1. Primary Care Derm

2. Seborrheic Keratoses Stuck on, white, tan, brown, black papules
Smooth with pearls
Rough, cracked
Mimic melanoma
In darker skin on the face called dermatosis papulosis nigricans
Can treat with LN2, currette or active nonintervention

3. Seb Ker

4. Cherry Angiomas

5. Pyogenic Granuloma
Lobular Capillary Hemangioma
Band-aid sign

6. Venous Lakes

7. Lentigo

8. Poikiloderma of Civatte

9. Cutis Rhomboidalis Nuchae

10. Dermatofibroma Seen more commonly females on the leg
Dimple sign- retraction with palpation (feels like pea under skin) benign

11. Epidermal Inclusion Cyst
Soft mobile masses, sometimes with punctum
Excision (need to remove cyst wall) is the only way to get rid of them
If inflamed, can inject with steroid

12. Basal Cell Carcinoma Risk Factor for BCC: inability to tan
Different types of BCC: nodular, superficial, micronodular, infiltr, morpheaform
Head- most common site for BCC
Needs surgical excision with about 3 mm margins, send to derm or MOHs

13. BCC

14. Actinic Keratoses Premalignant
Can process to SCC (3-8% if left untreated)
Distinguish two by biopsy
Treat with LN2

15. Actinic Keratoses
Scaly erythematous macules

16. Squamous Cell Carcinoma
Cumulative sun exposure
Found on scalp, hands, ears, lips
Need to biopsy
Treat with surgical excision 5 mm margins, Send to derm or MOHs

17. Squamous Cell Carcinoma
Keratoacanthoma- subtype that evolves rapidly

18. Nevi
Junctional nevi- melanocytes in the epidermis only, flat pigmented or flesh colored macules
Congenital nevi are nevi present at birth, they tend to be larger and darker

19. Nevi Compound Nevus- melanocytes in the epidermis&dermis
Intradermal Nevus- melanocytes in dermis only

20. Dysplastic Nevi
Diagnosis made by pathology
Melanocystes look atypical

21. Melanoma Superfical spreading- most common type
Greatest relative risk: personal h/o atypical moles, family h/o melanoma, > moles

22. Melanoma If thinking melanoma, do excisional bx
Treatment for melanoma is excision (margins depend of depth of melanoma)

23. Paget’s Disease On breast, associated with adenocarcinoma
Can look like nipple ezcema

24. Inflammatory

25. Acne Mild, noninflamm acne (open and closed comedones)
Treat with benzoyl peroxide wash qam, clindamycin qam, and retina qpm
Advise pt acne will get worse 4-6 wks, may take up to 3 mos for improvement (do not back earlier than 3mos)

26. Acne (moderate to severe)
Typically requires oral antibiotic (doxy 100mg BID or tcn 500 mg bid, then minocin 100 mg bid) or accutane
In addition to topical clindamycin, retina, benzoy peroxide wash

27. Cystic Acne

28. Rosacea
Treat with metrocream bid, azelaic acid bid, or PO tetracycline
No good treatment to get out redness, can use laser therapy
Avoid triggers

29. Rosacea

30. Seborrheic Dermatitis
Treat with nizoral cream bid, nizoral shampoo as face wash, sometimes low dose top steroid (desonide)
Typically seen in adult men

31. Seb Derm

32. Ezcema
Atopic dermatitis- typically occurs in children, improves as adults
Treat with moisturizers (and lots of them eucerin, aquaphor, cetaphil), cetaphil soap in shower, top steroids (tac ointment bid for 3 wks then off for 1 wk), oral antihistamines (zyrtec qam and atarax qpm)
Sometimes use cyclocort lotion or dermasmoothe solution

33. Ezcema

34. Dyshidrotic Ezcema Pomphylox Ezcema on the hands/feet in adults
Develop little blisters/peeling/erythema
Confused with tinea or pustular psoriasis (also check KOH)
Treat with moisturizer eucerin and strong topical steroid (lidex or clobetasol), limit hand washing (use cetaphil soap)

35. Hand Ezcema

36. Nickel Most common allergen Commonly seen in kids w atopic derm
Belt buckles, pants buttons, watches, jewelry
Pt needs to stop wearing product, can sew patch over pants button or paint clear nailpolish
Treat with topical steroid (tac or lidex bid for several weeks)

37. Psoriasis Seen in males/females, all ages
Auspitz sign- pinpoint bleeding when removing scale
Typically have papule and plaques with silvery scale
Subtypes include guttate, palmoplantar, pustular, inverse

38. Psoriasis

39. Psoriasis

40. Inverse Psoriasis

41. Psoriasis
Treatment: if guttate psoriasis- check for strep and if positive treat
Moisturizer to areas, topical steroid (lidex) alternating with dovonex, light therapy

42. Lichen Planus
Pruritic, Planar, Polygonal, Purple Papules

43. Lichen Planus Typically around joints (wrists, ankles)
No great treatment, topical steroids provide some relief, if severe may need oral immunosuppresants

44. Acne Keloidalis Nucha Occurs more commonly in darker skinned pts
Bumps on the back of the neck, can develop into keloids
Treat with doxy for sev mos, top clindamycin, and clobetasol soln

46. Pseudofolliculitis Barbae
Treat with retina, top antibiotics, hydroquinone, stop shaving, laser (laser works the best)
Can develop scarrring and keloids from inflammation

47. Acanthosis Nigricans
Seen in obesity, diabetes, pineal tumors, idiopathic ( overweight teenage girls)
No treatment

48. Hidradenitis Suppurativa
Double comedones, cysts, sinus tracts
Treat with oral and topical antibiotics, hibiclens/benzoyl peroxide to wash, sometimes accutane, surgery

49. Capillaritis
Schamberg’s Dz
Pigmented purpura
Cayenne pepper

50. Stasis Dermatitis Older individuals Blood supply is compromised
Treat with exercise, compressive stockings, emollients
Many times misdiagnosed as cellulitis refractory to antibiotics

51. Stasis Dermatitis

52. Lipodermatosclerosis
Women, lower 1/3 of lower legs c high BMI
Mimic cellulitis-warm and red
Woody induration from fibrosis of subq fat
Venous Insuff

53. Miliaria Retention of sweat as a result of occlusion of eccrine ducts
Hot, humid climates
Bundled children, bedridden patients

54. Erythema Ab Igne

55. Sarcoid Diagnosis by biopsy- will have granulomas
Erythema nodosum is a nonspecific finding seen in sarcoid
Can have lung involvement

56. Erythema Nodosum Looks like bruising on lower legs
More commonly seen in women
Seen with URI, Sulfa drugs, sarcoid, pregnancy, infection, estrogen
Treat with rest, NSAID

57. Alopecia Areata
Typically treat with intralesional steroid injections (start at 10 mg/cc ILK, inject 1-3 cc every 4-6 wks)
Can resolve without treatment
Can be seen with autoimmune thyroid dz or vitiligo

58. Pityriasis Rosea Viral infection
Herald patch- first lesion typically larger
Can have in christmas tree distr on back
Treat with emycin for 14 days, if itchy- treat itch

59. Scabies
Need to do scabies prep (seeing burrows in skin is not definitive)
Found on finger webspaces, wrist, waist, penis
Treat with elimite, kwell (lindane- can cause neurotoxic), (do not treat with Nix), ivermectin
                                    

61. Molluscum Treatment includes currettage, aldara, cryosurgery
Umbilicated papules
Virus- if left untreated with resolve in about 1 yr
In adults seen in pubic area as STD

63. Herpes (HSV) Virus, it diagnosed early can be treated with acyclovir
Causes lip and genital lesions
In pts with ezcema, can be generalized
Associated with erythema multiforme

65. Erythema Multiforme Targetoid lesions on body
Can occur after HSV, mycoplasma pneumonia
Treat is symptomatic, top steroids, if itchy antihistamines
Treat HSV with acyclovir

66. Herpes Zoster Grouped vesicles on an erythematous base
To treat herpes zoster: acyclovir (decreases neuralgia if given in first 48 hrs), narcotics, topical for itching

67. Verruca Virus- will go away in 3-7 yrs if left untreated
Use destructive methods to treat warts: paring down, LN2, aldara, podocon, cantharone
Flat warts more typically on face

68. Genital Warts

69. Staph Aureus Most common offender of skin infections
Causes carbuncles, treat with warm compresses, I&D with iodoform gauze, bactroban, sometimes oral antibiotics
Causes bullous impetigo (get honey colored crust)
Community acquired Staph common in Iraq, treat c clinda or bactrim, bactroban to nares/fingernails, hibiclens

70. Impetigo

71. Cellulitis Area is erythematous, tender to palpation, warm to touch
Diff: DVT, Erythema Nodosum, Fixed Drug, and Stasis Dermatitis
Treat with oral antibiotics (staph/strep coverage)

72. Tinea Versicolor
Caused by Pityrosporon orbiculare, ovale, and globalis
Treat with oral and topical ketoconazole
Fluorescence pale white/yellow with wood’s lamp

73. Tinea
Tinea pedis can look like dyshidrotic ezcema, look for maceration btwn toes
Most commonly caused by T. rubrum (which is cause of many cutaneous tinea infections)
If extensive, may need to treat with oral lamisil (terbinafine)