Clin Med- Core Derm Disease States and Papulosquamous diseases

acne vulgaris

- open and closed comedomes, erythematous papules, pustules, nodules, and cystic lesions on face, neck, chest, and back

-caused by excess sebum, plugged follicles, overgrowth of P. acnes

sx of acne vulgaris

- Mild tenderness

- Pain

- Excoriations/itching

treatment of comedonal acne

benzoyl peroxide topical and wash

topical retinoids

topical abx

Tx for papular/pustular acne (inflammatory)

all of comedonal PLUS

oral abx (monocycline, doxycycline)

oral contraceptive

tx for severe cystic ance

all of inflammatory acne OR

Isotretinoin (accutane)

perioral dermatitis

-often mistaken for acne

- erythematous papules/pustules usually in kids or adult females

- can be periorbital and/or in alar creases and called periorificial dermatitis

"cousin to rosacea"

perioral dermatitis tx

oral antibiotics

topical antibiotics

NOT steroids

rosacea

- erythema of cheeks with telangiectasias, flushing, rhinophyma, papules/pustules

- found on the face, neck, chest, ocular

- neurovascular inflammation

sx of rosacea

ophthalmic symptoms

pain

flushing

Rosacea treatment

- topical metronidazole, azelaic acid, ivermectin topical

- oral antibiotics (mino or doxy)

- avoid triggers (heat, spicy, alcohol, sun)

exanthems

generalized rash/eruption

- acute scarlet fever/strep

-acrodermatitis

-fifths disease

-measles

-HF&M

Fifth's Disease (Erythema Infectiosum)

Parvovirus B19

"slapped cheek" look with a subsequent lacy, maculopapular, evanescent rash on the trunk and limbs

common in ages 5-15

Fifths disease treatment

symptomatic

Hand-foot-mouth disease

coxsackievirus

- fever irritability, loss of appetite, blistering

- peeling of palm and soles, nails fall off

treatment of hand foot and mouth disease

symptomatic

measles

AKA rubeola

- koplick's spots (in mouth)

- dry cough/fever/runny nose/pink eye

-blotchy macular rash on face

measles treatment

symptomatic

measles complications

encephalitis, hepatitis, thrombocytopenia

there have been recent outbreaks of

measles

vitiligo

autoimmune destruction of melanocytes causing depigmented patches

- can be associated with systemic disease or idopathic

vitiligo tx

corticosteroids, narrowband UVB, laser, JAK inhibitor

dermablend

makeup to cover vitiligo

melasma

hyperpigmented patches

- cheeks, upper lip, forehead (symmetric)

- caused by sun exposure, hormone (pregnancy)

- most common in young women

treatment of melasma

sun avoidance

physical SPF (zinc oxide/titanium oxide)

hydroquinone 4% BID

tretinoin

laser

diabetic ulcer

deep punched out lesions on lower extremities

PAINLESS

tx of diabetic ulcers

smoking cessation, debridement if necrosis, wet to dry dressings

stasis ulcer

chronic venous stasis

preceded by stasis dermatitis

lower extremities

wide but superficial

tx of stasis ulcers

elevation, wound care, compression sock, check medications

arterial ulcer

- smaller than venous ulcers

- painful punched out appearance, pulseless, area distal to ulcer is cold

URGENT, schedule vascular surgery and stop smoking immediately

decubitus ulcer

bed sore, 4 stages, result of pressure decreasing blood supply

4 stages of decubiti

Stage I: Non-blanching erythema

Stage II: necrosis, shallow ulcer

Stage III: DEEP necrosis, skin loss to fascia

Stage IV: necrosis to muscle and bone

decubitus ulcer tx

PREVENTION

repositioning patients

duoDERM

wet dressing

PO abx if needed

burns (4 degrees)

1st: minor damage to epidermis (no blister)

2nd: extends to dermis (blister) PAIN

3rd: white charred appearance, NO pain!!

4th: subcutaneous tissue into muscle and bone

labs for burns

CBC, CMP, UA, CXR

extensive: consider ABG, EKG

burn treatment

- ABC, 2-18g needle

- sterile water to stop burning process (depends on chemical)

- manage shock

- place foley catheter, NG tube

- Assess for surgical intervention/ transfer

- if superficial and stable: topical silvadene cream

Rule of 9's for burns

Head = 9%

Arms = 18% (9% each)

Back = 18%,

Front/chest 18%

Legs 36% (18% each)

Genitalia = 1

order of topical potency

lotion

low potency

hydrocortisone

super high potency

clobetasol

atopic dermatitis/eczema

eryhtematous scaling papules/plaques, lichenification (chronic)

"itch that rashes"

Triad of atopic dermatitis

Allergic rhinitis

Atopic Dermatitis

Asthma

complications of atopic dermatitis

secondary staph/impetigo

eczema herpeticum

Tx for atopic dermatitis (eczema)

topical corticosteroids (lotion

Nummular Eczema

- pruritic nummular erythematous scaling lesions in young adults and the elderly

- more common in winter (dry)

- more spotty than atopic dermatitis

tx for nummular eczema

topical corticosteroid

atopic precautions

humidifier

increase water consumption

Dyshidrotic eczema

psuedovesicular/vesicular

tapioca appearance (blistery)

very itchy (pruritic)

tx for dyshidrotic eczema

topical steroids

**avoid irritants

Lichen Simplex Chronicus

erythematous or hyper-pigmented lichenified plaques with scale

self perpetuating itch-scratch cycle

keeps patient awake

Tx of LSC

topical corticosteroids

antihistamines

plaque psoriasis

genetics, obesity, injury induced (or vitiligo)

- eryhtematous, well demarcated, silvery scale

Auspitz sign

pinpoint bleeding after a scale is removed (psoriasis)

Plaque psoriasis treatment

topical corticosteroids: high potency ointment to improve outbreak and medium, then low potency to maintain

**never use oral steroids

erythrodermic psoriasis

- erythema with scale covering most of body

- impairs normal function of skin

- evaluate for systemic features

eryhtrodermic psoriasis treatment

cyclosporine, fast acting biologics, hospital if needed for supportive care (fluids)

guttate psoriasis

- occurs after streptococcal pharyngitis or exposure to strep

- 2-10 mm salmon pink papules with or without scales

- may progress into chronic plaque psoriasis

inverse psoriasis

erythematous patches in intertiginous areas (skin folds) without scale

systemic tx if patient desires

pustular psoriasis

life threatening

febrile, leukocytes

side effect of TNF-alpha medication or oral steroid

usually seen on palms and feet in clinic

first approved medication tx for generalized pustular psoriasis

IL-36 inhibitor spivego

seborrheic dermatitis

dandruff, cradle cap

increased sebaceous gland sites

- dry, yellow, oily scare with underlying erythema from Malassezia (yeast)

Seborrheic dermatitis treatment

ketoconazole shampoo, selenium, zinc pyrthioneqq

topical steroid cream/solution

topical antifungal

infants: 1% or 2% ketoconazole shampoo

simple drug eruptions

- appear in second weak of drug therapy with no symptoms or abnormal labs

- most common cause antibiotics (penicillin and quinolones)

complex drug eruptions

- appear 2-6 weeks after drug therapy

- fever, chills, eosinophila, abnormal LFT's and kidney function

- DRESS (drug eruption with eosinophila and systemic symptoms) /DIHS (drug induced hypersensitivity reaction)

- most common cause long acting sulfonamides, allopurinol, and anticonvulsants

Treatment and diagnosis of drug eruptions

- skin biopsy to confirm diagnosis

- discontinue medication and treat systemic manifestations if they arise

- most common are photosensitive medication reactions, drug induced lupus, fixed drug eruptions and urticaria

- Stevens Johnson Sydrome/Toxic epidermal necrolysis pts are critical and need to be managed inpatient as burn patients

drug eruptions

maculopapular, urticaria, angioedema, SJS/TENS, erythema multiforme, fixed drug eruption

Pityriasis rosea

- oval, salmon/fawn colored, collarette scale and "cigarette paper" appearance (herald patch)

- christmas tree pattern, inverse variation

- found on the trunk

Pityriasis Rosea labs and tx

labs: RPR (syphilis)

tx: self limiting 6-8 week course. Topical corticosteroids and/or antihistamines for pruritus

lichen planus

- violaceous, flat topped papules with white streaks (wickham striae)

- drug/medication induced, Koebner phenomenon, spontaneous

location for lichen planus

flexor surfaces and trunk, penis, lips, tongue, buccal mucosa

labs for lichen planus

hepatitis panel

biopsy to confirm dx

Treatment for lichen planus

- high potency topical steroids, tacrolimus in oral and vaginal disease

- oral corticosteroids in severe cases