Six Derm topics in sixty minutes Flashcards
Topics included in 6-lectures in 60minutes of derm
- tropical and travel dermatology
- urticaria (hives)
- pyoderma gangrenosum
- black and ethnic skin
- mycosis fungoides (cutaneous t-cell lymphoma)
- drug rashes
Topics under tropical and travel dermatology
- bot fly miasis
- cutanea larva migrans
- leishmaniasis
Etiology of bot fly miasis
- dermatobia hominis
- central and south america
- female bot flu uses mosquitoes to transmit eggs
Presentation of bot fly miasis
- tender red nodule with 2-3mm opening
- scalp, face and upper body
- enlarges, drains, more painful, necrotic
- 1 to 1.5cm soft white larvae with spicules
Etiology of Leishmaniasis
Parasite, many leshmaniasis species
- transmitted by sandflies
- can be cutaneous, mucocutaneous, systemic
- in the old world, was common in europe, asia and africa
- new world, common in americas = l. mexicana, l. brazilensis, l. peruviana
Presentation and treatment of leishmaniasis
- asymptomatic, red-violaceous ulcer with raised edges
- tx –> complicated in US –> CDC typing
Etiology of cutanea larva migrans
- creeping eruption
- ancyclostomia braziliense hookworm
- beach, sandy soils, sandbox, children
- hookworm eggs passed from anima feces
- larvae penetrate skin
presentation of cutanea larva migrans
- red winding serpigenous tract
- 2 to 4 weeks after returning from a beach vacation
Appearance cutaneau larva migrans
Serpiginous lesion usually on the feet
Characteristics of Urticaria
Can be acute or chronic
- triggered by foods, medications or other allergens
Appearance of urticaria
pruritic, red-pink, polycyclic wheals
- coalesce, migrate, recur
- variations: physical, cold, solar, cholinergic
Urticaria associated with:
Thyroid disease, viral infections, occult abscess
Urticaria Pigmentosa
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Characteristics of Pruritic Urticarial Papules and Plaques of Pregnancy
Appear on the belly
- look like stretch marks
Characteristics of Pyoderma gangrenosum
- inflammatory skin disease, results in ulceration, necrosis
- starts with mild trauma, rapidly expands
- ulcer with undermined border; neutrophilic inflammatory pattern; pathergic response
- Assoc. with inflammatory bowel disease (30%)
Appearance of pyoderma gangrenosum
lesions are multiple, ulcerations, necrotic, on the legs, very painful
- can ulcer straight to the bone
Treatment of pyoderma gangrenosum
Immunosuppression (steroids, cyclosporine, infliximab)
Diagnosis of Pyoderma gangrenosum
Often misdiagnosed as an infection, vasculitis, sweet’s syndrome –> often expensive with surgical debridement
How are appearances on ethnic skin different?
Varying clinical appearances, same diseases
- epidemiology is different in different races and ethnicity
- skin types 1-6
Skin color and pigmentation changes in black skin color
Epidermis is thicker More melanin in cells at BM Hair follicles at acute angle Larger and more number of melanosomes Same number of melanocytes
Black or ethnic skin problems
Keloids Pomade acne Skin cancers Traction alopecia Sarcoidosis - look like anything Lung involvement
Skin Cancer types in ethnic skin
Melanoma - 10 times greater in whites - more common in acral sites, looks really dark Basal Cell Carcinoma - uncommon in African-Am. - similar distribution to whites - most likely pigmented BCC type - looks pearly Squamous Cell Carcinoma - Most common skin cancer in black skin
Mycosis Fungoides (CTCL)
- variant of CTC lymphoma
- systemic lymphoma, presents in the skin
- Sezary syndrome is the systemic erythroderma variant of CTCL, in which the entire body is warm, inflamed and exfoliative.
- Many stages: MF, patch, plaque, tumor
Appearance of Mycosis Fungoides
- presents as thin, pink, scaly patches, over the trunk, resemble eczema and psoriasis.
- Sometimes termed “parapsoriasis.”
- Patch and plaque stage CTCL may show annular, round, oval, arcuate, serpiginous elevated plaques, which migrate and expand and ulcerate. Can also be nodules
- appear anywhere and behind legs, face, back of head, ears
List of drugs rashes
- Urticarial
- morbilliform
- fixed drug eruption
- acute generalized exanthematous pustulosis
- coumadin/warfarin necrosis
- pigmentary drug rashes
- erythema multiforme minor or major
- toxic epidermal necrolysis
- photo-toxic drug eruption
Appearance of urticarial drug rash and morbilliform drug rash
urticarial = polycyclic rings morbilliform = small blotches all over body. Can be pruritic
Appearance of fixed drug eruption
can look like small blisters, can scar, can look erythematous
Locations of Photo-allergic/toxic/induced drug eruption
Areas exposed to the sun - face, hands, feet, above the lip
Locations of acute generalized exanthematous pustulosis
Usually in folds of the skin like the neck
Warfarin or coumadin necrosis appearance
looks like a big ecchymosis
black and blue
Pigmentary drug eruptions appearance
usually above the lips, face and nails
appearance of erytherma multiforme
- circular red macules with central darker red lesions
- hands and lips, can be on arms
- can be big or small
- can ulcerate a little
- can also look like dark - blisters on the mouth
Appearance of steven-johnson syndrome
SJS –> there is sheet like skin and mucosal loss
- nearly always caused by medications
- starts as high persistent fever, cough, sore throat, conjunctivitis
- then rash spreads from body to face and limbs
- rash is either macules, targets (like in erythema multiforme) or flaccid blisters
- at least two mucosal surfaces are affected
What is erythroderma?
Intense reddening of the skin that is preceded by or associated with exfoliation (exfoliative dermatitis)
Sezary syndrome is a systemic erythroderma variant of CTCL, in which the entire body is warm, inflamed and exfoliative.
Characteristics of toxic epidermal necrolysis
can be wide pruritic macules or flat atypical targets
OR it can appear as large epidermal sheets and no pruritic macules
- healing without scarring
Staphylococcus Scalded Skin Syndrome
Need to exclude this to diagnose SJS and TEN
- Need to biopsy to diagnose
- Sheets of skin peel off, large blisters/bullae appear
- starts around eyes and mouth then spread to other areas of the body
