Therapy
Dermatologic treatment usually involves the use of topical therapy, which is a discipline unto itself. This form of treatment was primarily an art until about 20 years ago. Since then science has begun to unravel the biology of the epidermis, making it a more scientific process. Much of topical therapy is simply not written down and it is more complicated than the old bromide, If it's wet, dry it if it's dry, wet it. This discussion will cover some basic principles of topical therapy, but is by...
Therapy Vsd
Elimination of offending medications that suppress clotting and platelet function will reduce or temporarily eliminate symptoms. Reversal of corticosteroid-induced fragility will also occur, but more slowly and not as completely. Theoretically, topical 0.1 tretinoin cream applied over a prolonged period and combined with complete solar avoidance could partially reverse the process. This treatment is a decision between patient and practitioner after a full discussion of the costs and effort...
Therapy Ybt
Pigmented nevi are removed for basically three reasons 1 elective cosmetic excision, 2 elective excision because of an inconvenient location or persistent but otherwise benign symptoms, or 3 nonelective removal for features suggesting possible malignant transformation. Techniques vary depending on the indication, location, type of lesion, and the patient's preference. This is accomplished by several techniques. Because of the elective nature of the procedure, the patient must be fully informed...
Introduction Nrt
Plants of the genus Toxicodendron are found throughout East Asia, North America, and South America. Five species common to North America cause more cases of allergic contact dermatitis than all other contact antigens combined. These species are known best by their common designations When these plants are bruised or injured, they emit a sap called urushiol, which contains a mixture of highly allergenic, cross-reacting catechols. Contact with this sap in sufficient quantity can induce immune...
Conditions That May Simulate Tinea
Tinea of the scalp may be confused with any scalp disorder that causes patchy alopecia, inflammation, or scale. The presence of hairs broken off a short distance above or right at the scalp surface should cause immediate suspicion. Occasionally TCa does not produce hair breakage. The noninfectious dermatidities seborrhea and psoriasis can both cause inflammation and scaling of the scalp, but do not cause patchy hair shedding. Both are more diffuse than TCa. When any inflammatory scalp condition...
Introduction Icu
The term nevus, used in its broadest sense, refers to any abnormality or irregularity attributed to heredity or embryonic development related to conception, gestation, or postnatal development. Within the discipline of dermatology, the term refers to a large number of congenital and acquired hamartomas of different tissue types, although it is used most often in the context of benign melanocytic neoplasms composed of pigment cells. Discussion will focus on the common mole or nevocellular nevus,...
Important Abbreviations Used In This Part Www
Acquired congenital pattern melanotic nevus nevi Large congenital melanotic nevus nevi Medium congenital melanotic nevus nevi Small congenital melanotic nevus nevi Superficial spreading malignant melanoma
Part II Papular Papulosquamous and PapuloVesicular Skin Lesions
Learn to internalize what you are observing It is easy to look at a skin rash but not really see it. Look for and think about each of the distinguishing characteristics of the lesion. IMPORTANT ABBREVIATIONS USED IN THIS PART
What should you tell the patient about the solar lentigines
Answer Widespread solar lentigines are the result of chronic sun exposure, and generally are not treated. The patient should be warned about a small increased lifetime risk of melanoma, and should be counseled regarding sun avoidance, protective clothing, and use of sunscreen. Monthly self-examination based on the ABCD Asymmetry, irregular Borders, variegated Coloration, large Diameter system should be advised along with yearly office follow-up and immediate follow-up for a changing lesion.
Macrodistribution Ixq
1. Classic Scalp, pressure points over extensor surface of joints, presacral and upper gluteal clefts, glans penis. Psoriasis may occur on any skin surface see Fig. 8 . Figure 8 Macrodistribution of psoriasis vulgaris. Figure 8 Macrodistribution of psoriasis vulgaris. 2. Inverse Creases and folds. An uncommon intertriginous form is referred to as inverse psoriasis. 3. Generalized erythrodermic Generalized red skin. Lesions tend to be symmetric from side to side and across the midline, even in...
Therapy Hmr
Several azole-group antifungal agents have sufficient antimicrobial activity to treat most cases of erythrasma. Clotrimazole, econazole, miconazole, oxiconazole, and tiocona-zole have all been demonstrated effective and each is available in cream base, which is the appropriate vehicle. Ointments cause maceration in intertriginous regions and gel or aerosol vehicles are inherently irritating in these tender areas. Medication should be applied in a thin layer BID for 10 to 14 days. Erythrasma...
Dermatologic Physical Exam Rid
The earliest primary histologic lesion of miliaria is a crystalline intraepidermal vesicle see Photo 38 , which evolves into a small erythematous papule see Photo 39 . With prolonged occlusion, pustules may occur see Photo 40 . Secondary infection may lead to frank impetiginization. Microdistribution Periporal surrounds sweat duct orifices . Examination with a magnifier will demonstrate that the interspersed hair follicle openings are spared see Fig. 10 . Macrodistribution Large numbers of...
Therapy Gfk
Victims should avoid any circumstance that provokes sweating, as this will exacerbate symptoms and reactivate the eruption. High ambient temperatures, especially with high humidity or while in tight occlusive clothing, will prolong the glandular plugging. Clothing should be light, loose, and absorbent to wick moisture away from the skin surface. Figure 10 Microdistribution of miliaria. Figure 10 Microdistribution of miliaria. The only measure ever shown to speed resolution of miliaria is...
Molluscum Contagiosum Dimple Warts
A 16-year-old male high school student presents with a large number of papular lesions of recent onset in the right thoracic and axillary region. There is a second grouping of similar lesions on the right knee. The patient is on the wrestling team, desires removal of the lesions, and was sent to you by his wrestling coach to find out if they might be contagious. You suspect this is molluscum contagiosum. 1. What are the primary lesions you would expect to find in molluscum contagiosum 2. What...
Dermatologic Physical Examination
The four components of the dermatologic physical examination are 1 primary lesions, 2 secondary lesions, 3 distribution, and 4 configuration. Because primary and secondary lesions are rather constant with most dermatitides, they should be relied on heavily to lead to the correct diagnosis. The two other basic components of the physical exam, distribution and configuration, are used for support and confirmation. Some skin disorders lack a distinct distribution or configuration. Occasionally,...
Indicated Supporting Diagnostic Data
Examination of the skin remains a discipline that relies heavily on the basic clinical skills of vision and touch. If this information is combined with the practitioner's knowledge of the disease process, the correct diagnosis can be determined with a minimum of expensive laboratory testing. The dermatologist usually orders labwork to confirm a diagnosis or to stage the disease process rather than using it to seek a diagnosis. After all, the disease process is evolving before your eyes. In...
Specific History
A 75-year-old white male presents at your office with a history of tenesmus and perirectal pain. He describes extension of pain onto the left posterior thigh. He also has been aware of developing skin discoloration and surface roughness over the area of pain. Moistness and weeping have been present over some of the skin lesions. 1. Why is it important to accurately establish the date of onset of the problem 2. Why is it important to elicit from this patient's history whether the onset was acute...