Malignant tumors infiltrate the tissue

Benign tumours simply grow while remaining separated from the natural tissue, often by a capsule.

Connective Tissue

Freckle

Plural: Ephilides

The pigmented cells get more melanin (Hypertrophy rather than hyperplasia)

Intensified by sun exposure

Simple lentigines can occur at any age whereas Solar tend to occur in older patients

Simple lentigines have no relation to sun exposure

Simple does not change (darken) in response to sunlight

How are Solar Lentigines treated?

Describe the outcome

Laser treatment is used that fragments the pigment particles

After tx the spots will darken and then slough off

1. Dermal

2. Junctional

3. Compound

Dermal-found in the dermis

Junctional-found near the transition between dermis and epidermis

Photodocument with measurement

If suspicious recheck in 3-6 months

If no change recheck in 1 year

Refer for biopsy if changes do occur

Superficial Spreading Melanoma

Nodular Melanoma

Superficial spreading melanomas are less likely to metastasize than Nodular

Nodular grow vertically, penetrating the tissues

Clark's Levels (I, II, III --> V, by levels in the skin) -less accurate

Breslow depth (by depth in mm)

Sclerosing (Scarring)

Noduloulcerative

It is an immunomodulator-basically inhibits the replication of cells 

Although it may effectively destroy lesions without surgery it also may cause permanent pigmentation

1. Recurrent Meibomian gland Chalazion

2. Chronic eyelid/conjunctival infection

Neoplasia

Keratoacanthoma

Melanoma

Nevi

Verrucae

Papilloma

Seborrheic keratoses

Asymmetry

Borders

Color

Diameter

Elevation

(Location)

Fast growing lesion that started out as a red bump

Papular lesion on the skin 

looks hard, like a horn,

What might this be?

Likely Keratoacanthoma

Many resolve spontaneously, 

if not --> Derm. consult

A sub type of Melanoma that usually remains localized within the tissue-

Common in sunny places like Hawaii and Australia. 

Look for:

Sentinal vessels

Madarosis

Different pigmentation than surrounding skin

A flat or slightly elevated lesion

Round/oval

keratinized, may be greasy, waxy or scaly

1-6mm diamter

Verrucae

Nevi

Melanomas

Keratoacanthoma

Eczema

Neoplasia

Papilloma

Actinic Keratosis

Pruitic refers to itchiness

Eruption refers to a lesion of recent onset

Biopsy

Steroids

Vitamin A

Retinoids

Verruca plana

Verruca vulgaris

Verruca digitata

Vulgaris are rounder, they look like scabs

Digitata have stalks coming out of the infectious core, disgusting.

Excision

Keratolytic agents (emulsify and cauterize the tissue)

Laser

Cryo

Resolution (on its own)

Reassurance (pt education)

Removal

Perfectly round, flat elevations that may or may not have an umbilicated center. 

They are often shiny/waxy and in groups

Express the discharge

Then options for removal are excision, cryo or topical salicylic acid

Also educate the patient on hygiene and transmission

Herpes Zoster, caused by Varicella Zoster

Herpes Simplex, caused by Herpes Simplex virus

What is the everyday term for a demodex infestation

(ie. Demodicosis)

Topical Agents

Compromised immune system

Vector in spreading staph ( theory)

Folliculorum are 'cigar' shaped

Brevis are shorter and stubbier

(Think brevis is kinda like brief -->shorter)

Folliculorum are found in groups around the follicle

Brevis are solitary

Folliculorum-usually found at the base of the hair follicle

Brevis are found near sebaceous glands (which they can plug up)

Since they plug up sebaceous glands:

Dry eye

Chalazion formation

Itching

Burning

Crusts

Swollen lid margins

Loss of lashes

Lid margin erythema

conj. injection

Blepharitis

Cuffing around the lashes

Plugging of meibomian glands

Madarosis

Educate the pt about hygiene, possibly tea tree oil

In the office perform lid scrubs

Prescribe an ointment like erythromycin 

Also prescribe stronger anti-microbials if severe infection

The Pediculus are free-moving

The Phthirus are localized (remember they are the ones with claws, so they like to attach to stuff and stay put)

Egg

1st Instar nymph

2nd Instar nymph

3rd Instar nymph

adult male or female

Egg

Itchiness

Red eye

Insomnia

Irritability

Possibly swelling of preauricular lymph nodes

Nit cases in the lashes

Crusty lashes

Madarosis

Conj. injection

Lid edema and erythema

Erythromycin (Macrolide)

Bacitracin

Physostigmine (Cholinesterase inhibitor)

Ointment form

2 applications, 1 week apart

What is the name of the one product used to treat lice infestation that will kill all species, including the eggs?

What is the downside of this medication?

Ovide RX

Is much more expensive than the other options

1. Staphylococcus blepharitis

2. Albinism

3. Vogt-Koyanagi Harada syndrome (VKH)

Hypopigmentation of the skin, usually bilateral presentation on lids, pts have no symptoms

Presents <20 yo and is progressive

1. Cosmetic camouflage (make-up)

2. Skin protection for sun since their de-pigmented areas have a higher risk of over-exposure

3. Melanocyte stimulation and color-blending

4. Topical steroids

5. PUVA

6. Grafting

7. Depigmentation 

Darker pigmented populations like Asians, Native Americans, Hispanics and Middle Easterners. 

Ages 20-50

1. Prodromal phase

2. Acute Uveitic Phase

3. Convalescent Phase

4. Chronic-recurrent phase

Meningitis

Encephalopathy

Auditory disturbances

Anterior Uveitis

Posterior Uveitis

Acute Serous Retinal Detachment

Alopecia

Poliosis

Vitiligo

Fundus lesions

Depigmented limbal lesions

Name the 4 group included in diagnosis of VKH.

How many of these need to be present to confirm diagnosis?

Bilateral chronic anterior  uveitis

Posterior Uveitis

Neurological features

Cutaneous lesions

Need 3/4 to diagnose

STEROIDS

Oral 

Periocular injection

Topical for anterior uveitis

Immunosuppressives if steroids don't do the job

Name the disease:

Chronic, progressive, bilateral systemic autoimmune inflammatory disease that can cause blindness

BMMP

Benign Mucous Membrane Pemphigoid

Stage I starts with a conjunctivitis

Over the next 3-4 years the recurrent conjunctivitis worsens (II), develops in the other eye, causes scarring and shrinkage. 

In stage III there is symblepharon formation and this develops into stage IV which is severe dry eye, ankyloblepharon, corneal scarring and vision loss

Symblepharon is adhesions between the eyelid and the eyeball.

Ankyloblepharon refers to eyelids fusing together

Blepharitis and keratinization of lid margin

Entropion

Trichiasis

Cicatricial closure of puncta and lacrimal ducts

Shortening of fornices

Ankyloblepharon

1. Persistent dryness leading to epithelial defects

2. Infiltrates

3. Peripheral vascularization

4. Stomal thinning

5. ulceration

Chemical Trauma

Radiation injury

Patient history

Clinical presentation

Conjunctival Biopsy

1. STEROIDS-topical, subconj and oral!

2. Dapsone

3.Cyclophosphamide (advanced)

4. Azathioprine (advanced)

Chronic ocular lubricants

Antibiotics

Punctal plugs

eyelash epilation

Lid Scrubs

Soft CLs

Trichiasis

Entropion

Oculoplastic-for symblepharon and conj shrinkage

Corneal transplant (not as successful)

Erythema Multiforme

Stevens-Johnson Syndrome used to be in this category but is now on its own.

Minor-primarily involves the skin and maybe one mucosal membrane

Major-more severe, involves 2 or more mucosal membranes

Skin lesions are usually on the extremities, spare the trunk

Can last 1-4 weeks

Stevens-Johnson syndrome vs. Toxic Epidermal Necrolysis

Name 3 ways in which they are different

SJS affects <20% of body surface, TEN affects >20% (is much more severe)

Both are rare but TEN is a bit more prevalent 1 vs 6 cases/million

TEN has a much higher mortality rate ~5-7x that of SJS

Fever

Malaise 

Sore Throat

Headache

Sulfonamides

Tetracyclines

NSAIDs

Penicillins

Microbial infection:

-Mycoplasma pneumoniae

-Bacteria

-Viruses (HSV)

-Fungi

Mouth

Eyes

May also occur in genital areas

Targets/bull's eye

Pale round zone with an erythematous center

Usually found on the extremities

Papillary conjunctivitis

Pseudomembranous conjunctivitis

Bullae that form rapidly, rupture and scar

Vascular changes of conj accompanied by fibrosis, necrosis and keratinization

Eyelid involvement

There is no cure

Just treat infection (Antibiotics and Antivirals)

and PAIN CONTROL

Antibiotics

Topical Steroids

Soft CLs

Surgery after resolution

Lid scrubs

Epilation

Cool compresses

Stevens-Johnson Syndrome

Toxic Epidermal Necrolysis