Note: the following material is for personal use only see below for
Download 3.95 Mb.
|
- Navigate this page:
- Xanthomas
- Papulosquamous diseases
Erythema Nodosum [dermis]so many causes (see Ddx) / usu. painful / originally described by Mozart’s father / female > male / 20-30s / usually resolves within 3-6 weeks without scarring Vitiligo areas of depigmentation [pic][dermis] / associated with many systemic conditions like autoimmune diseases (pernicious anemia, hypothyroid, sarcoidosis) and tuberculous leprosy Xanthomashyperlipoproteinemia / extensor surfaces of extremities and buttocks / hyperTG usually eruptive / yellow papules with erythematous halo / marker for CAD Pseudoxanthomatus elasticum [pic][pic][dermis] this can be a clinical marker for early atherosclerosis / angioid streaks on fundus Foreign body granuloma [pic] Pediatric Skin Conditions Erythema toxicum neonatorum benign / days-wks / eosinophils Pustular melanosis more in blacks / weeks-months / hyperpigmented Salmon patch 1st wks / face (fade), nuchal/occipital (persist) Milia face, gingival of neonates / spontaneous resolution Urticaria pigmentosa [dermis]
Seborrheic dermatitis (see other) Linear IgA Dermatosis IM staining in basement membrane Treatment: dapsone, sulfapyridine – colchicine is alternative – usually remits before puberty – flares may not require dosage increase Very small, vesicular lesions surround bullous lesion, perioral predilection, IM shows at dermal, epidermal junction Eczematous diseases [dermnet] spongiosis inter-cellular edema / formation of vesicle is exocytosis acanthosis thickened Malphigian layer Acanthosis nigricans [pic][pic][pic][pic] Causes: Idiopathic – healthy, obese adolescents AD infancy/childhood – increases during adolescence / decreases in adulthood Pituitary tumor (Cushing’s, acromegaly), PCOS, obesity, diabetes drugs (steroids, nicotinic acid, DES) Malignant – onset in middle age, progressive (associated with gastric carcinoma, lymphoma, Hodgkin’s, osteogenic sarcoma) [pic] Associations: adenocarcinoma, porphyria cutanea tarda Pathology: symmetrical papillomatous epidermal hyperplasia with hyperpigmentation (really just thicker) Flexural areas most common: axilla, antecubital fossa, neck, skin folds, groin Occasionally: areolae, periumbilical, lips, buccal mucosa / palms, elbows, knees, interphalangeal joints hyperkeratosis thickened stratum corneum lichenified thickened skin from chronic rubbing parakeratosis retained nuclei in stratum corneum Grover’s disease transient acantholytic disease / Rx: topical / doesn’t respond well to systemic therapy Eczema [pic][pic][dermis] usually presents at early age / positive family history of allergies / pruritic Atopic dermatitis – pruritic [pic][dermnet] allergies / familial / IgE (80%) / childhood / pruritic / 90% will outgrow condition / defective cell-mediated immunity / superinfection (S.aureus) [treat familial Staph carriers] Treatment: moisturizing creams / topical corticosteroids Severe cases: Cyclosporine A (Neoral) / Tacrolimus / Ascomycin, Macrolactam (under investigation) / recombinant IFN-gamma / Zafirkulast / antimicrobial agents / phototherapy Seborrheic dermatitis – can be pruritic [pic][pic][pic][pic][pic][pic] common, worse with many neurological diseases / common and severe with AIDS / worse in winter / involvement in areas of prominent sebaceous gland activity / infancy and puberty (can present at any age) / causes dandruff / involvement of Pityrosporum ovale Treatment: antiseborrheic shampoos (including ketoconazole) / mild topical corticosteroids Stasis dermatitis [dermis] lower legs secondary to venous insufficiency / older patients Contact dermatitis – always pruritic [pic] allergic type IV - DTH occurs 2-3 days after exposure Appearance: vesicular, bright red / linear configuration, characteristic of exogenous exposure to antigen or irritant Pathology: spongiosis with intraepidermal vesicle formation Diagnosis: patch test irritation - dry, scaly, less vesicular / scratch test (different) Treatment: baths, wet dressings (Burrow’s/boric acid) Acrodermatitis enteropathica Zinc deficiency associated with malabsorption / long-term TPN / rarely inherited as AR Nummular eczema coin-shaped lesions [dermis] / mistaken for tinea Dishydrotic eczema abnormal sweating, associated with stress Neurodermatitis chronic scratching behavior Asteotic (xerotic) eczema dry skin on extremities / elderly patients with decreased oil on skin Fungi Tinea sp. microsporum, epidermaphyton, trichophyton / pink by PAS / black by GMS / easily visible on KOH prep Candida overgrowth in moist areas (scrotum, unlike true dermatophytes), eczematous or satellite pustules, produces yeast forms and hyphae Malassezia furfur yeast resident makes short hyphae and spores (spaghetti and meatballs) pityriasis versicolor limited to stratum corneum and follicles Mycosis fungoides T-cell lymphoma (not really a fungus at all) / eczematous eruption [dermis] / fungating in later stages / Pautrier microabscesses resemble spongiosis Papulosquamous diseasesPsoriasis (see psoriatic arthritis) [dermis] sharply bordered, often round or plaques with silver scale [pic], (knees [pic], arms [pic], scalp proliferation of keratinocytes / familial / 1% of population / ‘Koebner phenomenon’ (areas of trauma) / ‘auspitz’ sign (blood when you pick at it) / nail problems (onychodystrophy, onycholysis, nail pitting, and subungual keratosis, onychauxis) [pic] / arthritis
rash lasting more than 2 months / confused with pityriasis rosea Lichen planus – pruritic [dermis] papulosquamous (purple, polygonal, pruritic) / flat-topped plaques covered by Wickham’s striae (reticulated scale) [pic] / wrists, mucous membranes / nail deformities (NOT pitting) / bandlike infiltrate of histiocytes and lymphocytes in upper dermis, hyperkeratosis, acanthosis / Treatment: topical steroids, oral antihistamines / rare in children / usually self-resolving within 1-3 years Lichen variagatus [dermis] Lichen simplex chronicus [dermis] areas that are tempting to rub / hyperkeratosis, acanthosis, histiocytes, lymphocytes Treatment: topical steroids / may have underlying cause that is treatable
common, viral origin?, young adults / self-limited within 6 wks / trunk (usually), neck, proximal extremities herald patch followed (1-2 wks) by oval lesions (pink papule or plaque with scales) forming Christmas tree pattern (follows tension lines) rare inverse form involves distal extremities and face Ddx: secondary syphilis (serology), tinea corporis (KOH), drug eruptions Treatment: topical steroids, antihistamines Secondary syphilis (see micro) HA, fever, lymphadenopathy / palms and soles, any form of rash except vesicular / biopsy has variable plasma cells (may not be specific) / RPR, VDRL GI syphilis (endoscopy) Epidermal Tumors [Dermal Tumors / Melanocytic Tumors] Cowden, Muir-Torre (see tumor syndromes) Benign Seborrheic keratosis [dermis] common over 40s / tan to black papules, plaques / areas with numerous sebaceous glands (face, neck, trunk) / a “barnacle” that looks stuck on / sebaceous adenoma [pic] Nevus sebaceous [dermis] yellow linear plaques, elevated, head (hairless area) and neck / sebaceous, apocrine hamartoma / hormone stimulation at puberty causes verrucous growth / surgical excision (can be premalignant lesion for BCC) Keratoacanthoma [dermis] fast growing (10-20 mm in weeks) volcano-like / slow involuting / exposed (sun-damaged), hairy skin / more in whites / surgical excision because they mimic SCC Epidermoid cyst [pic][dermis] epidermis-lined cyst containing hydrated keratin (white pearl) / surgical excision optional Pre-malignant Actinic keratosis – 20% change of becoming malignant [pic][dermis] atypical keratinocytes / sun-exposure in older patients / reddish base (not tan/brown) papules or plaques, poorly defined, scaly texture / sun damage causes solar elastosis (yellowish skin, blueish collagen change histologically), wrinkles, telangiectasias, comedomes, hyperpigmentation Treatment: cryotherapy (few lesions), topical 5FU (many, ill-defined lesions), excision
may lead to SCC of mucosa / surgical excision Bowen’s disease (carcinoma in situ) [dermis] non-sun exposed areas / SCC in situ / several cm’s / Queyrat of penis? / surgical excision Malignant Sebaceous carcinoma [pic][dermis] Basal cell carcinoma (BCC) (good prognosis) [pic][dermis] most common neoplasm of humans / rolled edge, ulcerated center / small blue nuclei (basal cells) peripheral palisading, stromal retraction / almost never metastasize Noduloulcerative telangiectasia / Treatment: < 1 cm cryo, > 1 cm excision, high-risk areas recur (Moh’s microsurgery) Superficial – often confused with dermatitis / Treatment: topical 5-FU, cryo Sclerosing – deep soft tissue invasion / Treatment: Moh’s microsurgery Squamous cell carcinoma (SCC) (good prognosis) [dermis] much less common than BCC (still relatively common) but does metastasizes via lymphatics (esp. in non-sun exposed areas such as oral SCC) / scaling, hyperkeratosis (keratin pearls), ulceration / pink (more cytoplasm, keratin) / sun, tobacco, HPV, immunosuppression, Marjolin’s ulcers [pic] (rare, from burns and osteo and chronic ulcers, long-standing scars) / 35% oral involvement [pic][pic] / regional lymphadenopathy Treatment: excision (or cryo for small) / non-sun induced means more spread 90% cure rate Cutaneous small cell carcinoma ulcerative, erythematous nodule or superficial erosion, can metastasize / epidermal keratinocytes / sun exposed areas like lower lip Ddx: metastatic small cell carcinoma of the lung, were squamous cell carcinoma, basal cell carcinoma, amelanotic melanoma, carcinoid tumor, Merkel cell carcinoma, neuroendocrine carcinoma, malignant fibrous histiocytoma, atypical fibroxanthoma, and dermatofibrosarcoma protuberans.
tumor of neural tissue (multiple cell types) / soft, skin-colored lesions / single or multiple (neurofibromatosis or von Recklinghausen’s) / optional excision (may grow back) / increase in size over time Dermatofibroma [pic][dermis] hard, brownish nodules / anywhere, any age (common in legs) / optional excision / cheloid or keloid [pic] is a form that occurs from excessive healing (common in black earlobes) Download 3.95 Mb. Share with your friends:
|