2025 – PAGE 150 – DERMATOLOGY

DERMOID CYSTS

Dermoid cysts are saclike growths present at birth. They are like teratomas in that they can contain hair and teeth. They are often associated with tufts or sinuses. They grow slowly and can get infected, so most of them should be REMOVED. Especially those in sensitive areas, including the face or nasal area. They will require imaging before removal.

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EPIDERMOID CYSTS (AKA EPIDERMAL CYSTS)

These cysts are benign and are very common. They are flesh-colored nodules with a black punctum (black dot) that develop at one month of age or later.They often occur on pressure sites (buttocks, back, etc).

COMEDONAL ACNE

Think of comedonal acne as an OBSTRUCTIVE process that creates white heads and black heads. Treat with a RETINOID keratinolytic agent. You may also prescribe benzoyl peroxide.

PEARL: An answer with topical retinoic acid + benzoyl peroxide twice daily is probably WRONG. Benzoyl peroxide inactivates traditional retinoids (tretinoin), so one should be used at night, and the other in the morning (or at least with some time in between). Newer retinoids, like adapalene and tazarotene, are more stable and may be used at the same time.

INFLAMMATORY ACNE

Inflammatory acne is differentiated from comedonal acne by its RED BASE.

• Minor cases: If the acne is localized with small lesions, use a TOPICAL antimicrobial agent, such as Benzoyl peroxide, Clindamycin or Erythromycin. Retinoic acid topicals are also included in most regimens.
• Severe cases: If large, nodular, or in multiple areas, use ORAL antibiotics. First line is Tetracycline, Doxycycline, or Erythromycin. Minocycline is a second line agent. These antibiotics provide a bactericidal and an anti-inflammatory effect. You may also try oral contraceptivepills (OCPs) in females for their anti-androgen effects. If all else fails, use ISOTRETINOIN.

ISOTRETINOIN

Isotretinoin is a miracle drug that fights sebum production and bacteria, while also decreasing inflammation and comedonal acne. But it is TERATOGENIC, so obtain TWO negative pregnancy tests before starting the medications. Also, patients must use TWO forms of birth control starting one month before starting the medication and until one month after. In addition, they should have monthly pregnancy tests.

PEARL: Acne can begin as early as 8 years of age. If the boards present a 7-year-old child with what looks like acne, CONSIDER ANOTHER DIAGNOSIS! Consider exogenous steroid use, precocious puberty, and TUBEROUS SCLEROSIS.

(DOUBLE TAKE) APHTHOUS ULCERS

Aphthous ulcers are painful lesions found within the oral mucosa (buccal mucosa, lips, and tongue) with a grayish-white base and a rim of erythema. These can occur in isolation or in association with Behcet’s or Shwachman-Diamond syndrome.

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