The allergic triad of atopic dermatitis
Asthma, Hay Fever, allergies
Chronic Atopic Derm yields
Lichenification
MC allergy
Milk
Seborrheic Derm Presentation
greasy scales over erythematous plaque, presents on scalp, eyebrows, eyelids, galbella and chest
Lichen Simplex cycle, break it w/
itch-scratch-itch cycle
HIGH potency topical steroid and oral antihistamine
Redness to marked edema, involves the hands, common from wet work and hard soap. Tx for hard soap: Dx:
Alkaline soap, I think.
Irritant Contact Dermatitis
Given picture with linear streaks on the lower leg at a contact line with vesicular eruption
Poison Ivy- Allergic Contact derm
MC cause of contact redness
Nickel
Well demarcated erythematous plaque with silvery scale, thick stratum corner from epidermal proliferation (elbow, knee, scalp) Dx: Tx: Complication:
Psoriasis
Topical Steroids
30% people get Psoriatic Arthritis in the joints
Present- large pink/tan 2-6mc patch, a few days before a larger rash blossoms into red/ pink/brown scaly patches at trunk and extreme pruritus.
Shape, Name of rash?
Christmas tree Presentation
Pityriasis Rosea
Lichen Planus P’s
Tx
Pruritic, purple, papules. wickham’s striae, hep c, patches on buccal mucosa
topical steriod
Drug eruptions: time frame, step 1
start w/in 1 week of new medication
first remove offending drug
Tense bullae on skin, usually in flexural areas, intense pruritus
Bullous Pemphigoid
Oral Oral Oral Steroid (prednisone)
Erythema Multiforme
target lesions with a clear center- symmetric, erythematous skin lesions
self resolve
SJS
papule > vesicle > bullae> skin peeling
Ance progression
extreme Tx
Open (black) closed (white) comedones, cysts and nodules
Accutane (oral abx) need labs: pregnancy, lipids, CBC, hepatic/LFT
Rosacea
ETR
Erythematotetlangietacic: central face flush w/burn or sting, not periocular!, butterfly presentation.
Hidradenitis Suppurativa (HS)
comedome, follicular occlusion, murcopurulant discharge, scaring
HS progression
initial- pruritis, erythema
red & painful lesion erythema > pain > papule > access erupts > discharge
later- painful and smelly lesion
Vesiculopustules in intertirgous areas, scalloped border w/ white rim and satellite lesions
Intertrigo
Nail thickening and ridging, extends under the nail
Onchomycosis
bonus: oral antifungal (zole)
Tinea Faciale
Face
dermatophytosis
Tinea capitis
hair loss (oral rx, no topicals!)
Tinea versicolor presentation
malassezia furfur on human skin
seborrheic area- face,scalp,chest, hypo or hyper pigmented macules (not a tan)
Tinea versicolor tx and lab
KOH prep scraping shows hyphae and spores (spaghetti and meatballs)
Tx: selenium sulfide shampoo 15 min x 7days and ketoconazole oral (no showers 18 hrs post med)
Pediculosis capitis
plus tx
Head lice
Pyrethrin shampoo or ivermectin topical
Pediculosis carpers
body lice
Pediculosis pubis
Pthirus pubis
pubic lice
Scabies presents
linear burrow (breaky, lunch, dinner) with intense pruritus "7 year itch" remember the pubic scabies on exam 1
Strep pyrogens
Staph aureus cause
Cellulitis rubor- red calor- heat tumor- edema dolor-pain
Cellulitis mc spot
Legs!
causes malice, fever, chills
Impetigo: Non bullous bug
bullous bug
non: Staph aureus, GABHS or both
bullous: Staph aureus and coagulase
“slapped cheek” “lacy rash”
maculopapule rash
Erythema Infectiosum
5th disease
Shinges/Varicella
Herpes Zoster rxn. does not cross the midline, generalized eruptions, vesicular, painful, involves CNS
Molluscum Contagiosum
present:
single/multiple round, dome, pink, waxy papillose umbilicate with caseous plug, linear pattern on the face, trunk, extremity and groin
Acanthosis Nigricans
present
skin folds “dirty” hyper pigmented, velvety, plaque, asymmetric (neck & axilla) (DM)
Michael Jackson
Vitiligo
depigmented macules or macule patches. more distal is harder to treat
Actinic Keratosis aka…
presentation too
pre skin cancer
lesion is scaly, red, rough and sensitive
Actinic Keratosis
present on face, ears, scalp, forearm, chest, upper back, hands
Basal Cell Skin Cancer (remember skin cancer is important to relearn)
Sore that doesn’t heal: red, scaly, crusted patch, may bleed
pearly, shiny bump
Squamous Cell Skin Cancer
commonly affects the lips
SQUeeze your lips together for a kiss
Malignant Melanoma
superficial spread
mc in men=trunk
mc in women=legs
both=upper back
Alopecia Areata
discrete bald patches with smooth, non-inflamm underlying skin