Aging Effects by Disease Process

Benign tumors Cherry angiomas, chondrodermatitis nodularis helicis, seborrheic keratosis, skin tags Eczemas Asteatotic dry skin, contact, seborrheic Infections Candidiasis, herpes zoster, onychomycosis, scabies Photodamage Actinic elastosis, colloid milium, Favre-Racouchot syndrome, freckling, photoaging (wrinkling, solar lentigo), poikiloderma of Civatte Premalignant Actinic keratosis, Bowen disease Malignancies BCC, lentigo maligna melanoma, MF, SCC Ulcerations leg, pressure decubitus Other...

Localized Hair Loss

Spironolactone Hair Loss Women

Traction e.g., corn-rows, ponytails Nonscarring Alopecia Intact Hair Follicles 3. Anagen effluvium following chemotherapy 4. Androgenetic alopecia AGA male or female pattern baldness 6. Infections fungal i.e., tinea capitis, kerion Scarring alopecia Loss of Hair Follicles 1. Discoid lupus erythematosus DLE 3. Infections fungal, bacterial, TB, leprosy N.B. If scalp biopsy performed e.g., scarring alopecia , ideally a 4-mm punch biopsy is taken of a...

Actinic Keratosis AK Solar Keratosis

Most common precancerous lesions in humans, and more prevalent in fair-skinned individuals who tan poorly and burn easily. Etiology Sun exposure, ionizing radiation, and arsenic exposure. Physical Slightly erythematous, rough, scaly papules on sun-exposed areas, i.e., head, neck, backs of hands. and forearms. May be difficult to see, but often feel rough Palpation is essential to diagnosis. Occur on sun-exposed and damaged skin, most commonly in the elderly. Course lt 1 of all untreated AKs...

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Henry Foong Etiology Parasitic infection by Sarcoptes scabiei var. hominis mite. History Generalized and often debilitating pruritus, worse at night family members or sexual partners may also itch. Usually transmitted by direct close human contact incubation period 3 6 wk. More prone Overcrowding amp older patients in nursing homes, young children, amp sexually active adults. Physical Often nonspecific papules amp excoriations often present in the finger webs, flexor aspects of...

Drug Eruptions in Dermatology

Typical presentations in descending order of frequency Exanthema maculopapular, morbilliform Drugs most commonly resulting in an adverse skin reaction Amoxicillin Drugs Causing Skin Pigmentation Changes Drugs Causing Skin Pigmentation Changes ACTH, bleomycin, minocycline, oral contraceptives, zidovudine Amiodarone, antimalarials, minocy-cline, phenothiazines Drug Eruptions amp Likely Patterns Morbilliform, erythema multiforme, SLE Skin Reaction Patterns amp Drugs That Cause Them Anti-thyroid...

Keratosis Pilaris KP

Common, benign disorder of keratotic follicular papules. Etiology Genetic component more common in atopic and xerotic patients, and worse in winter. History Usually asymptomatic, with occasional pruritus, improves with age. Physical Hyperkeratotic follicular papules - erythema typically distributed over the outer aspects of upper arms and thighs, less commonly the face, forearms, amp buttocks. DDx Atopic dermatitis, folliculitis, lichen spinulosus. Treatment often disappointing in all but mild...

Acanthosis Nigricans Groin

Acanthosis Nigricans Warts Groin

Telangiectases, thick port-wine stains, venous lesions high risk of scarring Telangiectases, thick port-wine stains Telangiectases, thick port-wine stains Telangiectases, thin port-wine stains, cherry angiomas, childhood hemangiomas, warts, scars, striae, poikilo-derma of Civatte, leg veins Telangiectases, thin port-wine stains Long-pulsed Nd YAG safest in dark skin types Epidermal pigmented lesions, some red tattoos Only effective on darkly pigmented hair blond or gray hair resists N.B. 1...

Lupus Erythematosus

Images Lupus Profundus

Etiology Heterogeneous autoimmune disease resulting from the interplay of genetic, environmental, and hormonal factors. F gt M. History amp Physical Spectrum of disease varies from limited cutaneous involvement to severe systemic disease. Systemic Lupus Erythematosus SLE 1997 Update of the 1982 ACR Revised Criteria LE-specific skin manifestations are divided into 3 categories other less common forms exist as well . Classic butterfly malar rash. Often association with anti-dsDNA Ab and lupus...

Ao c

Punch biopsy A round cookie-cutter knife that obtains tissue specimen. Usually 3 to 5 mm is taken. Usually 1 to 2 sutures are required. 3. Incisional biopsy wedge An elliptical partial removal of a lesion down to fat. Useful, for example, when a malignancy is too large to remove by simple surgery, in scleroderma, panniculitis, and pyoderma gangrenosum. Requires layered closure with sutures. 4. Excisional biopsy An elliptical complete removal of lesion down to fat. Useful in completely...

Dermatologie Drugs in Pregnancy Continued

Intralesional Ketoconazole Methoxsalen Mycophenolate mofetil Nicotinomide Psoralens Rifampin Steroids Sulfonamides Thiabendazole Trimethoprim Liquid nitrogen direct from spray canister -195.8 0C or a dipped swab much less cold Liquid nitrogen cryotherapy is most commonly used for actinic keratoses, Bowen disease SCC in-situ , molluscum conta-giosum, myxoid cysts, pyogenic granulomas, skin tags, solar lentigines, and warts. See Image B on page 43.

Herpes Simplex HSV

Common viral infection affecting the oral mucocutaneous surface. HSV-1 is most commonly associated with oral-facial lesions. History amp Physical Most patients have subclinical primary episode, others experience primary gingivostomatitis, i.e., 3 5 d of fever, malaise, lymphadenopathy, oral mucosal erosions Recurrent HSV-1 infection herpes labialis after primary infection may be reactivated by a number of triggers stress, fever, UV light, trauma, menstruation burning and itching precede...

Dermatoses by Location

Actinic keratosis Basal cell carcinoma Contact dermatitis Dermatomyositis Herpes simplex Impetigo Keratoacanthoma Lupus erythematosus Melasma Nevus Perioral dermatitis Rosacea Sarcoidosis Sebaceous hyperplasia Seborrheic dermatitis Seborrheic keratosis Squamous cell carcinoma Varicella-zoster infection Vitiligo Pyoderma gangrenosum Seborrheic keratosis Stasis dermatitis Ulcer Vasculitis Candidal intertrigo Erythrasma Hailey-Hailey disease Hidradenitis suppurativa Psoriasis Seborrheic dermatitis...

Hyperhidrosis

Etiology Excessive sweating, either generalized or focal e.g., palmar, palmoplantar, axillae , and affecting 2 3 of general population most common in adolescence and young adults. Generalized hyperhidrosis can be associated with underlying systemic disorder, e.g., infectious e.g., TB , endocrine, or neurologic focal hyperhidrosis often idiopathic. Diagnostic criteria for primary focal idiopathic hyperhidrosis. Focal, visible, excessive sweating of at least 6 mo duration without apparent cause...

Irritant Contact Dermatitis ICD

Hyperkeratotic Papules

Etiology Acute or chronic cumulative direct nonimmunologic inflammatory reaction to toxic injury, e.g., by chemical irritant agents. Occurs in all individuals exposed to chemicals, given sufficient exposure times and concentrations no previous exposure necessary. History Regular exposure to common irritants water, soap, detergents, solvents, alcohol. Pain, burning, and stinging exceed pruritus early on. Those with history of atopic dermatitis are more susceptible. Physical Ill-defined...

Chickenpox Varicella

Etiology Varicella zoster virus VZV causes chickenpox after primary infection, VZV remains dormant in sensory nerve roots for life, reactivation results in herpes zoster shingles . History Often pruritic. Usually mild, self-limited illness in children more severe in adults rarely complicated by staph strep bacterial superinfection, pneumonia, cerebellar ataxia, encephalitis. Physical Characteristic exanthem Crops of erythematous macules progress to edematous papules and finally vesicles over 24...

Herpes Zoster Shingles

Etiology Varicella zoster virus VZV causes chickenpox after primary infection, VZV remains dormant in sensory nerve roots for life, and reactivation results in herpes zoster shingles . Reactivation may be idiopathic, but may occur with immunosuppression or stress. Increased incidence with increasing age more common in HIV amp hematologic malignancy. History Pain tenderness in a unilateral dermatomal distribution often precedes rash. Physical W i 3 4 d of onset of symptoms, clusters of...

Descriptors

Symmetrical, asymmetrical, sun-exposed, flexures extensors, acral hands feet Erythematous or nonerythematous lesions amp or underlying skin Surface Features Crusting, rough, smooth, scaly, warty Type Cyst, macule, papule, pustule, ulcer, vesicle Color Blue, brown, pink, purple, red, white Single or multiple, discrete, unilateral, generalized, disseminated, grouped, annular, gyrate, dermatomal, linear, serpiginous Well- or poorly defined, active edge, round, oval, irregular, pedunculated Scalp,...

Acne Vulgaris

Seborrheic Dermatitis Differin

Inflammatory disorder of pilosebaceous follicles with a 90 prevalence in adolescence and young adulthood. Etiology Abnormal follicular keratinization, increased sebum 2 to androgens, Propionibacterium acnes bacteria , inflammation. Genetic factors occlusive cosmetic agents medications steroids, ACTH, androgens, danazol, iodides, lithium, antiepileptics, oral contraceptives diseases congenital adrenal hyperplasia CAH , polycystic ovarian syndrome PCOS worse with emotional stress. History Often...

Pruritus Itch

Periungual Pigmentation Nail

Pediculosis capitis lice , psoriasis, seborrheic dermatitis Contact dermatitis axillae, waistline , erythrasma axillae , pediculosis corporis, psoriasis, scabies, seborrheic dermatitis chest , seborrheic keratoses, urticaria Candida, contact dermatitis, erythrasma, pediculosis pubis, scabies, tinea cruris Candidiasis, contact dermatitis, gonorrhea, hemorrhoids, pinworms, psoriasis, tinea cruris Contact dermatitis, eczema atopic, dyshidrotic , scabies Atopic dermatitis, dermatitis herpetiformis...