Derm PPT PDF 40-190 PDF

Perioral Dermatitis Topical: metronidazole (first Systemic: tetracycline or line), erythromycin or...

Perioral Dermatitis Topical: metronidazole (first Systemic: tetracycline or line), erythromycin or doxycycline or minocycline clindamycin (second line) (first line), erythromycin (second line) The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Perioral Dermatitis Do not use topical steroids. Avoid known triggers Avoid inhaled steroids if Can recur possible The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Acneiform Eruptions Folliculitis Folliculitis is an inflammation of hair follicles, most commonly caused by bacterial infection Several variants of folliculitis: – Bacterial: staph aureus or pseudomonas (hot tub) Deep bacterial folliculitis called sycosis – Fungal: pityrosporum orbiculare – Mechanical: traction, hair removal, friction – Pseudofolliculitis: ingrown hairs, esp in beard area The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Folliculitis Pathogen enters hair follicle à inflammatory response à peri follicular infiltrate of lymphocytes/neutrophilsà pustule formation Can be caused by staph aureus, pseudomonas, HSV, tinea barbae The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Folliculitis Itching or burning in hairy areas Bumpy rash in distribution of hair follicles Pustules in hair follicles Sycosis: Deep-seated, chronic, recalcitrant lesion on head and neck Hot tub: Pruritic or tender follicular or pustular lesions within 1–4 days after bathing in a hot tub, whirlpool, or swimming pool Pseudofolliculitis: more frequent in black males, papules and pustules at the site of follicles Fungal: 1-2mm pruritic pink papulopustules in the upper trunk and arms, often after periods of sweating The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Folliculitis  Folliculitis Bacterial (simple): topical mupirocin Fungal: topical azoles (clotrimazole, Bacterial (deep or extensive): ketoconazole), shampoo with azole, cephalexin selenium, or zinc Pseudomonas: usually resolves Sycosis or folliculitis in densely haired untreated, but if extensive give areas may require 4-8 weeks of ciprofloxacin treatment Patient Education Correct predisposing causes (friction, Stop shaving- laser hair removal can be oils) very beneficial if persistent Control blood glucose if diabetic pseudofolliculitis Be sure water in hot tubs is treated properly The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. PAPULOSQUAMOUS DISORDERS Atopic dermatitis Contact dermatitis Dyshidrotic eczema Nummular eczema Seborrheic dermatitis Lichen Planus Pityriasis Rosea Psoriasis  Papulosquamous Overview Presents with both papules, scales, and plaques “Eczema” is a general term used to describe several types of dermatitis The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Papulosquamous Disorders Atopic Dermatitis Onset in childhood in most patients. Tendency to recur. Personal or family history of allergic manifestations (asthma, allergic rhinitis) Psychosocial effects (sleep disturbance, fussiness in children, missed work, social isolation) “the itch that rashes” The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Atopic Dermatitis Affects 20% children in Rates rising in developed developing countries countries, stabilized in developing countries 90% have onset before age 5 Strong correlation with development of asthma Not entirely understood Genetic factors Environmental triggers/risk Association with food factors allergies controversial The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Atopic Dermatitis Decreased skin barrier function: reduced ceramide levels, increased trans epidermal water loss. Soaps/detergents increase skin pH increase activity of protease further breakdown of epidermal barrier function. Or skin is exposed to an allergen, causing release of pro- inflammatory chemicals like histamine/leukotrienes/ proteases These chemicals dilate blood vessels allowing inflammation/edema of skin The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Atopic Dermatitis Rash Itching (worse at night) Personal or family h/o asthma Acute: pruritic, erythematous Chronic: thickened plaques papules with excoriation, vesicles over erythematous skin, serous (lichenification) exudate. Most common in flexor surfaces The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Atopic Dermatitis Clinical diagnosis The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Atopic Dermatitis Education (skin care, use of emollients, avoidance of irritants, avoidance of allergens) Topical glucocorticoid therapy (do not use ultra high potency of face) Topical immunosuppressant (ie Tacrolimus) Oral antihistamines Management of secondary infections (Cephalexin, mupirocin ointment) Ultraviolet light therapy Systemic immunosuppressant agents The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Atopic Dermatitis Secondary infections (staph, Skin atrophy/striae due to herpes) topical steroids The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Atopic Dermatitis  Papulosquamous Disorders Contact Dermatitis Skin comes into contact with allergen (example: nickel) or irritant (example: hand sanitizer) – ACD – ICD May present with varied appearance, so history is key Occupational exposures are common Includes rhus dermatitis (poison ivy, oak, sumac) The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Contact Dermatitis Most common occupational skin Hands affected in 64% of disease in the United States. occupational allergic, 80% Accounts for 30% of all cases of occupational disease in irritant cases. industrialized countries. Allergic: nickel, fragrance, Irritant: soap, detergents, neomycin disinfectants, acids/alkalis The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Contact Dermatitis Personal care products Pain, burning, stinging early, Occupation then itching Onset of symptoms within minutes/hours Rash localized to area of In ICD, macular erythema, contact hyperkeratosis, fissuring Varied appearance common dependent on allergen The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Contact Dermatitis  Contact Dermatitis Usually clinical diagnosis Can use patch testing (ONLY POSITIVE IN ACD) No specific diagnostic criteria The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Contact Dermatitis REMOVE TRIGGER For ICD, identification and elimination of the irritant. Can use topical steroids in the short term, not for long term use. The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Contact Dermatitis AVOIDANCE AVOIDANCE AVOIDANCE The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Contact Dermatitis Secondary infection Generally good if avoidance Persistent post occupational maintained exposure in 11% of individuals The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Papulosquamous Disorders Dyshidrosis Also referred to as vesicular palmoplantar eczema or pompholyx Endogenous Chronic, relapsing, eruptions of vesicles (dyshidrosis) or bullae (pompholyx) Palms and soles most common Etiology unclear (contact allergy, stress, hot weather) Medium/high potency steroids The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Dyshidrosis/Pompholyx  Papulosquamous Disorders Nummular eczema Also known as discoid eczema Nummular = “coin shaped” Often chronic/recurring The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Nummular Eczema Mostly adults Men more than women Peak 50-65 Unclear- usually no history of atopy ? Role of skin hydration, internal infection, environmental allergens The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Nummular Eczema Onset days to weeks Dorsal hand most common Multiple lesions develop at Extensor forearm, lower leg, once thighs, and flanks also Intense pruritus common Small papules and vesicles Secondary abrasions and that that coalesce to form excoriations from scratching. circular shaped patches and Lichenification “thickening” if plaques chronic The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Nummular Eczema Clinical diagnosis Biopsy if other serious If difficult to distinguish from condition suspected. tinea corporis (ringworm), can do KOH prep The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Nummular Eczema Emollients to help restore Phototherapy skin barrier Anti-histamines Topical corticosteroids Methotrexate Patient Education Hydration and protection of Avoid strong skin soaps/detergents Hydration right after bathing Avoid tight fitting clothing The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Nummular Eczema Secondary infection Usually chronic, recurs at prior sites of involvement The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Papulosquamous Disorders Seborrheic Dermatitis Both infantile (cradle cap) and adult forms exist Sharply demarcated, yellow to red to brown, greasy patches and plaques May be cutaneous marker of HIV/AIDS May be associated with Parkinson’s Disease The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Seborrheic Dermatitis Infantile (self limited) during Incidence 2-5% of general first 3 months of life population Adult form chronic (ages 30- Risk factors: HIV, Parkinson’s, 40) Stress, cold/dry weather, sleep Male predominance in all ages deprivation, poor health Etiology Appears to be linked with the yeast Malessezia Abnormal immune response to yeast on skin The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Seborrheic Dermatitis Pts usually complain of dry, flaky or scaly, itchy scalp Infants with scaling/flaking on scalp and face Infants: pink to yellow Adults: mild presents as macules/patches with white dandruff: white flakes on greasy scales on scalp. Face and diaper areas may also be scalp, with or without affected itching. The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Seborrheic Dermatitis Clinical Findings: Physical Adults: moderate to severe with erythematous plaques with white, greasy scales. May involve forehead, eyebrows, eyelash line (blepharitis), nasolabial folds, ears. Severe cases may involve upper chest and intertriginous areas. The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Seborrheic Dermatitis  Seborrheic Dermatitis Clinical diagnosis Treatment - Medical Mild scalp SD can usually be controlled with OTC dandruff shampoos Moderate to severe scalp disease treated with prescription shampoos Facial involvement treated with topical antifungals If on eyelids, use baby shampoo scrubs to remove crusts In skin folds, use ketoconazole cream For infants: remove scales with warm olive oil compresses, followed by baby shampoo. Can use ketoconazole shampoo if persistent The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Seborrheic Dermatitis Beware association with HIV/AIDS Often chronic, relapsing and remitting. Intermittent use of topical therapies to prevent relapse The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Papulosquamous Disorders Lichen Planus Acute or chronic inflammatory dermatosis involving skin and/or mucous membranes (mouth, vulva/vagina) Predilection for flexor surfaces and trunk. “5 P’s”: purple, polygonal, pruritic, papule, planar The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Lichen Planus Prevalence around 1% of the Most cases 30-60 years old population Males = Females No ethnic or racial predilection observed Immune dysfunction Has been associated with – Keratinocytes in the skin and some drugs (antibiotics, mucous membranes are attacked by the immune diuretics, and antimalarials) system The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Lichen Planus Usually presents with pruritus Onset can be acute (days) or and onset of red bumps insidious (over weeks) Mucous membrane lesions are Lesions can last months to painful years Violaceous, flat-toped Eventually may get papules with fine white hyperkeratotic with thick plaques striae (Wickham striae) May demonstrate Koebner Papules confluent response The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Lichen Planus  Lichen Planus Biopsy can confirm Treatment - Medical Topical corticosteroids Intralesional triamcinolone Topical or oral cyclosporine Prognosis Typically persists for 1-2 years, relapse occurs in 15%-20% of cases and tends to recur in same area. The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Papulosquamous Disorders Pityriasis Rosea Acute, self-limited papulosquamous exanthem Lasts 6-8 weeks Starts with “herald patch” on trunk, which is salmon pink/oval Other smaller lesions develop in “Christmas tree” pattern The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Pityriasis Rosea  Pityriasis Rosea Ages 10-35 Recurrence in rare Slight female predominance Can have clusters of cases – Preceded by prodrome Very likely viral: reactivation – Occurs in clusters of HHV-6 and HHV-7 – Viral like particles in PR biopsy specimens using electron microscopy – 90% of the US population infected by HHV-6 by age of 3 years – Very similar to roseola (age 6 months to 2 years), caused HHV-6 and HHV-7 The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Pityriasis Rosea Prodrome of HA, malaise, sore throat may occur (less than half of pts) PRURITIC single lesion forms first, then rash on trunk “herald patch” in most cases- a single Can resemble tinea corporis, but KOH oval or round, sharp borders, pink will be negative patch on chest, neck, or back. 2-5 cm. About one week later, smaller lesions Erythema subsides, desquamation erupt on trunk and proximal occurs, lesions resolve over 4-6 weeks extremities in “Christmas Tree pattern” (top down and laterally) The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Pityriasis Rosea  Pityriasis Rosea Clinical Diagnosis, though may need KOH prep to distinguish from fungal disease The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. Pityriasis Rosea  Pityriasis Rosea Self limited, so no need to Topical corticosteroids for treat uncomplicated cases pruritus Patient education and Phototherapy for reassurance hyperpigmentation The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Papulosquamous Disorders Psoriasis A chronic disorder with polygenic predisposition combined with triggering environmental factors such as trauma, infection, or medication Erythematous scaly papules and plaques, most commonly on scalp, elbows, knees, hands, feet, trunk, and nails Several types: plaque (most common), inverse, guttate, pustular The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Psoriasis 2.1% of the US population All ages, peak onset 22.5 y/o Male = Female Heredity: if one parent has Triggered by physical trauma, psoriasis, 8% chance of stress, drugs offspring developing. If both (glucocorticoids, lithium, parents, 40% chance. antimalarials, alcohol) The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Psoriasis Hyperproliferation of epidermal keratinocytes (28 times the normal production of epidermal cells) causing thickening of the epidermis Environmental factors + inheritance = psoriasis Epidermal hyperplasia The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Psoriasis Clinical Findings Plaque type: most common type. A Scaly, red to pink plaque with silvery scale, may show Auspitz sign. Effects extensor surfaces, gluteal cleft, scalp. + Koebner phenomenon. (A) B Inverse psoriasis: Thin pink plaques with minimal scale in the axillae, inguinal area, under breasts, body folds. (B) The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Psoriasis Clinical Findings Guttate psoriasis: More common in A young adults. “Droplet-like” thin pink papules and plaques surrounded by fine white scale. Easily confused with pityriasis rosea. Associated with strep infection. (A) B Pustular psoriasis: small, monomorphic sterile pustules surmounting painful, inflamed, erythematous papules. + fever & malaise. Can appear on palms and soles. (B) The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Psoriasis Clinical Findings Psoriatic nails: Seen in 50% of patients with psoriasis. May be only manifestation. Nails exhibit pitting, thickening. Psoriatic arthritis: chronic inflammatory arthritis that affects 10-25% of patients with psoriasis. To be discussed in detail during MSK module. The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Psoriasis Biopsy if diagnosis unclear The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Psoriasis If topical therapy feasible: First line: topical corticosteroid Second line: additional topical, add phototherapy and/or intralesional steroids Third line: systemic therapy (with continued topical therapy) If unable to use topical therapy: First line: Phototherapy Second line: Systemic therapy The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Psoriasis Stress is a common trigger Guttate psoriasis is self Patients may have decreased limited, but have high risk of self esteem, depression, developing plaque arthritis impaired quality of life Plaque arthritis may go into spontaneous remission, but recurrence is very common The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. VASCULAR ABNORMALITIES Vascular Malformations Infantile Hemangioma Telangiectasias  Vascular Abnormalities Vascular Malformation Several types of vascular malformations (birthmarks) Can be subdivided into capillary, venous, arterial, lymphatic or some combination Capillary malformations most common The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Vascular Abnormalities Nevus Flammeus (“port wine stain”) Capillary Enlarge over Malformation many years Usually follow a Dark red macules dermatomal Can be anywhere distribution on the body Pulsed dye laser therapy Can indicate a more severe (though rare) syndrome The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, https://medlineplus.gov/ency/article/001388.htm precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Vascular Abnormalities Nevus simplex (“salmon patch”) Light red macule Blanch with compression Usually over nape of neck Benign Occurs in 50% of infants No clinical significance Some fade as child grows The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, https://medlineplus.gov/ency/article/001388.htm precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Vascular Abnormalities Infantile Hemangiomas Usually not present at birth (though may have a small area of erythema) Increases in size over about one year Involution phase 2-10 years Observation unless in an area that could disrupt normal development (periorbital, ear, lip, genitals) Propranolol or pulsed dye laser therapy if needed The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Vascular Abnormalities Telangiectasias “spider veins” Usually not a cause for concern Sun, wind, pregnancy, alcohol, seem to contribute to development Can occur with rosacea, liver disease, scleroderma, lupus The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. DISEASES OF THE HAIR AND NAILS Alopecia Telogen Effluvium Ingrown nail Onychomycosis Paronychia Nail Trauma  Hair and Nails Androgenetic Alopecia “male pattern” baldness (though females can have as well) Most common form of alopecia Due to changes in testosterone and genetic predisposition Treat with topical minoxidil (OTC), oral finasteride, oral spironolactone Can be psychologically devastating for patients The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Hair and Nails Alopecia Areata Hair loss, otherwise asymptomatic Affects males and females, average age 25-27 at onset Lifetime risk 1.7% Exact etiology unknown, most likely autoimmune. Patchy, oval shaped hair loss. Short broken hairs (called exclamation point hairs) Can progress to full body hair loss Treated with intralesional steroids or topical minoxidil Can have associated nail changes Hair regrows in 75% of patients with treatment Younger age of onset, atopic dermatitis worsen prognosis The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Hair and Nails Telogen Effluvium Diffuse hair loss Premature termination of the anagen (growing) phase of hair follicles Acute hair loss due to stressors (febrile disease, childbirth, surgery) Chronic due to thyroid disorders, malnutrition, drugs Usually resolves over time, treatment options very limited The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Hair and Nails Ingrown Nail Most common is the distal lateral edge of the big toenail Conservative treatment: insertion of cotton Invasive treatment: Ingrown nail removal https://emedicine.medscape.com/article/909807-treatment The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Hair and Nails Onychomycosis Fungal infection of the nail Usually caused by Trichophyton rubrum Yellow discoloration of nail with hypertrophy Diagnosis made with KOH Prep Antifungal drugs (topical or oral) for 12 weeks if patient has discomfort, diabetes, or immunocompromise Relapses very common The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Hair and Nails Paronychia A paronychia is an infection beneath the nail fold May be caused by trauma (manicure, nail biting) Pain, swelling, possibly drainage Treatment is drainage, warm soaks, local wound care The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Hair and Nails Subungual Hematoma A collection of blood under the nail due to trauma Can be drained by drilling a small hole in the nail to release the blood Can be associated with distal phalanx fracture Can take months to grow out The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition. NEOPLASMS (BENIGN) Seborrheic keratosis Melanocytic Nevi Epidermal cysts Milia Lentigo Lipoma  Benign Neoplasms Seborrheic Keratosis Most common benign epidermal tumor Well circumscribed, dull, flat, tan or brown patches with “stuck on” appearance Velvety or warty texture, 3-20mm Especially common in elderly No treatment needed, but can be frozen with liquid nitrogen if irritated or inflamed The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Benign Neoplasms Melanocytic Nevi “moles” Most common benign tumors in humans More common in Caucasians More common on sun exposed skin Appear in childhood, reaching maximum in 3rd or 4th decade Small, circumscribed macules, papules, or nodules Can be blue/black through brown Usually less than 1 cm No treatment needed, though biopsy if suspicious The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Benign Neoplasms Epidermal Inclusion Cysts May be referred to as epithelial cyst, sebaceous cyst Very common benign skin growth resulting from plugged pilosebaceous unit Filled with keratin and lipid-rich debris (cream colored, paste consistency) that can often be expressed Treatment: excise entire cyst, including lining, Intralesional steroids can control symptoms May become infected with staph aureus (red, inflamed)- treat with I&D and antibiotics The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Benign Neoplasms Milia 1-2 mm white papules which are commonly found around the eyes/upper face Common in infants Removal for cosmetic purposes The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Benign Neoplasms Lentigo Hyperplasia of melanocytes “Solar lentigo” begin in 30’s and 40’s on sun exposed skin “Simple lentigo” are present at birth No indication for removal- can use topical hydroquinone for cosmetic lightening Prevention with sunscreen The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or a patient. You should consult your healthcare professional before taking any drug, changing your diet or commencing or discontinuing any course of treatment. This information is for general educational purposes and should not be used to treat any condition.  Benign Neoplasms Lipoma Localized overgrowth of fat cells Rubbery nodule Management includes observation or surgical removal The information in this presentation is intended to supplement, not substitute for, the expertise and judgment of a qualified healthcare professional with a medical license. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effec