Pigmentary and Pustular Rashes Flashcards
Etiology of acne
From homrnal changes and effects on secbaceous glands on face, chest and back
Androgens increase and stimulate sbum production as well as folicular growth…the pore becomes opstructed
Obstruction complicated by increased sebrum
Propionibacterium acnes colonizes and serves as grwoth medium…enymes promote inflammation
Acne epidemiology, appearance,
Most in adolescents
Comedones from obstruction of follicle opening…if large then keratin builds up due to increased proliferation and can darken…appearing black…more common in mild acne
Nodules and cysts occur secondary to progressive infllamtion…moderate to severe acne
Levels of acne
Mild - 1/4 of face…comedones, papules, pustules…no nodules or scaring
Moderate - 1/2 of face…comedones, papules, pustules…nodules and a few scares
Severe - 3/4 of the face…comedones, papules, pustules…nodules and scarign
Tx of acne
Mild - tretinoin…normalizes desquamation of follicular epithelium and antiinflam
Moderate - topical retinoid, benzoyl peroxide and or topical AB…benzoyl is lipophilic so can penetrate strateum cornem..generates fre rads that oxidize proteins…clinda/erythro will decrease protein synthesis
Severe - treated with all and can add oral AB or consider isotretinoin that targets all 4 areas of pathogenesis
What targets
Androgen
Follicular grwoth/diff
Colonization of bacterai
Immune response
Oral contraceptive pills
Topical retinoid/isotretinoin
ABs and benzoyl peroxide
Multuple agents
Rosacea etiology/epidemiology
Activation of innate immune system with vascular hyperactivity that results in delayed clearance of inflammatory mediators
Men and women over 30
Rosacea appearance, distribtuon, exacerbating, tx
Erythema, telangiectasieas, papules or pustules
Nose, cheeks, chin
Alcohol, hot bevarges, spicy food
Metronidazole (topical AB)
Perioral dermatitis etiology, epi, appearance, dsitribution, tx
After top or inhalaed CSs
More in women
SMall <2mmm papules, pustules with erythematous base…NO comedones
Around moth
Metronidazole
Folliculitis etiology, appearance, distribtuon, tx
Superficial infection of follicle by S aureus
Pustule on hair follicles
Beard, pubic, axillae, thighs
Topical (mupirocin and clinda) as well as oral (trimethoprum-sulfamethoxand clindamycin) are accetpable
Cephalexin if low MRSA concern
Pityriasis versicolor (tinea versivcolor)
Epi/etio
Appeerance, dsitribtuion, sx, diagnosis, tx
Common fungal from malassezia
Adults
Hot and humd
Small hypopigmented or hyperpigmented round macules
Trunk, extremities, neck
Pruritis
Clinical…can use KOH (spaghetti and MBs)
Topical azoles (clotrimazole and ketoconazole) can be used…for more widespread dz, slenium snmphoo
Persistent tx with fluconazole
POst inflammatory hypo/hyperpigmentation
etiology, appearance, tx
Macules and aptches due to inflam melanocyte damage
Loss or gain of pigment…no depigmentation and indistinct borders
Resolves over months
Vitiligo etiology, appearance, distribtuion, tx
COmplete depigmentation from AI melanocyte destruction
Well defined macules and patches
Areas prone to trauma like knees and elbows…generalized starts on extremities…segmental is dermatomoal
Refer to dermatology
Acanthosis nigricans
Etiology, appearance, dsitr, tx
Epidermal proliferation with little increase in melanini…obesity or diabetes
Velvet thickening of skin
Neck, axillae, groin
Consider fasting glucose
Melasma etiology, epidemiology, appearance, dist, tx
Hypermelanosis of sun exposed areas…both genetic and hormona
Rarely occurs prior to puberty
Borwn macules with irregular borders
Symmetirc, reticular, lacy-like pattern or sun exposed
Remove the offending agent…skin lightening are mainstays of tx…tri-luma combines hydroquinone, tretinoin and fluocinolone
Solar lentigo etiology, epidem, appearance, dsitr, tx
UV exposrue causes local prolif of melanocytes
Common in thoe>40 y/o
Round, oval, irregular hsaped, circumscribed patch that is brown, black or tan
Face, dosral surface of hands
Sun protection and cryotherapy
