2-20-04
DERMATOLOGY
PIC:
Stasis Dermatitis
• Erythema, hyperpigmentation, and scale occurring on the distal lower extremities, particularly over the medial malleolus
• Stasis dermatitis is frequently preceded by chronic and recurrent edema of the lower legs
1. Vinette:
Pt w/o TX whould have a progosis with lrg tortuous vericose veins high vol. Venous reflux & early stasis changes of medial ankle.
Answer: - Venous ulceraton
2. Vignett:
Pt with lrg varicosities above the knee
Answer: Venous ulceration (takes a while to take place)
- Constant irrition could produce a squamous cell CA
Palms/Soles:
- TSS – 15y/o female
- Secondary Sphyllis
- Kwasaki
- Rocky Mt. Spotted Fever
-
If you culture a Strep bovis – Think Colon CA
• Meningococcemia: o Emergent
• ID-RASH DZ:
a. Lyme Dz
- Taget rash
- Look for Long Island Conn.
- Rash – erythema chronicum migrans
b. 5th Dz
- erythema infectiosum
- Rash “slapped cheek”
- Parvovirus B12, can cause aplastic anemia
- Test for Ab
c. Measels (rubeola)
- cough, roryza, conjunctivitis, Koplik
- rash accoumpanied by fever for measels
- Roseola – rash after fever
- Rubella – 3rd measels, lymphadenopathy
- Can immunize against measels, rubella, Lyme
d. Rocky Mt. Spotted Fever
- Look for Carolina’s
- Rash palms/feet
- Cat-scratch fever – papule, granuloma, lymphadenitis
- PCR most senstitive for Dx
- Kittens transmit more than cat
e. Rheumatology
- Juv. RA
Types:
- polyarticular- many, small joints, RF - , RF +
- Pauciarticular – fw lrg joints
- Type I – ANA+
- Rash, systemic fever
f. SLE
- Malar rash “wolf”
- Reanal involvement in child
- BX – for immunoflorescence
- Neonatal lupus – congenital heart block
g. Kwasaki
- Mucocutaneous lymph node syndrome
- Fever plus 4 to 5 following: o Conjunctivitis mucous membrane changes o Peripheral extremity changes o Rash (rash peeling on hands & feet “dequamation”) o Cervical lymph nodes o Cardia involvement
Henoch-Schoenlein Purpura:
- Rash usually below waist
- Usually follows viral illness
- Can have renal, GI involvement
Acute-Hep B:
- Exposure: vacrine + HBIG
- Clinical course: symptomatic vs asymptomatic
If you see increase eosinophiles, pt taking Bactrim = Drug Reaction
Tubulanterstitial Dz:
- Acute interstitial nephritis o Common cause o Adults: drugs (pen, ceph, sulf, NSAID’s) o Drug reactions
Malignant Melanoma (MM):
- A: Asymmetry
- B: Border
- C: Color
- D: Diameter (>.5)
- E: Elevation
Acanthosis Niaricans:
- Bx for CA (female)
- GI CA – most common cause
Urticaria:
- Cold can cause it
- Decrease temp causes mast cells to degranulate
- Type I: “Immediate Hypersensitivity” o Results from an Ag binding to IgE on the surface iof the mast cells & basophils o Degranulation of mast cells & IgE o Begins within sseconds
Meningococcemia:
- Emergent
- Abx ASAP
- DIC, necrosis, death
- Fever headache muscle aches
- Winter & spring
- Kids & teens
- Petechial & evolves to palpable purpura with central necrosis
- May or may not be N/V or menigeal syndromes (stiff neck)
Normal Anatomy: Layers:
- S. corneum
- S. lucidium
- S. granulosum
- S. spinosum
- Basale
- Dermal-epidermal Jnx
Langerhan cells:
- dendritic macrophages
- can also be stained with S-100 for a DDX of MM
Merkel cels:
- “of neural crest origin”
Terminology:
a. Macule
b. Papule
c. Nodule
d. Plaque
Neurofibrinotosis:
- small neurofibromas all over the body
- Peripheral cells (Schwann cells)
- Café-au-Lait spots
- Kid with no fibromas, but with café-au-lait spots: McCune-Albright's polyostotic dysplasia
Ichthyosis:
- Cool Dz!
- Keratin fails to shed
- Lizard skin
- Can get in eye = blindness
Skin CA:
- If CA head = BCC (does not METS)
- Below head = SCC (can METS)
- any where = MM (METS) S-100 stain to R/O (melanocytes stain with s-100)
Pityryiasis Rosaea:
- Common
- Young
- Initial lesion s the “Herald Patch”
- Christmas tree patten rash on the bach
- Usually asymptomatic (Sun exposure)
- If symptomatc (pruritis) topical cortisone
- Will go way in about 6wks with or without treatment
Impetigo:
- Infection of the skin
- Children (goldern crusty scabs)
- Staph aureus, can also be Beta Hemolytic Strep (glom-nephritis)
- Use topical Abx
Ring worm:
- Fungal
- Looks like a ring
- Itchy
- KOH prep
- Topical antifungal
- Contagious 