Introduction to Podiatric Introduction to Podiatric DermatologyDermatology

Jeffrey C. Page, DPMJeffrey C. Page, DPMPMED 1741PMED 1741

Podiatric Dermatology and Infectious Podiatric Dermatology and Infectious DiseasesDiseasesabscess

desquamation

Self-inflicted nail dystrophy

Introduction to Podiatric Introduction to Podiatric Dermatology Dermatology

General PrinciplesGeneral Principles Skin anatomySkin anatomy Lesion typesLesion types Patterns & ConfigurationsPatterns & Configurations

Disorders of SweatDisorders of Sweat Mechanical LesionsMechanical Lesions

Depigmentation post steroid injection

Exfoliation from reaction to gluten

Skin AnatomySkin Anatomy

Layers

Appendages

Purpose

Epidermal LayersEpidermal Layers

Stratum corneumStratum corneum Stratum lucidum (palms and soles)Stratum lucidum (palms and soles) Stratum granulosumStratum granulosum Stratum spinosum (prickle cell layer)Stratum spinosum (prickle cell layer) Stratum basale (germinativum)Stratum basale (germinativum) Merkel’s cells (storage granules)Merkel’s cells (storage granules) Langerhans’ cells (immune system)Langerhans’ cells (immune system) Melanocytes (produce melanin)Melanocytes (produce melanin) Keratinocytes (produce keratin)Keratinocytes (produce keratin)

Dermal LayersDermal Layers

Dermal-epidermal junction = basement Dermal-epidermal junction = basement membranemembrane

Papillary dermis (superficial)Papillary dermis (superficial) Reticular dermis (deep)Reticular dermis (deep) VesselsVessels NervesNerves Appendages (adnexa)Appendages (adnexa)

HairHair Glands (sweat & sebaceous)Glands (sweat & sebaceous) NailsNails

Subcutaneous LayerSubcutaneous Layer

Production and Production and storage of fat cellsstorage of fat cells

Supports blood Supports blood vessels and nervesvessels and nerves

Storage of nutritionStorage of nutrition ThermoinsulationThermoinsulation

Description of LesionsDescription of Lesions

Primary LesionsPrimary Lesions Secondary LesionsSecondary Lesions Elementary LesionsElementary Lesions

melanoma

atrophy from injections

Descriptions Must Include:Descriptions Must Include: Lesion type/ textureLesion type/ texture Size/areaSize/area Moisture levelMoisture level ColorColor LocationLocation

Primary LesionsPrimary Lesions

MaculesMacules PatchesPatches PapulesPapules PlaquesPlaques NodulesNodules WhealsWheals

VesiclesVesicles BullaeBullae PustulesPustules CystsCysts TumorsTumors

Macules & PatchesMacules & Patches

Lentigo

Hyperpigmentation from venous stasis

Hypopigmentation from skin trauma

PapulesPapules

verrucae

nevus Kaposi’s sarcoma

PlaquesPlaques

psoriasis

tinea corporis/pedis

NodulesNodules

Nodular melanoma

Neurofibromatosis

Hemangioma

PustulesPustules

Vesicles & BullaeVesicles & Bullae

Vesicular tinea

herpesChicken Pox

Wheals (Hives)Wheals (Hives)

truncal placques

angioedema

dermatographism

AngioedemaAngioedema

Cysts* & TumorsCysts* & Tumors

Inclusion cyst

Pedunculated nevus

*Cysts are sometimes called special lesions

Secondary LesionsSecondary Lesions

ScalesScales CrustsCrusts ExcoriationsExcoriations FissuresFissures UlcersUlcers

ErosionsErosions ScarsScars IndurationInduration AtrophyAtrophy Lichenification?Lichenification?

Plantar ulcer

ScalesScalesIcthyosis

Severe edema due to heart failure

Atopic dermatitis

CrustsCrusts

Impetigo

Scalp kerion

Erosions & UlcersErosions & Ulcers

osteomyelitis

Syphilitic chancre

Circinate balanitis

Fissures & AtrophyFissures & Atrophy

Fissure from frequent dishwashing Atrophy and

telangiectasia due to oral steroids

ScarsScars keloid

Hypertrophic scar following buionectomy

Hypopigmented scar from acne

Scars in construction worker

Elementary (Special) LesionsElementary (Special) Lesions

ExcoriationsExcoriations ComedonesComedones BurrowsBurrows PurpuraPurpura

PetechiaePetechiae EcchymosesEcchymoses Macular or PapularMacular or Papular

TelangiectasiaTelangiectasia Lichenification?Lichenification? Cyst?Cyst?

Sebacious cyst

Elementary (Special) LesionsElementary (Special) Lesions

Excoriations in factitial dermatitis

Comedones

PurpuraPurpura

Vasculitides

Elementary (Special) LesionsElementary (Special) Lesions

Burrow in Scabies

Telangiectasia from sun exposure

Elementary (Special) LesionsElementary (Special) Lesions

Lichenification Spider Angioma

Patterns and ConfigurationsPatterns and Configurations

RoundRound AnnularAnnular DiscoidDiscoid TargetoidTargetoid NummularNummular

Arciform-polycyclicArciform-polycyclic GeographicGeographic Herpetiform-groupedHerpetiform-grouped

Serpiginous-gyrateSerpiginous-gyrate LinearLinear ReticularReticular VerrucousVerrucous GuttateGuttate

Round LesionsRound Lesions

Discoid Annular

DermatofibromaTinea pedis/corporis

Round LesionsRound Lesions

Targetoid Nummular

Erythema multiforme

Nummular eczema

Arciform (polycyclic)Arciform (polycyclic)Lichen planus

Geographic LesionsGeographic Lesions

Pitted keratolysis

Pyoderma gangrenosum

Necrobiosis lipoidica diabeticorummelanoma

Herpetiform (Grouped) LesionsHerpetiform (Grouped) Lesions

Herpes zosterHerpes zoster

Serpiginous (Gyrate)Serpiginous (Gyrate)

Poison ivy Leishmaniasis

Linear LesionsLinear Lesions

wheals

scratches

Reticular (network) LesionsReticular (network) Lesions

nevi

Verrucous LesionsVerrucous Lesions

solitary mosaic

Guttate LesionsGuttate Lesions

MeaslesDiabetic dermopathy

Measles

Disorders of SweatDisorders of Sweat

Hyperhidrosis Hyperhidrosis (Excessive sweating)(Excessive sweating)

Bromhidrosis (foul Bromhidrosis (foul odor associated with odor associated with hyperhidrosis)hyperhidrosis)

Pomphylux Pomphylux (Dyshidrotic eczema)(Dyshidrotic eczema) Not actually a sweat Not actually a sweat

disorderdisorder

HyperhidrosisHyperhidrosis

Primary = Essential = Primary = Essential = IdiopathicIdiopathic

SecondarySecondary HyperthyroidismHyperthyroidism Endocrine Tx for CaEndocrine Tx for Ca Severe Psychiatric Severe Psychiatric

DisordersDisorders ObesityObesity MenopauseMenopause Febrile IllnessFebrile Illness MedicationsMedications

Three forms:Three forms: Emotionally InducedEmotionally Induced LocalizedLocalized GeneralizedGeneralized

Can cause significant Can cause significant emotional distress emotional distress and occupational and occupational disabilitydisability

0.6-1.0 incidence0.6-1.0 incidence 20x more common in 20x more common in

JapaneseJapanese

Treatment of HyperhidrosisTreatment of Hyperhidrosis PrimaryPrimary

Antiperspirants (aluminum chloride)Antiperspirants (aluminum chloride) Topical 20% aluminum chloride Topical 20% aluminum chloride IontophoresisIontophoresis Drugs (sedatives or anticholinergics)Drugs (sedatives or anticholinergics) Botulinum toxinBotulinum toxin Surgery (gland excision or sympathectomy)Surgery (gland excision or sympathectomy) Alternative (e.g. herbs, acupuncture)Alternative (e.g. herbs, acupuncture)

SecondarySecondary Treat underlying condition (e.g. anti-Treat underlying condition (e.g. anti-

estrogens)estrogens)

Mechanical LesionsMechanical Lesions

Hyperkeratosis Hyperkeratosis marginalismarginalis

TylomataTylomata CornsCorns Plantar keratosesPlantar keratoses Cutaneous hornCutaneous horn FissuresFissures BlistersBlisters

Hyperkeratosis Marginalis

TylomataTylomata

DiffuseDiffuse Non-nucleatedNon-nucleated

CornsCorns

Heloma molle Heloma durum

Plantar keratosesPlantar keratoses

IPK = Nucleated, well-circumscribed

Neurovasculare = very painful

Palmar plantar keratoderma

FissuresFissures

Regular emollient useRegular emollient use Avoid barefootAvoid barefoot Avoid sandalsAvoid sandals DebridementDebridement Use occlusionUse occlusion SuperglueSuperglue

Cutaneous HornCutaneous Horn

Padding to Reduce HyperkeratosisPadding to Reduce Hyperkeratosis

BlistersBlisters

FrictionFriction ThermalThermal ChemicalChemical Bullous Bullous

disordersdisorders

IntraepidermalIntraepidermal SubepidermalSubepidermal

““To de-roof or not To de-roof or not to de-roof?” to de-roof?” Depends onDepends on Likelihood of further Likelihood of further

traumatrauma Risk of infectionRisk of infection

Hydrocolloid and Polyurethane Film Hydrocolloid and Polyurethane Film DressingsDressings

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