skin cancer
risk factors
RF: fair complexion, h/o blistering sunburn as a child, increased sun exposure, fhx.
actinic keratosis
tx: cryotherapy for isolated lesions( SE: hypo pigmentation)
- 5-fu- Efudex- applied bid and make skin red and angry and apply until lesions crust over
squamous cell carcinoma
dx: biopsy
tx: excision, treat thoroughly with Mohls’ surgery to check margins
basal cell carcinoma
slowly enlarging nodule with central depression or ulceration with surface telangiectasis
mets rare
tx: same as squamous cell
Melanoma
seborrheic keratoses
benign, age-related plaques
-beige to brown to black
no tx needed
-waxy appearance
tx: curettage and freezing
- sudden eruption –> underlying malignancy
atopic dermatitis
pruritic, leads to scratch/itch cycle
– seen with fix with asthma or allergy
s/s: denny’s lines -inftraorbital darkness
tx: avoid triggers, topical steroids, protonic, elderly
systemic steroids only for extensive dz,
oral histamines.
contact dermatitis
irritant- chemical exposure
allergic: poison ivy and nickle
- confined to area of contact and later can spread beyond
tx: avoid irritants
-topical steroids
-burrow solution for wheeling solution
- tacrolimus
severe > 20% - use oral steroids
diaper dermatitis
d/t prolonged exposure to urine/ feces
- get with yeast
nummular eczema
coin-like lesions on LE
seen in older or younger adults
-older male/ETOH abuse
tx: hydration and systemic anti-histamines
- topical steroids
- phototherapy
perioral dermatitis
severe: oral tetracycline, doxycycline, minoclycline
taper meds
seborrheic dermatitis
tx: cleaning the area
- shampoos with selenium sulfide, ketoconazole,
- mild topical steroids
- maintenance tx required
stasis dermatitis
inflam reaction to leaky serum from varicose veins
brownish-purplish skin with weepiness
tx: improve blood flow to area
avoid neomycin ( neosporin)
wear compression stocking and wrap
-burrows solution
-abx for infection
dyshidrosis
tx:topical steroids
burrows solution
only systemic steroids for systemic cases
lichen simplex chronicus
lichen planus
can be caused by drugs
pityriasis rosea
benign, seen in young adults
drug eruptions
tx: d/c drug
- supportive care
fixed drug eruption- reintroduce drug and manifest in the same exact way and place
erythema multiforme
target lesions
Steven Johns and TEN ( toxic epidural necrolysis)
fever, HA, arthralgia, -confluent, asymmetric area of dusky erythema - shedding full sheets of skin -mm affected - taken to burn unit -causes: abx, anticonvulsant, NSAIDS - life-threatening Nikolksy sign- sloughing of skin and shear epidermis
tx:
bulls pemphigoid
pruritic tense blisters
tx: months--> years topical potent steroids -oral steroids dapsone negative Nikolsky
immune suppression
psoriasis
chronic, papulosquamous dz, genetic
silvery scales on bright red
Ausptiz sign, Koebner’s phenom a
worse in winter
tx; depend on extent of sz localized- topical steroids dovonex duodenum tazorac tar based products avoid stress and ETOH
generalized dx: phototherapy
methotrexate
oral retinoids
tine corporis
mild contagious
tx; topical anti fungal( azoles)
systemic: itraconazole
tine pedis
seen in young adult males
hype on KOH exam
management: prevention- use show shoes
dry, scaly- anti fungal txt
macerate: burrow wet dressing