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Introduction to Podiatric Introduction to Podiatric DermatologyDermatology
Jeffrey C. Page, DPMJeffrey C. Page, DPMPMED 1741PMED 1741
Podiatric Dermatology and Infectious Podiatric Dermatology and Infectious DiseasesDiseasesabscess
desquamation
Self-inflicted nail dystrophy
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Introduction to Podiatric Introduction to Podiatric Dermatology Dermatology
General PrinciplesGeneral Principles Skin anatomySkin anatomy Lesion typesLesion types Patterns & ConfigurationsPatterns & Configurations
Disorders of SweatDisorders of Sweat Mechanical LesionsMechanical Lesions
Depigmentation post steroid injection
Exfoliation from reaction to gluten
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Skin AnatomySkin Anatomy
Layers
Appendages
Purpose
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Epidermal LayersEpidermal Layers
Stratum corneumStratum corneum Stratum lucidum (palms and soles)Stratum lucidum (palms and soles) Stratum granulosumStratum granulosum Stratum spinosum (prickle cell layer)Stratum spinosum (prickle cell layer) Stratum basale (germinativum)Stratum basale (germinativum) Merkel’s cells (storage granules)Merkel’s cells (storage granules) Langerhans’ cells (immune system)Langerhans’ cells (immune system) Melanocytes (produce melanin)Melanocytes (produce melanin) Keratinocytes (produce keratin)Keratinocytes (produce keratin)
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Dermal LayersDermal Layers
Dermal-epidermal junction = basement Dermal-epidermal junction = basement membranemembrane
Papillary dermis (superficial)Papillary dermis (superficial) Reticular dermis (deep)Reticular dermis (deep) VesselsVessels NervesNerves Appendages (adnexa)Appendages (adnexa)
HairHair Glands (sweat & sebaceous)Glands (sweat & sebaceous) NailsNails
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Subcutaneous LayerSubcutaneous Layer
Production and Production and storage of fat cellsstorage of fat cells
Supports blood Supports blood vessels and nervesvessels and nerves
Storage of nutritionStorage of nutrition ThermoinsulationThermoinsulation
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Description of LesionsDescription of Lesions
Primary LesionsPrimary Lesions Secondary LesionsSecondary Lesions Elementary LesionsElementary Lesions
melanoma
atrophy from injections
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Descriptions Must Include:Descriptions Must Include: Lesion type/ textureLesion type/ texture Size/areaSize/area Moisture levelMoisture level ColorColor LocationLocation
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Primary LesionsPrimary Lesions
MaculesMacules PatchesPatches PapulesPapules PlaquesPlaques NodulesNodules WhealsWheals
VesiclesVesicles BullaeBullae PustulesPustules CystsCysts TumorsTumors
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Macules & PatchesMacules & Patches
Lentigo
Hyperpigmentation from venous stasis
Hypopigmentation from skin trauma
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PapulesPapules
verrucae
nevus Kaposi’s sarcoma
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PlaquesPlaques
psoriasis
tinea corporis/pedis
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NodulesNodules
Nodular melanoma
Neurofibromatosis
Hemangioma
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Vesicles & BullaeVesicles & Bullae
Vesicular tinea
herpesChicken Pox
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Wheals (Hives)Wheals (Hives)
truncal placques
angioedema
dermatographism
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AngioedemaAngioedema
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Cysts* & TumorsCysts* & Tumors
Inclusion cyst
Pedunculated nevus
*Cysts are sometimes called special lesions
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Secondary LesionsSecondary Lesions
ScalesScales CrustsCrusts ExcoriationsExcoriations FissuresFissures UlcersUlcers
ErosionsErosions ScarsScars IndurationInduration AtrophyAtrophy Lichenification?Lichenification?
Plantar ulcer
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ScalesScalesIcthyosis
Severe edema due to heart failure
Atopic dermatitis
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CrustsCrusts
Impetigo
Scalp kerion
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Erosions & UlcersErosions & Ulcers
osteomyelitis
Syphilitic chancre
Circinate balanitis
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Fissures & AtrophyFissures & Atrophy
Fissure from frequent dishwashing Atrophy and
telangiectasia due to oral steroids
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ScarsScars keloid
Hypertrophic scar following buionectomy
Hypopigmented scar from acne
Scars in construction worker
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Elementary (Special) LesionsElementary (Special) Lesions
ExcoriationsExcoriations ComedonesComedones BurrowsBurrows PurpuraPurpura
PetechiaePetechiae EcchymosesEcchymoses Macular or PapularMacular or Papular
TelangiectasiaTelangiectasia Lichenification?Lichenification? Cyst?Cyst?
Sebacious cyst
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Elementary (Special) LesionsElementary (Special) Lesions
Excoriations in factitial dermatitis
Comedones
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PurpuraPurpura
Vasculitides
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Elementary (Special) LesionsElementary (Special) Lesions
Burrow in Scabies
Telangiectasia from sun exposure
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Elementary (Special) LesionsElementary (Special) Lesions
Lichenification Spider Angioma
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Patterns and ConfigurationsPatterns and Configurations
RoundRound AnnularAnnular DiscoidDiscoid TargetoidTargetoid NummularNummular
Arciform-polycyclicArciform-polycyclic GeographicGeographic Herpetiform-groupedHerpetiform-grouped
Serpiginous-gyrateSerpiginous-gyrate LinearLinear ReticularReticular VerrucousVerrucous GuttateGuttate
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Round LesionsRound Lesions
Discoid Annular
DermatofibromaTinea pedis/corporis
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Round LesionsRound Lesions
Targetoid Nummular
Erythema multiforme
Nummular eczema
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Arciform (polycyclic)Arciform (polycyclic)Lichen planus
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Geographic LesionsGeographic Lesions
Pitted keratolysis
Pyoderma gangrenosum
Necrobiosis lipoidica diabeticorummelanoma
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Herpetiform (Grouped) LesionsHerpetiform (Grouped) Lesions
Herpes zosterHerpes zoster
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Serpiginous (Gyrate)Serpiginous (Gyrate)
Poison ivy Leishmaniasis
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Linear LesionsLinear Lesions
wheals
scratches
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Reticular (network) LesionsReticular (network) Lesions
nevi
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Verrucous LesionsVerrucous Lesions
solitary mosaic
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Guttate LesionsGuttate Lesions
MeaslesDiabetic dermopathy
Measles
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Disorders of SweatDisorders of Sweat
Hyperhidrosis Hyperhidrosis (Excessive sweating)(Excessive sweating)
Bromhidrosis (foul Bromhidrosis (foul odor associated with odor associated with hyperhidrosis)hyperhidrosis)
Pomphylux Pomphylux (Dyshidrotic eczema)(Dyshidrotic eczema) Not actually a sweat Not actually a sweat
disorderdisorder
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HyperhidrosisHyperhidrosis
Primary = Essential = Primary = Essential = IdiopathicIdiopathic
SecondarySecondary HyperthyroidismHyperthyroidism Endocrine Tx for CaEndocrine Tx for Ca Severe Psychiatric Severe Psychiatric
DisordersDisorders ObesityObesity MenopauseMenopause Febrile IllnessFebrile Illness MedicationsMedications
Three forms:Three forms: Emotionally InducedEmotionally Induced LocalizedLocalized GeneralizedGeneralized
Can cause significant Can cause significant emotional distress emotional distress and occupational and occupational disabilitydisability
0.6-1.0 incidence0.6-1.0 incidence 20x more common in 20x more common in
JapaneseJapanese
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Treatment of HyperhidrosisTreatment of Hyperhidrosis PrimaryPrimary
Antiperspirants (aluminum chloride)Antiperspirants (aluminum chloride) Topical 20% aluminum chloride Topical 20% aluminum chloride IontophoresisIontophoresis Drugs (sedatives or anticholinergics)Drugs (sedatives or anticholinergics) Botulinum toxinBotulinum toxin Surgery (gland excision or sympathectomy)Surgery (gland excision or sympathectomy) Alternative (e.g. herbs, acupuncture)Alternative (e.g. herbs, acupuncture)
SecondarySecondary Treat underlying condition (e.g. anti-Treat underlying condition (e.g. anti-
estrogens)estrogens)
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Mechanical LesionsMechanical Lesions
Hyperkeratosis Hyperkeratosis marginalismarginalis
TylomataTylomata CornsCorns Plantar keratosesPlantar keratoses Cutaneous hornCutaneous horn FissuresFissures BlistersBlisters
Hyperkeratosis Marginalis
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TylomataTylomata
DiffuseDiffuse Non-nucleatedNon-nucleated
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CornsCorns
Heloma molle Heloma durum
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Plantar keratosesPlantar keratoses
IPK = Nucleated, well-circumscribed
Neurovasculare = very painful
Palmar plantar keratoderma
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FissuresFissures
Regular emollient useRegular emollient use Avoid barefootAvoid barefoot Avoid sandalsAvoid sandals DebridementDebridement Use occlusionUse occlusion SuperglueSuperglue
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Cutaneous HornCutaneous Horn
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Padding to Reduce HyperkeratosisPadding to Reduce Hyperkeratosis
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BlistersBlisters
FrictionFriction ThermalThermal ChemicalChemical Bullous Bullous
disordersdisorders
IntraepidermalIntraepidermal SubepidermalSubepidermal
““To de-roof or not To de-roof or not to de-roof?” to de-roof?” Depends onDepends on Likelihood of further Likelihood of further
traumatrauma Risk of infectionRisk of infection
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Hydrocolloid and Polyurethane Film Hydrocolloid and Polyurethane Film DressingsDressings
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Describe this lesionDescribe this lesion
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Describe this lesionDescribe this lesion
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Describe this lesionDescribe this lesion
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Describe this lesionDescribe this lesion
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Describe this lesionDescribe this lesion
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Describe this lesionDescribe this lesion