• Clinical science

Collection of dermatological disorders

Summary

This learning card covers various dermatological disorders, including sebaceous and epidermoid cysts, cat scratch disease, miliaria, nummular eczema, livedo reticularis, xeroderma pigmentosum, pseudofolliculitis barbae, and albinism.

Sebaceous and epidermoid cysts

References:[1][2][3][4]

Cat scratch disease

References:[5][6][7][8][9]

Miliaria

Types
Miliaria crystallina Miliaria rubra Miliaria profunda
Epidemiology
  • Most common type
  • Rare; usually seen in adult men in tropical climates, who have had repeated episodes of miliaria rubra
Clinical findings

References:[10]

Nummular eczema (nummular dermatitis)

References:[11][12]

Livedo reticularis

Definition: a vascular syndrome that can be caused by either benign autonomic dysregulation of cutaneous perfusion or pathological obstruction of blood vessels

Physiological livedo

  • Pathophysiology: autonomic dysregulation; (functional disturbance) causing slowed cutaneous perfusion in response to external factors (i.e., cold)
  • Epidemiology: incidence highest in young women
  • Clinical findings
    • Symmetrical; livedo reticularis (regular, small, round) on the extremities and sometimes the trunk
    • Triggered by cold, regresses after application of warmth
  • Treatment: warmth, sauna, alternating cold and warm baths
  • Prognosis: improves with age

Pathological livedo

  • Pathophysiology: localized obstructions slow the blood flow (organic disturbance)
  • Etiology: vascular diseases (cholesterol embolism, atherosclerosis, vasculitis)
  • Clinical findings
    • Irregular; , unusual livedo reticularis of the extremities and sometimes trunk
    • Persists after warming the skin
  • Treatment: treat the underlying disease

Livedo reticularis that does not regress after application of warmth is indicative of an underlying vascular disease and requires treatment!

References:[13]

Xeroderma pigmentosum

  • Definition: rare, autosomal-recessive, hereditary skin disease caused by defective DNA repair mechanisms (i.e., nucleotide excision repair); in affected individuals, minimal UV radiation can lead to severe skin damage and has carcinogenic effects
  • Clinical findings
  • Management
    • Protection from light and avoidance of sun exposure
    • Frequent skin cancer screening, retinoids as prophylaxis
  • Prognosis: severely limited life expectancy

References:[14]

Pseudofolliculitis barbae

  • Definition: inflammatory skin disorder caused by shaving
  • Epidemiology: most common in black men (hair shafts typically form tight coils)
  • Pathophysiology
    • Extrafollicular penetration: Hair enters the interfollicular epidermis after it exits the follicular orifice.
    • Transfollicular penetration: Hair penetrates the dermis before exiting the follicular orifice.
  • Clinical findings: firm, hyperpigmented, tender, pruritic papules and pustules on beard area
  • Diagnosis: clinical appearance
  • Treatment
    • Cessation of shaving; alternative hair-removal techniques (e.g., laser hair removal)
    • Adjunctive: topical treatments (e.g., retinoids, corticosteroids, antimicrobials)


References:[15]

Albinism

  • Definition: : congenital disorders of melanin synthesis resulting in hypopigmentation
  • Epidemiology
    • Affects all races and both sexes
    • Most types of albinism are congenital and noticed early in life (e.g., newborns).
  • Classification
  • Pathophysiology: impaired melanin production
  • Clinical features
  • Treatment: only supportive treatment, no curative treatment available
    • Treatment of strabismus: eye-patching , eye surgery
    • Avoidance of direct exposure to UV light and regular screening for skin cancer
    • Wearing (prescription) sunglasses
    • Nitisinone : used for the treatment of hereditary tyrosinemia type 1

References:[16]