D2 Flashcards
Clinical manifestation of keratoacanthoma?
Rapidly growing nodule with ulceration and keratin plug
Often show spontaneous regression and resolution
Common in fair skin individual
Commonly involve UV exposure and trauma site
Clinical significance?
may resemble or progress to SSC
managment?
Excisional biopsy with complete mass removal
SCC-Ca risk?
UV light
Chronic skin ulcer
Scared/inflamed skin
If occur secondary to burn wound called Marjolein ulcer
radiotherapy and osteomyelitis site are also risk
visual assessment of a pigmented lesion for melanoma?
AbCDE(>=1-2 from below) Asymmetry Border irregularity Color variation Diameter > 6 mm Evolving appearance over time
other criteria(7 point checklist and Ugley duckling sign)?
7PC
>=1 major and >=3 minor criteria
MjC: Change in shape, size, or color
MiC:>7 mm size, local inflammation, crusting/bleeding, and sensory symptom
UDS
One lesion significantly different from other
Most important prognostic factor in melanoma?
Breslow depth(Distance from granular layer to the tumor depth point)
Nodular malignant melanoma caracterstich?
Grow vertically
nodular lesion on a sun-exposed area
Deeply rpigmented,asymmetric & uniform color
ABCD criteria are not good for assessment
suspect in case of .>1 from the following (Ugley duckling sign, elevation from around tissue, firm palpation, and continuous growth)
Basal cell carcinoma risk factor?
Sun/Uv light
fair/light skin
Ionizing radiation
Arsenic poisoning
CM?
Slowly growing Locally invasive Rare metastasis Pink/flesh-colored Pearly papule Translucent Central Telagectasis
Diagnosis?
Narrow margin 2-3 mm excisional biopsy
In the cosmetic area Mohs micrographic surgery
Sample taking in melanoma?
Excisional biopsy
2-3 mm from normal tissue
Full-thickness
But in the face and another important area, an incisional biopsy can considerd
Risk of Hidradinitis superlativa?
Smoking Obesity DM Family history Mechanical stress
pathogenesis of Hidradenitis suppurativa?
Chronic inflammation of pilosebaceous unit-disable keratinocyte shedding from follicular epithilium
CM?
Involve intertriginous /hair area
Solitary, Inflamed, Painful nodule
Chronic relapsing and remitting course
Can become purulent and drain serosangious fluid
Complication?
Scaring
Sinus
Comedone
Risk factor for pressure ulcers other than immobilization?
Malnutrition
Dementia
Decrease skin perfusion
Decrease sensation
Indication for imaging in diabetic foot ulcers for osteomyelitis suspicion?
Deep wound > 14-day stay >2 cm increase CRP/ESR associated adjacent ST involvement
Burn wound infection sign?
Sign of sepsis Progression of wound stage Loss of graft tissue Confusion Decrease urine output Thrombocytopenia
The pattern of infection etiology?
Usually multi bacterial
<5 days: G+Ve–S.Aureus
>5 days: G-Ve –Pseudomonas
What to do?
Quantitative wound culture
Biopsy(To determine depth)
managment?
Broad-spectrum(carpapenem)+
Vancomycin(MRSA)
Pseudomonas should be covered(Aminoglycoside)
wound care and debridement
more common in?
wound >20 %
CM of pyoderma gangrenusum?
Begin with papule and pustule Rapidly progressive Painful ulcer purulent base Vioulacious border Pathergy(precipitation at site of trauma)
Epidemiology of PG?
Common in age 40-60 and in women
Associated with: IBD.Other inflammatory Diseases (like RA) and malignancy
Diagnosis?
Is a diagnosis of exclusion
Biopsy: Neutrophilic infiltration
Management?
Topical/systemic corticosteroid
Surgical debridement should be avoided(pathergy)
CM of squamous carsinoma of skine?
Scaly nodule/plaque
+-hyperkeratosis/ulceration
Nurologic sign(if PN involvment)
SCC in situ:Red,slowley growing patch/plaque.
Involve below and lower Lip(At vermilion border)
Diagnosis?
Dysplastic/anaplastic keratinocyte with keratin pilare
Adverse prognosis sign?
Large size
Deep involvemnt
Regional LN involvment
Basal cell carcinoma fetcher in the biopsy?
Spindele cell surounded by pallaseding basal cell
Which skin cancer have ealy nural invasion?
SCC
Whay SCC have scaley lesion which blleed and ulcerate with peeling?
Due to high keratinization
Epidermal inclusion cyst pathogenesis?
Due to epidemis is loged ito dermis due to trauma, comedons or denovo
Form mass filled with keratin and lipid with surounded by Squamous cell.
CM(Mass caracter)?
Dome shaped freley moving firm nodule/cyst central punctum affect fece,neck and thrunk
Prognosis ?
Usually reocur
But can raptured and form chessy dischrge
Inflamed and involve surounding tissue
managment?
Observation
Drain if inflamed and form cyst
Dermatofibroma CM?
Firm Hyperpigmented Usually involve LE Fibrous componenet Central dimpling
cause of angiosarcoma after brast ca treatment?
Radiation
Lymphedema due to LN disection
Lead to internal lining of LV/BV proliferation
Lesion caracter?
4-8 year after treatment
echimotic
or purpuritic
papular lesion on breast,axilla and UE skin
Prognosis?
More agresive than primary angiosarcoma
Surgical resection is curative
Melanoma riisk factor?
>=2 familiy history Previous history Fair skin prior atypical nevi numerous>100 nevi sever burn history
Pressure ulcer managment?
Superficial:Moist dressing
Deep:Complex dressing and debridement
superficial BCC feucher?
redish pach,irritated area which can bleed
erythema multiformis pathogenesis?
T cell mediated rxn caused by Infection like HSV,M.Pnumonia Drug like sulfonamide Malignancy Collagen vascular disease
lesion caracter?
Involve all area exept genitalia Papular central dusky ring of pale lesion pheripherial erythema Involve mucosa if sever
managment?
resolve by itself Symptomatic therapy(topical CS or antihistamin)
Porphyria cutanea tarda CM?
affect sun exposed area bullea blister scaring and calcification Hypo/Hyperpigmentation Associated abdominal pai and nurophychiatric menifestation
Risk factor?
HIV HCV Exesive alcohol Estrogen Smoking
Diagnostic testing?
Elevated urine/plasma porphyrine
Elevated TA
Iron overload
Pathogenesis?
Urophyriphirogen decarboxylase deficiency—phyriphirogen accumulate iin skine–photosensetivity rxn
managment?
Phelebotomy
hydroxychloroquine
HCV Tx
Skine disease associated with HIV?
Recurent herpes zoster
Sudden onset sever psoriasis
Dissiminated molluscum contagiousum
Psoriasis CM?
involve extensor surface,scalp an sacrum plaque erythematous scaly autipitiz sign
Extra skine menifestation?
Psoriatic artheritis Naile change(pitting) Eye inflamation(conjectivitis and uvietus)
Pricipitating factor?
Trauma(kohebner phenomina)
withdrawal of GC
drug(antimaleria,endometacine & propranolol)
Infection(HIV,streeptococal pharengitis)
CM of vitiligo?
Hypopigmented
Pach
afect Acral, extensor surface and face
Clinical course?
In majority progress
10-20 repigmentation
associated autoimmune disease(MCC: Hashimoto and graves)
Treatment?
Minor: topical GC
Major: Oral GC/Topical calcineurin inhibitor and PUVA
Pathogenesis?
Autoimmune melanocyte destruction
Tinea cruris and candidia interigo D/C in lesion?
CI: Moist and macerated
TC: Dry and scaly similar to Tinea corporis
TC CM?
spares scrotum
caused by trichophyton rubrum
moisture and sweating increase the risk
Managment?
Mild:Topical azole
Resistant: oral azoles
keep perineum clean and dry
Treat another site Tinea infection
nummular eczema CM?
Circular scaly fissure pruritic intermittent exudation(yellowish discharge) Mostly affect extremity
pathogenesis?
Dry skin(poor lipid content)–Chronic inflammation
Risk factor for dermatophyte infection?
Environmental factor
Patient factor
Environmental factor?
Warm, Humid environment
Direct contact with infected fomite, person, and public shower
autoinoculation(from another site tinea infection)
IC(HIV, DM, and GC therapy)
Common drug associated with photosensitivity?
AB:Tetracycline(doxycycline)
APS:Chlopromazine,prochlopromazine
Diuretics:Furosamide and HCT
other:amidadrone,prometazine and piroxicam
Pathogenesis?
Drug metabolite reacts with UV—ROS–damage DNA and cell membrane
lesion type?
Similar to sunburn(direct DNA damage) but more painful and redder.
what about photoallergic rxn?
Due to hypersensitivity RXn to systemic or topical(sunscreen) medication
Eczematous lesion
Liches planus clinical finding?
5P papular/plaque Pruritic purple/pink polygonal lacy, White network line(Wickham stria)--mucosa flexural area(knee, wrist)
disease-associated?
HCV
Thiazide and ACE
natural history?
Chronic
Associated with trauma site(Kobbner phenomena)
resolve within 2 year
treatment?
Mild: Topical CS
Disseminated: systemic GC /phototherapy
