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Line 92: − − =Missed Concepts= − *Lichen Planus diagnosis is '''clinical, but a punch biopsy of prominent lesion can be sent to confirm''', presents with purple, polygonal, pruritic, papules and plaques, sometimes with '''Wickham striae'''. − *Pityriasis rosea has the classic herald patch and Christmas tree pattern, ddx includes secondary syphilis (involves palms and soles), tinea corporis, nummular eczema, psoriasis − *Hair loss: ddx male pattern baldness, tinea capitis (scaling and inflammation), '''alopecia areata''' (well demarcated, smooth, circular) − *Ichthyosis vulgaris is a familial dry fish-like scaly rash, worse in winter and fall, predominantly on the extensor surfaces of the legs. Treat with long baths to remove scales and urea-containing lotions − *Keloids are treated with '''intralesional glucocorticoids''' − *Seborrheic dermatitis, presenting as '''erythematous, pruritic plaques with greasy scale on the scalp, central face, and ears''' is associated with Parkinson disease and HIV and is treated with selenium sulfide or ketoconazole shampoos.
→Dermatophytes
=Missed Concepts=
*Lichen Planus diagnosis is '''clinical, but a punch biopsy of prominent lesion can be sent to confirm''', presents with purple, polygonal, pruritic, papules and plaques, sometimes with '''Wickham striae'''.
*Pityriasis rosea has the classic herald patch and Christmas tree pattern, ddx includes secondary syphilis (involves palms and soles), tinea corporis, nummular eczema, psoriasis
*Hair loss: ddx male pattern baldness, tinea capitis (scaling and inflammation), '''alopecia areata''' (well demarcated, smooth, circular)
*Ichthyosis vulgaris is a familial dry fish-like scaly rash, worse in winter and fall, predominantly on the extensor surfaces of the legs. Treat with long baths to remove scales and urea-containing lotions
*Keloids are treated with '''intralesional glucocorticoids'''
*Seborrheic dermatitis, presenting as '''erythematous, pruritic plaques with greasy scale on the scalp, central face, and ears''' is associated with Parkinson disease and HIV and is treated with selenium sulfide or ketoconazole shampoos.
*Axillary skin tags are associated with obesity, diabetes, insulin resistance, and metabolic syndrome.
*Desmoid tumors are slowly growing and locally recurring benign tumors.
*Cherry angiomas are benign and don't require further workup.
=Derm Terms=
=Derm Terms=
*Macule/Patch, Papule/Plaque, Nodule/Tumor (2 cm cutoff), Vesicle/Bullae/Pustule
*Macule/Patch, Papule/Plaque, Nodule/Tumor (2 cm cutoff), Vesicle/Bullae/Pustule
=Contact Dermatitis=
=Contact Dermatitis=
*H&P: Can have a clear border (allergic, type IV hypersensitivity, e.g '''nickel''', poison ivy) or not (irritant, e.g. nickel, makeup, detergents).
*H&P: Can have a clear border (allergic, type IV hypersensitivity, e.g '''nickel''', poison ivy) or not (irritant, e.g. nickel, makeup, detergents).
*Dx: Erythematous, pruritic, papules vesicles, sometimes with erosions, crusting, excoriations, and lichenification. Patch testing.
*Dx: Erythematous, pruritic, papules and vesicles, sometimes with erosions, crusting, excoriations, and lichenification. Patch testing.
*Tx: Avoid causative agents, cold compresses and oatmeal baths ± short course of topical steroids. For severe and widespread cases short course of oral steroids.
*Tx: Avoid causative agents, cold compresses and oatmeal baths ± short course of topical steroids. For severe and widespread cases short course of oral steroids.
=Psoriasis=
=Psoriasis=
*H&P: Immune mediated, probably genetic. Associated with arthritis of the DIP joints.
*H&P: Immune mediated, probably genetic. Associated with arthritis of the DIP joints.
*Dx: Well demarcated pink plaques on extensor surfaces, scalp, and gluteal cleft. Nails can have pitting and onycholysis (separation from nail bed).
*Dx: Well demarcated pink plaques with silvery scale on extensor surfaces, scalp, and gluteal cleft. Nails can have pitting and onycholysis (separation from nail bed).
*Tx: Topical steroids ('''low potency for face/intertriginous areas, high potency for extensor surfaces'''), vitamin D analogs, retinoids; For generalized (>30% of the body), use UVB or PUVA; severe cases ('''e.g. psoriatic arthritis''') warrant methotrexate, anti-TNF agents.
*Tx: Topical steroids ('''low potency for face/intertriginous areas, high potency for extensor surfaces'''), vitamin D analogs, retinoids; For generalized (>30% of the body), use UVB or PUVA; severe cases ('''e.g. psoriatic arthritis''') warrant methotrexate, anti-TNF agents.
=Rosacea=
=Rosacea=
*H&P: Fair skin, light-eyed people, with history of flushing. Erythema and inflamed papules on face, nose, forehead, chin without comedones, rhinophyma (enlarged irregularly textured nose) appears late. Conjunctival injection, eyelid telangiectasias, and dry eyes are also common.
*H&P: Fair skin, light-eyed people, with history of flushing. Erythema and inflamed papules on face, nose, forehead, chin '''without comedones''', rhinophyma (enlarged irregularly textured nose) appears late. Conjunctival injection, eyelid telangiectasias, and dry eyes are also common.
*Dx: Clinical. Ddx includes acne.
*Dx: Clinical. Ddx includes acne.
*Tx: Topical metronidazole; oral doxycycline or minocycline; clonidine for flushing.
*Tx: Topical metronidazole; '''oral doxycycline or minocycline'''; clonidine for flushing.
=Erythema Multiforme=
=Erythema Multiforme=
*H&P: Pruritic, well demarcated, central clearing.
*H&P: Pruritic, well demarcated, central clearing.
*Dx: Clinical, or with KOH prep. '''Tinea capitis is erythematous, scaly, pruritic, and associated with hair loss'''
*Dx: Clinical, or with KOH prep. '''Tinea capitis is erythematous, scaly, pruritic, and associated with hair loss'''
*Tx: Oral meds for onychomycosis (terbinafine) and tinea capitis (griseofulvin, itraconazole). Topical azaleas, terbinafine, or griseofulvin for others. Selenium sulfide for tinea versicolor.
*Tx: Oral meds for onychomycosis (terbinafine) and tinea capitis (griseofulvin, itraconazole). Topical azoles, terbinafine, or griseofulvin for others. Selenium sulfide for tinea versicolor.
=Basal Cell Carcinoma=
=Basal Cell Carcinoma=
*Dx: ABCDEs for moles. Skin biopsy shows melanocytes with cellular atypia.
*Dx: ABCDEs for moles. Skin biopsy shows melanocytes with cellular atypia.
*Tx: Surgical excision.
*Tx: Surgical excision.