Name of Disease Folliculitis

BACTERIA Staphylococcal Keratosis pilaris Pseudofolliculitis barbae Sycosis barbae Propionibacterium acnes S. aureus

KEY NOTES ~can be superficial or deep

Acne Vulgaris Furuncles, Carbuncles

~open and closed comedomes ~progression of folliculitis ~may lead to cellulitis ~MRSA, resistant to beta-lactam antibiotics

Cellulitis

Group A Strep ~secondary to trauma (surgery or lesions) S. aureus in adults ~systemic response, vascular and lymphatic systems Hemophilus influenzae B in ~may see streaking children (rare) Infectious: B-hemolytic strep, ~subcutaneous adipose tissue (panniculitis) leprosy, TB Non-infectious: drug rxn, autoimmune conditions ~acute inflammation ~widening of septa = exquisite pain ~flatten and brusie, but NO SCARRING!!! ~subacute or chronic = septal fibrosis

Erythema Nodosum

Impetigo

S. aureus

~contagious, pururlent SUPERFICIAL skin infection ~in children at daycares ~pustule formation, rupture, wet erosions, honey-colored crusts

Name of Disease Dermatophyte Infections

FUNGI Tinea corporis Tinea cruris Tinea pedis Tinea Unguium Tinea manus ~Ringworm

KEY NOTES

~spares the scrotum, but affects the buttocks and thighs ~secondary bac. infections very prominent ~test with 10% KOH ~distal subungual = crumbling nail, most common ~proximal subungual = intact surface, separation, HIV px ~affects mucous mem, internal organs, skin ~opportunistic, pregnancy, antibiotics, diabetes, etc. ~mucous mems = necrosis and sloughing off

Onychomycosis

90% dermatophytes 6% yeasts 4% non-dermatophytic fungi yeast-like fungus

Candidiasis

**involves scrotum, beefy ~apposing skin surfaces = maceration of pustules, satellite pustules red with satellite lesions** ~mouth angles = maceration, fissures, 2 infections Oral candidiasis = Oral Thrush

Name of Disease Herpes Simplex Virus (HSV)

VIRUSES HSV-1; HSV-2 ~acute, recurrent vesicular eruptions

KEY NOTES

~4-10 day incubation period ~dormant in dorsal nerve root ganglion, CN 5 also seen in Epstein-Barr virus ~intial lesion = most contagious ~pregnancy, child blindness via ophthalmic branch, corneal scar ~only affects the epithelium = NO SCARS!!! ~skin-skin contact ~reactivation is localized Human Papilloma Virus(HPV) Genital Warts = HPV6,11,16 ~epithelial basal cells Genital Cancer = HPV16,18 ~children, young adults ~direct contact (2-6 mths) Varicella Zoster (VZV) ~chicken pox and shingles ~mucous mem, skin, neurons ~latent infection in sensory ganglia (dorsal root), similar mechanism as HSV ~respiratory droplets, bloodstream, systemic response ~Chicken pox = URT, 2 wks, torso to periphery, dew drops on rose petal ~Shingles = localized dermatomal distribution, infection of keratinocytes, itching, burning pain on nerve, skin has sim. dewdrop on rose petal

Name of Disease Pemphigus vulgaris

BULLOUS DISEASES autoimmune blistering dx large, painful, fragile

Bullous Pemphigoid

autoimmune blistering dx itchy, tense, large

KEY NOTES ~usu. Middle aged or older ppl ~CHRONIC blistering ***positive for Nikosky's sign*** ~IgG to intercellular adhesion molecules, acantholysis of DESMOSOMES ~fragile SUPRABASAL blisters, rupturing is very PAINFUL, erosions and crusting, 2 infections, loss of fluid, malnutrition, usu. Fatal ~common in elderly ~less aggressive and not life threatening ~on medial thighs and trunk ***NO ACANTHOLYSIS*** ~IgG directed to the basement membrane proteins (BPAG1, 2) ~destroys connection b/t dermis and epidermis (hemidesmosomes), tense SUBEPIDERMAL blister ~pruritis (itchiness)

Name of Disease Eczematous Dermatitis

INFLAMMATORY CONDITIONS antigen stimulation

KEY NOTES ~affects DERMIS and EPIDERMIS; NO IMMUNOLOGIC TARGETING ~Ag, inflammatory infiltrate, keratinocytes separated, dermal edema, vesicle formation, hyperkeratosis, acanthosis, lichenification, excoriation

Allergic & Contact Dermatitis

~hypersensitivity rxns (Type 4, cell mediated) ~any pruritic rxn, common in teenagers and young adults ~requires previous exposure, T-cell sensitization ~Ag, presented to nave CD4-T-cells, activationAg re-exposure, memory T-cells ~hypersensitivity rxn ~skin is dry, hyperkeratotic, easily lichenified

Atopic Dermatitis

linked to cataracts related to allergic rhinitis (IgE, eosinophils, His, mast ~begins in early childhood or adolescence cells)Otitis Externa

similar to RINGWORM (itchy, flaky lesion) so you must look ***not breastfed, hygiene hypo, diet, digestion, His release, emotional tension at borders and use 10% KOH Psoriasis ~due to hyperplasia, at any age ~family hx = autoimmune process, HLA tendency ~multifactorial, T-cell mediated, increased cGMP:cAMP ratio, INCREASED KERATINOCYTE REPLICATION, thinned stratum granulosum, Auspitz sign (pinpoint bleeding d/t exposed capillaries) ~triggers = phys. Trauma, drugs, infections, stress, diet, increased cGMP/cAMP ratio COMPARE TO ONYCHOMYCOSIS, need to NAILS = hyperkeratosis, shedding nail plate, punched out lesions, PITTING and crumbling of take scraping and dissolve in nail platehyperplasia of skin below the nail, debris, lifts the nail, irregular nail separationOIL 10% KOH, look for presence of SPOTTING psoriatic lesions, psoriasis also linked to hx of chronic joint pain Drug Eruptions Urticaria IN THE DERMIS!! ~mimic any skin condition, hypersensitivity or non-immunologic process, most commonly d/t antimicrobials and antipyretics, convulsants and diuretics ~to burn, acute or chronic, common His-mediated rxn to a trigger (stress, pressure, temp, chem. antigens) ~Antigen sensitization IgE, mast cell degranulation, His release, dermal vasc. hyperpermeability, dermal edema and pruritis ~mediator is HISTAMINE!!! ~may be an automimmune condition involving mast cells ~H1 receptors=on sensory nerve endings, pick up His, induce pruritis, so give H1 blockers for skin and resp. tract conds. ~H2 receptors=in gut lining, promote acid secretion, give to px with chronic ulcers ~last less than 24 hrs, wheals,

Name of Disease

BENIGN & PREMALIGNANT HYPERPLASTIC LESIONS

KEY NOTES benign, from melanocytes, very common, aggregate at the dermoepidermal junction, grow into the dermi, elevation above the epidermis, maturation, cord-like growth, very well differentiated!! Junction (flat, macular), Compound (from macuar to papular), Dermal

Melanocytic Nevi

Common Moles Atypical and Dysplastic Nevi Actinic Keratosis associated with malignant melanoma

~aquired, familial association, compound nevi woth abnormal growth and cells, lentigionous hyperplasia ~premalignant condition, ass'd w/chronic sun exposure, fair skinned ppl ~excess sun, basal cell hyperplasia atypia and dyskeratosis , fibroblast damage abnormal , synthesis, thickened dermis parakeratosis thickened stratum corneum , *** Need to remove before they progress into SCC***

Name of Disease Squamous Cell Carcinoma

MALIGNANT LESIONS

KEY NOTES ~affects epithelial keratinocytes, ass'd with chronic skin damage, second most common skin cancer ~small and removable,low invasive potential ~not very aggressive ~local growth via expansion into the dermis, lateral spreading under the skin along the bone, muscle, spread along the nerves or vessels, spread thru the lymphatics and then blood (lungs, liver, skin, brain, bone) ~most common skin cancer

Basal Cell Carcinoma

SCALING, ULCERATION, EROSION, CRUST

~very slow growing, very rarely metastasize, locally invasive and destructive ONLY EPIDERMAL OR FOLLICULAR EPITHELIUM ~some cases are not even in sun exposed areas, eg ears and inner campus of the eyes ***NOT MUCOSAL*** ~UV, immunosupp ppl, defective DNA repair RED FLAG = WAXY, ~from basal keratinocytes PEARLY RAISED BORDER MAY HAVE CENTRAL ~UVB radiation!!!! ULCERATION MAY OR MAY NOT BE ~requires local stroma to support growth!!! PIGMENTED QUITE FIRM ~unpredictable growth, thus it is extremely aggressive locally ~multifocal growth = radial and lateral growth into the epidermis ~nodular growth = migration into the dermis

Malignant Melanoma

SUN, very aggressive, fatal via secondary metastasis Melanocytic Nevi: develop over decades, cells are Risk Factors = familiar and personal tendencies, large congenital nevus or immunosuppression differentiated, slower rate of mitosis <1/3 develop from nevi, need to ask evolution!!! Malignant Melanomas: develop over weeks, sample is ~radial growth, vertical growth, metastasis not differentiated, increased # of mitotic events