Class12.rtf

class 12
dermatology
multiple causation: can have inner causes manifesting on the skin - there are some skin disorders, primary (begin on skin), should know- patients will also ask about something (like a mole) - raised, with cellular debris, pus, wbc, bacteria (more next week: acne) - looks the same, but filled with clear fluids (herpes, for example) - solid lesion (deposits of calcium etc that are not normal) - change in skin color (black and blue, is macule); flush with surrounding tissue - for example,herpes is a macular vesicular lesion - macular, all red, with vesicle lesion on top depigmentation.
- tends to run in families- doesn't tan- considered autoimmune - genetic flaw- problem in gene that makes tyrosinase - which converts tyrosine (amino acid) to melanin - so no pigment in skin, hair and eyes (no melanin) primary skin infections.
- arising from the skin
- three of these are fungal, and then a few bacterial and viral
dermatophytosis- caused by dermatophytes, fungi from species tinea- tinea is more commonly known as ringworm- it is pruritic- if it affects scalp, tinea capitas - ungiium, (graying patches of scalp??, or loss of hair)- could possibly be some other syndromes- hair regrows - reddish outline of lesion, within clear and some red spots- very few (no) lesions outside border - when we look at candida, satellite lesions - jock itch- oral and topical pruritis- if you keep scratching, can have secondary bacterial infections - usually between toes, some cracking (webspace) - there is a fungal infection that doesn't look like this- tinea versicolor - similar to vitiligo in appearance- can be red, yellow, pink, tannish (cream color) (versicolor = various colors)- these don't absorb uv light, so they don't tan (so depigmentation)- "surfer's rot", but not as highly communicable- faintly pruritic ("kinda feels good to scratch")- tx: nizoral shampoo (anti-fungal shampoo), 10 or 15 min, 2 or 3 nights- preventive, once a month (has a tendency to reoccur) candida, yeast- specifically candida albicans - opportunistic; immune system drops, pH altered etc - change in quantity of normal bacteria flora - women on antibiotics sometimes yeast infection - in mouth, vaginal canal, etc- looks like tinea, but satellite lesions outside the red border- tends to be dark moist (vaginal canal, groin, armpit)- this is pruritic (but not as bad as tinea)- western: topical anti-yeast lotion, oral anti-yeast meds- caprillic acid, garlic, acidopholis- not eating sugar (aids yeast) impetigo- bacterial, staph or strep- more common in children, very contagious- this is macular vesicular lesion - red is flat with surrounding skin, vesicle forms on top- there are vesicular lesions on an erythematous base - vesicle breaks open, honey colored oozes out, then crusts - gives it a "stuck on" appearance- no scarring - folliculitis- furuncles (boils)- carbuncles folliculitis- inflammation of the hair follicle- usu staph, staph aureus furuncles- has now spread from hair follicle- redness with white lesion - warm compresses help activate it (bring it to a head)- supposedly tenderizing a leaf of cabbage carbuncles- a group of furuncles that coalesce together- can have systemic symptoms (fever, malaise)- common on nape of neck- diabetics more prone, others with immune compromised so, folliculitis, topical antibiotics- furuncles: want it to come out, ooze and keep covered, antibiotic lotion- carbuncles, often oral antibiotics along with topical (penicillin) - hpv, human papilloma virus- cryotherapy, but notorious for reoccurrence- burning - HSV1 causes oral herpes- maculo vesicular lesion, fluid filled - HSV2 is genital - hangs out in sacral ganglia- 1 shows in trigeminal ganglia - runs along thoracic, along the ribs (thoracic intercostal nerve)- travels along dermatome- varicella (same which causes chicken pox)- can be from chicken pox (goes into ganglia)- not pruritic, but can be painful (can be some neuralgia)- erythematous base, vesicles forming , clear fluid, pop open and crust (like chickenpox)- never had cp? could potentially catch this from someone (but is difficult)- can go to mandibular branch (close to eyes)- rare, saw C8, t1 dermatitis.
- generic term (aka eczema), "wastebasket" term
- have to figure out why!
- many types, we discuss three
- contact dermatitis- eczema due to contact with offending substance- also mechanical contact dermatitis (poor fitting shoes) atopic dermatitis- aka atopy- is an allergic thing, definitely - chronic, inflammatory peeling of the skin, pruritic- more commonly infantile, and usu a family history of allergies- in the blood, high levels of IgE antibodies- could be food, whatever.key is to find out what seberiac dermatitis- infants or adults- inflammatory scaling disorders (such as dandruff)- if in infants, called "cradle cap"- can affect other areas- cause unkown- very pruritic - candida, would look a little like this in some places, but no scaling of skin scabies- burrows through epidermis, intense itching sensation, worse at night- lays egg in epidermis, larva come out to stratum cornea (outer layer)- burrow down again, nourish on keratin- can see in finger webs, little tiny lines, these are fecal matter- highly transmittable- insecticide lotion pediculosis, lice- capitas, head lice- see white little organisms at scalp- crabs, genital lice- body lice (corpora) bed bugs- 3 to 6 mm (visible)- live on host, suck blood, can hang out for long time (up to one year)- have to fumigate the house- pruritic- bite, see a red circumscribed lesion Rocky Mountain spotted fever- it's not the bite, it's the saliva for both - rickettsia rickettsi (organism) in saliva- likes rbc's, multiplies- goes to spleen, dies, organism released into blood - now symptoms- fever, h/a, muscle ache, n/v- a week after being infected - these symptoms followed by rash (wrist, ankles, palms, soles)- patient is pretty sick (hospitalization), antibiotics Lyme disease- borellia burgdorfi is the organism- transmits organism (above) from saliva- inflammatory disease, s/s: unique skin lesion called erythema chronicum migrans - usu on extremity, expands to trunk, buttocks- expands up to 50 cm- can be cardiac symptoms following, neurological, kidney or joint (weeks, months, year)- joint: lyme arthritis- all of these result of antigen antibody complex- prompt tx important

Source: http://www.bewellsf.com/tcm/pathophys/class12.pdf