NPLEX Combination ReviewDermatology - 2

Paul S. Anderson, ND

Medical Board Review Services

Copyright MBRS

Seborrheic Keratosis

• Greasy,scaly, or verrucous, flat papules to plaques

• Appear stuck on skin• Occur more in sun

exposed areas• More in aging adults• Can get inflamed &

simulate a skin ca.

Skin tags

• Tag like growths around neck, axilla, under breasts, in groin

• Color-skin toned, brown, or pink

• If removing an unusual or inflamed tag, send in to path

• Scissor removal

Dermatofibroma

• Papules that develop mainly on legs

• Secondary to trauma• Overgrowth of

fibroblasts• Color- usually brown

and firm (feels like a BB under the skin)

Epidermal inclusion cyst(sebaceous cyst)

• Movable skin colored papules to nodules

• Subcutaneous• Face, back, ears, groin• Sack of epidermis under

skin, filled w/keratin/sebum

• Smell• Can get inflamed, usually

not infected

Lipomas

• Subcutaneous movable nodule

• Fatty growth/lobules• Hereditary/ numerous• Arms, trunk• Usually asymptomatic or

painful• Sometimes can not differ

from an EIC until surgery• Can recur after removal

Pilar cysts (wen)

• On scalp, subcutaneous movable nodule

• Have firmer keratin then EIC/ no smell

• Usually, pop out during surgery

Discoid Lupus Erythematosus

Chronic recurrent autoimmune disorder primarily affecting the skin.Unknown etiology; IgG and IgM deposited in skinExposure to sunlight frequently precedes lesionsMore common in females (10x), onset usually in 30’s

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Discoid Lupus Erythematosus

ClinicalLesions are rather distinctive, but sometimes resemble those of SLE

LabNo anemia, normal ESR, ANA absent or low, anti-DNA absent

Differential DxSLE, rosacea, seborrhea, photosensitivity dermatitis

Genital Warts (HPV)

• 80 types of HPV; 20 can infect genital area; usually HPV 6 and 11

• Soft, moist, skinned colored (or pink or red) pinhead papules to cauliflower-like masses

• HPV 16, 18, 31, 33 may lead to cervical dysplasia

Genital Warts (HPV)

Types of Hemangiomas

Capillary“Strawberry”Superficial angiomatous neviAffect the blood vessels in uppermost layers of the skin

CavernousSubcutaneous angiomatous neviMore deeply set in the dermis and subcutis

Hemangiomas in Adulthood

Cherry AngiomaOccur most often around the midtrunk

They increase in number from about the age of 40

Cause is unknown

They can be simply removed by diathermy or laser, but are usually left alone.

Cherry Hemangioma

Impetigo

Skin infection caused by bacteria (Streptococcus pyogenes and/or Staphylococcus aureus)

Pruritic pustules, vesicles, bullae with “honey-colored” crust

DX: Clinical, culture or Gram stain

Impetigo

Herpes Simplex

• One of the most common infections• Two main types:

– HSV Type 1: mainly facial infection; mainly infants and young children

– HSV Type 2: mainly genital infection; mainly after puberty, often sexual transmitted

• Latent state in the nerves; spread by direct contact with infected secretions

Herpes Simplex

• Prodromal tingling or itching; maybe fever• Oral (white patches on tongue, throat, palate

and inside cheeks): small fluid filled vesicles (blisters) on erythematous base; may be painful; usually burst and leave yellowish crust

• Genital: penile ulcerations on glans, foreskin or shaft; mucosa of vulva, vagina and cervix

Herpes Simplex

Herpes Zoster (Shingles)

Painful blistering rash caused by Chicken Pox (varicella) virus

Latent in nerves which supply sensation to the skin

Increased incidence with age Pain (maybe fever, HA); tenderness to

sensory nerve pathway

Herpes Zoster (Shingles)

Molluscum contagiosum

• Viral skin infection

• Small harmless skin growths

• Resemble pimples at first and later the spots enlarge

• Waxy pinkish look and small central pit

• Can spread person-to-person

Molluscum contagiousum

Venous UlcersVenous Ulcers

Granuloma annulare

Characterized by a ring of small, firm, flesh-colored or red papulesLateral or dorsal surfaces of hands and feetBegins with asymptomatic, flesh-colored papule that undergoes central involutionOver months size increases up to 5 cmSpontaneous involution or lasts for yearsHistology shows collagen degenerationTreatment:

Intralesional injections with triamcinolone

Infestations

• Scabies-mite– very pruritic, especially

night– red papules,

excoriations, burrows• Hands. Wrists,

elbows,axilla, umbilicus, groin/penis

– contagious– takes 6 weeks to show

after exposure

Elimite, neck down for 8 hours

Lice• Body Louse– Less common in US– poverty,war– live in clothes

• Pubic “crabs”– sexually transmitted– Pruritus

• Retreat in 1 week• Remove nits

– vinegar/H20 rinse– Lice/nit comb

Arthropod bite

• Flea bites– around ankles, go for

people once dog’s gone

– can be dormant for 1 yr

• Chiggers– bite in 3’s, like were

clothes bind (waist,socks.ankle)

Arthropod

• Mosquito bites– pink papule to nodule

to bulla

• Ant bites– papules to bulla– pustules in fire ants

• Sand flea– toes, buttocks (sitting

in sand)

• Pattern– red papule w/central

puncta, linear-grouped– vesicles– giant wheals(urticaria)– nodules