common derm problems- clin med

Involves head and body where sebaceous glands are present
Greasy appearance
All age groups
Chronic or intermittent
Scalp involvement can be minimal (dandruff) or extensive (plaques)
In children, scalp lesions are “cradle cap”
Often symmetrical

seborrhea tx:

Thick, silvery-white scales
Caused by rapid turnover of dermal cells
Usually on extensor surfaces
Nails also involved (pitting)
Psoriatic arthritis involves hands and feet
Guttate form has smaller lesions
Pustular form occurs on hands and feet
women > men
Less frequent in highly pigmented skin
Can be precipitated by stress

psoriasis tx:

what is Auspitz's sign:

Skin reaction to trauma (scratching)
May occur within days or weeks
Common in psoriasis, lichen planus

Sudden raised lesions due to minor trauma to skin
Wheal-like
Likely histamine related

Common exanthem (huge rash)
? Cause
Herald patch
Langer’s lines
Christmas (or fir) tree pattern
Lasts 5-8 weeks
Self-limiting
Easy confused with other conditions

PR tx:

Flat-topped papules and plaques on flexor surfaces of UE, LE, genitalia, and mucous membranes
Often violaceous color
Commonly ages 30 – 60 affected
Men = Women
Self-limiting though can last up to 5 years in mucous membranes

Lichen planus tx:

Autoimmune etiology
Can be fatal
Men = Women
Commonly ages 40-60
Bullous lesions start in mucous membranes then move to body
Painful lesions often interfering with eating
Weight loss, fatigue, malaise frequent
Dx made by bx
Death due to secondary infection

pemphigus tx:

Vesicular lesions on hands, feet
Women 2X men
May be acute, chronic, or intermittent
Pt c/o itching or burning

Pompholyx tx:

Acute, yet self-limiting
Can be mild or severe
Target lesions
All areas potentially involved (including mucous membranes)
Categorized into Minor and Major
Minor usually resolves in 3 weeks
Major can last up to 6 weeks with 5% fatal
Men slightly more frequent
Common ages 20-40
Multiple triggers including drug rxn and infection

erythema multiforme tx:

–also called palpable purpura
–triggered by drugs (penicillin), bugs (strep), tumor antigens, proteins

–Henoch-Schonlein purpura, essential mixed cryoglobulinemia, connective tissue disorders, serum sickness, hypocomplementemic urticarial vasculitis
(urticaria > 24 hours, arthritis, glomerulonephritis, gastrointestinal involvement)

causes of vasculitits:
pathogenesis:
complications:

testing for vasculitis:

Tx/prognosis for vasculititis:

–severe febrile mucocutaneous drug reaction:

types of TEN:

organ systems involved in TEN:

causes of TEN:

Chief concern (CC): –skin lesions
symptoms may precede cutaneous manifestations by 1-3 days
–fever
–stinging eyes
–pain upon swallowing (odynophagia due to mucosal lesions)
–cough
skin lesion patterns:
–often starts on trunk–progresses to neck, face, proximal extremities
–may include entire body (including soles and palms)

–initially erythematous, dusky-red, or purpuric macules of irregular size and shape
–progresses to gray color and flaccid blisters with full-thickness necrosis

what is Nikolsky sign:

wet surface (moist, glistening, exudative) characteristic of:

dry surface characteristic:

in TEN, what can be present on HEENT exam?

tx for TEN:

types of contact dermatitis:
lesions are often:

contact derm tx:

The itch that rashes
Itch – scratch cycle
Common in children (15%)
No specific test
-dry skin
-feels thickened
-red from scratching

atopic derm triad:

atopic (eczema) tx:

Round shaped lesions
Chronic
Worse in dry, cold weather
pruritis is often intense

Nummular dermatitis tx:

Lower extremities
Caused by venous insufficiency
Reddish-brown (brawny) color
Leg edema common
Condition may be precursor to others
Can become secondarily infected

stasis dermatitis tx:

fever, then lesions that start from head down, lasts 4-6 days, Koplik spots

caused by herpes 6, rash appears after fever, often spares the face

caused by parvovirus, onset with fever, then lesions (slapped cheek) after fever resolves

much like rubeola but last less time

Erythema infectiosum (5th disease):

most cases are irritant diaper dermatitis
–moisture
–prolonged contact with feces and urine
–bacteria
–alkaline pH
–mechanical disruption of the area

Tx diaper dermatitis:

Raised, erythematous, and edematous
Can be acute or chronic
Often challenging to find etiology
Sx range from itching to anaphylaxis

urticarial tx:

Multi – system disease
Lesions can be varied, but symmetrical if there are many
More common in Irish, Scandinavian, or African descendents

Sarcoidosis derm tx: