Derm Review Review of general histo/anatomy o o 2 weeks to get to stratum corneum, 2 weeks there, so total time is 4 weeks different

t cell types melanocytes: neural crest, ectodermal housekeeping in basal layer no functioning melanocytes, no skin color o o o o melanosome is how package, so this dictates skin color every race has same # of melanocytes if do not make color properly: vitiligo Do not genetically have: albinism

Langerhans cells- bone marrow, mesodermally derived Migrates, takes Ags to T cells in lymph nodes, critical in T cell mediated immunity

BM cell- complex structure of proteins Hemidesmosome is part of this If destroy this zone get sub-epith blister

Hair cycle Anagen Determines length of hair- genetic

Catagen Involutional phase, very short phase, very few hairs

Telogen Resting, shedding phase, once this is over, start again

Nail Nail plate is like hair shaft, like stratum corneum All dead structures, half moon shape

o o

Morphology- descriptive terms Pathology Eczema- internal or extrinsic cause Acute- warm, wet, oozing o MCC poison ivy

Chronic- dry

o o o

Cracked, epidermis w/ scale, diffuse If long lived, lots of scratching- normal epi response is thickening Nickel allergies

Seborrheic Dermititis- inflammatory Hair bearing areas Hypersensitivity to yeast, not true fungal infection because not an overgrowth See bad in HIV Inflammation of epidermis may inflame melanocytes- can have hypo of hyperpigmentation

Psoriasis- multifact genetic Classic is eryth plaque w/ silvery scale which bleeds when scraped External lesions- likes areas of trauma Can be widespread Most cases are sharply demarcated, eczema NOT sharply demarcated Seronegative RA type of arthritis Koebnerization- adhere to trauma area

Pityriasis Rosea Oval scale, can hyperpigment in center Christmas tree pattern- skin hangs, draping lines Think about syphilis as well

Tinea faciei Dermatophyte- classic angular lesions, KOH branching septated hyphae Pedis- often between 3 and 4 toe

TInea Capitis Most common cause of baldness in child Not like Cradle cap in baby- after hormones leave goes away

Candidiasis Warm and wet HIV common- but not pathopneumonic pseudohyphae

Tinea Versicolor Spores Humid times of the year

Herpes Tzanck test- all types of herpes, will not tell you which one MCC of chronic genital ulcers- herpes until excluded Oral type 1, genital type 2 V. Zoster- like to live in dermatome, reactivate usually in same spot, rarely recurs due to killing its own nerve

HPV Warts- common and genital (condyloma accumulata), condyloma lata is Syphilis

Molluscum Contagiosum Common, sexually transmitted Ask about HIV

Acne Vulgaris Obstruction, excessive sebum, comedome. Black head vs. white head P. acnes degrades material, breaks down sebum, inflammatory response, so get inflammatory pustule, if break more inflammation Acne cyst is not epithelially lined- misnomer Seems to run in families

Rosacea Not acne in pathophys, acne like in appearance NO COMEDOMES- older, northern European Flushing Often mistaken for acute lupus due to photo driven dz

Bacterial Crust- wet wash cloth can rub off Cellulitis- staph or strep- full thickness infection Erysipelas- always strep o Explosive onset, edema

Vitiligo Autoimmune Depigmentation- no color May repigment in dot pattern as melanocytes migrate

Albinism

Genetic, have problem producing or processing o o Often tyronsinase def Ocular problems- often blind, nystagmus

Glands, nerves, etc Eccrine always stands alone- volume of body sweat Apocrine- weird distribution, no clear Nerves- meissners and pacinian Nerves follow vessels- constriction and dilation depending on temp

Blister path Papilla Epithelial blisters- intra epi if epi falls apart Know Bullous Pemphigoid Pemphigus- autoimmune destroy desmosomes, epi falls apart, fragile blisters, peels off, often just see the base, erosions Ulcer- destroyed through BM vs. erosion- BM still intact

Neoplasms Seborrheic Keratosis Any color any shape, anywhere Difference between this and melanoma is that this is keratinocyte derived Age spots, etc- not born w/ these

Melanocytic nevis- group of benign melanocytes Nevis means collection of cells/stuff Benign proliferation of melanocytes, many places possible Dont take off all because malignant transformation so rare Know if melanocytic prolif is melan nevis

Hemangiomas No health risk- cherry angiomas as age In peds may see some removed for obstructive reasons

Dermatofibroma Scar like- bug bites, razors, Original lesion usually resolved Dermal component, very hard, cannot pick up/isolate No malig risk

BCC Skin type and environment 1 million this year #1 cancer and #1 skin cancer most benign- remove earlier, inconvenience not health risk, will invade though if they can grow ulcerated center, look around the edge- see pearly edge- biopsy here can have color in them

SCC Most common in transplant rec Higher chance of metast to lymph nodes Most in healthy individuals are good prognosis Always biopsy these (both SCC and BCC)

Melanomas Life threatening Most important prog indicator- lesional depth In situ mel, thin- not as bad, normal life expect One gets thicker, higher chance of mets, do sentinal lymph node biopsies #1 cause of cancer death in young people o o o o 16 fold increase in chance w/ tanning bed family hist, sun exposure (esp early) ABCDE Ulceration is not good prognostic sign

May see under nails o Hutchinsons sign- pathognomonic for melanoma Have pigment under nail and somewhere else near the nail

Systemic dzs Syphilis Primary o Chancre- asymp Secondary MC on penis Women often dont know because often on cervix

o o o Endocard

Condyloma lata- sudden Serology usually positive Rash- infectious, do not shake hands

Janeway lesions, oslers nodes Splinter hemorrhages

Kaposis sarcoma Vascular tumor HHV8- sexually transmitted Endemic in Mediterranean

Porphyria Cutana Tarda MC Hep C Iron problems, if carry gene for hemochromatosis is a problem

Leukocytic Vasculitis Primary lesion is small purpuric lesion Try to blanch- will not, know this is hemorrhage Neutrophils damaging vessels and causing hemorrhage Inflammatory small vessel dz

SLE Acute- MC associated w systemic Chronic cutaneous (discoid)- common, not all people w/ this have systemic o o Affects all races If lose color always have hyperpigmented border

Subacute cutaneous lupus o Know what is in handout

Dermatomyositis Heliotrope rash o o Purplish discolorization- look for other signs Gottrens papules- over the knuckles o Scaly eryth papules If just redness is Gottrens sign

Poikiloderma Very important to dx

Usually across the shoulders- shawl rash

Nail fold changes in CT dz Should not see rattiness, telagectasias, infarcts- start to think about syst dz if these exist

Scleroderma Tightness in face, clawed hands Progressive syst has high mortality MC systemic dz w/ Raynauds dz, can get cutaneous infarcts Know what CREST syndrome is: ie someone w/ sclero who has trouble swallowing Morphea and sclero are not the same, not a syst dz

Sarcoidosis More common is African American Lupus perneo (name for frostbite due to fact that it affects the same areas) o Marker for airway dz

Erythema nodosum Paniculitis deep problem in fat o Poorly demarcated

Oral Apthae- dx criteria for SLE, Behcets Necrobiosis Lipoidica More common in diabetes- 90% of NL have DM, but very few diabetics have

Acanthosis Nigracans Velvety thickness in neck and axillary areas o o o o Lichenoid- accentuation of valley Marker of insulin resistance Address menstrual problems In skinny older- malig

Pretibial myxedema Thyroid o o Deposition of mucinous type Difficult to treat

Xanthoma Xanthalasma type Lipid laden histiocytes Rubbery

Eruptive- triglycerides

Neurofibromatosis Caf au laut Freckles and fibromas

Tuberous sclerosis Ash leaf macule- shaped like leaf of ash tree Usually hypopigmented Assoc w/ seizures, mental retardation etc

Metast 2-5% of solid tumors present in the skin

Drug exanthem Morbiliform most common maculopapular (also measles)

Erythema multiforme MCC herpes, also drugs Tender, dusky, burn, itch

Stephens Johnson syndrome Rare Erythema multiform with mucosal involvement Hemorrhagic crust while sloughing oral mucosa

Toxic epidermal necrosis Skin sloughs off, survivable; 65% mortality- sepsis