Practical Approach to Dermatology Richard P. Usatine, M.D.

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Practical Approach to Dermatology Richard P. Usatine, M.D.

  1. 1. Practical Approach to Dermatology Richard P. Usatine, M.D. Director of Medical Student Education UTHSCSA Department of Family and Community Medicine
  2. 2. Goals of lecture: • Demonstrate a practical approach to the diagnosis of skin conditions using pattern recognition • review dermatology patterns by: – viewing multiple images – distinguishing between common and uncommon patterns – observing local and regional morphology
  3. 3. Primary Lesions • Macule • papule • plaque • nodule • wheal (hive) • pustule • vesicle • bulla
  4. 4. TINEA VERSICOLOR
  5. 5. DERMATOFIBROMA
  6. 6. Secondary (Sequential) Lesions • scale • crusts • erosion • ulcer • fissure • atrophy • excoriation • lichenification
  7. 7. Strategies for Diagnosis • Use magnification • Feel lightly • Palpate deeply • Distribution • Local patterns - groups, rings, lines
  8. 8. Looking for clues beyond the rash • Look at nails, hair, mucus membranes, hands, feet – nail pitting for psoriasis – scalp may be clue to seborrhea elsewhere – lichen planus may show a white lacy pattern in the mouth – fungal infection on the feet with ID reaction on the hand
  9. 9. Think Pathophysiology • Infections • Inflammatory Processes - dermatitis, seborrhea • Acne and related disorders • Immunologic • Benign and premalignant growths • Malignancies
  10. 10. Infections • bacterial • viral • fungal • infestations
  11. 11. Bacterial infections of skin • Impetigo, cellulitis, abscess • Folliculitis • Furuncle, carbuncle, abscess • Necrotizing fasciitis • Erythrasma, • pitted keratolysis
  12. 12. Impetigo • superficial skin infection of the epidermis • characterized by translucent (“honey”) crusts • caused by S. aureus and strep. pyogenes (GABHS) • Cephalexin and Dicloxacillin • Bactroban topical
  13. 13. Ecthyma and Bullous Impetigo • Two variations of impetigo • Ecthyma has a ulcerated “punched-out” base • Bullous impetigo is more often caused by S. aureus
  14. 14. Erysipelas • specific type of superficial cellulitis • prominent lymphatic involvement. • GABHS; H. flu in children • face or leg • admit if toxic or extensive involvement • otherwise, oral Augmentin with close follow-up
  15. 15. Flesh-Eating Bacteria • Necrotizing Fasciitis - Type 1 – Mixed anaerobes – Gram negative aerobic bacilli – Enterococci • Type 2 – Group A strep • Bisno, Stevens. Streptococcal Infections, NEJM, Jan 1996
  16. 16. Diagnosis of Necrotizing Fasciitis • diffuse swelling of arm or leg • follow by bullae with clear fluid which become violaceous in color • marked systemic symptoms • can lead to cutaneous gangrene, myonecrosis, and shock
  17. 17. Cellulitis vs. Necrotizing Fasciitis • necrotizing fasciitis may look like cellulitis at first • cellulitis only requires antibiotics • necrotizing fasciitis requires surgical debridement along with antibiotics
  18. 18. Viral • HPV • Herpes • Varicella/Zoster
  19. 19. Burrow
  20. 20. Infestations • scabies - Elimite • lice - Nix • Permethrin
  21. 21. Fungal Infections • Tinea pedis • Tinea capitis • Tinea corporis • Tinea cruris • Onychomycosis • Tinea versicolor
  22. 22. Granuloma annulare
  23. 23. Common Types of Dermatitis (Inflammation) • Hand Eczema • Atopic Dermatitis • Contact Dermatitis • Seborrheic Dermatitis
  24. 24. Cutaneous Anthrax MRIMRI
  25. 25. Take home points • Learn the patterns • Look at nails, hair, mucus membranes, hands, feet for clues to diagnosis • Use understanding of patterns

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