Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.
-
Upload
baldric-long -
Category
Documents
-
view
214 -
download
3
Transcript of Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.
![Page 1: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/1.jpg)
Dermatology
By
Katrice L. Herndon, MD
Internal Medicine/Pediatrics
June 2, 2005
![Page 2: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/2.jpg)
What is this?
![Page 3: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/3.jpg)
Acne Vulgaris
• Acne is a self-limited disorder primarily of teenagers & young adults.
• Acne is a disease of pilosebaceous follicles.
• 4 factors are involved:• Retention hyperkeratosis
• Increased Sebum production
• Propionbacterium acnes within the follicle
• Inflammation
![Page 4: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/4.jpg)
Acne Vulgaris• External Factors that contribute to Acne
• Oils, greases, dyes in hair products
• Detergents, soaps, astringents
• Occlusive clothing: turtlenecks, bra straps
• Environmental Factors: Humidity & Heavy exercise.
• Psychological stress
• Diet is controversial
![Page 5: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/5.jpg)
Acne Vulgaris
• Acne vulgaris typically affects those areas of the body that have the greatest number of sebaceous glands: • the face, neck, chest, upper back, and upper arms.
• In addition to the typical lesions of acne vulgaris, scarring and hyperpigmentation can also occur.
• Hyperpigmentation is most common in patients with dark complexions
•
![Page 6: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/6.jpg)
Acne Vulgaris• Classification of Acne
• Type 1 — Mainly comedones with an occasional small inflamed papule or pustule; no scarring present
Type 2 — Comedones and more numerous papules and pustules (mainly facial); mild scarring
Type 3 — Numerous comedones, papules, and pustules, spreading to the back, chest, and shoulders, with an occasional cyst or nodule; moderate scarring
Type 4 — Numerous large cysts on the face, neck, and upper trunk; severe scarring
![Page 7: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/7.jpg)
Acne Vulgaris
![Page 8: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/8.jpg)
What is this?
![Page 9: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/9.jpg)
Acne Rosacea• Rosacea is an acneiform disorder of middle-aged and
older adults.
• Characterized by vascular dilation of the central face, including the nose, cheek, eyelids, and forehead.
• The cause of vascular dilatation in rosacea is unknown.
• The disease is chronic.
![Page 10: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/10.jpg)
Acne Rosacea
• rosacea is a chronic disorder characterized by periods of exacerbation and remission.
• Increased susceptibility to recurrent flushing reactions that may be provoked by a variety of stimuli including hot or spicy foods, drinking alcohol, temperature extremes, and emotional reactions.
• The earliest stage of rosacea is characterized by facial
erythema and telangiectasias.
![Page 11: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/11.jpg)
Acne Rosacea• Patients with rosacea may develop severe
sebaceous gland growth that is accompanied by papules, pustules, cysts, and nodules.
• The diagnosis of rosacea is based upon clinical findings(1 or more of the following):• Flushing (transient erythema)
• Non-transient erythema
• Papules and pustules
• Telangiectasia
![Page 12: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/12.jpg)
Acne Rosacea• Topical antibiotics or benzoyl peroxide are the
initial treatments of choice.
• Tretinoin cream is used in patients with papular or pustular lesions that are unresponsive to other treatments.
• The chronicity of rosacea requires that medical therapy be continued long-term, not just for flare-ups of the condition.
![Page 13: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/13.jpg)
What is This?
![Page 14: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/14.jpg)
Allergic Contact Dermatitis
• Contact dermatitis refers to any dermatitis arising from direct skin exposure to a substance. It can be allergic or irritant-induced.
• An allergen induces an immune response, while an irritant directly damages the skin.
![Page 15: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/15.jpg)
Allergic Contact Dermatitis• The most common sensitizer in North America is the plant
oleoresin urushiol found in poison ivy, poison oak, and poison sumac
• Other common sensitizers in the US:• nickel (jewelry)
• formaldehyde (clothing, nail polish),
• fragrances (perfume, cosmetics),
• preservatives (topical medications, cosmetics),
• rubber
• chemicals in shoes (both leather and synthetic)
![Page 16: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/16.jpg)
Allergic Contact Dermatitis
• Treatment• Avoidance of exposure to the offending
substance.
• Use of corticosteroids topical or oral in the acute phase of the reaction maybe helpful.
• Cooling of the skin by using calamine lotion or aluminum acetate
![Page 17: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/17.jpg)
What is this?
![Page 18: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/18.jpg)
Psoriasis
• Psoriasis is a common chronic skin disorder typically characterized by erythematous papules and plaques with a silver scale.
• Most of the clinical features of psoriasis develop as a secondary response triggered by T-lymphocytes in the skin.
![Page 19: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/19.jpg)
Psoriasis• Several clinical types of psoriasis have been described:
• Plaque psoriasis - symmetrically distributed plaques involving the scalp, extensor elbows, knees, and back.
• Guttate psoriasis - abrupt appearance of multiple small psoriatic lesions.
• Pustular psoriasis - most severe form of psoriasis. Characterized by erythema, scaling, and sheets of superficial pustules with erosions.
• Inverse psoriasis - refers to a presentation involving the intertriginous areas.
![Page 20: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/20.jpg)
Psoriasis
• Nail psoriasis -the typical nail abnormality in psoriasis is pitting w/ color changes & crumbling of the nail.
![Page 21: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/21.jpg)
Psoriasis
![Page 22: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/22.jpg)
Psoriasis
• Most patients w/ psoriasis tend to have the disease for life.
• There is variability in the severity of the disease overtime w/ complete remission in 25% of cases.
• The diagnosis of psoriasis is made by physical examination and in some cases skin biopsy.
![Page 23: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/23.jpg)
PsoriasisTreatment• Treatment modalities are chosen on the basis of
disease severity.• Topical emmollients, topical Steroids, tar
• Calcipotriene(Dovonex) affects the growth and differentiation of keratinocytes via its action at the level of vitamin D receptors in the epidermis.
• Tazarotene, is a topical retinoid, systemic retinoids
• Methotrexate, cyclosporine
• Immunmodulator therapy (embrel, remicade)
• Ultraviolet light.
![Page 24: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/24.jpg)
What is this?
![Page 25: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/25.jpg)
Vitiligo• Vitiligo is an acquired skin depigmentation that affects all
races but is far more disfiguring in blacks.
• The precise cause of vitiligo is unknown Genetic factors appear to play a role.
• 20-30 percent of patients may have a family history of the disorder.
• The pathogenesis is thought to involve an autoimmune process directed against melanocytes.
![Page 26: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/26.jpg)
Vitiligo• Peaks in the second and third decades.
• The depigmentation has a predilection for acral areas and around body orifices (eg, mouth, eyes, nose, anus).
• The course usually is slowly progressive.
• The diagnosis of vitiligo is based upon the clinical presence of depigmented patches of skin
![Page 27: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/27.jpg)
Vitiligo
• Repigmentation therapies include:• corticosteroids
• calcineurin inhibitors
• Ultraviolet light
• Pseudocatalase cream
• Surgery – minigrafting techiniques
• Depigmentation therapy w/ hydroquinone
![Page 28: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/28.jpg)
What is this?
![Page 29: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/29.jpg)
Pityriasis Rosea• Pityriasis rosea is an acute, self-limited,
exanthematous skin disease characterized by the appearance of slightly inflammatory, oval, papulosquamous lesions on the trunk & proximal areas of the extremities.
• The eruption commonly begins with a "herald" or "mother" patch, a single round or oval, rather sharply delimited pink or salmon-colored lesion on the chest, neck, or back.
• 2 to 5 cm in diameter.
![Page 30: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/30.jpg)
Pityriasis Rosea
![Page 31: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/31.jpg)
Pityriasis Rosea• A few days later lesions similar in appearance to the herald
patch, appear in crops on the trunk & proximal areas of the extremities.
• The eruption spreads centrifugally or from the top down in just a few days.
• The long axes of these oval lesions tend to be oriented along the lines of cleavage of the skin, like a christmas tree pattern.
• Then the lesions fade without any residual scarring.
![Page 32: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/32.jpg)
Pityriasis Rosea
• The presence of a herald patch by history or on examination.
• The characteristic morphology and distribution of the lesions.
• The absence of symptoms other than pruritus combine to make PR an easy diagnosis in most instances.
![Page 33: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/33.jpg)
Pityriasis Rosea
• Differential Dx include: Psoriasis, secondary syphilis, tinea corporis, Lyme disease, & drug eruptions.
• Treatment is usually reasurrance.• Topical Steroids
• Antipruitic lotions (prax, pramagel)
• Phototherapy
• Erthyromycin in severe cases
• Rash usually persists for 2-3 months
![Page 34: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/34.jpg)
What is this?
![Page 35: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/35.jpg)
Cellulitis• Cellulitis is an infection of the skin with
some extension into the subcutaneous tissues.
• An extremity is the most common location but any area of the body can be involved.
![Page 36: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/36.jpg)
Cellulitis• Five factors were identified as independent
risk factors: • Lymphedema
• Site of entry (leg ulcer, toe web intertriginous, and traumatic wound)
• Venous insufficiency
• Leg edema
• Being overweight
![Page 37: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/37.jpg)
Cellulitis
• Cellulitis is a recognizable clinical syndrome with both local & systemic features.
• Systemic symptoms include:
• Fever and chills
• Myalgias
• Increased WBC count
![Page 38: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/38.jpg)
Cellulitis• Local findings typical of cellulitis:
• Macular erythema that is largely confluent
• Generalized swelling of the involved area
• Warmth to the touch of the involved skin
• Tenderness in the affected area
• Tender regional lymphadenopathy is common
• Lymphangitis may be present
• Abscess formation also may be present
![Page 39: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/39.jpg)
Cellulitis
• Cellulitis in the majority of patients is caused by beta-hemolytic streptococci groups A, B, C, G, and Staphylococcus aureus.
• Other less common pathogens include H.flu, P.aeruginosa, Aermonas hydrophilia, Pasturella multocida.
![Page 40: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/40.jpg)
Cellulitis• Diagnosis is clinical• Treatment: Anti-strep/Anti- staph
• Cefazolin• Nafcillin• Clindamycin• Vancomycin• Fluoroquinolones (3rd & 4th generations)• Macrolides (erythromycin, azithromycin)
Duration of treatment is usually 10-14 days
![Page 41: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/41.jpg)
What is this?
![Page 42: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/42.jpg)
Erysipelas
• Erysipelas is a characteristic form of cellulitis that affects the superficial epidermis, producing marked swelling.
• Bacterial Organisms:• Beta-hemolytic streptococci group A• Group C & G less commonly• Staph. Aureus• Streptococcus pneumoniae, enterococci, gram negative
bacilli
![Page 43: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/43.jpg)
Erysipelas
• The erysipelas skin lesion has a raised border which is sharply demarcated from normal skin.
• This is its most unique feature and allows it to be distinguished from other types of cellulitis.
• The demarcation is sometimes seen at bony prominences.
• The affected skin is painful, edematous, intensely erythematous, and indurated (peau d'orange appearance).
![Page 44: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/44.jpg)
Erysipelas
• The face historically was the most common area of involvement.
• Erysipelas is diagnosed clinically
• It can mimic other skin conditions:• Herpes zoster (5th cranial nerve)
• Contact Dermatitis
• Urticaria
![Page 45: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/45.jpg)
Erysipelas
• Treatment:• Penicillin is the preferred treatment• Erythromycin• Clindamycin• Fluoroquinolones
• Erysipelas does have the propensity of recur.
![Page 46: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/46.jpg)
What is this?
![Page 47: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/47.jpg)
Ecthyma
• Ecthyma is an ulcerative pyoderma of the skin caused by group A beta-hemolytic streptococci.
• Because ecthyma extends into the dermis, it is often referred to as a deeper form of impetigo.
• Preexisting tissue damage (excoriations, insect bites, dermatitis) & immunocompromised states ( diabetes, neutropenia) predispose patients to the development of ecthyma.
![Page 48: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/48.jpg)
Ecthyma• Ecthyma begins as a vesicle or pustule overlying an inflamed area
of skin that deepens into a dermal ulceration with overlying crust.• A shallow, punched-out ulceration is apparent when adherent
crust is removed.
• The deep dermal ulcer has a raised and indurated surrounding margin.
• Ecthyma lesions can remain fixed in size or can progressively enlarge to 0.5-3 cm in diameter.
• Ecthyma heals slowly and commonly produces a scar.
• Regional lymphadenopathy is common.
![Page 49: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/49.jpg)
EcthymaTreatment:
• Topical mupirocin ointment
• Gentle surgical debridement
• Oral/IV antibiotics• Penicillin
• Clindamycin
• Macrolides
• Cefazolin
![Page 50: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/50.jpg)
What is this?
![Page 51: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/51.jpg)
Tinea Vesicolor
• Tinea versicolor is a common superficial infection caused by the organism Pityrosporum orbiculare.
• Which is a saprophytic yeast that is part of the normal skin flora.
![Page 52: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/52.jpg)
Tinea Vesicolor• Lesions can be hypopigmented, light brown, or
salmon colored macules.
• A fine scale is often apparent, especially after scraping.
• Individual lesions are typically small, but frequently coalesce.
• Lesions are limited to the outermost layers of the skin.
![Page 53: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/53.jpg)
Tinea Vesicolor• Most commonly found on the upper trunk &
extremities, & less often on the face and intertriginous areas.
• While most patients are asymptomatic, some complain of mild pruritus
• The diagnosis of tinea versicolor is confirmed by direct microscopic examination of scale with 10 % potassium hydroxide (KOH).
![Page 54: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/54.jpg)
Tinea Vesicolor
• The differential diagnosis includes seborrhea, eczema, pityriasis rosea, and secondary syphilis.
• Treatment includes topical antifungals. Oral antifungals can be used for more extensive disease: Ketocanozole 400mg x 1 dose. Fluconazole and itraconazole are also effective.
![Page 55: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/55.jpg)
What is this?
![Page 56: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/56.jpg)
Cutaneous Warts
• Cutaneous warts AKA verrucae are caused by HPV which infects the epithelium of skin and mucus membranes.
• Cutaneous warts occur most commonly in children and young adults.
• Also more common among certain occupations such as handlers of meat, poultry, and fish.
• Predisposing conditions include atopic dermatitis & any condition in which there is decreased cell-mediated immunity.
![Page 57: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/57.jpg)
Cutaneous Warts
• Infection with HPV occurs by skin-to-skin contact
• Incubation period following exposure in 2-6 months.
• Warts can have several different forms based upon location & morphology (flat, mosaic, and filiform warts)
• Lesions may occur singly, in groups, or as coalescing lesions forming plaques.
![Page 58: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/58.jpg)
Cutaneous Warts
• The diagnosis of verrucae is based upon clinical appearance.
• Scrape off any hyperkeratotic debris & reveal thrombosed capillaries (seeds).
• The wart also will obscure normal skin markings
![Page 59: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/59.jpg)
Cutaneous WartsDifferential Diagnosis:
• Lichen Planus• Seborrheic Keratosis• Acrochordon or skin tag
• Clavus or corn
Treatment• Spontaneous regression in 2/3 over 2yrs• Salicylic acid, liquid nitrogen, cantharidin• Cyrotherapy, curettage, laser therapy• Immunotherapy, intralesional injections
![Page 60: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/60.jpg)
What is this?
![Page 61: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/61.jpg)
Secondary Syphilis
• Syphilis is a chronic infection caused by the bacterium Treponema pallidum which is sexually transmitted.
• Syphilis occurs in 3 stages:• 1st stage is characterized by the classic chancre,
which is a 1-2cm ulcer with raised indurated borders, usually painless and occurs at site of innoculation. Heals spontaneously.
![Page 62: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/62.jpg)
Secondary Syphilis
![Page 63: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/63.jpg)
Secondary Syphilis• Secondary or systemic syphilis is characterized by a rash.
• The rash is classically a symmetric papular eruption involving the entire trunk & extremities including the palms and soles.
• Systemic symptoms include fever, headache, malaise, anorexia, sore throat, myalgias, & weight loss.
• Lymphadenopathy (inquinal, axillary)
• So-called "moth-eaten" alopecia
• Condyloma lata, grayish white lesions involving the mucus membranes
![Page 64: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/64.jpg)
Secondary Syphilis
![Page 65: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/65.jpg)
Secondary Syphilis
• Diagnosis at this stage is usually by serologic testing but darkfield microscopy can also be done for direct visualization of spirochete.
• Non-treponemal testing:• Veneral disease research laboratory (VDRL)• Rapid plasma reagent (RPR)
• Treponemal testing:• Fluorescent treponemal antibody absorption test• Microhemagglutination test for antibodies
![Page 66: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/66.jpg)
Seconday SyphilisTreatment• T.Pallidum remains very sensitive to PCN.
• Long-acting benzathine penicillin G should be used.
• If documented chancre or a NR serologic testing was done in the past 1 yr, one IM dose is appropriate.
• If neither of the above applies this needs to treated as latent syphilis and 3 q week doses must be given.
• Doxycycline, erythromycin or zithromycin in pen allergic patients x 14 days.
![Page 67: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/67.jpg)
What is this?
![Page 68: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/68.jpg)
Herpes Zoster• Reactivation of endogenous latent VZV infection within
the sensory ganglia results in herpes zoster or "shingles", a syndrome characterized by a painful, unilateral vesicular eruption in a restricted dermatomal distribution.
• How the virus emerges from latency is not clearly understood.
• Patients frequently experience a prodrome of fever, pain, malaise and headache which precedes the vesicular dermatomal eruption by several days.
![Page 69: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/69.jpg)
Herpes Zoster• The rash initially appears along the dermatome as
grouped vesicles or bullae which evolve into pustular or occasionally hemorrhagic lesions within three to four days.
• The thoracic and lumbar dermatomes are the most commonly involved sites of herpes zoster.
• The complications of herpes zoster include ocular, neurologic, bacterial superinfection of the skin and postherpetic neuralgia
![Page 70: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/70.jpg)
Herpes Zoster
Treatment
• Antivirals:• Acyclovir
• Famciclovir
• Valacyclovir
• Antivirals w/ corticosteroids
• Analgesics: opioids/acetominophen
![Page 71: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/71.jpg)
What is this?
![Page 72: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/72.jpg)
Actinic Keratosis
• Actinic keratoses (AKs) are premalignant lesions that develop only on sun-damaged skin.
• AKs appear as patches of hyperkeratosis with some surrounding erythema on sun-exposed areas of the head and neck, forearms and hands, and upper back.
![Page 73: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/73.jpg)
Actinic Keratosis
![Page 74: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/74.jpg)
Actinic Keratosis• The differential diagnosis of AKs includes
seborrheic keratoses, verruca vulgaris, SCC, and superficial BCC.
• The treatment of AKs begins with prevention.• Avoiding sun exposure• sunscreens reduce the development of AKs,
• Active treatment of AKs depends upon the size of the lesion and the number of lesions present.
• Liquid Nitrogen
• Surgical curettage
• Chemotherapy (5-FU, diclofenac, imiquimod)
• Dermabrasion
• Photodynamic therapy
![Page 75: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/75.jpg)
Which one is which?
![Page 76: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/76.jpg)
• Basal Cell Carcinomas begins as small shiny nodules and grows slowly. It is the most common form of skin cancer.
• Frequently, the central portion breaks down to form an ulcer with a reddish-purple scab. These tumors usually remain fairly localized and rarely spread elsewhere.
![Page 77: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/77.jpg)
• Squamous Cell Carcinoma is another common form of skin cancer. When these tumors first appear they are firm to the touch. They appear most often on sun-exposed areas of your body.
• Squamous cell carcinoma evolves very slowly through a premalignant stage known as a solar or actinic keratosis.
• Untreated, significant numbers of these lesions can metastasize to distant sites. Tumors on the lower lip and ears are at higher risk to spread.
![Page 78: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/78.jpg)
• Malignant Melanoma is the most dangerous form of skin cancer.
• They arise from either pre-existing moles or normal skin.
• Malignant melanoma, like basal and squamous carcinomas, is linked to overexposure to the sun.
• But it can appear any place on your body.
• When detected early & with proper treatment, the recovery rate from this form of skin cancer can be very high.
![Page 79: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/79.jpg)
References
• Harrison’s 15th Edition. Principles of Internal Medicine
• Up to Date
• Emedicine
• Dermatology Pearls Adult and Pediatric
![Page 80: Dermatology By Katrice L. Herndon, MD Internal Medicine/Pediatrics June 2, 2005.](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649cf45503460f949c1bc8/html5/thumbnails/80.jpg)
Thank You