Part 31. The Skin

Chapter 594. Morphology Of The Skin

Chapter 595. Evaluation Of The Patients

★Wood Lamp

# *ectothrix & some endothrix infection

    ; *blue-green fluorescence

# scale, crusts

    ; pale yellow

# tinea versicolor

    ; *golden fluorescence

    ; cf. dermatophyte lesions - no fluorescence

# erythrasma due to corynebacterium minutissimum

    ; pink-orange

# pseudomonase aeruginosa

    ; yellow-green

chapter 596. principle of therapy

Shampoos

# *Tar-containing shampoos (e.g. T-Gel, Ionil-T, Sebutone, Polytar)

    ; *useful for psoriasis and severe seborrheic dermatitis

topical corticosteroids

# two classes

    1) nonfluorinated

    2) fluorinated

# absorption은 ointment or gel vehicle이 더 강하다.

# adverse effects

    ; cutaneous atrophy, striae, telangiectasia, hypopigmentation, increased hair growth

Chapter 597. Diseases Of The Neonate

Sebaceous Hyperplasia

Milia

Sucking Blisters

Cutis Marmorata

# persistent lesions

    ; de Lange, Down, trisomy 18 syndrome

Harlequin Color Change

Salmon Patch (Nevus Simplex)

; small, pale, pink, ill-defined, flat vascular lesions

; sites

    - *glabella, eyelids, upper lips, nuchal areas

Monglian Spots

Erythema Toxicum

; evanescent eruption

; 50% of full-term

; *firm, yellow-white, 1- to 2- mmpapules or pustules with a surrounding erythematous flare

; peak incidence

    - 2nd day of life

Transient Neonatal Pustular Melanosis

Infantile Actropustulosis

Eosinophilic Pustular Folliculitis

Chapter 598. Cutaneous Defects

Branchial Clefts And Thyroglossal Cysts And Sinuses

# 2nd brachial cleft cyst

    ; *▲common

Focal Facial Dermal Dysplasia (Bitemporal Aplasia Cutis Congenita, Ectodermal Dysplasia Of The Face)

Chapter 600. Vascular Disorders

Port-Wine Stain (Nevus Flammeus, Port-Wine Nevus)

# asso. syndrome

    ; *struge-weber, klippel-trenaunay-weber, rubinstein-taybi, cobb, beckwith-wiedemann, trisomy 13 syndrome

Capillary Hemangioma (Strawberry Nevus)

; *more common in girl

; favored sites

    - face, scalp, back, ant. chest

; ★Clinical Course

    - *60% involution by 5yr

    - *90-95% involution by 9yr

    - not correlated with size or site

    - *lip lesion mostly persistent

Cavernous Hamangioma

; diffuse, ill-defined, deeply situated lesion

 

Kasabach-Merritt Syndrome

; *comination of rapidly enlarging hemangioma, thrombocytopenia, acute or chronic consumption coagulopathy

Clinical Manifestation

    ; usually during earyl infancy

★Treatment

    ; systemic steroids

    ; embolization

    ; radiation therapy

    ; *aminocaproic acid - inhibits fibrinolysis

    ; *recombinant IFN-α

Prognosis

    ; mortality 20-30%

Chapter 601. Cutaneous Nevi

Congenital Melanocyte Nevus

Giant Congenital Pigmented Nevi

; commonly on post. trunk

; *predispositon for malignant melanoma

Chapter 602. Hyperpigmented Lesions

Ephelides Or Freckles

; light or dark brown macules less than 3mm

; poorly defined margins

; occur in *sun-exposed area such as face, upper back, arms, hands

Lentigens

; round, dark brown macules < 3cm

; anywhere on the body

Peutz-Jeghers Syndrome

Cafe Au Lait Spots

♥Table 602-1

Incontinentia Pigmenti (Bloch-Sulzberger Disease)

; multisystem ectodermal disorder features dermatologic, dental, ocular abnormalities

Etiology

    ; *gene on chromosome Xq28

    ; random X-inactivation of X-linked dominant gene

           --> functional mosaicism

           --> lethal in male

Cutaneous Manifestations

# alopecia ; 80%

# ocular anomalies

    ; neovascularization, microphthlmos, strabismus, optic nerve atrophy, cataracts, retrolenticular masses

Chapter 603. Hypopigmented Lesions

Tuberous Sclerosis

Clinical Manifestation

# adenoma sebaceum

    ; *▲common cutaneous marker

# ★Shagreen Patch

    ; *large, skin-colored, irregularly thickened plaques with a orange peel or cobblestone texture in lumbosacral area

# renal angiomyiolipoma

    ; hematuria

 

 

 

 

Chapter 620. Tumors Of The Skin

Mucosal Neuroma Syndorme (Sippel Syndrome)

; AD

; athenic or marfanoid habitus

; scoliosis, pectus excavatum, pes cavus, muscular hypotonia

; thick patulous lips, soft tissue prognathism stimulating acromegaly

; multiple mucosal neuroma or neurofibromas

    - pink, pedunculated or sessile nodules on ant. third of tongue, at commissures of lips, buccal mucos, palpebral conjunctiva

; ass. symptom

    - medullary carcinoma ass. with high calcitonin levels, pheochromocytoma, hyperparathyroidism