-steroids and moisturizers 

-avoid the allergen/irritant 

-common disorder among the 6-13 month olds

-also seen in incontinent patients or any patient with incontinence issues

-related to the moist skin that is permeable to irritants

-friction leads to breakdown of skin

-Erythematous and papularvascular over the diaper covered area

-Treatment with frequent diaper changes and a skin barrier

-confluent erosions, marginal scaling, and "satellite pustules" in the area covered by the diaper

-treatment must include anti-fungal agents like nvstatin or ketonazole

-chronic, pruritic 

-coin shaped lesion/plaques composed of groups of small papules and vesicles on an arythematous base

-common on the lower legs of older adult males, during winter months 

-unknown

unrelated to atopic diathesis with normal IgE levels 

-application of potent to super potent steroid ointment

-hydroxyzine TID

-intra-lesional triamcinenolone injections

-IM steroids

-Moisturize and gentile skin care because the entire skin is hypersensitive

-Erythematous micropapules/micropapulovescles that often become confluent on the perioral and perorbital skin

- 5 mm of clear zone between the vermillion border and affected skin

-unknow

-markedly aggravated by topical steroids  

-avoid steroids

-metronidazole and erythromycin gel

-sulfactamide lotion

-minocyclin/doxyclylcine or tetracyclin P/O

Seborrheic Dermititis

-common chronic dermititis characterized by redness and scaling 

-occurs where sebaceous glands are most active-face, scalp, chest and body folds 

-Parkinson's Disease

-Neuroleptic Drugs

-HIV

-Epilepsy

-Diabetes Mellitus 

-increase in Malassezia furfur in people with SD

-increase in IgG antibody levels to these organisms

-skin lipids are high

-the two mentioned above propagate lipophylic organism, produce inflammation and precipitate the condition

-2% ketoconazole shampoo

-selenum shampoo

-steroid lotion

-ears-combine steroid with antibacterial ointment

-Edema-->Inflammation and shunting of blood into the superficial veins, thus the pressure increase and flow rate lead to hemorrhage in the microvasculature

Predisposing factors

-Obsity

-CHF

-leg elevation

-compression dressings

-avoid trauma

this is also known for being an ID reaction

-AKA autoeczamatization

-refers to the development of widespread or distant dermititis from a local inflammation focus

-The agent causing local focus is not the direct cause of the dermititis at distant site

-often results of a minor trauma, an ulcer may form

-the dermititis may be weepy or dry, scaling of lichefied, it is generally hyperpigmented by melanin and hemosiderin

1. venous

2. arterial 

3. neuropathic 

-Irregular, sloped, borders, necrotic base

-Malleolar and supermalleolar 

-lipodermatosclerosis and statis dermititis 

-Atrophe blanch Pigmentation

Lymphedema

-vercose veins, pain, worse in independent state

-punched out necrotic base  

-pressure sites; distal toes, pretibial supramalleolar (lateral)

-atrophic, hair loss pallor or reactive hyperemia 

-weak abscent pulse, pallor or elevation of leg, pain worse on elevation of leg

-punched out

-pressure sites, plantar

-callus before ulceration and callus surrounds the ulcer

-peripheral neuropathy and decreased sensation and don't fell pain

-relapses, etiology not know

-highly pruritic, burning symmetric vescilles on the palms, lateral fingers or plantar feet

-deep seated vesicles, 1-5 cm, fluid think

-resolve slowly in 1-3 weeks, leaving a red cracked base with brown spots 

-unknown

-probably multifactorial

a. irritants

b. genetics

c. dematophyte infeciton

d. hyperhydrosis

e. smoking 

-Potent Topical steroids, may require systemic steroids as well

-occasionally anti-biotics such as Keflex or Tetracycline are very helpful

-results from repeated rubbing and scracthing

-localized form of lichenfication, circumscribed plaques

-involves the wrist, neck, ankles and anogenital area

-common in adults and lasts for decades 

Lichen Simplex Chronicus 

P.E.

-rubbing and scratching must stop

-occlusive dressings

-potent steroids-not on the face though

-antihistamine for anti anxiety

-intralesional triamcinolone injection

Dematophyte Infection

Drug Eruptions

Lichen Planus

Pityriasis rosea

Psoriasis

-Uncommon in children

-uncommon inflammatory papulosquamous disorder

-usually occurs on wrist, lumbar area, shins, penis and mouth

1. pruritic

2. planar

3. polygonal

4. papules

5. purple

-A common papulosquamous disorder of uknown etiology-HSV type 7 is suspected causative 

-Starts of a single patch, then few weeks or days later, more

-Christmas tree Patters.

-First patch known as Herald Patch

-symptomatic- may use steroid cream for itching

-inverse PR can occur in young children in the groin, axilla, elbows and knees- treat the same 

-A hereditary inflammatory condition with multiple clinical expressions

-equal in both males and females

Hereditary

-Physical Trauma (Koebner's phenomena)

-infection

-stress

-drugs

-alcohol

-abnormal differentiation

-keratinocyte hyperproliferation

-inflammation

-Eruptive/ Inflammatory

- Chronic Stable 

-AKA Guttate psoriasis 

-Multiple small lesions with a greater tendency to spontaneously resolve

-often but not always follows a streptococcal pharyngitis 

-acute guttate

-chronic stable

-pattern 

-Peranal, Genital and Body folds

-warm, moist environement

-no scales, just bright red and fissured

-sharp demarcation distinct from candidiasis, contact dermititis, and tenia curis 

Psoriasis Treatment 

Trunk/Extremities 

-Topical steroids+ointment base

-intralesional steroid injection

-VitD analog+steroids

-Topical Retinoids

-if greater than 10 percent of BSA combine these treatments with PUVA

-occlusive dressings and ointment based super-potent steroids 

-PUVA 

-Mild-Tar or Ketoconazole shampoo followed by steroid lotion/foam

-Severe-Remove scale with mineral oil or salicylic acid, then steroid cream

-NO SYSTEMIC STEROID USE!! causes a severe reaction in twenty percent of the cases

-at psoriasis center or by a dermatologist 

a. oral retinoids-teratogen

b. methotrexate

c. cyclosprine

d. monoclonal antibodies and fusion

-papulosquamous 

-present in

a. aceinform,

b. eczamatous 

c. lichenoid

-can mimic all morphology

-immunological reaction

-Most common,resembles viral infections

-due to ampicillin, isoniazid, phenytoin, quinidine, sulfonamides and thiazides

-maculopapular rash, itchy

-treat with antihistamines plus mild steroids 

-an anaphylactic IgE dependent reaction

-aspirin, PNC and blood product cause it 

-treat with antihistamines and steroids and cpinepherine 

-present with a single/multiple, round red plaques appear soon after the drug exposure, and reappear in the same site each time the drug is ingested 

-may occur anywhere 

-teracycline and contrimoxazole frequently cause this rxn 

-caused by amoxicillin or ampicillin

-a rash all over the body

-fungi that infect the startum corneum layer of the skin, hair and nails

-can come from animal and/or soil

-epidermophyton

-microsporum

-trichophyton

-are on exposed areas of the body

-exposure to an infected cat can occur

- trichophyton is the causative organism

-superficial fungal infection caused by C. albicans

-most common fungal pathogen that affects humans

-opportunistic yeast that is part of the gastrointestinal tract, skin, and mucous membranes 

Tinea Presentation 

1st pattern

-caused by an overgrowth of normal skin flora

-factors lower skin resistance allowing organisms to proliferate 

Tinea Versicolor

History/Physical

-Woods lamp reveals blue-green fluorescences 

-KOH reveals spaghetti and meatballs 

Mild disease-topical anti-fungal shampoo

-severe case-oral anti-fungal plus topical 

-uncommon autoimmune disease where IgG attacks the structural proteins in the DEJ junction (hemodesmosomal proteins)

-effects the olderly

1. Protect against secondary infection

2. oral steroids-this is the best treatment until blistering stops 

-erythema Multiforme

-Steven-Johnson Synderome

-Toxic Epidermal Necrolysis

-an acute inflammatory hypersensitivity syndrome of multifactorial etiology

-patient presents with a complain of "target" like lesions predisposed to the hands, feet and forearms, face, elbows knees and genitalia 

-must note whether mucuos membranes are involved 

-Oberved for TEN and SJS

-supportive 

-stop offending drugs

-treat with valtrex for HVS

-typically resolves in a month

-widespread disease may respond to systemic steroids 

-severe blistering mucoutaneous syndrome envolving at least 2 mucous membranes 

-more common in young adults and children 

-rare but serious 

-fever, couch or sore throat, appear 1-3 days prior to any cutaneous lesions.

-burning rash that begins symmetrically on the face and the upper part of the torso. 

-overall mortality is 30-50 percent

-treatment focused on pain control, removal of possible offending agent, maintaining fluid balance and local wound care

-treated in the burn unit

-rare, life treatening disease wide spread blistering and sloughing of skin

-typically related to drug ingestion, mycoplasma, streptococcal or syphilis infecton

-uncomplicated cases resolve in 1 month

-focus on removing the offending drug

-maintaining fluid, electrolytes, nutrition

-protect against secondary skin infections 

-tinea of the nails

-trichophyton infection of the nails

-treatment with systemic anti-fungals 

-athlete's foot

-wear opened toed shoes

-dry between the toes

-zeozorb powder daily

-mild/moderate-topical antifungal

moderate/severe-oral antifungal for at least two weeks 

-tinea of the head

-treatment with oral grisoelulving 20 mg/kg/day for 2 to 4 months

-must continue treatment for total time!!!

Tinea Corporis

chest and back

person to person contact

Treatment

mid/moderate-anti-fungal cream

moderate to severe- oral anti-fungal

Basal Cell Carcinoma

Squamous Cell Carcinoma

Melanoma 

-most common malignancy in humans

-sun exposed areas show most activity for BCC

-slow growing and rarely metastasizes 

-scaly, patches or papules

-pink to red/brown, often with central clearing 

-common on the trunk/arms

-mimics psoriasis or eczema 

-slow to progress and do not fluctuate in appearance 

-aggressive subtype

-sclerotic plaques or papules

-border-ill defined

-ulceration, bleeding and crusting are uncommon

-maybe mistake for a scar 

Basal Cell Carcinoma

Nodular BCC

-most common and usually occurs on the head/ back/neck

- waxy papules

-pearly

-erosion or ucler

-bleeding 

-crusting 

-rolled/raised borders

-hx of bleeding with minor trauma 

-translucency 

-same features as Nodular BCC

-increase of brown and/or black pigment

-most common in individuals with dark skin 

-UV induced mutation in the TP53 gene

-believed to arise from pluripotent cells in the basal layer of the epidermis 

-second most common skin cancer

-carries a significant risk of metastasis,most go to the lungs 

-UV induced mutation in the PT53 tumor suppressor gene

-malignant tumor of the epidermal keratinocytes

-most SCC's arise from the sun-induced precancerious lesions known as actinic keratoses 

-depends on the pathology report and level of invasion

-scc is situ- cryotherapy

-metastatic disease requires multidisciplinary treatment

-superficial spreading melanoma

-nodular melanoma

-lentigo melanoma

-acral letiginous melanoma

A-asymmetry

B-border

C-color

D-diameter

E-elevation 

-accounts for 15-30 percent of patients

-seen most commonly on legs/trunk

-rapid growth

-manifest as brown to black dome shaped nodules, may ulcerate or bleed 

-lacks the typical ABCDE of melanoma

-common for ages 30-50

-manifested as a flat or raised slightly elevated brown lesion with variegated pigmentation

-generally greater than 6 mm

-irregular borders 

-sequence of events where normal melanocytes transform into melanoma cells

-is a multi-factorial and related to risk factors 

-Head, neck, and arms in fair skinned people, usually older individuals

-usually presents in a lentigo that has been present for 10-15 years 

-variegated pigmentation 

-least common overall but most prevalent in non-whites 

-palms, soles and beneath a nail plate

-Hutchinson's sign-hallmark for ALM

-Lentigos

-Nevi

1. Congenital

2. Common Acquired/compound/ intradermal
3. Junctual

4. Atypical

-vary in size from small to large/giant

-thin-evenly pigmented 

-extending into the subcut fat- have array of colors and cannot be distinguished from melanoma

-macular and thinly papular

-range from brown to brownish-black

-simultaneously hyperpigmented

-display elevation relative to surrounding tissue 

-often lighter in color than other junctional nevi

-tan to brown

1. Exhibits ABCDE of melanoma

2. biopsy to rule out MM

3. if moderately or severely displastic-treat like MMIS and follow up with q 3 months for first year

-small, sharply pigmented macule surrounded by normal appearing skin

-hyperplasia of the epidermis and increase pigmentation of the basal layer

-may evolve slowly

"sun spots"

Seborrheic Keratosis

Actinic Keratosis

-distruction with cryosurgery

-excisional biopsy

-sharply defined, light brown, flat macules, maybe be sparse or numerous

-velvety to finely verrucuous surface, uneven warty surface

-appearance of being "stuck on" the skin

-vary from pale brown w/pink to dark brown or black

-most common benign tumor in older individuals 

-appear to be "stuck on" the skin

-Cryosurgery

-excision biopsy

-Medical Treatment

-begin as barely percieved rough spots on the skin, feel like sand paper and felt better than seen 

-later lesions become erythematous scaly plaques that may enlarge to several cm

-shares features with squamous cell carcinoma

-epidermal lesion

-keratinocytes at the basal layer may extend upwards to involve the granular and cornified layers 

-UV-light inducing lesion of the skin that may progress to invasive squamous cell carcinoma

-most common lesion with malignant potential to arise on the skin

-seen in fair-skinned individuals in ares of long term sun exposure