Derm Part 1 (CMPP)

A lesion that appear coral red under Wood’s Lamp is likely

Erythrasma

A lesion that appear organe under Wood’s Lamp is likely

Tinea versicolor

A lesion that appear blue under Wood’s Lamp is likely

Tinea capitis-

A lesion that appear yellow under Wood’s Lamp is likely

Tinea capitis-

A lesion that appear green under Wood’s Lamp is likely

Pseudomonas

What is the use of KOH prep wet mounts in derm

dx fungal infections

What biopsy can be done in derm

Shave

Punch

Excisional

What considerations must be done for darker skin in derm

Erythema may be particularly challenging to detect. It may appear dark brown or violaceous instead of pink or red

Typical erythematous and scaly lesions of eczema may appear as scaly lesions with a grayish, violaceous, or dark brown hue

Wheals of urticaria appear skin-colored or paler because dermal edema lightens the skin

Purpura may be difficult to detect, as it may be obscured by the skin color

Dry skin may have a whitish color and a reduction in skin shininess

Post-inflammatory hypopigmentation and hyperpigmentation are exaggerated in darkly pigmented skin compared with lighter skin

Primary skin lesions

Lesions present at onset of disease

Secondary skin lesions

Skin lesions caused by changes over time caused by disease progression, manipulation (scratching, picking, rubbing), or treatment.

Vesicle

an elevated, circumscribed, superficial, fluid-filled blister <5 mm in diameter

Bulla

a blister >5 mm in diameter

Cyst

an elevated, circumscribed area of the skin filled with liquid or semisolid fluid

Macule

a flat, circumscribed area; can be brown, red, white, or tan; <1 cm

Papule

an elevated, palpable, firm, circumscribed area generally <5 mm in diameter

Nodule

 an elevated, firm, circumscribed, and palpable area >5 mm in diameter

Plaque

an elevated, flat-topped, firm, rough, superficial papule >2 cm in diameter; papules can coalesce to form plaques

Pustule

an elevated, superficial area that is similar to a vesicle but filled with pus

Wheal

an elevated, irregularly shaped area of cutaneous edema; wheals are solid, transient, and changeable, with a variable diameter; can be red, pale pink, or white.

Lesion Type

Vesciles

Lesion Type

Bullae

Lesion Type

Cyst

Lesion Type

Macule

Lesion Type

Papule

Lesion Type

Nodule

Lesion Type

Plaque

Lesion Type

Pusutle

Lesion Type

Whals

Lesion Type

Wheal

Types of Primary Skin Lesions

Vesicles

Bulla

Cyst

Macule

Papule

Nodule

Plaque

Pustule

Wheal

Types of Secondary Skin Lesions

Crust

Excoriation

Lichenification

Scale

Erosion / Ulceration

Scar

Keloid

Crust

a slightly elevated area of variable size; consists of dried serum, blood, or purulent exudate

Excoriation

linear scratches that may or may not be denuded

Lichenification

rough, thickened epidermis; accentuated skin markings caused by rubbing or scratching

Scale

heaped-up keratinized cells; flakey exfoliation; irregular; thick or thin; dry or oily; variable size; can be white or tan

Erosion/ulceration — loss of epidermal tissue

— loss of epidermal tissue

Scar

collection of fibrous tissue to replace lost epidermal/dermal tissue

Keloid

augmentation of fibrous tissue beyond edges of original defect

Lesion Typre

Crust

Lesion Type

Excoriation

Lesion Type

Lichenification

Lesion Type

Scale

Lesion Type

Erosion-

Lesion Type

Ulceration

Lesion Type

Scar

Lesion Type

Keloid

Blaching in derm evaluation indications

Intact capillaries

Darier’s sign

rubbing a lesion causes an urticarial flair

Often seen with macrocytosis

Darier’s sign

Auspitz’s sign

Pinpoint bleeding after scale removed

Often seen with psoriasis

Auspitz’s sign

Nikolsky’s sign:

Pushing a blister causes further separation of the dermis

Often seen with Steven-Johnson’s syndrome, staph scalded skin syndrome

Nikolsky’s sign:

Koebner’s phenomenon

Minor trauma leads to new lesions at site of trauma

Many conditions: esp. psoriasis, vitiligo, lichen planus

Koebner’s phenomenon

Shagreen skin

Shagreen skin

Oval-shaped nevoid plaque.

Skin colored or pigmented on trunk/back that is associated with tuberous sclerosis

Indication for Solutions for Derm Issues

Hairy areas

Indication for Lotions for Derm Issues

Condition ooze / crust

Easy to spread

Indication for cream for Derm Issues

Condition ooze / crust

Palms / Soles

Indication for ointment for Derm Issues

Most hydrating

Dry scaling lesions

Palms and Soles

Indication for gel for Derm Issues

Easy spread

hair areas

Indication for foam for Derm Issues

Hairy area

Indication for powder for Derm Issues

Drying effect

Good for folds

Acne Vulgaris

Acne Vulgaris

Acne Vulgaris

Acne Vulgaris

Acne Vulgaris

Common chronic skin disease involving blockage and/or inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland)

Most common skin disease in the US

Acne Vulga

What factors lead to Acne Vulgaris

Release of inflammatory mediators into the skin

Follicular hyperkeratinization with subsequent plugging of the follicle

Cutibacterium acnes follicular colonization

Excess sebum production

What regulates sebum production

Androges

How does progesterone effect androgens

Inhibits conversion

What factors can worsen Acne Vulgaris

Cosmetic agents

Medications

Excess androgens/hormonal changes

Mechanical occlusion

Excessive sunlight

Stress

What medications worsen acne

Steroids,

lithium,

some antiepileptics

What medical conditions worsen acne

PCOS

Congenital adrenal hyperplasia

Pregnancy

Presentation of Acne Vuglaris

Non-inflammatory papules

Open (blackheads) or closed comedones (whiteheads)

Inflammatory papules

Pustules and nodules

Dense sebaceous follicles

Most Common Locations for Acne Vulgaris

Face

Upper Chest

Back

Stages of Acne

Stage 1 → Comedones; few papules

Stage 2 → Comedones, papules, few pustules

Stage 3 → Comedones, papules, pustules, few nodules

Stage 4 → Comedone, papules, pustules, nodules, cysts

dx of Acne Vulgaris

Clinical

Patient Education for Acne Vulgarism

AVOID SQUEEZING/PICKING LESIONS

gentle cleanser such as Cetaphil, Neutrogena, or Purpose

Apply non-comedogenic moisturizer (Cetaphil, CereVe, or Neutrogena) with an SPF

Wash face BID with low pH face wash

Wash with warm not hot water and do not scrub aggressively

Improvement may take at least 2-3 months

using cosmetics, use water-based and oil free

How does stage of acne effect treatment

Early stages can be treated topically

Late stage often needs combination of topical and oral

Topical 1st Line Acne Treatments

Topical Retinoids

Benzoyl Peroxide

Topical Antibiotics

MOA of Topical Retinoids

Vitamin A derivative

Reduces abnormal desquamation, comedolytic, and have some anti-inflammatory effects

tretinoin (Retin A),

Topical Retinoids

adapalene (Differin)-

Topical Retinoids

tazarotene (Tazorac and Avage)

Topical Retinoids

What topical acne treatment cannot be used wih fish allergy

Microsphere gel formations of topical retinoids

SE of Topical Retinoids

skin irritation

sun sensitivity

first line for mild comedonal acne

Topical retinoid with/without benzoyl peroxide

If using topical retinoids with other topical agents for acne, what should be done

Apply at different times

MOA of Benzoyl peroxide

Antimicrobial with some keratolytic effects

SE of Benzoyl peroxide

skin irritation,

bleaches clothing

What acne treatment bleaches clothes

Benzoyl peroxide

Role of Topical Abx for Acne

Role against C. acnes (formerly P acnes) and anti-inflammatory

Can develop resistance

Not comedolytic

What should used with topical abx for acne

benzoyl peroxide

What should not be given if treating acne with topical abx

oral abx

What abx are used topically for acne

Clindamycin

Erythromycin

Dapsone

Topical Agents for Retinoid Resistant Acne

Salicylic acid

Azelaic acid

Topical clascoterone (Winlevi

Azelaic acid

Topical agent FDA approved for rosacea but often used for acne