Dermatology Notes

1. Angioedema:

ACEI Bradykinin
Days weeks but can occur at anytime
Management:
o Secure airway
o Subcutaneous epinephrine (if vasomotor instability).
o Emergent tracheostomy (if no response to Epinephrine)
2. Allergic contact dermatitis:

Type IV HSR (delayed).

Initial sensitization required (lymphocyte)
Intensely pruritic rash at area of contact
Management:
o Avoidance of exposure
o Calamine lotion
o Topical antihistamine
o Topical steroids
Culprits:
o Poison ivy (linear)
o Nickel (jewelry)
o Formaldehyde (clothing & nail polish)
o Fragrances
o Preservatives
o Rubber
o Chemicals in shoes

3. Seborrheic dermatitis:

Presentation:

Pruritic erythematous plaques

With fine, loose, yellow, greasy scales
Scalp (dandruf), face (eyebrows, nasolabial folds, external ear canal)
Chest & intertriginous areas

Association:

Parkinson disease
HIV

Management:

Pityrosporum ovale (etiology)

Topical antifungals

4. Molluscum contagiosum:

Multiple dome-shaped lesions

 With central umbilication
Conjunctivitis may occur
Poxvirus
Commonly seen in immunodeficiency (AIDs)

5. Erythema multiforme:

No peripheral scaly
Recent Herpes simplex infection
Cell-mediated inflammatory disorder
Biopsy = Perivascular lymphocytic infiltrate & epidermal necrosis

6. Tinea Corporis:

Ring-shaped with central clearing

With scaly borders (no scaling in erythema multiforme)
Prominent itching
Trichophyton rumbrum
Dx microscopic exam using KOH

7. Tinea versicolor:

Pathogenesis:

Malassezia Globosa or M. Furfur (Non-dermatophytes)

Exposure to hot & humid weather

Clinical presentation:

Hypopigmented or hyperpigmented
Fine scale
Pruritis
Location:
o Children face
o Adults trunk & upper extremity

Diagnosis:
o KOH Hyphae & yeast cells.
o Spaghetti & meatballs pattern

Treatment:

o Topical ketoconazole or Terbinafine

o Selenium Sulfide

8. Pityriasis Rosea:

Oval scaly plaques

Follow cleavage lines of trunk
Herald patch initial lesion
 9. Lentigo:

Round oval macule

With even pigmentation
Only seen in older individuals
Result of intraepidermal melanocytes hyperplasia

10. Dermatitis Herpatiformis:

Subepidermal microabscesses (blisters)

IgA deposits (anti-epidermal TG)
At the tip of dermal papilla

Melanoma RF:

Family history ( 2 relatives)

Numerous nevi (> 100)
Atypical/dysplastic nevi
Fair skin & Hx of severe burn

11. Basal Cell Carcinoma:

Introduction:
MCC of skin cancer (75%)
Fair skinned individuals
Spread:
Spread via invasion of nearby structures
Distant metastasis is rare

Forms:

Ulcerated pearly nodules

With a rolled border
On sun-exposed skin
Possible features include:

o Pearly translucent nodule (pink, red, or white)

o Elevated or rolled border with central ulceration
o Reddish patch or irritated area (superficial BCC)
Management:

Face or delicate areas = Mohs Surgery

Body or trunk:
o Nodular BCC standard surgical excision (with 5 mm margin)
o Low risk lesions electrodissection & curettage (ED & C)
Tinea versicolor is the only tinea infection that is not caused by dermatophytes.

Note:

Cutaneous candidiasis presents as erythematous vesiculopapular rash in warm moist areas

(e.g., skin folds). It is often associated with recent antibiotic, uncontrolled diabetes, or
immunocompromised state.

HPV

HIV Screening should be offered to patients with new diagnosis of HPV.

The condition is self limited. If specific treatment desired, options include:

1. Trichloroacetic acid or podophyllin

2. Immune therapy (imiquimod)
3. Surgery (Cryosurgery, excision, laser)

12. Squamous cell carcinoma:

Etiology:

Much less common than BCC

Arises from precursor lesion (Actinic keratosis)
Faster growing than BCC

13. Keratoacanthoma:

Etiology:
Generally benign
Low-grade tumor (benign)
Resemble SCC
o Sometimes classified as variant of SCC
o Malignant transformation is rare (case reports)
Lesion:

Rapidly growing
Volcano like nodule
With central keratotic plug

Treatment:
Treated as well-diferentiated SCC
May regress spontaneously though.

14. Seborrheic Keratosis:

 Brown plaques or nodules
With greasy surface
Stuck on appearance
Not premalignant
Multiple SK may indicate occult malignancy (Leser-Trelat sign)

15. Vitiligo:

Pathophysiology:

Autoimmune antibodies
Regional destruction of melanocytes
Often associated with other autoimmune conditions:
o Primary adrenal insufficiency
o Hashimoto thyroiditis
o Alopecia Areata
o Rheumatoid arthritis
o Sjogren

Clinical Manifestations
Depigmented macules (Face commonly affected)
Lesions can be:
o Symmetrical
o Dermatomal
o Unilateral
Clinical Course:

Most cases progress gradually

Regimentation is spontaneous in 20%
Increased incidence of other autoimmune conditions:

o Lupus
o Thyroid disease
o Perinicious anemia
o Addison disease

Vitilligo Tinea versicolor

Retain partial
Complete depigmentation
pigmentation
Depigmented macules Hypopigmented macules
 Face & distal extremities Chest & upper back

Autoimmune disorders HIV

16. Melanoma:

Suspected melanoma:

Excisional biopsy -