1. NPLEX Combination Review Dermatology - 3 Paul S. Anderson, ND Medical Board Review Services Copyright MBRS

2. Nail Diseases Acute Paronychia Painful, bright red swelling of proximal and lateral nailfold Chronic type associated with contact with water Keep hands dry is best treatment-lotions and ointments should be avoided Separation of nail plate (onycholysis) may predispose to Pseudomonas infection

3. Paronychia

4. Nail Diseases Fungal Tinea unguium Trauma predisposes to infection DDX: Psoriasis (pitting not found in tinea) Treatment orally with fluconazole or itraconazole

5. Tinea Unguium

6. Contact Dermatitis Contact dermatitis is a reaction, which occurs when skin comes in contact with certain substances. Irritant contact dermatitis Organic solvents or soaps Allergic contact dermatitis Delayed hypersensitivity Hapten (low molecular weight substance) Cross-sensitization

7. Diagnosis History of onset; work-home exposure; skin care; medications; soaps; clothing (be persistent with questioning) If problem does not clear: According to the American Academy of Allergy, Asthma, and Immunology, "Patch testing is the gold standard for contact allergen identification ” Not to be used for irritant contact dermatitis Contact Dermatitis

9. Contact dermatitis due to allergy to rubber antioxidant in brassiere

10. Contact Dermatitis

11. Atopic Dermatitis Major Criteria Pruritus Flexural lichenification (thickening of the skin) and linearity in adults Facial and extensor involvement in infants and young children Chronic or chronically relapsing dermatitis Personal or family history of atopy (asthma, allergic rhinoconjunctivitis, atopic dermatitis) Labs serum IgE elevated above 200 IU/ml in 80-90% Eosinophilia

14. Psoriasis About 2% of adults (Psoriasis vulgaris) Triggers: rash starts after emotional stress, trauma to skin (Koebner’s phenomenon), strep throat Red scaly-white papules and plaques; removal of scale results in blood drops (Auspitz phenomenon)

15. Psoriasis Plaque Guttate-strep induced Palmoplantar pustulosis Inverse

16. Psoriasis

17. Seborrheic dermatitis Chronic superficial inflammatory process of hairy regions of the body Pityriasis capitis (dandruff) Cradle Cap (thick, yellow, crusty scalp lesions in infants) Proliferation of Pityrosporum ovale (yeast) Triggered by stress, fatigue, change of season or reduced general health

18. Seborrheic Dermatitis

19. Acne vulgaris Location-sebaceous skin –face, chest, back Lesion type –non-inflammatory comedone-open/closed cyst –inflammatory papule(red), pustule, nodule

20. AV

21. Treatment Correct abnormal keratinization (plugging) –Vit A cream Kill bacteria –topical ABX, oral ABX, Benzoyl peroxide Decrease inflammation –Tetracycline family Minocycline –Diet- decrease refined sugars/fried foods. –Sunlight/blue light Correct hormone imbalance

22. Rosacea In adults Two components –redness/flushing/telangiec tasia-burning –papules/pustules –No comedones Location-mid face, around eyes

23. Etiology Unknown- some relation to acne Racial group –Northern Europeons –Celtic –Men worse than women Triggers –Emotional stress- people who blush –Hot/cold air (exercise) –Food cheese, wine, spicy food, coffee Very Chronic

24. Pityriasis alba Children and young adults Round or oval; slightly elevated, fine scaling plaque that leave pale marks (hypopigmented) usually on face, neck and arms DDX: vitiligo, tinea versicolor (How do you tell?) Vitiligo and tinea versicolor appear white; borders are distinct in vitiligo; tinea versicolor is rare on the face and areas more numerous and often confluent; KOH to settle the debate

25. Pityriasis alba

26. Pityriasis rosea Teenagers and young adults; benign No known cause but linked to mycoplasma, picornavirus and human herpesvirus 7 “Harold Patch” (plaque) precedes eruption then followed by smaller plaques (0.5 to 2 cm in diameter) Follows long axes parallel lines of cleavage starting at spine (Christmas tree-like pattern)

27. Harold Patch Slightly erythematous, scaly, with slightly raised borders Pityriasis rosea

28. Lichen simplex (neurodermatitis) Common disorder, usually adults Repeated rubbing or scratching resulting in itchy patch of skin Sharply demarcated, red, scaly plaque with prominent skin lines

29. Lichen Simplex

30. Lichen planus Very pruritic rash on palms, wrists Polyangular, flat topped pink papules w/ wickham’s striae –criss/cross white lines

31. Verruca vulgaris (warts) Epithelial tumors caused by at least 60 types of human papillomavirus Frequent in older children, uncommon in elderly Common Type: flesh-colored papules evolve to dome-shaped, gray-brown, hyperkeratotic growths with black dots on the service

32. Verruca vulgaris (Common)

33. Tinea Tinea incognitoTinea incognito when the clinical appearance has changed because of inappropriate treatment

34. Tinea versicolor Chronic yeast overgrowth in skin increased by heat Pityrosporium obiculare Not contagious white, brown, pink scaling oval patches on trunk

35. Candidiasis Oral called thrush in infants Adult: check for diabetes, depressed immunity, elderly and patients with cancer Prolonged corticosteroids or broad spectrum antibiotics Candidiasis of large skin folds Warm and moist areas (under breasts, groin and armpits, diapers)

36. Dyshidrotic Eczema Symmetric, vesicular hand and foot dermatitis Preceded by moderate to severe itching Palms may be red and sweating Aggravated by contact with irritants such as water, detergents and solvents High incidence of nickel allergy

38. Vitiligo Pigment cells are destroyed resulting in white patches Associated with increased risk of autoimmune disorders (thyroid, pernicious anemia, Addison’s, and alopecia areata)

39. Vitiligo