Midterm Material Flashcards by Rachel Surprenant

SAD diet activates in pathogenesis of acne

IGF-1 and mTOR

increases lipogenesis

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Natural Tx Acne

Diet obvi
zinc/copper, chromium, selenium, omega 3 fatty acids, vitamin D
Berberine, Vitex, Indian Gooseberry

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Rosacea population

Age - 30-50 years, female>males
affects only the face - mainly central
30-50% have ocular symptoms (iritis, scleritis, keratitis, chalazia, blepharoconjunctivitis)

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Conventional tx for rosacea

topical metronidazole is reasonable first-line therapy

palliative

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Rosacea natural tx

Reduce triggers (hot liquid, spicy food, alcohol, sun, niacin)
Anti-inflammatory/elimination diet
Eat in a relaxed environment and chew food well
HCl, bitters, enzymes
Probiotics-Lactobacillus
Check for nutrient deficiencies- i.e. Vit B, D, glutathione, zinc
Acupuncture, homeopathy

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tender lesion in axillary, inguinal, intermammary and/or anogenital region

Hidradenitis suppurativa

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Rosacea ddx

Facial Papules/Pustule-acne, perioral dermatitis, folliculitis(Staph aureus), miteFacial Flushing/Erythema-Seborrheic dermatitis, SLE, dermatomyositis

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Hidradenitis suppurativa ddx

Furuncle, carbuncle, lymphadenitis, rupture inclusion cyst, cat-scratch disease, lymphogranuloma venereum, donovanosis

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Hidradenitis suppurativa RFs

Obesity
Female sex
Smoking
Acne vulgaris
Inflammatory bowel disease
Low zinc level
SAD

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Hidradenitis suppurativa Tx

Acne protocol
topical/oral abx
I+D

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Contact history positive, acute or chronic, often vesicular and oozing

contact derm

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Common, itchy skin at joints, acute, diffuse dry scaly, allergic hx, fam hx

atopic derm

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Yellowish oily patches near nose or scalp, less itchy, diffuse, scaly, greasy

seborrheic derm

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Pruritic, weeping vesicles on hands and feet, acute, recurring

Pompholyx

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Pruritic papulovesicular or scaly coin-shaped lesions

nummular eczema

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Single dry, thick scaly lesions, chronic itch

lichen simplex chronicus

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For acute and subacute Inflamed ICD, use

powder (“Country Comfort Baby Powder”), Ointments (Calendula, Comfrey, vitamin A+D)

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For acute, subacute and chronic dry ICD, use

wet soaks containing tap water, saline, colloidal oatmeal (Aveeno) for 15-20 minutes. Remove wet!

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For acute exudative ICD

wet dressing using gauze soaked in Burrow’s solution changed every 2-3 hours (aluminum acetate)

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treatment for diaper derm

Clinical and mycological benefits of topical application of honey, olive oil and beeswax

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Contact Allergic Dermatitis info

Class - Type IV (delayed) hypersensitivity usually appears 24-48 hours after contact
range 4 hours to 10 days
Can take up to year to become reactive with a weak antigen

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Acute vesicles

Poison Ivy

Linear lesions is a sign of resin being dragged over the skin while scratching

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Conventional tx for atopic dermatitis

topical steroids

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skin condition that affects following areas:

Scalp, eyebrows, eyelids, nasolabial fold, paranasal area, ears, sternum, inframammary fold, axilla, pubic area, gluteal and inguinal fold, and umbilicus

seborrheic derm

Acute, chronic, or recurrent dermatitis of the hands(80%) and soles Female=males12-40y.o. Unknown etiology-possible association with stress, allergens, metals (Ni,Co,Cr)

Pompholyx (Dyshidrotic Eczema)

Females >Males >20y.oUnknown cause-stress?Created and perpetuated by constant scratching and rubbing (itch-scratch-rash)Initial cause may have been ACD, ICD, fungal, bug bite

Lichen Simplex Chronicus (Neurodermatitis)

Common, chronic, coin-shaped plaques on Extensor aspects of extremities, buttock, breast, and posterior trunk

nummular derm

An itchy, dyshidrotic-like vesicular eruption on the fingers, forearms, thighs, legs, trunkThe phenomenon results from the release of cytokines that develop in a distal primary dermatitis, i.e. tinea pedis, stasis derm, etc.

“Id reaction” | Autosensitization Dermatitis

Cracked porcelain pattern is the hallmark Dryness of the skin-esp northern cold climates, low humidityErythema, inflammation, and scalingMore common in elderlyLower anterolateral legs, trunk, upper extr

Asteatotic Dermatitis

Eczematous dermatitis of the lower extremities, associated with edema, varicosed and dilated veins, and hyperpigmentation

stasis derm

pathogenesis of stasis derm

30 mm Hg normal pressure > 40 mm Hg can lead to ulcers 100% get ulcers at 60 mm Hg

Disease where this helps: Unna boot (zinc oxide) apply 1x/wk-until ulcer resolves

Venous Leg Ulcers

Delayed abnormal reaction to UV radiationAll races ( as high as 10%), including brown and blackFemales>male - around age 20 first noticedSpring, early summer – 2-24 hours after 1st exposure – last 7-10 days

Polymorphous Light Eruption

disease where you should consider antimalarial drugs

Polymorphous Light Eruption

Hyper proliferative skin disorder in genetically predisposed individuals2% of world pop (range 0.4-4.7%)Low in Africans, Asians, Eskimos, Native AmericansHigh in US and Canada (4.6 and 4.7%)75% onset by age 40 (range 1-80yo) female=male

psoriasis

Salmon-pink papules and plaques, sharply marginated with silvery-white scales.Removal of scales-reveals punctate bleeding called auspitz’s sign

psoriasis

Oil spot lesion

psoriasis

Triggered by group A streptococcal pharyngitis or viral infection Sudden onset of multiple scaling red papulesSelf-resolves in 3-4 months-no benefit found with antibiotics

Guttate Psoriasis

Koebner’s phenomenon

psoriasisa major factor eliciting lesions- rubbing and scratching

Both cells activate keratinocyte innate immune defenses, thus protecting the skin from pathogen invasion.

Th17 and Th22Both cells are enriched in many immune-mediated skin diseases, such as dermatitis, ACD and psoriasis

Drug for Mod-Severe plaque psoriasis

Ixekizumab, a monoclonal antibody that selectively targets interleukin-17A

Herald Patch (80%) 1-10 cm, pre-dates the reminder of the other lesions by hours to 14 days Common(2%), benign, self-limiting, distinctive, papulosquamous eruption Unknown etiology-viral origin is suspected (herpes virus type 7)75% between ages of 10-35years Pruritis-absent(25%), mild(50%),severe(25%)

Pityriasis rosea | Acyclovir may be effective

``` Sun exposed areas of skin male> females pre-malignant "sore that doesn't heal" 1 out of 1000 lesions develop into SCC annually 5-10% over a lifetime ```

Actinic keratosis (AK)

Protection against UV light can be achieved by diet rich in

lycopene and lutein

actinic keratosis nodular lesions should be biopsied (shave or excisional) unless

<0.5cm

Five p’s: pruritic, planar (flat-topped), polygonal, purple papules, 2-10mm in diameterSurface scales are lacy (reticulated) fine white lines called “Wickham’s striae” Seen best with mineral oil application

Lichen planus

Aloe vera gel may be effective for

oral lichen planus

Skin lesions: Dull red, Iris or targetlike lesions, macules to papules, localized or generalized, often symmetricSites:hands, feet, face, elbows, knees, mucous membranes, genitals(50%)

Erythema Multiforme Syndrome

Acute inflammatory/ immunologic rx of subcutaneous fat leading to painful red swollen nodules on the extensor aspect of the extremities.

Erythema Nodosum

Herald Patch (80%)1-10 cm, pre-dates the reminder of the other lesions by hours to 14 days Often asymptomatic and self-limiting and requires no treatment acyclovir may be effective

Pityriasis rosea

5-Fluorouracil or curaderm Tx for...

superficial basal cell or Actinic keratosis

Chronic itchy lesionsResistant to txNeg KOHNeg cultureBiopsy-spongiosis

nummular eczema

most common human cancer

basal cell carinoma | Locally invasive, aggressive, destructive least dangerous-limited ability to metastasize

Nodular, pearly, translucent when stretched Ulcerative (Rodent ulcer) Superficial type Pigmented/sclerotic

basal cell carinoma haphazard telangiectasia

0.005% mixture of solasodine glycosides (Zycure) may clear

Basal cell carinoma

addition of methyl aminolevulinate (MAL) to photodynamic therapy (PDT) may clear

Nodular basal cell carinoma

Seborrheic Derm Tx

Zinc B vitamins EFA’s Heliotherapy Hydrotherapy, acupuncture, homeopathy, mediation Topical –Honey 90/10 with water rub 2-3 minutes-3 hrs/4wks Shampoo: Selenium sulfide

SCC

sunscreen will px this but not other derm CA

Melanoma Types

``` Superficial spreading (60-70%) Nodular melanoma (15-30%) Lentigo maligna (5-15%) Acral lentiginous melanoma (5-15%) ```