cpc kurban nov 2009

8/8/2019 CPC Kurban Nov 2009

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Case 1Case 1


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fo amy histi oc ytes laden with intra c ellular f at dep o sits primarily withinfo amy histi oc ytes laden with intra c ellular f at dep o sits primarily withinthe upper reti c ular dermisthe upper reti c ular dermis


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x anth o ma c ells,x anth o ma c ells,


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X anthelasmaX anthelasma

derived f ro m the Greekderived f ro m the Greek x anth o sx anth o s (yell o w) and(yello w) and elasmaelasma (beaten metal(beaten metalplate).plate).

Yello w plaques that occ ur m o st co mm o nly near the inner c anthus of Yello w plaques that occ ur m o st co mm o nly near the inner c anthus of the eyelid, m o re of ten o n the upper lid than the l o wer lidthe eyelid, m o re of ten o n the upper lid than the l o wer lidX anthelasma palpebrarum is the m o st co mm o n c utane o usX anthelasma palpebrarum is the m o st co mm o n c utane o usx anth o ma.x anth o ma.c an be s of t, semis o lid, o r c alc are o usc an be s of t, semis o lid, o r c alc are o usOne hal f of these lesi o ns are ass oc iated with elevated plasma lipidOne hal f of these lesi o ns are ass oc iated with elevated plasma lipidlevelslevelsOcc urs in individuals > 50yrsOcc urs in individuals > 50yrsIn c hildren o r yo ung adults, ass oc iated with f amilialIn c hildren o r yo ung adults, ass oc iated with f amilialhyper c ho lestr o lemia o r f amilial dysbetalipidemiahyper c ho lestr o lemia o r f amilial dysbetalipidemiaManagement: Laser, e x c isio n, Ele c tro desi cc atio n, t o pic al appli c atio nManagement: Laser, e x c isio n, Ele c tro desi cc atio n, t o pic al appli c atio nof tric hlo ro ac etic ac idof tric hlo ro ac etic ac id


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Case 2Case 2


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variable epidermal sp o ngio sis o r ne c ro sis, Intense papillary dermalvariable epidermal sp o ngio sis o r ne c ro sis, Intense papillary dermaledema, super f ic ial and deep perivas c ular lymph oc ytic inf iltrate,edema, super f ic ial and deep perivas c ular lymph oc ytic inf iltrate,


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P erni oP erni o

In f lammat o ry skin co nditio n presenting a f ter e x po sure t o co ld asIn f lammat o ry skin co nditio n presenting a f ter e x po sure t o co ld aspruriti c and/ o r pain f ul erythemat o us t o vio lac eo us a c ral lesi o nspruriti c and/ o r pain f ul erythemat o us t o vio lac eo us a c ral lesi o nsidio pathi c o r se co ndary t o an underlying disease, likeidio pathi c o r se co ndary t o an underlying disease, like Chro nic Chro nic

myel o mo noc ytic leukemia, An o re x ia nerv o sa, Dyspr o teinemias, Ma c ro glo bulinemia,myel o mo noc ytic leukemia, An o re x ia nerv o sa, Dyspr o teinemias, Ma c ro glo bulinemia,Cryo glo bulinemia, c ryof ibrino genemia, co ld agglutinins, Antiph o sph o lipid antib o dyCryo glo bulinemia, c ryof ibrino genemia, co ld agglutinins, Antiph o sph o lipid antib o dysyndr o me,Raynaud diseasesyndr o me,Raynaud diseasedue t o an abn o rmal vas c ular resp o nse t o co ld e x po sure and is m o st due t o an abn o rmal vas c ular resp o nse t o co ld e x po sure and is m o st f requent when damp o r humid co nditio ns co inc idef requent when damp o r humid co nditio ns co inc ideP ro phyla c tic warming of ac ral areas, a c hieved by heat andP ro phyla c tic warming of ac ral areas, a c hieved by heat and

appr o priate c lo thing, best prevents perni o appr o priate c lo thing, best prevents perni o t o pic al and systemi c ster o ids, vas o dilat o rs, IV c alc ium fo llo wed byt o pic al and systemi c ster o ids, vas o dilat o rs, IV c alc ium fo llo wed byIM vitamin K, and ultravi o let B radiati o nIM vitamin K, and ultravi o let B radiati o nCalcium channel blockersCalcium channel blockersP eripheral arterial vas o dilat o rsP eripheral arterial vas o dilat o rs


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Diff erential Diagn o sisDiff erential Diagn o sis

Erythema Multi fo rmeErythema Multi fo rme

Hypersensitivity Vas c ulitisHypersensitivity Vas c ulitis(Leuk oc yt oc lasti c Vas c ulitis)(Leuk oc yt oc lasti c Vas c ulitis)

Sar co ido sisSar co ido sis


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Case 3Case 3


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Ex travasati o n of red bl oo d cells with marked hem o siderin dep o sitio n inEx travasati o n of red bl oo d cells with marked hem o siderin dep o sitio n inma c ro phagesma c ro phages


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Case 4Case 4


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inter f ac e dermatitis, di ff icult t o diff erentiate f ro m lupus erythemat o sus ,inter f ac e dermatitis, di ff icult t o diff erentiate f ro m lupus erythemat o sus ,


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Dermat o myo sitisDermat o myo sitis

idio pathi c inf lammat o ry my o pathy (IIM) with c hara c teristi c idio pathi c inf lammat o ry my o pathy (IIM) with c hara c teristi c c utane o us f indingsc utane o us f indingssystemi c diso rder that f requently a ff ec ts the j o ints, the es o phagus,systemi c diso rder that f requently a ff ec ts the j o ints, the es o phagus,

the lungs, and, less co mm o nly, the heart the lungs, and, less co mm o nly, the heart

path o gn o mo nic f eatures are the heli o tro pe rash and G o ttr o npath o gn o mo nic f eatures are the heli o tro pe rash and G o ttr o npapulespapulesP o ikilo derma may occ ur o n e x po sed skinP o ikilo derma may occ ur o n e x po sed skin

c ause of dermat o myo sitis is unkn o wnc ause of dermat o myo sitis is unkn o wngeneti c predisp o sitio n may e x ist geneti c predisp o sitio n may e x ist In f ec tio us agents, in c luding viruses (parti c ularly co x sa c kievirus,In f ec tio us agents, in c luding viruses (parti c ularly co x sa c kievirus,ec ho virus, human Tec ho virus, human T- -lymph o tro pic virus 1 [HTLVlymph o tro pic virus 1 [HTLV--1], and human1], and humanimmun o de f ic ien c y virus [HIV]),immun o de f ic ien c y virus [HIV]), T o x o plasmaTo x o plasma spe c ies, andspe c ies, and B o rreliaBo rreliaspe c ies, have been suggested as p o ssible triggers of the disease.spe c ies, have been suggested as p o ssible triggers of the disease.


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D ifferential D iagnosesD ifferential D iagnoses

CREST Syndr o meCREST Syndr o meP araps o riasisP araps o riasisGraf t Versus H o st DiseaseGraf t Versus H o st DiseaseP ityriasis Rubra P ilarisP ityriasis Rubra P ilaris

Lic hen My x edemat o susLic hen My x edemat o susP o lymo rph o us Light Erupti o nP o lymo rph o us Light Erupti o nLic hen P lanusLic hen P lanusP so riasis, P laqueP so riasis, P laqueLupus Erythemat o sus, A cuteLupus Erythemat o sus, A cuteRo sa ceaRo sa cea

Lupus Erythemat o sus, Dis co idLupus Erythemat o sus, Dis co idSar co ido sisSar co ido sisLupus Erythemat o sus, Suba c ute Cutane o usLupus Erythemat o sus, Suba c ute Cutane o usTinea C o rpo risTinea C o rpo risMo rpheaMo rpheaUrticaria, Chr o nicUrticaria, Chr o nic

Multicentri

cReti

cul

ohisti

ocyt

osisMulti

centri

cReti

cul

ohisti

ocyt

osis


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Case5Case5


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adip oc ytesadip oc ytes


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Lipo masLipo mas

A benign ne o plasm of adip oc ytes that fo rms in the sub c utane o us f at A benign ne o plasm of adip oc ytes that fo rms in the sub c utane o us f at (as well as in o ther o rgans s o metimes)(as well as in o ther o rgans s o metimes)mani f ests itsel f c linic ally as either an elevated tum o r o r a tum o r that mani f ests itsel f c linic ally as either an elevated tum o r o r a tum o r that c ann o t be visualized c linic ally, but that c an be palpated,c ann o t be visualized c linic ally, but that c an be palpated,

the skin o verlying it in b o th c irc umstan c es being n o rmalthe skin o verlying it in b o th c irc umstan c es being n o rmal A lipo ma, o nc e it presents itsel f , remains there fo r the li f etime of a A lipo ma, o nc e it presents itsel f , remains there fo r the li f etime of apers o n wh o c arries it.pers o n wh o c arries it.It may stay small o r be co me larger, s o metimes assuming giganti c It may stay small o r be co me larger, s o metimes assuming giganti c

dimensi o nsdimensi o nsbenign ne o plasm made up of adip oc ytes,benign ne o plasm made up of adip oc ytes,

Surgi c al e x c isio n is c urative i f a patient wants surgery fo r a n o t Surgi c al e x c isio n is c urative i f a patient wants surgery fo r a n o t--t oot oo --large tum o r. F o r th o se lip o mas that are t oo large t o be e x c ised,large tum o r. F o r th o se lip o mas that are t oo large t o be e x c ised,lipo su c tio n may be empl o yedlipo su c tio n may be empl o yed


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Diff erential Diagn o sisDiff erential Diagn o sis

seba c eo us c yst seba c eo us c yst abs c essabs c ess

Lipo sar co masLipo sar co mas


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Case 6, HIV indu c ed genital ul c ersCase 6, HIV indu c ed genital ul c ers


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Case 7Case 7


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perivas cular and perijun c tio nal in f iltrate of lymph oc ytes, plasma cells, andperivas cular and perijun c tio nal in f iltrate of lymph oc ytes, plasma cells, andma c ro phagesma c ro phages


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SyphillisSyphillis

Treponema pallidumTreponema pallidum is the mi cr oae r ophilic spi r o chete that cau ses syphilis, a is the mi cr o a e r ophilic spi r o chete th a t cau ses syphilis, a chr onic systemi c vene r ea l dise a se with m u ltiple c linica l p r esent a tionschr onic systemi c vene r ea l dise a se with m u ltiple c linica l p r esent a tionsSyphilis is charac te r ized by episodes o f ac tive dise a se (p r imar y, se c ond ar y,Syphilis is charac te r ized by episodes o f ac tive dise a se (p r imar y, se c ond ar y,te r tiar y st a ges) inte rru pted by pe r iods o f la ten cy.te r tiar y st a ges) inte rru pted by pe r iods o f la ten cy.P r imar y syphilis o ccur s within 3 weeks o f c ont ac t with an inf ec ted i nd ividua lP r imar y syphilis o ccur s withi n 3 weeks o f c o n t ac t with an inf ec te d ind ividua lSeco ndar y syphilis u sua lly pr ese n ts with a cu t an eo u s e ru ptio n within 2Seco ndar y syphilis u sua lly pr ese n ts with a cu t an eo u s e ru ptio n within 2--1010weeks af te r the p r imar y chancr e and is most f lo r id 3weeks af te r the p r imar y chancr e and is most f lo r id 3--4 mo n ths af te r 4 mo n ths af te r inf ec tio n inf ec tio n lesio n s o f be n ign te r tiar y syphilis u sua lly d evelop withi n 3lesio n s o f be n ign te r tiar y syphilis u sua lly d evelop withi n 3--10 ye ar s o f 10 ye ar s o f inf ec tio n inf ec tio n pr imar y lesio n (chancr e) o ccur s o n the pe n is o r scr ot um o f 70% o f m en pr imar y lesio n (chancr e) o ccur s o n the pe n is o r scr ot um o f 70% o f m en with syphilis and o n the v u lva , c e r vix , o r pe r in eum o f m o r e th an 50% o f with syphilis and o n the v u lva , c e r vix , o r pe r in eum o f m o r e th an 50% o f wo m en with syphilis.wo m en with syphilis.sin gle u lc e ra te d lesio n with a surr o und in g r ed ar eol a . The e d ge and ba se o f sin gle u lc e ra te d lesio n with a surr o und in g r ed ar eol a . The e d ge and ba se o f the u lce r ha ve a car tila gin o u s (b u tto n like) co n siste nc y o n pa lpa tio n .the u lce r ha ve a car tila gin o u s (b u tto n like) co n siste nc y o n pa lpa tio n .


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DLEDLE

c hro nic , s c arring, atr o phy pr o du c ing,c hro nic , s c arring, atr o phy pr o du c ing,ph o t o sensitive dermat o sis.ph o t o sensitive dermat o sis.

primary lesi o n is an erythemat o us papule o rprimary lesi o n is an erythemat o us papule o rplaque with slight plaque with slight- -t ot o --m o derate s c alingmo derate s c alingRes o lutio n of the a c tive lesi o n results in atr o phyRes o lutio n of the a c tive lesi o n results in atr o phyand s c arring.and s c arring.

Therapy withTherapy with suns c reenssuns c reens , t o pic al co rtico ster o ids,, t o pic al co rtico ster o ids,and antimalarial agents is usually e ff ec tive.and antimalarial agents is usually e ff ec tive.


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Ac tinic Kerat o sis Ac tinic Kerat o sisP so riasis, P laqueP so riasis, P laqueDermat o myo sitisDermat o myo sitisRo sa c eaRo sa c eaGranul o ma AnnulareGranul o ma AnnulareSar co ido sisSar co ido sisGranul o ma Fa c ialeGranul o ma Fa c ialeSquam o us Cell Car c ino maSquam o us Cell Car c ino maKerat o ac anth o maKerat o ac anth o ma

SyphilisSyphilisLic hen P lanusLic hen P lanusWarts, N o ngenitalWarts, N o ngenitalLupus Erythemat o sus, Suba c ute Cutane o usLupus Erythemat o sus, Suba c ute Cutane o us


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Case8Case8


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P LEP LE

an a c quired disease and is the m o st co mm o n of the idi o pathi c an a c quired disease and is the m o st co mm o n of the idi o pathi c ph o t o dermat o sesph o t o dermat o sesc hara c terized by re c urrent, abn o rmal, delayed rea c tio ns t o sunlight,c hara c terized by re c urrent, abn o rmal, delayed rea c tio ns t o sunlight,ranging f ro m erythemat o us papules, papul o vesi c les, and plaques t o ranging f ro m erythemat o us papules, papul o vesi c les, and plaques t o erythema multi fo rmeerythema multi fo rme like lesi o ns o n sunlight like lesi o ns o n sunlight- -e x po sed sur f ac es.ex po sed sur f ac es.Within any 1 patient, o nly 1 c linic al fo rm is co nsistently mani f estedWithin any 1 patient, o nly 1 c linic al fo rm is co nsistently mani f estedP apules (greatest in c iden c e), plaques, papul o vesi c les, and erythemaP apules (greatest in c iden c e), plaques, papul o vesi c les, and erythemamulti fo rmemulti fo rme like lesi o ns are the m o st co mm o n m o rph o lo gieslike lesi o ns are the m o st co mm o n m o rph o lo giesP ro phyla c tic ph o t o therapy o r ph o t oc hem o therapy at the beginningP ro phyla c tic ph o t o therapy o r ph o t oc hem o therapy at the beginningof spring fo r several weeks may prevent f lareof spring fo r several weeks may prevent f lare--ups thr o ugh o ut theups thr o ugh o ut thesummersummerTo pic al co rtico ster o idsTo pic al co rtico ster o ids

Antimalarials at l o w d o ses are s o metimes help f ul Antimalarials at l o w d o ses are s o metimes help f ulNico tinamide , Azathi o prineNico tinamide , Azathi o prine


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Co nta c t Dermatitis, Allergi cCo nta c t Dermatitis, Allergi c

Lupus Erythemat o sus, Suba c uteLupus Erythemat o sus, Suba c uteCutane o usCutane o us

cpc kurban nov 2009

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