Lou Mancano MD, FAAFP The Reading Hospital & Medical Center PAFP South Central Assembly September 19, 2009
Objectives
Recognize characteristics that aid in diagnosing similar-appearing skin lesions and conditions Use visual and other diagnostic modalities to assist in differentiating skin conditions that may look alike Formulate treatment options for the presented look-alike skin conditions
Disclosure Information Louis D. Mancano, M.D. I
have no relevant financial relationships to disclose. -AND – I will discuss the following off-label and/or investigational use in my presentation. UVB
light therapy, topical immunomodulators, topical tretinoin, topical calcipotriol, and oral hydroxychloroquine are mentioned as off-label treatments for some conditions presented
Practice Recommendation Screening for Skin Cancer The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin examination by a primary care clinician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population. This is an I statement. http://www.ahrq.gov/clinic/uspstf09/skincancer/skincanrs.pdf
Flat Warts
Angiofibromas
Steroid Acne
Keratosis Pilaris
Flat Warts
Flat Warts (Verruca Plana)
Benign proliferations of keratinized epithelium Caused by infection with types 3, 10, and 28 of the human papillomavirus (HPV) Autoinoculation also may occur Incubation period ranges 1 - 6 months
Flat Warts (Verruca Plana)
Slightly elevated fleshcolored to hyperpigmented papules Smooth or slightly hyperkeratotic Size usually 1 - 5 mm Numbers range from a few to hundreds that may become grouped or confluent
Flat Warts (Verruca Plana)
May occur anywhere on the skin and mucous membranes. Most common areas: – – –
face (children) hands beard area and shins (adults)
Koebner phenomenon - irritation from shaving legs and beard area probably accounts for this
Flat Warts
Treatment – –
–
Destructive methods - desiccation, freezing, and lasers are 60 to 80% effective Imiquimod - immune modifier approved for treatment of genital warts, but reports indicate successful tx of other warts. Topical tretinoin (retinoic acid) has some success
Angiofibromas (Adenoma Sebaceum)
Angiofibromas (Adenoma Sebaceum)
Hamartomas composed of fibrous and vascular tissue (do not represent sebaceous elements) The most common skin lesions associated with tuberous sclerosis (TS) TS is an autosomal dominant disorder characterized by hamartomas that may involve the skin, brain, heart, kidneys, and other organs Vogt’s classic triad of TS is seizure disorder, mental retardation (
