The World of Dermatology
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1 The World of Dermatology, F.A.A.D. Assistant Professor of Dermatology University of Nevada School of Medicine Director of J. Woodson Dermatology & Associates, LTD
2 Objectives Cite the advances in management as they relate to screening, diagnosis, and therapy Identify the optimal techniques in therapy with skin malignancies Assess how new data and therapeutic techniques can be incorporated in the individualized treatment of patients Review medical and surgical options for the management of skin diseases Describe the pathophysiology of immune-mediated chronic inflammatory diseases Outline the benefits and limitations of new and emerging immunosuppressive, anti-inflammatory, and disease-modifying treatments for immune-mediated chronic inflammatory diseases
3 Can You Identify This Condition?
4 Erythema Nodosum Clinical Red, tender nodules, anterior shin's, size, lower extremities and upper extremities Onset fever, chills, malaise, leukocytosis, arthropathy Immunologic reaction triggered, medications, benign and malignant systemic illness, bacterial, viral, fungal infections Infections Streptococcal, tuberculosis, Yersinia, coccidioidiomycosis, histoplasmosis, dermatophytes Acute respiratory illness, viruses, infectious mononucleosis, cat scratch disease, hepatitis B, sarcoidosis Sulfonamides,bromides,oral contraceptives Enteropathies,ulcerative colitis, Crohn's disease, malignancies lymphoma, leukemia, cervical cancer Spontaneous resolution 3 to 6 weeks, nonsteroidalanti-inflammatory's, systemic steroids, potassium iodide mg Q day
5 Can You Identify This Condition?
6 Cutaneous T-cell lymphoma (Mycosis Fungoides) Clinical Types Patch and plaque stage, hypopigmentedtype, pigmented purpura, alopecia mucinosa, erythrodermas, tumor stage, granulomatous and slack skin, pagetoid reticulosis Flat and raised lesions, pruritus, females, epidermotropism, increased mucinin follicles, tumor stage poor prognosis Diagnoses Biopsy at three month intervals, clonalityassists, malignant clonal T cell populations(cd4+/cd7-),cd4/cd8 ratio expansion into blood, memory cell marker CD45RO elevation peripheral blood involvement
7 Cutaneous T-cell lymphoma (Mycosis Fungoides) SezaryCells -enlarged hyper convoluted nuclei, activated T cells, 100 cells counted to assess percentage, greater than 5% poor prognosis Pognosis-10% or less median survival 12 years, tumors no involvement median survival 2-3 years Treatment -dapsoneor sulfa pyridine, intralesionaland topical high potency steroids
8 Can You Identify This Condition?
9 Nevoid basal cell carcinoma syndrome (Gorlinsyndrome) AD, patched gene (inhibits hedgehog signaling pathway) Decreased patched therefore increased smoothened gene therefore uncontrolled cell proliferation Frontal bossing, bifid ribs, calcification of falx cerebri, multiple basal cell carcinoma's, palmoplantar pits, painful odontogenic jaw cysts, medulloblastoma, hypertelorism and ovarian fibromas
10 Malignant Melanoma Sentinel node biopsy -greater than 1 mm or less than 1 mm with ulceration New biologic therapy's, interferon alpha Prognosis -Breslowdepth for primary lesion, ulceration second most important, sentinel node most important predictor for overall survival Poor prognosis -head and neck, increased number of nodes, metastasis visceral, increasing age, male, acral lentiginous type
11 Identify This Unknown!
12 Arsenical Keratosis
13 Identify This Unknown!
14 Erythrasma
15 Identify This Unknown!
16 Secondary Syphilis
17 Identify This Unknown!
18 Dental Fistula
19 Identify This Unknown!
20 Black Heel (Tinea Pedis)
21 Identify This Unknown!
22 Kaposi's Sarcoma (AIDS related)
23 Summary Identified common dermatologic conditions Addressed medical and surgical options for the management of skin diseases Described how new data and therapeutic techniques can be incorporated in the individualized treatment of patients Described the pathophysiology of immune-mediated chronic inflammatory diseases Outlined the benefits and limitations of new and emerging immunosuppressive, anti-inflammatory, and disease-modifying treatments for immune-mediated chronic inflammatory diseases
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