chronic, relapsing, IgE hypersenstivity

Sxs: rash that itches

found on flexor surfaces, eye lids, face, 

clincal features: inflam. itchy skin, pruritis, lichenfication, plaques or papules, hx of rhinits, allergies and asthma

Staph may be noted and plaques are less demarcated than psoriais

trxt: topical steriods, antihist, topical imminoglulators ( tacrolime, pimecroimus), keflex if abx needed.

general use cetaphil

coin shaped, pruritic patches or plaques often in clusters

found on legs mostly

healing presents with hyperpigmentation

Dx: based clinically with a -KOH

Trxt: acute- triamcinalone, severe- clobesterol

small vessicles appearing on hands and feet with pruritis

trxt: cetaphil, emolient barrier, burrow's sol'n, topical corticosteriods- clobesterol acute, triamcinalone or flucinomide, 

protopic and Elidel for long term mmngt

type IV delayed hypersensitivity

poison ivy, nickle etc

well demarcated linear pruritic rash that is itchy and burning

trxt: remove agent, cool showers, burrow sol'n, potent/super potent topical corticosteriod, severe rxn- systemic corticosteriods (prednisone) 

direct toxin rxn to rubbing, friction, maceration to chemical thermal agent

agents include: alkalis, acids, soups, detergents

erythemonous scaly, eczermatos erruption without allergen. 

mmngt: avoid agent and minimize contact 

happens in any age group

over hydration with urine and or feces

can erode and ulcerate- papules and plaques

trxt: zinc oxide, OTC hydrocortisone

Beefy red: C. Albicin- use antifungal ketaconazole with Nystatin powder. 

young women and childern

palulopustule or erythmatous bases- may have scales 

found around mouth

trxt: topical ABX- metronidaazole/ erythromyacin

severe cases- minoccycline or doxycycline

DO NOT USE TOPICAL STERIODS

eczematous eruption seen on lower legs due to venous insufficency

starts as scale then develops into erythema, edema, erosions, crusts and secondary infections, chronically changes skin to a woody thinkened appearence with ulcers. 

trxt: compression stockings, burrows soln, triamcinalone or desonide, secondary infection keflex

seborrheic dermatitis

common chronic inflammatory derm caused by P. Ovale

pruritic, yellowish, grayish scaly macules with greasey 

found on body folds, face and scalp

trxt: scalp- zinc or ketaconazole shampoo

face and body- desonide or vasiline

chronic solitary pruritic eczematous eruption caused by repetative rubbing or scratching

may be focal or in patches

found on neck, vulva, scrotum, wrists, extensor forarms, ankles and preiorbital groins

trxt:triamcinalone, occlusion, oral antihist, protopic, elidel 

most common, type IV- T helper cells

erythamous macules and papules primarily on the trunk and then generalizes in 2 days. Can present within 2wks or after 10 days post 

trxt: clears within 2 wks of stopping the meds

antihist and or low potency topical steriods

usually with intermittenly taken drugs NSAIDS, sulfas. barbs

round/oval erythemous plaques maybe puritic or asymptomatic, occurs at the same plac each time. 

6 or less mostly on genitals or oral mucosa

trxt: antihistamine, topical steriods 

pruritic inflammation of the skin, mucosa and hair follicles

t cell mediated

lesions are Purple, Polygonal, Pruritic, and Papule.

found grouped in flexor regions or wrist, lumbar, eye lids, shins, scalp

2/3 ppl have lesions that can cause hair loss and nail damage

Dx: biopsy

trxt: potent topical with occlusive dressing or intralesional steriods. 

heral patch

self limiting

goes away in 8 weeks

Psoriasis

general: chronic inflam scaling condition, t cell mediated, flares related to systemic, emotional, or enviormental factors

sx: well circumscribed erythmatous dry scaly laques or various sizes, silvery white scales

found on scalp, extensors, umbilical regions

usually symertrical and maybe pruritic 

acute psoriasis

eruptions of 2-5mm

lesions in deseminated pattern that spares the palms and soles

assocaited with Strep

abrupt widespread psoriasis with pustules that colace to form lakes

pt may have fever

topical corticosteriods

keralytic agents

calcipirtiene(vit D analog which works synergistically with corticosteriods)

UVB

intralesional injection of Triamcinalone

PUVA

laser

oral retinoids- soriatone, methotrexate, cyclosporie (no Babies)

immunosupressive -enbriel and humeria must have -ppd

drug exposure, viral infections, sulfa, barbs, PNC, phentynin

sx: begin as macules then papules, then vessicles then bullea in center

localizes to hands in feet, mucosa-painful

trxt: avoidence, severe rxn may need systemic steriods

mocoscutaneous blistering rxn from drugs

SJS is severe EM, TEN is severe SJS 

sx: fever mucosal inflammation

trxt: withdrawal and trxt at burn center wound trxt

autoimmune in the 6th decade of life, IgA

prodrome of uticarious lesions, bullea are large and many contain serrous or hemmorhagic 

Dx: biopsy

Trxt: self limiting, localized/limited- clobestol with occlusion

mod to severe- same or with prednisone; immunospressives for ppl who cant have steriods

inflammatory follicular papule eruption involving sebacous apartatus 2/2 to P. acnes

mild, moderate, severe

opened or closed comedomes

face neck chect back buttocks

trxt: LSM- no quick fix

benzolye peroxide, retin a, differens (↓sebascous gland opening, no babies), abx topical0 clindamycin, erythro, combine benzolye with retinoid, oral abx, tetracycline, acutane (I pledge)

insidious onset small papules pustules on cheeks chin and nose with telangiestasis

trxt: topical metragel

staph→soap clenser- cleocin t lotion- central hair grid like pattern found on hair baring areas 

p. ariginosa→pruritic lesions- resolves by itself

Pediculosis Humanis Capitus

commonly known as crabs. found on chest , axilla, eye lashes, scalp, pubic region

sx: intense pruritis, sometimes small blue macules. 

Dx: microscopy exam, biopsy

Trxt: topical- OTC Nix cream, RID, Actinicin

Oviod lotion- most effective for head lice- no babies <6

elimite cream

bactrim- kills lice straving

vasaline- cant breath-ice

enviormental: foamites killed via hot hot washes, bag items 2 wks, treat everyone in house. 

infestation of sarcoptes scabies which burrow into epidermis and deposit feces and lay eggs. Acts as IV hypersentitivity- irritant 30 days post 

Sx: pruritic lesions that form vessicles or papules

found on fingers, wrists, axilla, genitals, gluteal, feet (spares face)

trxt: topical permtherin, lindone(no babies or kids), percipitated sulfur ointment (good for kids and breasts)

oral: ivermectin

wash and remove for 72 hrs. 

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found in wood piles, grass, bluffs etc

Sx: bite pain after 3 hrs, neurcrotic develops within 8 hrs, w/ a bulla, erythema, and ischemia of muscles, becomes gangerious

trxt: RIE, anagelsic, TB, surgical debriment

small circle of redness with outer blanching- target, bodily cramping w/in hr then spreads, tachycardic, hypotensive, pulm edema, fever, chills, vomit, deleruim, partial paraylsis

trxt:acls, antivenom, morphine, benadryl, TB

common nonimflamm idiopathic hairloss in a well circumscribed round oval non scaring hair loss on the scalp, eyebrows, eye lashes, face

dx: tcell mediated of hair follicle

trxt: resolves alone

common baldness autosomal dominant

men- m pattern

women- keep front hair line but parietal thinning

trxt: minoxidal 

infammation involving the skin folds around the nail bed

acute due to aggressive manicure- Gram + staph

sx: erythema, swelling, pain, pus

trxt: warm water soaks, augmentin, topical steriods

frequent handwashing and food

pseudomosis and canaida

sx: swollen erythema, tender, neil becomes thickened with transverse ridges, 

warm soaks and antifungal 

fungal or yeast infections of fingers and toes

hands: t meatagrophyte

feet: candia albicans

lesion: nail thickening, subungal hyperkeratosis

dx: KOH

no real trxt

spread via respiratory droplets

9-12 days incubation

sx: cough, coryza, conjunctivitis, fever then a rash usually on the face

lesions start as macular miliform on anterior scalp and behind ears then 2-3 days cover the body

trxt: prevention with MMR vaccination

spread via toga virus of respiratiry secretions

incuabtion is 12-23 days

sx: 1-5 days fever malaise, ST, HA, pain with lateral upward eye movment, posterior cervical and anterior auricle lymph

lesions are pale morbilliform that begin on the face and spead inferiorly and gone in 3 days. 

trxt: vaccine MMR

pitechia on the soft palate and uvula

found in rubella

fifths disease

benign infection exanthem caused by parovirus- late winter early spring

incubation 4-14days

sx: 3 phases- 1. aburpt asymp erythema of the cheeks 2. day 4 descrete erthemotous macoles and palules on proximal extremities reticular into log pattern by day 9

3. recurring; eruption ↓ only to return with heat or sunlight

trxt:supportive

10-21days incubation

infectious 4 days prior and 5 days post

sx: rash, malaise, low grade fever, tear dropped vessicles that start on the scalp and spread, first pruritic then pustule, once crusted not infectious. complicated by staph or strep. 

dx: clincal or tzonk

trxt: kids supportive NO ASA due to Reyes Syndrome (hepatitis and encephalopathy)

immunization 1-12 rs 1 dose >13 2 doeses 4-8 weeks apart

inflammation of the dorsal root ganglion with hemorrhage necrosis of nerve cells which elad to neuronal loss and fibrosis. 2/2 varicella. 

sx: pain followed by rash in a particular dermatome- burning, electrical, throbbing.

55%thoracic

papules and plaques develop into vessicles that may turn hemorrhage or bulous. last 2-3 wks

of trigemical see optha

hutchinsons- lesion on side and tip of nose

antiviral within 2-3 days. 

acyclovir or famcyclovir

prednisone

Dombor soln

pain mmngt

complications: post herpatic neurolagia. 

HSV-1: oral labial >30% adults trigeminal

HSV-2: genital presacral ganglion

incubation 2-20days

triggered by stress, fever, infection, sunlight

sx: may be asymp then prodrome of fever malaise, mylagias

oral labial- tender grouped vessicles last 1-2 wks recurrence has tingling

genital- blisters and erosions 1-2 wks

no cure but can ↓ sxs and heal time

acyclovir, valacyclovir

recurrent use acyclovir or valtrex

nonpruritic flesh colored dome shaped papules 3-6 cm. curd material expressed that is classsically found on the face, trunk, extremeties and groin

trxt: eventually goes away

5-20y/os 

frequent exposure to water

found on hands, palms, periungual, nailfolds 

>1cm papules

children and youngadults

2-4mm flat topped flech colored 

face, neck, wrists, hands

on the sole of foot/ heel

mosaic wart 

verruca trxts

st anthonys fire

caused by GABHS

found on legs and face

sx: local redness, heat, swelling, RIASED INDURATION BORDER

puckered like an orange peel

trxt: immunocomp= hospital. if not analgesics, antimicrobial

dicloxacillin, cephalxor, clindomyocin

bactrim with MRSA suspection

acute inflammation of subcut. skin

S. pyogenes or S. aureus

sx: erthematous pain swelling warmth may develop fever and chils

trxt: MARK MARGINS

mild to early give doxy or cephalexin

severe give IV ABX

surgery for necrotizing facisitis or compartment syndrome

benign subcut neoplasm of mature fat cells

sx: soft, single or multiforme, small or large, lobulated compressible growths

found on trunk back of neckand upper arms

no trxt required 

epidermal inclusion cyst

infundable cyst, milia

results from plugging of follicular orfice 

found on face neck or trunk

sx: compresible cystic mass 

usually smooth shiny with comodome punction freely movable

contents are macerated keritin that is curd like 

can trxt or not

autoimmune destruction of melanocysts

trxt sunscreen protopic eximer laser

acne inversica 

recurrent abcess in the skin folds 

axilla, inginal, submamary, perirectal

engulfing of endocrine gland

higher incidence in fat ppl 

sx: tender red nodules then become firm and foliculated and painful. 

trxt: intralesional injection triamcinalone

po abx- tetracycline

topical clindamyocin

insitu dysplasias resulting from UV radiation that progesses to SCC

thick scaling growth-most common precancer

found in sunexposed areas

multiple descrete fat or elevated verrucous or keratotic red pigmented skin. may be scaly, smooth or shiny

only palpable as rough sand paper texture. 

3mm-2cm diamter

cryotherapy-best for limited lesions

imiquid 

5fu

must avoid UV light

most common slow growing rarely mets

report slow enlarging lesion that does heal and bleeds easily

face, hands, neck, scalp

Sx: flat, firm palpable, small raised pink or translucent, pearly!! rolled edge

ulcerative 

nodular- most common: wavy pealy rolled edges

superficial: dry scaly, flat edge shows thread like appreance

morpheaform: whie sclerotic plaque with talengiectasia- scar appearnence. 

pigmented: similar to nodule but brown or black

1. topical: imiquid or 5fu

2. surgery: E+C, excision with margins(more accurate), Mohs(large tumor best for cosmetics)

3. radiation- old ppls

20?NMSC

SCC in situ (BOWENS DISEASE) epidemeral thickness cancer

invasive: penatrates into dermis

superficial plaques, palules, or nodules descrete and hard arising form inuradate elevated base

becomes large and crusty and ulcerative

invades underlying tissue 

keratin pearls which are well formed desmosomes that attact intracytoplasmic bundles of keratin 

+lymph involvement

most deadly

risks are moles, red hair and freckles, inability to tan, severe burns, family hx

UVR

macular/nodular color vairent with irregular borders, can be acute or chronic and on nonsunexposed areas

ABCD

borders through uirregular and sharply defined 

multicolor