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NPLEX Combination Review Dermatology - 2 Paul S. Anderson, ND Medical Board Review Services Copyright MBRS.

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Presentation on theme: "NPLEX Combination Review Dermatology - 2 Paul S. Anderson, ND Medical Board Review Services Copyright MBRS."— Presentation transcript:

1 NPLEX Combination Review Dermatology - 2 Paul S. Anderson, ND Medical Board Review Services Copyright MBRS

2 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.

3 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

4 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)

5 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

6 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

7 Pilar cysts (wen) On scalp, subcutaneous movable nodule Have firmer keratin then EIC/ no smell Usually, pop out during surgery

8 Discoid Lupus Erythematosus Chronic recurrent autoimmune disorder primarily affecting the skin. Unknown etiology; IgG and IgM deposited in skin Exposure to sunlight frequently precedes lesions More common in females (10x), onset usually in 30’s


10 Discoid Lupus Erythematosus Clinical Lesions are rather distinctive, but sometimes resemble those of SLE Lab No anemia, normal ESR, ANA absent or low, anti- DNA absent Differential Dx SLE, rosacea, seborrhea, photosensitivity dermatitis

11 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

12 Genital Warts (HPV)

13 Types of Hemangiomas Capillary “Strawberry” Superficial angiomatous nevi Affect the blood vessels in uppermost layers of the skin Cavernous Subcutaneous angiomatous nevi More deeply set in the dermis and subcutis

14 Hemangiomas in Adulthood Cherry Angioma Occur 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.

15 Cherry Hemangioma

16 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

17 Impetigo

18 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

19 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

20 Herpes Simplex

21 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

22 Herpes Zoster (Shingles)

23 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

24 Molluscum contagiousum

25 Venous Ulcers

26 Granuloma annulare Characterized by a ring of small, firm, flesh-colored or red papules Lateral or dorsal surfaces of hands and feet Begins with asymptomatic, flesh-colored papule that undergoes central involution Over months size increases up to 5 cm Spontaneous involution or lasts for years Histology shows collagen degeneration Treatment: Intralesional injections with triamcinolone


28 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

29 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

30 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)

31 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

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