Scaling Lesions

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created 10 years ago by brclancy
I got skills! ...I mean scales.... *must be above 18 to use these I believe*
updated 10 years ago by brclancy
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Dermatophyte infection; annular, scaly patch with a discrete pink border (classic lesion)



group of fungi capable of infecting keratinized tissue (skin, hair, nails)

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Tinea Capitis
Scaling patches, with patchy alopecia
can be pustulous or a boggy mass (kerion)
associated pruritis/fever/pain

Tx: systemic antifungal (terbinafine, griseofulvin)

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Tinea Corporis

annular lesions; erythmatous; scaling; with raised margins and central clearing

direct contact transmission

Tx: topical, systemic antifungals

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Tinea Faciei

annular lesions; erythmatous; scaling; with raised margins and central clearing

direct contact transmission

Tx: topical, systemic antifungals

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Tinea Cruris

Multiple red papulovesicles with well marginated raised border

Scrotum usually spared (differentiate from candidal infections)

Tx: topical, systemic antifungals

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Tinea Pedis

Infection on interdigital spaces and soles of feet

Scaling and Fissuring is common

similar presentation as Tinea Manum (also two feet one hand)

Tx: topical, systemic antifungals

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Tinea Versicolor KOH prep

"spaghetti and meatballs" appearence

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Onychomycosis (Tinea Ungum)

Thickened yellow nails with subungual debris

often patient will present with Tinea on another part of the body

Tx: systemic (Lamisil, Sporonox)
ciclopirox nail lacquer (Penlac), requires year of treatment

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Candida Albicans (yeast)
*notice budding yeast forms and pseudo-hyphae

may present as thrush, vaginitis, balanitis, diaper dermatitis, intertrigo, nail infections

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Thrush (oral candidiasis)

white patches on the tongue and buccal mucosa
scrapes off leaving bright red surface

Tx: nystatin swishes, clotrimazole

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Candidal Angular Cheilitis

Redness and fissuring at oral commissures
associated with lip licking or sagging skin

Tx: topical nystatin, clotrimazole, myconazole, ketoconazole

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Candidal Intertrigo

occurs in skin fold type areas (intertrigenous)
Vesicopustules; eryethema, erosions surrounded by peripheral scaling
satellite lesions common

Tx: topical clotrimazole, miconazole, nystatin

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Candidal Intertrigo

*Not diaper rash! because of occurrence in skin folds and satellite lesions*

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Tinea Versicolor

Scaly hypopigmented patches (can be hyperpigmented)
Scales can be scraped off easily
Patches fail to tan

Tx: Ketocnazol shampoo, or Selsun Blu

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Seborrheic Dermatitis

Greasy yellow scales on erythematous background
Can be found on scalp, beard, eyebrows, cheeks, eyelid margins, sternum
Called cradle cap in infants

Tx: Ketoconazole or selsun blu shampoos; topical ketoconazole cream or mid potency steroid creams

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red, demarcated plaque with adherentsilver scales
often found on extensor surfaces, but can be found anywhere, including genitals (the scrotum is not spared, like Tinea Cruris)

Can be chronic, or occur after trauma or stressful events, pregnancy, metabolic syndrome

Tx: topical steroids, retinoids, Vit. D analogues, UV therapy, biologics, acitretin, methotrexate, cyclosporin

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pitting, oil spots, onycholysis

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Pityriasis Rosea

Oval, erythematous, papules and plaques with trailing scale
often found on trunk, prox. limbs and along skin tension lines
Often preceded by a herald patch

acute and self-limiting

Tx: symptomatic treatment only; topical corticosteroids, UV therapy, oatmeal baths, calamine lotion


Atopic Triad

asthma, allergic rhinitis, eczema

*the three factors often associated with atopic dermatitis

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Atopic Dermatitis
(in infants)

pruritic, pink papules and plaques on extensor surfaces and face
erythematous scaling
can be associated with nasal crease or Dennie-Morgan folds (infraorbital creases)

risk for bacterial infections

Tx: HYDRATION, topical steroids/calcineurin inhibitors, antihistamines, UV therapy

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Atopic Dermatitis

pruritic and associated with xerosis
erythematous patches and plaques, with scaling, excoriations or lichenification
often found on flexor surfaces in adults
can be found on hands

Tx: HYDRATION, topical steroids/calcineurin inhibitors, antihistamines, UV therapy


Allergic Contact Dermatitis

pruritic, eczematous reaction to allergen
ie poison ivy, nickel

can also present as vessicles and bulla

Tx: History is important! Identify allergen and avoid it, topical steroids, immunomodulators, taper of oral corticosteroids


Irritant Contact Dermatitis

reaction ranging from erythema, edema, vesicles, bulla, oozing, and in severe cases, necrosis or ulceration
Due to irritants such as acids and alkalais
(low grade irritants such as solvents can produce less severe results

Tx: avoid insult; emollients; topical steroids

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Stasis Dermatitis
(leaky veins)

Chronic erythema and scaling often seen in association with other signs of venous hypertension (varicosities, edema, hx of DVT)

*REMEMBER, differentiate with cellulitis which is usually unilateral and is not scaling*

Tx: emollients, topical steroids, support stockings, elevation of legs, weight loss

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Nummular Dermatitis

Circular/oval shaped scaly plaques, +/- vesicles and pustules
generally found on extensor surfaces and the tibia

Can occur at any age on anyone, but common in young women

scrape and KOH to differentiate from Tinea

Tx: emollients, topical steroids/calcineurin inhibitors

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Lichen Simplex Chronicus

Hyperpigmented leathery plaques due to habitual scratching and rubbing
Pronounced skin lines

Tx: break itch/scratch cycle; antipruritics; topical/interlesional corticosteroids; antihistimines

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Asteatotic Eczema

Dry, rough, scaly, and inflamed skin often resembling a "dry river bed"

Generally effects lower body

Tx: management of xerosis: emollients, luke warm baths; topical steroids to reduce flare