NPLEX Combination ReviewDermatology - 3

Paul S. Anderson, ND

Medical Board Review Services

Copyright MBRS

Nail Diseases

Acute ParonychiaPainful, bright red swelling of proximal and lateral nailfold

Chronic type associated with contact with water

Keep hands dry is best treatment-lotions and ointments should be avoided

Separation of nail plate (onycholysis) may predispose to Pseudomonas infection

Paronychia

Nail Diseases

Fungal

Tinea unguium

Trauma predisposes to infection

DDX: Psoriasis (pitting not found in tinea)

Treatment orally with fluconazole or itraconazole

Tinea Unguium

Contact DermatitisContact Dermatitis

Contact dermatitis is a reaction, which occurs when skin comes in contact with certain substances.

Irritant contact dermatitisOrganic solvents or soaps

Allergic contact dermatitisDelayed hypersensitivityHapten (low molecular weight substance)Cross-sensitization

DiagnosisHistory of onset; work-home exposure; skin care; medications; soaps; clothing (be persistent with questioning)

If problem does not clear:

According to the American Academy of Allergy, Asthma, and Immunology, "Patch testing is the gold standard for contact allergen identification”

Not to be used for irritant contact dermatitis

Contact DermatitisContact Dermatitis

Irritant Vs A llergic D erm atitis

B o rd e rs U su a lly N o n d is tin ct

N o n im m u no lo g icH ig h C on ce n tra tio n o f S u b s ta n ce

G ra du a l M od e o f O n se t

Irritant

M a y C o rre sp on d to C on tac ta n t

D e la ye d H yp e rsen s it iv ity R e a c tionU su a lly L ow S u b s ta n ce E xpo su re

U su a lly R a p id O n se t A fte r S e ns it ized

Allergic

C ontact D erm atitis

Contact dermatitis due to allergy to rubber antioxidant in brassiere

Contact Dermatitis

Atopic DermatitisAtopic Dermatitis

Major CriteriaPruritus Flexural lichenification (thickening of the skin) and linearity in adults Facial and extensor involvement in infants and young children Chronic or chronically relapsing dermatitis Personal or family history of atopy (asthma, allergic rhinoconjunctivitis, atopic dermatitis)

Labsserum IgE elevated above 200 IU/ml in 80-90%Eosinophilia

Psoriasis

About 2% of adults (Psoriasis vulgaris)

Triggers: rash starts after emotional stress, trauma to skin (Koebner’s phenomenon), strep throat

Red scaly-white papules and plaques; removal of scale results in blood drops (Auspitz phenomenon)

Psoriasis

• Plaque• Guttate-strep induced• Palmoplantar

pustulosis• Inverse

Psoriasis

Seborrheic dermatitis

Chronic superficial inflammatory process of hairy regions of the body

Pityriasis capitis (dandruff)

Cradle Cap (thick, yellow, crusty scalp lesions in infants)

Proliferation of Pityrosporum ovale (yeast)

Triggered by stress, fatigue, change of season or reduced general health

Seborrheic Dermatitis

Acne vulgaris

• Location-sebaceous skin– face, chest, back

• Lesion type– non-inflammatory

• comedone-open/closed• cyst

– inflammatory• papule(red), pustule,

nodule

AV

Treatment

• Correct abnormal keratinization (plugging)– Vit A cream

• Kill bacteria– topical ABX, oral ABX,

Benzoyl peroxide

• Decrease inflammation– Tetracycline family

• Minocycline

– Diet- decrease refined sugars/fried foods.

– Sunlight/blue light

• Correct hormone imbalance

Rosacea

• In adults• Two components

– redness/flushing/telangiectasia-burning

– papules/pustules– No comedones

• Location-mid face, around eyes

Etiology

• Unknown- some relation to acne

• Racial group – Northern Europeons– Celtic– Men worse than

women

• Triggers– Emotional stress-

people who blush– Hot/cold air (exercise)– Food

• cheese, wine, spicy food, coffee

• Very Chronic

Pityriasis albaPityriasis alba

Children and young adults

Round or oval; slightly elevated, fine scaling plaque that leave pale marks (hypopigmented) usually on face, neck and arms

DDX: vitiligo, tinea versicolor (How do you tell?)

Vitiligo and tinea versicolor appear white; borders are distinct in vitiligo; tinea versicolor is rare on the face and areas more numerous and often confluent; KOH to settle the debate

Vitiligo and tinea versicolor appear white; borders are distinct in vitiligo; tinea versicolor is rare on the face and areas more numerous and often confluent; KOH to settle the debate

Pityriasis alba

Pityriasis rosea

• Teenagers and young adults; benign• No known cause but linked to

mycoplasma, picornavirus and human herpesvirus 7

• “Harold Patch” (plaque) precedes eruption then followed by smaller plaques (0.5 to 2 cm in diameter)

• Follows long axes parallel lines of cleavage starting at spine (Christmas tree-like pattern)

Harold PatchSlightly erythematous,

scaly, with slightly raised bordersPityriasis rosea

Lichen simplex (neurodermatitis)

Common disorder, usually adults

Repeated rubbing or scratching resulting in itchy patch of skin

Sharply demarcated, red, scaly plaque with prominent skin lines

Lichen Simplex

Lichen planus

• Very pruritic rash on palms, wrists

• Polyangular, flat topped pink papules w/ wickham’s striae– criss/cross white lines

Verruca vulgaris (warts)

Epithelial tumors caused by at least 60 types of human papillomavirusFrequent in older children, uncommon in elderlyCommon Type: flesh-colored papules evolve to dome-shaped, gray-brown, hyperkeratotic growths with black dots on the service

Verruca vulgaris (Common)

Tinea

Tinea incognito when the clinical appearance has changed because of inappropriate treatment

Tinea versicolor

• Chronic yeast overgrowth in skin increased by heat

• Pityrosporium obiculare

• Not contagious• white, brown, pink

scaling oval patches on trunk

Candidiasis

Oral called thrush in infantsAdult: check for diabetes, depressed immunity, elderly and patients with cancerProlonged corticosteroids or broad spectrum antibioticsCandidiasis of large skin folds

Warm and moist areas (under breasts, groin and armpits, diapers)

Dyshidrotic EczemaDyshidrotic Eczema

Symmetric, vesicular hand and foot dermatitis

Preceded by moderate to severe itching

Palms may be red and sweating

Aggravated by contact with irritants such as water, detergents and solvents

High incidence of nickel allergy

Vitiligo

• Pigment cells are destroyed resulting in white patches

• Associated with increased risk of autoimmune disorders (thyroid, pernicious anemia, Addison’s, and alopecia areata)

Vitiligo