Carlos Shared "15 Dermatology" - 35 Picmonics

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15 Dermatology

Skin Layers
Skin has 3 layers: epidermis, dermis, subcutaneous fat (hypodermis, subcutis).
Stratum Corneum (keratin), Stratum Lucidum, Stratum Granulosum, Stratum Spinosum (desmosomes), Stratum Basale (stem cell site)
Palms and Soles have Lucidum skin
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Epithelial cell junctions
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Albinism
albinism
Normal melanocyte number with decreased melanin production
Due to decreased tyrosinase activity or defective tyrosine transport.
Increased risk of skin cancer
Acquired through locus heterogeneity - Mutations at different loci can produce a similar phenotype.
Autosomal recessive
Ocular albinism is X-linked recessive
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Melasma (Chloasma)
Hyperpigmentation associated with pregnancy (“mask of pregnancy”) or OCP use.
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Vitiligo
Pathophysiology
Autoimmune Destruction of Melanocytes
Presentation
Hypopigmentation
Acral Areas and Around Orifices
Diagnosis
Clinical Presentation + Woods Lamp
Risk Factors
Other Autoimmune Diseases
Treatment
Glucocorticoids
Tacrolimus
Phototherapy
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2 mins
Acne Vulgaris
Multifactorial etiology
Increased sebum/androgen production
Abnormal keratinocyte desquamation
Inflammation (papules/pustules, nodules, cysts)
Propionibacterium acnes colonization of the pilosebaceous unit (comedones)
Treatment includes retinoids, benzoyl peroxide, and antibiotics
pathoma
Comedones (whiteheads and blackheads), pustules (pimples), and nodules; extremely common, especially in adolescents
Due to chronic inflammation of hair follicles and associated sebaceous glands
Hormone-associated increase in sebum production (sebaceous glands have androgen receptors) and excess keratin production block follicles, forming comedones.
Propionibacterium acnes infection produces lipases that break down sebum, releasing proinflammatory fatty acids; results in pustule or nodule formation
Treatment also includes vitamin A derivatives (e.g., isotretinoin), which reduce keratin production. Isotretinoin is teratogenic, do not give to pregnant mothers.
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Atopic Dermatitis / Eczema
Presentation
Pruritic Vesicles
Inflammatory Skin Rash
Cheeks in Children
Skin Flexural Areas
Associated with Asthma and Allergic Rhinitis
Treatment
Tacrolimus
Moisturizers
Corticosteroids
Phototherapy
Avoid Triggers
Antihistamines
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Allergic contact dermatitis
Type IV hypersensitivity reaction that follows exposure to allergen
Lesions occur at site of contact (eg, nickel, poison ivy, neomycin).
Pruritic, erythematous, oozing rash with vesicles and edema
Arises upon exposure to allergens such as
Poison ivy and nickel jewelry (type IV hypersensitivity)
Irritant chemicals (e.g., detergents)
Drugs (e.g., penicillin)
Treatment involves removal of the offending agent and topical glucocorticoids, if needed.
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Melanocytic nevus/Junctional Nevus
Common mole.
Benign, but melanoma can arise in congenital or atypical moles.
Intradermal nevi are papular
Junctional nevi are flat macules
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Pseudofolliculitis barbae
Foreign body inflammatory facial skin disorder characterized by firm, hyperpigmented papules and pustules that are painful and pruritic
Located on cheeks, jawline, and neck.
Commonly occurs as a result of shaving (“razor bumps”)
Primarily affects African-American males
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Psoriasis
Presentation
Epidermal Hyperproliferation Keratinocytes
Defined Red Salmon Plaques
Silvery Scales
Extensor Surfaces
Bleeding when Removed
Auspitz Sign
Pruritus
Nail Changes
Histological Finding
Munro Microabscesses
Nucleated Cells in Stratum Corneum
Treatment
Retinoids
Topical Corticosteroids
Tar
Immunosuppressants
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2 mins
Rosacea
Inflammatory facial skin disorder characterized by erythematous papules and pustules, but no comedones.
May be associated with facial flushing in response to external stimuli (eg, alcohol, heat).
Phymatous rosacea (chronic rosacea) can cause rhinophyma (bulbous deformation of nose).
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Seborrheic keratosis
Flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts)
Coin-like, waxy, 'stuck-on' appearance
Lesions occur on head, trunk, and extremities.
Characterized by keratin pseudocysts on histology
Common benign neoplasm of older persons.
Leser-Trélat sign —sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (eg, GI or lymphoid (less common)).
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Verrucae
Warts; caused by HPV (Usually 6 and 11)
Soft, tan-colored, cauliflower-like papules
Epidermal hyperplasia, hyperkeratosis, koilocytosis.
Condyloma acuminatum on genitals
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Urticaria (Hives)
Also known as Hives
Pruritic wheals that form after mast cell degranulation
Characterized by superficial dermal edema and lymphatic channel dilation.
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Strawberry Hemangioma and Cherry Hemangioma
Strawberry hemangioma
Benign capillary hemangioma of infancy
Appears in first few weeks of life (1/200 births);
Grows rapidly and regresses spontaneously by 5–8 years old
Cherry hemangioma
Benign capillary hemangioma of the elderly
Does not regress.
Frequency increases with age.
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Angiosarcoma
Rare blood vessel malignancy typically occurring in the head, neck, and breast areas. Endothelial origin.
Usually in elderly, on sun-exposed areas.
Associated with radiation therapy and chronic postmastectomy lymphedema.
Hepatic angiosarcoma associated with vinyl chloride (like in PVC pipes) and arsenic exposures. Also associated with Thorotrast exposures.
Very aggressive and difficult to resect due to delay in diagnosis
Usually asymptomatic, may have RUQ pain or may impinge on nearby structures; excellent prognosis with resection
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Glomus Tumor
Benign, painful, red-blue tumor, commonly under fingernails
Arises from modified smooth muscle cells of the thermoregulatory glomus body
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Pyogenic granuloma
Polypoid lobulated capillary hemangioma that can ulcerate and bleed
Associated with trauma and pregnancy.
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Pemphigus Vulgaris
Pathophysiology
Autoantibodies against desmosomes
Symptoms
Flaccid Bullae on Skin
Oral Mucosa Involvement
Intraepidermal Acantholysis
Fluid Loss
Infection
Nikolsky Positive
Diagnosis
Biopsy showing Autoantibodies
Treatment
IVIG and Plasmapheresis
Oral Steroids
Immunosuppressants
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2 mins

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