ls /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace/derm…

mkdir -p /home/daytona/workspace/dermatology-ppt && ls /home/daytona/workspace/d…

~/dermatology-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Richard P. Usatine & Jennifer Krejci-Manwaring";
pres.title = "Dermatology";

// ── Color Palette ──────────────────────────────────────────────────
const C = {
  skin:     "F5EDE3",  // warm cream background
  deep:     "1A2C42",  // deep navy (dominant dark)
  teal:     "1F7A8C",  // teal accent
  rust:     "C0392B",  // rust red accent
  amber:    "E67E22",  // amber highlight
  white:    "FFFFFF",
  lightGray:"F0F4F8",
  midGray:  "8899AA",
  gold:     "D4A843",
};

// ── Helpers ────────────────────────────────────────────────────────
function darkSlide(slide) {
  slide.background = { color: C.deep };
}
function skinSlide(slide) {
  slide.background = { color: C.skin };
}
function lightSlide(slide) {
  slide.background = { color: C.lightGray };
}

function addAccentBar(slide, color, y = 0, h = 0.08) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y, w: "100%", h, fill: { color } });
}

function sectionHeader(slide, sectionNum, title, subtitle, bgColor, accentColor) {
  slide.background = { color: bgColor };
  // Top accent stripe
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.12, fill: { color: accentColor } });
  // Bottom accent stripe
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.5, w: "100%", h: 0.125, fill: { color: accentColor } });
  // Large section number watermark
  slide.addText(sectionNum, {
    x: 7.5, y: 0.5, w: 2.5, h: 4.5,
    fontSize: 140, color: accentColor, bold: true, align: "right",
    transparency: 75, fontFace: "Georgia",
  });
  slide.addText(title, {
    x: 0.5, y: 1.4, w: 7, h: 1.8,
    fontSize: 38, bold: true, color: C.deep, fontFace: "Calibri", align: "left",
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.5, y: 3.3, w: 7, h: 0.7,
      fontSize: 16, color: C.teal, fontFace: "Calibri", align: "left", italic: true,
    });
  }
}

function contentSlide(slide, title, bullets, accentColor) {
  lightSlide(slide);
  // Left colored sidebar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: "100%", fill: { color: accentColor } });
  // Top bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.1, fill: { color: accentColor } });
  slide.addText(title, {
    x: 0.35, y: 0.18, w: 9.4, h: 0.65,
    fontSize: 22, bold: true, color: C.deep, fontFace: "Calibri", align: "left",
  });
  // Divider
  slide.addShape(pres.ShapeType.line, { x: 0.35, y: 0.88, w: 9.3, h: 0, line: { color: accentColor, width: 1.5 } });

  const items = bullets.map((b, i) => {
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      return { text: b.replace(/^__/, ""), options: { bold: true, color: accentColor, fontSize: 13, bullet: false, breakLine: true, indentLevel: 0 } };
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    return { text: b, options: { bullet: { type: "bullet" }, breakLine: true, fontSize: 12.5, color: "2C3E50", indentLevel: b.startsWith("  ") ? 1 : 0 } };
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  slide.addText(items, {
    x: 0.45, y: 1.0, w: 9.2, h: 4.35,
    fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.15,
  });
}

function twoColSlide(slide, title, leftItems, rightItems, accentColor) {
  lightSlide(slide);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.1, fill: { color: accentColor } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: "100%", fill: { color: accentColor } });
  slide.addText(title, {
    x: 0.35, y: 0.18, w: 9.4, h: 0.65,
    fontSize: 22, bold: true, color: C.deep, fontFace: "Calibri",
  });
  slide.addShape(pres.ShapeType.line, { x: 0.35, y: 0.88, w: 9.3, h: 0, line: { color: accentColor, width: 1.5 } });

  // Col divider
  slide.addShape(pres.ShapeType.line, { x: 5.1, y: 1.0, w: 0, h: 4.2, line: { color: accentColor, width: 0.8, dashType: "dash" } });

  const makeItems = (arr) => arr.map(b => ({
    text: b, options: { bullet: { type: "bullet" }, breakLine: true, fontSize: 12, color: "2C3E50", indentLevel: b.startsWith("  ") ? 1 : 0 }
  }));

  slide.addText(makeItems(leftItems), { x: 0.45, y: 1.0, w: 4.5, h: 4.3, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.2 });
  slide.addText(makeItems(rightItems), { x: 5.25, y: 1.0, w: 4.5, h: 4.3, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.2 });
}

function tableSlide(slide, title, headers, rows, accentColor) {
  lightSlide(slide);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.1, fill: { color: accentColor } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: "100%", fill: { color: accentColor } });
  slide.addText(title, {
    x: 0.35, y: 0.18, w: 9.4, h: 0.65,
    fontSize: 22, bold: true, color: C.deep, fontFace: "Calibri",
  });
  slide.addShape(pres.ShapeType.line, { x: 0.35, y: 0.88, w: 9.3, h: 0, line: { color: accentColor, width: 1.5 } });

  const tableData = [
    headers.map(h => ({ text: h, options: { bold: true, color: C.white, fill: accentColor, fontSize: 12, align: "center" } })),
    ...rows.map((row, ri) => row.map(cell => ({ text: cell, options: { fontSize: 11, fill: ri % 2 === 0 ? "FFFFFF" : "EEF4FA", color: "2C3E50", align: "left" } })))
  ];

  slide.addTable(tableData, { x: 0.35, y: 1.0, w: 9.3, colW: Array(headers.length).fill(9.3 / headers.length), border: { pt: 0.5, color: "CCDDEE" }, autoPage: false });
}


// ══════════════════════════════════════════════════════════════════
//  SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════
let s = pres.addSlide();
darkSlide(s);
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.3, h: "100%", fill: { color: C.teal } });
s.addShape(pres.ShapeType.rect, { x: 0, y: 4.9, w: "100%", h: 0.725, fill: { color: C.teal }, transparency: 40 });
// Large decorative circle
s.addShape(pres.ShapeType.ellipse, { x: 6.8, y: -1.0, w: 5.5, h: 5.5, fill: { color: C.teal }, line: { color: C.teal }, transparency: 85 });
s.addShape(pres.ShapeType.ellipse, { x: 7.5, y: 2.8, w: 3.5, h: 3.5, fill: { color: C.gold }, line: { color: C.gold }, transparency: 80 });

s.addText("DERMATOLOGY", {
  x: 0.5, y: 0.9, w: 9, h: 1.4,
  fontSize: 58, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 8,
});
s.addText("Principles of Diagnosis · Management · Clinical Conditions", {
  x: 0.5, y: 2.35, w: 8.5, h: 0.6,
  fontSize: 16, color: C.gold, fontFace: "Calibri", italic: true, charSpacing: 1,
});
s.addShape(pres.ShapeType.line, { x: 0.5, y: 3.1, w: 5.5, h: 0, line: { color: C.teal, width: 2 } });
s.addText("Richard P. Usatine, MD  ·  Jennifer Krejci-Manwaring, MD", {
  x: 0.5, y: 3.3, w: 8.5, h: 0.45,
  fontSize: 14, color: C.midGray, fontFace: "Calibri",
});
s.addText("Family Medicine  |  Dermatology  |  Chapter 33", {
  x: 0.5, y: 3.75, w: 8.5, h: 0.4,
  fontSize: 13, color: C.gold, fontFace: "Calibri",
});
s.addText("Source: Textbook of Family Medicine  •  2026", {
  x: 0.5, y: 5.0, w: 9, h: 0.35,
  fontSize: 11, color: C.white, fontFace: "Calibri", transparency: 30,
});

// ══════════════════════════════════════════════════════════════════
//  SLIDE 2 – CHAPTER OUTLINE
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
darkSlide(s);
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.12, fill: { color: C.teal } });
s.addShape(pres.ShapeType.rect, { x: 0, y: 5.5, w: "100%", h: 0.125, fill: { color: C.gold } });
s.addText("CHAPTER OUTLINE", {
  x: 0.5, y: 0.2, w: 9, h: 0.65,
  fontSize: 28, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 4,
});

const sections = [
  ["01", "Principles of Diagnosis", "p. 740"],
  ["02", "General Management", "p. 741"],
  ["03", "Skin Problems Beginning in Childhood", "p. 742"],
  ["04", "Inflammatory Dermatologic Diseases", "p. 747"],
  ["05", "Infectious Skin Diseases", "p. 756"],
  ["06", "Infestations", "p. 767"],
  ["07", "Hypersensitivity Reactions & Other Eruptions", "p. 769"],
  ["08", "Skin Signs of Systemic Disease", "p. 771"],
  ["09", "Benign Growths", "p. 773"],
  ["10", "Premalignant & Malignant Skin Lesions", "p. 775"],
];

sections.forEach((sec, i) => {
  const col = i < 5 ? 0 : 1;
  const row = i < 5 ? i : i - 5;
  const xBase = col === 0 ? 0.4 : 5.2;
  const yBase = 1.05 + row * 0.87;

  s.addShape(pres.ShapeType.rect, { x: xBase, y: yBase, w: 4.5, h: 0.72, fill: { color: "1E3A54" }, line: { color: C.teal, width: 0.5 } });
  s.addText(sec[0], { x: xBase + 0.08, y: yBase + 0.08, w: 0.55, h: 0.55, fontSize: 15, bold: true, color: C.teal, fontFace: "Georgia", align: "center" });
  s.addShape(pres.ShapeType.line, { x: xBase + 0.65, y: yBase + 0.1, w: 0, h: 0.52, line: { color: C.teal, width: 0.7 } });
  s.addText(sec[1], { x: xBase + 0.75, y: yBase + 0.1, w: 3.0, h: 0.52, fontSize: 12.5, color: C.white, fontFace: "Calibri", valign: "middle" });
  s.addText(sec[2], { x: xBase + 3.75, y: yBase + 0.1, w: 0.65, h: 0.52, fontSize: 10, color: C.gold, fontFace: "Calibri", align: "right", valign: "middle" });
});


// ══════════════════════════════════════════════════════════════════
//  SLIDE 3 – SECTION 1 HEADER: Principles of Diagnosis
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "01", "Principles of Diagnosis", "Systematic approach to skin lesion identification", C.skin, C.teal);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 4 – Morphology & Lesion Types
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Primary & Secondary Skin Lesions",
  [
    "PRIMARY LESIONS",
    "  Macule – flat, color change <1 cm",
    "  Patch – flat, color change >1 cm",
    "  Papule – raised, solid <1 cm",
    "  Plaque – raised, solid >1 cm",
    "  Nodule – raised, solid, deeper",
    "  Vesicle – fluid-filled blister <0.5 cm",
    "  Bulla – large blister >0.5 cm",
    "  Pustule – pus-filled lesion",
    "  Wheal – transient edematous papule",
  ],
  [
    "SECONDARY LESIONS",
    "  Scale – flaking of stratum corneum",
    "  Crust – dried serum/exudate",
    "  Erosion – superficial epithelial loss",
    "  Ulcer – full-thickness skin loss",
    "  Fissure – linear crack in skin",
    "  Scar – fibrous replacement tissue",
    "  Lichenification – thickened skin",
    "  Excoriation – scratch-induced erosion",
  ],
  C.teal
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 5 – Distribution & Morphology Tips
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Diagnostic Approach: Key Principles", [
  "1. DESCRIBE THE LESION MORPHOLOGY FIRST",
  "  Identify: primary lesion type, size, shape, color, border, surface",
  "  Avoid premature diagnosis — describe before naming",
  "2. ASSESS DISTRIBUTION",
  "  Localized vs. generalized; sun-exposed vs. protected areas",
  "  Dermatomal (herpes zoster) vs. scattered (varicella)",
  "  Symmetrical (contact dermatitis) vs. random",
  "3. CONSIDER ASSOCIATED FEATURES",
  "  Pruritus, pain, systemic symptoms, fever",
  "  Onset, duration, triggers (drugs, foods, sun, stress)",
  "4. FITZPATRICK SKIN TYPE MATTERS",
  "  Type I–II: highest risk for skin cancer (UV damage)",
  "  Type V–VI: keloid tendency; post-inflammatory hyperpigmentation common",
  "5. USE DERMOSCOPY WHEN AVAILABLE",
  "  Improves diagnostic accuracy for pigmented lesions by 10–27%",
], C.teal);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 6 – Fitzpatrick Scale Table
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Fitzpatrick Skin Type Classification",
  ["Type", "Complexion", "Sun Response", "Skin Cancer Risk"],
  [
    ["I", "Very white", "Always burns, never tans", "Highest"],
    ["II", "White", "Burns easily, tans minimally", "Very High"],
    ["III", "White to olive", "Sometimes burns, slowly tans", "High"],
    ["IV", "Brown", "Burns minimally, always tans", "Moderate"],
    ["V", "Dark brown", "Rarely burns, tans well", "Low"],
    ["VI", "Black", "Never burns, deeply pigmented", "Lowest"],
  ],
  C.teal
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 7 – SECTION 2 HEADER: General Management
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "02", "General Management", "Treatment principles in dermatologic disease", C.skin, C.rust);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 8 – General Management Content
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "General Management Principles", [
  "TOPICAL THERAPY",
  "  Choose vehicle based on location & condition: ointments (dry/scaly), creams (moist), gels (oily/hairy areas)",
  "  Low-potency steroids: face, intertriginous areas, children",
  "  High-potency steroids: thick plaques on trunk/extremities",
  "  Avoid fluorinated steroids on face — risk of atrophy, telangiectasia",
  "PROCEDURAL APPROACHES",
  "  Cryotherapy: benign lesions, warts, actinic keratoses",
  "  Curettage & electrodesiccation: seborrheic keratoses, BCCs",
  "  Mohs micrographic surgery: highest cure rate for NMSC",
  "SYSTEMIC THERAPY",
  "  Antibiotics, antivirals, antifungals as indicated",
  "  Immunosuppressants (methotrexate, cyclosporine) for severe inflammatory disease",
  "  Biologics (dupilumab, TNF-α inhibitors): targeted therapy for psoriasis, atopic dermatitis",
  "PHOTOPROTECTION",
  "  SPF ≥30 broad-spectrum sunscreen; UVA + UVB protection",
], C.rust);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 9 – SECTION 3 HEADER: Skin Problems in Childhood
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "03", "Skin Problems Beginning in Childhood", "Atopic dermatitis, acne, and pediatric dermatoses", C.skin, C.amber);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 10 – Atopic Dermatitis
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Atopic Dermatitis (Eczema)", [
  "EPIDEMIOLOGY",
  "  Most common chronic skin disease in children; affects 10–20% of children, 1–3% adults",
  "  Atopic triad: eczema + asthma + allergic rhinitis",
  "PATHOPHYSIOLOGY",
  "  Filaggrin gene mutations → impaired skin barrier → IgE sensitization",
  "  Th2-skewed immune response; elevated IgE levels",
  "CLINICAL FEATURES",
  "  Infants: red weeping patches on cheeks, scalp, extensor surfaces",
  "  Children/adults: flexural lichenified plaques (antecubital, popliteal fossae)",
  "  Key feature: intense pruritus — 'the itch that rashes'",
  "MANAGEMENT",
  "  Emollients: cornerstone of therapy; apply immediately after bathing",
  "  Topical corticosteroids: first-line for flares",
  "  Topical calcineurin inhibitors (tacrolimus, pimecrolimus): steroid-sparing",
  "  Dupilumab (IL-4/IL-13 inhibitor): for moderate-to-severe disease ≥6 months",
], C.amber);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 11 – Acne Vulgaris
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Acne Vulgaris",
  [
    "PATHOGENESIS",
    "  1. Follicular hyperkeratinization",
    "  2. Excess sebum production (androgens)",
    "  3. C. acnes colonization",
    "  4. Inflammatory cascade",
    "LESION TYPES",
    "  Non-inflammatory: open comedones (blackheads), closed comedones (whiteheads)",
    "  Inflammatory: papules, pustules, nodules, cysts",
    "GRADING",
    "  Mild, moderate, severe / nodulocystic",
  ],
  [
    "TREATMENT LADDER",
    "  Mild: topical retinoids ± topical antibiotics (BPO combination)",
    "  Moderate: oral antibiotics (doxycycline, minocycline) + topical retinoid",
    "  Severe: oral isotretinoin (0.5–1 mg/kg/day x 5–6 months)",
    "SPECIAL NOTES",
    "  Isotretinoin: iPLEDGE program required (teratogenic)",
    "  Combination BPO + antibiotic reduces resistance",
    "  Hormonal therapy (OCP, spironolactone) for women",
    "  Avoid excessive washing — worsens dryness",
  ],
  C.amber
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 12 – Other Childhood Dermatoses
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Other Pediatric Skin Conditions", [
  "SEBORRHEIC DERMATITIS",
  "  'Cradle cap' in infants; greasy, yellow scales on scalp, eyebrows, nasolabial folds",
  "  Caused by Malassezia yeast; responds to antifungal shampoos (ketoconazole 2%)",
  "DIAPER DERMATITIS",
  "  Irritant contact dermatitis; spares skin folds (vs. candidal — involves folds)",
  "  Treatment: barrier ointments (zinc oxide), frequent changes, antifungals if candidal",
  "IMPETIGO",
  "  S. aureus or S. pyogenes; 'honey-colored' crusts — most common bacterial skin infection in children",
  "  Topical mupirocin (localized); oral cephalexin or amoxicillin-clavulanate (widespread)",
  "MOLLUSCUM CONTAGIOSUM",
  "  Poxvirus; pearly dome-shaped papules with central umbilication",
  "  Often self-limiting; curettage or cantharidin for troublesome lesions",
  "WARTS (VERRUCA VULGARIS)",
  "  HPV (types 1, 2, 4); rough hyperkeratotic papules; plantar warts (verruca plantaris)",
  "  Cryotherapy, salicylic acid; immunocompetent patients usually self-resolve",
], C.amber);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 13 – SECTION 4 HEADER: Inflammatory Dermatologic Diseases
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "04", "Inflammatory Dermatologic Diseases", "Psoriasis, rosacea, and other inflammatory conditions", C.skin, C.teal);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 14 – Psoriasis
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Psoriasis", [
  "EPIDEMIOLOGY & PATHOPHYSIOLOGY",
  "  Affects 2–3% of the population; T-cell mediated (Th17 pathway); IL-17, IL-23 key cytokines",
  "  Genetic (HLA-Cw6); triggers: stress, infection, medications (lithium, β-blockers, NSAIDs)",
  "CLINICAL VARIANTS",
  "  Plaque psoriasis (80%): well-demarcated, salmon-red plaques with silvery scale; extensor surfaces, scalp",
  "  Guttate: teardrop papules; post-streptococcal; common in children",
  "  Pustular: sterile pustules; can be life-threatening (von Zumbusch)",
  "  Erythrodermic: >90% BSA; medical emergency",
  "  Nail psoriasis: pitting, onycholysis, oil-drop sign, subungual hyperkeratosis",
  "  Psoriatic arthritis: 5–30%; asymmetric oligoarthritis; dactylitis; enthesitis",
  "AUSPITZ SIGN & KOEBNER PHENOMENON",
  "  Auspitz: pinpoint bleeding on scale removal; Koebner: lesions at sites of trauma",
  "TREATMENT",
  "  Mild: topical steroids + vitamin D analogues (calcipotriene)",
  "  Moderate-severe: phototherapy (nbUVB), methotrexate, biologics (TNF-α, IL-17, IL-23 inhibitors)",
], C.teal);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 15 – Rosacea & Other Inflammatory
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Rosacea & Lichen Planus",
  [
    "ROSACEA",
    "  Chronic facial condition; central face",
    "  Triggers: heat, spicy foods, alcohol, UV",
    "  Subtypes:",
    "  1. Erythematotelangiectatic: flushing, erythema",
    "  2. Papulopustular: acne-like (no comedones)",
    "  3. Phymatous: rhinophyma (thickened nose)",
    "  4. Ocular: blepharitis, keratitis",
    "  Treatment:",
    "  Topical: metronidazole, azelaic acid, ivermectin",
    "  Systemic: doxycycline 40 mg modified-release",
    "  Rhinophyma: laser or surgical debulking",
  ],
  [
    "LICHEN PLANUS",
    "  6 P's: Pruritic, Purple, Polygonal, Planar, Papules, Plaques",
    "  Wickham's striae: lacy white network on surface",
    "  Sites: wrists, ankles, oral mucosa, genitalia",
    "  Oral LP: may be premalignant",
    "  Pathology: band-like lymphocytic infiltrate at dermal-epidermal junction",
    "  Treatment: potent topical steroids; systemic steroids for severe/widespread disease",
    "",
    "CONTACT DERMATITIS",
    "  Irritant (80%): soaps, detergents — no prior sensitization needed",
    "  Allergic (20%): Type IV hypersensitivity; patch testing for diagnosis",
    "  Common allergens: nickel, latex, poison ivy (urushiol)",
  ],
  C.teal
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 16 – SECTION 5 HEADER: Infectious Skin Diseases
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "05", "Infectious Skin Diseases", "Bacterial, fungal, and viral dermatoses", C.skin, C.rust);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 17 – Bacterial Skin Infections
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Bacterial Skin Infections", [
  "CELLULITIS & ERYSIPELAS",
  "  Cellulitis: S. aureus/Strep; non-elevated border; deep dermis/subcutaneous",
  "  Erysipelas: Group A Strep; sharply demarcated, raised, bright red; superficial dermis",
  "  Treatment: dicloxacillin/cephalexin; MRSA coverage if purulent (TMP-SMX, doxycycline)",
  "FOLLICULITIS / FURUNCLE / CARBUNCLE",
  "  Folliculitis: superficial follicular pustules; S. aureus most common",
  "  Furuncle (boil): deep follicular abscess; incision & drainage primary treatment",
  "  Carbuncle: coalescing furuncles; more systemic involvement; I&D + antibiotics",
  "NECROTIZING FASCIITIS",
  "  Life-threatening surgical emergency; rapid spread along fascial planes",
  "  Type I (polymicrobial) vs. Type II (Group A Strep — 'flesh-eating')",
  "  Hard wooden feel on palpation; skin may look deceptively normal early",
  "  Treatment: immediate surgical debridement + broad-spectrum IV antibiotics",
  "METHICILLIN-RESISTANT S. AUREUS (MRSA)",
  "  CA-MRSA: USA300 clone; skin and soft tissue infections most common presentation",
  "  Preferred oral agents: TMP-SMX DS, doxycycline, clindamycin (D-zone test for inducible resistance)",
], C.rust);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 18 – Fungal & Viral Infections
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Fungal & Viral Skin Infections",
  [
    "DERMATOPHYTOSES (TINEA)",
    "  Tinea capitis: scalp ringworm; oral griseofulvin (topicals inadequate)",
    "  Tinea corporis: ring-shaped plaque with central clearing; topical azoles",
    "  Tinea pedis (athlete's foot): interdigital maceration; clotrimazole",
    "  Tinea unguium (onychomycosis): nail; oral terbinafine ×6–12 weeks",
    "  Tinea versicolor: Malassezia; hypo/hyperpigmented patches; selenium sulfide shampoo",
    "CANDIDIASIS",
    "  Intertriginous: satellite lesions are pathognomonic",
    "  Oral thrush: white plaques that scrape off",
    "  Topical nystatin or azoles; systemic fluconazole for resistant cases",
  ],
  [
    "HERPES SIMPLEX (HSV)",
    "  HSV-1: oral; HSV-2: genital (usually)",
    "  Grouped vesicles on erythematous base → painful ulcers",
    "  Tx: acyclovir, valacyclovir (suppressive for recurrent episodes)",
    "HERPES ZOSTER (SHINGLES)",
    "  VZV reactivation; dermatomal distribution",
    "  Prodrome: burning pain → vesicular rash",
    "  PHN: most feared complication (esp. >60 yrs)",
    "  Tx: valacyclovir 1g TID ×7 days (within 72 hr of onset)",
    "  Prevention: Shingrix vaccine (RZV) ≥50 yrs",
    "VERRUCAE (WARTS) — see Childhood section",
    "PITYRIASIS ROSEA",
    "  Herald patch → Christmas tree distribution",
    "  Associated with HHV-6/7; self-limiting 6–8 weeks",
  ],
  C.rust
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 19 – SECTION 6 HEADER: Infestations
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "06", "Infestations", "Scabies, pediculosis, and other infestations", C.skin, C.amber);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 20 – Infestations Content
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Scabies & Pediculosis",
  [
    "SCABIES",
    "  Sarcoptes scabiei mite; female burrows into stratum corneum",
    "  Intense pruritus — worse at night (hallmark)",
    "  Sites: web spaces, wrists, areolae, genitalia, waistband area",
    "  Burrows: thin, linear, serpiginous tracts",
    "  Norwegian (crusted) scabies: hyperkeratotic plaques; immunocompromised; highly contagious",
    "  Diagnosis: skin scraping + microscopy for mites/eggs/feces",
    "  Treatment: permethrin 5% cream (whole body, leave overnight) — first-line",
    "  Alternative: oral ivermectin 200 mcg/kg ×2 doses (2 weeks apart)",
    "  All household contacts treated simultaneously",
    "  Wash all clothing/bedding in hot water",
  ],
  [
    "PEDICULOSIS (LICE)",
    "  P. humanus capitis: head lice; nits firmly attached to hair shafts",
    "  P. pubis: pubic lice (crabs); STI; check for other STIs",
    "  P. humanus corporis: body lice; vector for typhus, relapsing fever",
    "  Treatment: permethrin 1% (capitis), malathion, benzyl alcohol",
    "  Wet combing: mechanical removal of nits",
    "  Lindane: third-line only (neurotoxicity risk)",
    "",
    "LARVA MIGRANS",
    "  Cutaneous larva migrans: hookworm larvae (Ancylostoma); serpiginous advancing tract",
    "  Treatment: albendazole or ivermectin",
    "",
    "MYIASIS",
    "  Fly larvae infestation; botfly most common in travelers",
    "  Occlusion technique (petroleum jelly) to expel larvae",
  ],
  C.amber
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 21 – SECTION 7 HEADER: Hypersensitivity Reactions
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "07", "Hypersensitivity Reactions\n& Other Eruptions", "Urticaria, drug reactions, and erythema multiforme", C.skin, C.teal);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 22 – Urticaria & Drug Reactions
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Urticaria, Angioedema & Drug Eruptions", [
  "URTICARIA (HIVES)",
  "  Transient wheals (<24 hr/lesion) + pruritus; can be acute (<6 wks) or chronic (>6 wks)",
  "  IgE-mediated (Type I) or non-immune (NSAIDs, ACE inhibitors, codeine)",
  "  Treatment: non-sedating antihistamines (cetirizine); omalizumab for chronic refractory",
  "ANGIOEDEMA",
  "  Deep dermis/subcutaneous edema; airway involvement = emergency",
  "  Hereditary angioedema (C1 inhibitor deficiency): no urticaria; bradykinin-mediated",
  "  ACE inhibitor-induced: bradykinin mechanism; switch to ARB",
  "DRUG REACTIONS",
  "  Exanthematous (maculopapular): most common type; aminopenicillins, sulfonamides",
  "  Fixed drug eruption: same site with each exposure; dusky-violet plaque → hyperpigmentation",
  "  DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms): fever, lymphadenopathy, organ involvement; aromatic anticonvulsants, allopurinol, sulfonamides",
  "  SJS / TEN (Stevens-Johnson / Toxic Epidermal Necrolysis):",
  "  SJS: <10% BSA detachment; TEN: >30% BSA; SCORTEN score for prognosis",
  "  Stop offending drug immediately; burn unit care; IVIG ± cyclosporine",
], C.teal);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 23 – Erythema Multiforme
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Erythema Multiforme & Photodermatoses", [
  "ERYTHEMA MULTIFORME (EM)",
  "  Target lesions (three concentric zones): dark center + pale inner ring + red outer ring",
  "  Most common trigger: HSV-1 (recurrent oral herpes) — 'post-herpetic EM'",
  "  Also: Mycoplasma pneumoniae, drugs",
  "  Self-limiting; suppressive acyclovir for HSV-triggered recurrent EM",
  "PHOTODERMATOSES",
  "  Polymorphous light eruption (PMLE): most common; papulovesicular rash on sun-exposed areas",
  "  Phototoxic reactions: exaggerated sunburn-like response; no prior sensitization (e.g., doxycycline, amiodarone)",
  "  Photoallergic reactions: Type IV delayed hypersensitivity; requires prior sensitization",
  "PITYRIASIS ROSEA (repeated for context)",
  "  Herald patch (2–5 cm) precedes rash by 1–2 weeks",
  "  Secondary eruption: Christmas tree pattern on trunk",
  "  Reassurance; antihistamines for itch; acyclovir may shorten course",
  "STASIS DERMATITIS",
  "  Chronic venous insufficiency; medial malleolus; lipodermatosclerosis in chronic cases",
  "  Compression stockings essential; low-potency topical steroids for itch",
], C.teal);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 24 – SECTION 8 HEADER: Skin Signs of Systemic Disease
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "08", "Skin Signs of Systemic Disease", "Cutaneous manifestations of internal medicine", C.skin, C.rust);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 25 – Systemic Disease Cutaneous Manifestations
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
tableSlide(s, "Cutaneous Signs of Systemic Disease",
  ["Disease/System", "Skin Manifestation", "Key Features"],
  [
    ["Diabetes mellitus", "Necrobiosis lipoidica, acanthosis nigricans, diabetic dermopathy", "Shin spots; insulin resistance marker"],
    ["Lupus erythematosus", "Malar 'butterfly' rash, discoid lupus, photosensitivity", "Spares nasolabial folds; anti-dsDNA"],
    ["Sarcoidosis", "Lupus pernio, papules, plaques, erythema nodosum", "Non-caseating granulomas"],
    ["Thyroid disease", "Pretibial myxedema (hyperthyroid), dry/coarse skin (hypothyroid)", "Graves: non-pitting orange-peel texture"],
    ["Liver disease", "Jaundice, spider angiomas, palmar erythema, pruritus, xanthelasma", "Caput medusae in portal HTN"],
    ["Vasculitis", "Palpable purpura, livedo reticularis, ulceration", "Non-blanching; IgA vasculitis in children"],
    ["Malignancy", "Acanthosis nigricans, dermatomyositis, Sweet's syndrome", "Paraneoplastic phenomena"],
    ["HIV/AIDS", "Seborrheic dermatitis, molluscum, Kaposi sarcoma, recurrent HSV/VZV", "CD4-dependent severity"],
  ],
  C.rust
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 26 – SECTION 9 HEADER: Benign Growths
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "09", "Benign Growths", "Nevi, seborrheic keratosis, cysts, and vascular lesions", C.skin, C.amber);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 27 – Benign Growths Content
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Common Benign Growths",
  [
    "SEBORRHEIC KERATOSIS",
    "  Keratinocyte origin; increases with age",
    "  'Stuck-on' appearance; varied colors (tan–black)",
    "  Leser-Trélat sign: sudden eruption → GI malignancy",
    "  Treatment: curettage, cryotherapy (cosmetic)",
    "",
    "MELANOCYTIC NEVI (MOLES)",
    "  Junctional: flat, at dermo-epidermal junction (premalignant potential)",
    "  Intradermal: raised, flesh-colored; benign",
    "  Compound: mixed features",
    "  Blue nevus: Spitz variant; benign",
    "  Dysplastic nevus: atypical features; increased melanoma risk",
    "",
    "DERMATOFIBROMA",
    "  Firm, hyperpigmented papule, usually on legs",
    "  Dimple sign positive (pinching invaginates lesion)",
    "  Benign; reassurance only",
  ],
  [
    "EPIDERMOID CYST",
    "  Most common cutaneous cyst; derived from follicular infundibulum",
    "  Punctum often visible; cheese-like contents",
    "  Excision when inflamed or cosmetically bothersome",
    "",
    "LIPOMA",
    "  Soft, mobile, encapsulated adipose tumor",
    "  Doughy consistency; non-tender; no treatment needed unless symptomatic",
    "",
    "VASCULAR LESIONS",
    "  Cherry angiomas: Campbell de Morgan spots; benign; increase with age",
    "  Spider angiomas: associated with liver disease or pregnancy",
    "  Hemangiomas: strawberry hemangioma; involutes by age 7–10; propranolol for problematic cases",
    "  Pyogenic granuloma: rapidly growing red vascular papule; bleeds easily; curettage or laser",
    "",
    "KELOID vs. HYPERTROPHIC SCAR",
    "  Keloid: extends beyond wound margins; higher risk in darker skin types",
    "  Hypertrophic: stays within wound; more likely to regress",
  ],
  C.amber
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 28 – SECTION 10 HEADER: Malignant Skin Lesions
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
sectionHeader(s, "10", "Premalignant & Malignant\nSkin Lesions", "BCC, SCC, melanoma, and actinic keratosis", C.deep, C.rust);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 29 – Actinic Keratosis & BCC
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
twoColSlide(s, "Premalignant & Basal Cell Carcinoma",
  [
    "ACTINIC KERATOSIS (AK)",
    "  Small lesions of epidermal proliferation; sun-exposed areas",
    "  ~1% risk of progression to SCC",
    "  Rough, scaly papule on erythematous base; 'sandpaper feel'",
    "  Treatment: cryotherapy, 5-fluorouracil, imiquimod, PDT",
    "",
    "BASAL CELL CARCINOMA (BCC)",
    "  Most common skin malignancy in adults",
    "  Strong UV association; rarely metastasizes",
    "  Subtypes:",
    "  Nodular (most common): pearly papule with rolled border + telangiectasias",
    "  Superficial: pink scaly patch; trunk/shoulders",
    "  Sclerosing (morpheaform): ill-defined; worst prognosis; skip lesions via neurotropism",
    "  Basosquamous: squamous differentiation; higher aggression",
    "  Treatment: Mohs (recurrent, sclerosing, face); excision; topical imiquimod (superficial)",
  ],
  [
    "SQUAMOUS CELL CARCINOMA (SCC)",
    "  2nd most common; UV + radiation burn scars",
    "  Bowen disease: SCC in situ; 5% progress to invasive",
    "  Marjolin ulcer: aggressive SCC in scar tissue",
    "  Well-differentiated: keratin pearls, intercellular bridges; cytokeratin positive",
    "  Poorly differentiated: few keratin pearls; wider excision margins (1 cm)",
    "  May cause nodal disease + distant metastases",
    "  Treatment: Mohs or wide local excision",
    "",
    "MOHS MICROGRAPHIC SURGERY",
    "  Maximum cure rate for NMSC",
    "  Maximum preservation of normal tissue",
    "  Indications:",
    "  - Recurrent BCC",
    "  - Sclerosing BCC",
    "  - Poorly differentiated SCC",
    "  - Functional/cosmetic areas (eyelid, nose, ear)",
  ],
  C.rust
);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 30 – Melanoma
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
contentSlide(s, "Melanoma", [
  "EPIDEMIOLOGY",
  "  3rd most common cutaneous malignancy; incidence rising 5% annually",
  "  Risk factors: UV exposure, >50 nevi, large congenital nevi, family history, fair skin",
  "THE ABCDE CRITERIA",
  "  A – Asymmetry    B – Border irregularity    C – Color variation    D – Diameter >6 mm    E – Evolution (change over time)",
  "SUBTYPES",
  "  Superficial spreading (70%): most common; radial growth phase; usually from preexisting nevi",
  "  Nodular (15–30%): early vertical growth; worst prognosis at presentation",
  "  Lentigo maligna (4–15%): melanoma in situ (Hutchinson freckle); sun-damaged skin of elderly",
  "  Lentigo maligna melanoma: dermal violation of lentigo maligna",
  "  Desmoplastic (2%): neurotropic; high local recurrence",
  "  Acral lentiginous: palms, soles, subungual; overrepresented in darker skin types",
  "HISTOLOGICAL MARKERS",
  "  S-100, Melan-A, HMB-45 (most specific — antibody vs. melanoma antigen)",
  "STAGING & TREATMENT",
  "  Breslow thickness: most important prognostic factor",
  "  Wide excision margins based on Breslow; SLNB if >0.8 mm",
  "  Adjuvant: BRAF inhibitors (vemurafenib), checkpoint inhibitors (pembrolizumab, nivolumab)",
], C.rust);

// ══════════════════════════════════════════════════════════════════
//  SLIDE 31 – Summary / Key Takeaways
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
darkSlide(s);
s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.12, fill: { color: C.gold } });
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  fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 4,
});

const takeaways = [
  ["01 Describe first", "Morphology before diagnosis — lesion type, distribution, associated symptoms"],
  ["02 Skin type matters", "Fitzpatrick I–II: highest skin cancer risk; darker types: keloid + PIH tendency"],
  ["03 Atopic triad", "Eczema + asthma + rhinitis; filaggrin mutations central to pathophysiology"],
  ["04 Psoriasis beyond skin", "5–30% develop psoriatic arthritis; IL-17/IL-23 pathway is treatment target"],
  ["05 MRSA rising", "TMP-SMX or doxycycline for CA-MRSA; I&D is primary for abscesses"],
  ["06 Scabies: treat all contacts", "Permethrin 5% cream; ivermectin alternative; pruritus may persist 2–4 weeks post-treatment"],
  ["07 SJS/TEN = emergency", "Stop causative drug immediately; burn unit; SCORTEN score guides prognosis"],
  ["08 Skin as a window", "Malar rash → SLE; spider angiomas → liver disease; palpable purpura → vasculitis"],
  ["09 Melanoma ABCDE", "Evolution (E) is the single most important warning sign; Breslow thickness = prognosis"],
  ["10 Mohs surgery", "Highest cure rate for BCC/SCC in high-risk locations; tissue-sparing technique"],
];

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// ══════════════════════════════════════════════════════════════════
//  SLIDE 32 – References / End Slide
// ══════════════════════════════════════════════════════════════════
s = pres.addSlide();
darkSlide(s);
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const refs = [
  "Usatine RP, Krejci-Manwaring J. Dermatology. In: Textbook of Family Medicine. Elsevier.",
  "Fitzpatrick TB et al. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. McGraw-Hill.",
  "Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. Elsevier.",
  "American Academy of Dermatology (AAD) Clinical Practice Guidelines. aad.org",
  "Wolff K et al. Fitzpatrick's Dermatology in General Medicine. McGraw-Hill.",
  "Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology. Elsevier.",
  "UpToDate – Dermatology sections (current clinical guidance).",
];

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// ══════════════════════════════════════════════════════════════════
//  SAVE
// ══════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/dermatology-ppt/Dermatology_Usatine_Krejci.pptx" })
  .then(() => console.log("✅ Saved: /home/daytona/workspace/dermatology-ppt/Dermatology_Usatine_Krejci.pptx"))
  .catch(err => { console.error("❌ Error:", err); process.exit(1); });

cd /home/daytona/workspace/dermatology-ppt && node build.js 2>&1

ls -lh /home/daytona/workspace/dermatology-ppt/Dermatology_Usatine_Krejci.pptx

melanoma subtypes clinical images superficial spreading nodular lentigo maligna acral