH more superficial and thus heal more rapid. Staphylococci are found at the nasal conjunctiva ears and pharynx. Nikolsky sign is positive.
  77. Syphilis
    Syphilis is also called Lues,is contagious sexually transmitted disease caused by the spirochete treponema palladium. The first sign  is usually the individual canker on the penis vagina. Usually occurs within 18 to 20 days after infection. Secondary syphilis manifests itself in 80 percent of the cases as early eruptions more or less only palms and feet. Alopecia is often seen as well as oral involvement as well.lymphadenopathy occurs in secondary syphilis. Late syphilis is indicated as infection of more than one year in duration. Tertiary syphilis is infection over 3-5 years. There're two main types of tertiary syphilis. Nodular syphilis and gumma syphilid.  Nodular syphilis consists of  reddish brown or copper-colored firm papules.
  78. Tinea versicolor
    Produced by the yeast malassezia or Pityrosporum ovale. The Yeast of this organism produces skin lesions when they grow in the hyphal phase. Commonly presents as hypo or hyperpigmented coalescing scale on the trunk and upper arms.  triazoles selenium sulfide Coclopirox  Salacytic  acids benzol peroxide, zinc pyrithione soap, are good successfully topical agents. Selenium sulfide Is a very cost-effective can be applied daily finally washed off at 10 minutes. After initial therapy patients may prefer to  continue washing with topicals zink pyrithion  bar and a single overnight application of selenium sulfide shampoo every 30 to 60 days.
  79. Tinea pedis
    Fungus of the feet remember two feet one hand 
  80. Tinea barbae
    Ringworm of the beard involvement is mostly one sided. Two types deep nodular suppurative lesions and superficial crusted partially bald patches with folliculitis. The deep type develops slowly and produces thick yellow kerion like swellings. The superficial type are more follicular.
  81. How does Tina Barbae differ link ally from staphylococcal folliculitis( sycosis vulgaris)
    Tinea Barbae does not involve tlip upper lip and is unilateral.
  82. Tinea faciei
    Fungal infection of the face. Often misdiagnosed as lupus
  83. Majocchi granuloma
    Occasionally a deep pustular type of tinea resembling a carbuncle or kerion is observed on the glabrous of the skin. Involve the follicles.
  84. CREST
    Variant of systemic scleroderma, usually limited systemic involvement.  There is a build up of collagen in the skin and other organs.

    Develop calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia. Patients may present with sclerodactyly, severe heartburn, or telangiectatic mats. The mats tend to have a smooth outline, in contrast to the mats of the Osler–Weber–Rendu syndrome, which tend to exhibit an irregular outline with more radiating vessels.

    This form of scleroderma generally lacks serious renal or pulmonary involvement. Anticentromere antibodies are highly specific for the CREST syndrome, being positive in 50–90% of cases and only 2–10% of patients with progressive sclerosis.
  85. Scleroderma
    generalized disorder of connective tissue in which there is thickening of dermal collagen bundles, and fibrosis and vascular abnormalities in internal organs.

    • Raynaud phenomenon is typically first sign. Other symptoms are “woody edema” of the hands.
    • Most common in woman 30-50

    Classic criteria include either proximal sclerosis or two or all of the following: 

    sclerodactyly, digital pitting scars of the fingertips or loss of substance of the distal finger pad, bilateral basilar pulmonary fibrosis.

    . The ACR has proposed an expanded list of criteria, including:

    • 1   
    • Skin changes: tightness, thickening, and nonpitting induration, sclerodactyly, proximal scleroderma; changes proximal to the metacarpophalangeal or metatarsophalangeal joints, and affecting other parts of the extremities, face, neck, or trunk (thorax or abdomen), digital pitting, loss of substance from the finger pad, bilateral firm but pitting finger or hand edema, abnormal skin pigmentation (often “pepper and salt”). The changes are usually bilateral and symmetrical, and almost always include sclerodactyly.

    • 2   
    • Raynaud phenomenon: at least two-phase color change in fingers and often toes consisting of pallor, cyanosis, and reactive hyperemia.

    • 3   
    • Visceral manifestations: bibasilar pulmonary fibrosis not attributable to primary lung disease, lower (distal) esophageal dysphagia, lower (distal) esophageal dysmotility, colonic sacculations.Skin findings
  86. Morphea
    Cutaneous type of scleroderma.

    Localized: presents most often as macules or plaques a few centimeters in diameter, but also may occur as bands or in guttate lesions or nodules. Rose or violaceous macules may appear first, followed by smooth, hard, somewhat depressed, yellowish-white or ivory lesions. They are most common on the trunk but also occur on the extremities.

    The margins of the areas are generally surrounded by a light violaceous zone or by telangiectases. Within the patch skin elasticity is lost, and when it is picked up between the thumb and index finger it feels rigid. The follicular orifices may be unusually prominent, leading to a condition that resembles pigskin. In guttate morphea multiple small, chalk-white, flat or slightly depressed macules occur over the chest, neck, shoulders, or upper back. The lesions are not very firm and may be difficult to separate clinically from guttate lichen sclerosus et atrophicus.
  87. Dermatitis herpetiormis
    • Dermatitis herpetiformis is an extremely itchy rash made of bumps and blisters. The rash is chronic, which means it continues over a long period of time. Symptoms of dermatitis herpetiformis include:
    • Extremely itchy bumps or blisters, most often on the elbows, knees, back, and buttocks. The rash is usually the same size and shape on both sides. Some patients may have scratch marks instead of blisters. A skin biopsy and direct immunofluorescence test of the skin are performed in most cases. Your doctor may also recommend a biopsy of the intestines.An antibiotic called dapsone may help most patients. A strict gluten-free diet will also be recommended to help control the disease.  Refer to GI and dietician.
  88. Dermatomyositis
    Dermatomyositis is an idiopathic inflammatory myopathy (IIM) with characteristic cutaneous findings. It is a systemic disorder that most frequently affects the skin and muscles, but may also affect the joints, the esophagus, the lungs, and, less commonly, the heartCalcinosis is a complication of dermatomyositis that is observed most often in children and adolescents. An association between dermatomyositis and cancer has long been recognized . Difficulty swallowing, Muscle weakness, stiffness, or soreness, Purple or violet colored upper eyelids, Purple-red skin rash, heliotrope rash, Gottron papules, poikiloderma, or scalp. Shortness of breath. Tests may include:     Bloods test to check levels of creatine phosphokinase and aldolase,  ECG, Electromyography,  Magnetic resonance imaging (MRI), Muscle biopsy. Treatment. The disease is treated with anti-inflammatory medicines called corticosteroids and drugs that suppress the immune system. However, most people with this condition must take a medicine called prednisone indefinitely. If the condition is associated with a tumor, the muscle weakness and rash may improve when the tumor is removed.
  89. Ehlers-Danlos syndrome
    Ehlers-Danlos syndrome (EDS) is a group of inherited disorders that affect your connective tissues — primarily your skin, joints and blood vessel. In Ehlers-Danlos syndrome, genetic mutations disrupt the production of collagen, a chief component of connective tissue. Prominent signs and symptoms of Ehlers-Danlos syndrome include stretchy, fragile skin and flexible joints that extend beyond the normal range of movement. 
  90. What are the types of Ehlers-Danlos syndromes?

    Classic type 

    • Marked joint hypermobility, skin hyperextensibility (laxity), and fragility are characteristic of the classic type of Ehlers-Danlos syndrome. 
    • Hypermobility type: hyper mobility in joints.

    • Vascular type;
    • In this form of Ehlers-Danlos syndrome, spontaneous rupture of arteries and bowel is a serious manifestation that can lead to death

    • Kyphoscoliosis type:
    • Fragile globe of the eyes, significant skin and joint laxity, and severe curvature of the spine (scoliosis) are typical features.
    • Athroclasia type:
    • Patients are short and heavy and affected by joint  laxity.

    • Dermatosparaxis;
    • Patients  have severely  fragile skin that is soft and doughy
    • Tenascin
  91. Epidermolysis bullosa
    Epidermolysis bullosa (EB) is a group of inherited bullous disorders characterized by blister formation in response to mechanical trauma. No treatment needed, it is aimed at wound care.
  92. Epidermolysis bullosa aquisita
    Epidermolysis bullosa acquisita (EBA) is a chronic autoimmune subepidermal blistering disease of the skin and mucus membranes. Epidermolysis bullosa acquisita is characterized clinically by blisters, scars, and milia primarily at the trauma-prone areas. Immunologically, epidermolysis bullosa acquisita is characterized by the presence of immunoglobulin G (IgG) autoantibodies (in most patients) targeting the noncollagenous (NC1) domain of type VII collagen, the major component of anchoring fibrils that connect the basement membrane to dermal structures. Direct immunofluorescence (see the image below): Direct immunofluorescence documents the immune-mediated disease process. Usually, it detects a thick band of IgG, and to a lesser extent C3.
  93. Hypertrophic scars
    • Keloids are the excess growth of scar tissue at the site of a healed skin injury.
    • They are more common in people ages 10 to 20, and in African Americans, Asians, and Hispanics. The hypertrophic scar is defined as a widened or unsightly scar that does not extend beyond the original boundaries of the wound. Unlike keloids, the hypertrophic scar reaches a certain size and subsequently stabilizes or regresses. Similar to keloids, hypertrophic scars are associated with adverse wound healing factors.
  94. Linear IgA bullous dermatosis
    Linear immunoglobulin A (IgA) dermatosis (LAD) is an autoimmune subepidermal vesiculobullous disease that may be idiopathic or drug-induced. Biopsy findings.  Linear IgA disease is a subepidermal blistering disorder. This means that a skin biopsy reports blistering just under the epidermis as opposed to some blistering disorders that result in blistering within the epidermis eg pemphigus.  direct immunofluorescence, reveals the immunoglobulin IgA along the basement membrane of the epidermis in a linear pattern. Sometimes these IgA antibodies can be detected by a blood test (indirect immunofluorescence). Research indicates the antibodies are directed against various basement membrane components (target antigens).Most patients with Linear IgA disease improve or clear with Dapsone 50 to 100mg daily.
  95. Pemphigoid
    Bullous pemphigoid is a chronic, autoimmune, subepidermal, blistering skin disease that rarely involves mucous membranes.  There is an attack on the basement membrane zone. pemphigoid is characterized by the presence of immunoglobulin G (IgG) autoantibodies specific. Bullous pemphigoid is a chronic, autoimmune, subepidermal, blistering skin disease that rarely involves mucous membranes.  There is an attack on the basement membrane zone. pemphigoid is characterized by the presence of immunoglobulin G (IgG) autoantibodies specific 
  96. Pemphigus
    •  Clinically, it is characterized by large, tense, subepidermal bullae with a predilection for the groin, axillae, trunk, thighs (Fig. 21-8), and flexor surfaces of the forearms. Key features distinguishing BP from other immunobullous diseases include subepidermal separation at the dermoepidermal junction.
    • The most common form, pemphigus vulgaris usually begins with blisters in your mouth, which then erupt on your skin. Blisters can also break out on the mucous membranes of your genitals. The blisters typically are painful, but don't itch. Pemphigus foliaceus. This type doesn't usually affect mucous membranes. The blisters, which usually begin on your face and scalp and later erupt on your chest and back, usually aren't painful. They tend to be crusty and itchy.
  97. Sarcoidosis
    • Sarcoidosis is a systemic granulomatous disease that involves the skin and many of the internal organs with an acute or persistent course. In addition to the skin, which is involved in approximately 25% of cases, other sites of involvement are the lungs, mediastinal and peripheral lymph nodes, eyes, phalangeal bones, myocardium, central nervous system (CNS), kidneys, spleen, liver, and parotid glands. 
    • Tests include
    • CBC scl 70 serum calcium, urine, ACE  levels X-ray for hilar adenopathy
    • Tx includes: methotrexate and plaquinel
  98. Hemosiderin hyperpigmentation

    Pigmentation due to deposits of hemosiderin occurs in purpura, hemochromatosis, hemorrhagic diseases, and stasis dermatitis. Clinically, hemosiderin hyperpigmentation is distinguished from postinflammatory dermal melanosis by a golden brown hue, as opposed to the brown or gray–blue pigmentation of epidermal and dermal melanin, respectively.  Some medications (including minocycline) deposit in the skin and complex with both iron and melanin, making uniquely colored (usually blue–gray) deposits.
  99. Diffuse hyperpigmentation
    This is related to folic acid deficiency.glossitis, cheilitis, and megaloblastic anemia, identical to vitamin B12deficiency, occur in folic acid deficiency. Low folic acid is associated with neural tube defects which are more common in light-skinned people, suggesting an association between ultraviolet (UV) exposure and reduction in folic acid.
  100. Cafe Au lait
     Flat brown macules .2-30cm . presence of 6 or more can aide in dx of neurofibromatosis.
  101. Diffuse hyperpigmentation
    Diffuse hyperpigmentation may have a systemic cause, such as Addison's disease, hyperthyroidism, or hemochromatosis
  102. Describe diffuse hyperpigmentation Related to Addison's disease.
    In Addison's disease, the adrenal glands fail to produce adequate amounts of mineralo-corticoids and glucocorticoids. When elevations of melanocyte-stimulating hormone and adrenocorticotropic hormone (also referred to as corticotropin) levels occur as the pituitary gland tries to stimulate the adrenal glands, melanin production increases, causing hyperpigmentation with a “muddy” appearance.7 The hyperpigmentation is diffuse, but more pronounced in sun-exposed areas and in the perineum, axillae, areolae, palms, and soles.8 Patients with Addison's disease should be treated with mineralocorticoid and glucocorticoid replacement to reduce the drive for excess production of adrenocorticotropic hormone and melanocyte-stimulating hormone.
  103. Describe how hyperthyroidism can cause diffuse hyperpigmentation
    Hyperthyroidism causes a pattern of hyperpigmentation similar to that in Addison's disease, especially in patients with darker complexions.9 Treatment is specific to the cause of hyperthyroidism and may involve antithyroid medications, surgical resection of the thyroid, or radioactive iodine therapy.
  104. Linear hyperpigmentation
    This disorder of pigmentation develops within a few weeks of birth and progresses for 1–2 years before stabilizing. There is linear and whorled hyperpigmentation following the lines of Blaschko without preceding bullae or verrucous lesions. Sparing of mucous membranes, eyes, palms, and soles is noted.
  105. Naevus ota
    This is a birthmark that occurs at birth or shortly after birth as a patch of blue black discolouration on one cheek, temple and eyelids (Fig 9). Usually one side of the face is affected although occasionally both sides of the {ace may be blue, black discolouration is present on the white of the eye. The pigmentation of Naevus of Ota can be reduced by pigment laser surgery
  106. Strawberry nevus
    These are vascular birthmarks (Fig 10). It can appear as a large red soft growth on the eyelids. The growth will continue to enlarge and grow as the baby grows old but the growth will slowly regress spontaneously when the child is 3-4 years old. If the vascular growths are small, they can be left alone to await spontaneous regression. If large and encroaching on the eyelid, vision may be affected. They should then receive treatment. Treatment options include oral medication, injections and laser ablation.
  107. Port wine stain
    There is another vascular birthmark. They present as flat red patches on the eyelids and the skin of the cheek at birth (Fig 11). Unlike strawberry naevus, portwine stains never disappear spontaneously as the child grows older. The vascular birthmarks increase in thickness and small blebs of blood vessels may be seen. These growths do not regress on their own and treatment is necessary. Most portwine stains respond to the vascular laser. Patients will need multiple laser treatments at 3 monthly intervals to achieve optimal result. There may also be a midline nevus to the glabellar region or on one upper eyelid called the angels kiss.
  108. Gouerot carteaud
    Greyish blue brown flat scaley wart like bumps. Lesions eventually join forming a net like pattern. This eruption begins on the upper lateral trunk and slightly scaly macules that slowly spread to involve the remainder of the trunk.  antibiotics have been successful in treating the disorder minocycline 100 milligrams twice a day for six weeks is usually most common.
  109. Hemangiomas
    Cavernous hemangiomas occur in the eyelid and block vision they're generally treated with steroid injections or laser treatments.
  110. Melasma
    Melasma is a very common disorder that affects darker complexion individuals especially east west and southeast Asians Hispanics and what people who live in intense sun exposed areas. Sun exposure female hormones are the common cause of melasma.
  111. Sturge-weber syndrome
    This is a rare disorder that's present at birth. The child with his condition will have a Portwine stain birthmark usually on face and a nervous system disorder. Like seizures paralysis or learning disabilities test Manklin CT scan MRI scans x-rays. Treatment includes anticonvulsant medications laser therapy for the Portwine stains physical therapy pretty paralysis or weakness.
  112. Elastosis
  113. Spitz nevi
    Melanocytic  benign nevus that have histpatholgical similarities of a melanoma.
  114. Epidermal nevus
    The individual legions of are verrucous , skin color, dirty grey light brown papules which coalesce to form a serpiginous plaque. It is generally on-site at birth but then they develop within the first 10 years of life they follow the lines of . Maybe associated with abnormalities the bones blood vessels and brain. Central nervous system problems may also be associated with this type of Nevi.
  115. Nevus comedonicus
    Closely arrange, group, often linear slightly elevated papules that have their central Keratinous plugs resembling comedones.These lesions maybe localized to a small area or have an extensive distribution. Most commonly unilateral, and follow the lines of blaschko. No tx is known.
  116. Xanthomas
    Deposit of lipids intissue. They are important markers for underlying dyslipidemia and potentially increased cardiovascular problems
  117. Tuberous xanthomas
    Tuberous xanthomas are found as flat or elevated him around yellowish or orange nodules located over the joints particularly elbows and knees. They are associated with the elevation of LDL-cholesterol levels and can also occur in primary biliary cirrhosis, myxedema. 
  118. Xanthoma tendinosum
    Xanthoma tendinosum are papules found in the tendons, especially in extensor tendons on the back of the hands and dorsal parts of  the feet and the Achilles tendons. They are associated with elevated LDL cholesterol and can be seen with liver disease diabetes and myxedema.
  119. Eruptive xanthomas
    Eruptive xanthomas are small yellowish orange to reddish-brown papules that appear in crops all of the body. They are associated with elevated triglycerides. Diabetes mellitus, obesity, chronic renal failure, hypothyroidism.
  120. Xanthoma planum
    • Xanthoma planum macules slightly elevated plaques with yellowish to Orange coloration of the skin spread diffusely over larges. They were associated with biliary cirrhosis and myeloma.
    • They may occur about the eyelids, neck , the trunk, shoulders on the armpits.
  121. Palmer xanthomas
    Palmer xanthomas are irregular yellowish plaques involving the palms and flexural surfaces of the fingers. These are seen in multiple myloma, biliary cirrhosis, and dysbetalipoproteinemia.
  122. Xanthelasma
    Xanthelasma the most common type.Occurs on the eyelids and is characterized by these soft  yellowish orange colored plaques inner canthus. They're seen in patients with elevated cholesterol.
  123. Amyloidosis
    Can be classified as systemic primary and  heredofamilial types. The systemic types can deposit amyloid proteins in multiple organs and related to the overproduction of a protein that cannot be adequately excreted or metabolized by the host. Primary Amyloidosis can lead to carpal tunnel syndrome enlarged heart liver enlargement kidney failure orthostatic hypotension. For diagnosis is suspected, a tissue sample of the abdominal wall fat, the rectum or the saliva gland can be examined for amyloid deposits.
  124. IVLEN
    • IVLEN 
    • An inflammatory linear verrucous epidermal naevus (ILVEN) is a special kind of epidermal naevus. Epidermal naevi are birthmarks due to an overgrowth of the epidermis (upper layers of the skin).
    • The abnormality arises from a defect in the ectoderm. This is the outer layer of the embryo that gives rise to epidermis and neural tissue. The defect causing the skin lesions may also result in disorders of other internal organs such as the brain, eyes and skeleton. This is extremely rare with ILVEN.

    • Like other linear epidermal naevi, ILVEN is characterised by warty lesions that tend to group together in a linear pattern. The difference is that the lesions are red, inflamed and itchy, sometimes intensely so. The surface of the lesions may look like eczema (dry, red, scratched) or like psoriasis (red & scaly).
    • ILVEN most often affects one leg and may extend from the buttock to the foot. It may be present at birth, but usually arises during the first 5 years of life and spreads over months or years. It is somewhat more common in females.
    • No curative treatment is available for ILVEN. Emollients and low potency topical steroids can relieve the itching. Emollients or topical calcipotriol may relieve the dryness.
  125. Dariers
    Darier disease is also known as ‘keratosis follicularis’. It is a rare genetic disorder that is manifested predominantly by skin changes. Onset of skin changes is usually in adolescence and the disease is usually chronic. It is inherited in an autosomal dominant pattern, which means that a single gene passed from one parent causes the condition. 

    • Recently the abnormal gene in Darier disease has been identified as ATP2A2, found on chromosome 12q23-24.1. This gene codes for the SERCA enzyme or pump (SarcoEndoplasmic Reticulum Calcium-ATPase) that is required to transport calcium within the cell. The exact mechanism by which this abnormal gene causes the disease is still under investigation but it appears that the way in which skin cells join together may be disrupted. The skin cells (keratinocytes) stick together via structures called desmosomes and it seems the desmosomes do not assemble properly if there is insufficient calcium.
    • The skin lesions are characterised by persistent, greasy, scaly papules (small bumps) which tend to occur over the seborrhoeic areas of the face (scalp margins, forehead, ears, around the nostrils and sides of nose, eyebrows, and beard area), neck, and central chest and back. The flexures (within natural folds of the skin around joints such as armpits and groins) and skin under breasts and between buttocks are also commonly affected. The papules have a firm, harsh feel like coarse sandpaper and may be skin-coloured, yellow-brown or brown in colour. If several of the small papules grow together they may form larger warty lesions which can become quite smelly within skin folds. The scalp is often affected with a heavily crusted rash which can be similar to seborrhoeic dermatitis but is usually harsher to the touch.Small pits (tiny indentations) on the palms and soles may occur and are very characteristic of Darier disease. Small warty lesions or areas of bleeding under the skin can also be seen on the palms and soles as well as the tops of the hands and feet. These are known as keratosis follicularis, and also sometimes called acrokeratosis verruciformis.  Most patients with Darier disease will have longitudinal broad stripes of white and reddish colour on the nails. A V-shaped nick at the free edge of the nail is also very suggestive of Darier. Treatment is required only if there are troublesome symptoms.medication such as acitretin or isotretinoin.
  126. Hailey hailey
    Hailey-Hailey disease usually appears in the third or fourth decade, although it can occur at any age. It typically begins as a painful erosive skin rash in the skin folds. Common sites include the armpits, groins, and neck, under the breasts and between the buttocks. The lesions tend to come and go and leave no scars. As the lesions get bigger the centre clears leaving a typical ring shape. If the lesions are present for some time they may become thickened. The skin then tends to macerate leaving quite painful cracks. Secondary bacterial infection, which is not uncommon, can give rise to an unpleasant smell. White bands on the fingernails and pits in the palms can also occur.

    Heat, sweating and friction often exacerbates the disease, and most patients have worse symptoms during the summer months. No cure.
  127. Tuberous sclerosis
    • Tuberous sclerosis--also called tuberous sclerosis complex (TSC)1--is a rare, multi-system genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin.
    • The name tuberous sclerosis comes from the characteristic tuber or potato-like nodules in the brain, which calcify with age and become hard or sclerotic.
    • Kidney problems such as cysts and angiomyolipomas occur.
    • Benign tumors called phakomas are sometimes found in the eyes of individuals with TSC, appearing as white patches on the retina.
    • Reddish spots or bumps called facial angiofibromas (also called adenoma sebaceum), which appear on the face.Areas of thick leathery, pebbly skin called shagreen patches, usually found on the lower back or nape of the neck.
    • Small fleshy tumors called ungual orsubungual fibromas that grow around and under the toenails or fingernails.  the teeth and gums for dental pits and/or gum . Diagnosis of the disorder is based on a careful clinical exam in combination with computed tomography (CT) or magnetic resonance imaging (MRI) of the brain, which may show tubers in the brain, and an ultrasound of the heart, liver, and kidneys.
  128. Behcets syndrome
    Recurrent aphthous ulcers, genital ulcerations, and uveitis leading to blindness. Although the cause of the disease is still unknown, it has become recognized as a multisystemic inflammatory disease.Oral ulceration, the hallmark of this disease, is usually the initial clinical symptom and can precede other manifestations by years. Ulcers are typically painful, appear in crops, and are nonscarring. For diagnostic purposes, at least 3 episodes in a 12-month period are required. In one study of pediatric Behçet syndrome, the average time interval between the initial oral ulceration and the second manifestation was 8.8 years.