Other Dermatoses Flashcards
How does acanthosis nigricans present?
- symmetrical hyperpigmented VELVETY* plaques
- skin folds (posterior neck most common in kids)
- usually asymptomatic (possible mild pruritus)
- unclear if friction and sweating play a role
- “dirty neck”-brownish
What are the “other dermatoses”?
acanthosis nigricans hidradenitis suppurativa lipomas epidermal inclusion cysts melasma pilonidal cyst pressure ulcers urticaria vitiligo
What is acanthosis nigricans caused by?
possible factors that stimulate epidermal proliferation: INSULIN
- association w/ insulin resistance & obesity
- check plasma insulin level
What is the treatment for acanthosis nigricans?
- treat underlying disease (weight loss, diabetes)
- improve appearance: keratinolytics, topical retinoids– these meds “thin out” plaques, make them peel off
Is there malignancy associated with acanthosis nigricans?
- not common
- associated with GI malignancy (underlying tumor aggressive)– can cause itchiness
- appear abruptly and widespread
- oral cavity may be involved
What is hidradenitis suppurativa? (HS)
- “disorder of the terminal follicular epithelium apocrine gland bearing skin”
- chronic
- starts at puberty
- females>males
- axillae, groin, inframammary, butt
- patients otherwise healthy!
What are the clinical features?
- erythema–>painful papules/nodules–>abscess–>discharge–>scarring
- recurs (CLASSIC FEATURE)
- scarring results in dermal contractures, rope like scar tissue formation, and open comedones
How is the HS diagnosis made?
clinically: typical lesion, distribution, recurrence
What is the treatment for HS?
- no cure
- surgery to remove glands (recurrence possible)
- antibiotics
- corticosteroids
- pain management
What are lipomas?
- benign, subcutaneous fatty tumors, made of fat cells
- discrete rubbery mass, 2-10 cm (feels like jelly)
- trunk/proximal extremities
- mild tenderness possible
- usually adults
- familial trait if multiple
What is the treatment for lipomas?
Not necessary
can surgically excise if bothersome (give local anesthetic)
What is an epidermal inclusion cyst?
- benign
- proliferation of epidermal cells within a circumscribed space in dermis
- may start as pimple or ingrown hair
- usually asymptomatic
- cheesy foul smelling contents
- can be inflamed
- Flesh colored firm round nodule ** - size varies, may have punctum (black head looking thing in middle)
What is the treatment for an epidermal inclusion cyst?
- no treatment necessary
- excision: must get out ALL of the lining or lesion will recur, if you just incise and drain, the lesion will recur because not all of the lining is removed
What is melasma?
- hypermelanosis of sun exposed skin
- hyperpigmentation: large patches or smaller individual lesions
- face
- females>males, due to hormonal influence (on OCP or w/ pregnancy)
- asymptomatic
- SUN EXPOSURE most important causative factor
What is the treatment for melasma?
- difficult to treat
- sun avoidance
- high SPF sunscreen
- avoid hormonal meds
- hydroquinone-bleaching agent
- topical retinoid
What is vitiligo?
- acquired pigmentary disorder of skin and mucous membranes
- melanocyte destruction
- depigmented macules or patches
- well demarcated
- asymptomatic
- hands, arms, feet, face, but can occur anywhere
- perioral & periocular
- hair may whiten
- progressive & not contagious
What are the causes of vitiligo?
- not completely known
- autoimmune, genetic, inherent defect of melanocytes
How is vitiligo diagnosed?
- clinically
- associated with thyroid disorders (check thyroid labs)
How is vitiligo treated?
- no cure, difficult to treat, no standard treatment
- the more distal, the more difficult to treat*
- high SPF
- systemic phototherapy to stimulate melanocytes (2-3x/wk, >6 months to see results, high risk of burning)
- excimer laser for small patches (like phototherapy)
- topical therapy (topical steroids, immunomodulators-protopic, elidel)
- depigmentation therapy–permanent!
- surgical: skin grafting, tattooing
- mental health referral
What is urticaria?
hives, most common derm presentation
- raised, well circumscribed lesion of erythema and edema (wheal)
- dermis + epidermis
- VERY pruritic
- lasts 6 weeks
What are causes of urticaria?
- release of histamine and other vasoactive substances in the dermis
- causes: infection, foods, meds, skin pressure, heat, cold, stress, pregnancy, sun exposure, chronic mental illness
What are other clinical features of urticaria?
- dermographism-scratching cuases hives
- angioedema-swelling of deeper tissue: lips, tongue, larynx
- fever, arthralgias, weight changes
What is the workup for urticaria?
no labs needed unless chronic:
CBC, TSH, ANA
What is the treatment for urticaria?
- ED if life threatening allergic reaction
- antihistamines (first line, usually works)-benadryl
- avoid systemic steroids
- xolair: biologic for chronic idiopathic urticaria
- remove offender
- epipen rx
What are pressure ulcers?
- an area of unrelieved pressure over a defined area, usually over a bony prominence, resulting in ischemia/cell death/tissue necrosis
- due to many factors: immobility, nutritional status, malignancy, incontinence
What are the stages of ulcers?
Stage1- intact skin w/ signs of impending ulceration-initially non blanchable erythema = reactive hyperemia
Stage 2 - partial thickness loss of skin involving epidermis and dermis
Stage 3 - full thickness loss of skin: into subcutaneous tissue but not through underlying fascia
Stage 4 - full-thickness tissue loss with extension into muscle, bone, tendon or joint capsule
*unstageable - full-thickness tissue loss –base of ulcer covered by slough or eschar so much that cannot determine full wound depth
What is the work up for pressure ulcers?
- wound cultures, blood cultures (rule out sepsis)
- CBC, UA, protein, albumin
- Xray, bone scan, MRI (osteomyelitis)
What is the treatment?
- divided into operative and nonoperative messages
- stage 1 & 2 ulcers: conservative (nonoperative)
- stage 3 & 4: surgery, flap reconstruction, some must be treated conservatively due to coexisting medical problems
- 70-90% pressure ulcers are superficial and heal by second intention
- reduce pressure
- debridement of necrotic & devitalized tissue
- meticulous wound care
What are the complications of pressure ulcers?
- osteomyelitis
- pyarthrosis
- sepsis
- malignant transformation
What is the prognosis for pressure ulcers?
- 60,000 deaths/year due to complications
- for patients w/ same underlying illness, the patient with the pressure ulcer as 4.5x higher risk of death!
What is pilonidal disease?
- cyst that occurs near the tailbone at the top of the cleft of butt
- hair punctures skin and becomes embedded
- infection results in a painful abscess
- most common in young men
What are risk factors of pilonidal disease?
- obesity
- sedentary lifestyle
- excess body hair
- poor hygiene
What are the symptoms that occur with abscess formation in pilonidal disease?
erythema
pain
discharge
What is the treatment of pilonidal disease?
incise and drain abscess
antibiotics
lesions recurrent after incision and drainage
complete excision for recurrent lesions
