Dermatology Basics David Surprenant, MD

Common Conditions

Cellulitis Common bacterial infection of the deep dermis and subcutaneous tissue Characterized by: Erythema Pain Warmth Swelling Often have: Fever Chills Malaise Leukocytosis Virtually never occurs bilaterally If purulence, swab it for culture Otherwise swab will only grow normal skin flora

Stasis Dermatitis A type of eczema that occurs in setting of venous insufficiency Obesity, CHF, DVT, injury, etc. Pruritus, aching, throbbing, discomfort Can be unilateral (often bilaterally) Can be warm to the skin Will not have other signs of infection, i.e. Tachycardia Leukocytosis Fever Will treat with topical corticosteroids Mention vehicle importance Compression is key – often will defer to vascular surgery if there is an active clot; also need to consider cardiac status prior to compression

Hidradenitis Suppurativa Inflammatory disorder Follicular occlusion -> rupture -> inflammation Occasionally bacterial superinfection Onset after puberty Treatment: Weight loss & smoking cessation Antibiotics (primarily for anti-inflammatory) TNF-alpha inhibitors Surgery Swab of area will grow bacteria – unlikely to be pathogenic or clinically significant These spots look infected—patient again will have no fever, chills, ns etc; can have leukocystosis

Ask the patient if this is new or changing Good day, bad day, average day for your skin? Often followed by outside dermatologist

Psoriasis Chronic inflammatory condition Think pink/red, scaly plaques Commonly involved areas: Occipital scalp Umbilicus Elbows Knees Treatment: Topicals vs systemic medication Can have deforming psoriatic arthritis

Erythroderma Erythema & scale >90% BSA Causes: Treatment: Psoriasis Atopic dermatitis Drug reactions Idiopathic CTCL Treatment: Fluid, electrolyte, and thermal regulation Wet wraps

Pyoderma Gangrenosum Inflammatory condition Non-infectious Overactive neutrophils Non-infectious Diagnosis of exclusion (biopsy will not be diagnostic) Surgery & debridement makes this condition worse! Pathergy Consider if non-healing wound Association with inflammatory bowel disease Treatment: Immunosuppression

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