introduction to podiatric dermatology
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Introduction to Podiatric Dermatology. abscess. desquamation. Jeffrey C. Page, DPM PMED 1741 Podiatric Dermatology and Infectious Diseases. Self-inflicted nail dystrophy. Introduction to Podiatric Dermatology. General Principles Skin anatomy Lesion types Patterns & Configurations - PowerPoint PPT PresentationTRANSCRIPT
Introduction to Podiatric Introduction to Podiatric DermatologyDermatology
Jeffrey C. Page, DPMJeffrey C. Page, DPMPMED 1741PMED 1741
Podiatric Dermatology and Infectious Podiatric Dermatology and Infectious DiseasesDiseasesabscess
desquamation
Self-inflicted nail dystrophy
Introduction to Podiatric Introduction to Podiatric Dermatology Dermatology
General PrinciplesGeneral Principles Skin anatomySkin anatomy Lesion typesLesion types Patterns & ConfigurationsPatterns & Configurations
Disorders of SweatDisorders of Sweat Mechanical LesionsMechanical Lesions
Depigmentation post steroid injection
Exfoliation from reaction to gluten
Skin AnatomySkin Anatomy
Layers
Appendages
Purpose
Epidermal LayersEpidermal Layers
Stratum corneumStratum corneum Stratum lucidum (palms and soles)Stratum lucidum (palms and soles) Stratum granulosumStratum granulosum Stratum spinosum (prickle cell layer)Stratum spinosum (prickle cell layer) Stratum basale (germinativum)Stratum basale (germinativum) Merkel’s cells (storage granules)Merkel’s cells (storage granules) Langerhans’ cells (immune system)Langerhans’ cells (immune system) Melanocytes (produce melanin)Melanocytes (produce melanin) Keratinocytes (produce keratin)Keratinocytes (produce keratin)
Dermal LayersDermal Layers
Dermal-epidermal junction = basement Dermal-epidermal junction = basement membranemembrane
Papillary dermis (superficial)Papillary dermis (superficial) Reticular dermis (deep)Reticular dermis (deep) VesselsVessels NervesNerves Appendages (adnexa)Appendages (adnexa)
HairHair Glands (sweat & sebaceous)Glands (sweat & sebaceous) NailsNails
Subcutaneous LayerSubcutaneous Layer
Production and Production and storage of fat cellsstorage of fat cells
Supports blood Supports blood vessels and nervesvessels and nerves
Storage of nutritionStorage of nutrition ThermoinsulationThermoinsulation
Description of LesionsDescription of Lesions
Primary LesionsPrimary Lesions Secondary LesionsSecondary Lesions Elementary LesionsElementary Lesions
melanoma
atrophy from injections
Descriptions Must Include:Descriptions Must Include: Lesion type/ textureLesion type/ texture Size/areaSize/area Moisture levelMoisture level ColorColor LocationLocation
Primary LesionsPrimary Lesions
MaculesMacules PatchesPatches PapulesPapules PlaquesPlaques NodulesNodules WhealsWheals
VesiclesVesicles BullaeBullae PustulesPustules CystsCysts TumorsTumors
Macules & PatchesMacules & Patches
Lentigo
Hyperpigmentation from venous stasis
Hypopigmentation from skin trauma
PapulesPapules
verrucae
nevus Kaposi’s sarcoma
PlaquesPlaques
psoriasis
tinea corporis/pedis
NodulesNodules
Nodular melanoma
Neurofibromatosis
Hemangioma
PustulesPustules
Vesicles & BullaeVesicles & Bullae
Vesicular tinea
herpesChicken Pox
Wheals (Hives)Wheals (Hives)
truncal placques
angioedema
dermatographism
AngioedemaAngioedema
Cysts* & TumorsCysts* & Tumors
Inclusion cyst
Pedunculated nevus
*Cysts are sometimes called special lesions
Secondary LesionsSecondary Lesions
ScalesScales CrustsCrusts ExcoriationsExcoriations FissuresFissures UlcersUlcers
ErosionsErosions ScarsScars IndurationInduration AtrophyAtrophy Lichenification?Lichenification?
Plantar ulcer
ScalesScalesIcthyosis
Severe edema due to heart failure
Atopic dermatitis
CrustsCrusts
Impetigo
Scalp kerion
Erosions & UlcersErosions & Ulcers
osteomyelitis
Syphilitic chancre
Circinate balanitis
Fissures & AtrophyFissures & Atrophy
Fissure from frequent dishwashing Atrophy and
telangiectasia due to oral steroids
ScarsScars keloid
Hypertrophic scar following buionectomy
Hypopigmented scar from acne
Scars in construction worker
Elementary (Special) LesionsElementary (Special) Lesions
ExcoriationsExcoriations ComedonesComedones BurrowsBurrows PurpuraPurpura
PetechiaePetechiae EcchymosesEcchymoses Macular or PapularMacular or Papular
TelangiectasiaTelangiectasia Lichenification?Lichenification? Cyst?Cyst?
Sebacious cyst
Elementary (Special) LesionsElementary (Special) Lesions
Excoriations in factitial dermatitis
Comedones
PurpuraPurpura
Vasculitides
Elementary (Special) LesionsElementary (Special) Lesions
Burrow in Scabies
Telangiectasia from sun exposure
Elementary (Special) LesionsElementary (Special) Lesions
Lichenification Spider Angioma
Patterns and ConfigurationsPatterns and Configurations
RoundRound AnnularAnnular DiscoidDiscoid TargetoidTargetoid NummularNummular
Arciform-polycyclicArciform-polycyclic GeographicGeographic Herpetiform-groupedHerpetiform-grouped
Serpiginous-gyrateSerpiginous-gyrate LinearLinear ReticularReticular VerrucousVerrucous GuttateGuttate
Round LesionsRound Lesions
Discoid Annular
DermatofibromaTinea pedis/corporis
Round LesionsRound Lesions
Targetoid Nummular
Erythema multiforme
Nummular eczema
Arciform (polycyclic)Arciform (polycyclic)Lichen planus
Geographic LesionsGeographic Lesions
Pitted keratolysis
Pyoderma gangrenosum
Necrobiosis lipoidica diabeticorummelanoma
Herpetiform (Grouped) LesionsHerpetiform (Grouped) Lesions
Herpes zosterHerpes zoster
Serpiginous (Gyrate)Serpiginous (Gyrate)
Poison ivy Leishmaniasis
Linear LesionsLinear Lesions
wheals
scratches
Reticular (network) LesionsReticular (network) Lesions
nevi
Verrucous LesionsVerrucous Lesions
solitary mosaic
Guttate LesionsGuttate Lesions
MeaslesDiabetic dermopathy
Measles
Disorders of SweatDisorders of Sweat
Hyperhidrosis Hyperhidrosis (Excessive sweating)(Excessive sweating)
Bromhidrosis (foul Bromhidrosis (foul odor associated with odor associated with hyperhidrosis)hyperhidrosis)
Pomphylux Pomphylux (Dyshidrotic eczema)(Dyshidrotic eczema) Not actually a sweat Not actually a sweat
disorderdisorder
HyperhidrosisHyperhidrosis
Primary = Essential = Primary = Essential = IdiopathicIdiopathic
SecondarySecondary HyperthyroidismHyperthyroidism Endocrine Tx for CaEndocrine Tx for Ca Severe Psychiatric Severe Psychiatric
DisordersDisorders ObesityObesity MenopauseMenopause Febrile IllnessFebrile Illness MedicationsMedications
Three forms:Three forms: Emotionally InducedEmotionally Induced LocalizedLocalized GeneralizedGeneralized
Can cause significant Can cause significant emotional distress emotional distress and occupational and occupational disabilitydisability
0.6-1.0 incidence0.6-1.0 incidence 20x more common in 20x more common in
JapaneseJapanese
Treatment of HyperhidrosisTreatment of Hyperhidrosis PrimaryPrimary
Antiperspirants (aluminum chloride)Antiperspirants (aluminum chloride) Topical 20% aluminum chloride Topical 20% aluminum chloride IontophoresisIontophoresis Drugs (sedatives or anticholinergics)Drugs (sedatives or anticholinergics) Botulinum toxinBotulinum toxin Surgery (gland excision or sympathectomy)Surgery (gland excision or sympathectomy) Alternative (e.g. herbs, acupuncture)Alternative (e.g. herbs, acupuncture)
SecondarySecondary Treat underlying condition (e.g. anti-Treat underlying condition (e.g. anti-
estrogens)estrogens)
Mechanical LesionsMechanical Lesions
Hyperkeratosis Hyperkeratosis marginalismarginalis
TylomataTylomata CornsCorns Plantar keratosesPlantar keratoses Cutaneous hornCutaneous horn FissuresFissures BlistersBlisters
Hyperkeratosis Marginalis
TylomataTylomata
DiffuseDiffuse Non-nucleatedNon-nucleated
CornsCorns
Heloma molle Heloma durum
Plantar keratosesPlantar keratoses
IPK = Nucleated, well-circumscribed
Neurovasculare = very painful
Palmar plantar keratoderma
FissuresFissures
Regular emollient useRegular emollient use Avoid barefootAvoid barefoot Avoid sandalsAvoid sandals DebridementDebridement Use occlusionUse occlusion SuperglueSuperglue
Cutaneous HornCutaneous Horn
Padding to Reduce HyperkeratosisPadding to Reduce Hyperkeratosis
BlistersBlisters
FrictionFriction ThermalThermal ChemicalChemical Bullous Bullous
disordersdisorders
IntraepidermalIntraepidermal SubepidermalSubepidermal
““To de-roof or not To de-roof or not to de-roof?” to de-roof?” Depends onDepends on Likelihood of further Likelihood of further
traumatrauma Risk of infectionRisk of infection
Hydrocolloid and Polyurethane Film Hydrocolloid and Polyurethane Film DressingsDressings
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