Transcript Slide 1

Cutaneous Care
Paul W. Baumert, Jr., M.D., FAAFP
Sports Medicine Rounds
November 15, 2007
Outline
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“Dermatology 101”
Clinical pearls
Common conditions
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Papulosquamous
Acneiform
Morbilliform
Urticaria
Skin cancers
CA-MRSA
Diagnostic tools
“Dermatology 101”
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If it’s dry: WET it
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If it’s wet: DRY it
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If it’s red and itchy: Use steroids
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MORE COMPLEX!!
Medicine is a calling, not a business.
You are in this profession as a calling, not as a business; as a calling which exacts from
you at every turn self-sacrifice, devotion, love and tenderness to your fellow-men. Once
you get down to a purely business level, your influence is gone and the true light of your
life is dimmed. You must work in the missionary spirit, with a breadth of charity that
raises you far above the petty jealousies of life.
Sir William Osler
Clinical pearls
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Dry skin
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Topical corticosteroids
Dry Skin
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Worsens almost any skin condition
Seasonal
Moisturizers
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Tips
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Types
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Avoid long, hot showers
Towel dry (get big drops off)
Apply to damp skin
Ointment > cream > lotion
Aquaphilic ointment
Winter Dry Skin handout (UIHC derm)
Topical Corticosteroids
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Treat the erythema, not the itch
Side effects
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Absorption depends on
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Atrophy/striae
Telangiectasia
Purpura
Skin thickness
Occlusion
Forms
Common Conditions
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Papulosquamous (“raised and scaly”)
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Eczematous or contact dermatitis
Tinea corporis
Scabies
Pityriasis rosea
Principles
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Proper diagnosis
Initial choice of treatment
Common Conditions
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Acneiform
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Acne
Molluscum contagiosum
Folliculitis
Common Conditions
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Morbilliform
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Viral exanthems
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Measles, rubella, roseola, enteroviruses, etc.
Scarlet fever
Scarlatinoform
Drug exanthems
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Usually pruritic
Usually within 2 weeks of beginning a medication
Common Conditions
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Urticaria (Hives)
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Ingestion
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Food
Medication
Physical
50% have no identifiable cause
Treatment pearls
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Potent antihistamine(s), adequate duration
Skin Cancers
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Melanoma
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Basal cell carcinoma
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Squamous cell carcinoma
Melanoma
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Incidence
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Lifetime risk (2006)
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1930: 1 in 1500
1960: 1 in 600
2001: 1 in 71
Caucasians: 1 in 60 (slightly higher in males)
Non-caucasians: 1 in 1176
75% of skin cancer deaths
Melanoma
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4 main types of malignant melanoma
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Clinical prediction rules
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ABCDE criteria (ACS)
7 point checklist (UK)
Types of melanomas
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Superficial spreading
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50% of cases
More frequent in
younger adults
Types of melanomas
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Nodular
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20 to 25% of cases
Also in younger adults
Types of melanomas
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Lentigo maligna
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15% of cases
Older adults
Types of melanomas
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Acral-lentiginous
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10% of cases
Palms, soles, around first
toenail
Risk factors for malignant
melanoma
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Atypical nevus syndrome with personal and
family hx of melanoma (500)
Changing mole (>400)
Atypical nevus syndrome with family hx of
melanoma (148)
Age > 15
Dysplastic moles (7-70)
Risk factors con’t
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Large congenital nevus (> 15 cm) (17)
Caucasian race (12)
Atypical nevi (7-27)
Regular tanning bed use before age 30 (7.7)
Multiple nevi (5-12)
Personal hx of melanoma (5-9)
Family hx (first degree) of melanoma (3-8)
Sun sensitivity/tendency to burn (2-3)
Clinical prediction rules
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ABCDE Criteria (American Cancer Society)
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7 point checklist (United Kingdom)
ABCDE Criteria
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Asymmetry
Border
Color
Diameter
Evolving (Elevation or Enlargement)
Asymmetry
Border
Color
Diameter
Evolving (elevation/enlargement)
7 point checklist (Glasgow)
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Major signs (1 or more):
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Minor signs:
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Change in size
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Inflammation
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Change in shape
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Crusting or bleeding
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Change in color
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Sensory change
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Diameter > 7 mm
A2BCD3EFG’s of Melanoma
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2005 Additions:
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Angularity
Dysplastic
Different (from patient’s other nevi)
EVOLVING
Family history
Great numbers of nevi
Clinical Assessment
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Apply the ABCD+ criteria
Excisional (full thickness) biopsy if either test
has positive criteria or if you or your patient
has any doubt
Guidelines are developed from large studies
and tell you nothing about the patient in front
of you
The Bottom Line Re: Melanomas
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When educating patients, if one were to stress
only one characteristic of melanoma, it would
be CHANGE.
However, only 25% of melanomas arise from a
preexisting lesion. 75% of the time they arise
de novo!
CA-MRSA
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Acquisition
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Treatment
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Contact, skin breakdown, hygiene
Physician-directed medication, drainage, care
Prevention
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Wash hands often, use alcohol-based hand rubs
Keep cuts/scrapes clean and covered
Do not touch other people’s cuts or bandages
Do not share personal items, such as towels or razors
Diagnostic Tools
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Experienced clinician/proper environment
KOH
Culture
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Biopsy
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Bacterial (+/- sensitivity)
Viral
Fungal
Punch
Specialty referral is not needed in most cases
Live neither in the past nor in the future,
but let each day’s work absorb your
entire energies, and satisfy your widest
ambition
Sir William Osler