dermatologia prieto 1 Flashcards by David Macias

clinica de BASOCELULAR

papula - nodulo
bordes regulares
APERLADO
CENTRO ULCERADO
TELANGIECTASIAS

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a que cancer predispone la QUERATOSIS ACTINICA

ESPINOCELULAR

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Clinica de queratosis actinica

lesion eritematosa o del mismo color de piel

- TEXTURA COMO LIJA

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DX MELANOMA

BIOPSIA ESCISIONAL (con margen de 1 - 3 mm de piel sana)

si sale en CARA o GENITALES, se hace BIOPSIA INCISIONAL

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MARCADOR DEL MELANOMA

SENSIBLE = S-100

ESPECIFICO = HMB 45

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FR melanoma

> 65 años

EXPOSICION AL SOL

fototipo Fitzpatrick I - II

NEVO GIGANTE 20 cm

> 100 nevos

> 5 nevos displasicos

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genes mutados en MELANOMA

CDKN2A
CDK4

** EN EL CROMOSOMA 9

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Tipo mas comun de melanoma

1 NODULAR (“zarzamora”)

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caracteristicas de MELANOMA NODULAR

1 EN MEXICO

Agresivo X CRECIMIENTO VERTICAL

afecta espalda y piernas

** NODULO ZARZAMORA

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caracterisitcas de MELANOMA ACRAL LENTIGINOSO

Sx hutchingson

- afecta palmas / plantas

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caracteristicas de MELANOMA “EXTENSION SUPERFICIAL”

Afecta espalda y piernas

* “CRECIMIENTO HORIZONTAL ANTES DE INVADIR”

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tipos de SIGNOS DE HUTCHINSON

melanoma acral lentiginoso
dientes de hutchinson
herpes zoster (vesicula que sale en la nariz)

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casificacion de MELANOMA

A = asimetria de bordes

B = bordes irregulares

C = colores >2

D= diametro >6mm

E = evolucion

F = familiares

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indicaciones de envio a DERMATOLOGICO en 2 SEMANAS

1 punto en la escala ABCDEF

Sx patito feo

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INDICACIONES DE ENVIO A DERMATOLOGICO EN 24 HRS

SANGRADO
AUMENTO RAPIDO DE TAMAÑO
PRURITO

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escala que mide profundidad en mm EN MELANOMA

BRESLOW

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escala que mide profundidad de manera HISTOLOGICA

CLARK

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escala CLARK

1) in situ
2) papilar
3) reticulo papilar
4) reticular
5) TCSC

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TNM en MELANOMA

IB = lesion 1mm ULCERADA

III = GANGLIOS +

IV = METS

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sitios de METS melanoma

1 GANGLIOS

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cancer que metastasisa mas frecuentemente en CORAZON

MELANOMA

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TX METS DE MELANOMA

DACARBAZINA

- TEMOZOLAMIDA

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TX MELANOMA SIN METS

CIRUGIA ESCISIONAL + reseccion de GANGLIO CENTINELA

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patogenia de psoriasis

hiperproliferacion de queratinocitos

GEN ASOCIADO A PSORIASIS

GEN PSOR 1

Farmacos asociados a PSORIASIS

- B BLOQ - BCC - LITIO - ANTIMALARICOS

lesion clasica de psoriasis

HIPERQUERATOSIS con PARAQUERATOSIS

abscesos presentes en psoriasis

ABSCESOS DE MUNRO-SABORAUD (neutrofilos en epidermis)

agente asociado a PSORIASIS GUTTATA

S. PYOGENES | es la mas comun en niños

tx psoriasis segun PASO

<10% = TOPICO >10% = SISTEMICO

TX PSORIASIS TOPICO

#1 CLOBETAZOLA + CALCIPOTRIOL #2 TACROLIMUS #3 ALQUITRAN DE HULLA / UREA / salicilatos

TX PSORIASIS SISTEMICO

#1 CICLOSPORINA / MTX #2 SSL / TACROLIMUS

TX INICIAL ARTRITIS PSORIASICA

#1 AINE

TX FALLA AL TX PSORIASIS

ANTI TNF ALFA o USTEKIMUMAB

mecanismo de accion de USTEKIMUMAB

INHIBIDOR DE IL 12 e IL23

caracteristicas de CARCINOMA BASOCELULAR

#1 tumor cutaneo en MEXICO - >60 años - PAPULA / APERLADA / ULCERACION CENTRAL con TELANGIECTASIAS . crecimeinto lento

DX CARCINOMA BASOCELULAR

- BIOPSIA ESCISIONAL

HISTOPATOLOGIA DE BASOCELULAR

- CELULAS en palizada | - basaloides

dx basocelualr

CIRUGIA DE MOHS

#1 TIPO DE CARCINOMA BASOCELULAR

#1 NODULAR - papula aperlada, color carne, telangiectasias, con ulceracion centrica - AFECTA PARPADO INFERIOR

datos de alto riesgo en BASOCELULAR

#1 >20mm - bordes irregulares - recurrencia

TX BASOCELULAR

#1 CIRUGIA DE MOHS #2 ABLATIVOS #3 IMIQUIMOD / 5 fluorouracilo

contraindicacion para dar ISOTRETINOINA

EMBARAZO CANCER HEPATOPATIAS

tx escabiosis

BENZILO

farmacos que se asocian a ACNE

- ANDROGENOS - AZATIOPRINA - ESTEROIDES - ISONIAZIDA - LITIO

clincia ACNE LEVE

comedores SIN cicatriz

clinica ACNE MODERADO

comedores papulas y pustulas quistes y nodulos

clinica ACNE SEVERO

quistes y CICATRICES

TX ACNE LEVE

- aseo 2 veces al dia #1 PEROXIDO DE BENZOILO #2 eritromicina #3 clindamicina #4 TRETINOINA (retinoide topico)

TX ACNE MODERADO

#1 BENZOILO + TRETINOINA + TETRACICLINA - limeciclina es de eleccion

TX ACNE GRAVE

#1 ISOTRETINOINA * ENVIO 2DO NIVEL

FR carcinoma ESPINOCELULAR / escamoso

* QUERATOSIS ACTINICA * - TABAQUISMO - VPH (por eso puede afectar, piel y genitales simultaneamente) * ulceras cronicas (ulcera de MARJOLIN)

CLINICA DE ESPINOCELULAR

- PAPULA ERITEMATOSA - SANGRANTE - CUERPO ACTINICO

Sitios mas comunes de espinocelular

#1 pabellon auricular o labio inferior - GENITALES - PERIANAL

HISTOPATOLIOGA DE ESPINOCELULAR

"PERLAS DE QUERATINA"

DX ESPINOCELULAR

BIOPSIA ESCICIONAL

TIPOS DE ESPINOCELULAR

a) BOWEN = in situ b) ERITROPLASIA DE QUEYRAT = Bowen en genitales c) ULCERAS DE MARJOLIN = secundarias a heridas cronicas o quemaduras

tx CARCINOMA ESPINOCELULAR

Bajo riesgo = curetaje ALTO riesgo = CX MOHS

TX METS ESPINOCELULAR

QT = - cisplatino + 5- FU