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Acanthosis Nigricans
- Typically occurs in African Americans
Causes
- May be inherited
- May appear in a healthy individual
- May be directly related to an underlying health issue which is usually an endocrine disorder
- Insulin resistant disorders are most common
- DM type 2
- PCOS
- Hypo or hyperthyroidism
- Cushing’s disease
- Acromegaly
- Insulin resistant disorders are most common
Clinical Presentation
- Brown or black poorly defined area of thickened or velvety skin
- Typically found in areas where the skin folds like the posterior neck or the axilla
Labs, Studies and Physical Exam Findings
- Usually a clinical diagnosis
- If found on mucosal surfaces it is suggestive of a coexisting malignancy
- Screen for possible endocrine issues
- Fasting blood sugar
- Thyroid panel
- etc
Treatment
- Treat any underlying endocrine issues
Hidradenitis Suppurativa
- Disease affecting areas of apocrine sweat glands
- Underarms
- Inner thighs
- Groin
- Buttocks
- The glands clog for unknown reasons leading to recurrent cyst and abscess formation.
- Think horrific acne
Predisposing and Triggering Factors
- Females are affected more often than males
- Post pubescent more commonly affected
- Genetic predisposition
- Possibly autoimmune related
- Excessive sweating
- Hot humid environment
- Being overweight
- Tight clothing
- OCPs
Clinical Presentation
- Chronic cysts which vary in size from the size of pea the size of a baseball
- These can be extremely painful when inflamed
Labs and Studies
- Clinical diagnosis. It is often misdiagnosed
Treatment
- Address predisposing factors
- Weight loss
- No OCPs
- Loose fitting clothing
- Antibiotic treatment
- Incision and drainage if necessary
- Steroid injection
- Oral steroid
- Psych consult
Lipoma
A benign tumor of fat cells. They are soft, mobile and usually non tender. They may be surgically removed for cosmetic reasons if the location of the lipoma causes irritation.
Epithelial Inclusion Cyst
The most common cutaneous cyst. Typically arise on the face, neck and trunk. These are an implantation of epidermis into the dermis. This may occur with trauma or surgery. Surgical removal is typically the treatment
Pilonidal Disease
This can be a cyst, an abscess, a sinus or a fistula near the natal cleft of the buttocks. These can be extremely painful. Treatment begins with antibiotic therapy and may progress to surgical excision.
Urticaria (Hives)
Causes
- Animal dander
- Insect bites
- Pollen
- Shellfish
- Nuts
- Milk
- Stress
Clinical Presentation
- Wheal – raised areas surrounded by red base
- Itchy
- Pinpoint up to several inches in size
Treatment
- Chronic urticaria is difficult to treat – monitor and eliminate triggers
- Antihistamines
Study tip
Experiment with different ideas