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Macule v. papule
- Both under 1 cm
- A macule is flat
- A papule is raised
Patch v. plaque
- Both over 1 cm
- A patch is flat
- A plaque is raised
Vesicle v. bulla
- Both are elevated, fluid filled lesions
- A vesicle is under 5 mm
- A bulla is over 5 mm
What is vitiligo?
Skin depigmentation, associated with AI diseases such as Addison's, pernicious anemia, type I DM, and hypothyroidism
- Chronic, allergic-type condition
- Begins in first year of life
- Red, itchy skin on head, arms, and trunk
- Family hx of allergies or asthma
- Tx with antihistamines and topical steroids
- Scaling skin on hair areas of the head (scalp, eyebrows, beard), forehead, nasolabial folds, and ears
- Tx with dandruff shampoo, topical steroids, and/or ketoconazole cream
Annular lesion on body or trunk with well-defined, scaly margins and healing centers
Tinea corporis (dermatophytosis)
Superficial skin infection that fluoresces under Wood's lamp
Microsporum sp (trichophyton sp do not fluoresce)
How are fungal infections diagnosed and treated?
- Dx with KOH prep of skin scraping
- Treat tinea capitis and onychomycosis with oral antifungals
- Treat all other fungal infections with topical antifungals (azoles, griseofulvin for severe infections)
How is candidiasis treated?
- Topical nystatin or azoles
- Oral nystatin or ketoconazole for severe infection
Visible burrows in the skin in the finger web spaces and flexor surfaces of the wrists
- Scabies (sarcoptes scabei)
- Treat with whole body permethrin cream
- Treat patient + family
Multiple patches of various size and color, typically on the torso, that do not tan with the rest of the skin
- Tinea versicolor, aka pityriasis versicolor (malassezia furfur)
- Treat with selenium sulfide or topical azoles
Why is permethrin preferable to lindane for tx of scabies and lice?
Lidane is neurotoxic
What do HPV serotypes 6 and 11 cause?
- Can treat with salicylic acid, liquid nitro, and curettage
- (serotypes 16 and 18 are carcinogenic)
Treatment options for acne
- First line--topical benzoyl
- If that doesn't work, try topical clinda or oral tetracyclin (to tx propionibacterium)
- If that doesn't work, try topical tretinoin
- Oral tretinoin is a last resort (effective but side effects include myalgias, elevated LFTs, and teratogenicity)
What is rosacea?
- Looks like acne, begins in middle age
- Associated with rhinophyma (bulbous, red nose) and blepharitis
- Treat with topical metro or oral tetracyclins
Describe the typical psoriatic lesions
- Dry, scaly, well-circumscribed, silvery, scaling papules and plaques
- Not pruritic
- Found on scalp and extensor surfaces
What is pityriasis rosea?
- Benign skin rash
- Begins with a scaly, oval, erythematous lesion called a "herald patch"
- Herald patch is followed by many similar lesions that spread out across the torso in a "christmas tree" pattern, and itch
- Remits within about a month
- Need to r/o herpes
- Pruritic, purple, polygonal papules, found on wrists and lower legs
- May be associated with whitish, lacy lesions on the oral mucosa
What drugs classically cause photosensitivity?
- Phenothiazines (neuroleptics)
What does erythema multiforme look like, and what are some possible etiologies?
- Target lesions (round, erythematous, with central clearing)
- Caused by IgM immune complex deposition in superficial vasculature
- Drugs (sulfa drugs, penicillin)
- Herpes infection
What is erythema nodosum?
- Inflammation of subQ, usually in the pretibial region
- Associated with sarcoidosis, coccidioidomycosis, and UC
- AI disease, associated with anti-desmoglein antibodies
- Presents in middle age with extensive blistering that starts in the oral mucosa and spreads all over the body
- Positive Nikolsky sign
- Dx on punch biopsy
- Tx with oral steroids
- AI skin disease, associated with IgG autoantibodies against hemidesmosomes
- Tense bullae, all over skin (rarely in oral mucosa)
- Linear staining on immunofluorescence
- Negative Nikolsky
What disease is associated with dermatitis herpetiformis?
Celiac (lots of IgA deposits in skin)
- Flesh-colored lesion with a central crater, containing keratin
- Typically on face
- Rapid onset, grows to full size within 2 months, and then spontaneously involutes
- No tx needed
- Easy to confuse with skin cancer
What does the classic lesion of basal cell carcinoma look like?
- Shiny papule in sun-exposed are that slowly enlarges and develops an umbilicated center and peripheral telangiectasias
- Rarely metastasizes, but can be locally invasive
What does actinic keratosis look like, and what is it associated with?
- Thick, scaly lesion in sun-exposed area (scalp, shoulders, back)
- Can develop into squamous cell carcinoma
What is Bowen's disease?
- Squamous cell carcinoma in situ
What is stomatitis, and what is it associated with?
- Inflammation of the oral mucus membranes
- (angular stomatitis--fissuring of the corners of the mouth)
- Associated with vit B deficiencies (riboflavin, niacin, pyridoxine) or vit C deficiency