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Dermatology (Common Skin Lesions (Epidermal Cyst
round, yellow, slow…
Dermatology
Common Skin Lesions
Epidermal Cyst
- round, yellow, slow growing nodule
- common: youth - middle age
- central punctum,pus filled
- may rupture
Pilar Cyst
- Multiple, hard nodules
- Under scalp
- Idiopathic
- M<F
- Second most common skin cyst
- Tx: Excision
Ganglion Cyst
- Solitary, rubbery
- Gelatinious Viscous Fluid
- Origin: Tendon/ joint Sheath
- Ass: OA
- Older Age
Tx: Incision and expression of contents
Milium
- 1-2mm SUperficial, white/yellow sub epidermal papules
*Eyelid, Cheek, forehead
- Any age → 40-50% infants
Tx: Resolves in infants, Incision and Drainage
Fibroius Lesions
- Dermatofibroma
- Firm, papule/nodule, red/brown
*legs arms trunk
*Benign
- no Tx
- Skin Tags
- Benign outgrowth of skin
- eyelids,neck,axillae, inframammary, groin
- No Tx or possible excision
Hyperkeritotic Lesions
- Seborrheaic Keritosis
- Comom, Benign, Tumour
- Waxy, Papule, Plaque
*Face, trunk, upper extremities
- No tx
- Actinic/ Solar Ketitosis
- Keratoacanthoma
Corns/Helomata
- Firm, Papule, cone- shaped,central hard keritin core
- Chronic Microtrauma
Keloid Scar
- Firm, Shiny, nodules
- Cutaneous Injury
- earlobes, shoulders, scapula, mandible
- Tx: Steroid, Cryo, silicon compression
Pigmented Lesions
- Congenital/ acquired Nevomelanocyctic Nevi
- aka MOLE
- risk of melanoma
*tx: Excision of suspicious
- Other
- Atypical
- Freckles
- Solar Lentigo ( Liver Spot)
- Becker's Nevus
- Melasma
Vascular Lesions
- Haemangiomia
- Red/Blue Mass
- Compressible and Blanches
- Benign
- Other
- Spider Angioma
- Cherry Angioma
*Pyogenic Granuloma
Lipoma
- Single/multiple, non-tender, subcut tumour
- Not serious
Differentials
Brown Macule
- Actinic Solar Keritosis
- Nevus
- BCC, MM
Discrete Red Papule
- Folliculitis
- Furuncle
- Scabies
- Acne Vulgaris
- Psoarisis
*Urticaria
- Bites/Stings
Red Scales
- Tinea
- Dermatitis
*Psoriasis
- Lichen Planus
*Neoplasm
Vesicle
- Impetigo
- Viral: HSV, HZV, molluscum, Coxsackie
- Scabies
Bullae
- Acute Dermatitis
Steven- Johnson Syndrome
- Toxic Epiderma Necrolysis
- SLE
Pustule
- Acne Vulgaris
- Candida
*Impetigo
- HZV
- Sepsis
Oral Ulcers
- HSV, HIV, HSV
- Syphilis, TB
- CMV
- Allergic Stomatitis
- BCC, SCC
Skin Ulcer
- Syphilis
- TB
- RA
- SLE
- Vasculitis
Infections
Dermatophytosis
- Fungal
- List:
- Tinea Capitis
- Tinea Corporis ( ringworm)
- Tinea Cruris
- Tinea Pedis ( athlete, foot)
- Tinea Unguim
Parasites
- Scabies
- Mite, clothing and sheets
- Tx: Bath, permethrin cream and wash sheets
- Lice (pediculosis
- permethrin cream/ shampoo
- Bed bugs
- Wheals, itching
- Tx: Fumigation, steroids
Virus
Herpes Simplex
- HSV 1 ( Mouth), HSV 2 (Genitals)
- Contact
- Tx: Topical antiviral
Herpes Zoster
- Tx: NSAIDS, Antiviral within hours
Molluscum Contagiosum
- Dome- shaped, pearly papules
- Pox Virus
- Spread by contact
- self-limiting: 1-2 yrs
Warts
Yeast Infections
Candidiasis
- Painful, red, swelling periungual skin
- Thrush
- Keep dry, medications
Tinea Versicolour
- asymptomatic fungal infection
- Brown/white scaling skin
- Aet: Microbe
STI's
- Syphilis
- Gonorrhea
- HSV
- HPV
Bacterial
- Impetigo
- GAS, Staph. Aur
- Tx: ABx
Cellulitis
- Dermis, sub.cut fat infection
- Tx: Abx
ErypelasOther
- Hypo dermis GAS
- Furuncles, Folliculitis, Carbuncles → Staph. Aureus
Acneiform Eruptions
Perioral Dermatitis
- Micro papules become confluent
*Perioral, nasal, orbital
- Symetrical
- Females, occ. young children
- Tx: topical Metonidoxole, systemic tetracyclins
Rosacea
- Papules/pustules, non-transiet flushing
*remisions and exerbastions
*Triggers: heat/Cold, Wind, Sun, ETOG, Caffiene, Stress
- Aet: Unknown
- Tx: Trigger Avoidance, Ablation, Abx
Acne Vulgaris
- Type 1: Comeedonal Sparse, no scarring
- Type 2: Comedonal papular, moderate scarring
- Type 3: Commedonal, Papular, Pustular, scarring
- Type 4: Nodular, Cystic, Severe scarring
- Aet: Angrogens
* Tx: Benxoyl Peroxide, Salicyclic Acid, Antimocirobials, Topical Retinoids, oral Abx, OCP, Roactutane ( Isotretanion)
Neoplastic
Benign
Acanthosis Nigricans
- hyperpigmentation(darkening) and hyperkeratosis(parakeratoisis
- Axilla, groin, back of neck
Cutaneous Sign of underlying pathology
- Types benign/malignant
- A/S: Insulin resistance and Malignancy (gastric Carcinoma)
Serorrheic Keratosis
- Common Benign Epithelial Tumour
- Aetiology and Pathophysiology: Mutation of FGF3 (Fibroblast growth Factor Receptor or paraneoplastic syndrome.
- Layers up on skn over tiem
- Melanoma Mimicker
* Morphology
- Exophytic with sharply demarcated borders
- Variable melanin pigmentation with basaloid cells
- surface hyperkeratosis
- horn cysts
- invagination cysts
- Round, flat, coin-like (nummular), waxy-plaques varying in size. (Squashed Sultana)
Actinic/ Solar Keratosis
- Pre- cancerous SCC
- Sun-exposure
- Clinical Features
- Flat/thickened papule/plaque
- White, yellow/tan
- Tender/asymptomatic
- Sun exposed areas
- TX: Cyrotherapy, Imiqiumod, 5-FU
Malignant
SCC
- Malignancy of keratinocyctes in epidermis
- Head, neck (men) and arms/legs (females)
- Causes
- UV Light. Immuosuppresion, radiation,Smoking, HPV 16,18
- Indurated erythematous nodules/plaque with surface scale/crust+/- Ulceration
- Enlargment more rapid than BCC
Other Types:
- Bowens Disease: SCC In situ
- Keratoacanthoma: Rapidly growing, firm, dome-shaped, erythematous/skin coloured nodule with celtral depression filled with keratin
TX:
- Cryotherapy and Surgical Excision
Melanoma
- Common malignanct neoplasm of epidermal melanocytes with metastatic potential
- Sites: Skins, mucous membranes, eyes, CNS, oral, adrenala
- ↑st AU/NZ, 1in5 Risk,common in 16-29yrs, 4th most common cancer
- Aet: Sun exposure, genetics, acuired mutations
- RF (no SPF is a SIN)
- Sun Exposure
- Pigment traits ( hair and eyes)
- Freckling
- Skin reaction to sun
- Immunosuppresion (organs Transplant)
- Naevi
- Fx and Hx of SCC, BCC, melanoma
- Age
- Intermittent Sun exposure
- Types
- Lentigo maligna (15-20%) :Vertical growth, invade dermis, Flat, tan/brown/black
- Superficial Spreading (60-70%): Irrefular, indurated, enlarging plaques, red/white/blue, ulceration/bleeding with growth
- Nodular (30%): Uniformly ulcerates, blue-black, rapidly fatal, Elevated, Firm, growing
- Acral Lentiginous (5%): Ill-defined brown/black macule, palms/soles, sublingual skin
- Clinical Features
*♂ Head/neck/trunk
*♀Legs, trunk, arms
*Asymmetry
*Border (irregular/indistinct
*Colour (varied)
*Diameter (>6mm)
*Evolutions: Elevation, change, firm, growth
Dermatoscopic changes to look for:
- Blue white veil
- Scar like
- Pseudopods
- Radial Streaming/Streaking
- Multiple Colours (>5)
Multiple Brown Dots
- Atypical Networks
Pathology Reports
- Breslow's thickness
- Ulceration
- Completness of excision
Treatment
- Excsion Biopsy with 2m margin
- Local re-excision following biopsy with proven diagnosis to excise in situe/invasive components
- Follow up: Beware of change, anything of concern, every 6 months, full body examination
BCC
- Most Common Human Cancer, 75% skin cancer, M>F
- Locally invasive rpoliferation of basal keratinocytes in epidermis
- RF
- Age/Gender
- Previous BCC, SCC, melanoma
- Sun Damage
- Repeate Sun burn
- Fait skin, blue eyes, blonde/red hair
- Previous cutaneous injury
- Naevus/Gorlin syndrome, eroderma Pigmentosa
- Albinism
- Immunosuppresion
- Slow growing plaqu/odule
- Skin coloured, pink/pigmented
- Sponaneous bleeding or ulceration
TX:
- Surgical excicison
- Photodynamic therpay
- Cryotherapy
- Immunomodulators
Refer
- Recurrent Lesions
- Incompletely excised lesions
- High risk subtypes
- Lesions on ears, central face. legs and genitals
-
- Dermatis
- Infallmation of skin
- Syx: Poorlr demarkaedpathces/plaques, erythema, pruritis, pain
Aseatotic Dermatitis
- Dry skin, elderly, during winter
Atopic Dermatitis (ezcema)
- Aboce Syx, with severs prolonged puritis
- Inflammation secondary to scratching
- Assocations with hx of atopy
- Triggers: Dergents, clothong, solvents, allergens, dust mites, heat, sweating, stress
- Mx: Non-pharm: Moisterisers and Bathinig practiices;
Pharm: Topical Corticosteroids and topical calcineurin inhibitors
Contact Dermatitis
- Irritant vs Allergic
- Irritant: non-immune, acute and cumulative reaction, Soaps, detergents, ETOH, tx: avoid, moisterise, steroids
- Allergic: Type 4 immune reaction, areas exposed, delayed, patch testing, Tx: as for irritant
Other
- Dyshidtoric Dermatitis
- Nummular Dermatisis
- Seborheaic Dermatitis
- Stasis Dermatitis ( bed/ pressure sores)
- Lichen Simplex, chronicus
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