Common skin lesions Flashcards

Question

milium tx

Answer 1

no tx incision and expression of contents electrodessication topical retinoid therapy

Answer 2

I - always burns, never tans II - always burns, little tan III - slight burn, slow tan IV (pale brown) - slight burn, faster tan V - (brown) - rarely burns, dark tan VI (dark brown or black) - never burns, dark tan

Answer 3

button-like, firm dermal papule or nodule, skin-coloured to red-brown * majority are asymptomatic but may be pruritic and/or tender * site: legs > arms > trunk * dimple sign (Fitzpatrick’s sign): lateral compression causes dimpling of the lesion

Answer 4

benign tumour due to fibroblast proliferation in the dermis

Answer 5

* unknown; may be associated with history of minor trauma (e.g. shaving or insect bites) * eruptive dermatofibroma can be associated with SLE

Answer 6

adults F>M

Answer 7

• dermatofibrosarcoma protuberans malignant melanoma Kaposi’s sarcoma blue nevus

Answer 8

biopsy if diagnosis uncertain

Answer 9

no tx required, excision if bothersome

Answer 10

* small (1-10 mm), soft, skin-coloured or darker pedunculated papule, often polypoid * sites: eyelids, neck, axillae, inframammary, and groin

Answer 11

benign outgrowth of skin

Answer 12

• middle-aged and elderly, F>M, obese, can increase in size and number during pregnancy

Answer 13

• pedunculated seborrheic keratosis compound or dermal melanocytic nevus neurofibroma fibroepithelioma of Pinkus (rare variant of BCC)

Answer 14

excision electrodessication cryosurgery

Answer 15

acrochordones fibroepithelial polyps

Answer 16

known as ‘wisdom spots,’ ‘age spots,’ or ‘barnacles of life’ * well-demarcated waxy papule/plaque with classic “stuck on” appearance * rarely pruritic * over time lesions appear more warty, greasy and pigmented * sites: face, trunk, upper extremities (may occur at any site except palms or soles)

Answer 17

• very common benign epithelial tumour due to proliferation of keratinocytes and melanocytes

Answer 18

* unusual <30 yr old * M>F * autosomal dominant inheritance * Leser-Trelat sudden appearance of SK that can be associated with malignancy, commonly gastric adenocarcinomas

Answer 19

• malignant melanoma (lentigo maligna, nodular melanoma) melanocytic nevi pigmented BCC solar lentigo spreading pigmented AK

Answer 20

biopsy if unsure

Answer 21

none req, cosmetic only cryotherapy, electrodessication, excision

Answer 22

* firm papule with a central, translucent, cone-shaped, hard keratin core * painful with direct pressure * sites: most commonly on dorsolateral fifth toe and dorsal aspects of other toes

Answer 23

• localized hyperkeratosis induced by pressure on hands and feet

Answer 24

• F>M, can be caused by chronic microtrauma

Answer 25

callus plantar wart

Answer 26

* relieve pressure with padding or alternate footwear, orthotics * paring, topical salicylic acid

Answer 27

* Corns have a whitish yellow central translucent keratinous core; painful with direct pressure; interruption of dermatoglyphics * Warts bleed with paring and have a black speckled central appearance due to thrombosed capillaries; plantar warts destroy dermatoglyphics (epidermal ridges) * Calluses have layers of yellowish keratin revealed with paring; there are no thrombosed capillaries or interruption of epidermal ridges

Answer 28

* firm, shiny, skin-coloured or red-bluish papules/nodules that most often arise from cutaneous injury (e.g. piercing, surgical scar, acne), but may appear spontaneously * extends beyond the margins of the original injury, and may continue to expand in size for years with claw-like extensions * can be pruritic and painful * sites: earlobes, shoulders, sternum, scapular area, angle of mandible

Answer 29

• excessive deposition of randomly organized collagen fibres following trauma to skin

Answer 30

* most common in black patients, followed by those of Asian descent (predilection for darker skin) * M=F, all age groups

Answer 31

* intralesional corticosteroid injections | * silicone compression

Answer 32

keloids extend beyond margins of original injury with claw-like extensions hypertrophic scars are confined to original margins of injury

Answer 33

sharply demarcated pigmented papule or plaque with regular borders ± coarse hairs • classified by size: small (<1.5 cm), medium M1: 1.5-10 cm, M2: >10-20 cm), large (L1: >20-30 cm, L2 >30-40 cm), giant (G1: >40-60 cm, G2: >60 cm) • may be surrounded by smaller satellite nevi

Answer 34

• nevomelanocytes in epidermis (clusters) and dermis (strands)

Answer 35

* present at birth or develops in early infancy to childhood * malignant transformation is rare (1-5%) and more correlated with size of the lesion * neurocutaneous melanosis can occur in giant CNMN (melanocytes in the central nervous system)

Answer 36

* take a baseline photo and observe lesion for change in shape, colour, or size out of proportion of growth * surgical excision if suspicious, due to increased risk of melanoma * MRI if suspicious for neurological involvement

Answer 37

* Purpura (e.g. solar, ASA, anti-coagulants, steroids, hemosiderin stain) * Post-inflammatory * Melasma * Melanoma * Fixed drug eruption

Answer 38

Flat light brown lesions with smooth or jagged borders

Answer 39

Areas of increased melanogenesis

Answer 40

6 or more is suggestive of neurofibromatosis type I Also associated with McCune Albright syndrome

Answer 41

Flat congenital melanocytic nevus, speckled lentiginous nevus

Answer 42

enlarge in proportion to the child No effective treatment

Answer 43

Brown pigmented macular background (caféau-lait macule-like) with dark macular or papular speckles

Answer 44

Increased melanocyte concentration

Answer 45

Risk of melanoma similar to that of a CNMN of the same size

Answer 46

Café-au-lait macule, agminated lentigines, Becker’s nevus

Answer 47

usually the light macular background is present at birth and speckles develop over time. Management is similar to that of CNMNs

Answer 48

Congenital greyblue solitary or grouped macules commonly on lumbosacral area

Answer 49

Ectopic melanocytes in dermis

Answer 50

99% occurs in Asian and Indigenous infants

Answer 51

Ecchymosis

Answer 52

usually fades, may persist

Answer 53

often a typical appearing nevus surrounded by a ring of depigmentation; not rare in children; uncommonly associated with vitiligo; no treatment required unless irregular colour or borders

Answer 54

round to oval macule/papule with homogenous blue to blue-black colour; often appears in childhood and late adolescence; no treatment required unless atypical features are noted

Answer 55

* common mole: well circumscribed, round, uniformly pigmented macules/papules <1.5 cm * average number of moles per person: 18-40 * 3 stages of evolution: junctional NMN, compound NMN, and dermal NMN

Answer 56

* new or changing pigmented lesions should be evaluated for aypical features which could indicate a melanoma * excisiona biopsy should be considered if the lesion demonstrates asymmetry, varied colours, irregular borders, pruritus or persistent bleeding

Answer 57

childhoood, majority progress to compound Flat, regularly bordered, uniformly tan-dark brown, sharply demarcated macul Melanocytes at dermal-epidermal junction above basement membrane

Answer 58

Any age Domed, regularly bordered, smooth, round, tan-dark brown papule Face, trunk, extremities, scalp NOT found on palms or soles Melanocytes at dermal-epidermal junction; migration into dermis

Answer 59

Adults Soft, dome-shaped, skin-coloured to tan/brown papules or nodules Sites: face, neck Melanocytes exclusively in dermis

Answer 60

Variegated macule/ papule with irregular distinct melanocytes in the basal layer Risk factors: family history

Answer 61

Hyperplasia and proliferation of melanocytes extending beyond dermal compartment of the nevus Often with region of adjacent nests

Answer 62

>5 atypical nevi increases risk for melanoma Numerous dysplastic nevi may be part of familial atypical mole and melanoma syndrome

Answer 63

Follow with baseline photographs for changes Excisional biopsy if lesion changing or highly atypica

Answer 64

Small (<5 mm) welldemarcated light brown macules Sites: sun-exposed skin

Answer 65

Increased melanin within basal layer keratinocytes secondary to sun exposure

Answer 66

Skin phototypes I-II most commonly

Answer 67

Junctional nevi Juvenile lentigines

Answer 68

Multiply and darken with sun exposure, fade in winter No treatment required Sunscreen and sun avoidance may prevent the appearance of new freckles

Answer 69

Well-demarcated brown/black macules Sites: sun-exposed skin

Answer 70

Benign melanocytic proliferation in dermal- epidermal junction due to chronic sun exposure

Answer 71

Most common in Caucasians >40 yr Skin phototypes I-III most commonly

Answer 72

Lentigo maligna, seborrheic keratosis, pigmented actinic keratosis

Answer 73

Laser therapy, shave excisions, cryotherapy

Answer 74

Hairy, light brown macule/patch with a papular verrucous surface Sites: trunk and shoulders onset in teen years

Answer 75

Pigmented hamartoma with increased melanin in basal cells

Answer 76

M>F Often becomes noticeable at puberty

Answer 77

Hairy congenital melanocytic nevus

Answer 78

hair growth follows onset of pigmentation Cosmetic management (usually too large to remove

Answer 79

Dark, usually symmetrical, skin discolouration on sunexposed areas of face (forehead, upper lip, cheeks, chin)

Answer 80

Increase in number and activity of melanocytes Associated with estrogen and progesterone

Answer 81

F>M Common in pregnancy and women taking OCP or HRT Risk factors: sun exposure, dark skin tone Can occur with mild endocrine disturbances, antiepileptic medications and other photosensitizing drug

Answer 82

Post-inflammatory hyperpigmentation

Answer 83

often fades over several months after stopping hormone treatment or delivering baby Treatment: hydroquinone, azelaic acid, retinoic acid, topical steroid, combination creams, destructive modalities (chemical peels, laser treatment), camouflage make-up, sunscreen, sun avoidance

Answer 84

Hot, firm red to blue plaques or tumours

Answer 85

benign vascular proliferation of endothelial lining

Answer 86

Appears shortly after birth; rarely may be congenital

Answer 87

Appears shortly after birth, increases in size over months, then regresses 50% of lesions resolve spontaneously by 5 yr

Answer 88

10% require treatment due to functional impairment (visual compromise, airway obstruction, high output cardiac failure) or cosmesis Consider treatment if not gone by school age; topical timolol, propranolol; systemic corticosteroids; laser treatment; surgery

Answer 89

Central red arteriole with slender branches, blanchable spider angioma will blanch when the tip of a paperclip is applied to the centre of the lesion

Answer 90

Can be associated with hyperestrogenic state (e.g. in hepatocellular disease, pregnancy, OCP) but often is not

Answer 91

Increase in number over tim

Answer 92

reassurance electrodessication or laser if patient wishes

Answer 93

Bright red to deep maroon, domeshaped vascular papules, 1-5 mm Site: trunk Less friable compared to pyogenic granulomas

Answer 94

Benign vascular neoplasm

Answer 95

>30 years old

Answer 96

Lesions do not fade in time Lesions bleed infrequently

Answer 97

usually no tx | Laser or elect ocautery for small lesions Excision of large lesions if necessary

Answer 98

Bright red, dome-shaped sessile or pedunculated friable nodule Sites: fingers, lips, mouth, trunk, toes DDx: glomus tumour, nodular MM, SCC, nodular BCC

Answer 99

Rapidly developing hemangioma Proliferation of capillaries with erosion of epidermis and neutrophilia

Answer 100

Lesion grows rapidly over weeks to months, then stabilizes Lesion may persist indefinitely if untreated

Answer 101

surgical excision with histologic examination Electrocautery; laser; cryotherapy

Answer 102

benign blue or violaceous papular lesion occurring on the face, lips, and ears due to dilation of a venule. Distinguished from malignant pigmented lesions through diascopy, as compression blanches the lesion

Answer 103

Red to blue macule present at birth that follows a dermatomal distribution, rarely crosses midline Most common site: nape of neck Never spontaneously regresses but grows in proportion to the child

Answer 104

congenital vascular malformation of dermal capillaries; rarely associated with Sturge-Weber syndrome (V1, V2 distribution)

Answer 105

laser or make up

Answer 106

Pink-red irregular patches Midline macule on glabella known as “Angel Kiss”; on nuchal region known as “Stork Bites Present in 1/3 of newborns Majority regress spontaneously

Answer 107

Congenital dilation of dermal capillaries

Answer 108

* single or multiple non-tender subcutaneous tumours that are soft and mobile * occurs most frequently on the trunk, and extremities but can be anywhere on the body

Answer 109

• adipocytes enclosed in a fibrous capsule

Answer 110

often solitary or few in number, if multiple can be associated with rare syndromes

Answer 111

angiolipoma, liposarcoma

Answer 112

biopsy if atypical features (painful, rapid growth, firm)

Answer 113

reassurance excision or liposuction only if desired for cosmetic purposes

Answer 114

a common inflammatory pilosebaceous disease categorized with respect to severity ■ Type I: comedonal, sparse, no scarring ■ Type II: comedonal, papular, moderate ± little scarring ■ Type III: comedonal, papular, and pustular, with scarring ■ Type IV: nodulocystic acne, risk of severe scarring • sites of predilection: face, neck, upper chest, and back

Answer 115

* hyperkeratinization at the follicular ostia (opening) blocks the secretion of sebum leading to the formation of microcomedones * androgens promote excess sebum production * Propionibacterium acnes metabolize sebum to free fatty acids and produces pro-inflammatory mediators

Answer 116

* age of onset in puberty (10-17 yr in females, 14 19 yr in males) * in prepubertal children consider underlying hormonal abnormality (e.g. late onset congenital adrenal hyperplasia) * incidence decreases in adulthood * genetic predisposition: majority of individuals with cystic acne have parent(s) with history of severe acne

Answer 117

• folliculitis keratosis pilaris (upper arms, face, thighs) perioral dermatitis rosacea

Answer 118

* Tretinoin creams * Glycolic acid * Chemical peels for superficial scars * Injectable fillers (collagen, hyaluronic acid) for pitted scars * Fraxel laser * CO2 laser resurfacing

Answer 119

Blackheads (comedones) are black because of oxidized fatty acids, not dirt

Answer 120

Acne is not caused by poor hygiene; on the contrary, excessive washing of face can be an aggravator

Answer 121

Antibiotics are used in inflammatory skin conditions since they also have antiinflammatory properties (e.g. macrolides in acne). Topical antibiotics may also be used to treat secondary bacterial superinfections (e.g. impetigo)

Answer 122

* Systemic medications: lithium, phenytoin, steroids, halogens, androgens, iodides, bromides, danazol * Topical agents: steroids, tars, ointments, oily cosmetics * Mechanical pressure or occlusion, such as leaning face on hands * Emotional stress

Answer 123

Mild acne - topical therapies OTC Benzoyl peroxide (BPO) - solugel, benzac, desquam, fostex Salicylic acid - Akurza Cream, dermalzone - prescription topical therapies Antimicrobials - Clindamycin (Dalacin T), Erythromycin Retinoids - Vit A Acid (tretinoin, Stieva-A, Retin A) Adapalene (Differin) Combination products - Clindoxyl (Clindamycin and BPO), Benzaclin (Clindamycin and BPO), Tactuo (Adapalene and bpo), biacna (clindamycin and tretinoin), benzamycine (bpo and erythromycin) A combination of topical retinoids and topical erythromycin or clindamycin is more effective than either agent used alone

Answer 124

Intralesional corticosteroid injections are effective in the treatment of individual acne nodules

Answer 125

Used when patients cannot tolerate a topical retinoid due to skin irritation

Answer 126

high rate of resistance when used as monotherapy

Answer 127

Backbone of topical acne therapy | All regimens should include a retinoid unless patient cannot tolerate

Answer 128

greater adherence and efficacy by combining different MOAs to increase efficacy and maximize tolerability

Answer 129

greater adherence and efficacy by combining different MOAs to increase efficacy and maximize tolerability

Answer 130

tetracycline/minocycline/doxycycline (sumycin/minocin/vibramycin) Cyproterone acetate-ethinyl estradiol (Diane 35) Spironolactone (Aldactone)

Answer 131

Use caution with regard to drug interactions: do not use with isotretinoin Sun sensitivity Antibiotics require 3 mo of use before assessing efficacy

Answer 132

After 35 yr of age, estrogen/progesterone should only be considered in exceptional circumstances arefully weighing the risk/benefit ratio with physician guidance

Answer 133

May cause hyperkalemia at higher doses Black box warning for breast cancer

Answer 134

* Use of Isotretinoin during pregnancy is associated with spontaneous abortion and major birth defects such as facial dysmorphism and cognitive impairment * Pregnancy should be ruled out before starting isotretinoin * Patients should use 2 forms of contraception while on isotretinoin

Answer 135

isotretinoin (accutane, clarus, epuris)

Answer 136

Most adverse effects are temporary and will resolve when the drug is discontinued Baseline lipid profile (risk of hypertriglyceridemia), LFTs and β-hCG before treatment May transiently exacerbate acne before patient sees improvement Refractory cases may require multiple courses of isotretinoin

Answer 137

discrete erythematous micropapules that often become confluent, forming inflammatory plaques on perioral, perinasal, and periorbital skin commonly symmetrical, rim of sparing around vermillion border of lips

Answer 138

* 15-40 yr old, occasionally in younger children | * predominantly females

Answer 139

• contact dermatitis, rosacea, acne vulgaris

Answer 140

* avoid all topical steroids * topical: metronidazole 0.75% gel or 0.75-1% cream to affected area bid * systemic: tetracycline family antibiotic (utilized for its anti-inflammatory properties) * occasional use of a non-steroidal anti-inflammatory cream (i.e. tacrolimus or pimecrolimus)

Answer 141

1. The evidence on whether isotretinoin causes depression and suicide is inconsistent; however, numerous controlled studies have shown an improvement in anxiety and depression scores in those taking isotretinoin. 2. There is no association between IBD and isotretinoin use. Only one study showed a significantly increased risk of UC. When considering using isotretinoin in a patient with IBD or with a strong family history, consider involving a gastroenterologist.

Answer 142

* dome-shaped inflammatory papules ± pustules * flushing, non-transient erythema, and telangiectasia * distribution: typically on central face including forehead, nose, cheeks, and chin; rarely on scalp, neck, and upper body * characterized by remissions and exacerbations * exacerbating factors: heat, cold, wind, sun, stress, drinking hot liquids, alcohol, caffeine, spices * all forms of rosacea can progress from mild to moderate to severe * rarely in longstanding rosacea, signs of thickening, induration and lymphedema in the skin can develop * phyma: a distinct swelling caused by lymphedema and hypertrophy of subcutaneous tissue, particularly affecting the nose (rhinophyma) * ocular manifestations: blepharoconjunctivitis, keratitis, iritis

Answer 143

all skin types, highest prevalence in fair-skinned people 30-50 year old; F>M

Answer 144

acne vulgaris, seborrheic dermatitis, perioral dermatitis, contact dermatitis

Answer 145

* trigger avoidance and daily sunscreen use for long-term management * avoid topical corticosteroids * telangiectasia: treated by physical ablation; electrical hyfrecators, vascular lasers, and intense pulsed light therapies * phymas: treated by physical ablation or removal; paring, electrosurgery, cryotherapy, laser therapy (CO2, argon, Nd:YAG) ``` 1st line - Oral tetracyclines Topical metronidazole Oral erythromycin (250-500 mg PO bid) Topical azelaic acid Topical Ivermectin ``` ``` 2nd line Topical clindamycin Topical erythromycin 2% solution Topical benzoyl peroxide Oral metronidazole ``` 3rd line oral retinoids

Answer 146

Rosacea can be differentiated from acne by the absence of comedones, a predilection for the central face and symptoms of flushing

Answer 147

``` Presence of one or more of the following primary features: • Flushing (tansient erythema) • Nontransient erythema • Papules and pustules • Telangiectasia ``` ``` May include one or more of the following secondary features: • Burning or stinging • Dry appearance • Edema • Phymatous changes • Ocular manifestations • Peripheral location ```

Answer 148

inflammation of the skin

Answer 149

* poorly demarcated erythematous patches or plaques * symptoms include pruritus and pain * acute dermatitis: papules, vesicles * subacute dermatitis: scaling, crusting, excoriations * chronic dermatitis: lichenification, xerosis, fissuring

Answer 150

* diffuse, mild pruritic dermatitis secondary to dry skin * very common in elderly, especially in the winter (i.e. “winter itch”) but starts in the fall * shins predominate, looks like a “dried river bed”

Answer 151

• skin rehydration with moisturizing routine ± corticosteroid creams

Answer 152

* subacute and chronic eczematous reaction associated with prolonged severe pruritus * distribution depends on age * inflammation, lichenification excoriations are secondary to relentless scratchng * atopic palms: hyperlinearity of the palms (associated with ichthyosis vulgaris) * associated with: keratosis pilaris (hyperkeratosis of hair follicles, “chicken skin”), xerosis, occupational hand dryness

Answer 153

* frequently affects infants, children, and young adults * 10-20% of children in developed countries under the age of 5 are affected * associated with personal or family history of atopy (asthma, hay fever), anaphylaxis, eosinophilia * polygenic inheritance: one parent >60% chance for child; two parents >80% chance for child * long-term condition with 1/3 of patients continuing to show signs of AD into adulthood

Answer 154

• a T-cell driven inflammatory process with epidermal barrier dysfunction

Answer 155

* clinical diagnosis | * consider: skin biopsy, patch testing if allergic contact dermatitis is suspected

Answer 156

* goal: reduce signs and symptoms, prevent or reduce recurrences/flares * better outcome (e.g. less flare-ups, modified course of disease) if diagnosis made early Initial assessment -> patient education, daily emollient use -> acute control of flare (topical corticosteroids or topical calcineurin inhibitor) -> maintenance therapy if disease is persistent and/or frequent recurrences (topical corticosteroid or calcineurin inhibitor at earliest sign of flare, long-term maintenance use of calcineurin inhibitors) -> Severe refractory disease - azathioprine - methotrexate - oral cyclosporin - oral steroids, potent topical steroids - phototherapy - psychotherapeutics ``` Adjunctive therapy • avoid triggers of AD - treat bacterial superinfections (topical or oral abx) - antihistamines - psychological interventions ``` • non-pharmacologic therapy ■ moisturizers ◆ apply liberally and reapply at least twice a day with goal of minimizing xerosis ◆ include in treatment of mild to severe disease as well as in maintenance therapy ■ bathing practices ◆ bathe in plain warm water for a short period of time once daily followed by lightly but not completely drying the skin with a towel; immediately apply topical agents or moisturizers after this ◆ use fragrance-free hypoallergenic non-soap cleansers • pharmacologic therapy ■ topical corticosteroids ◆ effective in reducing acute and chronic symptoms as well as prevention of flares ◆ choice of steroid potency depends on age, body site, short vs. long-term use ◆ apply 1 adult fingertip unit (0.5 g) to an area the size of 2 adult palms bid for acute flares ◆ local side effects: skin atrophy, purpura, telangiectasia, striae, hypertrichosis, and acneiform eruption are all very rarely seen ■ topical calcineurin inhibitors ◆ tacrolimus 0.03%, 0.1% (Protopic®) and pimecrolimus 1% (Elidel®) ◆ use as steroid-sparing agents in the long-term ◆ advantages over long-term corticosteroid use: sustained effect in controlling pruritus; no skin atrophy; safe for the face and neck ◆ apply 2x/d for acute flares, and 2-3x/wk to recurrent sites to prevent relapses ◆ local side effects: stinging, burning, allergic contact dermatitis ◆ U.S. black box warning of malignancy risk: rare cases of skin cancer and lymphoma reported; no causal relationship established

Answer 157

• infections ■ treatment of infections ◆ topical mupirocin or fusidic acid (Canada only, not available in US) ◆ oral antibiotics (e.g. cloxacillin, cephalexin) for widespread S. aureus infections

Answer 158

* Irritants (detergents, solvents, clothing, water hardness) * Contact allergens * Environmental aeroallergens (e.g. dust mites) * Inappropriate bathing habits (e.g. long hot showers) * Sweating * Microbes (e.g. S. aureus) * Stress

Answer 159

Scalp Extensor elbow

Answer 160

Neck Flexor elbow Flexor knee

Answer 161

Scalp, neck Hands, feet

Answer 162

cutaneous inflammation caused by an external agent(s)

Answer 163

mechanism of reaction - Toxic injury to skin; non-immune mechanism type of reaction - Erythema, dryness, fine scale, burning Acute: quick reaction, sharp margins (e.g. from acid/alkali exposure) Cumulative insult: slow to appear, poorly defined margins (e.g. from soap), more common frequency - Majority; will occur in anyone given sufficient concentration of irritants distribution - hands most common site examples - soaps, oils, detergents, weak alkali, organic solvents, alcohol management - avoidance of irritants, wet compresses with Burrow's solution, barrier moisturizers, topical/oral steroids

Answer 164

mechanism of reaction - cell mediated delayed (Type IV) hypersensitivity reaction type of reaction - erythema with a papulovesicular eruption, swelling, pruritus frequency - Minority; patient acquires susceptibility to allergen that persists indefinitely distribution - areas exposed examples - many are same as irritants management - Patch testing to determine specific allergen Avoid allergen and its cross-reactants Wet compresses soaked in Burrow’s solution (drying agent) Topical Steroids BID prn Systemic steroids prn if extensive

Answer 165

* “tapioca pudding” papulovesicular dermatitis of hands and feet that coalesce into plaques, followed by panful fissuring * acute stage often very pruritic * secondary infections common * lesions heal with desquamation and may lead to chronic lichenification * sites: palms and soles ± dorsal surfaces of hands and feet

Answer 166

* NOT caused by hyperhidrosis (excessive sweating) | * emotional stress may precipitate flares

Answer 167

* topical: high potency corticosteroid with plastic cling wrap occlusion to increase penetration * intralesional triamcnolone injection • systemic ■ prednisone in severe cases ■ antibiotics for secondary S. aureus infection

Answer 168

* nummular (coin-shaped), pruritic, dry, scaly, erythematous plaques * often associated with atopic and dyshidrotic dermatitis * secondary infection common

Answer 169

• little is known, but it is often accompanied by xerosis, which results from a dysfunction of the epidermal lipid barrier; this in turn can allow permeation of environmental agents, which can induce an allergic or irritant response

Answer 170

* moisturization | * mid to high potency corticosteroid ointment bid

Answer 171

* greasy, erythematous, yellow, scaling, minimally elevated papules and plaques in areas rich in sebaceous glands, can look moist and superficially eroded in flexural regions * infants: “cradle cap” * children: may be generalized with flexural and scalp involvement • adults: diffuse involvement of scalp margin with yellow to white flakes, pruritus and underlying erythema * sites: scalp, eyebrows, eyelashes, beard, glabella, post-auricular, over sternum, trunk, body folds, genitalia

Answer 172

possible etiologic association with Malassezia spp. (yeast)

Answer 173

* common in infants and adolescents * increased incidence and severity in immunocompromised patients * in adults, can cause dandruff (pityriasis sicca)

Answer 174

* face: ketoconazole (Nizoral®) cream daily or bid + mild steroid cream daily or bid * scalp: salicylic acid in olive oil or Derma-Smoothe FS® lotion (peanut oil, mineral oil, fluocinolone acetonide 0.01%) to remove dense scales, 2% ketoconazole shampoo (Nizoral®), ciclopirox (Stieprox®) shampoo, selenium sulfide (e.g Selsun®) or zinc pyrithione (e.g. Head and Shoulders®) shampoo, steroid lotion (e.g. betamethasone valerate 0.1% lotion bid)

Answer 175

* erythematous, scaly, pruritic plaques in lower legs, particularly the medial ankle * brown hemosiderin deposition, woody fibrosis, atrophy blanche, and lipodermatosclerosis in late stages usually bilateral, accompanied by swelling, oozing, crusting, may have accompanying varicosities

Answer 176

* chronic venous insufficiency leads to venous stasis | * surrounding soft tissue inflammation and fibrosis results

Answer 177

* Doppler and colour-coded Duplex sonography if suspicious for DVT * swab for bacterial culture if there is crusting

Answer 178

* compression stockings * rest and elevate legs (above the level of the heart) * moisturizer to treat xerosis * mid-high potency topical corticosteroids to control inflammation

Answer 179

• ulceration (common at medial malleolus) secondary bacterial infections

Answer 180

* well-defined plaque(s) of lichenified skin with increased skin markings ± excoriations * common sites: neck, scalp, lower extremities, urogenital area * often seen in patients with atopy

Answer 181

* skin hyperexcitable to itch, continued rubbing/scratching of skin results * eventually lichenification occurs

Answer 182

* if patient has generalized pruritus, rule out systemic cause: CBC with differential count, transaminases, bilirubin, renal and thyroid function tests, TSH, glucose, SPEP * CXR if lymphoma suspected

Answer 183

• antipruritics (e.g. antihistamines, topical or intralesional glucocorticoids, Unna boot)