Discover and read the best of Twitter Threads about #dermatologia

Most recents (24)

Varón de 32 años derivado por su MAP por Teledermatología por aparición de estas lesiones localizadas en espalda, flancos (imagen) y raíz de miembros superiores de 1 año de evolución Image
¿Cuál sería el siguiente paso a realizar?
Una sola imagen, sin historia clínica, no es nada (por poder ser, pudiera incluso no corresponder siquiera a nuestro paciente).
Así pues, lo citamos en consulta (RC: 4 ✅).
¿Cómo describiría la morfología del eritema?
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Si te cuento que esta paciente tiene lupus…
¿De qué subtipo hablamos?
¿Sabrías nombrar alguna otra entidad que dé este tipo de alopecia?
#dermatologia #dermtwitter #MIR2023
✅ Diagnóstico: Alopecia cicatricial en lupus discoide crónico.
➡️De forma resumida, hay que recordar los 3 patrones principales de afectación cutánea en el lupus.
1️⃣ - Lupus eritematoso agudo:
‼️ Asociación con enfermedad visceral en la mayoría de pacientes
🦋 Dermatológicamente: recuerda el eritema malar “en alas de mariposa”
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Vamos con un caso 📄 muy interesante de la guardia de ayer.
Mujer 👵🏼 de 82 años con antecedentes de interés de DM2, HTA y anemia crónica que acude por estas lesiones localizadas en cara interna de muslos y piernas de 5 días de evolución:
Lo primero de todo es describir bien las lesiones.
¿Cuál es la lesión elemental primaria que se aprecia?
En la imagen, se aprecian ampollas (>0,5 cm) tensas sobre una base eritematosa. Algunas de ellas están rotas, dando aspecto erosionado a las mismas.
Después de definir 🕵🏼‍♀️🕵🏽 las lesiones, ¿Cuál sería el siguiente paso a realizar?
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Para los #2mir2022, se acerca la época de preguntar especialidad y lugar para la misma.
Además de las cosas obvias, en mi opinión, lo más importante de cara a ello (y a veces suele olvidarse) se resume en los siguientes tweets:
1- Por mucho que se hable o te hagan contra, si hay una especialidad que te encante y siempre te ha llamado, pese a lo que pase, recomiendo cogerla. Eso de la “numeritis” existe, y repetir el MIR por ello es una gran pu..da
2- Acudir presencialmente a preguntar, aprovechar para conocer al servicio en persona, la forma de trabajar “in vivo” dista mucho de lo que se puede conocer por teléfono. También te dará la opción de conocer esa ciudad…
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#Dermatología: en época de baja temperatura ambiental se recomienda:
1.Baño con agua tibia. No caliente.
2.Sustituto de jabón, dove o de bebé.
3.Crema lubricante dos o tres veces al día en todo el cuerpo.
4.Uso de guantes para las manos. (1)
5.Uso de labello (vaseline sólido labial), al natural no con menta o mamadas de esas.
6.Vaseline sólido en narinas (los hoyos de la nariz)
7.Gotas lubricantes en ojos, como refresh.
8.No usará jamás zacate o estropajo. Menos las toallas japonesas. (2).
9.Calefacción con humidificador.
10.Abrigarse lo propio, no demás. Menos a los infantes, pueden causar miliaria (salpullido). (3).
#dermatología
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#Melanoma: tumor agresivo de la piel. Frecuente en México en la región plantar. Mancha café a negro. Crece horizontal en un inicio y posteriormente invade. Se conoce como melanoma acral lentiginoso con crecimiento radial y vertical. Si está ulcerado, es peor el pronóstico (1).
Si tiene mayor cantidad de células que invaden, espesor tumoral (Breslow) tiene posibilidad de entrar en vasos linfáticos, por ello es el factor pronóstico más importante. Debe incluirse en mm en el reporte histopatológico. Si es mayor de 0.8mm, cambia de estadio pT (2).
Es trascendental que se realicen revisiones anuales de toda la superficie de la piel. Que incluya que le revisen entre los dedos y si se ha visto lesiones en genitales, también deben ser evaluadas. Usamos el dermatoscopio para encontrar patrones incipientes. #dermatoscopia (3)
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Okay #medtwitter and #dermtwitter, you knew it was only a matter of time, didn’t you?! Let’s do this #COVID19 themed #medthread:

#COVID TOES, a #TWEETORIAL!

#MedEd #FOAMEd #dermatology #dermatologia @AADskin @AADMember @Meddermsoc @dermhospitalist
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First, a word of caution – this is one person’s thoughts on a new skin finding reported in a new disease that the medical community is still learning about! As such, nothing in the #tweetorial should be regarded as definite. Just wanted to share a thought process!
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So, who cares? #COVID19 is devastating, at times even for the young & healthy! But it’s all respiratory, right?

Well, as we're learning, there's so much more to #SARScov2, and as a #dermatologist, this is the perfect example of how the exam helps frame possible mechanisms.
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STAPHYLOCOCCAL SCALDED SKIN SYNDROME - A #dermatology/#dermtwitter #tweetorial!

Let's start with a question: You are seeing a new patient with a rash you suspect of being SSSS, but aren't sure if it might be bullous impetigo.

What test will help you differentiate the two?
2/
The correct answer is wound culture! SSSS should be sterile or skin flora; bullous impetigo will have lots of staph grow out. Keep reading to find out why! 👇

But before we get there, let's talk about the SSSS exam. The pic is a good example of "sad facies." pc:@dermnetnz
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The other great clue you are dealing with SSSS is the predilection for skin folds. This eruption can cause a high BSA of erythema --> desquamation.

SSSS is more common in the #pediatrics population, especially in kids <5 years of age (for all the #tweetiatricians out there!)
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Why exactly do the lesions in pityriasis rosea appear in the “Christmas Tree” pattern?

Well, in honor of today being #Christmas, let’s do a brief #dermatology/#dermtwitter #tweetorial on…

PITYRIASIS ROSEA!

So what say you? What’s the reason for the Xmas Tree pattern?
2/
PR presents in "Langer's Lines," aka the skin tension lines. This paper notes diseases in this pattern seem to have activated leukocytes in the pathophy, which could be explained by other papers looking at how skin stretch impacts immune response!

sciencedirect.com/science/articl…
3/
This same paper points out a limited group of skin diseases that can have this distribution:

- PR
- Secondary syphilis
- Sign of Leser Trelat
- Mycosis Fungoides

Ultimately, the cause of this distribution might have to do with skin tension, but is best described as unknown.
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ERYTHEMA MULTIFORME – a #dermatology #tweetorial/#medthread!

#MedEd #FOAMEd #dermatologia #dermtwitter #medtwitter #derm pc: @dermnetnz

Let's warm up with a question for all y'all tweeps out there!

What is the most common trigger for erythema multiforme (EM) in adults?
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EM is an immunologic syndrome usually triggered by infection in adults. We usually consider HSV and mycoplasma. A simple history for cold sores or genital ulcers can be telling, but mycoplasma can go undetected symptomatically.

What primary lesions do you expect in EM?
3/
EM is usually made up of papular (raised) targets. Pic1 is of EM; you can see the 3 zones in a typical target (red rim, then white, then red center). Versus SJS/TEN (pic2), where macular targetoid (2 zones of red rim, dusky center & flat).

2nd photo: my.clevelandclinic.org/health/disease…
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ACUTE SKIN GRAFT-VERSUS-HOST DISEASE:
A #tweetorial/#medthread on this complication of stem cell transplantation!

#MedEd #FOAMEd #dermtwitter #onctwitter #medtwitter #dermatology #dermatologia pc:@dermnetnz

1st, a poll:

How do you differentiate acute & chronic skin #GVHD?
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Acute vs. chronic GVHD is usually differentiated by when it occurs: before or after 100 days since allogeneic stem cell transplant. BUT in the skin, MORPHOLOGY is key!

As with almost everything else in derm, start with the exam. That will tell you what you're dealing with!
3/
Acute GVHD is usually morbilliform, which means "measles-like." Morphologically, we describe this eruption as "3-4 mm pink papules that coalesce into plaques." Whenever we see this in a SCT pt, the ddx includes the following:
- acute GVHD
- morbilliform drug
- viral exanthem
Read 14 tweets
Syphilis! RMSF! Hand-foot mouth!

Slow down there, Tiger! Let's dive deeper into:

ACRAL RASHES - a #tweetorial/#medthread
(aka rashes on the "palms and soles" - kind of 😉).

#MedEd #FOAMEd #medtwitter #dermtwitter #dermatology #dermatologia pc:@dermnetnz
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No where else on the body does a rash evoke more of a knee-jerk differential. That's not wrong per se, as we all learn this in med school, but it's more complicated then starting doxycycline and checking an RPR!

Let's start with a definition - what does "acral" actually mean?
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Technically, "acral" just means our distal body parts. So while we often think of palms and soles, it's actually inclusive of the whole hand, the whole foot, ears, and some include even the nose!

I actually didn't learn this until #derm residency, which was shocking to me.
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Hey #medtwitter, can you help me?

I’m leading a session today for the Ohio #derm association/@AADskin career launch Bootcamp on...

THE POWER OF TWITTER!

Could you help RT & like to help me prove the reach of this platform!
Thank you!
#dermtwitter #dermatology #dermatologia
@AADskin Thanks to all! This is what we ended up with the presentation. Appreciate all of #medtwitter's help!
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Let's go back to the basics today, and talk about some #morphology in the #dermatology exam.

Today's #tweetorial/#medthread will be about evaluating....

SCALE!

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
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Before we get too far into it, how do we think about #scale? Meaning, which one of the following is it?
2/
When we say "primary lesion," we mean the most basic element of a lesion/rash (papule, macule, patch, plaque etc).

SECONDARY CHANGE (which scale is) means the extra exam element that occurs on top of the primary lesion!

Tertiary/Quaternary isn't a thing. I'm just a jerk.
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I had a bit of an “ah ha moment” while attending in our #dermatology resident clinic a month ago.

The way I run this clinic means that when the timing is right, I try to have our senior resident precept the junior resident. I try to stay silent and literally say nothing.

1/
When this happened, we had a brand new senior and a brand new first year. Essentially both residents were settling into their respective roles.

In typical fashion, the junior resident presented the key points to the senior resident as I listened on.

2/
Jr: the patient doesn’t have a rash today, but the pictures look like wheals. He says that pressure causes it. Diphenhydramine doesn’t work that well. He doesn’t have dermatographism.

Sr: what do you think it is?

::both look at me to see what I’m thinking/about to say::

3/
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PYODERMA GANGRENOSUM – a #tweetorial/#medthread

After my recent #thread on Sweet Syndrome, I thought we’d continue our discussion of neutrophilic dermatoses with a focus on PG this time! Join me below!👇👇👇

#dermtwitter #medtwitter #dermatology #dermatologia pc: @dermnetnz
1/
#Pyodermagagrenosum is a rare ulcerating skin condition that most of us think of in conjunction with IBD. PG can be associated with other things too, so if there’s no IBD, we should also consider other triggers, like the possibility of paraneoplastic processes.
2/
PG is a neutrophilic dermatosis, so like Sweet Syndrome, it starts as a pustule, & ulcerates from there. Remember pathergy is a classic associated finding with neutrophilic derms. See my #tweetorial on sweet syndrome for a discussion of pathergy!


3/ Image
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CUTANEOUS LUPUS – a #tweetorial/#medthread!!

We all learn about Systemic Lupus Erythematosus (SLE) in medical school, but did you know there are multiple forms #lupus can take in the #skin?

#Meded #FOAMed #dermtwitter #medtwitter #rheumtwitter #dermatologia pc: @dermnetnz
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It wasn’t until #dermatology residency I learned about all the subtypes of cutaneous lupus (CLE)! I thought it was all just one disease: SLE. But in reality there are many forms of CLE, each with its own implications on systemic involvement and effect on the patient.
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Let’s start with the 3 subtypes:
Acute, Subacute, and Chronic Cutaneous Lupus Erythematosus (ACLE, SCLE, CCLE). CCLE is aka Discoid.
Each subtype "overlaps" with SLE in a different way.

Eg: ACLE overlaps completely with SLE, so they all have SLE! 👇
onlinelibrary.wiley.com/doi/abs/10.111…
3/ Image
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Time for a #tweetorial/#medthread on:

#CALCIPHYLAXIS!

This is a devastating diagnosis often seen in inpatients, so this goes to all the @DermHospitalist & #hospitalists out there!

#FOAMed #MedEd #dermatology #dermatologia #dermtwitter #medtwitter @SHMlive @DermHospitalist
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First of all, what is it? The exact mechanism is unknown. What we do know is that there is calcium in the arterioles of the skin, with arterial thrombosis. This interruption of blood flow causes painful ulcers and retiform purpura. Remember this?



2/
That interruption of blood flow causes the clinical picture of calciphylaxis - retiform purpura with a predilection for fatty areas, violaceous borders, necrosis with ulceration, and TERRIBLE PAIN. Without the pain, I really think one needs to reconsider the diagnosis!

3/
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In honor of my recent trip to Taiwan, where I was eaten alive by mosquitoes, I thought I'd put together a #tweetorial/#medthread on...

BUGBITES and STINGS!

#dermtwitter #dermatology #dermatologia #medtwitter #MedEd #FOAMEd pc:@dermnetnz
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First of all, did you know that #dermatologists refer to bug bites and stings as an "arthropod assault?" In case you ever wanted to throw that into your next conversation....
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While there are some rashes that can be classic for certain types of bites/stings, many are rather nondescript. So when you see a #dermatologist with what looks like bug bites, we are often making an educated guess. Classically, you see pink edematous papules/plaques.
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In honor of #skin #cancer awareness month, here's a #tweetorial on #SKINCANCER!

There is SO much we could talk about, so I'm going to keep it basic. #Dermtwitter, please add more!

#MedEd #FOAMed #dermatology #medtwitter @aadmember #dermatologia pc: @dermnetnz & @aadskin
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There are many types of skin cancer, but we'll focus on the big 3 in this #thread. We'll discuss basal cell carcinoma (BCC), Squamous cell carcinoma (SCC) & melanoma. The first two are types of "non-melanoma skin cancer (NMSC)," or more aptly named "keratinocytic carcinomas."
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BCCs are the most common cancer diagnosed. Classically described as "pink pearly papules," they often have "arborizing" (tree-like) telangiectasias. But, they don't always have to look classic. The 1st pic is the classic, but the others are also BCCs (superficial & pigmented)!
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Get your #dermatology jokes out now, because this is a #tweetorial/#medthread on....

TOPICAL STEROIDS!

Read on for tips on how to prescribe them, which one to choose, when does it matter, etc.

#MedEd #FOAMed #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
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Truly the workhorse of the #dermatologist's medicine chest, topical steroids are great for a multitude of reasons:
- Delivery straight to the organ of interest
- Systemic absorption is usually minimal
- Can be cheap (usually)

What on skin exam best suggests steroids may work?
2/
Erythema is a great indicator that there is inflammation. As such, topical steroids may be a good treatment option. However, there are some reasons NOT to use topical steroids. For example, if the rash is infectious (eg: tinea in photo1, herpes in photo2), steroids = no bueno.
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Thanks, @MelBreggs for the mention, and thank you to @gopiastik for a great #tweetorial on #AGEP (acute generalized exanthematous pustulosis). I would add a couple thoughts here. Please read on!

#MedEd #FOAMEd #derm #dermatology #dermatologia #medthread PC: @dermnetnz
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First of all, the name AGEP can be confusing, but really all it is a description (we dermatologists just like to sound #fancy). If you break it down, Acute (really quick onset) generalized (everywhere), exanthematous (rash-y), pustulosis (pustules)!
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The exam is red plaques studded with pustules (see photo). These pustules can coalesce and become "lakes of pus!" The 2nd picture doesn't have pustules b/c all of them came together, lifted off, and left the "collarette" of scale (which means there's a footprint leftover!
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Just wrapped up 2 weeks on the @MGHMedicine service! Let's celebrate with....

#CELLULITIS - a #tweetorial/#medthread!

#MedEd #FOAMEd #dermtwitter #medtwitter #derm #dermatologia #dermatology PC:@dermnetnz
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What is cellulitis? It's a bacterial infection of the deep dermis & subcutis. Every year, there are ~ 14.5 million cases diagnosed in the US, leading to >600,000 admissions! What does it usually look like? Remember: Tumor, rubor, color, dolor (swelling, red, warm, painful)!
2/
Most likely organisms are staph or strep. Abx choice targets those organisms. For a non-purulent cellulitis in a non-sick pt (1 or fewer SIRS criteria), oral abx are good. IV for non-responders or those with 2 or >SIRS. Check out the algorithm from: jamanetwork.com/journals/jama/…
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#hospmed19 is here, and I'm excited to join up with all my @SHMlive colleagues soon! In honor of the momentous occasion, I put together one last inpatient #tweetorial before the conference!

Let's chat about RED MAN SYNDROME (RMS)!

#MedEd #FOAMed #medthread #dermatology
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What is RMS? It's a hypersensitivity reaction, most commonly reported to vancomycin. However, it's been reported with other anti-infectives too (including cipro, rifampin, amphotericin, etc). What is the usual distribution seen clinically with RMS?
2/
RMS usually occurs around the head and neck and upper torso. That's why it's other name is "Red Neck Syndrome." The clinical exam is described as flushing & erythema. Patients complain of pruritus, & can also get pain, spasms, and even hypotension!

pc: aac.asm.org/content/56/12/…
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