Dermatology_Notes_For_PG_Training_S.pptx

Dermatology notes for PG training

1. Dermatology

2. Skin punch biopsy instrument Clean with surgical spirit Local anesthesia Twist the punch and remove Pull out the skin segment with a curved needle, cut at its bottom attachement Site – active edge. For IMF, out of the sedge, within 1cm from the edge. (at the edge immune complexes are destroyed) For histology transport in 10% formal saline. For IMF, transport in Michelle solution Put a suture, dress with betadine , remove and bath in 2 days, suture removal in 4-5d

3. Papulosquamous lesions Primary cutaneous Systemic Drugs Psoriasis Lichen planus Pityriasis rosea Tinea Bowen T verr cutis SLE Secondary syphilis Sarcoidosis MF Reiter Ps: BB, Li Pr : BB, ACEi , metronidazole LP: BB, ACEi , Q, HCT LP associations – HCV, chronic GVHD

4. Erythroderma Primary cutaneous Systemic Drugs Psoriasis Dermatitis (atopic / contact / seborrhoeic / stasis / pityriasis rubra pilaris ) CTCL (MF) Solid tumours (in late stages): lung, liver, prostate, thyroid, colon DRESS: penicillin, sulfonamides, AED, allopurinol Pseudolymphoma syndrome – erythroderma , LN, atypical L in BP: with AEDs DRESS + GI bleeding – Allopurinol

5. Alopecia Non-scarring Primary cutaneous Systemic Drugs Telogen effluvium Androgenetic alopecia Alopecia areata Tinea capitis Trauma – trichotillomania, traction alopecia SLE Secondary syphilis – moth eaten Thyroid – high / low Hypopit Undernutrition – Fe, Zn, biotin, protein Te : warfarin, heparin, vit A preps, ATD, Li, BB, Ae : Daunorubicin , high dose MTX, colchicine. Irreversible: post RT Scarring Primary cutaneous Systemic Drugs DLE – active: red scaly edge. Inactive: hyperpig edge, hypopig centre LP – violet macules at the edge. Folliculitis decalvans – pustules at the edge Morphea – bound down skin SLE with DLE Sarcoidosis Mets -

6. Figurate skin lesions – annular / arc Primary cutaneous Systemic Drugs Tinea Granuloma annulare Psoriasis E A centrifugum E infectiosum E multiforme Sweet Discoid eczema Livedo reti / racemose Erythema ab igne Migratory ECM - Lyme EGR - CA NME - Glucagonoma E marginatum – RhF Non migratory SCLE 2ry syphilis Sarcoidosis MF -

7. Acneiform eruptions Carcionid flush may leave background erythema and telengiectasia mimicking acne rosacea Pustular eruptions Acne Follicular pustules: Infectious folliculitis : Staph, Pseudo aeru (hot tub folliculitis), Malassezia , dermatophyte ( Majocchi granuloma) Non infectious folliculitis : HIV associated Ephilic foll ., steroids Non follicular pustules : Pustular psoriasis AGEP ( eg : CP Abtcs ) Primary cutaneous Systemic Drugs Acne vulgaris Acne rosacea Agn excess – Cushing, CAH, tumor ( adr / ov ), PCOS Disseminated cryptococcosis Behcets Steroids (mono morphic acne)

8. Telengiectasia Primary cutaneous Systemic Linear Acne rosacea VV Carcinoid Systemic mastocytosis Ataxia – telengiectasia Poikiloderma (T, hyper & hypopig , atrophy) Radiation P. Vasculare atrophicans DMitis MF XP Spider angioma Pregnancy Cirrhosis Mat - SSCl / CREST Periungual - SLE DMitis SSCl HHT Papular - HHT

9. Ulcers PG Ecthyma gangrenosum Leish Anthrax Fish tank Calciphylaxis Warfarin LV Vs DLE

10. Generalized rash MP – measles, RMSF, syphilis, HIV Petechiae / purpura Vasculitis Nm Hypopig – viti , t versicolor, MF, leprosy Hyperpig – NF, MF, leprosy, Nodular – KS, LL, NF, bac angio ,

11. DD periungual telengienctasia SLE SSCl DMitis Nail fold erythema ++ - ++ Ragged cuticle - - ++ Capillaroscopy Glomerula r shaped Long capillary loops Visible venules Drop outs and dilated loops Bushy capillaries Drop outs and dilated loops

12. Ragged cuticle of DMitis

13.  (A) Early scleroderma pattern: few giant capillaries (arrow) and no evident loss of capillaries; (B) active scleroderma pattern -frequent giant capillaries (arrows) with capillary hemorrhage (arrow head); (C) late scleroderma pattern -absent giant capillaries and hemorrhages, severe loss of capillaries with neoangiogenesis (arrow); (D) PM/DM pattern -“bushy” capillaries (arrows), twisted enlarged capillaries; (E) SLE pattern -long capillary loops (arrows) with venular visibility (arrow head); (F) MCTD pattern -dystrophic, extremely convoluted, branched capillary with pseudoglomeruli capillary formation (arrows); (G) nonspecific (H) normal pattern -hairpin capillaries, arranged in a parallel fashion

14. Hypopigmentation Generailzed Generalized vitiligo Albinism PKU Homocystinuria Chediak Higashi Hermansky Pudlack

15. Localized hypopigmentation VVSL Said TM was inflammed Vitiligo Versicolor Pityriasis – scaling Scleroderma – speckled leukoderma Leprosy – TT / indeterminate Sarcoid TS – ashleaf macule MF Post inflammatory hypopigmentation

16. Tuberous sclerosis -AD inheritance Ashleaf macule Angiofibroma (cutaneous hamartoma ) Cheeks Gums Subungual Shagreen patch – connective tissue nevus Hamartoma – CNS, retina, gut, skin AMLs and cysts – renal (PCKD), hepatic Pul LAM (women), cardiac Rhabdomyoma Low IQ, fits Dental pitting Rx Sirolimus / everolimus – mTORi – reduce fits, renal AML, LAM Surgical excision

17. Irregular nodular gum lesions – AFoma Phenytoin gum hypertrophy is diffuse Special stain colours dental pitting

18. Ash leaf macule – hypopigmented 1-3cm Shagreen patch – irregular plaque / nodule (upper lumbar region here)

19. TB Lupus Fungal Leishmania Cancer – BCC, SqCC , MF, KS, paraneo Psoriasis, LP

20. Cream Lotion Gel Emollient Ointment Acqueous cream – non alkalinizing soap substitute Salicylate – keratolytic

21. Paraffin Urea – has a moisturizing effect. Good for dry skin Salicylate KMnO4 – for oozing eczmas Bandaging – absorb ooze, allow emollient to act

22. TB skin EN – never ulcerates. Can affect trunk EI – ulcerates

23. Calciphylaxis / calcific uremic arteriopathy Very tender Fatty areas – abdomen, buttock, thigh Advanced CKD with MBD Dx : arteriolar calcification and occlusion without vasculitis 2ry infection common. Poor prognosis Rx: optimize Ca /P balance. Sevalemer over CaCO3; cinacalcet over Vit D (reduce PTH. But keep over 100 to Px ABD) IV Na thiosulphate , hyperbaric O2, bisphosphanates IV/PO

24. Hands palms feet soles

25. Madura foot

26. Charcot foot

27. Chromoblastomycosis

28. Face Lupus pernio Dmsitis Leprosy – LL, B, TT Cancer Leish Seborrheic dermatitis Scleroderma Malar flush and malar rash Herpes Acrodermatitis enteropathica Sycosis barbae SJS, EM

29. Malar rash DD SLE Rosacea Malar flush of mitral stenosis Diabetic erythema Carcinoid

30. 5.This patient is on cyclosporine

31. Trichomegaly

32. Impetigo Strep, staph

33. Ear

34. Non dermatomal distribution – scrum pox

35. Vemurafenib and dabrafenib selective BRAF inhibitors that increase overall survival in metastatic melanoma. paradoxically activates the MAPK pathway in keratinocytes and can cause squamous cell carcinomas, often within the first three months of therapy. The risk higher in older patients and they can occur in sun-protected sites.

36. BCC

37. Mouth

38. Kaposi sarcoma Violaceous Head and neck, MM affected HHV8 Differential dx---pyogenic granuloma, hemangioma , melanocytic nevus, granuloma annulare Treatment---radiotherapy, cryosurgery, laser surgery, intralesional chemotherapy

39. KS Dx – Bx Rx – HAART +/- chemo (local / systemic) +/- RT

40. Neck Ludwig angina

41. Scrofuloderma DD – cervical actinomycosis