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Ddx for erythematous patch + long Hx of sun exposure |
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Definition
Squamous Cell Carcinoma (>2cm high risk; scaly, erythematous base, irreg borders, easy bleeding), Actinic keratosis (scaly patches easily felt), Basal cell carcinoma (waxy appearance, no itching or change in skin color, rarely mets), Melanoma (Dark brown or black pigmented lesions, ) Fungal infection (most acute presentation) |
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solid, raised, >1cm; in epidermis, dermis or subQ |
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solid mass of skin or subQ, larger than a nodule |
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fluid filled, raised, <1cm |
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fluid filled, raised, >1cm |
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area of elevated edema in upper epidermis |
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Typical Distribution patterns of skin lesions |
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Psoriasis: extensor surfaces atopic eczema: flexor surfaces of extremities erythema multiforme, syphillis, eczema: Palms and soles |
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Herpes simplex or herpes zoster |
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Prostate exam finds symmetrically firm and enlarged prostate... |
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BPH. Firm, nodular, asymmetric or indurated suggests malignancy |
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Corticosteroid creams Creams v Ointments v. Lotions and gels |
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Definition
Creams: mix of oils and water, cosmetically most acceptable, best for acute inflamm
ointments: little or no water, enhanced potency
lotions and gels: alcohol, often used in scalp, good for exudative inflamamation (poison ivy) |
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Group 1-6 topical corticosteroids used for |
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Definition
Group 1,2 (most potent) Psoriasis, lichen planus, eczema, alopecia areata Group 3.4,5: Atopic dermatitis, nunmmular eczema, statis dermatitis, seborrheic dermatitis Group 6.7 (weakest): Dermatitis in eyelids and diaper area, mild dermatitis on face, and mild intertrigo |
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Side fx of topical corticosteroids |
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Definition
Skin atrophy, hypopigmentation
Also: HPA axis suprression, glaucoma, HTN, |
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Oral therapy: Griseofulvin |
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Tinea unguium (onychomycosis) Rx |
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Oral therapy: Griseofulvin (long term therapy needed) |
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Tinea pedis, tinea magnum, tinea corporis and tinea cruris Rx |
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Definition
opical antifungal medications; 'Azole' cream, gel, lotion or shampoo |
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Squamous cell carcinoma in-situ Rx |
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Definition
1) Surgical excision 2) Moh's microscopic surgery (surgeon reviews pathology) 3) Topical 5-fluorouracil 4) Cryosurgery 5) Patient education: limit sun exposure and skin self exam |
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1.Behavior modification (limit fluids, diuretics) 2.Alpha adrenergic antagonists 3.5 alpha reductase inhibitors 4. Combo therapy 5. Surgery (if combo therapy fails, or risk of infection) |
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