Papules and Disorders of Pigmentation

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1

What is Verruca (Warts)?

Growth of epidermal cells secondary to infection with Human Papilloma Virus (HPV)

2

What are the different types of Verruca (warts)?

Verruca vulgaris – common warts (HPV 1,2,4)
Plantar warts (HPV 1,2,4)
Verruca plana – flat warts (HPV 3)
Condyloma acuminatum – genital warts
(benign genital warts are from HPV 6 and 11)
(oncogenic genital warts are from HPV 16 and 18)

3

Differential Diagnosis of Warts

Seborrheic keratosis
Lichen planus
Acrochordon (skin tag)
SCC

4

What is the treatment?

Destruction by freezing or electrodessication
Salicylic acid
Immune modulation (Aldara)
Tretinoin
Efudex-very aggressive
Trichloracetic acid
Cantharidin (“beetle juice”)
Intralesional immunotherapy (candida antigen, etc)-you infect the skin and expect the skin to create an immune response

5
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Plantar Wart

6

What is Molluscum Contagiosum?

benign growth due to pox virus infection

7

What does Molluscum Contagiousum look like?

Umbilicated, flesh-colored papule

8

How is it transmitted in children and adults?

Children: transmitted by skin to skin contact
Adults: considered an STD or by contact sports

9

What is the differential dx?

flat warts, genital warts, adnexal tumors, BCC, amelanotic melanoma

10

What is the treatment?

Destruction, tretinoin or immune modulation (Aldara)

11
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Molluscum Contagiousum

12
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What is an Epidermal Inclusion Cyst?
What is it erroneously called?

Epithelial-lined sac in the dermis with connection to epidermis, filled with keratin
It is MOBILE, subcutaneous nodule with central punctum
Erroneously called “sebaceous cysts”

13

What is the treatment?

if symptomatic, excision and can prescribe antibiotics

14

What is a Callus?

more general thickening due to chronic rubbing of epidermis

15

What is a Corn (clavus)?

focal pressure on BONY prominence (where shoes are rubbing)

16

What is the differential diagnosis?

wart, foreign body reaction, SCC

17

What is the treatment?

mechanical or chemical paring down, changing footwear

18

What is seborrheic keratoses?

Benign neoplasm of keratinocytes; appear to have a hereditary tendency

19

What do they look like?

Waxy, brown, stuck-on papule on any cutaneous surface except palms and soles

20

What are the several variants?

stucco keratoses, dermatosis papulosa nigra (DPN)

21

What is the differential dx?

nevus, melanoma, pigmented BCC, skin tag

22

What is the treatment?

Destruction or surgical removal
LN2
Acid peels
Dessication
Shave removal-if you are worried it is malignant
Curretage

23
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Seborrheic Keratoses
(The key is that is looks like someone stuck it there)

24

What is Acrochordons?

Skin Tags
Benign neoplasm of epidermis usually in areas of friction
Seen in approx 25% of adults; likely familial tendency

Usually skin colored; can be hyperpigmented

25

What is the differential dx?

neurofibroma, pedunculated nevus (intradermal benign mole

26

What is the treatment?

Destruction by snip excision or cryodestruction

27
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Skin tag

28

What is a neurofibroma?

Benign tumors of the peripheral nerve sheath

29

What does it look like?

Soft, flesh-colored or hyperpigmented papules

30

What are the types?

Sporadic
Neurofibromatosis, Type I
AD, NF-1 gene mutation (neurofibromin)
CALM, axillary freckling, Lisch nodules, neurofibromas

31

What is the treatment?

None required; surgical removal if desired

32
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Neurofibroma

33

What is Ephelides?

"freckles"
benign increase of melanin in the basal layer of the epidermis
it is present by age 3 after UV exposure
marker for susceptibility to skin cancer

34

What is the differential diagnosis?

lentigo, junctional nevus

35

What is the treatment?

Bleaching creams (hydroquinone)
Chemical peels
Laser removal
Sunscreen important for prevention

36
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ephelides

37

What is Lentigo?

benign increase in number of melanocytes in the basal layer of the epidermis

38

What are the different types?

Simple and solar

39

What is the differential dx?

Ephelides, junctional nevi, lentigo maligna

40

What is the treatment?

Bleaching creams (hydroquinone), chemical peel, laser removal
Encourage pts to wear their sunscreen!

41
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lentigo

42

What is Melasma?

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Hyperpigmented patches, usually on cheeks, chin, and forehead of young women
More common in patients with darker skin

Can be worsened/caused by pregnancy, oral contraceptives

43

What is the treatment?

Change or stop causal medication, bleaching creams, retinoids, peels, laser, sunscreen

44

What is acquired Melanocytic Nevi?

Benign accumulation of melanocytes that develops during puberty and evolves over lifetime
Can be induced by sun exposure

45

The types are:
Junctional
Compound
Intradermal
How are they different?

Junctional-flat with pigment
Compound-raised with pigment
Intradermal-raised but no pigment

46

What is the treatment?

Benign and not required. But surgical removal if desired

47
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Junctional acquired melanocytic Nevi

48

What is Congenital Nevi?

Accumulation of melanocytes in skin, present from birth

Types: Small (<1.5cm), Medium (1.5-20cm), Large (>20cm)

No significant risk of development of melanoma

49

What is the treatment?

Observation, surgical removal if desired.

50
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LARGE congenital nevi

51

What is a Hemangioma?

Benign proliferation of capillary endothelium in epidermis
more common tumor of infancy

52

was is the differential dx?

vacular malformations

53

What is the treatment?

None unless tumor is causing functional deficit. IL or PO steroids, propranolol, laser removal

54
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Hemangioma

55

What is Vascular Malformation?

Developmental error in a combination of capillary, venous, or lymphatic tissue
Port-wine stain, nevus flammeus (“stork bite” or “salmon patch”)
-Grows proportional to child
Lesions do NOT resolve

56

What is the treatment?

Laser removal

57
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Vascular malformation

58

What is acne?

Disease of pilosebaceous unit with open and closed comedones, papules, pustules and possible nodules on face, chest, and back
can leave significant scarring

59

What are the aggravating factors?

Hormonal influence on hair follicle
Propionibacterium acnes

60

What is thet treatment?

Topical retinoids, oral and/or topical antibiotics, BPO, and systemic retinoids (Accutane)

61
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Severe case of acne

62
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acne present as well as scarring

63

What is rosacea?

Chronic inflammatory disorder of the blood vessels and pilosebaceous units of the face; “adult acne”

64

What are the stages?

-Flushing
-Persistent erythema (redness)
-Papules/ pustules
-Rhinophyma

65

What is the treatment?

SUNSCREEN, avoid triggers (alcohol, spicy foods, hot foods/drink, caffeine), oral antibiotics, topical metronidazole, lasers

66
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Rosacea

67

What is vitiligo?

Acquired depigmentation of the skin thought to be autoimmune
Melanocytes attacked by immune system
Many variations, usually symmetric

68

What is the differential dx?

post-inflammatory hypopigmentation, tinea versicolor, idiopathic guttate hypomelanosis, pityriasis alba

69

What is the treatment?

15-25% spontaneous repigmentation
Sunscreen
Cosmetic cover-ups
Topical steroids or calcineurin inhibitors
UV light therapy
Total depigmentation to be considered if >50-80% involvement

70
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vitiligo

71

What is Albinism?

-Partial or complete congenital absence of pigment in the skin, hair, and eyes (oculocutaneous) or eyes alone (ocular)
-Melanocytes present, but non-functional
-Multiple forms with defects in various parts of melanin formation or transport

-Multiple syndromes associated with albinism
-Serious sequelae: skin cancer and visual disturbances

72

What is the treatment?

No effective treatment to allow for repigmentation
Sun protection and avoidance
Skin surveillance
Appropriate screening for associated abnormalities depending on particular syndrome

73
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Albinism


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