Definitions

1
Definitions

• Macule color change, flat and smooth (large or
  small)
• Pustule small circumscribed elevation of skin
  filled w/ cloudy white or yellow or green
  material
• Fissure linear cleft through the epidermis-
  rarely into dermis
• Cysts space occuping lesion, very sharply
  circumscribed, movable and copressible- sac
  containing liquid or semi-solid materials
• Nodule larger than a papule in all three
  dimesions
• Agagen hair cycle growth phase lasts 3-4 years
• Vesicle fluid-filled lesion (clear) upto 0.5 cm
• Abrasion superficial skin loss not penetrating
  the dermo-epidermal juncture
• Urticaria evanescent, often pruritic, irregular
  shaped lesions w/in 1hr of eating seafood

2
Burns

• 4th degreeDestroys full thickness of skin and
  underlying structures
• 3rd degree split thickness skin graft- best long
  term healing
• 2nd degree epidermis and various layers of the
  dermis

3
Escharotomy

• No distal pulse
• Circumfrential burn full thickness
• Is a longitudinal incision to prevent blood flow
  disruption

4
Wound healing

• 1st phase Inflammatory phase
• Full- thickness wounds heal form edges
• Maturation phase no net colloagen productions ,
  cross-linking occurs, flat more supple scar
• Inflammatory phase no collagen, macrophages,
  PMNs present
• Clean wound less than 100,000 organisms/gram of
  tissue
• Proliferative phase raised, red scar, high
  collogen production
• Prevention of infection soft tissue adequated
  debridement
• Chemical spills must decontaminate first
• Edema beneath burn skin ivntravascular volume
  loss death
• Strength dermis-fascia
• Prophylactic antibiotics insertion of vascular
  prosthesis
• Short operation time low wound infections rate

5
Malignant fibrous histiocytoma

• Histo atypical spindle cells storiform pattern
  bizarre cells

6
Superficial spreading melanoma

• Pigmented lesion grows rapidly and starts
  vertically
• 170 lifetime chance of getting
• ABCD
• Asymmetry of border
• Border (scalloped)
• Color (red, white, blue)
• Diameter (6mm)

7
Breslow classification

• 1.51 to 3.99mm deep regional metastasis
  incidence of 51

8
Basal cell carcinoma

• Pearly, papule blood vessels over surface
• Histo nest of basaloid cellsw/ peripheral
  palisading
• Rarely metastasize
• Rodent ulcer nodular basal cell carcinoma
• Radiation non surgical candidate, and advanced
  lesions
• MCC type nodular
• MC skin cancer
• Skin growing pearly papule / nodule, rolled
  raised border with central depression
• () telangiectasia
• Bleed if scratch
• Lesion brown / black
• DDx SCC v . BCC with biopsy
• Tx imiquimod (aldara)

9
Malignant melanoma

• Prognosis level and depth
• Found in skin and conjunctiva
• Dull red, central dork kerotoic plug, firm

10
Squamous cell carcinoma

• Marjolins ulcer chronic unstable burn scars
• 2 MC
• Skin mucosal keratocytes
• Chronic sun exposure
• ORAL SCC
• Lower lip,
• Dome shaped crust, firm red nodule
• Watch for metastase

11
Vitiligo

• Disfiguring disease of unknown origin
  destruction of melanocytes
• Woods light help diagnosis

12
Senile purpura

• Purple patches, no blancheing
• Corticosteroid use

13
Granuloma annulare

• Dorsum of hand
• Changed from discrete nodule to lesion w/
  circumferentially raised border, same color as
  adjacent skin antifungal does not work

14
Seborrheic keratosis

• Uniform brown lesion
• stuck on appearance
• Sign of Leser-trelat

15
Senile (actinic) Keratosis

• Premalignant lesion
• Histo hyperkeratosis, acanthois, celluar atypia-
  lower dermis
• Basophilic degeneration lymphocytic infiltration-
  upper dermis
• Finely scaly, read to tan, irregular surface
• 5 fluoro-uracil
• Tx chemical peels
• Progress to SCC (earliest stage)
• Burn itch sting
• Tx imiquimod (aldara)

16
dermatomyositis

• Gottrons sign (papules over knuckles)
• Heliotrope eruptions and upper eyelid edema
• Poikiloderma
• Pt. has difficulty combing hair, climbing stairs,
  getting up from chair

17
Seborrheic Dermatitis

• Greasy yellow loose scaly
• Face scalp nasal, labial, eyebrows, glabella,
  under arms, butt, groin
• Tx
• Ketoconazole
• Green Tea Shampoos
• Scale removal
• Lopox gel / cream
• Seborrheic Blepharitis
• On eyelids

18
Lichen Planus

• Saw-tooth patter of epithelium, liquefaction,
  band of mononuclear cells
• Flexor aspects of wrists and forearms pruritic
  flat-topped, polygonal violaceous paules
• () Auspitzs sign
• Puruitic
• Oral lesions painful
• Rx hydrochlorothiazide
• 5 Ps
• Pruritis
• Planar (flat topped)
• Polyangular
• Papule
• Pterygium (triangle deformity of nails)
• SSx

19
Pityriasis Rosea

• Herald atch
• Collarette of scale with in border not on
  outside

20
Bullous pemphigoid

• Subepidermal non-acantholytic blister
• Immunofluorescence linear IgG basement membrane
• large tense bullae erythematous bse or normal
  skin older pts.
• Benign no scar
• Around umbilicus
• Itch and burn
• (-) Nikolsky sign
• DOC predenisone (ID)

21
Pemphigus vulgaris

• Tx systemic steroids and steroid-sparing meds
• Intraeptithelial blister
• Immunofluorescence intercellular IgG and
  complement
• () nikolskys sign

22
Mongolian spot

• Dark blueblack pigmented macularpathces
• Childern slate colored, resolve spontaeously
• Location butt and lower trunk

23
Psoriasis

• Sharply defined silver-white plaques
• MC elbows / knees
• Histo acanthosis and elongations of the rete
  ridges, parakeratosis
• Munro abscesses
• Tx etretinate (tegison) - SQ
• Tx PUVA (psoralens-vua radiation)- moa
  formation of DNA adduct decreased DNA
  replication
• Tx Goeckermann Regimen
• 90 effective for 9 months
• UVB old tar
• Tx Ingram regime
• Goeckermann Regimen with anthralen instead of tar
• Tx ethotrexate infiximab (Remicade) IV
  infusion Amevive (alafacept) T-cells IV
• Auspitz sign (), Koebner reaction ()
• Pustular psoriasis tx systemic retinoids
• Transmitted genetically
• Develop at sight of trauma
• Winter worse, 1-3 population
• Triggers strep / stress / Alcohol / Physical
  Trauma (Koebner Rxn)

24
Psoriasis

• Types
• Guttate
• Drop like lesions after strep infection
• Localized polymoplanar pustulosis
• Erythordermic
• Psomatic arthritis
• Dx KOH
• Poor self image 30 get arthiritis
• Topical creams make sure get under scaly skin
• Tachofolaxes atrophy, thinning of skin d/t long
  term less potentcy
• Underlying Cause T-cells mediators with TNF

25
Koebner Rxn

• Psorasis
• Lichem planus
• Lichen nitidus

26
Molluscum contagiousum

• Umbilicated papules dome shaped pink waxy
• Exhaggerated with ethyl-chloride
• Auto inoculation around the eyes
• Facial lesions in kids
• Poxvirus
• Sexual transmitted
• Spontaneously resolve except immunocompromised
• More common males
• NO significant skin symptoms
• Histo cup-like hyperplasia of epidermal cells
  homogeneous ellipsoid inclusions
• Usually self-limiting
• Tx aldara

27
Erythema multiforme

• Herpes simplex episode multiple target lesions
  (palms soles)
• Result of hypersensitivity reaction to infection
  or medications
• Target lesions central necrosis perivenular
  inflammation concentric rings with vesicles in
  center uticarial plaques
• Lesions on soles/palms
• Prodrome HSV outbreak
• Severe Steven Johnson Syndrome
• Even more severe Toxic Epidermal Necrolysis
  (TEN)

28
Measles (rubeola)

• Diffuse erythematous maculopapular rash face
  and trunk
• Fever, lethargic, viral ezanthemas
• Koplik spots- mouth
• Conjunctivitis (photophobia)

29
Bullous impetigo contagiosa

• Honey-crusted
• Staphylococcus aureus
• Nonbullous impetigo B-hemolytic strep

30
erysipelas

• St Anthonys fire
• Acute cellulitis
• Prodrome N/v, headache, fever, chills (24-48h)

31
Onychomycosis

• Fungus of nail
• Types
• Superficial white
• Proximal subungual
• PATHOGNUMONIC for HIV
• Distal subungal
• MOST COMMON

32
furuncle

• Abscess
• Boil
• Collection of pus
• Hair bearing area
• () scarring
• Pt is usually afebrile
• Tx ID

33
Staph Scalded Skin Syndrome (SSSS)

• Ritters Disease
• () Nikolskys sign

34
Nikolskys sign

• ()
• SSSS
• Toxic Epidermal Necrolysis (TEN)
• Plemphigus Vulgaris
• (-)
• Bullous pemphigoid

35
Erythema infectiousum/ 5ths disease

• Malar rash on cheeks and arms leaves reticulated
  pattern
• parvovirus

36
Hand, foot and mouth disease

• Rash on hands, feet and mouth
• Low grade fever, arthralgia
• Coxsackie virus
• () Tzanck

37
Herpes simplex

• Small blisters on erythematous base (above lip)
• Tingling sensation overlying the area
• Recurrent episodes
• Oral acyclovir
• Cluster pustules / vesicles on eryth. Base
• Tzanck smear
• Giemsa Stain
• Giant multinucleated cells

38
HZV

• Assoc with cancer and HIV
• HZ opthalimucius
• () Hutchinsons sign
• Lesion _at_ tip of nose
• Ramsey-Hunt syndrome
• CN V and CN VIII
• Ear and ear problems
• Bells palsy

39
Varicella

• DDx small pox
• Varicella lesions all different stages all over
  body that move from the central to the periphery

40
Warts / Verrucae / HPV

• Verruca Vulgaris
• Black dots, common wart
• MCC kids
• Crusted lesion
• Filiform
• Singl soft
• Comlication esophogeal cancer
• Tx imiquimod (aldara)
• Parvovirus (5ths disease)
• Aplastic crises and anemia

41
ORF

• Sheep pox
• Swelling fever pain lymphadenitis
• Eryth. With halo

42
Roseola infantum

• Hepres virus

43
scabies

• Sever pruritus _at_ night
• Papular lesions interdigitally hands and feet w/
  linear burrow
• DOC elamite

44
Cutaneous Larva Migrans(Creeping Eruptions)

• anklystoma brasiliensis
• Walking barefoot
• Squiggly movement under skin

45
Erythrasma

• Woods light coral red fluorescence
• Caused by corynebacterium minutissimum

46
Acne

• Starts early in males on nose as micro-comedones
• Monobezone (benoquin) causes propionibacterium
  acnes proliferation
• Treatment topical- clindamycin
• Stages 1 -open/closed comedomes
• 2- papules/pustules
• 3- nodules / cysts
• 4- scars
• Male female
• Inflamm disease
• MCC microcomodones

47
Acne vulgaris

• Nodules and cyst on face and chest
• Treat w/ accutane (is a retinoid)

48
Acne keloidalis

• Hard nodules and papules, discrete and confluent
  associated with hair loss in same area

49
Acne conglobata

• Severe widespread, cicatrices (scars), drainning
  sinuses and polyporous comedones

50
Rosacea

• Severe flushing of face flushers and blushers
• increase reactivity of capillaries to heat
• telangiectasia
• Inflamed papules and pustules
• Coffee
• Tx tetracycline, sunscreens,, clindamycin green
  based cosmetic foundations
• Not tx red wine intake

51
Hair cycle

• Agagen hair cycle growth phase lasts 3-4 years

52
Alopecia Areata

• Oval /round patches of hair loss
• Spontaneously returns
• Family hz
• Exclamation point hairs
• Associated dz hashimotos dz, addisons dz,
  vitiligo, hypOparathyroidism
• Alopecia
• No new hair after birth
• Follicular plugging DISCOID LUPUS
• Moth-eaten hair loss SYPHILIS
• Trichofillomania
• Kids pulling out own hair

53
Traction alopecia

• Braided hair
• Thinning and sparse hairs

54
Hot comb alopecia

• Depigmentation and hyperpigmentation and scarring
  alopecia vertex of scalp

55
Telogen effluvium

• Large loss of scalp hair (clumps or most)
• Pulled out w/ little pressure
• Pervious serious infection (febrile)

56
Sclerosis progressive systemic

• Aka scleroderma
• Prognosis not by Raynaunds Phenomenon
• Most common feature is Raynauds phenomenon

57
Tuberous sclerosis

• Ash-leaf macules, periungual fibromas, shagreen
  patch, adenoma sebaceum
• Seizure risk
• Flat red discoloartion of right anterior and
  lateral forehead involves the eylids and tip of
  nose on the same side

58
Seizures

• At risk ash-leaf spots, shagreen patches,
  and adenoma sebaceum

59
Toxic epidermal necrolysis (TEN)

• Due to drug reaction
• () Nikolsky sign
• Life threatening
• Moist large raw areas crusts then detachment of
  skin
• PLEMPHIGUS VULGARIS

60
Bullous hemorragic cellulitis

• Mediated Tumor necrosis factor alpha

61
Acrodermatitis enteropathica

• Serum zinc level
• Failure to thrive
• Malodorous pale, bulky stools
• Hair loss

62
Sarcoptes scabiei

• Circumscribed alopecia w/ vesicles
• Hyphae and spores

63
Tinea cruris

• Sites groin, thighs, butt, pubic region
• Not scrotum and penis
• Groin NOT genitals

64
Tinea Manuum

• Dorsum of hand looks like ringworm
• Palmar hand increase creases
• 2-feet-1-hand syndrome
• () dermatophytid RXN
• DDx granuloma annularia
• (-) KOH
• (-) pruritis

65
Tinea Pedis

• MCC dermatophytosis
• Patterns
• Interdigital
• Moccasin
• Acute vesicular
• ()dermatopytid RXN

66
Miliaria rubra

• Beach
• Erythematous papulopustular rash on face, neck
  and extremities

67
Hemangioma

• Soft, raised strawberry colored lesion
• Appeared after birth and has enlarged

68
Candidial diaper dermatitis

• Diaper rash- erythema of pernineal region
• creased of butt and proximal thighs
• Satellite papules peripherally

69
Candidal intertrigo

• Ddx psoriasis, eczema, bacterial folliculitis,
  seborrheic dermatitis
• not herpetic eruption

70
Miliaria crystalina

• Diffuse scaly rash scalp and eyebrows

71
Granulation tissues

• Capillaries an inflammatory cells

72
Dermatitis herpetiforms

• A gluten-free diet
• Immnofluorescence IgA dermal papillae
• Microabscesses at tips of dermal papillae
• Duhrings Disease
• Herpes-like
• Hallmark XXXX-pruritic itchy rash
• Assoc with HLA-BA

73
Atopic Dermatitis

• Atopy (hayfever eczema)
• () Fam Hx
• Pruritic, recurrent, flexures
• All ages (MC children)
• Comorbid warts, virus, mollus. Contag.
• Stages
• Infantile 2mo-2y
• Childhood 2y-10y
• Adult 10y-adult (only 1 out of 3-4 of cases get
  here)
• INCREASED IgE
• S. aureus
• Tx muperacin or gentamycin (nostrils)
• HypO / hyperpigmentation inflamm with chronic
  irritation
• Allergies nickel, neomycin (neosporin)
• ATOPIC KERAToCONJUNctivitis chronic childhood

74
Atopic Dermatitis

• Features
• Dennie Morgan Fold
• Keratosis
• HErtoghes sign
• Headlight Sign
• White dermopgraph
• Cataracts
• NOT triple response of Lewis
• Increase risk of
• Staph (Karposis Varicelliform)
• Wart eruption, Moll. Contag.

75
Cowdens dz

• Features breast lesions, thyroid goiter, hand
  keratosis , facial papules

76
Keloids and Hypertophic scars

• Early scars are read and firm initially
• pruritus
• Smooth domed surface
• No cosmetic procedures
• Not usually hyper-pigmented in Afican americans

77
UV hn

• Causes cutis rhomboidalis, squamuos cell
  carinoma,, poikiloderma of Civatte
  Favre-Racouchet syndrome
• Does not cause seborrheic keratosis

78
Favre-Racouchet Syndrome

• Zits around around eyes in old people raccoon
  eyes
• Nodular periorbital
• Leads to Ca

79
Atopic dermatits

• FHx of asthma, hayfever, or allergic rhinitis
• Diagnosis- IgE levels
• Infantile stage starts _at_ 2mon
• Use cotton clothing
• Conolized by staph. Aureous
• Tx tacrolimus ointment

80
Tinea versicolor

• Spaghetti and meatballs
• Hypopigmentation
• Commony recurs
• Repigmentation takes months
• Dx KOH (Spag meatballs)
• Onset scalp
• Tx ketoconazole

81
Tinea corporis

• Dermatiophyte infection of body (glabrous skin)
• Ringworm of the body
• Scaly border, clear center that flattens as
  border advances
• XXX contagious
• Tx topical for 4 weeks
• Redo KOH to confirm

82
Tinea Capitus

• MC organism tryophyte tonsorans
• Types
• Seborrheic dermatitis
• Diffuse patches
• Hair losses luster
• (-) KOH, need hair for Dx
• Inflamm type KERION

83
Tinea facioli

• Tx topical only
• Flat scaly spots that extend peripherally

84
Tinea Barbae

• Hair by fungi falls out
• Hair by bacteria DOES NOT fall out
• Tx systemic antifungals

85
Candidal balanitis

• Ddx genital warts, psoriasis, eczema molluscum
  contagiosum
• A yeast infection frequently found in the
  uncircumcised penis

86
Candidiasis

• Marker for HIV
• Oral Thrush
• Superinfection d/t wide spectrum antibiotics
• Dx diflucan

87
Perleche

• Angular chelitis
• Lip licking / drooling

88
Mycosis fungoides

• Nodules neoplastic T-cells (nuclei cerebriform
  pattern

89
Keratoacoanthoma

• Nodular, central keratin-filled crater
• Fast appearance, rapid growing
• Elderly men leads to SCC
• Smmoth shiny lesion with telangiectasia

90
Trichotillamania

• Oval irregular patch of hair loss frontal
  scalp, enlarging
• broken hairs w/in patch of hair loss
• No telogen hair roots

91
Anagen effluvium

• Abrupt hair loss, cytotoxic drug treatment
• Thallium can cause similar problems
• Eventual complete regrowth

92
vehicle

• Brings meds into contact w/ skin
• Benefits cooling, protective, emollient,
  occlusive
• Not subcutaneous atrophy

93
Retinoids

• Isotretinoin- severe cystic acne
• Moa mediated via enhanced transcription via
  receptors like thyroid/steroid super family
• Helps reduce size of sebaceous gland
• Etretinate (tegison) and acitrein (soritane)
  psoriasis
• Teratogenic potential long term

94
Glucocorticoids

• Topical Vasoconstriction, anti-proliferative,
  immunosuppression, anti-inflammatory, atrophy of
  hypertrophic scars
• Bind DNA sequence glucocorticoid responsive
  elements
• Activation of expression of target gene
• Physiological responses anti-inflammatory
  response
• MOA in psoriasis- anti-mitotic effects
• Used to inhibit formation of prostaglandins

95
Finasteride (propecia)

• Inhibits 5-alpha reductase controls production of
  DHT

96
Trioxsalen (trisoralen)

• Psoralen used for re-pigmentation (vitiligo)

97
Hydroquinone

• Inhibition of tyrosinase enzyme thus inhibiting
  melanin formation blocks oxidation of tyrosine

98
Immunoflourescence

• Important in diagnosis of blistering disease

99
Chemical peels

• Complications pigmentary changes, infection,
  prolonged erythema, milia
• For pigmentary dyschromias

100
Lasers

• Light amplification by stimulated emission of
  radiation
• Monochromatic, highly collimated, controllable,
  coherent
• Used for vascular disorders through selective
  thermolysis

101
sclerotherapy

• For varicose and telangiectatic veins
• Complications cutaneous necrosis and ulceration,
  pulmonary embolism, superficial thrombophlebitis,
  post-sclerotherampy hyperpigmentation

102
Tzanck test

• Air-dried
• Tzanck stain postivie for multinucleated giant
  cells tx w/ intravenous acyclovir

103
dermatomyositis

• Management Systemic gluco-corticosteroids,
  methotrexate, plasmapheresis, rest and
  physiotherapy
• Internal malig of older patients
• () gorrrus papules
• Photosensitive violacema on knuckles, face, neck,
  trunk
• Lupus-like skin

104
Carcinoid Syndrome

• Episodic intense flushing of face, neck and upper
  chest
• GLUCAGONOMA SYNDROME
• Alpha-cell tumor 80 malig
• Looks like eczema
• Ssx malaise, wgt loss, polyuria
• Tx excision and topical steroids

105
Syndromes

• Sweet Syndrome
• Prodrome URIs
• FM
• Assoc with internal malig
• Gardners Syndrome
• Multiple epidermal cysts (scalp/face)
• Malig intestinal polyps
• Fibrous skin tumors
• Pigemnted ocular fundus
• Plapable osteomas

106
Scleredema Diabeticorium

• Non-pitting eryth.
• Woody feeling

107
Xanthomas

• Palmar
• Biliary sclerosis DM lipid accmulation
• Striated
• Palmar creases as yelow lines
• Tuberous
• Any age
• 1 hyperLIPID/CHOLESTEROLemia

108
Discoid Lupus

• Butterfly rash
• Tests antinuclear antibodies
• Scarring alopecia
• Elevated read plaques w/ firmly-adherent scale
  (butterfly rash)
• Procainamide- cases a lupus like syndrome
• Systemic lupus false postive syphilis serology

109
Chronic cutaneous lupus

• UV light precipitates attack

110
Erythema nodosum

• Form of panniculitis (inflammation of
  subcutaneous fat), lymphohistiocytic
  infiltration, giant cells, eosinophils, NO
  vasculitis
• Back of leg () TB
• Self limiting
• Deep hot painful tender 1-5cm nodules on PRE
  TIBIAL SKIN
• Tx naproxsyn

111
Lentigo

• Solar lentigo
• Freckle like blotchy
• Lentigo Maligna
• 10-20y exposure (chronic)
• Melanoma in situ
• Asymm irreg border macular lesions face, neck,
  dorsal arms
• Tx Mohs surgery
• Lentigo Maligna Melanoma (LMM)
• Vertical growth and metastases

112
Cutais Rhomboidal Nuchae

• Thick tough skin leathery waxy exhaggeration of
  normal skin markings
• Pre-ca and Ca

113
Compound nevus of spitz

• Children mistaken histologically w/ malignant
  melanoma
• Spitz nevus spindle-shaped and plump epithelioid
  cells w/ irregularities

114
Dysplastic nevi

• Multiple members of the family may be affected

115
Post op fever

• Look to water, wound, walk, wind

116
Erythema toxicum neonatorum

• 1st 3 days of life, resolves 2 weeks
• Firm yellow papule, irregular red base, no
  therapy needed
• Eosinophils present

117
Mal perforans ulcer

• Pts. w/ diabets or leprosy, distal extremites

118
Eczama herpeticum

• Multiple crops of vesicles over much of the body

119
Rhus dermatitis

• Linear eczematious streaks

120
Syphilis

• Secondary syphilis coin- shaped lesion
• Annular, concentric, arcuate coppy penny lesions
  on palms/soles/head/neck
• Dx FTA Antibodies

121
Kerion

• Kerion boggy tender inflamed purulent lesion on
  scalp, assoc. w/ posterior cervical adenopathy
• Alopecia with pustules
• Scarring perm hair loss
• (-) KOH
• Tx griseofulvin, itraconzole, fluconazole

122
Langerhans cell histiocytosis

• Seborrheic-like rash w/ petechial component

123
Condyloma acuminatum

• Papillomatous epidermal hyperplasia w/
  cytoplasmic vacuolation of superficial
  keratinocytes

124
CREST syndrome

• sclerodactyly

125
Fibroepithelial polyp

• Firobvascular core covered by benign squamous
  epithelium

126
Porphyria cutanea tarda

• Photosensitivity lease to vesicles and or bullae
  may scar
• MC porphyria
• Rfs Alcohol
• Tx phlebotomy (decrease iron stores)