Académique Documents
Professionnel Documents
Culture Documents
By
Katrice L. Herndon, MD
Internal Medicine/Pediatrics
June 2, 2005
What is this?
Acne Vulgaris
Acne is a self-limited disorder primarily of
teenagers & young adults.
Acne is a disease of pilosebaceous follicles.
4 factors are involved:
Retention hyperkeratosis
Increased Sebum production
Propionbacterium acnes within the follicle
Inflammation
Acne Vulgaris
External Factors that contribute to Acne
Acne Vulgaris
Acne vulgaris typically affects those areas of the body that have the
greatest number of sebaceous glands:
Acne Vulgaris
Classification of Acne
Type 1 Mainly comedones with an occasional small inflamed
papule or pustule; no scarring present
Acne Vulgaris
What is this?
Acne Rosacea
Rosacea is an acneiform disorder of middle-aged and
older adults.
Acne Rosacea
rosacea is a chronic disorder characterized by periods
of exacerbation and remission.
Acne Rosacea
Patients with rosacea may develop severe
Acne Rosacea
Topical antibiotics or benzoyl peroxide are the
initial treatments of choice.
What is This?
nickel (jewelry)
formaldehyde (clothing, nail polish),
fragrances (perfume, cosmetics),
preservatives (topical medications, cosmetics),
rubber
chemicals in shoes (both leather and synthetic)
What is this?
Psoriasis
Psoriasis is a common chronic skin disorder
typically characterized by erythematous
papules and plaques with a silver scale.
Psoriasis
Several clinical types of psoriasis have been described:
Plaque psoriasis - symmetrically distributed plaques
Psoriasis
Psoriasis
Psoriasis
Most patients w/ psoriasis tend to have the disease
for life.
Psoriasis
Treatment
Treatment modalities are chosen on the basis of
disease severity.
Topical emmollients, topical Steroids, tar
Calcipotriene(Dovonex) affects the growth and
What is this?
Vitiligo
Vitiligo is an acquired skin depigmentation that affects all races
but is far more disfiguring in blacks.
Vitiligo
Peaks in the second and third decades.
The depigmentation has a predilection for acral areas
Vitiligo
Repigmentation therapies include:
corticosteroids
calcineurin inhibitors
Ultraviolet light
Pseudocatalase cream
Surgery minigrafting techiniques
Depigmentation therapy w/ hydroquinone
What is this?
Pityriasis Rosea
Pityriasis rosea is an acute, self-limited, exanthematous
skin disease characterized by the appearance of
slightly inflammatory, oval, papulosquamous lesions
on the trunk & proximal areas of the extremities.
2 to 5 cm in diameter.
Pityriasis Rosea
Pityriasis Rosea
A few days later lesions similar in appearance to the herald
patch, appear in crops on the trunk & proximal areas of the
extremities.
Pityriasis Rosea
The presence of a herald patch by history or on
examination.
Pityriasis Rosea
Differential Dx include: Psoriasis, secondary syphilis,
tinea corporis, Lyme disease, & drug eruptions.
Topical Steroids
Antipruitic lotions (prax, pramagel)
Phototherapy
Erthyromycin in severe cases
Rash usually persists for 2-3 months
What is this?
Cellulitis
Cellulitis is an infection of the skin with
some extension into the subcutaneous
tissues.
Cellulitis
Five factors were identified as independent
risk factors:
Lymphedema
Site of entry (leg ulcer, toe web intertriginous,
and traumatic wound)
Venous insufficiency
Leg edema
Being overweight
Cellulitis
Cellulitis is a recognizable clinical syndrome with
both local & systemic features.
Cellulitis
Local findings typical of cellulitis:
Cellulitis
Cellulitis in the majority of patients is
Cellulitis
Diagnosis is clinical
Treatment: Anti-strep/Anti- staph
Cefazolin
Nafcillin
Clindamycin
Vancomycin
Fluoroquinolones (3rd & 4th generations)
Macrolides (erythromycin, azithromycin)
What is this?
Erysipelas
Erysipelas is a characteristic form of cellulitis that
Bacterial Organisms:
Erysipelas
The erysipelas skin lesion has a raised border which is
sharply demarcated from normal skin.
Erysipelas
The face historically was the most common area
of involvement.
Erysipelas
Treatment:
What is this?
Ecthyma
Ecthyma is an ulcerative pyoderma of the skin caused
by group A beta-hemolytic streptococci.
Ecthyma
Ecthyma begins as a vesicle or pustule overlying an inflamed area
of skin that deepens into a dermal ulceration with overlying crust.
A shallow, punched-out ulceration is apparent when adherent
crust is removed.
Ecthyma
Treatment:
Topical mupirocin ointment
Gentle surgical debridement
Oral/IV antibiotics
Penicillin
Clindamycin
Macrolides
Cefazolin
What is this?
Tinea Vesicolor
Tinea versicolor is a common superficial
infection caused by the organism
Pityrosporum orbiculare.
Tinea Vesicolor
Lesions can be hypopigmented, light brown, or salmon
colored macules.
Tinea Vesicolor
Most commonly found on the upper trunk &
extremities, & less often on the face and
intertriginous areas.
Tinea Vesicolor
The differential diagnosis includes seborrhea,
eczema, pityriasis rosea, and secondary syphilis.
What is this?
Cutaneous Warts
Cutaneous warts AKA verrucae are caused by HPV
which infects the epithelium of skin and mucus
membranes.
Cutaneous Warts
Infection with HPV occurs by skin-to-skin contact
Incubation period following exposure in 2-6 months.
Warts can have several different forms based upon
location & morphology (flat, mosaic, and filiform
warts)
Cutaneous Warts
The diagnosis of verrucae is based upon clinical
appearance.
Cutaneous Warts
Differential Diagnosis:
Lichen Planus
Seborrheic Keratosis
Acrochordon or skin tag
Clavus or corn
Treatment
Spontaneous regression in 2/3 over 2yrs
Salicylic acid, liquid nitrogen, cantharidin
Cyrotherapy, curettage, laser therapy
Immunotherapy, intralesional injections
What is this?
Secondary Syphilis
Syphilis is a chronic infection caused by the
bacterium Treponema pallidum which is
sexually transmitted.
Secondary Syphilis
Secondary Syphilis
Secondary or systemic syphilis is characterized by a rash.
The rash is classically a symmetric papular eruption involving
the entire trunk & extremities including the palms and soles.
Secondary Syphilis
Secondary Syphilis
Diagnosis at this stage is usually by serologic testing
but darkfield microscopy can also be done for direct
visualization of spirochete.
Non-treponemal testing:
Veneral disease research laboratory (VDRL)
Rapid plasma reagent (RPR)
Treponemal testing:
Fluorescent treponemal antibody absorption test
Microhemagglutination test for antibodies
Seconday Syphilis
Treatment
T.Pallidum remains very sensitive to PCN.
What is this?
Herpes Zoster
Reactivation of endogenous latent VZV infection within
Herpes Zoster
The rash initially appears along the dermatome as grouped
Herpes Zoster
Treatment
Antivirals:
Acyclovir
Famciclovir
Valacyclovir
Antivirals w/ corticosteroids
Analgesics: opioids/acetominophen
What is this?
Actinic Keratosis
Actinic keratoses (AKs) are premalignant
with some surrounding erythema on sunexposed areas of the head and neck,
forearms and hands, and upper back.
Actinic Keratosis
Actinic Keratosis
The differential diagnosis of AKs includes
Surgical curettage
Chemotherapy (5-FU, diclofenac, imiquimod)
Dermabrasion
Photodynamic therapy
skin cancer. When these tumors first appear they are firm
to the touch. They appear most often on sun-exposed areas
of your body.
References
Harrisons 15th Edition. Principles of Internal
Medicine
Up to Date
Emedicine
Dermatology Pearls Adult and Pediatric
Thank You