Dermatology PDF

Dermatology
Diagnostic Test
Measures
Indications
Dermoscopy
Examination of skin lesions using a

device made up of a magnifier,
non-polarised light source, and a
transplarent plate
Any skin lesion
ABCDE's of
Dermatology
Process for inspecting

pre-existing or new
moles
Skin Biopsy
Shave Biopsy
Punch Biopsy
Excisional
Biopsy
A
B
C
D
E
Asymmetry
Borders
Color
Diameter
Elevation / Evolve
Find the newest lesion
to sample
Timing
Timing is not important

for basal cell carcinoma
or dysplastic nevi
Histologic analysis of
skin tissue
Skin lesion and a thin

layer of surrounding skin
are removed with a small
blade
Multiple dermal layers

are removed
Complete removal of
lesion and surrounding
skin
Result
Site Selection
Most characteristic area

of the lesion
Go for advancing
borders
Avoid hyperkeratotic,
scarred, excoriated, or
denuded areas
Basal cell carcinoma
Squamous cell
carcinoma
Actinic keratosis
Verrucae
Molluscum contagiosum
Dysplastic nevi
Malignant melanoma
Granuloma annulare
Erythema nodosum
Vasculitis
Dermal pathology
Depth of lesion is
needed for staging
Melanoma
Thought to be in the
deep dermis of
subcutaneous fat
Test Interpretation
Parameters
Melanoma
Other
Asymmetric
Irregular borders
Various colors
Larger than a pencil
Elevated
Procedure
Clean biopsy site with alcohol
Mark site (if needed)
Anesthetize
Shave lesion
Perform wound care
Send to pathology
Procedure
Clean biopsy site with alcohol
Mark site (if needed)
Anesthetize
Punch lesion
Remove specimen w/ tissue scissors
Close with suture
Perform wound care
Elliptical excision usually with layered
closure
Compiled by Drew Murphy, Duke Physician Assistant Class of 2015
Dermatology
Diagnostic Test
Measures
Serology
Study of antibodies in plasma

serum or other body fluids
Indications
Result
HSV I
HSV II
Lyme disease
Autoimmune diseases
Test Interpretation
Parameters
Lesion is cut.
Mohs Surgery
Black light
KOH Prep
Quick, inexpensive fungal test to

differentiate dermatophytes and
Candida albicans from other skin
disorders
Diascopy
Test for blanchability by

applying pressure with a
glass slide and observing
color changes
TV lesion
Vitiligo
Erythrasma
Tinea Capitus
Tinea cruris
Erythrasma
Vitiligo
Tinea versicolor
Dermatophytes
Candida albicans
Yeast
Tinea Versicolor
Blanching
Erythematous lesions
Non-Blanching
Vesicles
Vesicle Viral
Culture
Determines presence of
a viral infection
Tzanck
Preparation
Alternative testing
modality for viral
infections
Pustule
Culture
> 98% cure rate
Microscopically controlled surgery

Tissue micrscopically analyzed.
used to treat common types of
Tissue repeatedly cut and analyzed until the tissue
skin cancer
is cleared of cancer cells.
Wood's Lamp
Herpes zoster
Herpes simplex
Bacterial culture of a
pustule
Vesicular infections
Pemphigus
Other
Viral Infection
Coral fluorescence
No fluorescence
Hypopigmentation
visible
Scale is collected by scraping the
advancing border of the lesion with a
Spaghetti and meatballs
#15 blade or glass slide. Allow scale
to fall onto second glass slide
Inflammation
Angiomas
Purpura
Ecchymosis
Portwine stain
Vasculitis
Procedure
Select a fresh lesion
Use a #11 blade or swab to unroof
the vesicle
Roll swab over lesion to collect fluid
and place in viral culture medium.
Send to lab
Multinucleated giant
cells
Procedure
Blister is opened along side.
Roof is folded back.
Underside scraped.
Material collected is smeared onto a
microscope slide.
Procedure
Select a fresh lesion.
Use a #11 blade to gently nick the surface of the
pustule
Use a bacterial culture swab to collect content.
Send for culture and sensitivity.
Dermatology
Diagnostic Test
Scabies
Preparation
Measures
Indications
Test Interpretation
Parameters
Test to diagnosis scabies
Thin shave biopsy is performed

Specimens placed on a microscope slide and
covered with immersion oil.
Look under low power
Determines sensitivities
to specific allergens
Examples of Testable
Allergens
Neomycin
Black rubber
Fragrance
Propylene glycol
Nickel
Wool alcohols
Other
Mite
Select a linear burrow or intact papule.
Allergic contact dermatitis
Patch Testing
Result
POSITIVE
Eggs
Feces
Patients avoids antihistamines or any
steroid preparations for > 2 weeks
before testing.
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms

Flat
(nonpalpable)
Macule
Primary lesion
Test
Laboratory
Result
Treatment
Medications
Other
Patch
Large macule (> 1 cm)
1 cm
Alteration in color
Raised
(palpable)
Papule
Primary lesion
Plaque
Large papule (> 1 cm)
1 cm
Variable color
Bulla
Large vesicle (> 1 cm)
Raised
Vesicle
Primary lesion
Filled with clear fluid

1 cm
Raised
(palpable)
Pustule
Primary lesion
Varable size
Circumscribed collection
of inflammatory cells
and free fluid
Raised
Nodule
Primary lesion
Round and solid

Deeper than papule
Wheal
(Hive)
Primary lesion seen in

type I hypersnesitivity
reaction
1 cm
Firm, edematous papule
or plaque
Unbound fluid
Flat-topped elevations
Transient
Very common in fungal skin
infections.
Scale
Secondary lesion
Crust
(Scab)
Secondary lesion
Erosion
Secondary lesion
Collection of serum,
blood, or pus
Focal loss of epidermis
Heals without scarring
Compiled by Drew Murphy, Duke Physician Assistant of 2015
Clinical Medicine
Condition / Disease
Ulcer
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Other
Focal loss of epidermis

and dermis
Secondary lesion
Heals with scaring
Fissure
Secondary lesion
Atrophy
Secondary lesion
Excoriation
Lesion from scratching
Comedo
Blackhead or whitehead
Milia
Small, superficial keratin

cyst
Cyst
Closed sac that has a

distinct membrane and
devision compared to the
nearby tissue
Burrow
Narrow, elebated tunnel

due to a parasite
Linchenification
Thickening of the skin
Linear "crack"
Visible opening is often

seen
Clinical Medicine
Condition / Disease
Cause
Telangectasia
Dilated superficial vessels
Signs and Symptoms
Test
Laboratory
Result
Treatment
Other
Purpura
Large petechaie (> 1 cm)
Nonblanchable
Petechiae
Medications
Blood deposit
1 cm
Non-Bullous Impetigo
Impetigo
"Scabbing eruption"
caused by group A
-hemolytic
Streptococcus pyogenes
or S. aureus
Bactroban
Small pustules or
vesticles that erode and
curst (honey-colored)
Topical Antibiotics
Usually inflammed
Bullous Impetigo
Vesicles or bullae
containing clear or
turbid fluid
Surrounding skin can
be normal
Plaques with more
defined borders
Altabax
(MSSA only)
Cephalosporins
Systemic
Antibiotics
Dicloxacillin
Can be confused with inflammatory

dermatoses such as psoriasis,
seborrheic dermatitis, or atopic
dermatitis
The role of topical steroids is
controversial.
Neck-fold intertrigo in babies is due
to Strep.
No satellite lesions
Bacterial
Intertrigo
Odor
Non-specific bacterial
infection of opposed skin
Etiologies
Group A and B
Streptococci
Non-dpihtheroid species
of Corynebacterium
Very common in child but adults can

also be infected
Pre-Disposing Factors
Trauma
Underlying dermatoses
Poor hygiene
Previous antibiotic therapy
Warm temperatures and high
humidity
Ecthyma
Impetigo that extends into dermis
Topical antibiotics
P. aeurginosa
Erythrasma
Chronic superficial skin

infection by
C. minutissimum
Commonly seen in
intertriginous skin
Benzoyl peroxide
Topical Antibiotics
Appears bright red with

Wood's lamp
Systemic
Antibiotics
Mupirocin
Imidazoles
Doxycycline
Macrolides
Dermal ulceration
Ecthyma
Impetigo that extends

into dermis
Yellowish-gray crust
Crust is thicker and
harder than seen in
impetigo
Clinical Medicine
Condition / Disease
Cause
Abscess
Localized, walled-off
collection of pus
Signs and Symptoms
Carbuncle
Deep-seated
erythematous nodule
Large area of coalescing
abscesses or furuncles
Laboratory
Result
Treatment
Medications
Systemic antibiotic
Warm compresses
Antibacterial
soaps
Carbuncle
Chronic carriage of S.
Trauma
aureus
Diabetes
Obesity
Poor hygiene
Minor Immunologic
Bactericidal defects
Deficits
Chemotactic defects
Prevention
Monthly Betadine
or Hibiclens
showers
Control of any
predisposing
conditions
Culture and sensitivity
CA-MRSA Skin
Infection
Soft Tissue
Infections
Most common clinical

manifestion of MRSA
Infection of the skin and

the soft tissue below it
Other
Incision and drainage
Abscess
Furuncle
Furuncle
Test
Abscess, furuncle, or
carbuncle
Risk Factors
Skin trauma
Cosmetic body shaving
Sharing equipment not washed between uses
Acute, diffuse
Warmth
inflammation
Tenderness
Lack of systemic symptoms (common)
Trauma
Surgery
Mucosal infection
Immunologic deficiency
Underlying dermatoses
Cellulitis
Extends into
subcutaneous tissue

(large abscesses)
Surveillence (small abscesses)
Antibiotics (adjunctive therapy)
At-Risk Populations
Sulfamethoxazole
Native Americans
/ Trimethoprim
African Americans
Homeless
Clindamycin
Populations in close quarters
Competitive atheltes
Linezolid
Penicillinaseresistant synthetic
penicillins
Systemic
Antibiotics
Cephalosporins
Indistinct borders
Etiologies
Macrolides
(if PCN allergic)
Group A Strep
S. aureus
Others (in special clinical
settings)
Erysipelas
Rest
Superficial cellulitis
Lower extremities and

face most commonly
affected
Raised borders with

clear demarcation
Etiologies
Group A Strep
S. aureus (rare)
Supportive
Treatment
Elevation
Warm compresses
Clinical Medicine
Condition / Disease
Cause
Necrotizing
Soft-Tissue
Infection
Infection of the skin and

soft tissue that leads to
necrosis
Fournier's
Gangrene
Type of necrotizing
infection or gangrene
usualy affecting the
perineum
Infectious
Folliculitis
Pseudofolliculitis
Barbae
Keloidal
Folliculitis
Pseudomonas
Folliculitis
Infection of the upper

portion of the hair follicle
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Begins with soft-tissue

Progression into
infection
multi-organ failure
Pain out of proportion to physical findings
Etiologies
Clostridium
Bacteroides
Peptostreptococcus
Enterobacter
Proteus
Pseudomonas
Risk Factors
Impaired cellular
PAD
immunity
IVDU
Smoking
Alcoholism
Hypertension
CAD
Chronic steroid use
Lymphedema
Varicella lesions
Genital trauma
EMERGENCY
10 : 1
Fulminant NSTI of the

perineum and genitalia
Complicates GU or
anorectal surgery
Etiologies
E. coli
Klebsiella
Proteus
Bacteroides
Single, scatteed papules
No tenderness
or pustules
No pruritis
Shaving
Friction / occlusion of
hair-covered areas
Immunosuppression
Topical corticosteroids
Sites of Prediliction
Face
Scalp
Neck
Legs
Trunk
Buttocks
PRSPs
Oral Antibiotics
(7 - 10 days)
First gen.
cephalosporins
Macrolides
(if PCN allergic)
Correct any predispoing condition
Can evolve into a pyoderma

Bacterial Agents
S. aureus
Gram (-) bacteria
Pseudomonas
Special Types of IF
Pseudofolliculitis barbae
Keloidal folliculititis
"Hot tub" folliculitis
Encourage antibacterial soaps
Shaving cessation
Barber's itch
Other
Common Infection Sites
Perineum
Extremities
Trunk
Common in shaved areas

of the face
Small curly hairs become ingrown

resulting in foreign-body reaction to
the hair.
Antibiotic therapy
Papules that coalesce
into nodular masses
Chronic folliculitis found

at the nape of the neck
Develops over slowly

over months or years
Antibiotic therapy
(cyclic administration common)
Occurs on the trunk

after bathing in tubs
"Hot tub" folliculitis
Resolves spontaneously in 1 - 2 weeks
Far less common than S. aureus

folliculitis
Very alarming to patients
Incubation period of
1 - 5 days
Clinical Medicine
Condition / Disease
Acute
Lymphangitis
Vibro Cellulitis
Cause
Infection of the
subcutaneous lymphatic
channels
Signs and Symptoms
Laboratory
Result
Treatment
Medications
Other
Erythematous linear
streaks extending from
wound / skin break
Antibiotic coverage for Strep and
Staph
Etiologies
Group A Strep
S. aureus
P. multocida
Mycobacteria
Sporothrix
Subacute Etiologies
(rare)
Cellulitis due a Gram

negative bacteria found
in marine animals that
inhabit warm water
Test
Starts as macular area

that develops into
bullous lesions
Occupation with fish and
seafood
Common In
Brackish water exposure

Immunocompromised
Serum iron levels
Mycobacterial
Skin Infection
Infrequent cause of skin

infection
Cutaneous
Anthrax
Very rare infection of the

skin
Anti-TB drugs are not helpful

Suspect M. marinum in patients with
frequent aquatic exposure
Single nodule that

ulcerates or crusts
Resolve spontaneously
Joined by satellite
lesions
Excision may hasten resolution

Papulovesicular lesion
Necrosis
Eschar-covered ulcer
7 - 10 day course of ciprofloxacin or

doxycycline
Predisposing Factors
Dermatophytic
Infections
Skin infection by a unique

group of fungi that infect
keratinized epithelium
Atopy
Occulsion
Steroid use
Humidity
KOH Wet
Mount
Diagnostic
Dry skin
Dermatophytic infection
of the feet
Tinea Pedis
"Athlete's foot"
Erythema
Scaling
Sweating
Vesicles
Occulsion (by shoes)
Contaminated public
Maceration
floors
Involvement of toe nails
Interdigital Type
Scaling
Maceration (between
4th and 5th toes)
Moccasin Type
Erythema
Scale and papules on
heels, soles, and lateral
foot borders
Inflammatory / Bullous
Type
Fluid-filled vesicles that
erupt into erosions
Imidazoles
Topical
Antifungals
(2 - 4 weeks)
Allylamines
Usually acquired via contact with

infected animals, animal products,
feed, or soil contaminated with
spores of the bacillus
Etiologies
Microsporum
Trichophyton
Epidermophyton
Routes of Transmission
Person-to-person
Animal-to-human
Environmental
Ulcerative Type
Interdigital infection spreads to
plantar and lateral surfaces of foot
For severe or
refractory cases
Imidazole
Oral Antifungals
(2 - 6 weeks)
Allylamines
Monitor liver
function if therapy
to exceed 4 weeks
Treat any secondary infection

Open infection to air
Clinical Medicine
Condition / Disease
Tinea Cruris
Tinea Corporis
Cause
Signs and Symptoms
Subacute or chronic infection

of the groin / medial thighs
Erythematous, scaling,
and well-demarcated
plaques
"Jock itch"
Dull red, tan, or brown
Subacute infection of
neck, trunk, and/or
extremities
Test
Laboratory
Result
Treatment
Topical antifungals
Griseofulvin
Asymptomatic
Tinea Capitus
Dermatophtyic infection
of the scalp
Systemic
Antifungals
(6 - 12 weeks)
Imidazoles
Terbinafine
Black Dot
Antibiotics for any secondary

infections
Kerion
Tinea
Incognito
Any type of tinea in which the

appearance of the lesion has been
altered by inappropriate
treatment (usually a topical
steroid)
Topical ketoconazole or selenium

sulfide (reduces transmissibility)
Less demarcated
Flatter borders
Lack scaling
Larger lesions
Tinea
(Pityriasis)
Versicolor
Infection involving sites

where maceration and
occulsion create a warm,
moist environment
Chronic skin infection by

the opportunistic
pathogen
Malasezzia furfur
Most common in African-American

children between 6 - 10 years old.
Ectothrix
Infection is outside hair shaft
Endothrix
Infection is inside hair shaft
"Black Dot"
Broken-off hairs resemble dots
"Gray Patch"
Arthrosporse give gray appearance
and circular areas of alopecia
Kerion
Infection accompanied by swollen,
painful nodule
More pustular in appearance

Nystatin
Intertriginous
Candidiasis
Other
Risk Factors
Obesity
Tight clothing
Topical antifungals
Plaques with sharp

borders
Smaller pustules or
vesicles within borders
Enlarge peripherally
Central clearing
Medications
Imidazoles
Glucocorticoids (used sparingly)

Asymptomatic
Multiple welldemarcated macules
Hyper- or hypopigmenting
Fine scaling
Common Sites
Upper trunk
Axillae
Groin
Thighs
Neck
Sites of Oil / Grease
Face
Applications
Scalp
Obesity
Diabetes
Hyperhydrosis
Steroid use
Infection in the small body folds is
more common in cooks, bartenders,
health-care workers, or others that
keep their hands frequently in water.
Selenium sulfide
Yeast
Microscopic
Study
Topical
Antifungals
Works only in
limited disease
Imidazoles
Pseudohyphae
Ketoconazole
"Spaghetti and
meatballs"
Oral Antifungals
Fluconazole
Itraconazole
Clinical Medicine
Condition / Disease
Subcutaneous
Fungal
Infections
Cause
Rare and slow progressing

subcutaneous infection by
saprophytes found in soil
Signs and Symptoms
Laboratory
Result
Treatment
Usually acquired by
Outdoor occupations
trauma
Persistent lesions that are poorly responsive to
antibiotics
Etiologies
Sporothrix
Exophila
Fonsecaea
madurella
Pseudallescheria
Rash preceded by
Self-limiting
prodrome
Oral lesions (possible)
Common Childhood Viral Exanthems
Rubeola
Rubella
(measles)
(German measles)
Varicella
Roseola
(chicken pox)
(sixth disease)
Erythema infectiosum (fifth disease)
Viral Exanthem
Generalized skin eruption

secondary to systemic
viral infection
Hand-Foot-Mouth
Disease
Systemic Coxsackie
viral infection
Oral lesions (erosions)
Perioral infection by
HSV-1 or HSV-2
Group vesicles on
erythematous base
"Cold sore" or
"fever blister"
Preceded by prodrome
of sensory complaints
Herpes Labialis
Test
Outbreaks every
3 years
Vesciualr exanthem
limited to the distal
extremtriteis
Penciclovir (topical)
Valacyclovir
Fever
Rare but severe disseminated HSV

infection that generally occurs at
sits of skin damage
VaricellaZoster Virus
Infection
Primary infection
(varicella) permanent
infection and latency
until reactivation that
results in zoster
(shingles)
Molluscum
Contagiosum
Viral skin infection

caused by pox virus
Wart
Keratinocyte and
mecusous membrane
infection by HPV
Other
Scarlatinform Type
Generalized erythema
Worse in body creases
Morbiliform Type
Maculopapular
Vesicular Type
Vesicles papules pustules
erosions
Acyclovir
Eczema
Herpeticum
Medications
Complications
Systemic symptoms
Conjunctival/corneal autoinoculation
Bell's palsy
Erythema multiforme
Eczema herpeticum
Severe, diffuse infection (in
immunocompromised)
HSV-1 > HSV-2
Malaise
Eruptions may take

1 week to compeletely
evolve
Distinct flesh-colord or
pearly white papules
with umbilicated centers
Possible secondary
infection by S. aureus
Necrosis (possible)
Single dermatome
distribution
Dose acyclovir, valacyclovir,

famciclovir, or foscarnet
(acyclovir-resistant strains)
Prednisone (if 50 years old)
Analgesics
Gabapentin
Pregabalin
Post-Herpetic
Tricyclics
Neuralgia
Capsaicin
Lidocaine
Spontaneous resolution
Post-herpetic neuralgia (PHN) is the

most worrisome complication. Oral
steroids may help prevent.
Thoracic > trigeminal > lumbosacral
> cervical
Zosatvax is a live vaccine for the
prevention of shingles.
Very common in children and

sexually active adults
Transmission is through skin-to-skin
contact
Oncogenic potential
Cutaneous Warts
Common
Filiform
Flat
Clinical Medicine
Condition / Disease
Contact
Dermatitis
Irritant Contact
Dermatitis
Acute Irritant
Contact
Dermatitis
Chronic Irritant
Contact
Dermatitis
Cause
Eczematous dermatitis
caused by exposure to
environmental agents
Most common
occupational skin disease
Acute damage to
keratinocytes
Disruption of normal skin

barriers
Signs and Symptoms

Papules
Test
Laboratory
Result
Treatment
Medications
Vesicles
Pruritus
Burning
Stinging
Pruritus
Recurs within days of
return to work
Pain
Discomfort
Clears within 2 - 3 break
from work
Slight improvement over weekend is

unlikely with allergens
Patch Test
Diagnostic
Identify and remove the offending

agent
Chronic lip licking
Erythema
Bizarre configuration
Vesciulation
Lesions do not spread Patch Testing
beyond area of contact

Crusting
Sharp borders
Dryness
Chapping
Erythema
Scaling
Hyperkeratosis
Crusting
Fissuring
Other
Environmental agents are
characterized as irratants or
allergens.
Wet dressings with Burrow's solution

NEGATIVE
Potent topical steroids

Oral steroids (in severe cases)
Seen particularly in frequent handwashers
Potent topical steroids + lubrication
Barrier creams
Hands (most common)

Occupations
ICD Chrome
Ulcers
Ulcers caused by the

corrosive necrotizing
effects of chromates
Tanning
Electroplating
Chrome production
Intense pruritus
Allergic
Contact
Dermatitis
Acute
Sensitized T-lymphocytes
respond to a recognized
antigen to produce
inflammation
Subacute
Dry skin
Mechanical
Atopic
Dermatitis
Disruption of the epidermal

barrier
Macules
Papules
Vesicles
Bullae
Erythematous plaques
with scale
Firm papules with scale
Chronic
Acute
Immunologic
T cells and Langerhans cells trigger Secondary Infection with
S. aureus
IgE-mediated inflammatory
response
Chronic
Test only known

Wet dressings
substances
Concentrations
Potent topical steroids
predetermined
Phytodermatitis
Lichenified plaques
Scaling
Fissured lesions
Excoriation
Co-existing atopic
manifestations
Ill-defined papules
Plaques and patches
Erythematic
( edematous)
underlying skin
Linear excoriations
Pustules
Crusting and oozing
Lichenification
Fissuring
Scalp, plams, and soles are relatively

resistant.
Mucous membrane involvement is
uncommon.
See PowerPoints for specific antigen
reactions
Avoid testing with Systemic steroids

acute dermatitis (if widespread involvement)
Patch Test
Test site should be Oral antihistamines
free of dermatitis
Phototherapy or cyclosporine
Patches applied
(in more severe cases)
for 48 hours
Read 72 - 120
Allergen avoidance
hours later
Moisturizers (emollients only)
Tacrolimus
Topical steroids
Topical immune modulators
Pimecrolimus
Oral antihistamines
Phototherapy
Manage secondary infection with
systemic therapy
Cyclosporine
Sites of Predilection
Flexual surfaces
Face
Wrist
Dorsal feet
Infantile, child, adult, hand, and
follicular variants
Exacerbating Factors
Specific autoallergens
Winter season
Wool clothing
Emotional stress
Clinical Medicine
Condition / Disease
Cause
Lichen Simplex
Chronicus
Atopic dermatitis
associated disorder due
to repetitive scratching
and rubbing
Dyshidrotic
Eczema
Nummular
Eczema
Psoriasis
Signs and Symptoms
Deep, tapioca-like
vesicles
Treatment
Medications
Other
potency topical steroids
Bullae
Fissuring
Shortened keratinocyte
cell cycle with increased
CD8 cells causues
epidermal
hyperproliferation
Laboratory
Result
Localized area of
lichenification
Vesicular eruption on
hands and feet
Also known as discoid

dermatitis
Test
Coin-shaped papuless
and vesicles grouped in a
plaque
Underlying skin may be
erythematous
Oral steroids (severe cases)

More common in winter months
More commonly found on
extremities
Moisturizers
Intensely pruritic
Chronic plaque
Acute guttate
Psoriais Vulgaris
Palmoplantar
Inverse
Erythroderma
Pustular
Trigger Factors
Streptococcal infection
Injury / trauma
Drugs
Humidity
Overtreatment with
Emotional stress
steroids
Lithium
blockers
CCBs
Exacerbating Drugs
ACE inhibitors
Antimalarials
NSAIDs
Systemic steroids
Months to years
Plaque distribution
Palms / soles / scalp may
somewhat symmetrical
be the only sites
affected
Chronic Plaque
Psoriasis
Chronic type of psoriasis
Guttate Psoriasis
Psoriasis usually seen in

children and young adults
Small papules of short

duration
(weeks to months)
Streptococcal URI within

1 - 2 weeks of
presentation
Inverse Psoriasis
Psoriasis that affects

intertriginous areas
Marcerated scales
Erythematous plaques
with shiny appearance
Topical steroids
Anthralin
Steroids
Tars
Topical Therapy
Cyclosporine
Peak incidence in 20s.

Associations
Cardiovascular disease
Depression
Lymphoma
Adalimumab
Narrowband UVB
PUVA
Retinoids
Systemic Therapy
Tazarotene
Vitamin D analogs
Retinoids
Taclonex
UVB
Phototherapy
Dovonex
Methotrexate
Immunemodulating
therapy
Alefacept
Etanercept
Infliximab
Ustekinamab
Nail involvement (10 - 25%)

Relatively rare form
Can co-exist with chronic plaque psoriasis
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Other
Guttate Lesions
Salmon-pink papules
Loose scales
Scales not readily visible
Psoriasis
Vulgaris
Most common form of

psoriasis
(+) Auspitz sign

Chronic Stable Lesions
Well-demarcated
erythematous plaques
with silvery white scale
Variable pruritus
Erythrodermic
Psoriasis
Extremely dangerous
form of exfoliative
dermatitis in adults
Plaques coalesce to form

variable patterns
More common in scalp
and anogential areas
EMERGENCY
Serious Underlying Illnesses
Hypo- / hyperthermia
Protein loss
Dehydration
Renal / cardiac failure
Diffuse erythema
Skin thickening
Scale
Pustules
(instead of papules)
Surrounding skin
Pustular
Psoriasis
Uncommon form of
psoriasis consisting of
widespread pustules on
an erythematous
background
Erythema
Palmoplantar
Chronic pustules limited

to palms and soles
Generalized Acute
(Von Zumbusch)
Rare
Pustules develop in
waves over entire body
"Lakes" of pus
Systematic symptoms
Can precede or follow
psoriasis vulgaris
Erythema
Scaling
Seen in areas with sebaceous gland activity
Seborrheic
Dermatitis
Common, chronic, and

inflammatory dermatitis
Infants (Cradle Cap)

Greasy adherent scale
on vertex
Accumlations of scales
and inflammation
2 Infection may occur
Adults
Erythematous / grayish
plaques with greasy or
white scale
May appear as severe
dandruff
Blepharitis
Variable pruritus
In infants
Scale removal
Triamcinolone
M. furfur may be a possible causative

factor.
Genetic and environmental factors
influence onset and course.
Treat infection
Reduce inflammation
Frequent washing of all involved areas
Acetonide
Topical steroids
Change shampoo
Betamethasone
Valerate
Maintenance therapy
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms

Abrupt onset
Scaling flat plaque on

trunk or proximal
extremities
Papules and smaller
scaling plaques
(7 - 14 days after onset)
Pityriasis
Rosea
Common, benign, and

self-limiting dermatoses
Test
Laboratory
Result
Treatment
Medications
Other
Appears as salmon pink in whites and
hyperigmented in African-Americans.
Oral antihistamines
Topical steroids
Collarete scale
"Christmas tree"
arrangement
10 - 35 years old (75%)
Pruritus worse at night

and with heat
(if present)
Recent history of acute infection with fatigue,
headache, sore throat, lymphadenitis, and fever
(20%)
Acyclovir
Asymptomatic
40 - 50 years old
Lichen Planus
Acanthosis
Nigricans
Hailey-Hailey
Disease
Dermatitis
Herpetiformis
Pemphigus
Inflammatory dermatitis
of skin and/or mucous
membranes
Familial Benign Pemphigus
Topical
Intralesional
Systemic
Cyclosporine
Triggers
Drugs
Chemical exposure
Bacterial infection
Post-bone marrow transplants
Retinoids
Wickham's striae on
papules
Pruritis
4 P's of Lichen Planus
Pruritic
Polygonal
Purple
Papule
Methotrexate
PUVA
Antihistamines
Associations
Obesity
Endocrine abnormalities
Certain drugs
Malignancy (onset is rapid)
Typically on the neck and

other body folds
"Velvety" appearance
Vesicles
Erosions
Topical / oral antibiotics
Occur in body folds
Chronic blistering skin

condition
Autoimmune bullous
disease that leads to
acantholysis
Steroids
1 - 10 mm flat-topped
papule with an irregular
angulated border
Hyperpigmentation of
the skin
Rare genetic disorder
characterized by chronic oozing
lesions that fissure and crack
Oral prednisone UVB phototherapy

(in severe cases)
Lesions frequently become colonized

with S. aureus Candida
Topical steroids
Papules and vesicles

near the elbow
Serous-filled vesicles and

bullae
On scalp, axillae, face,
groin, and trunk
Aggressive systemic steroid treatment
Immunosuppressive therapies
(+) Nikolsky sign

Initial lesions start on
oral mucosa
Skin lesions typically

develop months later
Correct any electrolyte discrepancies
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Other
Generalized
erythematous papules
Bullous
Pemphigoid
Most common
autoimmune bullous
disease
Urticarial lesions
Systemic steroids azothioprine
Bullae
60 - 80 years old
Follicular plugging and dilatation
Affects face, neck, upper trunk, and arms
Inflammation and pustules
Acne Vulgaris
Comedonal
Acne
Acne
Conglobata
Common inflammatory
disease of the hair
follicles and
sebum-producing glands
of the skin
Acne with a high number

of comedones
Possible cyst formation
May lead to scarring or keloid formation
Blackheads
Behavioral Modiciation
No picking
No mechanical exofoliation
Mild, gentle cleansing twice a day
Oil-free, non-comedogenic products
Topical Comedolytics
Cell turnover
Prevent new
Retinoids
comedones
(Vitamin A)
Chemically
exfoliate
Azelaic acid
Glycolic acid preparations
Salicyclic acid preparation
Benzoyl peroxide
For specific details
Clindamycin
Topical
on acne
Erythromycin
Antibacterials
Sulfur-containing medications, see
preparations
PowerPoint slides.
Metronidazole
Dapsone (inflammatory acne)
Oral antibiotics
Severe, nodularcystic acne
Isotretinoin
Inflammatory,
recalcitrant acne
Teratogenic
Oral
Hormone Therapy contraceptives
Spironolactone
Comedo extraction
Photodynamic therapy
Laser therapy
Chemical peels
Most common in adolescents

Flaring Elements
Sweating
Chocolate
Cell phones
Hands on face
Cosmetics
Complications
Scarring
Keloids
Psychological impact
Pyogenic granulomas
Whiteheads
Cysts
Fissures
Abscess formation
Deep scaring
High inflammation
Severe, chronic, and

cystic acne
Begins in puberty
Worsens with time
Flourishes on trunk
Not as severe on face
Clinical Medicine
Condition / Disease
Hidradenitis
Suppurativa
Cause
Sinus tract formation possibly

caused by obstruction and
infection of an apocrine duct
Signs and Symptoms
Rosacea
Perioral
Dermatitis
Wart
Unknown inflammatory
etiology
Fistulas
Scarring
Oral prednisone (14 days)
Occurs in the axillae, inguinal folds, perianal, and

scalp (rare)
Pustules
No comedones
Telangiectasia
Rhinophyma
Grouped 1 - 2 mm
Symmetrical around
border of mouth
Flushing
Occurs on cheeck and
nose
Tenderness
Mobility limitations
Cosmesis
Malignant degeneration
Obscure skin lines
Necrotic capillaries
Occur in sites of skin

trauma
Metronidazole
Sulfacetamide /
sulfur
Azelaic acid
Brimonidine
Oracea
Laser therapy
Metronidazole
Erythromycin
Clindamycin
(if immune-competent)
Cryotherapy
Duct tape occlusion
Laser therapy or cautery
Excision
Chemical destruction
Immunodulation
Cantharadrin
Podophyllin
Retinoids
Salicylic Acid
5-FU
Imiquimod
Cimetidine
Sinecatechins
Triggers
Cinnamon products
Tartar control toothpastes
Whitening agents
Heavy facial moisturizers
Topical steroids
HPVs can cause both benign and
malignant lesions.
Regression of warts is dependent on
cell-mediated immunity.
Warts occur more often in
immunosuppressed individuals.
5% prevalence in children
Thrombosed capillaries
Common wart
Dermatoglyhic loss
5 - 20 years old
Periungual
Warts
Topical
Treatments
Topical Therapy
Pain
Other
Mostly
30 - 50 years old; peak 40 - 50
Triggers
Hot / spicy food or drink
Sun
Alcohol
Exercise
Avoidance of triggers
Avoidance of triggers
Verrucous surface
Verruca
Vuglaris
Medications

(simple cases)
Excision by surgery
(complex cases)
Papules
No comedones
Small, rough growth due

to human papilloma virus
Treatment
Deep undermining cysts
Lingering erythema
Chronic condition
characterized by facial
erythema and sometimes
pimples
Laboratory
Result
Oral / topical antibiotics

Intralesional triamcinolone
Double comedone
"Acne Inversa"
Test
Difficult-to-treat wart
near the nail matrix
Prefers hands or places

of trauma
Around the nail bed
Flat-topped surface
Pink to brown
Verruca Plana
Flat Wart
Multiple
Prefers the face, dorsal hands, wrists, neck, and
legs
Flat warts frequently
Koebner's Phenomenon
occur in a linear
formation
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Other
Verrucous surface
Verruca
Plantaris
Thrombosed capillaries
Plantar wart
Multiple and coalescent

("mosaic warts")
"Kissing lesions" on adjacent toes are common
Most common STD
High risk lesions are often
hyperpigmented
Caused by HPV 6, 11, 16, and 18
Lobulated surface
Condyloma
Acuminata
Cauliflower-like
Genital wart
Gray or pink
Can occur on cervix, vulvovaginal skin, anus, penis,
and perianal skin
"Exclamation
point" hairs
Alopecia
Areata
Androgenetic
Alopecia
Hair is lost from some or

all areas of the body
Patchy, nonscarring
alopecia
May involve entire scap

or body
Topical / intralesional corticosteroids
Scalp Biopsy
Lymphocytes
around hair bulb
Increased 5- reducatase
causes testosterone
conversion to DHT
resulting in hair
miniaturization on scalp
but increased hair on
other body areas
Starts with recession of

frontal hairline
Shaft length and
thickness
Castration prevents
alopecia
Later onset
Less progressive
Advance loss or male
pattern is associated
with hirsutism
No treatment (regrowth < 1 year)
Systemic steroids (severe cases)
Worse prognosis with acute onset of

hair loss, extensive hair loss, or hair
loss beginning over the ears.
Associated Diseases
Thyroid disease
Stress
Vitiligo
Autoimune disease
Diabetes
Atopic dermatitis
Nail pitting
Inherited condition
Minoxidill (Rogaine)
Finasteride (Propecia)
Hair transplantation
Wigs, hairpieces, or "comb over"
Anagen
Effluvium
Hair loss due to

chemotherapy or
radiation therapy
Telogen
Effluvium
Diffuse hair shedding as

more follicles are shifted
from anagen to telogen
phase
Rapidly dividing hair

follicles
High metabolism in hair
follicles
Can occur 3 months
after events
Occurs After "System Shock"
Stressful event
Surgery
Childbirth
Thyroid disease
Massive blood loss
Crash dieting
High fever
Car accident
Hair regrows after offending agent is

removed
Beau's lines in the nails
Surveillence
(hair loss is temporary)
Clinical Medicine
Condition / Disease
Trichotillomania
Traction
Alopecia
Cause
Pleasure / relief from

pulling hair out
Signs and Symptoms

Irregular pattern of
alopecia
Broken and variable
length hair in affected
areas
Usually occurs with
psychosocial stress
Test
Laboratory
Result
Pigment casts
Scalp Biopsy
Achordion
Stretching of
epithelium
Treatment
Referral to child psychiatry
Other
7x more common in children and
2.5x more common in
Treat underlying psychiatric disorders

Pharmacotherapy
Incidence in African Americans
Most common in
frontotemporal scalp
Constant pulling or traction on

hair follicles from wearing tight
braids and cornrows leads to hair
loss
Medications
Get a new hairstyle

Can lead to scarring
alopecia if ignored
Nail Pitting
Nail
Manifestations
of Psoriasis
Nail changes seen in

patients with psoriasis
Muercke's
Lines
Nonspecific nail
manifestation that associated
with decreased protein
synthesis
Discoloration
Alternating white and

pink lines
May be caused by cirrhosis or

nephrotic syndrome
Blanchable
Located in the nail bed
Usually Staph
Acute
Paronychia
Inflammation of the
nail folds
Affects proximal nail fold

Usually Candida
Chronic
Affects lateral nail folds
Common in diabetics,
waitstaff, bartenders,
and food handlers
Beau's Lines
Half and Half
Nails
Blue Nails
Nail growth arrest caused

by severe illness, high
fever, or pregnancy
Nail changes seen in chronic
renal disease
"Lindsey's Nails"
Horizontal grooves in
nail plate
White proximal nail
Red-brown distal nail
Nail color change due to

Wilson's disease, argyria,
and ochronosis
Clinical Medicine
Condition / Disease
Cause
Pseudomonas
Nail Infection
Infection of the nail by

Pseudomonas
Digital Mucous
Cyst
Benign ganglion cysts of

the digits
Myxoid Cyst
Longitudinal
Melanonychia
Nail discoloration due to

melanoma
Squamous Cell
Carcinoma of
the Nail
Neoplasm around the

nail bed
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Other
Green discoloration
Translucent papule at
proximal nail fold
Clear, viscous, jelly-like
substance at DIP joint
space
Longitudinal ridge or indentation in the nail plate
distal to growth
Common and normal in African
Americans. May be a sign of
melanoma in caucasians.
Dark brown or black

pigmentation at the
proximal nail fold
(Hutchnson's sign)
May mimic a wart

located around the nail
folds
Biopsy
Alopecia
Oral ulcers
Photosensitivity
Acute Cutaneous LE
Malar or butterfly rash
Papules / papular
urticaria
Scaly plaques
Discoid lesions
Bullae
Palmar erythema
Subacute Cutaneous LE
Confirm diagnosis
Sun exposure may trigger acute

lesions.
Non-Specific Lesions / Rashes
Lupus profundus
Vasculitic lesions (purpura)
Livedo reticularis
Urticaria
Annular / papular lesions
Systemic Lupus
Erythematosus
> 85% of SLE patients

have skin manifecstions
Start as small
with scale
Resembles erythema
multiforme
(less common)
Seen on shoulders, forearms, neck, and trunk
Chronic Cutaneous LE
Associated with anti-Ro

and anti-La antibodies
Discoid lesions
Start as well-defined
scaling plaques that
extend into hair follicles
Expand slowly
Dyspigmentation
atrophy
Heal with scarring

Seen on face, neck, and
scalp
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Other
Gottron's Papules
Slightly raised pink,
dusky red, or violaceous
papuls over the dorsal
sides of MCP/PIP
DIP joints
Gottron's Sign
Macular rash in the
same areas as Gottron's
papules
Dermatomyositis
Connective-tissue disease
related to polymyositis
that is characterized by
inflammation of muscles
and skin
No papules
Shawl Sign
Macular rash over
posterior shoulders and
neck
Poikiloderma
Mottled red or brown
discoloration that
develops from old DM
lesions
Calcifications
Periungual erythema
Telangiectasias
Cuticle overgrowth
Sclerodactyly (95%)
Systemic
Scleroderma
Chronic autoimmune
disease that primarily
affects the skin
Sclerosis of face, scalp,

and trunk
Pigmentation
abnormalities
Linear erythema over

extensor surfaces of
joints
Raynaud's phenomenon
(79%)
Periungual and mat-like
telangiectasia
Calcinosis cutis
Palpable purpura
Vasculitis
Inflammation of blood
vessels
Primarily on lower
extremities
Well-defined raised
petechaie and macules
central area of
hemorrhage
Can become ulcerative
or necrotic
Flaring Factors
Infections
Drugs
Connective tissue disease
Clinical Medicine
Condition / Disease
Diabetes
Mellitus
Cause
Endocrine disorder that

leads to multiple skin
manifestions
Signs and Symptoms
Test
Laboratory
Result
Skin infection
Acanthosis nigricans
manifestations
Diabetic Dermopathy
Atrophic, small (< 1 cm),
brown lesions on lower
extremities
Asymptomatic
Last 18 - 24 months
Diabetic Bullae
Appear spontaneously
on hands or feet
Sterile (no scarring)
Hemorrhagic
Non-scarring (triggered
by sun exposure)
Necrobiosis Lipodica Diabeticorum
Treatment
Medications
Other
Topical / intralesional steroids (NLD)
Flesh-colored or reddishbrown plaques that

evolve into waxy plaques
May become ulcerative
or necrotic
Diabetic Ulcers
Ulcer prevention
Result from neuropathic

or ischemic causes
Often surrounded by
callus formation
Secondary to loss of
protective sensation
Granuloma
Annulare
Xanthelasma
Urticaria
Generalized granuloma annulare has

been associated with systemic
disease.
Papules and plaques in

annular distribution
Uncommon benign skin

disorder
Self-limiting
Variants
Non-painful skin lesion of

the eyelid
Localized swelling of the

skin and mucous
membranes with
immunologic and nonimmunologic etiologies
Localized
Generalized
Perforating
Yellow plaques occuring
near medial canthus of
eyelid
Upper lid > lower lid

Soft lesions
Wheal
CBC
Edematous papule or
LFT
plaque
Thyroid Tests
Transient
Renal
Very pruritic
Function Tests
Occurs once
Individual lesions resolve ESR / CRP
Acute
< 24 hours
Hepatitis
Serologies
Lasts days to 6 weeks
Recurrent or constant
ANA
Chronic
> 6 week duration
Biopsy
Undetermined trigger
Reduction of serum lipids
50% of cases are associated with

lipid levels.
Surgical excision
Evaluation
In cases of
vasculitis
H-1 and H-2 blockers

(synergistic effect)
Doxepin
Glucocorticoids
Epinephrine (Epi-Pen)
Allergist or rheumatologist referral
Avoid systemic
corticosteroids
Identify causative
Chronic
factors
Management
Constant
antihistamines
Up to 20% of the population will have

an acute episode.
Clinical Medicine
Condition / Disease
Venous
Insufficiency
Cause
Multiple skin
manifestations secondary
to decreased or absent
return of venous blood
and increased capillary
pressure
Signs and Symptoms

Pitting edema
Varicose vein
Atrophie blanche
Hyperpigmentation
(mottled blue or purple)
Skin fibrosis
Venous ulcers
(lipodermatosclerosis)
Stasis Dermatitis
Erythematous papules
Scale
Erosion
Excoriation
Occurs on lower legs and
ankles
Test
Laboratory
Result
Treatment
Compression
Stasis Dermatitis
Medications
Other
of patients with venous
insufficiency will develop ulcers.
Oral antibiotics
Topical steroids
Asymptomatic
Most common
Macules / Papules
Sarcoidosis
Chronic multisystem
granulomatous disease
Plaques
Brown, yellow, or purple
Occur on face and

extremities
Annular or serpiginous
Possibly scaly
Occurs on buttock,
trunk, and extremities
Lupus Pernio
Infiltrating violaceous
plaque
Occurs on nose, cheeks,
ears, and lips
Macule
Papule with vesicle or

bulla in center
Analgesics
Stevens-Johnson Syndrome and Toxic

Epidermal Necrolysis are considered
separate clinical entities.
Mild
Symmetric
Erythema
Multiforme
Steven-Johnson
Syndrome / Toxic
Epidermal
Necrolysis
Cutaneous immunologic
response to varied
antigens
Pain pruritic
Occurs on hands, forearms, feet, face, and possibly
mucous membranes
No bullae
Mild
Lesions on upper
extremities and face
Severe EM
1 mucous membranes
involved
Major
Epidermal detachement
< 10% of total body
surface area
Topical steroids
Major
Discontinue any
offending drugs /
factors
EMERGENCY
Monitor fluid / electrolytes
Widespread bullae
Occurs on trunk, face,

and mucous membrane
Systemic steroids
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Cutaneous reaction to
antigenic stimuli
Infective
Endocarditis
Infection of endocardium
Meningococcemia
Gram (-) blood infection that can

cause disseminated intravascular
coagulation
Lyme Disease Skin

Manifestations
Infectious disease caused

by bites from
Borrelia tick
Arthropod Bite
Papular
Urticaria
Other
Triggers
Infections
Drugs
Systemic disease
Erythematous nodules
Erythema
Nodosum
Medications
Limited to extensor
surfaces of lower
extremities
Very painful
Associated systemic
symptoms
Osler nodes
Janeway lesions
Subungual hemorrhages
Petchiae
Purpura
Necrosis
Erythema migrans
Lymphocytoma cutis
Acrodermatitis chronica
Atrophicans
Dermatologic reaction
Pruritis
Allergic reaction
Inflammatory reaction
Lesions
Transient erythema
Papular urticaria
Bullae
Erosions
Hemorrhagic ulcers
Necrotic
Bite from a bug or spider
Most Common Biters

Fleas
Mosquitoes
Bedbugs
2 - 8 mm erythematous,
papulovesicular lesions
Hallmark lesion of
arthropod bite
Arranged in clusters
Children > adults
Seen in exposed areas

Possible secondary infections
Systemic symptoms
Black Widow
Spider
Potent neurotoxin whose

site of action is
neuromuscular junction
Muscle cramping
Brown Recluse
Spider
Extremely toxic venom
Update tetanus immunization

Analgesics
Antibiotics (if needed)
Hypertension
Tachycardia
Toxic effect caused by a protein

that stimulates platelet
aggregation and infiltration of site
by neutrophils
RICE
Dark, dry places

Dermal necrosis
Antivenom
RICE
Found in the southeast US
Update tetanus immunization

Systemic symptoms
Dark, quiet places
Found in clothing and

shoes
Analgesics
Antibiotics (if needed)
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms

Tunnels
Scabies
Laboratory
Result
Treatment
5% Permethrin cream
Excoriated papules and

pustules
Highly contagious mites

that are spread by direct
or sexual contact
Test
1% Lindane lotion
Hypersensitivity
Medications
Other
At Risk Populations
Young, sexually active adults
Bed-ridden patients
Care-givers of bed-ridden patients
Oral ivermectin
Finger webs
Flexor aspects of wrist
Elbows
Axillae
Penis
External genitalia
Feet
Ankles
Treat family members

(even if asymptomatic)
Wash bedding / clothing in hot water
Sedating antihistamines
(at bedtime)
Severe crusting
Norwegian
Scabies
Limited number of
papules and burrows
Crusted scabies
Variable pruritus
Usually underlying
immunodeficiency
Can infest head, neck,

and genital and perianal
(homosexual )
Dermatitis
Immediate bath in hot soapy water
Papules / hives
Chiggers
Known as bedbugs or
jiggers
Severe pruritis
Prevention
Avoid brush
Proper clothing
Repellant (DEET)
Antihistamines
Ankles
Back of knees
Groin
Axillae
Topical steroids
Rosacea (possibly)
Demodex Mite
Ticks
Mite found in hair

follicles and sebaceous
glands
Arthropods that are

frequently vectors of
human disease
Nose
Cheeks
Forehead
Neck
Chest
Papules
Local edema
Local erythema
Induration
(after a few days)
Nodular
(after a few days)
Pruritus tenderness
Granulomatous reaction (rare)
Oral antihistamines medium to high

potency topical corticosteroids
Intralesional steroids (if severely
symptomatic)
Attracted by the smell of sweat, body

heat, and color white
Advise patients that local raections
may persist for 3 - 4 weeks
Excision (if severely symptomatic)

Permethrin and DEET
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Erythema Migrans
Bull's eye lesion
Lyme Disease
Infectious disease caused

by bites from Borrelia tick
Other
Erythema Chronicum Migrans
Erythema migrans lasting longer than
4 weeks
4 day - 3 week onset

Occurs 50% of cases
Vesicles
Malar rash
Variants
Urticaria
Nodules
Lymphocytoma Cutis
Single 1 - 5 cm bluish
nodule
See Ticks treatment section
Develops in response to
antigenic stimulation
Site of bite
Earlobe
Areola
Neck
Acrodermatitis Chronica Atrophicans
Bluish erythema
+ edema
Can lead to atrophy of
all layers of skin if
untreated
Small erythematous
Hemorrhagic puncta
papules
Linear excoriations
Bluish-brown or gray
Maculae Ceruleae
macules at the site of
the bite
Secondary infection
Vesicles
possible
Body Lice
Infect clothing
Lay eggs on seam fibers
Not seen on skin except
Reemerging in US in
when feeding
homeless
Pruritus
Head Lice
Scalp pruritus
Excoriations
Cervical adenopathy
Major problem in school
Rare in Africanchildren
Americans
Transmission through
Diagnosis made by
direct contact or
observing nits in scalp
formites
Public Lice
Small erythematous
1 - 2 mm lice are often
papules
visible
Inguinal adenopathy
Can infest eyelashes
Moderate pruritus (worse at night)
Sites
Pediculosis
Flies and
Mosquitoes Bite
Infestation of lice
Blight upon humanity
Pruritic wheals and

papules
Possibly vesicular,
eczematous, or
granulomatous lesions
Removal of nits
Permethrin
Wash all bedding,
clothing, hats, and
combs
Head Lice
Pediculicides are not ovicidal, and

patients need to be re-treated in 1
week.
Malathion
Pediculicides
Sklice
Ivermectin
Pubic Lice
Lindane lotion
Sklice
5% permethrin
Manual removal
Eyelashes
Prevention
Petroleum jelly
TID for 5 days
Prophylactic
antihistamine
Lindane
Allergic response to irritating salivary

secretions
Insecticide
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Flat bugs that feed at

night
Other
Spread by travelers in clothing and
baggage
Papular urticaria
Bedbugs
Medications
May be vesicular /
eczematous lesions
Linear arrangement
Erythematous macules
Fleas
Blood-sucking insects
Oral prednisone (for severe)

Excoriations
Grouped lesions
Bee Sting
Fire Ants
Destroy fleas at home
Urticarial-like papules
Potentially fatal insect

sting
Worst creatures in
existence
Lesion
Vesicle
Itchy pustule
Crusting
Secondary infections are

common
Erythema
Pain
Diffuse urticaria
Anaphylaxis
Angioedema
Shock
Age > 30
Appear "stuck-on" but
can come off
Oral histamine
Immediate pain
Acrochordon
White, pink, tan, light

and dark brown, or black
Multiple keratin cysts

imbedded within surface
of lesion
Sign of Leser-Trelat
Single or multiple
Sudden eruption of
many seborrheic
keratosies
Skin tag
4% of US population is sensitized.
Ice
Can be seen anywhere

on the body
Smooth, velvety,
verrucous, or
hyperkeratotic
Very common, benign,

epidermal growths
Stinger removal
RICE
Antihistamines (questionable)
Oral steroids (if severe)
Epi-Pen
Medic-Alert bracelets
Local cleansing
Flare reaction
Seborrheic
Keratosis
Antibiotics for secondary infections
Maybe a cutaneous sign

of internal malignancy
Oral steroids
Update tetanus (if needed)
Cryotherapy
Shave removal
Light electrocautery
Curettage
Most common in and obese
Fleshy filiform or
pedunculated papules
Surveillence (asymptomatic)
Flesh-colored, pink, or
brown
Cryotherapy
Occur in the axilla, neck, groin, eyelids, antecubital

and popliteal fossa, inframammary folds, beltline,
and other friction areas
Scissors-snip removal
Electrodessication
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Most common in legs

but can occur on trunk
and arms
Dermatofibroma
Very common, benign,

firm dermal papule
Lipoma
Subcutaneous, benign
fatty tumors
Flesh-colored, brown, Slightly to very raised or

pink, red, or tan
slightly depressed
Pruritus
Tenderness
Dimple sign
Button sign
Arise spontaneously or secondary to insect bites or
trauma when shaving legs
Excision (if symptomatic)
Medications
Other
Dimple Sign
Pinching surrounding skin between 2
fingers cause the lesion to dimple
Button Sign
Pinching surrounding skin between 2
fingers cause the lesion to raise
Single or multiple
Palpable
Epidermoid Cyst
Epidermal Inclusion Cyst
Epidermal Cyst
Cheesy consistency
when ruptured or
manually expressed
Infundibular Cyst
Nasty odor
Firm and mobile
Possible visible opening
Asymptomatic
Benign lesions composed

of organized clusters of
melanocyte-derived
nevus cells
Nevus
Overlying skin is mobile

Filled with keratin
Sebaceous Cyst
Pilar Cyst
Wen
Excision (if needed)
Variable size
Treatment is not indicated unless

symptomatic or on the face

Be suspicious of new moles
appearing or moles that are growing,
changing shape, or changing colors in
adults.
Can appear, grow,

darken, lighten, and
disappear during lifespan
Junctional Nevus
Flat or slightly raised
Tan or brown
Round or oval
Most on palms, soles, genitals, and mucosa, but
they can occur anywhere.
Compound Nevus
Slightly to markedly
raised
Tan, brown, or black
Center may be more
elevated and pigmented
Exicision
(if symptomatic or concerned about
malignancy)
Common on face, scalp,

trunk, and extremities
Found at both the DEJ

and in the dermis
Intradermal Nevus
Raised and soft papules

Flesh-colored, tan, or
brown
Mole
Course hairs may grow

Common on the face, scalp, and neck, but can be
seen on trunk and extremities
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Other
Blue Nevus
Cells located within the
deeper dermis
Tyndall effect
Macules or papules
Blue, gray, or black
Common on head, neck, buttock, and
dorsal hands / feet
Halo Nevus
Surrounded by a rim of
depigmentation
Nevus
Continued
Mole
Ephilides
Freckles
Autoimmune
phenomena preceding
its disappearance
Area usually repigments
Spitz Nevus
Dome-shaped smooth
papules
Pink, tan, or brown
History of rapid growth
Common on face, scalp, neck, and legs
Nevus Spilus
Sharply-defined tan to
brown patch with
multiple
hyperpigmented
macules papules
Can occur anywhere
Becker's Nevus
Brown patch, a patch of
hair, or both
Vary in size
May enlarge
Not a true nevus
because it lacks nevus
No malignant potential
cells
Congenital Melanocytic Nevus
Verrucous surface
Dark brown and raised
Greatly vary in size
Present at birth of
during infancy
Risk of malignant
Recommend excision
melanoma in lesions
after puberty
> 20 cm
1 - 2 mm
Well-defined
Red, tan, or browncolored macules
Darken with sun
Appear in childhood
exposure
Fade in winter
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms
Liver Spots
Wisdom Spots
Sebaceous
Hyperplasia
Common and benign

enlargement of the
subaceous glands on the
face
Fordyce Spots
Ectopically-located
sebaceous glands on the
buccal mucosa and
vermillion of lips
Cherry
Angioma
Extremely common,
benign proliferation of
dilated superficial
capillaries
Venous Lake
Dilated blood-filled
vascular channel
Spider
Angioma
Common, benign,
dilatation of superficial
bleed vessels
Laboratory
Result
Treatment
Medications
Other
Multiple lesions are

referred to as lentigines
Age Spots
Lentigo
Test
Juvenile Lentigines
Appear in childhood Do not darken in sun and
Part of several
fade is absence of
hereditary syndromes
sunlight
Solar Lentigines
Occur on sun-exposed Size and number with
caucasians
age
1 - 3 mm elevated
papules
Flesh-colored or yellow
May have central
umbilication
Could be solitary but common occur in multiples
on the forehead, nose, cheeks, and eyelids
Small, pinpoint macules
papules
No treatment
Orange or yellow
Single or multiple
0.5 - 5 mm
Smooth and domeshaped, flat, or polypoid
papules
Cherry red to purple
May occur anywhere but more common on the
trunk
2 - 10 mm papule on sunexposed skin
Single or multiple
Soft and usually
compressible
Common on the lower lip and ears, but almost
always on the face
Composed of an
arteriole (body)
perpendicular to the skin
Multiple radiating
capillaries parallel to
skin surface
Eruptive onset of hundreds of these

may be seen with the sign of LeserTrelat.
Diascopy
Common on face and
hands, but also occurs
on trunk and arms
Blanching
Electrocautery or laser
(risk of scarring)
In both children and adults

Those appearing during pregnancy
and in childhood tend to disappear
spontaeously.
Clinical Medicine
Condition / Disease
Cause
Signs and Symptoms

Slow growing
Locally destructive
Most common on the
Usually > 40 years old
face, scalp, ears, and
>
Nodular BCC
Most common variant
Dome-shaped papule
with overlying random
telangectasias
Center becomes flattens Borders become raised
or ulcerates
or rolled
Frequently bleed and develop crust scale
Superficial BCC
Least aggressive variant
Basal Cell
Carcinoma
Most common skin

cancer
Erythematous and scaly

plaques rolled border
Test
Laboratory
Result
Treatment
Excision
Nodular BCC
MMS
(for recurrent or
high risk)
ED&C
Superficial BCC
Excision
ED&C
Excision
Pigment BCC
MMS
(for recurrent or
high risk)
More common on the trunk and extremities

Pigmented BCC
Morpheaform BCC
Squamous Cell
Carcinoma
Potentially invasive,
primary cutaneous
malignancy of
keratinocytes in the skin
or muscous membranes
Scaly, hyperkeratotic, or
rough-textured papules
Flesh-colored, yellow,
brown, pink, or red
Most commonly seen on
May present as
sun-exposed skin of faircutaneous horns
skinned patients
Usually occur on face, scalp, neck, ears, dorsal
hands, and forearms
Vismodegib
MMS
Locally-advanced
disease not
amenable to
surgery or
radiation
Gorlin syndrome
Cutaneous horns should always be

biopsied.
5-FU (Efudex) and imiquimod (Aldara)
Cryotherapy
ED&C
ED&C
Flesh-colored, pink,
yellow, or red
MMS
Excision
Chemotherapy (if metastatic)

Face, scalp, neck, and
hands of older patients
Bowens Disease
SCC in situ
Slow-growing, slightly
raised, red plaque with
scale
Actinic Cheilitis
Actinic keratosis on the lower lip
Palpate lesions for induration and if
present, the lesion should be
biopsied to rule out SCC.
Photodynamic therapy
Indurated papules,
plaques, or nodules with
scale
May be ulcerated or
eroded
Vismodegib
Metastatic BCC
Morpheaform BCC
Least common varient
White to yellow patch
with poorly-defined
borders
Tumor may extend beyond borders of clinical
lesion
Actinic
Keratosis
Other
Risk Factors
Cumulative sun exposure
White-skinned patients with poor
tanning
Albinos
Sunburns prior to age 14
Arsenic ingestion
Prior XRT
ED&C
May resemble
melanoma
Common, persistent,
keratotic growth with
malignant potential
caused by cumulative sun
exposure
Medications
5-FU
Bowens Disease
(dependent on
location, patient,
and size of lesion)
Cryotherapy
ED&C
Excision
MMS
Risk Factors
Ultraviolet radiation (causative)
Radiation
Chemicals (arsenic and hydrocarbons)
Tobacco
Chronic infection
Chronic inflammation
Burns
HPV infection
Accounts for approximately 20% of
all skin cancers
Palpate regional LNs for mets,
especially for lesions on the ear,
scalp, lips, and temples
Erythroplasia of Queyrat
SCC in situ of the penis
Clinical Medicine
Condition / Disease
Keratochanthoma
Cause
Cannot be clinically
distinguished from an
invasive SCC
Signs and Symptoms

Rapidly growing
Solitary, firm, and red
nodule with a central
keratotic plug or
cutaneous horn
>
Dysplastic nevus
Atypical Nevus
Clarks Melanocytic
Nevus
A
B
C
D
E
Test
Laboratory
Result
Treatment
Medications
Biopsy
> 50 years old
Solitary lesions appear
sporadically and are
common
May start in childhood
but more common in
adults
Asymmetry
Border irregularity
Color
Diameter
Evolving
Biopsy
Diagnostic
Grade atypia
Excision
Mild Atypia
Observation
Excision
Moderate Atypia
Excision
Severe Atypia
Treated as if it is
melanoma
Multiple lesions are thought to be of

autosomal dominant inheritance and
are uncommon.
Mole mapping
(multiple atypical nevi)
Deramatology referral
Breslow Level
Depth of lesion (in mm) from the top
of the clinical lesion to the bottom of
of the lesion in the tissue specimen
Most important prognostic indicator
Clark Level
Level of anatomic invasion
Important in areas of thinner skin
May appear anywhere in the body
and exam should include LN
palpation for mets
Flat, raised, nodular, or

ulcerated
Punch Biopsy
Early detection
Variable color
Malignant
Melanoma
Metastatic
Melanoma
Malignancy of
melanocytes
Deadly form of skin

cancer
Other
Most commonly occurs on sun
exposed skin of caucasians
Any new mole presenting in adulthood or any

mole changing in size, shape, or color
Risk Factors
PMH or FMH
Fair skin
Blue eyes
Blond or red hair
Many moles
UV exposure from both
History of blistering
sun and tanning beds
sunburns
Most common metastatic site is the skin, but any
organ can be involved. CNS mets are most
common cause of death
Lentigo Maligna
Melanoma in situ
Usually seen in older
caucasians
Commonly seend on
face, neck, and arms
Superficial Spreading MM
Most common type of
MM
Asymmetric and flat
> 6 mm
Variable color
Most common in
Usually seen on the
caucasians
trunk and extremities
Spread laterally but may develop deeper
Nodular MM
Very rapid growth
Most common on the
extremities
10 - 15% of all MM
Grow vertically
Diagnostic
Incisional
Biopsy
Excision
IL-2
Ipilimumab
BRAF inhibitors
IL-2
Lentigo maligna represent 5 - 10% of

all melanoma.
70 - 80% of all melanoma is
superficial spreading MM
Ipilimumab
Vemurafenib
MEK inhibitor
Dabrafenib
Treatments only halt or delay

progression of the disease and are
rarely curative.
Trametinib
Clinical Medicine
Condition / Disease
Acral Lentiginous
Metastatic
Melanoma
Amelanotic
Metastatic
Melanoma
Cause
Most common type of

metastatic melanom in
Asian-Americans and
African-Americans
Nonpigmented
melanoma of any
subtype
Signs and Symptoms
Test
Laboratory
Result
Treatment
Medications
Other
Least common type of MM in
caucasians.
7% of all MM
Primarily occurs on the

hands, feet, and nails
>
Pink to red colored
papules
Enlarged plaques and

nodules
Scares the crap out of all

dermatologists
2% of all MM
Pharmacology
Drug
Generic Examples /
Brand Name
Mechanism of Action
Indications
Inhibit macrophage
accumulation in
inflamed areas
Topical
Steroids
Capillary permeability
and edema formation
Potency
Formulation
Factors for Absorption
Medium
Potency
High Potency
Very High
Potency
Contraindications
Adverse Effects
Bacterial infection
Viral infection
Fungal infection
Skin drying / cracking / thinning

Skin atrophy
Purpura
Tolerance / tachyphylaxis
Adrenal suppression
Use with dressings
Monitoring / Other
Discontinuation of Therapy
Depends upon dose, duration,
and disease
Risk of rebound flare when
discontinued
Frequency of application
Histamine antagonist
Low Potency
Pharmacokinetics
A: After bathing when
skin is moist
D: "Fingertip unit"
Onset: 1 - 2 days
% of total dose absorbed

through skin
Face
Genitals
Armpits
Skin folds
Children
Chronic use
Occlusive dressings
Large body areas
HC butyrate
Trunk
Arms
HC valerate
Legs
Face (limited)
clocortolone
Chronic eczema
Radiation dermatitis
hydrocortisone
halcinonide
triamcinolone
augmented
betamethasone
dipropionate
Severe psoriasis
Skin conditions where steriod will not be

discontinued abruptly
Cream
Face
Intertriginous areas
Use with caution in occlusive

dressings
Occlusive dressings
Face
Groin
Armpit
Skin folds
Do not use more than 2

weeks.
Be aware of symptoms of
adrenal suppression
Eczema
clobetasol
halobetasol
Generally choose nonfluorinated products
Most skin areas
Mostly absorbed
Drying effect
Opaque
Dry, scaly lesions
Skin that needs

protection
D: Should not exceed

50 grams/week
Hairy areas
Ointment
Therapeutic advantage of ointment + cosmetic

advantage of cream
Gel
Can have cooling effect
Lotion
Occulsive
Dressings
Fingertip Unit
Amount of steroid squeezed

out of tube that covers from
the tip to the first crease of
the finger
Weeping lesions in areas

subject to chafing
Evaporates quickly
Penetrates easily
Drying effect
(if contains alcohol)
Skin penetration by
moisture content of
stratum corneum
Beneficial in resistant
cases
Hand
Foot
Face and Neck
Arm
Leg
Front or Back Trunk
1 fingertip unit
2 fingertip unit
2.5 fingertip unit
3 fingertip unit
6 fingertip unit
7 fingertip unit
High potency steroids
Increases adverse effects of steroid Do not use for > 12 hours /

day
1 fingertip unit = 500 mg of

cream or ointment
Pharmacology
Drug
Generic Examples /
Brand Name
Mechanism of Action
Indications
Pharmacokinetics
Free-radical oxidation
Benzoyl
Peroxide
Salicyclic Acid
Stridex
Sulfur /
Resorcinol
Acne
Mild keratolytic with

drying and desqamative
actions
Clearasil
Removes excess
keratin
Desquamation of the
horny layer
D: Daily
Acne
Nongential warts
Acne
Increases horny cell

adhesion
D: Q evening
Effect: 2 - 3 weeks with
optimal > 6 weeks
Reduces the adhesiveness of

follicular epithelial cells
Tretinoin
Tazarotene
Acne
Anti-inflammatory
Clindagel
50S ribsome subunit

inhibitors
A: Foam or gel
D: Daily (Clindagel and
foam) or BID
P. acnes
Acne
D: Daily or BID
Erythromycin
50S ribosome
subunit inhibitor
P. acnes
Gels are the most effective

formulation
Peeling / dry skin

Stinging / burning
Irritation
Pruritis
Pain
Discoloration
Edema
Photosensitivity
Contact dermatitis
Fissuring
Peeling / dry skin
Stinging / burning
Irritation
Pruritis
Oiliness
Folliculitis
Photosensitivity
Nausea / vomiting / diarrhea
Peeling / dry skin
Burning
Erythema
Pruritis
Oiliness
Eye irritation
Acne
Modulates
differentiation and
proliferation of
epithelial tissue
Ophthalmic irritation
Noticeable color and odor
Dark brown scale (reversible)
Pregnancy
D: Q evening
Monitoring / Other
Directions for Use
Wash skin
Apply thin layer
Avoid eyes, mouth, lips, and
nose
Peeling / dry skin

Stinging / burning
Erythema
Pruruitis
Photosensitivity
Changes in skin pigment
Edema
Blistering
Peeling / dry skin
Stinging / burning
Pruruitis
Photosensitivity
Blistering
Dermatitis
Eczema
Acne
Modulates cell
differentation,
keratinization, and
inflammatory
processes
Adverse Effects
Stinging / burning
Dryness
Irritation
Peeling
Redness
Contact dermatitis
Bleach hair / towels / carpeting
Sun sensitivity
Stinging / burning
Confusion
Headache
Dizziness
Peeling
Benzoyl peroxide use
Stimulates mitosis and

turnover in epithelial
Adapalene
Clindamycin
Diabetes (use caution)

Poor circulation
Infants
Pregnancy (category C)
D: Daily
Keratolytic
Clearasil
Contraindications
D: Daily
Effect: 4 - 6 weeks
Second-line retinoid
Resistance is increasing.
Pharmacology
Drug
Generic Examples /
Brand Name
Sodium
Sulfacetamide
Mechanism of Action
Inhibits bacterial
dihydrofolic acid
synthesis
Azelex Cream
Azelaic Acid
Finacea Gel
Microbial cellular
protein synthesis
inhibitor
Stinging / burning
Pruritus
Erythema
Peeling / dry skin
Contact dermatitis
Hypersensitivity
Photosensitivity
Rash
Nausea / vomiting / diarrhea
Tooth discoloration
Intracranial pressure (rare)
Acne
Acne
Doxycycline
30S and (possibly)

50S ribosomal
subunit inhibitor
Acne
Dapsone
Inhibits bacterial
dihydrofolic acid
synthesis
Acne
norethinodrone
Decrease circulating androgen
norgestimate
Decreases sebum production
Adverse Effects
Monitoring / Other
Irritation
Hypersensitivity
D: BID
Effect: 4 weeks
30S and (possibly)

50S ribosomal
subunit inhibitor
A: Oral on empty
stomach
D: Q6 hours for 1 - 2
weeks
A: Oral
D: BID
Dizziness / vertigo
Hypersensitivity
SLE
Bulging fontanelle
Pseudotumor cerebri (rare)
A: Oral
Photosensitivity
GI disturbance
BUN
Bulging fontanelle
A: Topical (safer) or oral

D: BID for 12 weeks
Peeling / dry skin

Erythema
Oiliness
Acne
Patients with dark complexions

should be monitored for early
signs of hypopigmentation.
Monitor LFTs and CBC for longterm treatment
Monitor LFTs, renal function,

and CBC for long-term
treatment
Do not take calcium, iron,
magnesium, or aluminum
antacids or supplements
4 hours.
Monitor LFTs, renal function,
and CBC for long-term
treatment
Do not take calcium, iron,
magnesium, or aluminum
antacids or supplements
4 hours
Acne
D: BID
Isotretinoin
Inhibits sebaceous
gland function and
keratinization
Acne
Mupirocin
Bacterial isoleucyl
t-RNA synthetase
inhibitor
Bacterial infection
Interfere with
cellular permability
Fungal infection
Allylamines
Contraindications
Acne
Minocycline
Oral
Contraceptives
Pharmacokinetics
D: BID
Oxygen radical scavenger
Inhibits bacterial
protein synthesis
Tetracycline
Indications
butenafine
naftifine
terbenafine
tolnaftate
A: Topical or nasal
D: TID
Pregancy (category X)
Severe birth defects

Peeling / dry skin and mucous
membranes
Lip inflammation
Hypertriglyceridemia
Myalgia
Anemia
Conjunctiviitis
Various skin conditions
Under restricted distribution

Monitor for depression or
aggressive behavior, LFTs,
lipids, CBC, and hearing
changes.
Burning / pruritis
Headache
Rhinitis
Nasal congestion
High level resistance has been

reported in S. aureus and
coagulase (-) staphylococci
Short time to cure
Pharmacology
Drug
Azoles
Ciclopirox
Generic Examples /
Brand Name
clotrimazole
econazole
ketoconazole
miconazole
oxiconazole
sulconazole
sertaconazole
Mechanism of Action
Indications
Pharmacokinetics
Adverse Effects
Monitoring / Other
Requires skin turnover for
complete effect
Fungistatic
Dermatophyte infection
Yeast skin infection
Loprox
Polyvalent cation chelator
Dermatophyte infection
Penlac
Inhibits metal-dependent
fungal enzymes
Yeast skin infection
Alters membrane
permability
Fungal infections
Nystatin
Contraindications
Acyclovir
Zovirax
Antiviral
Valacyclovir
Valtrex
Antiviral
Famcyclovir
Famvir
Docosanol
10% Cream
Abreva
Interferes with viral

entry into target cell
Shingles Vaccine
Zostavax
Prevention of
shingles in patients
> 60 years old
Shingles
HSV-1 infection
Antiviral
Shingles
D: 2 g Q12 hours for 1

day or 1 g TID for 7 days
(shingles)
E: Renal
D: 500 mg Q8 hours for
7 days
E: Renal
D: 5x a day
Discolors light-colored hair
Headache
Nausea / diarrhea
Malaise
Mild pain / burning / stinging
Neutropenia
LFTs
See Acyclovir
A: Cream or oral
D: 5x a day for 4 days
(cream) or 5 days (oral)
E: Renal
HSV-1 infection
HSV-1 infection
Seizures
Immunosuppression
Breastfeeding
See Acyclovir
Penciclovir
Active metabolite of
famcyclovir
Decreases healing time
HSV-1 infection
Shingles
May be used in patients

with previous shingles
episodes
Avoid antivirals for 1 day

before and 14 days after
vaccination.

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Dermatology

Examination of skin lesions using a

Any skin lesion

Process for inspecting

Timing is not important

Skin lesion and a thin

Multiple dermal layers

Most characteristic area

Basal cell carcinoma

Compiled by Drew Murphy, Duke Physician Assistant Class of 2015

Study of antibodies in plasma

Quick, inexpensive fungal test to

Test for blanchability by

> 98% cure rate

Microscopically controlled surgery

Compiled by Drew Murphy, Duke Physician Assistant Class of 2015

Test to diagnosis scabies

Thin shave biopsy is performed

Select a linear burrow or intact papule.

Allergic contact dermatitis

Compiled by Drew Murphy, Duke Physician Assistant Class of 2015

Signs and Symptoms

Filled with clear fluid

Round and solid

Primary lesion seen in

Focal loss of epidermis

Heals without scarring

Compiled by Drew Murphy, Duke Physician Assistant of 2015

Signs and Symptoms

Focal loss of epidermis

Lesion from scratching

Small, superficial keratin

Closed sac that has a

Narrow, elebated tunnel

Thickening of the skin

Visible opening is often

Compiled by Drew Murphy, Duke Physician Assistant of 2015

Dilated superficial vessels

Signs and Symptoms

Can be confused with inflammatory

Very common in child but adults can

Chronic superficial skin

Appears bright red with

Impetigo that extends

Compiled by Drew Murphy, Duke Physician Assistant of 2015

Signs and Symptoms

Culture and sensitivity

Most common clinical

Infection of the skin and

Incision and drainage

Incision and drainage

Lower extremities and

Raised borders with

Compiled by Drew Murphy, Duke Physician Assistant of 2015

Infection of the skin and

Infection of the upper

Signs and Symptoms

Begins with soft-tissue

Fulminant NSTI of the

Correct any predispoing condition

Can evolve into a pyoderma

Encourage antibacterial soaps

Common in shaved areas