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DERMATOLOGY TIKI TAKA

----------------------. CELLULITIS:
-----------. Cellulitis with systemic manifestations e.g. fever,rigors,chills & confusion is ttt by
I.V. NAFICILLIN or Cefazolin.
. caused by staph or strept.
. Generalized swelling which is erythematous "linear streaks", warm, tender but less
well demarcated than Erysipelas.
. An associated fungal infection may acts as a portal of entry.
. Tinea Corporis:
----------------. Ring shaped scaly patches with central clearin & scaly borders.
. Dx: KOH -----> Hyphae. . Tx: Local Terbinafine or systemic Griseofluvin.
. Tinea Versicolor:
------------------. Pale velvety pink or whitish hypopigmented macules that DON'T TAN !
. SCALE ON SCRAPING.
. Dx: KOH preparation ----> Spaghetti & meat ball appearance.
. Tx: Selenium sulfide.
. NECROTIZING FASCIITIS:
-----------------------. Severe pain & swelling.
. H/O of recent trauma.
. High fever > 39 c.
. Edematous limb with PURPLISH DISCOLORATION of the injured area "denoting
start of
gangrene!".
. Surgical debridement of all necrotic tissue.
. Empiric IV Antibiotics e.g AMPICILLIN + SULBACTAM + CLINDAMYCIN.
. Bullae & seroanguinous discharge.
. Seborrheic dermatitis:
-----------------------. Fine loose waxy scales with underlying erythema.
. On scalp, eye brows.
. Associated with HIV or parkinsonism.
. PRIMARY BILIARY CIRRHOSIS:
---------------------------. Pruritis, jaundice, steatorrhea, HSM, ++ ALP, ++ Bilirubin.
. +ve Anti-mitochondrial Antibodies.
. Immune mediated destruction of intra hepatic bile ducts ---> Bile stasis &
cirrhosis.
. Cutaneous association ---> XANTHELASMA

"Yellowish, soft plaques on the medial aspects of the eyelids bilaterally".


. CHALAZION:
-----------. Painful swelling that progresses to a nodular rubbery lesion.
. due to MEIBOMIAN gland obstruction.
. Recurrent chalazion may be due to meibomian gland carcinoma !
. U can't differentiate bet. PERSISTENT CHALAZION & BASAL CELL CARCINOMA
except through
HISTOPATHOLOGICAL exam.
. MOLLUSCUM CONTAGIOSUM is caused by POX VIRUS not HPV !!!!!!! (REPEATED
FAULT) !!
. BASAL CELL CARCINOMA:
----------------------. Fair skinned individual.
. Prolonged sun exposure.
. Slowly growing nodule with rolled border.
. SHINY PEARL.
. Most common location is the lower eyelid margin.
. Seborrheic Keratosis:
----------------------. OLD AGE.
. WAXY - "STUCK ON" - well circumscribed lesion.
. Not pre-cancerous.
. No therapy is required.
. Surgical removal for cosmetic purpose.
. MELANOMA -----------> Excisional biopsy " FULL THICKNESS".
. Varicella Zoster virus = Shingles:
-----------------------------------. Vesicular eruption that occurs in a dermatomal distribution.
. Preceided by pain.
. The 1ry disease in children is termed "chickenpox".
. ANGIO-EDEMA:
-------------. H/O of ICU pt on ACEIs e.g ENALAPRIL.
. Edema in the face, mouth, lips.
. Laryngeal edema may occur causing airway obstruction.
. occurs due to BRADYKININ release.
. it may occur at any time not just at the start of drug intake.
. Dx----> Low levels of C2 & C4.
. Tx----> STOP ACEIs + FRESH FROZEN PLASMA + Secure the airway.
. HERIDITARY angioedema:
-----------------------. C1 esterase inhibitor defeciency.

. Drug induced PHOTOTOXICITY:


----------------------------. The most common drug is DOXYCYCLINE (TETRACYCLINE).
. Manifest as exaggerated sunburn reactions with erythema ,edema & vesicles over
sunexposed areas.
. WARFARIN induced skin necrosis:
--------------------------------. More common in females.
. Common sites: Breasts, buttocks, thighs & abdomen.
. Initial complaint is pain followed by bullae formation & skin necrosis.
. Occurs within weeks after starting therapy.
. Tx: Discontinue WARFARIN & Give Vit. K & maintain anticoagulation using Heparin.
. Dermatitis Herpetiformis:
--------------------------. Pruritic papules & vesicles over the extensor surfaces.
. Presence of anti-endomysial antibodies.
. Tx----------------> DAPSONE.
. Dermatitis Herpetiformis:
--------------------------. Ass. with celiac disease.
. Erythematous papules, vesicles & bullae that occur bilaterally, symmetrically & in
groups "herpetiform" arrangement.
. On the extensor sufraces of the elbows,knees,buttocks.
. Tx: Gluten free diet & DAPSONE.
. Pemphigus Vulgaris:
--------------------. Thin & fragile large wide bullae.
. +ve Nikolsky sign.
. Mouth is involved.
. H/O of ACE Is use.
. Deposition of IgG in the epidermis.
. Bullous Pemphigoid:
--------------------. Thick & intact small & narrow bullae.
. Bullae don't rupture easily.
. No mouth involvement.
. H/O of SULFA drugs use.
. Deposition of IgG & C3 in the epidermis.
. ROSACEA:
---------. 30 - 60 ys old pt.
. TELANGECTASIA over the cheeks, nose & chin.
. Flushing of these area is precipitated by hot drinks,heat,emotion.

. Tx: initial ttt is METRONIDAZOLE.


. Toxic Epidermal Necrolysis "TEN":
---------------------------------. Much more surface area involved.
. Higher mortality rate.
. +ve NIKOLOSKY sign.
. Although the most common cause of death is sepsis, Anitibiotics is not indicated.
. TEN has similar features to SSSS, however, TEN is DRUG INDUCED but SSSS is
caused by a toxin.
. Vilitiligo (Leukoderma):
-------------------------. Young 20-30 ys.
. Pale whitish macules with hyperpigmented borders.
. Around body orifices.
. Auto-immine destruction of melanocytes.
. STEVENS JOHNS $YNDROME:
------------------------. Immune complex mediated hypersensitivity.
. H/O of SULFONAMIDES, NSAIDs & PHENYTOIN intake.
. Characteristic "TARGET" appearance.
. Fever, conjunctivitis, ++HR, --BP, altered consciousness, coma, convulsions may
occur.
. RUBELLA:
--------. Middle aged female.
. Maculo-papular rash starting on the face & extends to involve the trunk &
extremeties
(Not involving th palms & soles).
. Tender lymphadenopathy (Post. auricular & post. cervical LNs).
. Poly-arthritis.
. Secondary $yhphilis:
---------------------. Maculopapular rash (involving the palms & soles).
. The papules may coalese to form CONDYLOMA LATA in severe cases!
. NICKEL jewelry can cause allergic contact dermatitis (Type 4 hypersensitivity).
. Frost-bite injury:
-------------------. Rapid re-warming with warm water.
. Dead Tissue debridement is WRONG.
. Rapid re-warming with fry heat or fan is WRONG.
. SQUAMOUS CELL CARCINOMA:
-------------------------. Non-melanoma skin cancer.

. Second most common skin cancer after Basal cell carcinoma.


. Aggressive due to distant mateastasis.
. EXPOSURE to SUN LIGHT is the most imp. risk factor.
. MILD ACNE & NON-INFLAMMATORY COMEDONES -----> Topical retinoids.
. MILD INFLAMMATORY ACNE ---------------------> Topical benzyl peroxide.
. MODERATE to SEVERE ACNE (NODULO-CYSTIC) ----> ORAL ISOTRETINOIN.
. GRAFT VERSUS HOST DISEASE (GVHD):
----------------------------------. in pts with bone marrow transplantation.
. due to activation of the DONOR "T" lymphocytes.
. Skin ---> Maculopapular rash.
. Intestine ---> Bloody diarrhea.
. Liver ---> Abnormal LFTs & jaundice.
. Drug induced type 1 hypersensitivity reaction:
----------------------------------------------. IMMEDIATE ONSET.
. Mediated by IgE & Mast cells.
. Urticaria & pruritis without systemic symptoms.
. Tx: ANTI-HISTAMINICS & dis-continue the offending drug !
. MELANOMA criteria (ABCDEs):
----------------------------. Assymetry.
. Border irregularities.
. Color variation.
. Diameter > 6mm.
. Evolving: lesion changing in size, shape or color; new lesion.
. The most concerning sign for malignancy is ZONES OF DIFFERENT SKIN COLORS !
. PORPHYRIA CUTANEA TARDA:
-------------------------. photosensitivity reaction to accumulating porphyrins.
. Painless blisters on the dorsum of the hand.
. Hypertichosis on the face & Hyperpigmentation.
. H/O of liver disease (HCV) or OCP use.
. Dx: Urinary uroporphyrins.
. Tx: Phlebotomy & Deferoxamine.
. SQUAMOUS CELL CARCINOMA:
-------------------------. isolated solitary ulcer.
. in the Vermilion area of the lip.
. H/O of sun exposure (FARMER).
. Histologically: INVASIVE CORDS OF SQUAMOUS CELLS WITH KERATIN PEARLS.
. BASAL CELL CARCINOMA:

----------------------. INVASIVE CLUSTERS OF SPINDLE CELLS SURROUNDED BY PALISADED BASAL


CELLS.
. CHERRY HEMANGIOMA:
-------------------. Small vascular bright red papular lesion.
. 30-40 ys & ++ in no with age "Senile hemangioms".
. Don't regress spontaneously.
. Sharply circumscribed areas of congested capillaries.
. ACTINIC KERATOSIS:
-------------------. Erythematous papule with a central scaling.
. Sand paper like texture.
. H/O of chronic sun exposure.
. Pre-cancerous ----> may convert to squamous cell carcinoma.
. Molluscum Contagiosum (Pox virus):
-----------------------------------. Firm, flesh colored, dome-shaped, umbilicated papules.
. Transmitted through sexual contact.
. Due to CELLULAR immunodefeciency.
. Associated with HIV.
. SHINGLES (HZV) may develop due to "INFLIXIMAB" therapy causing
immunodefeciency.
. Allergic contact dermatitis:
-----------------------------. Type 4 hypersensitivity reaction.
. Prurutic erythematous rash with vesicles.
. Bilateral distribution.
. H/O of cutting woods (Poison Sumac).
. Vesicular fluid is sterile and grows coagulase -ve staphylococci (S. Epidermidis).
. May be 2ry infected staph or strept !
. ACANTHOSIS NIGRICANS:
----------------------. Symmetrical, hyperpigmented, velvety plaques in the axilla, groin & neck !
. Ass. with INSULIN RESISTANCE in YOUNG pts e.g. DM & PCO.
. Ass. with GIT malignancy in OLD pts.