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crazysupermedic
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what type of warts evolve into dome-shaped, gray-brown, hyperkeratotic papules with black dots on surface
Common warts (Verruca Vulgaris)
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what is the MC site for common warts (verruca vulgaris)
Hands most common site
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what is the tx for common warts (verruca vulgaris)
- Liquid nitrogen, repeated in 2-4 wks
- Light electrocautery
- Topical salicylic acid (may take months)
- Topical Imiquimod 5% (Aldara)
- Blunt dissection (large, resistant lesions)
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what type of wart is this
common wart (verruca vulgaris)
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which type of wart is this
filiform warts
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which type of wart has fingerlike, flesh-colored projections, and is most common found on the face
filiform warts
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what are filiform warts tx
- Curettage
- Light electrocautery
- Light cryosurgery
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what type of warts are these
flat warts (verruca plana)
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which type of warts are flat-topped papules, often grouped, usually found on the forehead, around mouth, backs of hands and shaved areas (beard, legs)
flat warts (verruca plana)
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how are flat warts (verruca plana) tx
- Imiquimod 5% cream (Aldara)
- Careful cryosurgery or electrosurgery
- 5-fluorouracil cream (Efudex)
- Tretinoin cream (Retin-A)
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which type of warts are these
plantar warts
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these types of warts are found on the soles of feet, may be painful, they are frequently at points of maximum pressure, such as over metatarsal heads or heels and are assoc with callus formation
plantar warts
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how are plantar warts tx
- Regular debridement
- Hot soaks
- Duct tape
- Salicylic acid (Occlusal-HP, Duoplant)
- 40% salicylic acid plasters
- Blunt dissection
- Imiquimod 5% cream (Aldara)
- Cryosurgery
- Laser
- Electrodessication and curettage
- Cantharidin, with occlusion
- Chemotherapy (bichloracetic acid)
- Intralesional beomycin sulfate–Expensive…if all else fails
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which type of wart is this
subungual and periungual warts
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what spreads subungual and periungual warts
cuticle biting
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how are subungual/periungual warts tx
- Cryosurgery
- Cantharidin
- Duct tape
- Blunt dissection
- Salicylic acid
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which type of warts are these
genital warts
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these are also known as condyloma acuminate or veneral warts, they are MC assoc with HPV 6,11, and 16.
genital warts
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what is the most common viral STI
genital warts
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These lesions are pink with numerous, discrete, narrow-to-wide projections on a broad base. Surface is moist and lacks hyperkeratosis of warts found elsewhere. May coalesce to form large, cauliflower-like mass
genital warts
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what are some tx considerations for genital warts
- Cryosurgery
- Scissors excision, curettage, or electrosurgery
- Trichloroacetic acid (TCA)
- Podophyllum resin
- Imiquimod 5% cream (Aldara)
- Podofilox gel (Condylox)
- 5-Fluorouracil cream (Efudex)
- Carbon dioxide laser
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what is this
bowenoid papule
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these are small, brown or pink, flat or slightly irregular, discrete grouped papules, they resemble flat or genital warts
bowenoid papules
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what is the tx for bowenoid papules
- Cryosurgery
- Electrosurgery
- Excision
- CO2 laser
- 5-FU cream (Efudex)
- Imiquimod 5% (Aldara)
- Abstinence
- Condom use
- Check sexual partner
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what is this
molluscum contagiosum
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this is most common in kids, usually affects the arms and face, it is spread thru self-inoculation. If found in adults, it is spread thru sexual contact and is found in the groin, pubis, and thighs
molluscum contagiosum
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these are small discrete 1-2mm skin colored or slight pink smooth shiny papules, they have central umbilication with a curette small white bead, and if they are large lesions (1cm) they will be inflamed and crusted
molluscum contagiosum
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what is the etiology of molluscum contagiosum
DNA poxvirus
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how is molluscum contagiosum tx in babies, small children
- Retin-A .025-.05% cream qd-tid
- Titrate to response
- Lesion irritated-rub off with cloth
- Wash area to prevent spread
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how is molluscum contagiosum tx if found in older kids or adults
- Curette (best)–Use anesthesia –Control bleeding
- LN2 –May need multiple applications
- Multiple lesions–Retin-A or TCA
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what is this
herpes simplex
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what is the primary mode of herpes virus transmission
asymptomatic viral shedding
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this has grouped vesicles on an erythematous base
herpes simplex
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what will you see on a Tzanck prep if a pt has herpes simplex
multinucleated giant cells
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how is herpes simplex tx
- oral: zovirax, valtrex, famvir
- herpes labialis: penciclovir or abreva
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what are some suggested regimens for recurrent HSV
–Acyclovir (Zovirax) 400 mg TID x 5 days–Valacyclovir (Valtrex) 500 mg BID x 3 days–Famciclovir (Famvir) 125 mg BID x 3-5 days
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what is this
varicella
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what is the tx for varicella
- Cool bathes (Aveeno)
- Antihistamine PRN
- Tylenol, avoid ASA due to Reye’s Syndrome
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when would you use acyclovir for a pt with varicella
- If can start within 24 hrs
- Non-pregnant over age 13
- Chronic skin disease
- Children on steroids or immunocompromised
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what is this
herpes zoster
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what is the tx for herpes zoster
- Acyclovir/Valtrex/Famvir
- -- To prevent postherpetic neuralgia…the major cause of morbidity.
- -- Treat within first 72 hrs
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what are the suggested regimens for Herpes Zoster
- Valacyclovir (Valtrex) 1 gram TID
- Famciclovir (Famvir) 500 mg TID
- Acyclovir (Zovirax) 800 mg 5x/day
- Tx for 7-10 days
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how can Zoster be prevented
- Zostavax
- --Single dose, subcutaneous, live attenuated vaccine
- --For pts age 60 and older
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why would you do a shave bx
- To obtain tissue for diagnostic purposes
- To remove benign surface neoplasms
- For raised lesions, when full-thickness tissue specimen is not necessary
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why would you use a punch bx
- For full thickness specimen
- For flat lesions
- *Sizes range from 2 to 8 mm
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what are some important things to consider when doing an excisional bx
- Biopsy should include 2-mm of margin of normal skin
- Length should be 3 times the width when drawing ellipse
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when should scalp sutures be removed
10-14
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when should eyelid sx be removed
3-4 days
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when should facial sx be removed
5-7 days
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when should neck sx be removed
7-10d
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when should trunk sx be removed
10-14 d
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what is this
linear epidermal nevus
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this is a benign proliferation of epidermal cells, it is hyperpigmented due to a thickened epidermis
linear epidermal nevus
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how is linear epidermal nevus tx
decrease discomfort and improve cosmetic appearance
- Cryosurgery
- Partial thickness excision
- Topical agents (5-FU, retiniods)
- Laser
- Dermabrasion
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what is this
melanocytic nevus
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what will a bx show for a melanocytic nevus
nest of nevus cells
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what is the treatment for melanocytic nevus
- follow up for ABCS changes
- if >100 mole f/u at 6-12 mo intervals
- sx excision for suspected lesions with bx
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when would you suspect a melanocytic nevus to have an increase for malignant melanoma
if they are large
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is this a congenital or acquired melanocytic nevus
congenital
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acquired melanocytic nevus is affected by what
hormones and sun
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which melanocytic nevus has the nevus with nest that goes into the upper dermis, it is raised and often papular
compound melanocytic nevus
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which melanocytic nevus has all nests in the dermis, it is domed shaped and is skin colored with hair
intradermal melanocytic nevus
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which type of melanocytic nevus is this
acquired
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which type of melanocytic nevus is this
junctional
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which type of melanocytic nevus is this
compound
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which type of melanocytic nevus is this
intradermal
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what is this
Mongolian spot
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this have blue-black lesions of dermal melanocytes, this is MC in the scalp, presacral, backs of hands, face/trunk in a dermatomal pattern
mongolian spot/nevus of Ota/ blue nevus
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why does the mongolian spot/ nevus of ota/ blue nevus apprear blue-black
it is due to the Tyndall effect of melanin deeper in the skin
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what is this
nevus of Ota
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this is a blue-black pigmentation in the 1st-2nd branch of the trigeminal nerve. It affects the sclera, conjunctiva and skin around the eye. It is common in orientals, females
nevus of Ota
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how is the nevus of Ota tx
- laser to lighten lesions
- monitor pt for glaucoma
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what is this
halo nevus
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this is most common in adolescence, may herald onset of vitiligo, this has one or more hypopigmented to white lesions that contain a central red, brown or black nevus. The nevus regresses and pigment returns
halo nevus
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where is the halo nevus most commonly found
on the trunk
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what is the tx for a halo nevus
- teens- none needed
- adults- woods lamp looking for vitiligo
- - bx if suspect MM
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what is this
dysplastic nevus
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how is a dysplastic nevus dx
bx-- if it is raised, has any variation in pigment and borders or alteration of skin markings require bx
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how is dysplastic nevus tx
- excision bx with margins
- pt educated on self-exam and sun avoidance
- consider baseline pix
- f/u at least annually (at risk for MM)
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what is this
tinea/ pityriasis versicolor
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this is due to overgrowth of yeasts, highly sebaceous areas and hot, humid climates
Tinea/Pityriasis Versicolor
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these are scattered round to confluent color change/superficial flaking and are usually distributed to the mid chest, back, antecubital fossa, neck, extensive upper arms and lower face
Tinea/Pityriasis Versicolor
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how is Tinea/Pityriasis Versicolor dx
- KOH
- --Numerous short, broad hyphae and clusters of budding cells
- --“spaghetti and meatballs” or “bats and balls”
- Wood’s light
- --Pale white/yellow fluorescence
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how is Tinea/Pityriasis Versicolor tx
- –Limited dz:
- Tx of choice is ketaconazole (Nizoral) 2% shampoo–Apply x 5 minutes, then wash off –Use for 3 days
- –Oral agents (more extensive dz):
- --Ketoconazole (Nizoral)–Single dose of 400 mg–Exercise afterwards…no shower x 12 hrs
- --Itraconazole (Sporanox)–200 mg QD x 7 days
- --Fluconazole (Diflucan)–Single dose of 300 or 400 mg
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how do u tx a pt with recurrent Tinea/Pityriasis Versicolor
- Ketaconazole (Nizoral) 2% shampoo AAA x 5-10 minutes once weekly
- Ketaconazole 400 mg once monthly
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this starts as a stratum corneum vesicle or pustule, it classically presents as a honey crusted weeping lesion.
impetigo contagiosum (nonbullous impetigo)
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how is impetigo contagiosum (nonbullous impetigo) tx
- Cool or warm soaks to remove crust
- Control infection–topical mupirocin 2% (Bactroban)
- Systemic antibiotics–Dicloxacillin, Cephalexin –prevent acute glomerulonephritis
- Dressing to prevent spread
- Culture - 2nd infection
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what is this
impetigo contagiosum (nonbullous impetigo)
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this type of impetigo is common in any age, usually is from staph only (no secondary strep), and has less exudative crusting
bullous impetigo
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how is bullous impetigo tx
- Strict hand washing
- Warm or cool soaks, to remove crusts
- Mupirocin ointment (Bactroban)
- Systemic antibiotics after culture to r/o resistance»Dicloxacillin, Cephalexin, Erythromycin
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what is this
bullous impetigo
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this is caused by water that is not hot enough or chemically treated well enough to prevent growth of pseudomonas. It is usually found in areas that are occluded by a bathing suit. The pt presents with pruritis, malaise with low grade fever, and may develop follicular pustules with surrounding erythema
hot tub folliculitis
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what is the tx for pseudomonas folliculitis (hot tub folliculitis)
- Showering after exposure will not help
- usually self-limiting, may take up to 3 mo
- Antihistamine, such as Atarax PRN
- Localized dz - Vinegar soaks (acetic acid 5%), Domeboro’s, or Burrow’s
- More involved/severe - Ciprofloxacin 500mg BID x 5 days for more toxic cases
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what is this
pseudomonas folliculitis (hot tub folliculitis)
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what is this
erythrasma
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where is the most common site for erythrasma
4th interdigital space (also located in bilateral inguinal area, axillae, inframmary folds)
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how is erythrasma dx
- Need to do KOH
- woods light- coral red fluorescence due to prophyrins produced by organism
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what is the tx for erythrasm
- Keep area clean, dry
- Systemic: Erythromycin 250mg QID up to 2 wks or Clarithromycin 1 gram x 1 dose
- Topical: Erythromycin, Miconazole, Clotrimazole
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what is this
erythrasma
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this is found in infrequent shavers, this is staph impetigo of the beard. The razor spreads the infection from follicle to follicle. It involves the entire depth of hair follicle
sycosis barbae
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how is sycosis barbae tx
- if mild: mupirocin (bactroban ointment)
- if severe: oral abx x 2 weeks
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what is this
sycosis barbae
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this type of scabies is highly contagious, it is scaly packed with mites, affects the hands and/or face and HIV is highly suspicious with this
crusted Norwegian scabies
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what is this
crusted Norwegian scabies
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this is suspected if you see red papules on the neck, see eggs on hairs, these live on seams of clothing, and can cause adenopathy and secondary infx
pediculosis capitis
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how do you get rid of pediculosis capitus
- elimite or RID shampoo (put in 10 min, don't shave head, comb out knits after vinegar soak)
- coat eyelashes with Vaseline, wash with baby shampoo TID x 5 d
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whats this
pediculosis capitus
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what is this
cutaneous larva migrans
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this is commonly found in on the back of workers that work under porches, can be found on the back, buttock and foot/hand of sunbathers on a beach. it is caused by an accidental invasion by dog and cat hookworm. On PE you will see a long serpiginous lesion
cutaneous larva migrans
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what is the tx for cutaneous larva migrans
- None–Larva dies eventually
- Topical–Thiabendazole qid x 1 week –Topical steroid decrease inflammation
- Oral–Severe cases:Thiabendazole –Albendazole
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this is the loss of resting hairs that are ready to be shed. It can be due to severe physical or emotional stressors, delivery of a child, discontinuing OCPs, high fevers or sx, and serious weight loss
telogen effluvium
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what is the tx for telogen effluvium
- Reassurance hair will regrow
- Cosmetic ways to make hair look thicker
- Full recovery expected
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what is this
telogen effluvium
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what are the 2 follicle types of male androgenic balding
- top- androgen sensitive
- sides- androgen independent
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what is the tx for male androgenic balding
- Minoxidil (Rogaine)
- Finasteride (Propecia)
- transplants
- advancement flaps-small areas
- hair weave
- toupee
- anything advertised on TV or in health food store!!!
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this type of androgenic balding is due to a loss on the vertx, begins at menopause when there is a drop in estrogens and a relative increase in androgens
female androgenic balding
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what labs should be considered for female androgenic balding
- DHEA
- prolactin
- testosterone
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what is the tx for female androgenic balding
OTC minoxidil
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the presence of terminal hairs in females in a male-like pattern is known as what
hirsutism
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what are some possible causes of hirsutism
- PCOS
- cushing syndrome
- androgen-secreting tumors
- corticosteroid use
- obesity
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this type of carcinoma is red and scaly, it is persistent, it can be a hypertrophic lesion with ulcer or hyperkeratosis (cutaneous horn). If on the lip it will look like an ulcer with induration and it is malignant
SCC
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how can someone acquire SCC
- Up to 60% of SCC lesions develop from AKKeratinocytes/spinous layer of epidermis
- Bowen’s
- Thermal/radiation burns
- Chronic irritation
- Infection (HPV)
- Inflammation
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what is the management for SCC
- excision with margins
- examine for nodes
- f/u q6 mo for life
- photoprotection
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this type of cancer is slow growing, pts are asymptomatic, and nodular is the MOST COMMON form (can be skin or pink colored and is firm)
BCC
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if you see a pt with a shiny, pearly papule with telangiectasis and central ulceration with rolled borders, what type of CA are you thinking
BCC
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