Introduction to Podiatric Dermatology

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Introduction to Podiatric Dermatology. abscess. desquamation. Jeffrey C. Page, DPM PMED 1741 Podiatric Dermatology and Infectious Diseases. Self-inflicted nail dystrophy. Introduction to Podiatric Dermatology. General Principles Skin anatomy Lesion types Patterns & Configurations - PowerPoint PPT Presentation

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  • Introduction to Podiatric DermatologyJeffrey C. Page, DPMPMED 1741Podiatric Dermatology and Infectious Diseases

    abscessdesquamationSelf-inflicted nail dystrophy

  • Introduction to Podiatric Dermatology General PrinciplesSkin anatomyLesion typesPatterns & ConfigurationsDisorders of SweatMechanical LesionsDepigmentation post steroid injectionExfoliation from reaction to gluten

  • Skin AnatomyLayersAppendagesPurpose

  • Epidermal LayersStratum corneumStratum lucidum (palms and soles)Stratum granulosumStratum spinosum (prickle cell layer)Stratum basale (germinativum)Merkels cells (storage granules)Langerhans cells (immune system)Melanocytes (produce melanin)Keratinocytes (produce keratin)

  • Dermal LayersDermal-epidermal junction = basement membranePapillary dermis (superficial)Reticular dermis (deep)VesselsNervesAppendages (adnexa)HairGlands (sweat & sebaceous)Nails

  • Subcutaneous LayerProduction and storage of fat cellsSupports blood vessels and nervesStorage of nutritionThermoinsulation

  • Description of LesionsPrimary LesionsSecondary LesionsElementary Lesionsmelanomaatrophy from injections

  • Descriptions Must Include:Lesion type/ textureSize/areaMoisture levelColorLocation

  • Primary LesionsMaculesPatchesPapulesPlaquesNodulesWheals

    VesiclesBullaePustulesCystsTumors

  • Macules & PatchesLentigoHyperpigmentation from venous stasisHypopigmentation from skin trauma

  • PapulesverrucaenevusKaposis sarcoma

  • Plaquespsoriasistinea corporis/pedis

  • NodulesNodular melanomaNeurofibromatosisHemangioma

  • Pustules

  • Vesicles & BullaeVesicular tineaherpesChicken Pox

  • Wheals (Hives)truncal placquesangioedemadermatographism

  • Angioedema

  • Cysts* & TumorsInclusion cystPedunculated nevus*Cysts are sometimes called special lesions

  • Secondary LesionsScalesCrustsExcoriationsFissuresUlcersErosionsScarsIndurationAtrophyLichenification?Plantar ulcer

  • ScalesIcthyosisSevere edema due to heart failureAtopic dermatitis

  • CrustsImpetigoScalp kerion

  • Erosions & UlcersosteomyelitisSyphilitic chancreCircinate balanitis

  • Fissures & AtrophyFissure from frequent dishwashingAtrophy and telangiectasia due to oral steroids

  • ScarskeloidHypertrophic scar following buionectomyHypopigmented scar from acneScars in construction worker

  • Elementary (Special) LesionsExcoriationsComedonesBurrowsPurpuraPetechiaeEcchymosesMacular or PapularTelangiectasiaLichenification?Cyst?Sebacious cyst

  • Elementary (Special) LesionsExcoriations in factitial dermatitisComedones

  • PurpuraVasculitides

  • Elementary (Special) LesionsBurrow in ScabiesTelangiectasia from sun exposure

  • Elementary (Special) LesionsLichenificationSpider Angioma

  • Patterns and ConfigurationsRoundAnnularDiscoidTargetoidNummularArciform-polycyclicGeographicHerpetiform-grouped

    Serpiginous-gyrateLinearReticularVerrucousGuttate

  • Round LesionsDiscoidAnnularDermatofibromaTinea pedis/corporis

  • Round LesionsTargetoidNummularErythema multiformeNummular eczema

  • Arciform (polycyclic)Lichen planus

  • Geographic LesionsPitted keratolysisPyoderma gangrenosumNecrobiosis lipoidica diabeticorummelanoma

  • Herpetiform (Grouped) LesionsHerpes zosterHerpes zoster

  • Serpiginous (Gyrate)Poison ivyLeishmaniasis

  • Linear Lesionswhealsscratches

  • Reticular (network) Lesionsnevi

  • Verrucous Lesionssolitarymosaic

  • Guttate LesionsMeaslesDiabetic dermopathyMeasles

  • Disorders of SweatHyperhidrosis (Excessive sweating)Bromhidrosis (foul odor associated with hyperhidrosis)Pomphylux (Dyshidrotic eczema)Not actually a sweat disorder

  • HyperhidrosisPrimary = Essential = IdiopathicSecondaryHyperthyroidismEndocrine Tx for CaSevere Psychiatric DisordersObesityMenopauseFebrile IllnessMedicationsThree forms:Emotionally InducedLocalizedGeneralizedCan cause significant emotional distress and occupational disability0.6-1.0 incidence20x more common in Japanese

  • Treatment of HyperhidrosisPrimaryAntiperspirants (aluminum chloride)Topical 20% aluminum chloride IontophoresisDrugs (sedatives or anticholinergics)Botulinum toxinSurgery (gland excision or sympathectomy)Alternative (e.g. herbs, acupuncture)SecondaryTreat underlying condition (e.g. anti-estrogens)

  • Mechanical LesionsHyperkeratosis marginalisTylomataCornsPlantar keratosesCutaneous hornFissuresBlistersHyperkeratosis Marginalis

  • TylomataDiffuseNon-nucleated

  • CornsHeloma molleHeloma durum

  • Plantar keratosesIPK = Nucleated, well-circumscribedNeurovasculare = very painfulPalmar plantar keratoderma

  • FissuresRegular emollient useAvoid barefootAvoid sandalsDebridementUse occlusionSuperglue

  • Cutaneous Horn

  • Padding to Reduce Hyperkeratosis

  • BlistersFrictionThermalChemicalBullous disorders

    IntraepidermalSubepidermal

    To de-roof or not to de-roof? Depends onLikelihood of further traumaRisk of infection

  • Hydrocolloid and Polyurethane Film Dressings

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