Electrodessication and curettage

Why, where 

superficial cancerous and pre cancerous growths are removed from the skin by repeated scraping and burning.

works best on trunk and extremities in non hairbearing becuase cancer can go down the hair follicle.

Do on skin lines, so minimal scarring 

cutaneous candidiasis

clinical presentations 

intertrigo (yeast infection on skin)

angular cheilitis- corners of mouth

balanitis-penis

bulvovaginitis-vaginal area 

candida intertrigo-

clinical presentation

brightly erythematous, moist, macerated skin

often has milky film, yeasty odor

main areas have satellite lesions, small papules and pustules with areas of normal skin between 

candida intertrigo-

treatment 

must dry out chronically moist area

showers, baths, soaks

use powders sparingly, helps to try and cool the affected environment, topical anti yeast medications 

-later oral commissures creating an environment of moisture and occlusion

- presents as erythematous cracked crutsted itchy painful lesions at the corner of the mouth

-treatment includes steroids but aslo need anti yeast

yeast infection of the genitals

can follow sexual activity and many other activities

overgrowth of pre existent flora 

Cutaneous candidiasis

Diagnosis 

The tineas

diagnosis 

the tineas

treatment 

topical antifungals- the azoles

terbinafine 

lipophilic yeast- colonized skin, hair follicles around puberty

has been implicated in terms of having a role in dandfruff

prefers trunk, where sebum production is high 

pityriasis versicolor

diagnosis 

clinical based on history and apperance

KOH prep yields classic spaghetti and meatballs from budding spores 

pityriasis versicolor

treatment 

topicals-selenium sulfide

chronic course needing periodic maintenance, can be presenting sign of the hiv 

isolated infection (pyodermas)

vs follicular infections 

isolated= depend on a portal of entry into the skin

follicular= use pre-existing skin structures as a portal of entry. 

wet, erythematous, crusted plaques, "honey crust"

itchy 

lymphangitis

DX

TX

acute infection of the subcutaneus lymphatics, GABHS, wont get fooled.  only thing that looks like this.

DX: clinical picture, tender erythematous linear streaks heading toward lyph nodes

TX:  find primary infection and attempt culture. usually need IV antibiotics 

NF (necrotizing faciitis)

Present

Folliculitis

presentation 

EIC:

back shoulders face and neck with oily skin.  dome shaped but doesn't point. pt HX of EIC in that area. well difined patch of pink faint erythmia 

ABSCESS: 

surrounded by diffuse poorly defind area of bright red erythemitous 

destructive

topical chemotherapy (5-FU) 

topical immunotherapy (aldera, induce allergic reaction 

cases are recurrent. maliase, fever, fatigue, myalgias. symptomatic burning or tingling before an outbreak. clears in 7-10 days.

BE careful of blame game. 10+ yrs of dormacy. LOCATION DOESN'T ALWAYS CORRESPOND TO INFECTION SITE 

VSV Varicella Zoster Virus

(chicken pox) 

Herpes Zoster

shingles 

chronic stable plaque psoriasis

guttate psoriais

palmoplantar pustular psoriasis 

clinical presentation of psoriasis

chronic stable plaque 

Psoriasis DX

usually clinical diagnosis. skin biopsy.

guttate psoriasis-should get a throat culture for cronic strep.  

PPP- occasionally need to biopsy because it could like eczema

topical steroid ointment(most potent), creams, gel

topical coal tar derivatives, retinoids

topical calcipotrine 

phototherapy, with narrow band and psoralen ultraviolent methotrexate and cyclosporine.

*make sure its not tinea with a scrape b/c steroids will flare.

*main risk with steroids is atrophy, thinning, milky skin 

*last resort is biologics 

oral antibiotics, topical steriods, narrow band uvb and natural sunlight. time (spontaneously resolve bw 4 & 6 weeks.)

*be ready to explain that Guttate can develop into chronic stable plaque 

very stubborn.  superpotent topical steroid under occlusions. (wrap in plastic wrap) topical coal tars and UV light treatment. oral retinoids.

*combo therapy usually a rule 

types of Eczema/dermatitis

irritant contact dermatitis (ICD)

allergic contact dermatitis (ACD)

atopic dermatitis (eczema)

lichen simplex chronicus (LSC)

Seborrheic Dermatitis (dandruff)

exposure to any irritating substance. mediated by substance direct toxicity to skin cells. can occur immediately after first exposure or take months after repeated.

mid-early: pink mildly erythematous patches or slightly raised papules and plaques. scaley or vesicular

severe-late: eroded, crusted, fissured freaqently bleed and get secondary infection

croton oil, kerosene, gasoline, detergents, always suspect sizing chemicals in unwashed new clothing.

also topical antibiotics 

inherited disorder. accompanied with asthma or hay fever.  characterized by chronically dry itchy skin. easily secondary infection.  exastperated by scratching.  ivolved areas include ears, face, eyelids, occipital scalp, posterior neck, ventral upper extremity, lower legs, popliteal fossa, dorsal feet.

stress induced or onset of cold weather where skin dries out and becomes itchy.

often chronic. 

Accute- widespread erythematous patches, papules, plaques.  often excoriated and wheeping cresting.  scaley lesions

Chronic- effected areas become thickened and lichenified. over a period of time hypopygmentation. fissuring and cracking can develop. 

Lichen Simplex Chronicus

( Prurigo nodularis "broad patches") 

"it feels good when you scratch it"

great pleasure in itching. secondary to atopic dermatitis. lesions are lichenified thickened well defined plaques and violacious to pink color.

usually presents in elderly patients on arms legs trunk hands.  cracked china appearance. lesions are erythematis to pink. dry scaley patches and plaques.

extreme itchyness. excoriated 

dyshidrosis

vesicular form of hand dermatitis. pt often have prior hx of atopic dermatitis.  tends to occur in accute episodes. "bubbly looking"  translucent papules and vesicles on hands which develop over several weeks. tapioca pearl appearance. peeling and fissuring are the rule.

sx: burning itching and tingling 

systemic lupus erythmatosus (SLE)

chronic cutataneus LE

subaccute cutaneus LE 

wide range of lesions with some level of multisystem involvement.  photosensitive. occuring on face, upper chest, shoulders, extensor surfaces of the arms, dorsal hands and fingers, erythematous patches and plaques

*sparing the knuckles.

* butterfly rash

important diagnostic test for lupus and CTD. 95% will have positive for this test. will not diagnose lupus need further workup for presence of internal disease.

serum antibody test 

classic discoid lesion or circular shape.  usually presents assymetrical raised violacious to red flat topped plaques of 1-3 cm diameter. firmly adherant scale.  has carpet tract texture on underside because scaling penetrates hair follicles. appears on face scalp and neck.  famale > male.  age of 40. UV exposure, physical trauma can induce or worsen lesions.

plaques are hypopygmented. lesions last months to years 

1. heliotrope rash-swollen face, sunburn

2. gottren's papules- flat topped papules on back of fingers, or knuckles

3. vioalcous scaling patches- over knees elbows and backs of hands

4. periungual telangiectasias- nail folds are thickened rough and erythematous with lots of small blood vessels

5. symmetrical proximal muscle weakness 

early dx and treatment increases outcomes

oral steroids and immunosuppresants

Calcinosis

Raynaud's

Esophogeal dysmotility

Sclerodactyly (hardening of skin and digits)

Telegiectasia (face, chest, mouth)

CREST

skin becomes hard, waxy, no wrinkles, no sweat glands or hair 

DX:  usually clinical. punch biopsy. review of systems to find internal involvement. physical exam of peringuinal regions. ANA

TX : difficult and only partially effective. managed by preventing secondary infection.

not entirely understood.  thought to be a reaction of keratinocytes. lrg areas of epidermis become necrotic and slough off in sheets.  increase in secondary bac. infectinion and water loss of skin. Rare and life threatening. stop drug, hospitalize quickly.

*nikolsky sign=pushing on blister causes it to spread laterally without much resistance

ideopathic erruption defined by four Ps:

1. pruritic

2. purple

3. polygonal

4. papules 

tends to affect wrists, flexor extremities, lumbar areas, genitals and mucosa.  lasts 6 mo.-yr. and leaves deep long lasting hyperpigmentation.  presence of Wickham's striae= rub with oil or alcohol to see honey comb texture