Dermatologic Disorders

History and physical examination are adequate for diagnosing many skin lesions. Some require biopsy or other testing.

Topical dermatologic treatments are grouped according to their therapeutic functions and include

Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne develops on the face and upper trunk. It most often affects adolescents. Diagnosis is by examination. Treatment, based on severity, can involve a variety of topical and systemic agents directed at reducing sebum production, comedone formation, inflammation, and bacterial counts and at normalizing keratinization.

Bacterial skin infections can be classified as skin and soft tissue infections (SSTI) and acute bacterial skin and skin structure infections (ABSSSI). SSTI include

Atypical moles are benign melanocytic nevi with irregular and ill-defined borders, variegated colors usually of brown and tan tones, and macular or papular components. Patients with atypical moles have an increased risk of melanoma. Management is by close clinical monitoring and biopsy of highly atypical or changed lesions. Patients should reduce sun exposure and conduct regular self-examinations for new moles or changes in existing ones.

Bullae are elevated, fluid-filled blisters ≥ 10 mm in diameter.

Skin cancer is the most common type of cancer and commonly develops in sun-exposed areas of skin. The incidence is highest among outdoor workers, sportsmen, and sunbathers and is inversely related to the amount of melanin skin pigmentation; fair-skinned people are most susceptible. Skin cancers may also develop years after therapeutic x-rays or exposure to carcinogens (eg, arsenic ingestion).

Calluses and corns are circumscribed areas of hyperkeratosis at a site of intermittent pressure or friction. Calluses are more superficial, cover broader areas of skin, and are usually asymptomatic. Corns are deeper, more focal, and frequently painful. Diagnosis is by appearance. Treatment is with manual abrasion with or without keratolytics. Prevention involves altering biomechanics, such as changing footwear. Rarely, surgery is required.

The meaning of the word "dermatitis" is inflammation of the skin. However, in clinical dermatology, dermatitis is used to describe a variety of different skin conditions that share the same inflammatory reaction pattern with similar clinical manifestations.

Candidiasis is skin and mucous membrane infection with Candida species, most commonly Candida albicans. Infections can occur anywhere and are most common in skinfolds, digital web spaces, genitals, cuticles, and oral mucosa. Symptoms and signs vary by site. Diagnosis is by clinical appearance and/or potassium hydroxide wet mount of skin scrapings. Treatment is with drying agents and antifungals.

Alopecia is defined as loss of hair from the body. Hair loss is often a cause of great concern to the patient for cosmetic and psychologic reasons, but it can also be an important sign of systemic disease.

The immune system plays a significant role in a large number of skin disorders, including dermatitis, sunlight reactions, and bullous diseases. Although all of these disorders involve some level of inflammation, certain skin disorders are primarily characterized by their inflammatory component or as a hypersensitivity reaction, be it to a drug, infection, or cancer. These disorders include

A variety of disorders can affect nails, including deformities, trauma, infections of the nail, paronychia, retronychia, and ingrown toenails. Nail changes may occur in many systemic conditions and genetic syndromes or result from trauma.

Bedbug bites are usually painless but cause reactions, often pruritic, in susceptible patients. Diagnosis is clinical. Treament is symptomatic treatment of bites and chemical and physical eradication of bedbugs.

Melanin is the brownish pigment responsible for the color of skin, hair, and the iris of the eyes. It is produced by melanocytes. Most people have similar numbers of melanocytes, and the wide range of color shades of human skin is due to the amount of melanin that is produced rather than the number of melanocytes. There are different subtypes of melanin, the main ones in the skin being

Pressure injuries are areas of necrosis and often ulceration (also called pressure ulcers) where soft tissues are compressed between bony prominences and external hard surfaces. They are caused by unrelieved mechanical pressure in combination with friction, shearing forces, and moisture. Risk factors include age > 65, impaired circulation and tissue perfusion, immobilization, undernutrition, decreased sensation, and incontinence. Severity ranges from nonblanchable skin erythema to full-thickness skin loss with extensive soft-tissue necrosis. Diagnosis is clinical. Prognosis is excellent for early-stage injuries; neglected and late-stage injuries pose risk of serious infection and are difficult to heal. Treatment includes pressure reduction, avoidance of friction and shearing forces, and diligent wound care. Sometimes, skin grafts or myocutaneous flaps are needed to facilitate healing.

Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Multiple factors contribute, including genetics. Common triggers include trauma, infection, and certain drugs. Symptoms are usually minimal, but mild to severe itching may occur. Cosmetic implications may be major. Some people develop severe disease with painful arthritis (psoriatic arthritis). Diagnosis is based on appearance and distribution of lesions. Treatment can include topical treatments (eg, emollients, vitamin D3 analogs, retinoids, coal tar, anthralin, corticosteroids), phototherapy, and, when severe, systemic drugs (eg, methotrexate, oral retinoids, cyclosporine, immunomodulatory agents [biologics]).

The skin may respond to sunlight with chronic (eg, dermatoheliosis [photoaging], actinic keratosis) or acute (eg, photosensitivity, sunburn) changes.

There are two types of sweat glands: apocrine and eccrine.

Molluscum contagiosum is characterized by clusters of pink, dome-shaped, smooth, waxy, or pearly and umbilicated papules 2 to 5 mm in diameter caused by molluscum contagiosum virus, a poxvirus. Diagnosis is based on clinical appearance. Treatment aims to prevent spread or remove cosmetically unacceptable lesions and can include mechanical methods (eg, curettage, cryosurgery) and topical irritants (eg, imiquimod, cantharidin, tretinoin).