Barkley Derm

circumscribed flat area of skin that is different in color and texture from its surrounding tissue, less than 1 cm in size.

A circumscribed elevation of the skin that contains serous fluid that is under 1 cm in diameter

Solid mass of skin, observed as an elevation or can be palpated that is over 1 cm in diameter. It often extends into the dermis (deeper)

Small solid elevated lesion
under 1 cm in diameter

Elevated white or pink compressible papule or plaque
red axon-mediated flare often surrounds it
Commonly associated with allergic reactions

Papule

a localized collection of purulent fluid in a cavity formed by disintergration or necrosis of tissues that is over 1 cm in size

mass over a few centimeters in diameter.
It can be firm or soft, benign or malignant

Macule

A visible accumulation of purulent fluid under the skin under 1 cm in diameter

A circumscribed elevation of the skin that contains serous fluid that is under 1 cm in diameter

Raised, encapsulated, fluid filled lesion
can be found anywhere

Elevated white or pink compressible papule or plaque
red axon-mediated flare often surrounds it
Commonly associated wtih allergic reactions
(circumscribed area of skin edema

a localized collection of purulent fluid in a cavity formed by disintergration or necrosis of tissues that is over 1 cm in size

flat, red-purple discoloration caused by RBCs lodged in the skin
DOES NOT BLANCH

Small solid elevated lesion
under 1 cm in diameter

Papule

Macule

Fluid filled lesion over 1 cm in diameter
ex blister (COMMON EXAM QUESTION)
necrotizing fascitis

papule

Papule

Papule

Pustule

Pustule

Vesicle

Vesicle

Vesicle

Nodule

is a deposition of yellowish cholesterol-rich material in tendons or other body parts in various disease states.
They are cutaneous manifestations of lipidosis in which there is an accumulation of lipids in large foam cells within the skin.

They are associated with hyperlipidemias, both primary and secondary types.

If 2/6 usually MM
ABCD
Asymmetry
Borders Irregularity
Color variation
Diameter>6 mm pencil eraser
Elevation and Enlargment

xanthoma

There are various type of xanthomas.
xanthelasma of the eyelids.

xanthoma

Freckles
Macule

Small purapura- doesn't blanch
(1-2mm) red or purple spot on the body, caused by a minor hemorrhage (broken capillary blood vessels).
< 1 cm, usually caused by thrombocytopenia (a low platelet count)
Petechiae's an example of a Macule

Pict of vasculitis, has some purapura also

Macule

Patch

Patch

Annular
Tinea

Confluent/ Coalesce

Grouped

Gyrate
eg. Scabies

Linear

Polycyclic

Solitary or discrete

Target
Lyme dx

Zosteriform
herpes zoster

Target

Nodule

macule
Freckles

are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchyme tissue. The term "fibroblastic" or "fibromatous" is used to describe tumors of the fibrous connective tissue. When the term fibroma is used without modifier, it is usually considered benign, with the term fibrosarcoma reserved for malignant tumors.

fibroma

fibroma of tongue

Bulla

Bulla

Bulla

Bulla

Wheal

Wheal

cyst

lump or plug in the skin

blackhead
opening capped with a blackened skin debris

whitehead
obstruced openings

Papule/ Pustule

Pustules and Papules
Comedones (black and white)
Cysts
Nodules
Scarring

Cysts, Nodules or a lot of scarring

usually 90 days

creams

Benzoyl peroxide
Salicylic acid (Neutrogena2% wash)
Azelaic acid (Azelex)
Tretinoin (Retin-A)
Adapalene (Differin)
Tazarotene (Tazorac)

Benzoyl peroxide+ Erythromycin (Benzamycin)
Benzoyl peroxide+ Clindamycin (BenzaClin
Benzoyl peroxide + Drying agents Sulfacetamide sulfur (Novacet or Sulfacet)

Benzoyl peroxide+ Erythromycin (Benzamycin)

bacteriocidal

acne, cradle cap, dandruff and seborrheic dermatitis, warts and other lesions.

therapy is treatment to remove warts and other lesions (in which the epidermis produces excess skin. In this therapy, acid medicine, such as salicylic acid is put on the lesion. Keratolytic therapy thins the skin on and around the lesion.) It causes the outer layer of the skin to loosen and shed.

Keratolytics can also be used to soften keratin, a major component of the skin. This serves to improve the skin's moisture binding capacity, which is beneficial in the treatment of dry skin. Such agents (keratolytics) include urea, lactic acid, and allantoin.

While cytostatic agents such as zinc pyrithione are first line, keratolytics (salicylic acid and sulfur) can also be used in the treatment of dandruff and seborrheic dermatitis.

Sulfur and salicylic acid can also be used to effectively treat acne and cradle cap in some patients.

reduces comedone formation

bacteriocidal and reduces comedone formation

increases risk of sun burn
Pregnancy category C

1 (Differin)
2 Less skin irritation then Retin A
3 Pregnancy cetegory C

Expensive
Pregnancy Category X

Clindamycin
Erythromycin
Tetracycline
Metronidazole

Clindamycin

Erythromycin

Tetracycline

Metronidazole

Tetracycline
Erythromycin
Minocycline
Doxycycline
Clindamycin

tetracycline

In pregnancy and children under 9 yrs b/c of staining of the teeth

hyperpigmentation

Isotretinion (Accutane)

Combination therapy is most effective
Ortho Tri Cyclen and Estro- Step
May cause brownish blotches or Melasma on the skin

Always obtain informed consent
It's contraindicated in pregnancy, 2 forms of birth control are needed

Melasma

Melasma

Furuncle

Clindamycin
Erythromycin
Tetracycline
Metronidazole

Staphylococcus aureus

1 Tazarotene
2 Pregnancy Category X
3 Expensive

Staph, but cellulitis is usually by strep

Adapalene (Differin)

1.Strep pyogenes (Group A Strep
2.Staph Aureus-less common
3. Other Strep (Gp B,C,G)

1.Strep pyogenes (Group A Strep
2.Staph Aureus-less common
3. Other Strep (Gp B,C,G)

1 Gm neg organisms like e coli, Klebsiella, Pseudomonas, Enterobacter)
2. S aureus (MRSA? CA-MRSA?)
3 Strep

S aureus

1 Bactrim (95-100%)
2 Doxy/ Minocycline (90-95%)
3 Clindamycin (85-95%)

S pyogenes

Inflammation of the hair follicle

Tazarotene (Tazorac)
Used as a comedolytic agent
Preg category x

Boil, localized infection originating in the hair follicle caused by staphylococcus aureus

Tetracycline
Erythromycin
Minocycline
Doxycycline

S aureus

Benzoyl peroxide+ Erythromycin (Benzamycin)
Benzoyl peroxide+ Clindamycin (BenzaClin
Benzoyl peroxide + Drying agents Sulfacetamide sulfur (Novacet or Sulfacet)

S pyogenes

S aureus

1 Bactrim (95-100%)
2 Doxycycline
3 Minocycline (90-95%)
4 Clindamycin (85-95%)

S aureus

Strep pyogenes

Benzoyl peroxide
Salicylic acid (Neutrogena2% wash)
Azelaic acid (Azelex)
Tretinoin (Retin-A)
Adapalene (Differin)
Tazarotene (Tazorac)

1 Gm neg organisms like e coli, Klebsiella, Pseudomonas, Enterobacter)
2. Staph aureus (MRSA? CA-MRSA?)
3 Strep

You need additional coverage
Bactrim, Doxycycline/ Minocycline or clindamycin with a
beta lactam or 1st generation cephalosporin
(PCN, Amoxicillin), 1 st generation cephalosporin (Keflex)

A beta-lactamase inhibitor is a drug given in conjunction with a beta-lactam antibiotic. Although the inhibitor does not usually have significant antibiotic activity on its own, it inhibits activity of beta-lactamase, a protein that confers resistance of beta-lactam antibiotics to bacteria.

Beta-lactamase inhibitors in clinical use include clavulanic acid and its potassium salt (usually combined with amoxicillin or ticarcillin), sulbactam and tazobactam
Clavulanate+ Ticarcillin =Timentin
Clavulanate+ amoxicillin= Augmentin
Tazobactam+Pipercillin=Zosyn
Sulbactam+ ampicillin=Unasyn

The β-lactam ring is part of the core structure of several antibiotic families, the principal ones being the
1-penicillins
2-cephalosporins,
3-carbapenems,
4-monobactams,
5-Cephamycins
6-Beta-lactamase inhibitors

Bacteriocidal

Nearly all of these antibiotics work by inhibiting bacterial cell wall biosynthesis. This has a lethal effect on bacteria. Bacteria can, however, become resistant against β-lactam antibiotics by expressing a β-lactamase.

E coli, klebsiella, pseudomonas, enterobacter

Dicloxacillin or Cephalexin (Keflex)

purpura (purple patches).

Erysipelas

Erysipelas

Erysipelas

a rapid progression of an erythematous, warm, indurated area

skin disease that most commonly affects areas bearing apocrine sweat glands or sebaceous glands, such as the underarms, breasts, inner thighs, groin and buttocks

staph aureus infection

hidradenitis suppurativa

Staph aureus

infection of the skin (vesicle to pustules)
Primary lesion is a thin walled vesicle that breaks easily, it's honey colored crust at the edge, commonly satelite lesions can appear and spread to remote areas of the skin,
can have pustules

Staph aureus

Staph around the nail fold

1 regional lymphadenopathy
2 pain
3 swelling
4 warmth
5 erythema
6 vesicles
7 pustules
8 purulent drainage

1 fever
2 malaise
3 chills
4 anorexia

Culture if needed
I&D as needed
Systemic tx should be directed at the offending organism
May need antipyretic, analgesic

Bacitracin, Bactroban (Mupirocin)

1 st generation cephalosporin (Cephalexin- Keflex)
or Penicillinase resistant PCN (Dicloxacillin)
Clincamycin or amoxicillin clavulanate may be used if it's a human bite, but not so great for polymicrobial infect.

Pain along a dermatomal distribution, usually on the trunk
Grouped vesicle eruption along the dermatomal pathway

May scrape the blisters for analysis

Treatment options include Acyclovir, Famiciclovir, Valaciclovir

Refer

Gabapentin (neurontin)
Pregabalin (Lyrica)

Zostavax prophylaxis indicated at age 60 yrs

Actinic Keratoses and Keratoacanthoma lesions can progress into Squamous cell

Basal Cell carcinoma

Malignant Melanoma

Malignant Melanoma
Mortality Highest
May metastasize from a mole to any organ

Herpes zoster

a condition with vesicular eruptions due to varicella zoster virus; may be life threatening in immunocompromised adults

grouped vesicle eruption along the dermatomal pathway with pain usually on the trunk

A harmless rash, pityriasis rosea usually begins with a single, scaly pink patch with a raised border. Days to weeks later, a scaly rash appears on the arms, legs, back, chest, and abdomen, and sometimes the neck. The rash may appear like a "Christmas tree". The rash, whose cause is unknown, isn't believed to be contagious and can be itchy. It often goes away in 6-8 weeks without treatment. Pityriasis rosea is most often seen between the ages of 10 and 35.

the most common skin cancer
waxy pearly appearance, may be shiny red
central depression or rolled edge may have telangiectatic vessels

slowly 1-2 cm after years

shave/ punch biopsy and surgical excision

biopsy and surgical excision

40 yrs

-Malignant
-May metastasize from a mole
-Mortality is highest of all cancers
-May metastasize to any organ

One that gives a sign or indication of something to come

Pityriasis Rosea

Eczema

Chronic skin condition characterized by intense pruritis,
acute flare ups
red, shiny or thickend patches
inflamed/ scabbed lesions with erythema/ scaling
dry, leathery lichenification

Atopic Dermatitis

Topical Steroids
Prednisone taper if severe

Do not Scrub with soap and H2O

Topicals for scalp (tar/Salicyllic acid shampoo)
Topical steroids (betamethasone)
UVB light exposure

Acute or chronic condition characterized by inflammation at the site of contact with chemical allergens
Redness, Pruritits, Scabbing etc.
Sharp, defined borders

Benign hyperproliferative inflammation of the skin that can be acute or chronic

HIV may be present as a first sign of HIV infection (explosive onset)

S/S
1 Itching,
2 red
3 precisely defined plaques with silvery scales
4 Fine pitting of the nails
5 Auspitz sign

droplets of blood when scales removed

Mild, acute inflammatory disorder

female during the Spring and Fall

Pruritic rash found on the trunk and proximal extremities

Initial lesion 2-10 cm herald patch with a general rash within 1-2 weeks.
Lesions follow a christmas tree pattern (follows cleavage lines on the trunk) and resolve within 2-10 weeks

the eruptions lasts for 4-8 weeks

syphyllis

distinctive bull's eye macular/papular rash and/ or flu like symptoms

Erythema chronicum migrans

Erythema migrans

24-48 hrs

ELISA

Western Blot

Amoxicillin
Cefuroxime (Ceftin), Azythromycin, others
Doxycycline (not in children or pregnancy)

xanthoma

If 2/6 usually MM
ABCD
Asymmetry
Borders Irregularity
Color variation
Diameter>6 mm pencil eraser
Elevation and Enlargment

premalignant small patches occuring on sun exposed parts of the body, that may be tender, rough, flesh colored, pink or hyperpigmented

Pharm options
1 5FU
2 Imiquimod
3 Diclofenac gel
4 PDT with topical delta aminolevulinic acid

Tissue destruction options
1 Liquid Nitrogen (cyrotherapy)
2 Laser Resurfacing
3 Chemical Peel

Actinic Keratoses
Keratoacanthoma

Firm irregular papule/ nodule that develops over a few months from prolonged sun exposed areas in fair skin people
3-7% metastisize

Biopsy and surgical excision (Mohs)

also known as chemosurgery, is microscopically controlled surgery used to treat common types of skin cancer.

Benign

no

beige, brown or black plaques with a stuck on appearance that are usually 3-20 mm in diameter

none or liquid nitrogen

Concentric
Concentric objects share the same center, axis or origin with one inside the other.

The rash usually first appears as a large, pink patch (which may be scaly in texture) on the chest or back. This first patch is called the herald patch or the mother patch. One to 2 weeks after the appearance of the mother patch, more pink patches will appear. Christmas tree like pattern. Like the mother patch, they are pink, often scaly, and oval. After a period of 2 to 10 weeks, the rash disappears on its own (spontaneously). Rarely, pityriasis rosea may be localized to a specific region of the skin.

May be viral in origin
Erythromycin seems to help it

1 Any signs of inflammation
2 Regional lymphadenopathy
3 Pain
4 Swelling
5 Erythema
6 Warmth
7 Vesicles
8 Pustules
9 Purulent drainage

Cellulitis
Erysipelas

This skin disorder leads to a scratch-itch cycle:
It may begin with something that rubs, irritates, or scratches the skin, such as clothing.
This causes the person to rub or scratch the affected area. Constant scratching causes the skin to thicken.
The thickened skin itches, causing more scratching, which causes more thickening.
The skin may become leathery and brownish in the affected area.

Most skin conditions such as
Impetigo
Hidradenitis suppurativa
Paronychia
Folliculitis
Furuncle
Carbuncle

.
Seroconversion is a term that refers to the development in the blood of antibodies to an infectious organism or agent.
The phenomenon of seroconversion can be important in diagnosing infections that are caused by latent viruses

Typically, seroconversion is associated with infections caused by bacteria, viruses, and protozoans. But seroconversion also occurs after the deliberate inoculation with an antigen in the process of vaccination

When these viruses first infect people, the viral nucleic acid can become incorporated into the genome of the host. As a result, there will not be an immune response mounted against the virus. However, once viral replication has commenced antibodies to viral proteins can accumulate to detectable levels in the serum.

lesions altered by outside manipulation, tx, natural course of dx
ex crust
raised lesion caused by dried serum and blood remnants, develops when a vesicle ruptures.
crust
excoriation
lichenification
scales
erosion
ulcer
fissure

1 macule (patch)
2 papule (plaque)
3 pustule (abcess)
4 petechiae (purapura)
5 vesicle (bulla)

1 plaque
2 bullae
3 abcess (big pustule)
4 Nodule
5 Tumor

A cyst, wheal and purpura can be any size

cyst
wheal
purpura

in an ring
Example: tinea
Erythema migrans (lyme dx) is concentric/ bull's eye/ target

Generalized over body without a specific pattern or distribution
Maculopapular rash associated with rubella

Confluent lesions
Multiple lesions blending together

Grouped lesions without a pattern
Some acnes

In streaks
Poison ivy/ oak

Appearing in a net like cluster
erythema infectiosum = 5th dx slapped cheek appearance

limited to boundaries of a single or multiple dermatones
Shingles

http://www.aafp.org/afp/2000/0815/p804.html

1 Excoriation
2 Crust
3 Lichenification
4 Scales
5 Erosion
6 Ulcer
7 Fissure

usually linear, raised lesion often covered with a crust
ex. scratches over a nickle allergy (contact dermatitis)
can be any size

Raised lesions produced by dried serum and blood remnants
Ex. scab

can be any size

Skin thickening usually found over pruritic or friction areas
ex callous on the foot
eczema

can be any size

Raised superficial lesion that flake with ease
ex dandruff
psoriasis

can be any size

loss of epidermis
area beneath a bullae or vesicle

> 1 cm

Loss of epidermis and dermis
syphilitic ulcer

> 1 cm

narrow linear crack into the epidermis, exposing dermis

athletes foot
crack on dry lips

> 1 cm

This includes aspects of the outward appearance (shape, structure, color, pattern)

Distribution

figure, determined by the arrangement of its parts or elements
Example Annular, Clustered, Linear, Reticular, Dermatormal, confluent

Actinic Keratoses
Keratoacanthoma

Actinic Keratoses
Keratoacanthoma

also called "solar keratosis" and "senile keratosis"
Llight or dark, tan, pink, red, brown occasionally flesh colored, scaly, often tender on the sun exposed skin surfaces such as the face, neck, back of the hands and forearms.
Size ranges from microscopic to several cm

Can progress into squamous cell carcinoma, some go away on their own

Red or brown scaly often tender . Occasionally flesh colored,on the sun exposed skin surfaces such as the face, neck, back of the hands and forearms.
Size ranges from microscopic to several cm

Pharmacotherapy or tissue destruction options.

Pharmacotherapy or tissue destruction options.

Pharmacotherapy Options
1 5 FU topical 5 fluorouracil
2 5% Imiquimod Cream
3 Topical Diclofenac Gel
4 PDT Photodynamic therapy with topical delta aminolevulinic acid

Tissue destruction options
1 Cryosurgery
2 Laser Resurfacing
3 Chemical peel

Pharmacotherapy Options
1 5 FU topical 5 fluorouracil
2 5% Imiquimod Cream
3 Topical Diclofenac Gel
4 PDT Photodynamic therapy with topical delta aminolevulinic acid

Tissue destruction options
1 Cryosurgery
2 Laser Resurfacing
3 Chemical peel

typically skin colored or slightly reddish when they first develop, appearance usually changes from smooth, dome shaped and then within a few weeks, grow to 1-2 cm, craterlike with outer rim of tissue, with a crusted interior on sun exposed areas

typically skin colored or slightly reddish when they first develop, appearance usually changes from smooth, dome shaped and then within a few weeks, grow to 1-2 cm, craterlike with outer rim of tissue, with a crusted interior on sun exposed areas

25

lesion that just appears
not arising from a previous lesion- mole

Surgical removal
less commonly tx with 5 FU or radiation

keratoacanthomas

Surgical removal
less commonly tx with 5 FU or radiation