Escolar Documentos
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Cultura Documentos
Dermatology
SKIN LESIONS 87 ACNE VULGARIS 93
FUNGAL INFECTIONS 88 ACNE ROSACEA 93
TINEA CAPITIS 88 ALLERGIC SKIN DISEASES 93
TINEA CORPORIS 88 ECZEMA 93
TINEA CRURIS (JOCK ITCH) 88 URTICARIA 94
TINEA PEDIS 88 ERYTHEMA MULTIFORME 95
TINEA UNGUIUM (ONYCHOMYCOSIS) 89 ERYTHEMA NODOSUM 95
TINEA (PITYRIASIS) VERSICOLOR 89 TOXIC EPIDERMAL NECROLYSIS 96
CANDIDA ALBICANS 89 MEDICATION-INDUCED SKIN DISEASES 96
NOTES 90 SCALY PAPULAR DISEASES 96
VIRAL INFECTIONS 90 PSORIASIS 96
WARTS 90 PITYRIASIS ROSEA 96
MOLLUSCUM CONTAGIOSUM 90 LICHEN PLANUS 96
HERPES SIMPLEX 90 ACTINIC (SENILE) KERATOSIS 97
HERPES ZOSTER 91 MALIGNANT SKIN DISEASES 97
BACTERIAL INFECTIONS 91 BASAL CELL CARCINOMA (BCC) 97
IMPETIGO 91 SQUAMOUS CELL CARCINOMA (SCC) 97
ERYTHRASMA 92 MELANOMA 97
ERYSIPELAS 92 MISCELLANEOUS 98
ERYSIPELOID 92 VITILIGO 98
NECROTIZING FASCIITIS 92 PEMPHIGUS VULGARIS 98
FOLLICULITIS 92 ACANTHOSIS NIGRICANS 99
FURUNCULOSIS 92 LIPOMA 99
HIDRADENITIS SUPPURATIVA 92 KELOID 99
PARONYCHIA 92 FIBROSARCOMA 99
LUPUS VULGARIS 93 DESMOID TUMOR 99
PARASITIC INFECTIONS 93 DERMOID CYST 99
SCABIES 93 SEBACEOUS CYST 99
PEDICULOSIS (LICE) 93
Fungal Infections
Tinea Capitis (refer to Fig. 2.1)
l Introduction: Ringworm of the scalp.
l Organisms: Dermatophyte, Microsporum or
Tricophyton.
F IG . 2.2 Tinea corporis
l Clinical picture: Lesions are itchy, well circum-
scribed, and are usually multiple on the scalp.
They are oval in shape, of variable sizes, and con- l Clinical picture: Lesions are itchy, oval or rounded,
tain hair stumps. with red elevated circinate margins and central
l Prognosis: Lesions heal without scar formation. clearing, hence also known as Tinea Circinata.
l Treatment: Oral antifungal, such as terbinafine, l Treatment: Topical antifungals. Oral antifungals
itraconazole or griseofulvin for 4–6 weeks. are reserved for severe cases.
l Notes:
1. Kerion: A subtype of tinea capitis infections. Tinea Cruris (Jock Itch)
Clinical picture: Red, warm, tender swelling
with pustular discharge, often confused with an l Area involved: Groin and buttocks.
abscess. Treatment: No incision and drainage is l Clinical picture: Lesions are itchy, bilateral and
needed, antifungals usually suffice. symmetrical, reddish in color with raised festooned
2. Favus: A subtype of tinea capitis infections. Clin- edges.
ical picture: Saucer-shaped, crusty lesions in the l Treatment: Topical antifungals. Oral antifungals
scalp, known as scatula. Scatula is yellow in are reserved for severe cases.
color with reddish margins. Unlike other tinea
infections, this one heals with a scar and could
cause alopecia. Tinea Pedis (refer to Fig. 2.3)
l Introduction: Athlete’s foot.
l Area involved: Mostly in the interdigital spaces, but
Tinea Corporis (refer to Fig. 2.2) can occur anywhere in the foot.
l Clinical picture: Itchy erythematous macerated lesions.
l Introduction: Ringworm of the trunk.
l Treatment: Local antifungals. Oral antifungals are
l Organisms: All dermatophytes can cause this disease.
reserved for severe cases.
Notes
l Most fungal infections could be easily treated with Molluscum Contagiosum (refer to Fig. 2.9)
a topical antifungal, e.g.: imidazole cream or oint-
ment; except for two infections that require sys-
l Organism: Pox virus.
temic therapy: Tinea capitis and Tinea unguium.
l Area involved: Mainly face and neck, but can also
l Griseofulvin attacks only dermatophytes, and occur in the genital area.
causes GI upset.
l Clinical picture: Lesions are pearly white, umbili-
l Ketoconazole and terbinafine are hepatotoxic. cated papules.
l Diagnosis: Identifying the inclusion molluscum
bodies upon staining the contents of the lesion
with Wright or Geimsa stains.
Viral Infections l Treatment: Lesions often regress spontaneously.
Cauterization, either cryo, electrical or chemical
Warts (refer to Fig. 2.8) using ether is reserved for non-resolving lesions.
l Introduction: A common benign tumor from the
epidermal layer of the skin.
l Organism: Human papilloma virus (HPV). Herpes Simplex (refer to Fig. 2.10)
l Clinical picture: Starts as a papule and can occur at l Introduction: Very common infection, mainly in
any part of the body. Commonly a cauliflower-like
children, age 2–5 years.
lesion; however it can occur in any shape or form. l Organism: Herpes simplex virus (HSV):
l Treatment: Cauterization, either cryo, electrical or
chemical using podophyllin resin in alcohol. Topi- 1. HSV type I targets the eyes and mouth.
cal imiquimod is an alternative treatment. 2. HSV type II targets the genitals.
Bacterial Infections 91
F IG . 2.11 Shingles
Bacterial Infections
Impetigo
l Introduction: A contagious superficial pyogenic
infection.
F IG . 2.10 Herpes simplex type I l Organisms: Staphylococcus aureus or Streptococci.
92 2. Dermatology
Erythrasma
Furunculosis
l Clinical picture: Red, scaly lesions found in skin
folds, often confused with tinea. l Introduction: Inflammation of the deep part of the
l Diagnosis: Examination of the lesions under hair follicle.
Wood’s light shows red fluorescence. Erythro = l Area involved: Neck and buttocks.
Red. l Clinical picture: Lesions are deep boils with pustu-
l Treatment: Oral tetracycline. lar discharge.
l Treatment: Oral antibiotics and hot compresses.
Incision and drainage is reserved for large, compli-
cated lesions.
Erysipelas l Note: A collection of furuncles is known as a
l Area involved: Face and lower limbs. carbuncle.
l Organism: Group A streptococci.
l Clinical picture: A superficial, well-demarcated,
red, warm cellulitis. Hidradenitis Suppurativa
l Treatment: Oral antibiotics, mainly penicillin or l Introduction: Local inflammation of the apocrine
cephalosporins. In case of penicillin allergy, treat glands in the axilla and groin.
with erythromycin. l Organism: Staphylococcus aureus.
l Clinical picture: Reddish, painful nodules in the
axilla or groin.
Erysipeloid l Treatment: Oral antibiotics, tetracycline is best.
Surgical drainage and debridement is also needed.
l Organism: Erysipelothrix rhusiopathiae.
l Risk factor: The patient is usually a butcher or a
fisherman who uses sharp objects contaminated Paronychia (refer to Fig. 2.12)
with animal flesh.
l Clinical picture: Lesion is a small tender purplish
l Introduction: Inflammation of the periungual
area on the finger, where the injury with the sharp tissue.
object has occurred.
l Treatment: Penicillin.
Necrotizing Fasciitis
l Introduction: A deep infection of the fascia, usually
polymicrobial. It is not well demarcated and could
be very aggressive, to the point of fatality.
l Clinical picture: Affected area is red, warm, tender,
swollen and might show bullae, discoloration and
loss of sensation.
l Treatment: Broad-spectrum antibiotics and surgi-
cal debridement. F IG . 2.12 Paronychia
Allergic Skin Diseases 93
l Predisposing factors: A hangnail or ingrown of action is to assume sexual abuse until proven
toenail. otherwise.
l Clinical picture: The paronychial fold is erythema- l Note: Lindane is contraindicated in pregnancy and
tous, swollen and tender. in children as it might cause CNS toxicity. The
l Treatment: Hot compresses and penicillinase-resis- alternative treatment in both cases is permethrine.
tant penicillin.
Acne Vulgaris
Lupus Vulgaris l Introduction: Inflammation of the pilosebaceous
l Introduction: The most common form of cutaneous glands; common in adolescents.
TB lesions. l Area involved: Face, chest and back.
l Area involved: Face and neck. l Clinical picture: Comedones which might progress
l Clinical picture: Lesions are nodular plaques. Press- to papules or even pustules.
ing the lupus vulgaris lesion with a glass slide l Pathology: The exact etiology of acne is not clear;
reveals a characteristic brownish apple jelly color. however some theories suggest a link to hormonal
This type of test is known as diascopy. imbalance, mainly increased androgens. Others
l Treatment: TB treatment. link acne to infection with Propionibacterium
acne.
l Treatment:
F IG . 2.13 Eczema
Erythema Multiforme
l Introduction: A skin reaction to infections or drugs.
l Clinical picture:
1. The minor form: Characterized by target-shaped
lesions known as or iris-lesions, which are skin
lesions that look like a bull’s eye. Just like
3. C: Color changes.
4. D: Diameter of more than 6 mm.
l Microscopically: Lesions show melanocytes with
malignant characteristics.
l Prognosis: The most important prognostic factor is
the depth of the lesions.
l Treatment: Surgical excision, and chemotherapy
with interleukin-1.
l Note: Melanoma of the Scalp, Neck, Arm and
Back – SNAB – carry worse prognosis.
F IG . 2.24 Melanoma
l Note: Blistering of the skin could happen sometimes l Diagnosis: Muscle biopsy.
in healthy individuals after minor trauma; this is l Next best step: Chest X-ray to look for metastases.
known as Epidermolysis Bullosa. l Treatment:
1. Non-metastatic: Wide local excision of tumor,
Acanthosis Nigricans or amputation of the whole limb if bone is
involved.
l Clinical picture: Hyperpigmented skin lesions that 2. Metastatic: Radiation therapy.
occur in skin folds, e.g.: axilla.
l Note: These lesions are indicative of:
1. GI malignancy: Mainly gastric.
2. Endocrine disorders: Mainly insulin resistant DM.
Desmoid Tumor
l Introduction: A fibrosarcoma of the rectus sheath
of the abdomen, a.k.a. Paget disease of rectus
Lipoma sheath.
l Introduction: A benign tumor of the adipose tissue. l Clinical picture: A tumor in the abdominal wall,
l Clinical picture: Patient presents with soft lobulated below the level of the umbilicus that protrudes
tumor. more with contraction of abdominal muscles.
l On exam: Two pathognomonic signs: l Metastases: Local infiltration only.
l Treatment: Wide local excision.
1. Dimpling of the skin on displacing the tumor.
2. Slippery edge on palpation: This is because the
tumor is surrounded by two capsules.
l Complications: Dermoid Cyst
l Introduction: A cutaneous cyst that forms due to
1. Intraluminal: Airway obstruction, intussusceptions.
excessive epithelial growth.
2. Others: Cosmetic, malignant transformation (rare).
l Pathology: Lined by squamous epithelium, filled
l Treatment: Enucleation. with sebaceous material, and covered by a fibrous
capsule.
l Clinical picture: Cystic, mobile, painless swelling,
Keloid usually at the site of a previous needle prick or injury.
l Introduction: Hypertrophied scar tissue, more com- l Complication: Intracranial extension.
mon in African-Americans. l Treatment: Excision after an X-ray to rule out intra-
l Clinical picture: Patient presents with skin growth at cranial extension.
the site of a scar from previous trauma or surgery.
l Treatment:
1. Active (erythematous and pruritic): Topical Sebaceous Cyst
steroids.
2. Inactive (non-erythematous and non-pruritic):
l Introduction: A retention cyst, due to obstructed
Excision. sebaceous gland’s duct.
l Clinical picture: Well defined cystic swelling, usually
on the face, which opens up into the surface via a
Fibrosarcoma punctum.
l Complications: Infection or malignant
l Introduction: A malignant tumor that arises from
transformation.
the muscles and tendons. l Treatment: Elliptical excision, which must include
l Clinical picture: Well defined, un-capsulated
the punctum.
smooth firm muscular swelling.