Dermatology Lecture 1 pt 3 Flashcards
What are two condition with vesicular bullae?
Bullous Pemphigoid
Pemphigus vulgaris
What is this condition? Describe
Bullous Pemphigoid
-Localized or generalized tense
vesicles and/or bullae formation
on normal skin or an erythematous base
- Few bullae can be hemorrhagic
- May be preceded by an urticarial
or eczematous rash
Symptoms fo Bullous Pemphigoid
Symptoms: moderate/severe
pruritis progresses to tenderness
over the eroded lesions
Remember bulla are greater than 1cm
Often filled with serum
What areas of the body is bullous pemphigoid found?
Axillae, thighs, groin are commonly affected. Mucous membrane lesions are less severe and less painful than seen in Pemphigus
vulgaris
What cause Bullous Pemphigoid?
-This is an autoimmune disorder that occurs in elderly patients (typically >80yo)
* Autoantibodies, complement fixation, neutrophil, and eosinophils
cause bullous formation
* May have an association with malignancy
Tests to diagnosis Bullous Pemphigoid?
Laboratory: Biopsy and immunofluorescence to confirm diagnosis
*Nikolsky Sign cannot be elicited (top layer of blister does not slip off when pressed)
What is treatment for Bullous Pemphigoid?
Systemic prednisone at high doses till remission; then lower for maintenance:
- Azathioprine may be added
- Mild cases or local reoccurrences can be treated with topical cortisone
(dapsone) - Very mild cases – topical glucocorticoid therapy
What is this condition? Describe
Pemphigus Vulgaris
The term “pemphigus” describes a group of autoimmune, mucocutaneous, blistering disorders characterized by acantholysis (loss of keratinocyte-to-keratinocyte adhesion) in the epithelium of mucous membranes or skin.
How do the signs of pemphigus vulargis develop?
Vesicles or bullae that rupture
and leave erosions and crust.
Oral lesion usually 1st sign of
disease.
Skin lesion occur 6-12
months later
Symptoms and diagnostics of pemphigus vulgaris
Nikolsky’s sign can be elicited
*Weakness, malaise, pain or burning sensation my be present
- May or may not have pruritis
- Serious autoimmune disease where the IgG antibodies induce acantholysis, resulting in a loss of cell-to-cell adhesions
- Occurs in middle-aged adults (30-60yo)
- Laboratory: Immunofluorescense and Bx
What is Hailey-Hailry disease?
When pemphigus vulgaris occur affects primarily neck, armpits, skin
folds, and genitals
What is the treatment for Pemphigus Vulgaris?
Treatment: Oral prednisone, then add immunosuppressant like azathioprine, and/or methotrexate .
extras:
Dapsone, gold, or cyclophosphamide may help refractory cases
* Supportive therapies like fluid and electrolyte replacement, cleansing baths, wet dressings, topical steroids, and antibiotics as needed
What are 3 examples of Acneiform Lesions?
Acne Vulgaris
Rosacea
Folliculitis
What are these images of? Describe
Acne Vulgaris
open and closed comedones, inflammatory papules and pustules, nodules, and cysts.
Sinus tracts can be seen in nodular acne.
Considered a complex and
multifactorial inflammatory disease
What are the 4 element of pathogenesis for Acne Vulgaris?
follicular epidermal hyperproliferation,
sebum production,
presence and activity of Propionibacterium acnes,
Inflammation and immune response
What laboratory tests for Acne Vulgaris?
Testosterone, FSH, LH, and DHEA-5 can be measured if suspecting and endocrine disorder
Treatment of Acne Vulgaris pt 1
-Careful cleaning & removal of oils
* Topical antibacterials (e.g., benzoyl peroxide, clindamycin)
* Topical retinoic acid
Treatment of Acne Vulgaris pt 2
-Oral tetracycline, minocycline, or erythromycin in moderate (nodular)
- Systemic isotretinoin only for unresponsive severe nodulocystic acne (teratogenic-all females must be screened for pregnancy prior to initiation and maintain effective contraception during treatment course.
What monitoring is necessary for isotretinoin?
Baseline serum triglyceride, CBC, LFTs.
- Follow serum triglyceride levels – repeat at 4-8 weeks of therapy
- Increase frequency of monitoring if triglycerides >500
- Interrupt therapy for levels >800, treat with lipid-lowering drug
- Leukopenia, thrombocytopenia, elevated LFTs can occur
- Issues with fetus occur very early in pregnancy – therefore, prevention is
paramount - RX 2 forms of contraception and continue for 1 month post med stop
Typically treat for 20 weeks – not an absolute
When would you add oral antibiotics for acne vulgaris treatment?
Oral antibiotics are added to topical therapy if patient has significant amount
of inflammatory lesions and/or cysts-TCN, Minocycline (can cause blue-black pigmentation), Doxycycline, Bactrim
- Oral contraceptives in female patients
What is the treatment for Acne Vulgaris that is severe scaring cystic acne
Isotretinoin can be prescribed by providers who are registered with the government-regulated I-pledge program
-Inhibits sebaceous gland functioning and keratinization
-Side effects: Dry eyes, nose, lips, joint pain, mood swings, and suicidal thoughts. Premature closure of long bones, visual changes, headache with blurred vision, hepatic enzyme elevation, leukopenia,
triglyceridemia and teratogenicity
What condition is this? Describe?
Rosacea (chronic inflammatory skin disease)
Scattered small inflammatory
papulopustules and sometimes
nodules occurring cheeks, chin,
forehead, glabella and nose.
Face usually appears red or
flushed. Telangiectasia are often
present
What is a common complication of Rosacea?
Rhinophyma- enlarged nose-is a common complication
Treatment for Rosacea?
Avoid triggers-heat, sun, spicy food, alcohol
-Topical metronidazole gel or cream, sodium sulfacetamide, azelaic acid
-Oral antibiotics TCN, minocycline, or doxycycline if topical treatment
fails
- Systemic isotretinoin only for severe disease not responding to antibiotics or topical treatment
What condition is this? Describe
Folliculitis
Folliculitis refers to inflammation of the superficial or deep portion of the hair follicle
Erythematous papules or pustules at hair follicules
Common pathogens causing folliculitis?
What bacteria causes hot tub folliculitis? Treatment?
Pseudomonas
Treat with fluoroquinolones
Standard treatment for folliculitis?
Treatment: Gentle cleansing and topical
clindamycin, erythromycin, or Mupirocin
-Oral antibiotics for more extensive cases
What is this condition? Describe
Pseudofolliculitis Barbae
Looks very similar to a folliculitis
- Much more common in dark skin and curly hair
What is this condition? Describe
Seborrheic Keratosis
Verrucated, velvety, stuck on
beige to brown or black plaque
- These are benign
What is this condition? Describe?
Actinic/solar keratosis
Scaly, erythematous,
plaques/papules that occur
on sun exposed skin,
sometimes painful
What is this condition? Describe
Pearly papule with telangiectasias
on sun-damaged skin (ie. face,
scalp, ears, chest, back, and legs).
- Patients commonly complain of
bleeding.
What is this image? Describe
BCC
Showing central ulceration and a
pearly, rolled, telangiectatic
tumor borde
What is the condition? Describe
SCC
Hyperkeratotic crusted and somewhat
eroded plaque on the lower lip.
What is this condition? Describe?
Kaposi Sarcoma
Oval, purple papule with faint
yellow-greenish halo
What is this condition? Describe?
Also, Kaposi Sarcoma
Violaceous confluent papules
and nodules, purple hue, with edema
What is this condition?
Also, Kaposi Sarcoma
What is this condition? Describe
Also, Kaposi Sarcoma
Violaceous nodules on the upper
gingiva, covering the teeth
What do classic KS lesions look like?
Lesions appear reddish, violaceous,
or bluish-black macules and
patches that spread and coalesce
to for nodules or plaques
- Predominately arises on the legs;
but also may occur in lymph nodes
and abdominal viscera
What type of KS? How to describe?
African Cutaneous KS
Nodular, infiltrating, vascular
masses occur on the extremities,
mostly men between the ages of
20-50
- Endemic in tropical Africa
- Locally aggressive, but
systemically indolent
What type of KS? How to describe?
African Lymphadenopathic KS
Lymph node involvement,
with or without skin
lesions
- May occur in children
under 10 years old - Aggressive, often fatal
within 2 years of onset
What type of KS? How to describe?
AIDS-Associated KS
Cutaneous lesions begin as one or
several red to purple-red macules, that
rapidly progress to papules, nodules,
and plaques
- Predilection for the head, neck, trunk,
and mucous membranes - Fulminant, progressive course with
nodal and systemic involvement is
expected - May be the presenting manifestation
of HIV
What type of KS? How to describe it?
Lesions resemble those
seen in Classic KS; however,
site presentation is more
variable
- Tends to occur in recipients
of renal transplants and
cancer patients being
treated with cytotoxic
chemotherapy
What is this condition? Describe
Melanoma
Black, brown, pink, blue, and/or flesh
colored macule, papule, nodule or
plaque that is > 5 mm in diameter,
asymmetric, has an irregular surface
(elevated) or border, or has variation
in color
What is the ABCDE acronym?
Asymmetry
Border irregularity
Color
Diameter
Evolution
What type of Melanoma is this?
Superifical spreading melanoma
Most common type of malignant
melanoma & demonstrates color
variation (black, blue, brown,
pink, and white) and irregular
borders.
What type of Melanoma is this?
Lentigo Maligna Melanoma
Characterized by a single, flat, freckle-like macule with an irregular border,
usually on the face.
- Very long radial growth phase before invasion
Occurs on sun-exposed skin (elderly) as a
large, hyperpigmented macule
or plaque with irregular borders
and variable pigmentation
What type of melanoma is this?
Acral Lentiginous
- Occurs on palms and soles, mucosal
surfaces, in nail beds and mucocutaneous junctions - Similar to lentigo maligna melanoma but
with more aggressive biologic behavior - Metastasize easily, are often mistaken for plantar warts or subungual hematomas
What type of melanoma? Describe?
Nodular melanoma: Most commonly manifests itself as a rapidly growing, often
ulcerated or crusted black nodule.
Starts as a papule which becomes an elevated nodule with irregular borders
and variegation in color.
- Generally poor prognosis because of invasive growth from onset
- Must be differentiated from a hemangioma, angiokeratoma, or pigmented
basal cell carcinoma.
