Derm E2: need to know

based off her announcement

What are precancerous lesions?

actinic keratosis, cutaneous horns, keratoacanthoma, congenital melanocytic nevus, dysplastic nevus

What are cancerous lesions?

Basal cell carcinoma, squamous cell carcinoma, Merkel cell, Melanoma, mycosis fungoides

What precancerous lesion is a precursor lesion to SCC?

actinic keratosis

What is a precursor to malignant melanoma?

dysplastic nevus

What is the diagnostic workup for Actinic Keratosis?

clinical or dermoscopy; bx if uncertain

What is the tx for Actinic Keratosis?

• topical fluorouracil

• severe: cryo

• resistant: curettage

• suspicion of SCC: excision

What is the dx & tx for a Cutaneous Horn?

excisional biopsy

What is the diagnostic workup for Keratoacanthoma?

biopsy

What is the tx for Keratoacanthoma?

surgical excision or Mohs (for face lesions)

What is the diagnostic workup for a Congenital Melanocytic Nevus?

clinical or dermoscopy

What is the tx for a Congenital Melanocytic Nevus?

can remove when old enough to tolerate anesthesia

What is the diagnostic workup for a Dysplastic Nevus?

digitalized dermoscopy

What is the tx for a Dysplastic Nevus?

surgical excision if suspicious

What is the diagnostic workup for Basal Cell Carcinoma?

skin biopsy

What is the tx for BCC?

excision (Mohs)

What is the diagnostic workup for Squamous Cell Carcinoma?

skin biopsy or dermoscopy

What is the tx for SCC?

surgical excision (Alt: Mohs)

What is the diagnostic workup for Merkel Cell Carcinoma?

skin biopsy, get imaging for staging & to check for metastasis

What is the diagnostic workup for Melanoma?

thorough history, ABCDEs, dermoscopy, excisional biopsy, find Clark level (1-5)

What is staging 1 &2?

negative lymph node (lymph mapping, CXR, labs)

What is staging III?

positive lymph node (lymph mapping, CXR, labs, CT, PET)

What is staging IV?

metastasis (lymph mapping, CXR, labs, chest CT, MRI brain, bone scan, GI series)

What is the tx for Melanoma?

early: excisional biopsy

stage 4: chemo

What are the different types of Melanoma?

• Superficial Spreading: MC

• Nodular Melanoma

• Lentigo Maligna Melanoma

• Acral Lentiginous Melanoma (MC in darker skins)

• Amelanotic Melanoma (no pigment)

What is the diagnostic workup for Mycosis Fungoides?

skin biopsy

What is the tx for Mycosis Fungoides?

UVA phototherapy, steroids, topical chemo, radiation

What is the cause behind Erythema Nodosum?

delayed hypersensitivity rxn caused by drugs

What is the cause behind Erythema Multiforme?

acute immune mediated rxn; caused by bacterial, fungal, or viral infx (especially HSV & mycoplasma), or by malignancy or meds

What is the cause behind Erythema Migrans?

lyme disease (black deer tick)

What is the clinical presentation of Erythema Nodosum?

erythematous tender nodules on shins

What is the clinical presentation of Erythema Multiforme?

target-like lesions

Minor: little/no mucosal involvement, extremities & spreads inward, HSV

Major: mucous membrane involved, caused by drug rx

What is the clinical presentation of Erythema Migrans?

bull’s eye (similar to multiforme), fever, chills, HA

What conditions are associated w/ Erythema Nodosum?

sarcoidosis, GI disease, strep, malignancy

What conditions are associated w/ Erythema Multiforme?

infections, malignancy, sarcoidosis, hormone issues, COVID

What conditions cause hyperpigmentation?

Melasma, Acanthosis Nigricans, Post inflammatory hyperpigmentation

What conditions cause Hypopigmentation?

Vitiligo, Albinism, Post inflammatory hypopigmentation

What causes Post inflammatory hyperpigmentation?

acne, lichen planus, dermatitis → hyperpigmented macules or papules

What causes Melasma?

hyperfunctional melanocytes

What causes Acanthosis Nigricans?

elevated glucose or metabolic syndrome → thick velvety hyperpigmented plaques

What causes Post inflammatory hypopigmentation?

chemical leukoderma, drug induced leukoderma, halo nevus, psoriasis, pityriasis versicolor → hypopigmented macules & patches

What causes Vitiligo?

usually thyroid or DM related, loss of melanocytes in epidermis → sharply marginated depigmented macules & patches

What causes Albinism?

congenital reduction or absence of melanin → hypopigmented macules/patches, usually have eye symptoms too

What is the criteria of a 1st degree burn?

superficial epidermis only, pain, erythema, heals w/in 3-6 days

What is the criteria of a 2nd degree burn?

partial (epidermis & dermis), painful, weeping, blistering, can take 3 weeks to heal

What is the criteria of a 3rd degree burn?

full (epidermis, dermis, & SC), no pain, waxy, gray/white, need surgical tx

What is the criteria of a 4th degree burn?

full (SC, muscle, fascia, bone), no pain, life threatening, need surgical tx

Know how to calculate % TBSA w/ Rule of 9s

What is the burn center criteria?

• partial burns >10% TBSA

• burns on face, hands, feet, genitalia, major joints

• 3rd degree +

• electrical & chemical burns

• burned children in hospitals w/o qualified personnel

• burn in pts who require special social, emotional, or rehab intervention

What is the clinical presentation of Acute Cutaneous Lupus?

malar or butterfly rash, morbilliform rash (red eruption on sun exposed areas)

What is the clinical presentation of Subacute Cutaneous Lupus?

papules, psoriasiform, or annular plaques

What is the clinical presentation of Chronic Discoid Cutaneous Lupus?

(MC type) indurated plaques w/ well formed scale in hair follicle, plaques heal & leave scars & pigmentation

What is the clinical presentation of Chronic Lupus Panniculitis?

painful nodules → scarring

What is the prevention and tx for Cutaneous Lupus?

SPF, steroids (topical, IL or oral); antimalarial drugs if refractory

What forms of Lupus can include vascular manifestations?

all of them

What is the clinical presentation of Behcet Syndrome?

recurrent apthous & genital ulcers, cutaneous lesions

What would the lab findings of Behcet Syndrome?

>3 oral apthae in 1 yr + genital ulcers, eye lesions, skin lesions, can do pathergy test (would be +)

What is the tx for Behcet Syndrome?

• aphthous and genital ulcers

  • topical glucocorticoids +/- topical sucralfate

• Recurrent ulcers

  • Colchicine 1-2 mg/day divided twice daily

• Refractory lesions

  • Prednisone 15 mg/day and taper down
    or Azathioprine 50 mg daily

What is the clinical presentation of Dermatomyositis?

proximal muscle weakness, Gottron’s papules, Heliotrope eruption (periorbital skin), Shawl sign (on neck/shoulders)

What would the lab findings of Dermatomyositis show?

CK, aldolase, LDH, ANA, Anti-Mi-2, Anti-Jo antibodies

What is the tx for Dermatomyositis?

Hydroxychloroquine + Methotrexate

What would the lab findings of Cutaneous Lupus show?

ANA positive

What is the clinical presentation of Scleroderma?

pruritus, edema, thickening skin, raynauds, painful ulcer in DIP & PIP, sclerodactyly

What would the lab findings of Scleroderma show?

ANA +, ACA & Anti-Scl-70 Ab sometimes

What is the tx for Scleroderma?

Methotrexate

What is the clinical presentation of Raynauds?

digital color changes, numbness, pain

What is the tx for Raynauds?

CCBs (amlodipine)

What is the clinical presentation of IgA Vasculitis?

palpable purpura, arthritis, arthralgia, abd pain

What would the lab findings of IgA Vasculitis?

leukocytoclastic vasculitis in postcapillary venules w/ IgA deposition

What is the tx for IgA Vasculitis?

supportive analgesics; hospital if Sx are severe

What is the clinical presentation of Polyarteritis Nodosa?

purpura, painful nodules, ulcers, necrosed skin

What would the lab findings of Polyarteritis Nodosa?

ANCA, ANA, complement PTNs

What is the tx for Polyarteritis Nodosa?

prednisone, severe: azathioprine or MTX

What is the clinical presentation of Kawasaki Disease?

children, fever, erythema & edema w/ desquamation, bilateral conjunctivitis, cracked cherry red lips, cervical LAD

What would the lab findings of Kawasaki Disease show?

high LFTs/ESR, leukocytosis, thrombocytosis, anemia, pyuria

What is the tx for Kawasaki Disease?

IVIG infusion (slowly) and aspirin

What is the clinical presentation of Sarcoidosis?

papules, plaques, lupus pernio (violet infiltrate on nose), erythema nodosum

What would the lab findings of Sarcoidosis show?

apple jelly semi translucent on diascopy, noncaseating granuloma

What is the tx for Sarcoidosis?

intralesional or topical steroids; if systemic → oral steroids; refractory MTX or hydroxychloroquine

What is the clinical presentation of Granulomatosis w/ Polyangiitis?

necrotizing granuloma in URT/lungs, vasculitis, glomerulitis

What would the lab findings of Granulomatosis w/ Polyangiitis show?

anemia, leukocytosis, high ESR, impaired renal function, RBC casts, anti-neutrophil cytoplasmic antibodies

What is the tx for Granulomatosis w/ Polyangiitis?

cyclophosphamide or rituximab & prednisone, followed by maintenance w/ MTX or rituximab or azathioprine

What is the clinical presentation of Bullous Pemphigoid?

bulla, pruritus

What would the lab findings of Bullous Pemphigoid show?

none, just do biopsy

What is the tx for Bullous Pemphigoid?

clobetasol or PO steroid or doxy

What is the tx for Erythema Nodosum?

if moderate NSAID, if severe PO steroid

How do you dx Pityriasis Rosea?

clinical dx: look for Herald patch or Christmas tree pattern of scaly oval pink/hyperpigmentated papulosquamous lesions

What is the tx for Pityriasis Rosea?

sx relief w/ med potency topical steroids for pruritis

How do you dx Granuloma annulare?

dx w/ biopsy to confirm (can do KOH to r/o tinea)

What is the tx for Granuloma Annulare?

topical or IL steroids

How do you dx Lichen Planus?

+Koebner, dermoscopy, or biopsy; look for Wickham Striae & 6 Ps (pruritic, purple, polygonal, planar, papules, plaques)

What is the tx for Lichen Planus?

super high potency top steroids

How do you dx Erythema multiforme?

w/ biopsy; minor will NOT have mucous involvement, major will

What is the tx for Erythema Multiforme?

Sx: antihistamines, analgesics, top med potency steroids, acyclovir if HSV

How do you dx Melasma?

clinical dx

What is the tx for Melasma?

Hydroquinone or Retin-A, can also do chemical peels or oral tranexamic acid

How do you dx Vitiligo?

biopsy, do labs to r/o other conditions

What is the tx for Vitiligo?

localized: top steroids or calcineurin inhibitors

refractory/disseminated: UVB phototherapy

How do you dx Albinism?

clinical dx

What is the tx for Albinism?

prevent w/ sunscreen & eye protection

What is a stage 1 ulcer?

intact skin, impending ulceration