Cocktail Party Dermatology: John RT Reeves

Dermatitis Papulosa Nigra

Dark, fleshy papules in mask distribution

35% of adult blacks, familial, onset in early adulthood

Treatment: surgical shave or cautery

Accessory Tragus

Fleshy Papule(s) anterior to tragus

Present at birth, branchial arch defect

Soft or firm (cartilage), pedunculated

Shave or excise

Ear Corn

(Chondrodermatitis nodularis helicis)

Tender keratotic papule on apex of helix

Pain on resting head on pillow, older white men, (solar, pressure)

Inject cortisone, soft pillow or excise

Syringomas

Yellowish-white, tiny polygonal plaques

Lower lids of women   “moles” of eccrine sweat glands

Electrocautery moderately successful

Sebaceous Hyperplasia

Yellow-orange donut-shaped papules

Forehead/malar regions of white men who have large pores

Benign overgrowth of sebaceous glands

Light cautery or liquid nitrogen

Solar Elastosis

Yellowish white plaques on the temples and malar regions

Older white men mainly  “cooked” sun-damaged collagen

?improved by retin A

Idiopathic Guttate hypomelanosis

Tiny polygonal white areas on extremities up to 50% of all adults, all races. Probably related to sun exposure

No treatment

Keratosis Pilaris

Keratotic spicules in follicles, arms and legs

Dry skin of follicles feels sandpapery, catches on clothing

Occasionally mildly inflamed

Emollients somewhat helpful

Coiled Hairs

(usually) middle aged obese males

Pressure areas (especially belt line)? related to dry skin

Asymptomatic, no treatment

Stucco Keratosis

Lower legs, dorsa of feet of whites

Warty lesions, flake off with thumb-nail

Probably sun-related

Liquid nitrogen or keratolytics

Ladder Nail

“Ladder” of horizontal grooves, centre of thumb-nail

Habit tic – repeated trauma to posterior nail fold

Reverses with abstinence

Trichomycosis Axillaris

Yellow, red or black coatings on axillary or pubic hair

Asymptomatic Coating with Corynebacterium Tenuis

Shave, topical antibiotics

Soggy Sock Syndrome

(Juvenile plantar dermatosis)

Dryness, peeling, fissuring distal 1/3^rd of sole and pads of toes  Usually children  Occlusive footwear, wet socks

Dry socks, powder, leather soles

Pitted Keratolysis

Asymptomatic, tiny pits in keratin of soles

Usually in moist, macerated smelly foot

Caused by Corynebacterium of Dermatophilus

No shoes or use sandals. Drying paints

Peizogenous Papules

Soft nodules, margins of soles of feet

Present only when standing

Occasionally painful  usually in obese persons

Bulging of fat pads through fascia

Angiokeratosis Scroti

Dusky red papules on scrotum, often along course of venules

Asymptomatic, onset middle age

acquired haemangiomas, keratotic tops

Electrodessication

Pearly Penile Papules

Pearly papules on coronal of glans

Asymptomatic, onset puberty normal variant – in c. 30%

No treatment