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Acne Rosacea
Chronic acneiform disorder:
vassular dililation of central
face:
Nose
Cheek
Eyelids
Forehead
Background erythema
Distribution
Lesions
Primary
-Open comedomes (Blackheads;lipid has oxidized)
Primary
-Papules, pustules, nodules,
cysts telangiectasia (later)
Secondary
-Erythema
-Scarring
Special lesions
-Rhinophyma (hyperplasia of
the soft tissues of the nose.
(Nose appears larger)
Flushing <heat, alcohol, spicy
food, sunlight, hot food
-Closed comedomes
White head
-Papules
-Pustules
-Nodular cysts
Secondary
-Erythema
-Scar
-Excoriation(scratching)
Signs/Sympto
ms
Dx
-Clinical appearance
-Age
-Can do hormonal panel
Non puritic
History
2
Bullous, Vesicular Diseases( Chart 1 of 1)
Pemphigus vulgaris
Bullous Perphigoid
-A chronic blistering autoimmune
Pres (pemphix=bubble)
disease(idiopathic)
enta A potentially fatal autoimmune
-Attachment of basal cells to basement
disease characterized by
tion
membrane is selectively damaged
destruction of the desmosomes
Commonly affects people 60yoa or older
of stratified squamous epithelium
-Occurs twice as often as
of mucus membranes and skin
pemphigus vulgaris
Incidence 1/1000,000 and
-Less aggressive than Pemphigus vulgaris
usually occurs in middle or older
and is not life threatening
aged individuals
Widespread blistereing eruption in a older
Dermatitis herpetiformis
(clustering)
Dist
ribit
on
Lesi
ons
Signs
/
Sx
Localized: -mouth
Generalized: -scalp; -face; -chest;
-axillae; -groin
Pirmary: -Bullae
Secondar; -Erosions; -erythema
Lesions; -Skin colored; -Round or
oval; -Randomly scattered
Mucous membranes
-Erosions of mouth, nose, pharynx,
larynx ad vagina
Painful
Bullae are rarely seen
No pruritis
Dx
Extensor surfaces
-Sarcum; -Elbows; -Knees; -Lower
back; -Shoulders
Primary
Vesicles; Papultes; Uriticarial
wheals; Plaques
Secondary
Excoriations; Erythema
Often no intact primary lesions are seen
because of the intense pruritis and
excoriations
-Puritis
-Intense episodic burning or
stinging of skin
-Gluten enteropathy in most
patients
-Local symptoms(pruritis and
stinging of skin) precede
appearance of skin lesions by
8-12 hours
-Clinical eruption of sever itching,
burning and stinging
-On extensor surfaces
Biopsy
PMNs
(polymorphonucleocytes) and
subepidermal blister formation
-Symmetric
-Predilection for dorsum of hand, tops of feet, soles
-Also on forearms, feet, face, penis and vulva
Primary
Papules; Plaques
Secondary
Erythema
Lesions
- blanch with pressure; -Vesicles and bullae in center
of papule; -Iris or target shaped lesions
-Central clearing; -Localized to hands or generalized
Severe fever
Sever prostration (complete physical or mental exhaustion)
Mild form
-Little or no mucus membrane involvement
-No bullae or systemic Sx
-Eruptions usually confined to extensor surfaces
Severe form
-Most often occurs as a drug reaction
-Always involves mucous membrane
History
Duration
Scabies
Excoriated eczema
Insect bites
DDx
Dermatitis Herpetiformis
Apthae (canker sores)
Erythema multiforme
Tx: -Systemic
corticosteroids(prednisone)
-Immunosuppressant
agents(methotrexate) -Referral
3
Urticaria(Chart 1 of 1)
Urticaria (burning)
Presentation
From Latin to burn and the nettle species Urtica which produces a stinging sensation of the skin when contacted.
Common condition characterized by Pruritic, transient hives or wheals as a result of vasodilation and subsequent fluid leakage into the dermis
Distribution
Lesions
Signs/Sx
Dx
When taking history, include onset, medications, environmental changes, foods, illness
Acute Urticaria: Lesions are present for less than 6 weeks
Chronic Urticaria: Lesions last longer than 6 weeks
Generalized Urticaria: May be life-threatening and involve major organ systems
History
Duration
DDx
Erythema multiforme
Insect bites
Other
4
Papilloquammous Diseases( Chart 1 of 2)
Allergic/Contact
Dermatitis
Nummular
eczema(Discoid eczema)
Lichen Simplex
Chronicus
Atopic Dermatitis
Localized form of
lichenification usually
occurring in circumscribed
plaques
Presentation
Distribution
Site of contact
Lesions
Primary
Vesicles, bullae, papules and
wheals
Secondary
Erythema, edema, exudate,
excoriation, fissures,
lichenification and
hypopigmentation
Sign
Symptom
Puritis
Puritis
Primary/acute phase
Plaques, papules Skin appears puffy and
edematous(swollen)
Secondary
Erythema, scale excoriation, fissures, crusts and
lichenification in chronic lesions
Chronic scratching
Dx
History
Psoriasis
Contact dermatitis
5
Papillosquammous Diseases( Chart 2 of 2)
Lichen Planus
Seborrheic Dermatitis
Characterized by a polygonal
Common, chronic
Present violaceous(violet) papules and
erythematosus scaling eruption
ation
plaques
of unknown cause that affects
all age groups but usually
affects adults 20 years or older
Distrib
ution
-Mouth
-Genitals
-Volar wrist s(bracelet)
-Ankles
-May be generalized
-Symmetrical
-Nails may be involved(varies
from minor dystrophy to total nail loss)
Lesions Papules and plaques
Post inflammatory
hypopigmentation (similar to a
scar)
Signs
Psoriasis
An itching condition
Common hyperproliferative inflammatory
disorder of unknown cause
Results in rapid cell turnover in the
epidermis(1000x than normal)
Pityriasis Rosea
-Eruptive dermatitis that primarily affects people age
10-35
Suspected to be of viral origin
-Characteristic eruption usually begins with a
herald patch on the trunk 1 to 2 weeks prior to the
onset of the truncal eruption
Occurs in regions where the -Can be single lesion or lesions localized Trunk
to one area(i.e penis, nails) or it can be
sebaceous glands are
regional(i.e. scalp)
Upper extremities
most active
-Face -Scalp
-Unilateral or bilateral
-Often spares exposed areas(palms)
Rarely on face
-Body folds
Scalp involvement is commonly Favors elbows, knees, intertriginous (where 2
known as dandruff in adults and
surfaces rub together) areas and scalp
cradle cap in infants
Nail involvement
-Pitting of nails, oil spot(yellow-brown)
-Distal separation of the nail plate
from the bed (onycholysis)
-Scale forms underneath nail plate
Skin lesions
-Sharply demarcated papules and
plaques
-well developed lesions have a
thick silvery scale
-Peeling off the scale will reveal
pinpoint bleeding from capillaries close
to the top layer of skin (Auspitzs sign)
Sx
Dx
Hx
prognosis
DDx
Psoriasis
Lichenoid drug eruptions
Psoriasis
Candidiasis
Acne rosacea
Butterfly rash of SLE(Systemic
lupus Erythematosus)
Herald Patch
-Several cm in diameter and can mimic tinea
corporis
-Oval, slightly raised dull red plaque, bright red with a
fine collarette/centripical scale at periphery
- Herald patch occurs in 80% if patients
-Herald patch is followed by generalized secondary
eruption
Generalized eruption
-Plaques, papules, erythematous scale,
hyperpigmentation in dark skinned patients
-Scales tend to be centrally located
Exanthum: Fine scaling papules and plaques with
typical marginal collarette(scaling around edge)
Trigger factors
-Kobners phenomenon(physical
trama will lead to the development of
a plaque)
-Infections; -Stress; -Drugs
-Diet high is arachidonic acid,
cGMP cycle