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102 Cards in this Set
- Front
- Back
what is HAIR-AN syndrome?
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Acanthosis Nigrans: Velvety hyperpigmentation of the skin associated with insulin resistance,
endocrine disorders HyperAndrogenism Insulin Resistance Acanthosis Nigricans |
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Causes of generalized
hyperpigmentation— |
“None of the skin is SPARED”
Sunlight Pregnancy Addison’s disease Renal failure Excess iron (hemochromatosis) Drugs (e.g., busulfan) |
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Dx and treatment:
>>Velvety hyperpigmentation of the skin >>may develop type 2 diabetes, dirty-appearing, prominent skin lines |
Dx: acanthosis nigrans
Tx: weight reduction for obesity and insulin resistance or search for occult malignancy. >>rule out DM. |
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Histology shows hyperkeratosis and proliferation of melanocytes. what should be ruled out and tx
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Tx: weight reduction for obesity
and insulin resistance or search for occult malignancy. Dx: acanthosis nigrans |
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Common drugs causing
hyperpigmentation |
minocycline, amiodarone,
chloroquine, gold, chlorpromazine, bleomycin, 5-FU, and daunorubicin. |
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>>A slowly enlarging area of pink or brown macular patches is seen,predominantly affecting the flexor surfaces.
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Erythrasma
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pathogen that cause erythrasma?
predominant in what group of people? |
Corynebacterium minutissimum and other corneybacterium species.
predominant in diabetics |
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what would be seen in wood's light and KOH prep in erythrasma?
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>>Wood’s light causes lesions to fluoresce coral pink or red
>>KOH prep is - |
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treatment of erythrasma?
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Rx: Topical or oral erythromycin
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hypersensitivities
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Anaphylactic—type I
Cytotoxic—type II Immune complex—type III Delayedhypersensitivity— type IV |
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skin disorder characterized by pruritus. Persistent scratching → lichenification
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Atopic Dermatitis/Eczema
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allergic triad
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atopic dermatitis, asthma, and
hay fever |
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Macule
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Flat area of skin discoloration < 1 cm in diameter.
. . |
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Papule
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Elevated area of skin < 1 cm in diameter.
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Plaque
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Elevated area of skin > 1 cm in diameter.
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Nodule
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Elevated and deep (continues beneath skin) area of skin > 0.5 cm in
diameter. |
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Cyst
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Nodule containing fluid
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Vesicle
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Fluid-containing skin elevation < 0.5 cm in diameter
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Wheal
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Transient, pruritic, edematous papule or plaque.
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Bulla
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Fluid collection in elevated skin > 0.5 cm in diameter.
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Pustule
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Papule containing purulent fluid.
. |
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Petechiae
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Nonblanching, flat, red/purple lesions caused by thrombocytopenia associated
microhemorrhages. |
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Purpura
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Visible collection of extravasated RBCs.
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Telangiectasia
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Visible dilated capillaries on the surface of the skin.
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Hyperkeratosis
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Thickening of the stratum corneum
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Keloid
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Scar tissue hypertrophy.
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Scale
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Thick, detached areas of stratum corneum.
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Crust
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Dried exudate.
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Excoriation
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Shallow abrasion caused by scratching.
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Erosion
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Loss of epidermis above the basal layer.
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Ulcer
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Loss of epidermis and part or all of the dermis.
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Nevus
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Benign growth, such as a mole, that is a cluster of melanocytes.
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atopic dermatitis viral associations
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impetigo
cellulitis HSV-1 skin infection (eczema herpeticum)Molluscum contagiosum. |
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Bullous Pemphigoid autoantibodies
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BP1 and BP2 found in the basement membrane of the skin.
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tx pemphiguds vulgaris
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Oral steroids. Patients must continue steroids to prevent recurrence. Immunosuppressants
such as azathioprine can be used to ↓ steroid dose. ■ Severe cases may require plasmapheresis. ■ Lesions should be cared for as burns |
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how is contact dermatitis diagnosed? Tx for mild and severe cases
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>> skin patch testing.
tx: ■ Mild cases: Cool compresses or oatmeal preparation; topical steroids 3–4 times a day to reduce pruritus. ■ Severe cases: An extended course of systemic corticosteroids may be required; antihistamines to reduce pruritus |
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recurrent erythema multiforme
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Think HSV infection with
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what would an erythema multiforme show on skin biopsy.
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Skin biopsy shows perivascular lymphocytes (mostly T cells) and necrotic keratinocytes
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what medication both a precipitating factor and a treatment for erythema nodosum.
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NSAIDs are both a precipitating factor and a treatment for erythema nodosum.
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treatment for erythema nodosum
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Supportive. Elevate leg, bed rest, potassium iodide, NSAIDs.
■ Systemic corticosteroids may be necessary for persistent cases |
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Lichen Planus is associated with?
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Often induced by drugs and strongly associated with HCV
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Dx:purple, polygonal pruritic papules with an overlying network of white lines (Wickham’s striae)
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Lichen Planus
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treatment Lichen Planus for itch and severe cases.
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Topical steroids and oral antihistamines to reduce itch; severe cases require cyclosporine, oral prednisone, oral retinoids, and PUVA.
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Munro microabscesses
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(neutrophils in stratum corneum) seen in psoriasis
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psoriasis: mild and severe
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Topical steroids and topical calcipotriol for mild to moderate disease.
■ Phototherapy (PUVA/UVB) and immunosuppressants such as methotrexate for severe or generalized disease. ■ Biologic agents (e.g., infliximab, etanercept). |
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young person with severe seborrheic dermatitis
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Suspect HIV
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what yeast is Seborrheic Dermatitis
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Pityrosporum yeast.
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The leading cause of (SJS/TEN)
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is sepsis from superimposed bacterial skin infections (S. aureus in the early stages; gram- rods such as Pseudomonas in later stages).
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SJS skin biopsy:
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Perivascular mononuclear infiltrate and degeneration of the basal layer.
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TEN skin biopsy
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Full-thickness, predominance of macrophages and
dendrocytes and a strong immunoreactivity for TNF-α. |
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tx: SJS/TEN
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Early diagnosis and elimination of offending agents
Hospitalize in the burn ICU to manage skin and fluid losses. |
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With vitiligo, consider other
autoimmune diseases, name them |
pernicious anemia, thyroid
disease, Addison’s disease, and type I DM |
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tx .vitiligo
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Topical artificial tanning creams, steroid/tretinoin creams, or phototherapy
can be used. Lesions can be refractory |
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what test should be done before administering isotretinoin
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Isotretinoin is teratogenic, so
women must have pregnancy testing before and during therapy. |
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tx for mild moderate acne
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Mild acne: Topical clindamycin or erythromycin; benzoyl peroxide; topical
retinoids. ■ Moderate acne: The above regimen plus oral antibiotics such as tetracycline. ■ Severe nodulocystic acne: Oral isotretinoin (Accutane |
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tx. for cellulitis/folliculitis
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For mild to moderate cases, give oral antibiotics (cephalexin or dicloxacillin)
× 7–10 days. ■ Hospitalize and give IV antibiotics in the presence of any signs of systemic toxicity, |
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Small, scaling, hyper- or hypopigmented macules that tend to enlarge and sometimes coalesce. (“spaghetti and
meatballs” on KOH prep |
PITYRIASIS VERSICOLOR
treatment topical antifungal agents and selenium sulfide shampoo. |
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tx. for HSV erruptions: decrease viral shedding, recurrenc and have more than 6 out breaks per year
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Acyclovir ointment reduces the duration of viral shedding
■ Oral or IV acyclovir frequency and severity of recurrences. ■ Daily acyclovir suppressive therapy = > 6 outbreaks per year. |
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Nonbullous impetigo
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Characterized by superficial pustules with surrounding
erythema. |
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Bullous impetigo
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Begins as small, erythematous macules → thin-walled vesicles or bullae on an erythematous base. Caused by coagulase- staphylococci that produce exfoliatin, a toxin.
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lice treatments
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Permethrin shampoo or cream; decontaminate sources of reinfection such as combs, bed sheets, and clothing.
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describe scarlet fever
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Sandpaper-like rash on the trunk; “strawberry” tongue;
circumoral pallor. The rash desquamates after a few . days. |
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scarlet fever occurs in patients who has untreated disease and how to prevent rheumatic fever
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Occurs in patients with untreated streptococcal pharyngitis treat with penicillin to prevent rheumatic fever.
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If you see large molluscum
contagiosum lesions, think of? |
HIV
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what is Fournier’s gangrene?
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is necrotizing fasciitis of the perineal region
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treatment for necrotising fasciitis
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■ Surgery to explore deep fascia and muscle and to remove necrotic tissue.
■ Gram stain and culture of tissue to determine appropriate antibiotic therapy |
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Necrotizing Fasciitis
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rapidly developing infection of skin and fascia that has high mortality without emergent treatment.
>>Caused by group A streptococci, mixed aerobicanaerobic bacteria, or Clostridium perfringens. |
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tx. scabies for puritus, close contacts
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TREATMENT
■ Treat with 5% permethrin cream; give antihistamines for pruritus. ■ Treat close contacts; wash bedding and clothing to prevent reinfestation. |
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Verrucae (Warts)
Caused by; Hx/PE: Rx: |
■ Caused by HPV.
■ Hx/PE: Usually occurs in older children; commonly found on the hands. ■ Rx: Salicylic acid, liquid nitrogen, curettage. |
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lichen sclerous
cancer risk diagnosis tx |
>>risk of squamous cell carcinoma in rare cases.
>>biopsy shows hyperkeratotic epidermis with follicular plugging, progressing to atrophy >>Short-term, high-potency topical glucocorticoids or oral hydrochloroquine |
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Tuberous sclerosis
cutaneous manifestation |
Shagreen patches (thickened areas of skin), ash leaf spots (hypopigmentation), angiofibromas (red papules around the nose).
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Tuberous sclerosis: non dermatologic symptoms
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Periventricular tubers, seizures, mental retardation,kidney or heart tumors.
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Neurofibromatosis cutaneous manifestation
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Café-au-lait spots, axillary
freckling. scoliosis, seizures. |
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Neurofibromatosis non dermatologic symptoms
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neurofibromas,Meningiomas, acoustic neuromas, Lisch nodules (iris lesions), optic nerve gliomas, renovascular hypertension,
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Sturge-Weber syndrome cutaneous manifestation
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Port-wine stain on the face (hemangioma) over the distribution of CN V1.
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Sturge-Weber syndrome cutaneous manifestation
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Seizures, mental retardation, visual impairment.
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von Hippel–Lindau cutaneous manifestation
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Hemangiomas.
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von Hippel–Lindau cutaneous manifestation
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Retinal vascular hamartomas, renal cell cancer, syndrome pheochromocytomas, polycythemia.
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When numerous seborrheic
keratoses acutely erupt, Dx |
“sign of Leser- Trélat” and can be a sign of underlying malignancy (e.g., gastric cancer
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tx for seboherric dermatitis
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cryosurgery or curettage for cosmetic purposes
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tx for basal cell carcinoma
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curettage, surgical excision, Mohs’ micrographic surgery
(serial excisions with fresh-tissue microscopic examination to maximize cosmesis), cryosurgery, and radiation. ■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun exposure. |
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tx: actinic keratosis
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Rx:
■ Cryosurgery, topical 5-FU, curettage, or chemical peel. ■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun exposure. |
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tx: SCC
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Rx:
■ Surgical excision, Mohs’ micrographic surgery, or radiation. ■ Prevent with UVA/UVB sunscreens and avoidance of prolonged sun exposure |
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tx. kaposi sarcoma
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Rx: Antiretrovirals for HIV; chemotherapy for lesions (radiation, intralesional
vinblastine, liquid nitrogen cryotherapy |
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biopsy of kaposi sarcoma
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proliferation of small vessels and slitlike intercellular spaces with extravasated RBCs.
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Bx: SCC
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Biopsy shows irregular masses of anaplastic epidermal cells proliferating down to the dermis
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Bx: actinic keratosis
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dysplastic squamous epithelium (hyperkeratosis,
with cells of the lower epidermis showing loss of polarity, pleomorphism, and hyperchromatic nuclei) without invasion into the dermis |
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Bx: basal cell carcinoma
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characteristic basophilic cells palisading with retraction
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Bx: mycosis fungoides
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Biopsy shows infiltrate of atypical lymphocytes with convoluted cerebriform
nuclei in the upper dermis and microabscesses in the epidermis (Pautrier’s microabscesses). |
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Tx:Mycosis fungoides.
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PUVA photochemotherapy, topical nitrogen mustard, total-body electron
beam irradiation, ultra-high-potency topical steroids, systemic and topical retinoids. |
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complication of mycosis fungoides
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Sézary’s syndrome, secondary sepsis to high grade lymphoma
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what is rhinophyma?
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Men can develop (large, porous, lobulated nose) when they have roscea
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treatment for rosacea
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■ Avoid precipitating factors.
■ Topical metronidazole, sulfur lotions, and oral tetracycline or isotretinoin are options |
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histology of erythyma multiforme
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Perivascular T lymphocytes;
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histology of SJS
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Perivascular mononuclear cells
with eosinophils in the papillary dermis; degeneration of the basal layer; subepidermal blister formation. |
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histology of TEN
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Full-thickness, eosinophilic
necrotickeratinocytes.epidermal necrosis; cell-poor infiltrate with predominance of macrophages and dendrocytes; strong immunoreactivity for TNF-α. |
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Location: pemphigous vulgaris vs. bullous pemphigoid
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PV: Mucous membranes, skin.
BP: Only the skin; usually the arms and thighs. |
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Autoantibody target: pemphigous vulgaris vs. bullous pemphigoid
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PV: Desmocollins, desmogleins.
BP: BP1 and BP2 |
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Location of Intercellular: pemphigous vulgaris vs. bullous pemphigoid
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PV: Epidermal-dermal junction.
BP: autoantibodies |
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Location of blister: pemphigous vulgaris vs. bullous pemphigoid
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PV: Intraepidermal, shallow.
BP: Subepidermal, deep. |
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Nikolsky’s sign: pemphigous vulgaris vs. bullous pemphigoid
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PV: positive
BP: negative |
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Symptoms: pemphigous vulgaris vs. bullous pemphigoid
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PV: Painful
BP: Itchy |