Dermatology Flashcards
1
Q
How should a skin exam be performed?
A
- Should be conducted in good light
- Should be complete
- Evaluation of scalp, hair, nails, eyes, mouth, palms, soles
- Exam should be visual & tactile
2
Q
What are the types of primary lesions?
A
- Macule, patch
- Papule, plaque
- Nodule, tumor
- Vesicle, bulla
- Pustule
- Cyst
- Wheal
3
Q
Macule
Patch
A
-
Macule
- Flat & nonpalpable
- Represent cutaneous color changes
-
Patch
- Large macule
4
Q
Papule
Plaque
A
-
Papule
- Epidermal or superficial dermal lesions
- Elevated above the skin surface
-
Plaque
- Large or coalesced papules
5
Q
Nodule
Tumor
A
- Nodule
- Dermal lesions below the skin surface
- May have epidermal component
-
Tumor
- Large nodule
6
Q
Vesicle
Bulla
A
-
Vesicle
- Fluid-filled papules
-
Bulla
- Large vesicle
7
Q
Pustule
A
purulent-filled papules
8
Q
Cysts
A
nodules filled w/ expressible material
9
Q
Wheals
A
cutaneous elevations caused by dermal edema
10
Q
What are examples of secondary characteristics?
A
- Scaling
- Crusting
- Pigmentation changes
- Excoriations
- Scars
- Ulcers
- Atrophy
- Fissures
11
Q
Scaling
A
desquamation of the stratum corneum
12
Q
Crusting
A
dried exudate & debris
13
Q
Excoriations
A
linear erosions into the epidermis
caused by fingernail scratches
14
Q
Scars
A
thickened fibrotic dermis
15
Q
Ulcers
A
absence of epidermis & some of dermis
16
Q
Atrophy
A
thinning of epidermis or dermis
17
Q
Fissures
A
linear cracks into the dermis
18
Q
What are examples of configuration & distribution?
A
-
Configuration of lesions
- Linear
- Annular (circles)
- Arcuate (half-circles)
- Grouped
- Discrete (distinct & separate)
-
Distributions
- Generalized
- Acral (hands, feet, buttocks)
- Confined to dermatome
- Other specific locations
19
Q
What are some diagnostic procedures for dermatology?
A
-
Woods light
- Identifies pigmentary changes & some dermatophytes
- Scrapings
-
Cultures
- Bacteria, virus, fungus
- Invasive techniques
-
Immunofluorescent staining
- Autoimmune vasculitic disorders
20
Q
What scrapings are used for diagnosis in dermatology?
A
-
Fungus
- 10% KOH added to scraping of scale or exudate to identify fungal hyphae
-
Scabies
- Examine scraping of unscratched lesion or burrow for mites, eggs, feces
-
HSV
- Base of vesicle scraped
21
Q
What are some invasive techniques used for diagnosis in dermatology?
A
- Incision & drainage
- Diagnosis, cultures, therapy
- Biopsy
-
Shave or tangenital
- Epidermal or superficial dermal lesions
-
Punch
- Epidermal, dermal, superficial subq
-
Excision
- Complete lesion removal
-
Shave or tangenital
22
Q
Absorption of topical agents in children vs. adults
A
- Skin of child = skin of adult
- Exception
- Premature infant
- Absorption is greater
- Thinner stratum corneum
23
Q
Therapeutic efficacy of a topical agent is related to both the _________ and the ______.
A
active ingredient, vehicle
24
Q
Hydration of the skin is critical. What are some examples of moisturizers?
A
-
Ointments
- Little or no water
- Maximal water-retaining properties
- Useful for very dry skin
-
Creams
- 20-50% water
- Useful for skin of average dryness
-
Lotions
- More water than creams
- Useful for minimally dry skin, large SA
-
Solutions & alcohol-based gels
- Useful for areas w/ hair (scalp)
25
What is thickened skin called?
What does it require?
**Hyperkeratosis**
* Keratolytics
* Salicylic acid
* Urea
* Alpha-hydroxy acids
* Retinoic acid
26
What are some examples of **destructive** therapies?
Used for warts, molluscum contagiosum
* High dose salicylic acid
* Podophyllin
* 5-FU
* Cryotherapy
* Electrotherapy
* Laser therapy
27
What are some examples of anti-infective agents?
* Topical antibiotics
* Antifungals
* Antivirals
* Antiparasitic agents
28
What **anti-inflammatory agents** are used for treatment in dermatology?
**Topical corticosteroids**
* Weakest steroid that will achieve the treatment goal should be used first
* Low-potency on the face or groin
* Epidermis is thinner, increased side effects
* Systemic vs. local side effects
* Other
* Tacrolimus ointment (atopic dermatitis)
* 1-5% sulfer (acne)
* Tar (eczema & psoriasis)
29
What are the **local side effects** of topical corticosteroids?
* Acne (acne rosacea)
* Hirsutism
* Folliculitis
* Striae (axilla, groin)
* Hyper/hypo-pigmentation
* Atrophy
* Ecchymoses & telangiectasias
* Tachyphylaxis (insensitivity)
30
What is **contact dermatitis**?
What are the 2 categories?
* Inflammation of the **epidermis & superficial dermis** secondary to direct contact w/ the skin by a sensitizing substance
* Categories
* Allergic contact dermatitis
* Primary irritant contact dermatitis
31
What is the **etiology** of allergic contact dermatitis?
* **Direct T-cell mediated response to an exogenous applied allergen**
* Steps for rxn
* Initial sensitization
* Rechallenge (small, not dose-dependent)
* Common causes
* Poison ivy, oak, sumac
* Nickel-containing jewelry & belt buckles
* Topical lotions & creams
* Perfumes & soaps
32
**Allergic contact dermatitis**
clinical features
management
* **Erythematous** **papules** & **vesicles** in the area that came into contact w/ the allergen
* Treatment
* Topical corticosteroids
* Avoidance of the offending allergen
33
What is the **etiology** of primary irritant contact dermatitis?
What is the most common type?
* **Caustic substances that irritate the skin**
* Not an allergic rxn, no sensitization needed
* Dose-dependent
* Most common type: **diaper dermatitis**
* Multifactoral disorder
* Prolonged contact w/ urine & fecal matter, friction, maceration, proteases in feces
* Secondary infection: *Candida albicans*
34
What are the **clinical** features of primary irritant contact dermatitis?
* **Erythema w/ papules** on upper thighs, buttocks, genitourinary area
* _NO_ involvement of inguinal creases
* Candidal superinfection
* Involvement of inguinal creases
* More-intense confluent erythema
* Satellite lesions
35
How is primary irritant contact dermatitis managed?
* Keep skin free from urine & stool
* Skin moisturizers
* Barrier creams & ointments (zinc oxide)
* Frequent diaper changes
* **Low-potency corticosteroids**
* Severe inflammation
* **Nystatin, Clotrimazole** (anti-fungal)
* Candidal infection
36
**Seborrheic Dermatitis**
epidemiology
etiology
* Infants & adolescents
* Cause _unknown_
* **Hypersensitivity rxn to saprophytic yeast**
* *Pityrosporum ovale*
* Lives in areas that overproduce sebum
37
What are the **clinical** features of Seborrheic Dermatitis?
* Eruption of **red scales & crusts** in areas w/ high numbers of sebaceous glands
* Scalp, face (eyebrows, nose, beard), chest, groin
* Skin lesions may be **greasy**
* **Infants**
* Dermatitis limited to scalp ("cradle cap")
* Face, upper chest, flexor creases of extrem
* **Adolescents**
* Dermatitis in nasolabial folds, pinna, scalp
38
How is Seborrheic Dermatitis managed?
* Low potency topical corticosteroids
* Sulfer, zinc, salicylic acid-based shampoos
* Light scrubbing w/ brush to remove crusts
* Loose scales removed w/ mineral oil
* Topical anti-fungal medication
* Eradicate *Pityrosporum ovale*
39
**Pityriasis Rosea**
epidemiology
etiology
* Uncommon \<5 YO
* Extremely common during late childhood/adolescence
* Cause **unknown**
* Similar to hypersensitivity rxn to virus
40
What are the **clinical** features of Pityriasis Rosea?
* **Papulosquamous disorder**
* Solitary, large 2-5 cm scaly, erythematous lesion (**herald patch**)
* Trunk or extremities
* 1-30 days
* **Oval erythematous macules & papules**
* 1-2 wks after herald patch
* 3-6 wks from chin to mid-thigh
* Skin lines: "Christmas tree" distribution
* Lesions are pruritic (50%)
41
How is Pityriasis Rosea managed?
* Topical or systemic anti-histamines
* Exposure to UV light may shorten course
42
**Psoriasis**
epidemiology
etiology
* 3% of children in the US
* More common in adults
* 30% develop in childhood
* Autosomal dominant inheritance
* **Immune dysregulation --\> epidermal proliferation**
43
What are the **clinical** features of Psoriasis?
* Distribution of skin lesions & severity variable
* **Scaling papules & plaques**
* Scalp: non-greasy w/o hair loss
* Ears, elbows, lumbosacral, groin
* Classic: _silvery scale_
* **Koebner phenomenon**
* New lesions at sites of skin trauma
* **Nail** involvement common
* Pits, distal thickening, lifting of nail bed, nail destruction
* **Arthritis** during childhood uncommon
44
How is Psoriasis managed?
* Moderate/high-potency corticosteroids
* UV light therapy
* Analogs of Vitamin D
* 3% salicylic acid in mineral oil for scalp
* Retinoids
* Anthralin (downgrades EGF)
45
What is **Miliaria Rubra** (Heat Rash)?
What is the etiology?
* Distrupted sweat ducts near the upper dermis (occlusion/friction) that result in sweat being released onto the skin
* **Sweat on skin --\> inflammatory response**
* More sweat, more occlusion, heat rash
46
What are the clinical features of **Malaria Rubra**?
How is it managed?
* **Small erythematous pruritic papules/vesicles**
* Areas of occlusion or rubbed areas
* Inguinal region, axilla, chest, neck
* Treatment
* Avoidance of occlusive clothing
* No medications
47
What are the 4 types of **hypersensitivity** disorders?
* Urticaria
* Serum sickness
* Erythema Multiforme
* Toxic Epidermal Necrolysis
48
What is **serum sickness**?
* May initially appear as urticaria
* Systemic signs & symptoms
* **Fever**
* **Arthralgias**
* **Adenopathy**
* **Evidence of organ injury**
* Medications are common causes
* Cephalosporins
49
What is **Erythema Multiforme**?
* Hypersensitivity rxn to many stimuli
* Drugs, viruses, bacteria, fungi, protozoa, systemic disease
50
What are the 3 major categories of Erythema Multiforme?
What is the classic skin lesion?
* Categories
* Erythema multiforme minor
* Erythema multiforme major
* Stevens-Johnson syndrome
* Classic lesion
* **Target lesion**
* Fixed, dull red, oval macule
* Duskey center w/ papule or vesicle
51
**Erythema Multiforme Minor**
* major cause
* skin findings
* mucous membrane findings
* systemic findings
* management
* prognosis
* major cause
* **HSV**
* skin findings
* **Symmetric target lesions (acral)**
* mucous membrane findings
* **One surface (mouth, 25%)**
* systemic findings
* **Prodrome**: low fever, arthralgias, myalgias
* management
* Supportive care, **Acyclovir** (preventative)
* prognosis
* **Good**, possible recurrence
52
**Erythema Multiforme Major**
* major cause
* skin findings
* mucous membrane findings
* systemic findings
* management
* prognosis
* major cause
* *Mycoplasma pneumonaie*, drugs
* skin findings
* **Symmetric target lesions (acral, truncal)**
* mucous membrane findings
* **2 mucosal surfaces (mouth, eyes)**
* systemic findings
* **Prodrome**: low fever, arthralgias, myalgias
* management
* Supportive care, **erythromycin/azithromycin** (M. pneumoniae), stop offending drug
* prognosis
* Good
53
**Stevens-Johnson Syndrome**
* major cause
* skin findings
* mucous membrane findings
* systemic findings
* management
* prognosis
* major cause
* **Drugs**
* skin findings
* **Widespread atypical, asymmetric target lesions, blisters, necrosis**
* mucous membrane findings
* **2 mucosal surfaces (mouth, eyes)**
* systemic findings
* **Prodrome**: high fever, cough, malaise, headache, arthralgias
* management
* Supportive care, stop offending drug, optho consult, steroids, IVIG, burn unit
* prognosis
* **High morbidity & mortality (5%)**
54
What is **Toxic Epidermal Necrolysis**?
What are the clinical features?
What is the prognosis?
* Severe rxn to drugs
* Anti-convulsants
* Antibiotics
* Anti-inflammatory drugs
* **Widespread epidermal necrosis**
* **Sloughing of the epidermis (\>30% skin loss)**
* Severe mucous membrane involvement
* No target lesions
* **Nikolsky sign**: skin peels away w/ lateral pressure
* _Mortality (10-30%)_
* Sepsis, dehydration, electrolyte abnormalities
55
**Fungal infections** are common during childhood & are most associated with _________ & with _______ living conditions.
humidity
urban/crowded
56
What are the 4 categories of fungal infections?
* Tinea capitis (hair)
* Skin infections
* Tinea corporis (body)
* Tinea pedis (foot)
* Tinea cruris (groin)
* Tinea unguium (onychomycosis)
* Tinea versicolor
57
What is the etiology of **tinea capitis**?
* *Trichophyton tonsurans* (95%)
* Human-to-human contact
* *Microsporum canis* (5%)
* Cats & dogs
58
What are the clinical features of **tinea capitis**?
* **Patchy hair loss**
* Black dot ringworm: hairs break at scalp
* M. canis: broken hairs thick & white
* **Scales & pustules**
* **Kerion**
* Large red boggy nodule
* Hypersensitivity rxn to dermatophyte
* **Occipital & posterior cervical lymphadenopathy**
59
How is **tinea capitis** diagnosed?
* Microscopic evaluation of hairs w/ 10% KOH
* Identify fungal hyphae, fungal culture
* Hairs fluoresce under Woods light w/ *M. canis*
60
How is tinea capitis treated?
* Systemic oral antifungal therapy (griseofulvin)
* 6-8 wks
* Topical antifungal agents ineffective
* Topical 2.5% or 5% selenium sulfate shampoo
* Reduces infectivity
61
Pathogens for fungal infections of the skin include....
* *M. canis*
* *T. tonsurans*
* Other *Trichophyton* species
62
**Clinical features**
* tinea corporis
* tinea pedis
* tinea cruris
* **tinea corporis ("ringworm")**
* Oval or circular scaly erythematous patches w/ partial central clearing
* **tinea pedis (athlete's foot)**
* Post-pubertal adolescents w/ scaling & erythema btwn toes or on the plantar aspect of the foot
* Vesicles may be seen
* **tinea cruris**
* Scales & erythema in groin/inguinal creases
63
How are fungal infections of the skin diagnosed?
How are they managed?
* Clinical features
* KOH examination of skin scrapings
* Fungal hyphae & culture
* Treatment
* Topical antifungal medications
* Clotrimazole, terbinafine, ketoconazole
64
What is **tinea unguium**?
How is it treated?
* Fungal infection of the nails (**onychomycosis**)
* Thickening & yellow discoloration of 1 or several nails (usually toenails)
* Topical management challenging
* **Prolonged therapy required**
* Systemic medictations
* Griseofulvin
* Terbinafine
* Ketoconazole
65
What is **tinea versicolor**?
What causes it?
* **Superficial fungal disorder**
* Adolescents & young adults
* *Pityrosporum orbiculare*
* Yeast of the stratum corneum
66
What are the **clinical** features of tinea versicolor?
* **Fine, scaly oval macules**
* **Trunk, proximal arms, face**
* Hypo/hyper-pigmented
* More prominent w/ _sun exposure_
* Infection may be asymptomatic
67
How is **tinea versicolor** diagnosed?
How is it managed?
* KOH examination of scraping of lesion
* **Fungal hyphae or circular spores**
* **"spaghetti & meatballs"**
* Woods light
* Yellow or orange fluorescence
* Treatment
* Overnight application of _2.5% selenium sulfide_ weekly for 3-4 wks
* Ketoconazole shampoo or cream
* Systemic anti-fungal medications
68
What are the 10 **viral** skin infections of children?
* Viral exanthem
* Measles & rubella
* Erythema infectiosum (5th disease)
* Roseola infantum (exanthem subitum)
* Gianotti-Crosti syndrome (papular acrodermatitis)
* Varicella (chickenpox)
* HSV-1, HSV-2
* Hand-foot-mouth disease & herpangina
* Warts
* Molluscum contagiosum
69
What is viral exanthem?
* Skin rash associated w/ viral infection
* **Enanthem**: involvement of oral mucosa
* **Morbilliform**: measles-like
* **Scarlatiniform**: scarlet fever-like; papular, vesicular, petechial
70
What is the etiology of Erythema infectiosum?
* Most common in school-age children
* **Parvovirus B19**
* 5th disease transmitted by respiratory secretions
* Aplastic crisis (pts w/ hemoglobinopathies)
* Prolonged anemia (immunosuppressed pts)
* Fetal hydrops
* Miscarriage in pregnant women
71
What are the clinical features of **5th disease**?
* **UR symptoms**
* Cough, fever, rhinorrhea
* **"Slapped-cheek" rash** (1-2 wks after URI)
* Red macular rash
* Lasts several days
* _No longer contagious_ when facial rash appears
* **Lacy, reticular rash on trunk & extremities**
* Lasts 3-5 days
* Exercise, heat, sunlight can induce rash
* **Arthralgias** (adults \> children)
72
How is 5th disease treated?
* Supportive
* IVIG for chronic anemia (immunosuppressed pts)
73
**Roseola infantum (exanthem subitum)**
* age group
* etiology
* clinical features
* treatment
* Children \<2 YO
* Most common: **HHV-6, HHV-7**
* Adenovirus, parvovirus B19, echovirus 16
* Clinical
* 3-5 days of **high fever**
* **Pink papular eruption on trunk**
* Fades in 24-48 hrs
* Treatment is supportive
74
What is **Gianotti-Crosti syndrome**?
(papular acrodermatitis)
What are the clinical features? Treatment?
* Children \<3 YO
* **HepB**, EBV, CMV, Coxsackie virus
* Clinical features
* **Red or flesh-colored flat-topped papules**
* **Acral** areas (extremities, buttocks, cheeks)
* Skin lesions last wks, may recur
* URI symptoms precede eruption
* Treatment is supportive
75
What is the incidence of **varicella**?
What is the age group?
* Incidence has decrased since vaccinations
* Any age in unimmunized children & adults
76
What are the **clinical** features of varicella?
* 7-21 day incubation period
* **Intensely pruritic erythematous macules**
* Central vesicles w/i 1-2 days
* Classic lesion: **"dew drop on rose petal"**
* Crops of lesions over 2-5 days
* Crusting, hundreds of vesicles
* **Fever** is common
77
How is **varicella** managed?
* Anti-pyretics
* Cleansing w/ anti-bacterial soaps
* Prevent bacterial superinfection
* Antihistamines for itching
* Monitoring
* Treatment of complications
* **IV Acyclovir**
* Varicella pneumonia & encephalitis
* Pts at high risk for complications
* Pts w/ ophthalmic involvement
78
What is the pathophysiology of **HSV**?
* **Neonatal infection**
* Passage through birth canal
* Mother w/ primary HSV infection
* 2/3 HSV-2, 1/3 HSV-1
* **Gingivostomatitis**
* Most common HSV infection during infancy & childhood (HSV-1)
79
What are the **complications** of varicella infection?
* Bacterial superinfection (Staph aureus)
* Necrotizing fasciitis (group A strep)
* Scarring
* Reye syndrome (ingestion of salicylates)
* Pneumonia
* Encephalitis
* Acute cerebellar ataxia
* Hepatitis
* Herpes zoster
* Infection during pregnancy
80
What are the complications of **varicella** infection during **pregnancy**?
* **Teratogenic effects**
* **Congenital varicella syndrome**
* Zigzag scarring of the skin
* Shortened or malformed extremities
* CNS damage
* Eye abnormalities
* Cataracts, chorioretinitis
* **Severe varicella infection of neonate**
* Mother acquires varicella w/i 1 wk of delivery
81
What are the **clinical** features of HSV?
* HSV gingivostomatitis
* Neonatal HSV
* Herpetic whitlow
* Recurrent HSV infection
82
What is **HSV gingivostomatitis**?
* Young infants
* **Grouped vesicles & ulcers**
* Lips, corners of mouth, tongue
* Pain on swallowing
* Drooling
* Fever
* Infection lasts **1-2 wks**
83
What is **neonatal HSV**?
What are the serious sequelae?
* 1st wk of life w/ variable signs & symptoms
* Few vesicles at the site (scalp) in contact w/ maternal lesions
* Signs & symptoms of sepsis
* Apnea, lethargy, irritability, seizures
* **Serious sequelae**
* Meningoencephalitis
* Hepatitis
* Sepsis
* Shock
* Death
84
What is **herpectic whitlow**?
* HSV-1 infection of the **thumb** or **fingers**
* Secondary to thumb/finger sucking by child w/ oral HSV lesion
85
How does **recurrent** HSV infection occur?
* HSV resides in the **dorsal root ganglion**
* Mild & less symptomatic
* Generally occur on the lip
* Reactivation by fever, sunlight, emotional stress, trauma
86
How is HSV diagnosed?
* **Tzanck preparation**
* Epidermal giant cells on microscopy
* **Direct fluorescent ab testing**
* Detection of HSV antigen
* **Culture** of base of lesion
* **PCR** to identify HSV in CSF
87
How is HSV managed?
* Neonatal HSV
* Medical emergency
* Immediate hospitalization
* **IV acyclovir**
* Cutaneous & oral HSV
* **Oral acyclovir**
* Prevents recurrent infection also
88
What is **hand-foot-mouth disease & herpangina**?
What are the clinical features?
How is it treated?
* **Coxsackie virus type A16** (most common)
* A2, A5, A10
* Clinical features
* Vesicles, papules, pustules
* Palms, soles, fingertips
* Shallow ulcers/erosions on soft palate/tongue
* Fever
* Only oral lesions = herpangina
* Treatment is **supportive**
89
What are the clinical features of **warts**?
**HSV**
* Any skin surface
* Irregularly-shaped discrete flesh-colored papules
* Smooth or rough
* Increase in size, contagious, spreads adjacently
* **Condyloma acuminata**
* Multiple external warts in genital area
90
How are warts managed?
* **Resolve spontaneously w/i 1-2 yrs**
* Treatment
* Liquid nitrogen
* Salicylic acid
* Cantharidin
* Podophyllin
* Surgical excision
* Recurrance after any treatment is high
91
What are the **clinical** features of molluscum contagiosum?
**Poxvirus**
* Small asymptomatic flesh-colored papules w/ _central umbilication_
* Anywhere on skin w/ hair follicles
* Face, proximal extremities, trunk
* Lesions are **contagious**
* HIV infection: extensive eruptions
92
How is molluscum contagiosum treated?
* Observation, no therapy
* Removal
* Curettage
* Podophyllin, trichloroacetic acid, liquid nitrogen, salicylic acid, cantharidin
93
What are 2 examples of Ectoparasites?
* Louse infestation
* Scabies
94
**Louse infestation**
* types
* etiology
* epidemiology
* Types
* Head lice (scalp)
* Body lice (body)
* Pubic lice (groin)
* Organisms
* ***Pediculus humanus***: head & body lice
* ***Phthirus pubis***: pubic lice
* Small 6-legged insect that attaches to skin & ingests blood
* Crowded living conditions, sharing of hats, clothes, combs, hairbrushes
95
What are the clinical features of **Louse** infestation?
* **Head lice**
* Itching, bodies found on scalp
* Nits (eggs): oval-white bodies attached to the hair shaft
* **Body lice**
* Papules & pustules on trunk w/ excoriations
* **Pubic lice**
* Lice or nits in groin
* Black crusted papules or blue macules (macula cerulea)
96
What are the clinical features of **scabies**?
***Sarcoptes scabiei***
* Pruritic papules or vesicles
* Abdomen, dorsum of hands, groin, axilla, flexor surfaces of wrists, interdigital spaces
* Infants: facial & neck involvement
* Itching is severe
* S-shaped burrows
97
How is **scabies** diagnosed & treated?
* Microscopic examination of scraping of unscratched burrow (mite, eggs, feces)
* Treatment
* Overnight application of **5% permethrin lotion or 1% lindane** (adolescents/adults)
* Highly contagious (treat all contacts)
* Itching up to 30 days after treatment
* Bed sheets, pillowcases, clothes washed in hot water
98
What are the 4 types of **hypopigmentation**?
* Postinflammatory hypopigmentation
* Pityriasis alba
* Vitiligo
* Oculocutaneous albinism
99
What is **postinflammatory hypopigmentation**?
* May follow any skin inflammation
* ex: atopic dermatitis
* Generally resolves over months to yrs
100
What is **Pityrasis alba**?
* Related to atopic dermatitis
* **Hypopigmented, dry, scaly patches**
* Commonly on _cheeks_
* Treatment
* Moisturizers
* Mild corticosteroids
101
What is **vitiligo**?
* Complete loss of skin pigment in patchy areas
* **Melanocyte destruction**
* Partial repigmentation may occur
* No effective treatement
* Psoralen + UV light may be helpful
102
What is **oculocutaneous albinism**?
* **Genetic defect in melanin synthesis**
* White skin & hair, blue eyes
* Photophobia, nystagmus
* No treatment
103
**Tuberous Sclerosis**
inheritance
skin findings
* Autosomal dominant
* **Ash-leaf spots**
* ****hypopigmented macules seen best under Woods light
* **Adenoma sebaceum**
* ****angiofibromas on nose/face
* **Shagreen patch**
* thickened orange peel appearance
* **Ungual fibromas**
104
**Tuberous Sclerosis**
CNS findings
* Seizures (95%)
* Infantile spasms
* Intracranial calcifications
* Cortical or subependymal tubers
105
**Tuberous Sclerosis**
systemic findings
* Renal cysts
* Cardiac rhabdomyomas
* #1 cause of neonatal cardiac tumors
* Retinal astrocytoma or hamartoma
* Mental retardation
106
**Neurofibromatosis type 1**
inheritance
skin findings
* Autosomal dominant
* Cafe-au-lait spots
* Axillary or inguinal freckling
* Plexiform neurofibroma or skin neurofibromas
107
**Neurofibromatosis type 1**
CNS findings
* Optic glioma (3 YO)
* Intracranial calcifications
* CNS neurofibromas
108
**Neurofibromatosis type 1**
systemic findings
* Osseous lesions (1 YO)
* Sphenoid dysplasia
* Thinning of long bone cortex
* Scoliosis
* HTN
* Learning problems
109
What are **congenital nevi**?
* Black, brown, tan, flesh-colored papules/plaques
* Birth-6 mo
* 1-2% of neonates
* **Increased risk of malignancy**
* Giant nevi (\>20 cm) have 6-7% lifetime risk of malignant melanoma
* Management
* Excision
* Careful observation
110
What are **acquired nevi**?
* Moles
* 2-3 yrs, 11-18 yrs
* Well-demarcated brown/black papules
* Increase in size & number during puberty or pregnancy & after sunburn
* Most are **junctional nevi**
* Risk of malignant transformation lower than congenital
* Management: careful observation
111
What are 4 common disorders of the hair?
* Alopecia areata
* Tinea capitis
* Traumatic alopecia
* Trichotillomania
* Traction alopecia
* Telogen effluvium
112
**Alopecia areata** is caused by ________ & affects ______ persons.
* Autoimmune lymphocyte-mediated injury to the hair follicle
* 1 in 1,000 persons
113
What are the **clinical** features of alopecia areata?
* Complete hair loss
* 1-3 sharply demarcated scalp areas
* No scalp inflammation
* Sudden, underlying skin smooth & soft
* Pitting of nails (40%)
* Subtypes
* **Alopecia totalis** (loss of all scalp hair)
* **Alopecia universalis** (body + scalp)
114
How is alopecia areata managed?
* Regrowth of hair w/i 1 yr without treatment
* Accelerated hair growth
* topical or injected corticosteroids
* topical minoxidil
* Wigs & counseling
115
What is **Trichotillomania**?
* **Conscious** or **unconscious** pulling/twisting of hair
* Clinical features
* Irregularly bordered areas of hair loss
* Hairs broken off at different lengths
* Scalp: perifollicular petechiae & excoriations
* Eyelashes & eyebrows also
* Cause unknown, associated w/ **anxiety**
* Management
* Stress relief
* Search for precipitating events
* Application of oils (harder to pull out)
116
What is **traction alopecia**?
* **Hair loss caused by constant traction or friction**
* Tight hair braids or curlers, vigorous scalop massage, constant rubbing
* Patchy areas of alopecia w/ thinned, small hairs
* Few broken hairs
* Management: stop inciting trauma
117
What is **Telogen effluvium**?
* 2nd most common type of alopecia
* After male-pattern baldness
* **Acutely stressful event** that converts hairs from growing phase (anagen) to resting phase (telogen)
* Pregnancy, surgery, acute illness, trauma
* Clinical features
* Generalized excessive hair loss
* **\>100 hairs/day 2-3 mo after event**
* Normal: 50-100 hairs/day
* Hair loss continues for 3-4 mo, then spontaneously resolves (regrowth)
118
What are some other conditions that cause hair loss?
* Hypothyroidism
* DM
* Hypopituitarism
* Nutrition disorders
* Hypervitaminosis A
* Zinc deficiency
* Marasmus
* Medications
* Warfarin, heparin, chemotherapy, cyclophosphamide
* Ectodermal dysplasia
* Hair shaft structural defects
119
\_\_\_\_\_ is the most common skin disease.
Acne
120
What is the pathophysiology of acne?
* Excessive **shedding** & **cohesion** of cells that line the sebaceous follicles located on the chest, back & face
* Production of **sebum** by sebaceous glands under the influence of androgens
* Obstruction of sebum outflow
* **Comedone** formation
* Inflammation from proliferation of ***P. acnes***
121
What are the clinical features of acne?
* 1-2 yrs before puberty
* **Noninflammatory acne**
* Open comedones (blackheads)
* Closed comedones (whiteheads)
* **Inflammatory acne**
* Erythematous papules, pustules, nodules, cysts
* Most pts have both
122
How is acne treated?
* Both types
* Topcial benzoyl peroxide
* Tretinoin (Retin-A)
* Salicylic acid
* Inflammatory acne
* Antibiotics (oral, topical)
* Benzoyl peroxide
* **Systemic isotretinoin (Accutane)**
* All types (nodular & cystic also)
* Pregnancy test & birth control due to teratogenic effects
