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Clinical slide RV

Basic Histology of skin. Immune rxns. 1. type 1 (Immediate HSR): IgE binding to mast cells releasing Histamine examples: Urticarria and anaphylaxis2. Type 2 (Hummiral cytotoxic): IgG bind to tissue fixed antigen. This activates complement system and damage happens as a result to inflammationPemphigus and BP

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Clinical slide RV

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    1. Clinical slide RV Dermatology

    3. Immune rxns 1. type 1 (Immediate HSR): IgE binding to mast cells releasing Histamine examples: Urticarria and anaphylaxis 2. Type 2 (Hummiral cytotoxic): IgG bind to tissue fixed antigen. This activates complement system and damage happens as a result to inflammation Pemphigus and BP…

    4. Immune rxns Type 3 : Immune complex Disease: IgG Directed/binds to circulating antigrn/or other antibody: vasculitis and immune complex disease. The damage happens when immune complexes sit/deposit usually in areas where circulation is tight or not moving enough: Kidneys, skin capillaries and lower extrimities

    5. Immune reactions Type 4 HSR (Delayed /celluar): this is the only type where cells rather than antibodies are involved. The cells are lymphocytes and macrophages. Examples: ACD, Granulomas, ..

    6. Derm. History Chief complaint +Duration: Rash: multiple red things with/out scale Lesion: one or few things Others: as appropriate ( e.g hair loss, blisters, color change…)

    7. Derm HX Analysis of the complaint: Onset : site where it started and how Progression: increasing/decreasing/same and which sites Symptoms: itch/pain… Modifying factors: Recent illness: viral/fevers.. Atopy: asthma+eczema+hay fever (personal or 1st degree relative) Drugs used

    8. Derm HX R.O.S: Related Past Hx: as per others Family hx …

    9. Derm Exam T. SAD: Type: primary vs secondary (modified..scratched, traumatised…) lesion Macule/patch: pigmentary disorder or resolving papulosq Scaly papules/plaques: papulosquamous condition Non scaly papules/plaques: reactive erythema Bullae/vesicles: bullous dis….

    10. Derm exam Shape: Color: red: more RBC.s(Hb) eithre intravascular(dilated vessels) or extravascular (hemorrhage) Brown/black: melanin Exogenous…. Surface: Scaly: papulosqumaous Non scaly. Margins: well defined vs ill-defined

    11. Derm exam Arrangement: Grouped: grouped vesicles (Herpes), Linear ( plane warts, Kobner… Distribution: Unilateral: infection, contact… Bilateral: inflammatory

    12. Linear arrangmemnt VEN Plane warts

    13. Grouping

    14. Red NON-Scaly rash Red is BLOOD. This is either Intra vascular: dilated vessel due to usually release of inflammatory mediators (histamine..) DIASCOPY……….BLANCHABLE DDX: Reactive Erythema: EM/EN/URT Extra vascular: Hemorrhage Vessel wall injury: vasculitis Bleeding tendency or due to trauma… DIASCOPY……….NON-BLANCHABLE

    15. Red NON-Scaly Algorhythm

    16. Red NON-Scaly rash Urt -Urticaria weals: have a TIME limit (24 hrs) -Distribution: generalized - Special feature: angioedema

    17. EN Individual NODULES last for 3-6 weeks Distribution: favorite site is shins special feature: when they start healing 1-2 weeks they leave Bruises

    18. EM Individual papules/plaques.. Last for 10-14 days Distribution is ACROFACIAL Special feature: Targets

    19. Vasculitis: Diascopy non-Blanchable -polymorphic primary lesions last for few weeks Distribution: mainly legs but can be generalized - special feature

    20. Patients with Red scaly rashes (papulosquamous) Scale is flake (piece) from horney layer. Usually indicates hyper-proliferation of epidermis The group includes many conditions but commonest are: Eczema - Lichen Planus Psoriasis - Fungal infections Pityriasis Rosea

    22. Ecz: Red,scaly, ill-defined, bilateral and symmetrical

    24. LP Special feature

    25. PR Special feature

    26. T.Corp single lesion Scraping is a must for single/unilateral scaly patches/plaques

    27. Diagnostic tools

    28. Other diagnostic tools DIF Tzanck

    29. Wood’s light Source of UVA (365 nm) diagnosis of some infections: Tinea capitis: green flu on hair shaft P. Versicolor: golden yellow Pitryosporum: orange Pseudomonas: blue Pigmentary disorders: Hypopigmentation (pale) vs Depigmentation (chalky white) Hyperpigmentation: good enhancement (epidermal/good prognosis) vs poor enhancement (dermal pigment/poor prognosis )

    30. HSV Ecz.her

    34. Staph Folliculitis+ Recurrent

    35. Recurrent staph infections

    36. Pigment loss

    38. Depressed scars

    39. Pilo-sebaceous unit

    44. Scabies principles of Rtt 1. treat all family at same time 2. application of scabicidal: Jaw line to toes and overnight Emphasis on: webs, axillae, genitalia and belo nails Any area washed:reapply Repeat after 1 week 3. attention to sheets, clothes, beddings 4. cover with anti histamines for 3-4 weeks

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