Dermatology

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Author:
margaret
ID:
82884
Filename:
Dermatology
Updated:
2011-05-15 07:46:01
Tags:
Toronto notes
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Description:
Vehicles for topical treatment
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  1. Ointment
    water in oil

    (fn) hydrates, greasy
  2. Cream
    Oil in water

    (fn) hydrate, variable
  3. Lotion
    Powder in water

    (fn) drying, cosmesis
  4. Solutions
    water, alcohol, propylene, glycol
  5. Gel
    Solution that melts on contact with skin

    (fn) drying
  6. UVA
    aging
  7. UVB
    Burning
  8. SPF
    Burn time with cream divided by burn time without cream on
  9. Sun Protection Mneomnic
    "Seek, Slip, Slap, Slop"

    • Seek Shade
    • Slip on a shirt
    • Slap on a hat
    • Slop on sunscreen
  10. Side effects of topical steroids
    • Local
    • -atophy
    • -purpura
    • -thin skin
    • -perioral dermatitis
    • -steroid acne
    • -rosacea
    • -contact dermatitis
    • -tachyphylaxis (tolerance)

    • Systemic
    • -suppression of HPA axis
    • (if high potency like clobetasol, large area, long time or under occlusion)
  11. Side effects of systemic steroids
  12. Erythema Nodosum Ddx
    NODOSUM

    • No cause - 40%
    • Drugs (slfonamides, OCP)
    • Other infx (GAS+)
    • Sarcoidosis
    • Ulcerativ colitis and Crohns
    • Malignancy (leukemia, Hodgkin's lymphma)
  13. Pruritus Ddx
    SCRATCHED

    • Scabies
    • Cholestasis
    • Renal
    • Autoimmune
    • Tumorours (ca)
    • Crazies
    • Hematology (polycythemia, lymphoma)
    • Endocrine thyroid, parathyroid, iro ndef)
    • Drugs, Dry skin
  14. Uncommon Causes of ulcers
    CHIP IN

    • Cancer, Chromosomal
    • Hemoglobinopathy
    • Inflammatory
    • Pyoderma gangrenosum
    • Infections
    • Necrobiosis lipoidica diabeticonum
  15. Itchy Eruptions in Kids
    UC-SCAB

    • Urticaria
    • Contact dermatitis
    • Scabies
    • Chicken pox
    • Atopic dermatitis
    • Bites
  16. Urticaria Ddx
    DAM HIVES

    • Drugs / foods
    • Allergic
    • Malignancy
    • Hereditary
    • Infection
    • Vasculitis
    • Emotions
    • Stings
  17. 6P's of Lichen Planus
  18. Purple
    • Pruritic
    • Polygonal
    • Peripheral
    • Papules
    • Penis (periphery)
  19. For dermatoscopy, 7 point checklist....
    Need >3 for melanoma

    • Major (Ap Av BW) - 2pt each
    • -Atypical pigment network (blue, white)
    • -Atypical vascular network
    • -Blue white veil

    • Minor (BDRS) - 1pt each
    • -Irregular blotches
    • -irrecular dots + globules
    • -Regression streaks
    • -Irregular Streaks
  20. Patterns and Distribution
    • Acral - hands/feet
    • Annular
    • Follicular
    • Guttate - drop like
    • Koebner - isomorphic
    • Morbilliform
    • Reticular
    • Satellite
    • Target (iris)Discrete
    • Clustered
    • Linear
    • Confluent
    • Dermatitic
  21. Types of cysts
    • Epidermal cyst
    • Pilar Cyst (Trichelemmal)
    • Dermoid cyst
    • Ganglion cyst
    • Milium (pl = milia)
  22. Dimple sign

    Found on legs>arms>trunk
    Dermatofibroma

    (dermatoscopy) hypopigmented centerally

    • ddx:
    • Dermatofibrosarcoma protruberans
    • Malignant melanoma
    • Kaposi's sarcoma
    • Blue nevus
  23. Skin tags, aka...
    • Acrochordons
    • Fibroepithelial polyps
    • Soft fibrromas
    • Pedunculated lippofibromas
    • Cutaneous papillomas
  24. Types of Actinic Keratoses
    • Erythematous: typical AK
    • Hypertrophic: thicker, rough papule/plaque
    • Cutaneous horn: firm hyperkeratotic outgrowth
    • Actinic chelitis: confluent on lip
    • Pigmented: flat, tan-brown, scaly plaque
    • Spreading pigmented
    • Proliferative
    • Conjunctival
  25. Corns vs Plantar warts
    • Corn
    • -firm papule with central translucent cone shaped hard keratin core, pain with direct P, esp dorsolateral 5th toe


    • Plantar warts
    • -bleed when pared
    • -pain with lateral P
    • -thrombosed vessels give plantar warts a black speckled central appearance not seen in corns
  26. Hemangiomas vs Vascular Malformations
    • Hemangiomas
    • -spon't resolution
    • -tx: propranolol or topical corticosteroids (Timal) if superfical
  27. Why are open comedones black?
    • Oxidized melanin
    • (NOT dirt)
  28. Acne exacerbating factors
    • Systemic meds - lithium, phenytoin, steroids, halogens, androgens, iodides, bromides, danazol
    • Topical agents - steroids, tars, oints, oily cosmetics
    • Mechanical P / occlusion
    • Emotional stress
  29. Mech of Action:
    a) Clindamycin, Erythromycin
    b) Benzoyl peroxide
    c) Adapalene (differin), Tretinoin (Retin-A)
    d) Diane 35 (cyproterone acetate ethinyl estradiol)
    e) Isotretinoin (Accutane)

    f) BenzaClin gel
    g) Benzamycin
  30. a) inhibit protein synthesis
    • b) protein oxidant with bactericidal effect
    • c) comedolytic)
    • d) anti androgenic, incr levels of sex hormone binding globulin (SHBG), decr circulating plasma levels of androgens
    • e) inhibits sebaceous gland fn and keratinization
    • f) 1% clindamycin, 5% benzoyl peroxide
    • g) 3% erythromycin, 5% benzoyl peroxide
  31. Dose for oral tetracyclilne
    • Tetracycline 500mg po OD -BID
    • ***don't use with isotretinoin (risk of pseudotumor cerebri)
    • -need 3-6months until see result

    Erythromycin 500mg po BID
  32. Tx for Perioral Dermatitis
    • 1) Metronidazole 0.75% gel (metrogel) to area BID
    • OR
    • 2) Tetracycline 500mg po OD -BID
  33. Types of Rosacea
    • -Erythromatotelangiectatic
    • -Papulopustular
    • -Phymatous
    • -Ocular
    • -variant = granulomatous
  34. Top ten allergens (via North American Contact Derm Gr)
    • 1) Nickel sulfate - jewerly, buckles
    • 2) Neomycin sulfate - topical Abx
    • 3) Balsam of Peru - fragrance material
    • 4) Fragrance mix
    • 5) Thimerosal - common preservative, in vaccines, contact lens solution, cosmetics
    • 6) Sodium gold - jewellery, dentistry
    • 7) Formaldehyde - gas
    • 8) Quaternium-15
    • 9) Cobalt chloride - hard metal in cosmetics, jewellery, buttons, tools
    • 10) Bacitacin - topical Abx
  35. Woronoff's Ring
    Blanched halo that surrounds psoriatic lesions a/f topical or phototherapy tx.
  36. Dovonex vs Dovobet
    Dovonex - calcipotriol (Vit D derivative)

    Dovobet - calcipotriene + betamethasone diproportionate
  37. PSORIASIS: presentation and pathoPSL
    • P - pink papules/plaques/pinpt bleed (Ausptiz sign), physical injury (Koebner phen)
    • S - silver scale//sharp margins
    • O - onycholysis / oil spots
    • R - rete ridges with regular elongation
    • I - itch
    • A - arthritis/abscess/autoimmune
    • S - Stratum corneum with nucei
    • I - immunologic
    • S - stratum granulomsum absent
  38. Mech of Biologics
    -mab
    -rcept
    • - mab = monoclonal Ab
    • - rcept = receptor
  39. PemphiguS VUlgaris vs
    Bullous PemphigoiD
    • PV = Superficial
    • BP = Deep
  40. Ddx for Urticaria
    DAM HIVES

    • D - drugs and foods
    • A - Allergic
    • M - Malignancy

    • H - hereditary
    • I - infectious
    • V - vasculitis
    • E - emotions
    • S - stings
  41. Approach to Vasculitis
    • 1. Hx and P/E
    • 2. if lesions <24hrs, attacks <6wks = ACUTE, no inv, referral for allergy testing
    • 3. If <24hrs lesions, but attacks >6wks, CHRONIC, inv: CBCd, UA, ESR, LFTs
    • 4. if lesions >24hrs, Vasculitis = bx of lesion and referral to derm
  42. Raynaud's Phenomenon Ddx
    COLD HAND

    • C - cryoglobulins / cryofibrinogens
    • O - obstruction / occupational
    • L - lupus or other CTD
    • D - DM, drugs

    • H - hematologic problems (PCV, leukemia)
    • A - Arterial problems
    • N - neurologic problems
    • D - disease NYD, idiopthic

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