Discover and read the best of Twitter Threads about #dermtwitter

Most recents (24)

We're seeing more consult questions for this, and it's also garnering national attention, so let's take a brief moment in #tweetorial format to talk about:


#xylazine #MedEd #FOAMEd #dermtwitter #medtwitter

What is Xylazine? It was created in the 70s as a veterinary anesthetic. As an analog of clonidine, it has similar effects as an alpha-2 agonist, leading to sedation, anesthesia, and euphoria in the CNS.
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Recently, Xylazine has entered the drug supply, moreso in certain cities, but increasingly everywhere. It is often mixed with fentanyl as a cutting agent, and can also be used on its own. It may be called Tranq, Zombie Drug, or anestesia de caballo (horse anesthetic).
Read 12 tweets
Let's go back to the basics. Syphilis is from an infection by the bacterium Treponema pallidum. Usually spread by sexual means, syphilis has three main stages of disease.

Primary infection usually presents as a papule that turns into a painless ulcer called a chancre.
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Time from inoculation to chancre usually is 10-90 days (21 days is most typical).

There is a rare variant where the patient can get many smaller ulcerations, which is called Follman balanitis.
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Read 16 tweets
FINALLY clinician’s have figured that the PSEUDOSCIENTIFIC term “squamoproliferative lesion” means nothing more than a proliferating squamous lesion 🤣
#dermpath #dermtwitter #pathtwitter #dermatologia #dermatology #dermatologist #histopathology #dermatopathology Image
Squamoproliferative lesion was invented by some hotshot pathologist pretending its a diagnostic entity, but it actually means nothing more than an unspecified and unqualified proliferating squamous “lesion”.

#dermpath #dermtwitter #pathtwitter #dermatology #dermatopathology
Viral warts, seborrhoeic keratosis, actinic keratosis, keratoacanthomas, in situ and invasive squamous carcinomas are ALL either benign, atypical or malignant “squamoproliferative lesions”
#dermpath #dermtwitter #pathtwitter #dermatologia #dermatology #histopathology
Read 4 tweets
50+ Female, painful “end” nodule middle finger after trauma ?Neuroma

A rare Pacinian Corpuscle Neuroma 🤩

#dermpath #dermtwitter #pathtwitter #pathresident #dermatologia #dermatology #dermatologist #pathologist #histopathology #surgpath #dermatopathologia #dermatopathology ImageImageImageImage
A short commentary of some interesting facts. Image
Read 3 tweets
⏭️Esta imagen a primera vista es muy sugestiva..¿Qué preguntarías ?
This image is very suggestive…¿What would you ask for?
#CaseChallenge #DermTwitter #MIR #ENARM 🕵🏼‍♀️🕵🏼‍♀️ Image
‼️Nunca olvidéis la regla de afectación Palmoplantar (adjunto mi regla)
Habrá que preguntar por todo esto.
El paciente relató relaciones sexuales de riesgo 2-3 meses antes, con una lesión oral (ya no presente en la exploración) que probablemente sería el chancro
Se realizó serología con pruebas reagínicas y treponémicas que confirmaron en diagnóstico y se pautó penicilina benzatínica 2.4 millones de unidades
A la revisión, a los 3 meses títulos de RPR en descenso y clínicamente asintomático Image
Read 5 tweets
An 85-YO in rural Mississippi: months of tender, erythematous plaques & edema on bilateral hands extending to the elbows & on feet extending below the knees with significant pain

🔬skin granulomatous inflammation & numerous AFB

#IDtwitter #dermatology ImageImage
A repeat skin extensive granulomatous inflammation (A), with Ziehl-Neelsen stain clusters of acid-fast bacilli throughout the dermis (B).
Kinyoun stain >9 AFB/high-power field (C & D).

#dermpath #microbiology (A) Skin biopsy specimen, h...
Molecular identification: 100% identity to multiple Mycobacterium leprae


#MedTwitter #MolBiol
Read 19 tweets
💡Caso muy bonito y recientemente aceptado para su publicación
¿Qué os parece esta lesión en un niño de 5 años?
Diagnosis of this lession in a 5-years-old child?
#CaseChallenge #DermTwitter ImageImageImage
🤓¿Cuál es la lesión elemental primaria?
📍RC: 2. Se trata de un surco eritematoso, de unos 3-4 cm y que se extiende desde la planta al dorso del pie.
❓Ante esta lesión, ¿qué es lo más importante que tenemos que preguntar en la anamnesis?
Read 13 tweets
A 50-YO ♀️ bitten by her pet rat: fever, myalgia, sore throat, headaches a nonpruritic rash on extremities including palms & soles, arthralgias, knees arthritis.

A punctate wound with central necrosis on L palm, & her R thumb.

#rheumatology #internalmedicine #dermatology
Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
✔️Gram stain: scant pleomorphic gram-negative bacilli in chains with lateral bulbar swellings
#microbiology #rheumatologist
Synovial fluid 🧫culture: Streptobacillus moniliformis identified by biochemical testing & confirmed by MALDI-TOF.


#bacteriology #IDtwitter #microbiología
Read 9 tweets
13 años ♂️: lesiones verrugosas en mucosa oral de 2 años de evolución, con progresivo aumento en tamaño y número.

🖊️Alonso P, Vázquez A, Santos JL.…
@ContinuumAEP @aepediatria
#pediatria #dentista #AtencionPrimaria
📌infección viral rara de la mucosa oral
📌causada por el virus del papiloma humano, especialmente los subtipos 13 o 32.

#infecciosas #microbiología #MIR
@ContinuumAEP @aepediatria ✔️Es una proliferación epitelial benigna, ✔️asintomática,
✔️ múltiples pápulas de 3 a 10 mm con color de mucosa oral normal.

La frecuencia de esta enfermedad varía ampliamente de una región geográfica y grupo étnico a otro.

#healthcare #MedicinaInterna
Read 7 tweets
A 17-YO♀️, unprotected #sexual intercourse with multiple male partners: a 1-month history of pruritic genital lesions, multiple smooth, grayish-white papules & plaques were noted on the vulva & upper inner thighs.

DOI: 10.1056/NEJMicm2207538
#gynecology #womenshealth Image
A Treponema pallidum particle agglutination assay:➕
Rapid plasma reagin titer: ➕1:16.


#microbiology #gynecologist #primarycare
✔️Testing for other sexually transmitted infections, including HIV infection: ➖

✔️Counseling on the importance of condom use

✔️IM penicillin G benzathine
At the 1-month follow-up visit, the lesions had resolved, and the RPR was 1:8.

#dermtwitter #IDtwitter #MedTwitter
Read 5 tweets
I just finished another week rounding in the nursery and had a great time. I love my job! 👶🏼👩🏾‍🍼

Here are 7 common baby rashes that we didn’t cover last time.

#PedsTwitter #MedTwitter
1. Pink patches on the face
This is a nevus simplex (aka salmon patch/stork bite/angel kiss). 👼🏻💋

They can worsen with crying and go away with time. They're usually on the forehead/eyelids and have feathery borders (vs. a port-wine stain). They're actually not nevi (moles) but capillary dilations.
Read 17 tweets
A 37-YO, farmer in India, #HIV+ immunecompromised ♂️, treatment for suspected pulmonary tuberculosis: papulonodular lesions of 3-month duration over the face, neck, trunk, limbs, palms & soles, & oropharynx; fever & generalized lymphadenopathy
🔬: ?

#IDTwitter #microbiology Wide spread papules and nodules over face. Similar lesions w
🔬: Blastoconidias within the macrophages.
🧫: Histoplama capsulatum: characteristic colony, conversion to yeast form, characteristic🔬appearance.


doi: 10.4269/ajtmh.17-0432
#dermpath #mycology #internalmedicine 1.- Histologic section of skin lesion showing sheets of macr
Diagnosis is usually suspected on visualization of characteristic intracellular yeast (blastoconidias), the pathogenic or tisular form, with a clear rim and garnulomatous cellular infiltrate in tissue specimen or lymph node aspirate

#MedTwitter #Doctor
Read 7 tweets
A 31-YO ♂️, sex with men, HIV treatment, HCV: in 2022, fever, cervical lymph nodes & erythemato-squamous papules, with umbilications & ulcerations, vesicles & pustules, & honey-colored crusts on the face, trunk & limbs including his palms & soles

#IDtwitter #primarycare ImageImageImage
PCR: ➕for MPXVirus.
#HIV viral load of < 40 copies/mL and a CD4 + count of 167 cells/mm3


#healthcare #internalmedicine #microbiology…
Supportive care of Mpox was provided, namely,
✔️beta-lactams due to bacterial superinfection of the lesions,
✔️in addition to analgesia, which was initially administered with NSAIDs and then escalated to opioids.

#MedTwitter #MedStudentTwitter #dermtwitter
Read 7 tweets
A 32-YO ♂️ sex worker, sex with men unprotected, HIV under treatment: 20 lesions scattered throughout the body of umbilicated, erythematous, violaceous papules with central ulcerations & pustules, fevers, cervical & axillary lymph nodes

#IDtwitter #primarycare #healthcare
HIV viral load of 1577 copies/mL and a CD4 + count of 932 cells/mm3

PCR: ➕ for Mpox virus


#internalmedicine #microbiology…
Mpox had been a neglected disease until May, 2022, and since then, there has been a notorious increase in the number of human monkeypox cases in non-endemic areas

#MedTwitter #MedStudentTwitter #dermtwitter
Read 5 tweets
An 86-YO ♂️, injury on his L leg 47 years prior, several debridements, skin grafts, & vein stripping procedures: chronic bilateral leg progressive ulcers.

Superficial🧫: multiple organisms including E. coli & coagulase➖Staphylococcus.

#internalmedicine #IDtwitter Image
Skin biopsy🔬: bilateral invasive squamous cell carcinomas.


#dermatology #dermpath… Image
The mean time period between development of a wound to malignancy is 30–35 years.

The most common malignancies seen in Marjolin ulcers are squamous cell carcinomas, but basal cell carcinomas and melanomas have been reported.

#Doctor #healthcare #MedStudentTwitter
Read 6 tweets
A 20-YO ♀️, college wrestling, Mexico: itching in the past 2 months, erythematous & fine-scaling papules with annular plaques having a raised border affecting the face, neck, & torso.

doi: 10.18502/cmm.6.4.5439
#dermatology #primarycare #MedTwitter
KOH: multiple thin & septate hyphae.
🧫, MALDI-TOF-MS: Trichophyton tonsurans
T. tonsurans was isolated in 4 cases belonging to the school fighting team & from one of the training mats


Oral terbinafine for 3 weeks: clinical & mycological cure.
Tinea gladiatorum is a type of dermatophytosis that occurs in combat athletes, such as wrestlers and judo fighters, as a result of Trichophyton species.

doi: 10.18502/cmm.6.4.5439
#IDtwitter #microbiology #Doctor
Read 6 tweets
It's been ages since I've put out a #dermtwitter #tweetorial, so I thought what better way than to share a diagnosis that was the original motivator for me to become a dermatologist! A 🧵 on:


#MedEd #dermatology #medtwitter #FOAMEd @healourskin #pemphigus
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What is Pemphigus Vegetans? This is where breaking down the terms can be super helpful. It's the diagnosis we give when pemphigus has the morphology of vegetative plaques.

A #tweetorial on pemphigus if you need it👇

Some people think Vegetans occurs when Vulgaris goes untreated. Others think it's just a rare subtype of vulgaris.

Given the clinical findings, the path looks different with pseudoepitheliomatous hyperplasia (but still with a suprabasal split!).…
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Read 12 tweets
A 27-YO ♀️, fever and PCR + for #SARSCoV2: One week later, she developed migratory, pruritic urticarial erythematous plaques (wheals) on her face, limbs, trunk, palms & soles, and angioedema of her lips.

#dermtwitter #IDtwitter #MedTwitter
Treated with cetirizine, 12 weeks later, she was still having episodes of urticaria
The most likely diagnosis was CHRONIC SPONTANEOUS URTICARIA TRIGGERED BY SARS-CoV-2, but other considerations were urticarial vasculitis and chronic inducible urticaria.

#dermatology #Doctor
Urticaria is commonly triggered by viral & bacterial infections, including herpes simplex virus, cytomegalovirus, Epstein–Barr virus, HIV & mycoplasma.

It commonly precedes or occurs concurrently with COVID-19, but can rarely occur after symptoms have resolved.

Read 4 tweets
QuizTime 13
Happy New Year 2023

40yr old M comes to us with the following lesions of few months duration.
Applying various ointments from different places

Dx ?
#dermtwitter #MedTwitter #dermatology #MedEd #FOAMed #NEET #USMLE Image
Local adverse effects of topical corticosteroid use

On detailed history taking and careful examination it was found out
The patient was using verities of topical ointments from shops and sources for prolonged duration
They mostly contained corticosteroids
Self medication +
Skin atrophy is the most prominent cutaneous adverse effect
Involves both the epidermis and dermis

The development/ exacerbation of dermatoses of the face
steroid rosacea, acne, and perioral dermatitis, is a well-known side effect of topical corticosteroids
Read 5 tweets
Lesión circular,de crecimiento progresivo en el muslo izquierdo de 6 semanas de evolución. No mejoría con gentamicina y betametasona en crema.

¿Qué es?

Pregunta visual para el
#2MIR24 #2MIR23 para entrar en calor con la #dermatología #dermatology #dermtwitter #dermatologia Image
¿Con qué tratarías esta lesión?
Durante la anamnesis de la paciente,¿sobre qué es importante preguntar para llegar al diagnóstico?
Read 5 tweets
QuizTime 11
Good afternoon my dear friends
32 yr F
>1yr duration
H/O burn
Slowly progressing
Dx & Management?

#MedTwitter #dermatology #dermtwitter #MedEd #NEET #FOAMed #surgery #scar Image
Hypertrophic Scar HTS

Keloids and (HTS) are the result of an overgrowth of fibrous tissue following healing of a cutaneous injury
Extend beyond the margins of the original wound
Do not usually regress spontaneously
Tend to recur after excision

do not expand beyond the boundaries of the initial injury may undergo partial spontaneous resolution.
Read 4 tweets
A 77-YO ♂️, 2 weeks before herpes zoster on the right T3 and T4 dermatomes, celecoxib to treat new-onset back pain: a coalescing, erythematous eruption that spared the skin surrounding crusted herpes zoster lesions

DOI: 10.1056/NEJMicm2205584
#IDtwitter #dermatology
Skin-biopsy: consistent with a drug rash
Patch testing identified celecoxib as the trigger.

REVERSE ISOTOPIC RESPONSE in a drug rash sparing a healed herpes zoster infection.

#MedTwitter #dermtwitter #Doctor
A reverse isotopic response or an isotopic nonresponse occurs when:
✔️a new skin disorder by an unrelated disease
✔️spares the area of skin previously affected, healed dermatosis.

The mechanism of this phenomenon is unclear.

#MedStudentTwitter #resident
Read 4 tweets
QuizTime 10

35 yr F
Slight itchy/mostly asymptomatic lesions
Present on face back chest
Sun exposed areas
>1yr duration

Dx ?
#MedTwitter #dermatology #dermtwitter #MedEd #usmle #NEET #FOAMed #Medstudent #health #education Image
Chronic Cutaneous Lupus Erythematosus/Classic DLE

Begin as red-purple macules, papules, or small plaques Rapidly develop a hyperkeratotic surface
Early classic DLE- sharply demarcated, coin-shaped (i.e., discoid) erythematous plaques covered by a prominent, adherent scale+
Typically expand with erythema and hyperpigmentation at the periphery
Leaving hallmark atrophic central scarring/telangiectasia/hypopigmentation
Read 4 tweets
It’s officially #chilblain (AKA perniosis) season again ❄️ 🧊
Chilblains are itchy, burning, red/purple, lumps on the toes/fingers…
A 🧵 with some tips (based on professional and personal experience!) -
#dermtwitter Image
1. When at home avoid barefoot/ thin socks on cold, tiled/wooden floors
2. Keep indoor environment warm (including water bottles/ blankets where appropriate!)
3. Wrap up outside - hands, feet, core and head!… especially relevant if not moving e.g watching sport 🏉 ⚽️
4. Being thin puts you at higher risk (less padding!) so if you’re heading out, layer-up
5. Hand and foot warmers are useful
6. Keep moving - activity/ exercise improves circulation
7. Good overshoes and thick socks when cycling 🚴‍♂️
Read 5 tweets

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