Dermatology Chart
| DISEASE | ETIOLOGY | SIGNS & SYMPTOMS | DIFFERENTIALS | DIAGNOSIS | TREATMENTS |
|---|---|---|---|---|---|
| Acne Vulgaris | Inflammation on the sebaceous glands of certain body areas. | Comedones (blackheads) Closed (whiteheads) | Folliculitis Rosacea Acne keloidalis nuchae | H&P | Mild Acne: topical antibiotics (clindamycin, erythromycin) Benzoyl peroxide gel Topical retinoids Moderate Acne: Oral Antibiotics (Minocycline) Dicycline Severe Acne: Isotretinon: a retinoid that inhibits sebaceous gland function -Tetragenic; need UPT/birth control -Night blindness has been report -Decrease tolerance to contact lens Goal is to AVOID SCARRING |
| Atopic Dermatitis | Can be caused by foods ( eggs, milk, soybeans, fish, wheat) Dust mites Skin dehydration Hormonal Infections Seasonal Wool clothes Emotional stress | Dry skin Pruritus is the main symptom The constant scratching leads to a vicious cycle of Itch---scratch---itch The rash is lichenification (hyperplasia of the skin)= may have a rubbery look | Psoriasis Irritant/ Allergic contact dermatitis | H&P Bacterial culture Blood cultures (increased IgE in serum) | Acute Topical antipruritic: Menthol/Camphor Wet dressing and Topical steroids Hydroxyzine PO QID for pruritus Oral antibiotics Dicloxacillin Erythromycin If there is a secondary infection give Bactrim Chronic Oral Antihistamine Topical ointments (containing H1 and H2 blockers ) DOXEPIN (treats pain & itchy skin if its not controlled by hydroxyzine) Hydration (oil baths, oatmeal powder baths, |
| Contact Dermatitis (Allergic) | Exposure to poison oak/ivy, leaves, flowers that contain milky sap, cashew nut, painter’s ink, mango rind, Furniture lacquer Can also present on the skin from something they may have ate | Well demarcated patches of erythema. Sites of direct contact can have characteristic linear lesions pruritic lesions Secondary infection due to pruritis Sleep deprivation due to pruritus | Atopic dermatitis Eczema | H&P | Topical Steroids If the patient has blisters Oral Prednisone If infection suspected, give Bactrim |
| Contact Dermatitis (Irritant) | Exposure of the skin to chemical or other physical agents which are capable of irritating the skin -cleaning agents, occupational exposures Those at Risk painters, metal workers, mechanical engineers, construction workers, fishermen | Itching Burning Stinging | Atopic dermatitis Eczema | H&P | Prevention Wear protective clothing, goggles, shields, gloves If contact occurs, wash with water or neutralizing solution Barrier creams Medication Topical Corticosteroids Oral steroids Prednisone (taper over 2 week period) If Severe Corticosteroids IM |
| Fungal Infections Manuum: hands Facialis: face Corporis: body Cruris: groin (“jock itch”) Pedis: feet (athlete’s foot) Unguium: nails | Caused by a fungal infection | Superficial fungal infection with varying presentation depending on site | Atopic dermatitis Pityriasis versicolor Lichen simplex chronicus | Lab finding Microscopic exam of skin scrapings or hair (hypae) Wood’s lamp- affected hair takes on a greenish appearance under the lamp Fungal cultures (from fungal culture plate) | Topical antifungals are effective for fungal infections of the skin but not for those of hair or nails Oral antifungal agents are required for fungal infections of hair or nails. Be sure to monitor liver function studies when giving an antifungal agents. |
| Psoriasis | Hereditary disorder Caused by the shortening of the cell cycle for 311 hours to 36 hours, which results in 28 times the normal production of epidermal cells. T cells present in the present in the psoriasis lesions. | Salmon pink papules and plaques, sharply marginated silvery-white scale. Removal of scales results in the appearance of minute blood droplets | SLE Eczema Seborrheic dermatitis | H&P | Avoid trauma to the skin Topical steroids Steriod-impregnated tape (Cordan tape)-useful for small plaque Tramcinolone injections-small plaque Vitamin D cream Tazarotene cream (topical retinoid) Prolonged periods of topical leads to skin |
| Rosacea | Increased reactivity of capillaries to heat, leading to flushing and ultimately to telangiectasia -alcohol , hot foods, spicy foods | Symmetrical localization on the face( cheeks, chin, forehead, nose) | Contact Dermatitis Systemic lupus erythematosus | H&P | Prevention Reduce or eliminate alcoholic or hot beverages Medication Metronidazole (Flagyl) gel or cream If topical treatment fails, add oral antibiotics Tetracycline, Minocycline, or Doxycycline |
| Seborrheic Dermatitis “cradle cap” | A skin condition that cause mainly in the scalp, face, and upper chest and back Affects oily areas of the body | Yellowish-red or gray white skin, often with greasy or white, dry scaling macules and papules of varying size. Sticky crusts and fissures are common. On the scalp there is mostly marking scaling {“dandruff”} | Psoriasis SLE Acne Vulgaris | H&P Skin biopsy (confirms SD, only needed when in serious doubt) | Topical steroid OTC shampoos containing selenium sulfide Ketoconazole shampoo (on scalp, face, and chest) OTC tar shampoo UV radiation This is a chronic disorder with recurrences and remission In infants remove the crust first with warm olive oil compresses followed by baby shampoo, 2 % ketoconazole shampoo and application of 1 -2.5% hydrocortisone cream, 2% ketoconazole cream |
| Skin Cancer Basal cell carcinoma | Most common type of skin cancer. Caused by heavy sun exposure in youth years | Skin lesion: Papule or nodule translucent or “pearly; surface is usually smooth & glistening; hard & firm to palpation; usually an isolated, single lesion. Danger sites: naolabial area, around the eyes, in the ear canal, on the scalp | Squamous cell carcinoma | Skin exam Biopsy | Surgery Electrocautery (leaves scars) Cryosurgery; not in the danger sites Radiotherapy; if surgery may cause disfigurement Topical 5 FU |
| Skin Cancer Squamous cell | Most common cause of ultraviolet radiation (sun exposure) | Ulcerated lesion indurated macule or papule on the face,cheeks, nose, lips, tips of the ear, scalp in bald men, hands, forearms. Usually erythematous, yellow in color, hard to palpation; usually isolated but may be multiple; in sun-exposed | Basal cell carcinoma Melanoma | H&P Biopsy | Surgery Cryotherapy (leaves a white spot that remains for life) 90% remission rate after therapy If the patient has a family history, they should see a Dermatologist yearly. |
| Skin Cancer Melanoma | Changing mole (flattened papule becoming a plaque and then developing one or more nodules. May bleed, itching or burning Asymmetrical, irregular borders Haphazard-uneven, no-order Isolated, single lesions #1 site is back, then legs, under feet | H&P Biopsy | Teach to re-apply sunscreen every 2 hours while in the sun. Chemotherapy Radiation |