General DermatologyGeneral Dermatology - VCU SOM · “Cradle cap” as infant ... S perficial F ngal InfectionsSuperficial Fungal Infections ... Mycosis fungoides Mycosis fungoides

General DermatologyGeneral DermatologyGeneral DermatologyGeneral Dermatology

Julia R. Nunley, MD, FAAD, FACPJulia R. Nunley, MD, FAAD, FACPProfessorProfessor

iiProgram DirectorProgram DirectorDepartment of DermatologyDepartment of Dermatology

General Dermatology ObjectivesGeneral Dermatology ObjectivesGeneral Dermatology ObjectivesGeneral Dermatology Objectives Learn to recognize some common dermatologic Learn to recognize some common dermatologic

di d d i d i h idi d d i d i h idisorders and some associated with systemic disorders and some associated with systemic diseasesdiseasesL h i i b iL h i i b i Learn the causative organism or basic Learn the causative organism or basic pathogenesis of these conditionspathogenesis of these conditionsL di i li i l l bL di i li i l l b Learn some diagnostic clinical or laboratory Learn some diagnostic clinical or laboratory clues to aid in diagnosisclues to aid in diagnosisL i kiL i ki Learn to recognize common skin cancersLearn to recognize common skin cancers

Learn the risk factors, prognostic factors and Learn the risk factors, prognostic factors and li i l l lli i l l lclinical clues to melanomaclinical clues to melanoma

General DermatologGeneral DermatologGeneral DermatologyGeneral Dermatology

Papulosquamous disordersPapulosquamous disorders Papulosquamous disordersPapulosquamous disorders InfectionsInfections Blistering disordersBlistering disorders Acneiform eruptionsAcneiform eruptionspp Disorders of pigmentationDisorders of pigmentation Benign tumorsBenign tumors Benign tumorsBenign tumors Malignant tumorsMalignant tumors Urticaria / VasculitisUrticaria / Vasculitis

Papulosquamous DisordersPapulosquamous Disorders

Primary skin disorders that effect the Primary skin disorders that effect the ith liith lisquamous epitheliumsquamous epithelium

EczemaEczemaPsoriasisPsoriasisSeborrheic dermatitisSeborrheic dermatitisPityriasis roseaPityriasis rosea

Question 1Question 1This postoperative rash is This postoperative rash is most like a form of which most like a form of which

AA EczemaEczema

of the following?of the following?

A.A. EczemaEczemaB.B. Seborrheic dermatitisSeborrheic dermatitisC.C. PsoriasisPsoriasisD.D. Tinea corporisTinea corporisE.E. Tinea versicolorTinea versicolor

Question 2Question 2Question 2 Question 2

Which of the papulosquamous disorders is Which of the papulosquamous disorders is p p qp p qassociated with the development of a seroassociated with the development of a sero--negative rheumatoid arthritisnegative rheumatoid arthritis--type of arthritis?type of arthritis?

A.A. EzcemaEzcema

gg ypyp

B.B. PsoriasisPsoriasisCC Seborrheic dermatitisSeborrheic dermatitisC.C. Seborrheic dermatitisSeborrheic dermatitisD.D. Pityriasis roseaPityriasis rosea

EczemaEczemaEczemaEczema

Inflammatory condition of the epidermisInflammatory condition of the epidermis Inflammatory condition of the epidermisInflammatory condition of the epidermis AcuteAcute

Weeping draining frequently warm and redWeeping draining frequently warm and red Weeping, draining, frequently warm and redWeeping, draining, frequently warm and red

ChronicChronic Dry scaly frequently hyperkeratoticDry scaly frequently hyperkeratotic Dry, scaly, frequently hyperkeratoticDry, scaly, frequently hyperkeratotic

Wide variety of causesWide variety of causes IntrinsicIntrinsic IntrinsicIntrinsic

Atopic dermatitis, dyshidrosis Atopic dermatitis, dyshidrosis

ExtrinsicExtrinsic ExtrinsicExtrinsic Allergic or irritant contact dermatitisAllergic or irritant contact dermatitis

Acute Eczema Acute Eczema

Acute EczemaAcute Eczema –– Contact DermatitisContact DermatitisAcute Eczema Acute Eczema Contact DermatitisContact Dermatitis

Acute EczemaAcute Eczema –– Poison IvyPoison IvyAcute Eczema Acute Eczema Poison IvyPoison Ivy

Acute EczemaAcute Eczema -- SpongiosisSpongiosisAcute Eczema Acute Eczema SpongiosisSpongiosis

Chronic EczemaChronic EczemaChronic EczemaChronic Eczema



Ac te EczemAc te Eczem Atopic Derm titisAtopic Derm titisAcute Eczema Acute Eczema –– Atopic DermatitisAtopic Dermatitis

Chronic Eczema Chronic Eczema –– Nummular Nummular Eczema Eczema (Nickle Allergy)(Nickle Allergy)


Psoriasis VulgarisPsoriasis VulgarisPsoriasis VulgarisPsoriasis Vulgaris

Heritable primary skin disorderHeritable primary skin disorderp yp y Affects 1Affects 1--2% of general population2% of general population Multifactorial inheritanceMultifactorial inheritance

Characteristic clinical presentationCharacteristic clinical presentation Typical lesionTypical lesionTypical lesionTypical lesion

Well demarcated plaques with silveryWell demarcated plaques with silvery--white scalewhite scale

Typical distributionTypical distributionypyp Knees, elbows, gluteal cleft, scalpKnees, elbows, gluteal cleft, scalp Nail changesNail changes

Associated with seroAssociated with sero--negative arthritisnegative arthritis

PsoriasisPsoriasisPsoriasisPsoriasis



PsoriasisPsoriasis





PsoriasisPsoriasis –– KoebnerizationKoebnerizationPsoriasis Psoriasis KoebnerizationKoebnerization

PsoriasisPsoriasis –– Nail ChangesNail ChangesPsoriasis Psoriasis –– Nail ChangesNail Changes

Psoriatic ArthritisPsoriatic ArthritisPsoriatic ArthritisPsoriatic Arthritis

Seborrheic DermatitisSeborrheic DermatitisSeborrheic DermatitisSeborrheic Dermatitis

AKA d d ffAKA d d ff AKA: dandruffAKA: dandruff Chronic cutaneous disorder involving sites of Chronic cutaneous disorder involving sites of

sebaceous gland activitysebaceous gland activity “Cradle cap” as infant“Cradle cap” as infant 15% of the population affected15% of the population affected

Thought to be due to a hypersensitivity reaction Thought to be due to a hypersensitivity reaction g yp yg yp yto to pityrosporumpityrosporum (Malassezia)(Malassezia)

More common in HIV and CNS diseaseMore common in HIV and CNS disease More common in HIV and CNS diseaseMore common in HIV and CNS disease



S b h i D i iS b h i D i iSeborrheic Dermatitis Seborrheic Dermatitis

Cradle CapCradle CapCradle CapCradle Cap

Pityriasis RoseaPityriasis RoseaPityriasis RoseaPityriasis Rosea

C hC h Common exanthemCommon exanthem More common in spring and fallMore common in spring and fall Unknown etiologyUnknown etiology

Classic clinical presentationClassic clinical presentation Herald patchHerald patch “Christmas tree” pattern“Christmas tree” patternpp

Secondary syphilis may mimic this disorderSecondary syphilis may mimic this disorder


Pityriasis RoseaPityriasis Rosea


Question 3Question 3Question 3Question 3A positive Tzanck test confirms the diagnosis A positive Tzanck test confirms the diagnosis

f hi h f h f ll i i f i ?f hi h f h f ll i i f i ?

M ll iM ll i

of which of the following infections?of which of the following infections?

A.A. Molluscum contagiosumMolluscum contagiosumB.B. DermatophytosisDermatophytosisC.C. ImpetigoImpetigoD.D. ErysipelasErysipelasD.D. ErysipelasErysipelasE.E. HerpesHerpes

S perficial F ngal InfectionsS perficial F ngal InfectionsSuperficial Fungal InfectionsSuperficial Fungal Infections

DermatophytesDermatophytes 3 common genera3 common genera

Microsporum, Trichophyton, EpidermophytonMicrosporum, Trichophyton, Epidermophyton

YeastsYeasts PityrosporumPityrosporum (Malassezia)(Malassezia) CandidiasisCandidiasis

Diagnosis frequently made by KOHDiagnosis frequently made by KOHDiagnosis frequently made by KOHDiagnosis frequently made by KOH


Dermatophytes Dermatophytes -- AKA: “ring worm”AKA: “ring worm” Thrive on nonThrive on non--viable keratinized structures: viable keratinized structures:

stratum corneum, hair, nails stratum corneum, hair, nails Tinea corporis Tinea corporis ---- bodybody Tinea capitis Tinea capitis ---- headhead Trichophyton tonsuransTrichophyton tonsurans Tinea pedis Tinea pedis ---- feetfeet Trichophyton rubrumTrichophyton rubrum

Ti iTi i ii Tinea cruris Tinea cruris ---- groingroin Tinea unguium (onychomycosis) Tinea unguium (onychomycosis) ---- nailsnails

KOH of scale shows branching hyphaeKOH of scale shows branching hyphae KOH of scale shows branching hyphaeKOH of scale shows branching hyphae


YY YeastsYeasts PityrosporumPityrosporum (Malassezia)(Malassezia)

Tinea versicolor Tinea versicolor ---- most commonly on torsomost commonly on torso More common in humid environmentsMore common in humid environments KOH: short nonKOH: short non branching hyphae and sporesbranching hyphae and spores KOH: short nonKOH: short non--branching hyphae and sporesbranching hyphae and spores

Candidiasis: Candidiasis: commonly due to commonly due to candida albicanscandida albicans Affects warm moist placesAffects warm moist places Affects warm, moist placesAffects warm, moist places Many predisposing factorsMany predisposing factors

Diabetes, antibiotics, immunosuppressionDiabetes, antibiotics, immunosuppression

KOH: pseudohyphaeKOH: pseudohyphae

TineaTineaTiTi CorporisCorporisTineaTineaC iC iCorporisCorporis

Tinea CorporisTinea CorporisTinea CorporisTinea Corporis

Tinea FacieiTinea FacieiTinea FacieiTinea Faciei

Tinea ManuumTinea ManuumTinea ManuumTinea Manuum

Tinea CrurisTinea CrurisTinea CrurisTinea Cruris

Tinea PedisTinea PedisTinea PedisTinea Pedis

Ti i ( h i )Ti i ( h i )Tinea unguium (onychomycosis)Tinea unguium (onychomycosis)

Tinea CapitisTinea CapitisTinea CapitisTinea Capitis

Tinea VersicolorTinea VersicolorTinea VersicolorTinea Versicolor

CandidiasisCandidiasisCandidiasisCandidiasis

CandidiasisCandidiasisCandidiasisCandidiasis

KOHKOHKOHKOH

Common Warts Common Warts –– Verruca VulgarisVerruca Vulgaris

Viral InfectionsViral Infections WartsWartsViral Infections Viral Infections -- WartsWarts

Human papilloma virusesHuman papilloma virusesp pp p Over 70 subtypes: specific subtypes prefer specific Over 70 subtypes: specific subtypes prefer specific

anatomic sites:anatomic sites: Verruca vulgaris, plantar warts, verruca plana, condyloma Verruca vulgaris, plantar warts, verruca plana, condyloma

acuminata ......acuminata ...... Some have malignancy potentialSome have malignancy potential

Cervical carcinomaCervical carcinoma

M ll t iM ll t i P iP i Molluscum contagiosum Molluscum contagiosum -- PoxvirusPoxvirus Common in childhoodCommon in childhood Sexually transmitted disease in adultsSexually transmitted disease in adults Sexually transmitted disease in adultsSexually transmitted disease in adults Can be extensive in HIV infectionCan be extensive in HIV infection

Plantar WartsPlantar WartsPlantar WartsPlantar Warts

Filiform Warts Flat WartsFiliform Warts Flat WartsFiliform Warts Flat WartsFiliform Warts Flat Warts

CondylomaCondylomaCondylomaCondyloma

HPVHPV--Related Mucosal ChangesRelated Mucosal ChangesHPVHPV Related Mucosal ChangesRelated Mucosal Changes

Molluscum ContagiosumMolluscum ContagiosumMolluscum ContagiosumMolluscum Contagiosum

Molluscum ContagiosumMolluscum ContagiosumMolluscum ContagiosumMolluscum Contagiosum

Viral InfectionsViral Infections HerpesHerpesViral Infections Viral Infections -- HerpesHerpes

Herpes simplexHerpes simplex Herpes simplexHerpes simplexPrimary infection vs recurrent outbreakPrimary infection vs recurrent outbreak

HSV type 1HSV type 1 Cold sores / fe er blistersCold sores / fe er blistersHSV type 1 HSV type 1 ---- Cold sores / fever blistersCold sores / fever blisters

HSV type 2 HSV type 2 ---- Genital herpesGenital herpes

H ti hitlH ti hitlHerpetic whitlowHerpetic whitlow Varicella zoster virusVaricella zoster virus

Primary Primary -- chickenpoxchickenpoxRecurrent Recurrent -- shinglesshingles

Diagnosis made with (+) Tzanck testDiagnosis made with (+) Tzanck test

Primary HSV1Primary HSV1 / Recurrent HSV1/ Recurrent HSV1Primary HSV1Primary HSV1 / Recurrent HSV1/ Recurrent HSV1

Recurrent HSV 2Recurrent HSV 2Recurrent HSV 2Recurrent HSV 2

Chronic HSV UlcerChronic HSV UlcerChronic HSV Ulcer Chronic HSV Ulcer

Herpetic WhitlowHerpetic WhitlowHerpetic WhitlowHerpetic Whitlow

Primary VaricellaPrimary Varicella –– ChickenpoxChickenpoxPrimary Varicella Primary Varicella ChickenpoxChickenpox

Recurrent VaricellaRecurrent Varicella -- ShinglesShinglesRecurrent Varicella Recurrent Varicella ShinglesShingles

Recurrent VaricellaRecurrent Varicella –– Herpes ZosterHerpes ZosterRecurrent Varicella Recurrent Varicella Herpes ZosterHerpes Zoster

Recurrent VaricellaRecurrent Varicella ShinglesShinglesRecurrent Varicella Recurrent Varicella -- ShinglesShingles

Recurrent VaricellaRecurrent Varicella ShinglesShinglesRecurrent Varicella Recurrent Varicella -- ShinglesShingles

Tzanck PreparationTzanck PreparationTzanck PreparationTzanck Preparation

Bacterial InfectionsBacterial InfectionsBacterial InfectionsBacterial Infections

ImpetigoImpetigo ImpetigoImpetigo An acute and superficial skin infectionAn acute and superficial skin infection

Characteristic: honeyCharacteristic: honey--colored crustcolored crust Characteristic: honeyCharacteristic: honey--colored crustcolored crust

CellulitisCellulitisS ti i fl ti i l i thS ti i fl ti i l i th Suppurative inflammation involving the Suppurative inflammation involving the subcutaneous tissue layersubcutaneous tissue layer

E i lE i l ErysipelasErysipelas Group A betaGroup A beta--hemolytic strephemolytic strep infection of the infection of the

fi i l d l l h tifi i l d l l h tisuperficial dermal lymphaticssuperficial dermal lymphatics

ImpetigoImpetigoImpetigoImpetigo

CellulitisCellulitisCellulitisCellulitis

ErysipelasErysipelasErysipelasErysipelas

InfestationsInfestationsInfestationsInfestations

ScabiesScabies ScabiesScabies Female Female sarcoptes scabieisarcoptes scabiei burrows into the stratum burrows into the stratum

corneum and lays eggscorneum and lays eggscorneum and lays eggscorneum and lays eggs Identified by wet prepIdentified by wet prep

Lice (Pediculosis)Lice (Pediculosis) Lice (Pediculosis)Lice (Pediculosis) Can carry and transmit infectious diseaseCan carry and transmit infectious disease

Body louseBody louse -- Pediculosis humanusPediculosis humanus varvar corporiscorporis Body louse Body louse -- Pediculosis humanusPediculosis humanus var var corporiscorporis Head louse Head louse -- Pediculosis humanusPediculosis humanus var var capitiscapitis Pubic or crab louse Pubic or crab louse -- Pthirus pubisPthirus pubispp

Nits frequently found in hair and lashesNits frequently found in hair and lashes

Scabitic MiteScabitic MiteScabitic MiteScabitic Mite

ScabiesScabiesScabiesScabies

ScabiesScabies

LiceLiceLiceLice

LiceLiceLiceLice

Question 4Question 4Question 4Question 4

For which of the following primary blisteringFor which of the following primary blistering disorders is caused by autoantibodies to the desmosomal structural proteins?

A.A. Epidermolysis bullosaEpidermolysis bullosa

desmosomal structural proteins?

B.B. PemphigoidPemphigoidCC PemphigusPemphigusC.C. PemphigusPemphigus

Vesiculobullous DisordersVesiculobullous DisordersVesiculobullous DisordersVesiculobullous Disorders

PemphigusPemphigus PemphigusPemphigus Autoimmune disorder: desmosomeAutoimmune disorder: desmosome

A h l i i hA h l i i h i id l blii id l bli Acantholysis with Acantholysis with intraepidermal blisterintraepidermal blister Bullous pemphigoidBullous pemphigoid

Autoimmune disorder: HemidesmosomeAutoimmune disorder: Hemidesmosome SubepithelialSubepithelial blisterblister

Epidermolysis bullosaEpidermolysis bullosa Genetic defects in structural proteins of cutaneous Genetic defects in structural proteins of cutaneous pp

basement membranebasement membrane

Cartoon of EpidermisCartoon of EpidermisCartoon of EpidermisCartoon of Epidermis

Bullous PemphigoidBullous PemphigoidBullous PemphigoidBullous Pemphigoid


Primary Subepidermal Blistering Primary Subepidermal Blistering DiseaseDisease


PemphigusPemphigusPemphigusPemphigus

PemphigusPemphigusPemphigusPemphigus

Epidermolysis Bullosa SimplexEpidermolysis Bullosa SimplexEpidermolysis Bullosa SimplexEpidermolysis Bullosa Simplex


Which of the following organisms is pivotalWhich of the following organisms is pivotalWhich of the following organisms is pivotal Which of the following organisms is pivotal to the development of acne vulgaris?to the development of acne vulgaris?

A.A. BetaBeta--hemolytic group A streptococcushemolytic group A streptococcusBB Staphylococcus aureusStaphylococcus aureusB.B. Staphylococcus aureusStaphylococcus aureusC.C. Pityrosporum (Malassezia)Pityrosporum (Malassezia)D.D. PropionibacteriumPropionibacteriumE.E. Pseudomonas aeruginosa Pseudomonas aeruginosa gg

FolliculitisFolliculitisFolliculitisFolliculitis

Common and superficial pyogenic infectionCommon and superficial pyogenic infection Common and superficial pyogenic infection Common and superficial pyogenic infection of the hair folliclesof the hair follicles

Staphylococcus aureusStaphylococcus aureus is the most commonis the most common Staphylococcus aureusStaphylococcus aureus is the most common is the most common organismorganism

O h l f lli li iO h l f lli li i Others may also cause folliculitisOthers may also cause folliculitis PityrosporumPityrosporum Candida speciesCandida species Candida speciesCandida species PseudomonasPseudomonas sp. sp. ---- “hot tub folliculitis”“hot tub folliculitis”

Occurs anywhere there is hairOccurs anywhere there is hair Occurs anywhere there is hairOccurs anywhere there is hair

FolliculitisFolliculitisFolliculitisFolliculitis

Hot Tub Folliculitis / PityrosporumHot Tub Folliculitis / PityrosporumHot Tub Folliculitis / PityrosporumHot Tub Folliculitis / Pityrosporum

Acne V lgarisAcne V lgarisAcne VulgarisAcne Vulgaris

Disorder of pilosebaceous unitsDisorder of pilosebaceous units PathobiologyPathobiologygg

Obstruction of follicular orificeObstruction of follicular orifice Abnormal keratinizationAbnormal keratinization

Increase in sebum productionIncrease in sebum production Role of androgensRole of androgens

Over growth of Over growth of propionibacterium acnespropionibacterium acnes Produces lipase which breaks down sebum to release Produces lipase which breaks down sebum to release

proinflammatory free fatty acidsproinflammatory free fatty acids

Pathogenesis of Acne V lgarisPathogenesis of Acne V lgarisPathogenesis of Acne VulgarisPathogenesis of Acne Vulgaris

Acne VulgarisAcne Vulgaris –– ComedonesComedonesAcne Vulgaris Acne Vulgaris ComedonesComedones

Acne VulgarisAcne VulgarisAcne VulgarisAcne Vulgaris



Acne RosaceaAcne RosaceaAcne RosaceaAcne Rosacea

C i fl di iC i fl di i Common inflammatory conditionCommon inflammatory condition Northern European ancestryNorthern European ancestry

Si ifi tSi ifi t Significant sun exposureSignificant sun exposure

Peculiar increase in vascular reactivityPeculiar increase in vascular reactivityFlush and blushFlush and blushFixed erythemaFixed erythemaTelangiectasiaTelangiectasia

Inflammatory papules and facial edemaInflammatory papules and facial edemaRhinophyma may occur in menRhinophyma may occur in men



Disorders of PigmentationDisorders of Pigmentation

All disorders deal with alterations in melanin All disorders deal with alterations in melanin productionproductionproductionproduction

TanningTanningVi iliVi iliVitiligoVitiligoAlbinismAlbinism

T iT iTanningTanning

A defensive response to UV lightA defensive response to UV light Skin types are partially defined by thisSkin types are partially defined by this

Immediate tan Immediate tan ---- UVA exposureUVA exposure Alteration in oxidized state of melaninAlteration in oxidized state of melanin Occurs immediately, fades quicklyOccurs immediately, fades quickly

Delayed tanDelayed tan ---- UVB exposureUVB exposure Delayed tan Delayed tan UVB exposureUVB exposure Increases production of melaninIncreases production of melanin Occurs in a few days fades in weeksOccurs in a few days fades in weeks Occurs in a few days, fades in weeksOccurs in a few days, fades in weeks

TanningTanninggg

VitiligoVitiligoVitiligoVitiligo

A i d l l l f lA i d l l l f l Acquired, local loss of melanocytesAcquired, local loss of melanocytes May be extensive and devastatingMay be extensive and devastating

IdiopathicIdiopathic Autoimmune diseaseAutoimmune disease Assoc. with FH, DM, thyroid disease, etcAssoc. with FH, DM, thyroid disease, etc

Results in DEPIGMENTATIONResults in DEPIGMENTATION Increase risk of skin cancerIncrease risk of skin cancer Variety of patternsVariety of patterns Variety of patternsVariety of patterns




Albi iAlbi i O lO lAlbinism Albinism -- OculocutaneousOculocutaneous

Genetic abnormalityGenetic abnormality Genetic abnormalityGenetic abnormality Autosomal recessive disorderAutosomal recessive disorder

Aff ki h i dAff ki h i d Affects skin, hair and eyesAffects skin, hair and eyes Variably hypopigmentedVariably hypopigmented Increased risk of skin cancerIncreased risk of skin cancer Reduction in visual acuity and nystagmusReduction in visual acuity and nystagmus

Several different genetic defectsSeveral different genetic defects All result in defective melanin production or All result in defective melanin production or pp

transfertransfer

AlbinismAlbinismAlbinismAlbinism

Question 6Question 6Question 6Question 6Which of the following cutaneous tumors is the most common cause of cutaneous malignancy?

A.A. Basal cell carcinomaBasal cell carcinoma

g y

B.B. DermatofibromaDermatofibromaC.C. Seborrheic keratosisSeborrheic keratosisD.D. Squamous cell carcinomaSquamous cell carcinomaEE Malignant melanomaMalignant melanomaE.E. Malignant melanomaMalignant melanoma

Cutaneous TumorsCutaneous Tumors

BenignBenign Seborrheic keratosisSeborrheic keratosis

MalignantMalignant Basal cell carcinomaBasal cell carcinoma Seborrheic keratosisSeborrheic keratosis

Melanocytic neviMelanocytic neviH iH i

Squamous cell Squamous cell carcinomacarcinoma

HemangiomaHemangioma CystsCysts

carcinomacarcinoma MelanomaMelanoma

C TC T llll DermatofibromaDermatofibroma Cutaneous TCutaneous T--cell cell

lymphomalymphoma

Seborrheic KeratosisSeborrheic KeratosisSeborrheic KeratosisSeborrheic Keratosis

C mm d b iC mm d b i Common and benignCommon and benign FamilialFamilial

f ff f Occurs after age of 30 yearsOccurs after age of 30 years “Age spots” etc“Age spots” etc

More common on the face, trunk and More common on the face, trunk and upper extremitiesupper extremities

Localized and benign epidermal Localized and benign epidermal proliferationproliferation

S k ”S k ” “Stuck on appearance”“Stuck on appearance”

Seborrheic KeratosesSeborrheic KeratosesSeborrheic KeratosesSeborrheic Keratoses

Seborrheic KeratosesSeborrheic KeratosesSeborrheic KeratosesSeborrheic Keratoses

Seborrheic KeratosesSeborrheic KeratosesSebo e c e atosesSebo e c e atoses

Melanocytic NeviMelanocytic NeviMelanocytic NeviMelanocytic Nevi

Most are acquired lesionsMost are acquired lesions Most are acquired lesions Most are acquired lesions Occur 5 years to 60 yearsOccur 5 years to 60 years May be congenitalMay be congenital May be congenitalMay be congenital

Benign melanocyte proliferationBenign melanocyte proliferation Sharply demarcatedSharply demarcated Flat or raisedFlat or raised FleshFlesh--colored to dark browncolored to dark brown

Risk of any one mole becoming malignant Risk of any one mole becoming malignant is miniscule is miniscule

Melanocytic NevusMelanocytic NevusMelanocytic NevusMelanocytic Nevus

Melanocytic NevusMelanocytic NevusMelanocytic NevusMelanocytic Nevus

Melanoc tic Ne iMelanoc tic Ne iMelanocytic NeviMelanocytic Nevi

M l i N iM l i N iMelanocytic NeviMelanocytic Nevi

HemangiomaHemangioma

All are a result of a vascular processAll are a result of a vascular process Some are hypertrophic changes some areSome are hypertrophic changes some are Some are hypertrophic changes, some are Some are hypertrophic changes, some are

proliferative disorders, some are caused by proliferative disorders, some are caused by vasodilation, some are true arteriovasodilation, some are true arterio--venousvenousvasodilation, some are true arteriovasodilation, some are true arterio venous venous abnormalitiesabnormalities

Some are congenital, some acquiredSome are congenital, some acquiredSome are congenital, some acquiredSome are congenital, some acquired Only a few have a health riskOnly a few have a health risk

HemangiomasHemangiomasHemangiomasHemangiomas

“Stork Bite” Port Wine Stain“Stork Bite” Port Wine StainStork Bite Port Wine StainStork Bite Port Wine Stain

Hemangioma and Port Wine StainHemangioma and Port Wine StainHemangioma and Port Wine StainHemangioma and Port Wine Stain

CCCystsCysts

All have a cellular, epithelial liningAll have a cellular, epithelial lining Contents may be fluid or semiContents may be fluid or semi--solidsolid

Depends on cell type liningDepends on cell type lining Most common:Most common:

Follicular cyst, infundibular type (epidermal Follicular cyst, infundibular type (epidermal inclusion cyst)inclusion cyst) Common on face, neck, torso, scrotumCommon on face, neck, torso, scrotum Stratified squamous epitheliumStratified squamous epithelium Keratinous material contentKeratinous material content Keratinous material contentKeratinous material content

CystsCystsCystsCysts

CystsCystsCystsCysts

C stsC stsCystsCysts

DermatofibromaDermatofibroma

Common, benign dermal tumorCommon, benign dermal tumor Composed of dermal fibroblastsComposed of dermal fibroblastspp Most common on extremitiesMost common on extremities Cause unknownCause unknown Cause unknownCause unknown

?? Trauma with abnormal scarring?? Trauma with abnormal scarring Clinical: Dermal tumor tightly adherent toClinical: Dermal tumor tightly adherent to Clinical: Dermal tumor, tightly adherent to Clinical: Dermal tumor, tightly adherent to

epidermis, with “dimple sign”epidermis, with “dimple sign”

DermatofibromaDermatofibromaDermatofibromaDermatofibroma

Basal Cell CarcinomaBasal Cell CarcinomaBasal Cell CarcinomaBasal Cell Carcinoma

Most common cutaneous malignancyMost common cutaneous malignancy > 400,000 cases this year> 400,000 cases this year

Develops from the basal cell layerDevelops from the basal cell layer Most common on the head and neckMost common on the head and neckMost common on the head and neckMost common on the head and neck Background of sun damageBackground of sun damage

P l l l i h l i iP l l l i h l i i Pearly translucent papule with telangiectasiaPearly translucent papule with telangiectasia Nickname: “rodent ulcer”Nickname: “rodent ulcer”

Basal Cell CarcinomaBasal Cell Carcinoma --NodularNodularBasal Cell Carcinoma Basal Cell Carcinoma NodularNodular




S C ll C iS C ll C iSquamous Cell CarcinomaSquamous Cell Carcinoma

S d kiS d ki Second most common skin cancerSecond most common skin cancer Arises within the squamous epitheliumArises within the squamous epithelium Setting of sun damage and precancerous lesions: Setting of sun damage and precancerous lesions:

actinic keratosisactinic keratosis Upper extremities, trunk, face and neckUpper extremities, trunk, face and neck Associated with other exogenous insults Associated with other exogenous insults

Poorly demarcated scaly, indurated plaquesPoorly demarcated scaly, indurated plaques Higher metastatic potential than BCCHigher metastatic potential than BCC

Squamous Cell CarcinomaSquamous Cell CarcinomaSquamous Cell CarcinomaSquamous Cell Carcinoma



S C ll C iS C ll C iSquamous Cell CarcinomaSquamous Cell Carcinoma

M lM lMelanomaMelanoma

D dli t f th ki rD dli t f th ki r Deadliest of the skin cancersDeadliest of the skin cancers Increasing at an alarming rateIncreasing at an alarming rate

l b fl b f May arise in mole, but more often occurs May arise in mole, but more often occurs de novode novo

i k fi k f Risk factorsRisk factors Family historyFamily history

kk Skin typeSkin type UV light exposureUV light exposure

N b f l i i lN b f l i i l Number of moles, or giant congenital nevusNumber of moles, or giant congenital nevus

MelanomaMelanoma

Di ti l ABCD’Di ti l ABCD’ Diagnostic clues: ABCD’sDiagnostic clues: ABCD’s A:A: AsymmetryAsymmetry BB B rderB rder B:B: BorderBorder C:C: ColorColor D:D: DiameterDiameter D:D: DiameterDiameter EE EvolutionEvolution

Completely excise suspicious lesionsCompletely excise suspicious lesions Completely excise suspicious lesionsCompletely excise suspicious lesions Most important prognostic indicator: Most important prognostic indicator: Lesional Lesional

thicknessthicknessthicknessthickness

MelanomaMelanomaMelanomaMelanoma




MelanomaMelanomaAcral Lentiginous MelanomaAcral Lentiginous Melanoma

MelanomaMelanoma -- MetastaticMetastaticMelanoma Melanoma MetastaticMetastatic

Cutaneous TCutaneous T--Cell LymphomaCell LymphomaCutaneous TCutaneous T Cell LymphomaCell Lymphoma

Most uncommon of skin malignanciesMost uncommon of skin malignanciesgg AKA:AKA: Mycosis fungoidesMycosis fungoides

Malignancy of lymphocytesMalignancy of lymphocytes Malignancy of lymphocytesMalignancy of lymphocytes Predominately CD4 cellsPredominately CD4 cells

P h d ikil dP h d ikil d Presents as patches and poikilodermaPresents as patches and poikiloderma Long term diseaseLong term disease

2020-- 40 years40 years Risk of systemic lymphomaRisk of systemic lymphomay y py y p Leukemic phase: Sezary syndromeLeukemic phase: Sezary syndrome

Mycosis FungoidesMycosis FungoidesPatches Stage / TumorsPatches Stage / Tumors

Mycosis FungoidesMycosis FungoidesMycosis FungoidesMycosis FungoidesSezary SyndromeSezary Syndrome

UrticariaUrticariaUrticariaUrticaria

Very common conditionVery common condition Very common conditionVery common condition Transient wheals, “hives”Transient wheals, “hives”

Lesions last < 24 hoursLesions last < 24 hours Lesions last < 24 hoursLesions last < 24 hours Generally very itchyGenerally very itchy Many causes or associationsMany causes or associations Many causes or associationsMany causes or associations

Acute urticaria, < 30 daysAcute urticaria, < 30 days Likely IgE mediated allergyLikely IgE mediated allergy Likely IgE mediated allergyLikely IgE mediated allergy

Chronic urticaria, > 30 daysChronic urticaria, > 30 days M t lik l n t ll r i in m h ni mM t lik l n t ll r i in m h ni m Most likely not allergic in mechanismMost likely not allergic in mechanism

UrticariaUrticariaUrticariaUrticaria

VasculitisVasculitisVasculitisVasculitis

D l i fl iD l i fl i Due to vascular inflammationDue to vascular inflammation Different diseases affect different vessels and vessel Different diseases affect different vessels and vessel

sizessizes Arterioles, capillaries, venules … etc.Arterioles, capillaries, venules … etc.

Clinical picture represents affected vesselClinical picture represents affected vessel Palpable purpuraPalpable purpura ---- small sized vesselssmall sized vesselsp p pp p p Cutaneous nodules Cutaneous nodules ---- medium and largemedium and large UlcersUlcers ---- may suggest larger sized vesselmay suggest larger sized vesselUlcers Ulcers may suggest larger sized vesselmay suggest larger sized vessel


VasculitisVasculitis –– Palpable PurpuraPalpable PurpuraVasculitis Vasculitis –– Palpable PurpuraPalpable Purpura


Question 1Question 1This postoperative rash is This postoperative rash is most like a form of which most like a form of which

AA EczemaEczema

of the following?of the following?

A.A. EczemaEczemaB.B. Seborrheic dermatitisSeborrheic dermatitisC.C. PsoriasisPsoriasisD.D. Tinea corporisTinea corporisE.E. Tinea versicolorTinea versicolor


Which of the papulosquamous disorders is Which of the papulosquamous disorders is p p qp p qassociated with the development of a seroassociated with the development of a sero--negative rheumatoid arthritisnegative rheumatoid arthritis--type of arthritis?type of arthritis?

A.A. EzcemaEzcema

gg ypyp

B.B. PsoriasisPsoriasisCC Seborrheic dermatitisSeborrheic dermatitisC.C. Seborrheic dermatitisSeborrheic dermatitisD.D. Pityriasis roseaPityriasis rosea

Question 3Question 3Question 3Question 3A positive Tzanck test confirms the diagnosis A positive Tzanck test confirms the diagnosis

f hi h f h f ll i i f i ?f hi h f h f ll i i f i ?

M ll iM ll i

of which of the following infections?of which of the following infections?

A.A. Molluscum contagiosumMolluscum contagiosumB.B. DermatophytosisDermatophytosisC.C. ImpetigoImpetigoD.D. ErysipelasErysipelasD.D. ErysipelasErysipelasE.E. HerpesHerpes

Question 4Question 4Question 4Question 4

For which of the following primary blisteringFor which of the following primary blistering disorders is caused by autoantibodies to the desmosomal structural proteins?

A.A. Epidermolysis bullosaEpidermolysis bullosa

desmosomal structural proteins?

B.B. PemphigoidPemphigoidCC PemphigusPemphigusC.C. PemphigusPemphigus


Which of the following organisms is pivotalWhich of the following organisms is pivotalWhich of the following organisms is pivotal Which of the following organisms is pivotal to the development of acne vulgaris?to the development of acne vulgaris?

A.A. BetaBeta--hemolytic group A streptococcushemolytic group A streptococcusBB Staphylococcus aureusStaphylococcus aureusB.B. Staphylococcus aureusStaphylococcus aureusC.C. Pityrosporum (Malassezia)Pityrosporum (Malassezia)D.D. PropionibacteriumPropionibacteriumE.E. Pseudomonas aeruginosa Pseudomonas aeruginosa gg

Question 6Question 6Question 6Question 6Which of the following cutaneous tumors is the most common cause of cutaneous malignancy?

A.A. Basal cell carcinomaBasal cell carcinoma

g y

B.B. DermatofibromaDermatofibromaC.C. Seborrheic keratosisSeborrheic keratosisD.D. Squamous cell carcinomaSquamous cell carcinomaEE Malignant melanomaMalignant melanomaE.E. Malignant melanomaMalignant melanoma

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General DermatologyGeneral Dermatology - VCU SOM · “Cradle cap” as infant ... S perficial F ngal InfectionsSuperficial Fungal Infections ... Mycosis fungoides Mycosis fungoides