Dx Tinea (corporis) vs Granuloma Annulare

Tinea => border is scaly


Granuloma Annulare => border is non-scaly

Dx Acne Vulgaris vs Acne Rosacea

Vulgaris => comedones (keratin plugs in pilosebaceous unit) - white or black (if oxidised)


Rosacea => no comedones


NB:
Important DDx of (white heads) comedones = Milia  |  Usually found in infra-orbital/cheek regions

Milia = keratin "bleb" vs keratin "plug" in vulgaris (forming a comedone)

Parapsoriasis - What Is It?

A continuum is thought to exist: 

Chronic dermatitis ---> Parapsoriasis ---> T cell lymphoma (mycosis fungoides)

Parapsoriasis may be defined thus

1. Plaque-type (usually elderly and on legs; circinate patches may be red, yellow, brown, pink; plaques tend to be thin)

    (sometimes called chronic scaly superficial dermatitis)

.. Small plaque

.. Large plaque

2. Lichenoid

.. Pityriasis lichenoides

.... acute

.... chronic

Most cases aren't painful or itchy

If this is part of DDx -> consider punch biopsies to exclude a T cell lymphoma

Else histology changes tend to be non-specific

Emollients very important to hydrate skin

Otherwise,Rx tends to be that for dermatitis, including topical c.steroids and UV therapy

Always a good reference site, I find ...

Parapsoriasis - Medscape Reference

emedicine.medscape.com/article/1107425-overviewApr 19, 2013 - Parapsoriasis describes a group of cutaneous diseases that can be characterized by scaly patches or slightly elevated papules


DDx includes
- dermatitis (particularly circinate/nummular type)
- psoriasis (plaque or guttate form)
- T cell lymphoma (mycosis fungoides)
- Pityriasis rosea
- Syphylis (secondary)

--> biopsies

--> ?syphylis serology

Skin Grafts

Two Broad Types

1. Full thickness
= epidermis + dermis (all of it)
Note!
Don't include fat

2. Partial ("split") thickness
= epidermis + part of dermis
And, again: no fat!

Skin Closure after Surgical Excision of Skin Lesion

Techniques to consider in order of preference (a guide only):
Most common technique
= primary closure
[Don't forget secondary closure - not 2nd on list, but not to be forgotten]
Then
- skin graft (split/not full thickness)
Flaps
- advancement
- rotational
- transformational
Finally
- skin graft (full thickness)

Dry Skin May Only Require Hydration with Emollients rather than Topical C.steroids

Dry skin is not necessarily inflamed

Emollients (good [greasy] ones) are essential and may be all that is required

However, [appropriately potent] topical c.steroid should be available

Molluscum contagiosum Rx

Rx

• EMLA cream 60 mins prior to Rx (especially in children)

• Curettage

• or

• Umbilicate

Other topical Rx messy, expensive and far less effective

NB:

• In cases of dermatitis, ensure this is treated too as MC more likely to spread
• Also, avoid baths to reduce risk of spread