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Primary Care Derm

Primary Care Derm. Seborrheic Keratoses. Stuck on, white, tan, brown, black papules Smooth with pearls Rough, cracked Mimic melanoma In darker skin on the face called dermatosis papulosis nigricans Can treat with LN2, currette or active nonintervention. Seb Ker. Cherry Angiomas.

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Primary Care Derm

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  1. Primary Care Derm

  2. Seborrheic Keratoses • Stuck on, white, tan, brown, black papules • Smooth with pearls • Rough, cracked • Mimic melanoma • In darker skin on the face called dermatosis papulosis nigricans • Can treat with LN2, currette or active nonintervention

  3. Seb Ker

  4. Cherry Angiomas

  5. PyogenicGranuloma • Lobular Capillary Hemangioma • Band-aid sign

  6. Venous Lakes

  7. Lentigo

  8. Poikiloderma of Civatte

  9. Cutis RhomboidalisNuchae

  10. Dermatofibroma • Seen more commonly females on the leg • Dimple sign- retraction with palpation (feels like pea under skin) benign

  11. Epidermal Inclusion Cyst • Soft mobile masses, sometimes with punctum • Excision (need to remove cyst wall) is the only way to get rid of them • If inflamed, can inject with steroid

  12. Basal Cell Carcinoma • Risk Factor for BCC: inability to tan • Different types of BCC: nodular, superficial, micronodular, infiltr, morpheaform • Head- most common site for BCC • Needs surgical excision with about 3 mm margins, send to derm or MOHs

  13. BCC

  14. Actinic Keratoses • Premalignant • Can process to SCC (3-8% if left untreated) • Distinguish two by biopsy • Treat with LN2

  15. Actinic Keratoses • Scaly erythematous macules

  16. Squamous Cell Carcinoma • Cumulative sun exposure • Found on scalp, hands, ears, lips • Need to biopsy • Treat with surgical excision 5 mm margins, Send to derm or MOHs

  17. Squamous Cell Carcinoma • Keratoacanthoma- subtype that evolves rapidly

  18. Nevi • Junctional nevi- melanocytes in the epidermis only, flat pigmented or flesh colored macules • Congenital nevi are nevi present at birth, they tend to be larger and darker

  19. Nevi • Compound Nevus- melanocytes in the epidermis&dermis • Intradermal Nevus- melanocytes in dermis only

  20. Dysplastic Nevi • Diagnosis made by pathology • Melanocystes look atypical

  21. Melanoma • Superfical spreading- most common type • Greatest relative risk: personal h/o atypical moles, family h/o melanoma, >75-100 moles

  22. Melanoma • If thinking melanoma, do excisional bx • Treatment for melanoma is excision (margins depend of depth of melanoma)

  23. Paget’s Disease • On breast, associated with adenocarcinoma • Can look like nipple ezcema

  24. Inflammatory

  25. Acne • Mild, noninflamm acne (open and closed comedones) • Treat with benzoyl peroxide wash qam, clindamycin qam, and retina qpm • Advise pt acne will get worse 4-6 wks, may take up to 3 mos for improvement (do not back earlier than 3mos)

  26. Acne (moderate to severe) • Typically requires oral antibiotic (doxy 100mg BID or tcn 500 mg bid, then minocin 100 mg bid) or accutane • In addition to topical clindamycin, retina, benzoy peroxide wash

  27. Cystic Acne

  28. Rosacea • Treat with metrocream bid, azelaic acid bid, or PO tetracycline • No good treatment to get out redness, can use laser therapy • Avoid triggers

  29. Rosacea

  30. Seborrheic Dermatitis • Treat with nizoral cream bid, nizoral shampoo as face wash, sometimes low dose top steroid (desonide) • Typically seen in adult men

  31. SebDerm

  32. Ezcema • Atopic dermatitis- typically occurs in children, improves as adults • Treat with moisturizers (and lots of them eucerin, aquaphor, cetaphil), cetaphil soap in shower, top steroids (tac ointment bid for 3 wks then off for 1 wk), oral antihistamines (zyrtec qam and atarax qpm)

  33. Ezcema

  34. Dyshidrotic Ezcema • Pomphylox • Ezcema on the hands/feet in adults • Develop little blisters/peeling/erythema • Confused with tinea or pustular psoriasis (also check KOH) • Treat with moisturizer eucerin and strong topical steroid (lidex or clobetasol), limit hand washing (use cetaphil soap)

  35. Hand Ezcema

  36. Nickel • Most common allergen • Commonly seen in kids w atopic derm • Belt buckles, pants buttons, watches, jewelry • Pt needs to stop wearing product, can sew patch over pants button or paint clear nailpolish • Treat with topical steroid (tac or lidex bid for several weeks)

  37. Psoriasis • Seen in males/females, all ages • Auspitz sign- pinpoint bleeding when removing scale • Typically have papule and plaques with silvery scale • Subtypes include guttate, palmoplantar, pustular, inverse

  38. Psoriasis

  39. Psoriasis

  40. Inverse Psoriasis

  41. Psoriasis • Treatment: if guttate psoriasis- check for strep and if positive treat • Moisturizer to areas, topical steroid (lidex) alternating with dovonex, light therapy

  42. Lichen Planus • Pruritic, Planar, Polygonal, Purple Papules

  43. Lichen Planus • Typically around joints (wrists, ankles) • No great treatment, topical steroids provide some relief, if severe may need oral immunosuppresants

  44. Acne Keloidalis Nucha • Occurs more commonly in darker skinned pts • Bumps on the back of the neck, can develop into keloids • Treat with doxy for sevmos, top clindamycin, and clobetasolsoln

  45. Pseudofolliculitis Barbae • Treat with retina, top antibiotics, hydroquinone, stop shaving, laser (laser works the best) • Can develop scarrring and keloids from inflammation

  46. Acanthosis Nigricans • Seen in obesity, diabetes, pineal tumors, idiopathic ( overweight teenage girls) • No treatment

  47. Hidradenitis Suppurativa • Double comedones, cysts, sinus tracts • Treat with oral and topical antibiotics, hibiclens/benzoyl peroxide to wash, sometimes accutane, surgery

  48. Capillaritis • Schamberg’sDz • Pigmented purpura • Cayenne pepper

  49. Stasis Dermatitis • Older individuals • Blood supply is compromised • Treat with exercise, compressive stockings, emollients • Many times misdiagnosed as cellulitis refractory to antibiotics

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