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Introduction to Podiatric Dermatology - SharingDoctors

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					     Introduction to Podiatric
           Dermatology
                  Jeffrey C. Page, DPM
                       PMED 1741
          Podiatric Dermatology and Infectious
abscess                  Diseases
                                                  desquamation


                  Self-inflicted nail dystrophy
       Introduction to Podiatric
             Dermatology
§ General Principles
  § Skin anatomy
  § Lesion types
  § Patterns & Configurations
§ Disorders of Sweat
§ Mechanical Lesions
                                   Exfoliation
                                   from reaction
                                   to gluten
         Depigmentation post
         steroid injection
Skin Anatomy
  Layers
  Appendages
  Purpose
             Epidermal Layers
§   Stratum corneum
§   Stratum lucidum (palms and soles)
§   Stratum granulosum
§   Stratum spinosum (prickle cell layer)
§   Stratum basale (germinativum)
§   Merkel’s cells (storage granules)
§   Langerhans’ cells (immune system)
§   Melanocytes (produce melanin)
§   Keratinocytes (produce keratin)
                Dermal Layers
§ Dermal-epidermal junction = basement
    membrane
§   Papillary dermis (superficial)
§   Reticular dermis (deep)
§   Vessels
§   Nerves
§   Appendages (adnexa)
    § Hair
    § Glands (sweat & sebaceous)
    § Nails
         Subcutaneous Layer
§ Production and
  storage of fat cells
§ Supports blood
  vessels and nerves
§ Storage of nutrition
§ Thermoinsulation
           Description of Lesions
 § Primary Lesions
 § Secondary Lesions
 § Elementary Lesions



melanoma




                          atrophy from injections
      Descriptions Must Include:
§   Lesion type/ texture
§   Size/area
§   Moisture level
§   Color
§   Location
       Primary Lesions
§   Macules     §   Vesicles
§   Patches     §   Bullae
§   Papules     §   Pustules
§   Plaques     §   Cysts
§   Nodules     §   Tumors
§   Wheals
       Macules & Patches



                         Lentigo




Hyperpigmentation    Hypopigmentation
from venous stasis   from skin trauma
        Papules



                   verrucae




nevus         Kaposi’s sarcoma
Plaques
  psoriasis




              tinea
              corporis/pedis
                   Nodules
                    Neurofibromatosis




Nodular melanoma




                                        Hemangioma
Pustules
         Vesicles & Bullae




              Vesicular tinea



Chicken Pox                     herpes
              Wheals (Hives)

                     truncal
                     placques




dermatographism




                                angioedema
Angioedema
                 Cysts* & Tumors

                                   Inclusion cyst




                  Pedunculated nevus


*Cysts are sometimes called
special lesions
       Secondary Lesions
§   Scales         §   Erosions
§   Crusts         §   Scars
§   Excoriations   §   Induration
§   Fissures       §   Atrophy
§   Ulcers         §   Lichenification?


                              Plantar ulcer
               Scales
                        Icthyosis




                            Severe edema due
                            to heart failure




Atopic dermatitis
Crusts

                 Impetigo




  Scalp kerion
          Erosions & Ulcers




                      osteomyelitis



Circinate balanitis
                                      Syphilitic chancre
          Fissures & Atrophy




Fissure from frequent
                        Atrophy and
dishwashing
                        telangiectasia due to oral
                        steroids
                      Scars     keloid




        Hypertrophic scar
        following buionectomy




                                Scars in
Hypopigmented scar from         construction
acne                            worker
    Elementary (Special) Lesions
§   Excoriations
§   Comedones
§   Burrows
§   Purpura
    §   Petechiae
    §   Ecchymoses
    §   Macular or Papular
§ Telangiectasia
§ Lichenification?           Sebacious cyst
§ Cyst?
Elementary (Special) Lesions




Excoriations in        Comedones
factitial dermatitis
 Purpura


Vasculitides
Elementary (Special) Lesions




 Burrow in        Telangiectasia from
 Scabies          sun exposure
Elementary (Special) Lesions




Lichenification    Spider
                   Angioma
     Patterns and Configurations
§ Round                   §   Serpiginous-gyrate
    §   Annular           §   Linear
    §   Discoid           §   Reticular
    §   Targetoid
                          §   Verrucous
    §   Nummular
                          §   Guttate
§   Arciform-polycyclic
§   Geographic
§   Herpetiform-grouped
                 Round Lesions




Dermatofibroma
                          Tinea pedis/corporis




  Discoid                 Annular
             Round Lesions

Erythema
multiforme




                       Nummular eczema




 Targetoid            Nummular
Arciform (polycyclic)
              Lichen planus
            Geographic Lesions
                            Pyoderma gangrenosum




Pitted keratolysis




                          Necrobiosis lipoidica
               melanoma   diabeticorum
Herpetiform (Grouped) Lesions




                      Herpes zoster
      Herpes zoster
         Serpiginous (Gyrate)




Poison ivy           Leishmaniasis
         Linear Lesions




                          scratches


wheals
Reticular (network) Lesions

             nevi
           Verrucous Lesions



solitary                       mosaic
          Guttate Lesions




Measles      Diabetic       Measles
             dermopathy
          Disorders of Sweat
§ Hyperhidrosis
  (Excessive sweating)
§ Bromhidrosis (foul
  odor associated with
  hyperhidrosis)
§ Pomphylux
  (Dyshidrotic eczema)
  § Not actually a sweat
    disorder
               Hyperhidrosis
§ Primary = Essential =   § Three forms:
  Idiopathic                § Emotionally Induced
§ Secondary                 § Localized
  § Hyperthyroidism         § Generalized
  § Endocrine Tx for Ca   § Can cause significant
  § Severe Psychiatric      emotional distress
    Disorders               and occupational
  § Obesity                 disability
  § Menopause             § 0.6-1.0 incidence
  § Febrile Illness
                          § 20x more common in
  § Medications             Japanese
      Treatment of Hyperhidrosis
§ Primary
  §   Antiperspirants (aluminum chloride)
  §   Topical 20% aluminum chloride
  §   Iontophoresis
  §   Drugs (sedatives or anticholinergics)
  §   Botulinum toxin
  §   Surgery (gland excision or sympathectomy)
  §   Alternative (e.g. herbs, acupuncture)
§ Secondary
  § Treat underlying condition (e.g. anti-
    estrogens)
           Mechanical Lesions
§ Hyperkeratosis
    marginalis
§   Tylomata
§   Corns
                        Hyperkeratosis Marginalis
§   Plantar keratoses
§   Cutaneous horn
§   Fissures
§   Blisters
Tylomata


     §   Diffuse
     §   Non-nucleated
               Corns




Heloma molle       Heloma durum
            Plantar keratoses
Palmar plantar
keratoderma




        IPK = Nucleated, well-
        circumscribed
        Neurovasculare = very painful
Fissures
    §   Regular emollient use
    §   Avoid barefoot
    §   Avoid sandals
    §   Debridement
    §   Use occlusion
    §   Superglue
Cutaneous Horn
Padding to Reduce Hyperkeratosis
                Blisters
                       §   Intraepidermal
§   Friction
                       §   Subepidermal
§   Thermal
§   Chemical
                       § “To de-roof or not
§   Bullous
                           to de-roof?”
    disorders
                           Depends on
                           § Likelihood of further
                             trauma
                           § Risk of infection
Hydrocolloid and Polyurethane Film
             Dressings
Describe this lesion
Describe this lesion
Describe this lesion
Describe this lesion
Describe this lesion
Describe this lesion

				
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posted:4/13/2014
language:English
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