THE K NOWLEDGE BYTE SE RI ES 4
THE K NOWLEDGE BYTE SE RI ES - 4 IADVL AP TEAM KRISHNA
KNOWLEDGE BYTE # 91 PEELS FOR MIXED PIGMENTATION Causes • • • Melasma Pigmented contact dermatitis Periorbital melanosis Solar lentigines Poikiloderma Fixed drug eruptions Actinic lichen planus Ashy dermatosis PIH Exogenous ochronosis CHOICE OF PEELS • Glycolic acid 50 -70% applied for 3 -20 minutes depending on the type & thickness of the skin, till erythema appears • TCA 25 -30% Combination peels : Glycolic acid 70% + TCA 25% Jessner’s + TCA 25% IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 92 HENRY DAGGETT BULKLEY • Was called a pioneer in American dermatology • Was an authority in cutaneous medicine & one of the first in the country to lecture on skin disorders • Established the first Skin Dispensary in America • Was the first president 7 founder of the New York Dermatological Society • Only dermatologist to serve as the president of New York Academy of Medicine IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 93 TUBEROUS SCLEROSIS - EPILOA TRIAD • Epilepsy • Low intelligence • Angiofibromas of face • Other cutaneous features include • Shagreen patch, fibrous patch, ashleaf macules, confetti like skin lesions, periungual fibromas IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 94 DIMPLE SIGN • Seen in Dermatofibroma • If overlying epidermis is squeezed over a lesion of dermatofibroma, a dimple is seen in the centre or if lateral pressure is applied to the lesion, a dimple is seen in the centre • The sign is due to tethering of overlying epidermis to the dermal lesion at the centre • Also known as Fitzpatrick Sign or Retraction Sign, Pinch Sign PS : A puckered dimple of skin just anterior to distal humerus in supracondylar fracture of humerus. It is a sign of difficult reduction IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 95 RETINOIDS - Classification 1 st generation 2 nd generation 3 rd generation non aromatic monoaromatic Polyaromatic Newer retinoids ? 4 th generation Bexarotene Seletinoid G Tretinoin Isotretinoin Etretinate Tazorotene Alotinoid Alitretinoin Acitretin Tamibarotene Etretin Retinoyl B glucuronide Motretinide Arotinoid sulfones Fenretinide • ADAPALENE is not classified as a retinoid. It is a derivative of naphthoic acid with retinoid like properties IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 96 TADPOLE CELLS • Are cells with ‘tadpole like’ shape • Presence of more than 10 tadpole cells in a tzanck smear at 100 magnification is a diagnostic indicator for vesicular spongiotic eczema • Stains : H& E IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 97 TERRY’S NAILS • Described by Terry in 1954 in 82% of cirrhotic patients • An example of apparent leukonychia • Proximal white nail with narrow distal pink or brown band (0. 5 -3 mm) • Seen in : Cirrhosis Congestive heart failure Adult onset Diabetes Mellitus Peripheral vascular disease HIV IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 98 PEELS FOR PERIORBITAL MELANOSIS • Lactic acid : start with 30% & gradually increase to 50% • Polybionic acids like lactobionic acid & gluconolactone can be used – mainly for dry & sensitive skin Combination peels • Citric acid – 70% Tricarboxylic acid • Lactic acid 15% + TCA 3. 75% • TCA 10 -15% peel : start with single coat, later 2 coats can be tried, once a month • Lactic acid + Arginine • Lactic + Kojic acid • Arginine + Vitamin-C 20% patch • Retinol peel IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 99 ADOLPH KUSSMAUL • A German physician • First to describe a case of vasculitis – polyarteritis nodosa • It was also called Kussmaul-Maier disease • His name continues to be used in many eponyms : Kussmaul breathing, Kussmaul’s sign, Kussmaul coma, Kussmaul aphasia • First to : describe dyslexia, progressive bulbar paralysis, diagnose mesenteric embolism, perform pleural tapping, gastric lavage, oesophagoscopy & gastroscopy IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 100 REITER’S SYNDROME TRIAD • Urethritis • Acute non-purulent seronegative arthritis • Conjunctivitis • Other cutaneous manifestations include circinate balanitis, erosions of buccal & rectal mucosa & keratoderma blennorrhagica IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 101 GOTTRON’S SIGN • Erythematous or violaceous scaly macules or patches on the metacarpophalangeal joints, proximal interphalangeal joints or distal interphalangeal joints • Is the most specific cutaneous finding • Present in atleast 70% of patients • Seen in Dermatomyositis IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 102 ISOTRETINOIN • Impacts all etiological factors implicated in acne • Sebosuppressive – antiandrogenic action at sebaceous level • Normalises ductal cornification • Comedolytic • Indirectly lowers P. acnes counts Dosing • 0. 5 mg-1 mg/kg in single or two divided doses after food • Total cumulative dose : 120 -150 mg/kg IADVL-AP TEAM KRISHNA Drug of choice • Nodulocystic acne • Refractory & difficult acne • Mild – moderate acne with imminent scarring Adverse effects • Teratogenic • Chelitis & dry skin • Susceptibility to local infections • Depression, psuchosis & suicidal ideation • Persistent headaches & hair shedding • Hypertriglyceridemia & elevated transaminases
KNOWLEDGE BYTE # 103 REITER CELLS • Are macrophages 40 microns in size • Contain one or more polymorphonuclear leucocytes & deep staining basophilic globular structures within the cytoplasm • Found in Reiter’s disease • 50 -70% of synovial fluid specimens show Reiter cells • Stain : H & E IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 104 MELANONYCHIA • Diffuse hyperpigmentation of nails • Multiple nails are affected Causes : • Racial pigmentation (constitutional) • Drugs • Malnutrition, Vit-B 12 deficiency • Pregnancy • Endocrine causes : hemochromatosis, hypopituitarism, hyperthyroidism, Addison’s disease, adrenal insufficiency (cushung’s syndrome), • HIV infection • Idopathic IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 105 AGING SKIN PROBLEMS • • Fine & deep wrinkles Dyschromias Dry rough skin texture Surface growths Dilated pores Vascular lesions Skin laxity Loss of volume IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 106 NIELS RYBERG FINSEN • Faroese physician & scientist of Icelandic descent • Believed to be the Father of Modern Phototherapy • Was awarded Nobel Prize in Medicine & Physiology in 1903 for his contribution to treatment of diseases – especially lupus vulgaris with phototherapy • Also researched the effects of low sodium diet IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 107 GRAVES DISEASE TRIAD • Pretibial myxedema – localised edematous & thickened pretibial plaque formation • Thyroid acropachy – clubbing of fingers & toes associated with soft tissue swelling of hands & feet & or periosteal new bone formation • Exophthalmos • Known as Diamond Triad IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 108 CROWE’S SIGN • Diffuse freckling of axillae in patients with Neurofibromatosis –Type 1 • Other cutaneous features of NF-1 include : café-au-lait macules & neurofibromas IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 109 ACITRETIN • Metabolite of etritinate • Binds to RARs & leads to alterations in gene transcription • Normalises epidermopoiesis • Reduces cell growth & proliferation • Reduces collagenase production • Has anti sebum effects, but < isotretinoin Dosing • 25 -30 mg daily for 2 -4 weeks & then dose escalation upto 75 -100 mg/day • Monitor liver enzymes & triglycerides IADVL-AP TEAM KRISHNA Indications • Psoriasis – generalised, pustular, • • • palmoplantar Dariers’ disease, PRP, LP Ichthyosis & other keratodermas Premalignant conditions like oral leukoplakia, Bowens disease Recalcitrant warts • Adverse effects • Teratogenic • Dyslipidemias • Arthralgias & myalgias • Spinal hyperostosis • Xerosis, photosensitivity, alopecia & superficial infections
KNOWLEDGE BYTE # 110 WARTHIN FINKLEDEY CELLS • Giant cells that vary in size • Contain as many as 100 nuclei per cell • Contains cytoplasmic or nuclear inclusions • Pathognomonic of measles • Cells found in reticuloendothelial system, kolpik spots, exanthem & respiratory secretions • Stains : H& E IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 111 DRUG INDUCED MELANONYCHIA Drugs implicated • Anti malarials • Minocycline • Phenytoin • Psoralens • Sulphonamides • Zidovudine • Anti metabolites : cyclophosphamide, doxorubicin, methotrexate, azathioprine IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 112 IADVL-AP TEAM KRISHNA GLOGAU CLASSIFICATION FOR PHOTOAGING TYPES AGE FEATURES Type – 1 Early wrinkles 20 s - 30 s Early photoaging, mild pigment changes Minimal wrinkles, No age spots, Requires little or no makeup Type – 2 Wrinkles in motion 30 s - 40 s Early to moderate photoaging, Appearance of smile lines, Early brown spots, Skin pores more prominent, Little make up Type – 3 Wrinkles in rest 50 s or older Advanced photoaging, Visible brown age spots, Prominenet brown pigmentation, Discoloration with telangiectasia & actinic keratosis Type – 4 Only wrinkles 60 s or 70 s Severe photoaging, Yellow-gray skin color, Multiple actinic keratosis, Wears makeup with poor coverage
KNOWLEDGE BYTE # 113 FERDINAND JEAN DARIER • French physician, pathologist, dermatologist • Called the Father of Modern Dermatology in France • Known for discovering several diseases – Follicular Keratosis (Darier White syndrome), Dermatofibrosarcoma (Darier -Ferrand disease), Subcutaneous sarcoidosis (Darier-Roussy sarcoid), Darier’s sign in Mastocytosis IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 114 PELLAGRA TRIAD • Dermatitis • Diarrhoea • Dementia • Due to Niacin deficiency • Dermatitis begins as symmetric erythema on sun exposed areas that later become hyperpigmented with desquamation & crusting • Casal’s necklace is the classical lesion IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 115 GROOVE SIGN • Seen in Lympho Granuloma Venereum • The sign has been originally described by Greenblatt • Enlargement of inguinal lymph nodes & femoral lymph nodes above & below the inguinal ligament forms a groove IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 116 BEXAROTENE • Selectively acts on retinoid X receptors which regulate apoptosis • Induces cell differentiation & apoptosis & prevents drug resistance Indications • Cutaneous lesions of Cutaneous T-cell lymphoma in patients refractory to atleast one prior systemic treatment Adverse effects • Teratogenic • Anti angiogenic • Hyperlipidemias • Inhibits cancer metastasis • Hypothyroidism Dosing • Leucopenia/Neutropenia • Available as 1% gel & 75 mg capsule (Targetrin) • LFT abnormalities • 300 mg/m 2/day PO in divided doses • Headache, asthenia, pruritus IADVL-AP TEAM KRISHNA • Pancreatitis • Photosensitivity/Phototoxicity
KNOWLEDGE BYTE # 117 WRIGHT CELLS • Are large macrophages that contain numerous protozoa grouped together in a typical swarm of bees fashion within the weakly basophilic cytoplasm • Seen in cutaneous & mucosal leishmaniasis • Stains : May Grunwald Giemsa IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 118 LONGITUDINAL PIGMENTED BAND • Appears in the distal matrix extending to the tip of the nail • Appears as brown or black streaks on the nail plate • May be single or multiple • Mostly benign • MELANOMA MUST BE EXCLUDED IADVL-AP TEAM KRISHNA Modified ABCDEF criteria for LPB • Age : 5 th -7 th decade • Band : brown or black, breadth > 3 mm • Border : irregular / blurred • Change : rapid change in growth &/ colour & failure of nail dystrophy with treatment • Digit involved : Thumb > Great toe > Index finger; single > multiple digits • Dominant hand • Extension : of pigment to proximal or lateral nail fold (Hutchison’s sign) • Family history / Personal history : previous melanoma or dysplastic nevus syndrome
KNOWLEDGE BYTE # 119 SUPERFICIAL PEELS FOR MINIMAL AGING SKIN TYPE OF PEEL CONDITIONS Glycolic acid 35 -50% Fine lines, dyschromias, open pores TCA 10 -25% Rough skin texture & superficial growths Salycilic acid 20 -30% Thick oily acne prone skin Lactic acid 40 -50% Dry & sensitive skin & rosacea Glycolic 50% + Kojic 10% Photoaging & pigmentation Tretinoin peel 1 -5% Mild photoaging IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 120 AUGUST PAUL VON WASSERMANN • German bacteriologist, worked under Robert Koch at Institute for Infectious Diseases in Berlin • Developed the first complement fixation test for Syphilis in 1906 – Wassermann Test • This test allowed for early detection of Syphilis (despite its nonspecific symptoms) & thus prevention of transmission IADVL-AP TEAM KRISHNA
KNOWLEDGE BYTE # 121 MELTZER’S TRIAD • Recurrent showers of dependent palpable purpura • Asthenia • Arthritis or arthralgia • Seen in Mixed Cryoglobulinemia (types 2&3) IADVL-AP TEAM KRISHNA
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