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Board Review Dermatology

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Title: Board Review Dermatology Created Date: 8/25/2008 2:09:55 PM Document presentation format: On-screen Show (4:3) Company: LSUHSC Other titles – PowerPoint PPT presentation

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Title: Board Review Dermatology


1
Board ReviewDermatology
  • Erin Pratt

2
Serum Sickness
  • Type III Hypersensitivity reaction to proteins in
    antiserum or antibiotics
  • Si/sx fever (prior to rash), malaise,
    arthralgias, GI issues, LAD and urticarial rash
  • Characteristic serpiginous erythematous and
    purpuric eruptions on hands and feet at junction
    of plantar and palmar skin

3
Serum Sickness
4
Serum Sickness
  • Common drugs we use Cephalosporins (Ceclor,
    Keflex), Bactrim, Captopril, PCN, Dilantin
  • Treatment
  • D/C offending agents
  • Symptomatic antihistamines, pain relievers,
    steroids
  • Resolves spontaneously

5
Scabies
  • Acarius scabiei
  • Highly contagious direct contact with infested
    human
  • Hypersensitivity reaction to mite
  • Characteristic eruption 4-6 weeks after contact
    pruritic papules, vesicles, pustules and linear
    burrows
  • Linear burrow, made by female mite, is
    pathognomonic
  • Areas finger and toe webs, axillae, flexor
    surfaces of wrists and elbows, around nipples and
    waist, and groin and buttocks
  • Infants and Toddlers head, neck, trunk, palms,
    soles, dorsa and instep, lateral wrist (also more
    prone to nodular reaction)

6
Scabies
7
Scabies
  • Diagnosis can be masked by excoriation,
    secondary infection or secondary eczematous
    eruption
  • Consider scabies if no h/o atopic derm but
    severe pruritus and recent onset of eczema
    type rash
  • Look to the distribution to help with diagnosis

8
Scabies
  • Diagnosis skin scraping with mineral oil
    (burrows or papules)
  • Treatment Elimite (Permethrin 5 cream) apply
    head to toe at night and wash off in am or
    Lindane lotion
  • May have to repeat treatment
  • Can use oral antipruritics or topical steroids
    for secondary reactions

9
Acne
  • Acne vulgaris disorder of pilosebaceous
    apparatus
  • Areas face, back and upper chest
  • As early as 8 yrs but typically during puberty
  • Androgens stimulate sebaceous gland
    differentiation and growth and production of
    sebum
  • Exact pathogenesis is unknown

10
Acne
  • Closed comedones (blackheads)/ Open comedones
    (whiteheads)
  • Proliferation of Propionibacterium acnes in
    noninflammatory comedones and rupture of the
    contents into the dermis may lead to inflammatory
    papules, pustules and cysts
  • Cystic acne frequently leads to scarring

11
Acne
  • Treatment
  • Mild to Mod topical retinoic acid, benzoyl
    peroxide, and anitbiotics
  • Mod to Severe oral antibiotics with topical
    agents
  • Oral 13-cis retinoic acid or isotretinoin should
    be reserved for severe, scarring cystic acne not
    responding to conservative measures above

12
Molluscum
  • Poxvirus
  • Sharply circumscribed single or multiple
    skin-colored, dome-shaped papules with waxy
    surface. Usually umbilicated center although can
    have protruding white center.
  • Areas trunk, axillae, face, and genitals
  • Contagious, spread by scratching so often in
    linear pattern
  • Curdlike core often expressed (typical molluscum
    bodies under microscope)
  • Treatment sponateous remission Can curette the
    core or use blistering agent followed by plastic
    tape for three days

13
Molluscum
14
Trichotillomania
  • Repetitive hair pulling or twisting
  • Short broken-off hairs with different lengths in
    adjacent areas often in broad, linear bands
  • Areas vertex or sides of scalp, eyebrows and
    eyelashes
  • Often caused by situational stress or habitual
    behavior in school-aged or adolescnets also seen
    in psych patients
  • Often denied by patient and parents
  • Distinguished from alopecias by no areas of
    complete baldness and hair follicles not easily
    removed

15
Trichotillomania
16
Tinea Capitis
  • Trichophyton tonsurans causes 95of scalp
    ringworms Microsporum canis (dog/cat ringworm)
  • Endemic in school-aged black children
  • Diagnosis KOH exam of hair pulled not cut to
    look at root Wood light only floresces M. canis
    not T. tonsurans
  • Several presentations

17
Tinea Capitis
  • 2. Endothrix invades hair causing breakage in
    salt-and-pepper appearance
  • 1. Mild erythema and scaling of scalp with
    partial alopecia

18
Tinea Capitis
  • 3. Annular lesion simulating tinea corporis
  • 4. Erythema, edema and pustular formation from
    sensitization ruptures causing golden crusts
    simulating impetigo

19
Tinea Capitis
  • 6. Kerion raised, tender, boggy plaques or
    masses with pustules simulating an abscess
  • 5. Patches of heaped up scale in association
    with small pustules

20
Tinea Capitis
  • Treatment
  • Topicals do not penetrate deeply enough
  • Griseofulvin or ketoconazole over 2-4 months
  • Concurrent use of Selenium sulfide 2.5 reduces
    spore formation and shedding
  • High risk of recurrence
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