-
Seborrheic keratosis
- Stuck on appearance
- Benign, multiple-arms, back & face
- Black, brown or skin colored
-
Leser-trelat
- Sudden explosive multiple SKs
- Assoc w/ internal malignancy
-
Actinic keratosis
- Keratotic, precancerous lesions
- Pre SCC (10%)
- Sun exposure
- Scab/dry skin-reccuring
- Face, scalp HANDS
-
Cutaneous horn
- Actinic keratosis
- Scale becomes thicker, more yellow
- Scale built up
-
Pigmented ak
- Resembles solar lentigo
- Fine scaling
-
Actinic chilitis
- Lower lip
- Focal crusting/scaling
- Higher chance of scc
-
Scc
- Pink/red dome-shaped nodule w/ adherent yellow-white scale
- Develops necrotic, crusted center
-
Bowens dz
Full-thickness scc in situ
-
Keratoacanthoma
- Scc variant
- Fast growing
- Large, nodular crater-like nodule w/ central necrosis
-
Scc metastatsis
- Mc on mucous membranes or more advanced lesion
- w/in 2-3 yrs of lesion
-
basal cell carcinoma
- malignancy arising from basal alyer of keratinocytes
- rarely mets
- pearly white nodules
-
bcc
- mushy texture w/ curettage
- bleed
-
junctional nevi
- nevus cells at dermoepidermal junction
- flat or slightly raised
-
compound nevi
- nevus cells at dermoepidermal junction and within dermis
- raised pigmenet papules
-
intradermal nevi
- w/in dermis. May extend to subcutaneous tissue
- flesh colored to dark brown
- coarse hair growing from them
-
blue nevi
blueish macules or papules d/2 pigmented melanocytes in deep dermis
-
halo nevi
preexisting nevus develops annular rign of hypopigmentation
-
dyspalastic nevus syndrome
familial syndrome of multiple atypical nevi
-
melanoma
- mc ca age 25-29
- 2% skin ca causes 75% deaths
- Abcde
-
Nodular mm
- 10-15%
- More common-extremities
- Brown-black raised papules appear and grow rapidly
-
Lentigo maligna
- 5-10
- Flat, irregular, variant in pigment
-
Acral lentignous melanoma
- All skin types
- Mc in Asians and aa
- May occur a=hands, feetm, NAIL
-
Kaposi sarcoma
- Malignancy of lymphocytic endothelial cells
- Purple patches that thickn and darken
- Start @feet/ankes and spreads proximally
-
Atopic dermatitis
Itch that scratches
-
Atopic dermatitis triggers
- Irritants
- Allergens
- Perspiration
- Heat
- Tight clothing
- Rough fibers
- Emotional distress
-
Atopic Dermatitis Infantile Distribution
- Cheeks, perioral, scalp
- Extensor surfaces of the knees and elbows
-
Atopic Dermatitis Childhood Distribution
- Flexural areas
- ~~Antecubital and popliteal fossae
- ~~Neck
- ~~Wrists, ankles
- May become lichenified
-
Atopic Dermatitis Adult Distribution
- Flexural involvement
- Hand dermatitis
- Eyelid or lip dermatitis
- Xerotic skin, ichthyosis vulgaris, keratosis pilaris
-
Nummular Eczema
- Round, coin-shaped eczematous lesions
- Most common in adults
- Sharply demarcated lesions on arms and legs
- Tends to recur when steroids with drawn
- One of the more difficult forms of eczema to treat
- DDx - fungal
-
Contact dermatitis
- Allergic or irritant reaction caused by skin contact with a substance
- Rash will occur where the exposure occurs
-
Rhus Dermatitis (contact)
- Caused by delayed hypersensitivity reaction to plants
- Poison ivy, oak, and sumac
- Linear vesicles and erythema
-
Dyshidrosis
- Recurrent vesicular, eczematous dermatitis involving the hands and occasionally feet
- "tapioca like"
-
Lichen Simplex Chronicus
- Chronic plaques with enhanced skin markings that result from chronic inflammation
- Caused by continued rubbing and scratching
-
Dermatitis Herpetiformis
- Vesicular disease seen in patients with gluten-sensitive enteropathy
- Uncommon in children
- Does not correlate with bowel symptoms
- CELIACS
-
Bullous Pemphigoid
- Autoimmune disorder typically seen in older patients
- Subepidermal blistering
- Tense bullae on erythematous skin
- Negative nikoslky
- ANTIb DO NOT CORRELATE
-
Drugs trigger bullous pemphigoid
- Furosemide
- Captopril
- Some NSAIDs
-
Pemphigus Vulgaris
- Rare, potentially life-threatening autoimmune disease
- Intraepidermal blistering involving the skin and mucous membranes
- NIKOLSKY SIGN
- LABS CORRELATE
-
Nikolsky sign
- Applying traction on intact skin causes formation of bulla
- Applying pressure to intact bulla causes it to extend into surrounding tissue
-
Morbiliform Drug Eruption rash
- Maculopapular
- Erythematous macules and papules become confluent
- Symmetric, generalized
- Usually spares the face
- May involve mucous membranes, palms, soles
- Pruritic
-
Urticarial Drug Reaction
- Most common causes ASA, NSAIDs, PCN, blood products
- Includes anaphylactic reactions, serum sickness
- May have immediate reaction (anaphylaxis) or occur hours to days later
- Certain medications trigger histamine release: Not true hypersensitivity
- ........ie codeine, morphine
-
Fixed Drug Eruption
- Sharply demarcated, dusky red plaques
- Present shortly after drug is started, reappear in the same place each time the drug is taken
- Prodromal itching or burning
- May occur anywhere on the skin, but the glans penis is the most common location
-
Photosensitive Drug Reactions
- May be due to medicines administered internally or externally
- Phototoxic reaction
- Photoallergic rxn
-
Phototoxic drug rxn
- Dose dependent
- Limited to area of sun exposure
- Subsides when drug is stopped
- Occurs within 24 hours of exposure
-
Photoallergic drug reaction
- Less common
- No relation to dose
- Does not begin until about 48 hours after exposure
- May spread to non-sun exposed area (histones in body)
-
Acneiform rash
Steroids or hormones
-
Lupus-like rash
hydralazine, procainamide
-
Photosensitivity
thiazides, sulfonamides, tetracycline
-
Amiodarone
blue-grey in photodistribution
-
Minocycline
blue-grey on gingiva and teeth
-
Antimalarial
brown on the shins
-
Oral contraceptives
melasma on face
-
Rifampin
red man syndrome (high dose)
-
Lichen planus
- Inflammatory papulosquamous dz
- "Purple Polygonal Papule"
- Wickhams striae
- + KOEBNERS PHENOMENON
-
5 ps of lichen planus
- Pruritic
- Planar
- Polygonal
- Purple
- Papules
-
Wickham's striae
- Lacy pattern
- Surface of papule has white, reticulated pattern
- Assoc lichen planus
-
Types of lichen planus presentation
- Papular
- Hypertrophic
- Follicular
- mucosal
-
KOEBNERS Phenomenon
New lesions appear in area of trauma
-
Pityriasis Rosea
- HERALD PATCH
- 1-2w later-multiple smaller lesions
- CHRISTMAS TREE DISTRIBUTION
- COLLARETTE OF SCALE
- Self limited: 4-12 w
-
Christmas tree
Pityriasis rosea distribution
-
Collarette of scale
Pityriasis rosea
-
Herald patch
- Salmon-colored plaque occurs on chest or torso
- Thin collarette of scale along border
- Generally 1-2 cm in size
- ASSOC W/ PITYRIASIS ROSEA
- May mimic tinea-KOH to r/o
-
Psoriasis
Common, chronic inflammatory papulosquamous disease predominated by T-cell dysfunction and autoimmune dysregulation
-
Psoriasis - Triggers
- Stress
- Strep infection
- HIV infection
- Koebner phenomenon
- Drugs (lithium, antimalarials, steroid withdrawal)
-
Psoriasis forms
- Plaque
- Guttae
- Pustular
- inverse
-
auspitz sign
- Adherent silvery scale that bleeds when removed
- Plaque psoriasis
-
-
Psoriasis complications
- Both the disease itself as well as treatment may carry long-term effects
- Increased risk CAD
- AE from steroids or chronic immunosuppression
- AE from phototherapy
- Monitor lipids, HTN
- Regular skin cancer screenings
- Other f/u as warranted by their medications
- Desquamation and Hypersensitivity Syndromes
-
Erythema Multiforme
- Recurrent, inflammatory condition with "target" lesions
- Fairly common
- Commonly associated with HSV, Mycoplasma and URIs
-
Erythema Multiforme - Clinical Presentation
- Multiforme = multiple morphologies
- ~~Target lesions, macules, papules, urticarial, vesicles
- ~~NEED TO HAVE TARGET LESIONS TO DX CLINICALLY
- Palms, soles, hands, feet, distal arms and legs
- + Koebner phenomenon
-
Target lesions
Erythema multiforme
-
Stevens-Johnson Syndrome
- Severe, blistering mucocutaneous syndrome
- Involves at least two mucous membranes
- Most common in children and young adults
-
Sjs medications
- Phenytoin, phenobarbital, carbamazepine
- Sulfa drugs, PCNs
- Usually started within 1 month of onset
-
Toxic Epidermal Necrolysis
- + nikoslky sign
- Life-threatening disease with blistering and sloughing of the skin and mucous membranes
- Most often caused by medication: Within 1-3 weeks before onset
- ~~~~~Sulfa, antimalarials, anticonvulsants, NSAIDs, allopurinol
- Other causes triggered by recent immunization or infection
- Mortality:30-50%
-
fx aggravate acne
- Women with hirsuitism and obesity - PCOS
- Young children - signs of secondary sex characteristics - precocious puberty
- Irregular menses in middle aged women - perimenopause
- Steroid use
- Bodybuilders/athletes - anabolic steroid use
-
Acne
- Comadone-noninflammatory
- Inflammatory lesions (Papules, pustules, cysts)
-
Rosacea
- Common facial rash with redness, blushing, telangiectasias, papules and pustules
- NO comedones
- INVOLVES NASOLABIAL FOLDS
-
Rosacea trigger
- Hot food or drink
- Red wine
- Sunlight
- Skin irritants
- Embarrassment
- Spicy food
-
Rhinophyma
- Enlargement of the nose due to chronic inflammation and skin thickening
- More common in men
- Rosacea SYMPTOM
-
Ocular rosacea
- May occur with or without skin disease
- Mild conjunctivitis
- ~~Erythema, discomfort, FB sensation, tearing
- ~~May cause blepharitis, chalazions, corneal vascularization over time
-
Cellulitis
- Infection of the dermis and subcutaneous tissue
- Associated with systemic symptoms
- Red, swollen, painful plaque-no borders
-
Erysipelas
- Acute, superficial cellulitis with prominent lymphatic involvement
- Infection MORE SUPERFICIAL-DERMIS AND UPPER SUPCUTANEOUS TISSUE
- Sudden onset of erythematous, tender, firm spot with SHARPLY DEMARCATED BORDERS
- May have lymphatic streaking
-
Impetigo
- Highly contagious SUPERFICIAL SKIN INFECTION
- Caused by S. pyogenes or S. AUREUS (MOST COMMON)
- May develop on damaged skin or normal skin
- Infections more common in children or those who are in close contact with others
-
HONEY COLORED CRUST
IMPETIGO SX
-
Bullous impetigo
- Thin-roofed bullae form
- As bullae collapse, a HONEY-COLORED CRUST FORMS
- Lesions may coalesce
- Lesions in many stages of healing
- mild adenopathy
-
Non-Bullous Impetigo
- Vesicles or pustules rupture and
- scaling, tinea-like border forms
- Honey colored or whitish crust forms
- May have satellite lesions around the periphery
-
Candidiasis - Risk Factors
- Diabetes
- Hormonal - pregnancy, OCP use
- Systemic antibiotics or steroids
- Skin maceration
- Conditions that affect cell-mediated immunity (viruses)
-
Candidal Intertrigo
- Affects skin folds
- Develop beefy red plaques within the skin folds
- Advancing border - sharply defined
- Satellite lesions
- May have maceration of skin folds
-
-
Tinea versicolor-wood's light
hypopigmented areas with a faint yellow-green fluorescence
-
spaghetti and meatballs pattern
tinea versicolor KOH
-
Onchomycosis
Tinea infection of nail plate
-
Tinea cruris
- Half-moon shaped erythematous plaque
- well defined scale along the border
-
tinea corporis
- ringworm
- flat scaly papules
-
tinea capitis
inflammatory lesions may lead to alopecia
-
-
roseola
- herpes virus 6&7
- high fever
-
almond shaped lesions
roseola
-
erythema infectiosum
- slapped cheek
- parvovirus B19
-
Kawasaki virus
Strawberry tongue
-
Examthems-Diagnostic Criteria (need 5 of 6)
- FUO > 5 days
- Bilateral conjunctival injection
- Changes in lips and oral cavity
- Cervical lymphadenopathy
- Polymorphous exanthema with vesicles and crust
- Changes in peripheral extremities
-
MOOUSCUM CONTAGIOSUM
- Flesh colored dome papules become UMBILICATED
- Virus w/in papule=x body
-
Varicella
- Dew drop on a rose petal
- Highly pruritic
- Prodomal symptoms
- Patients will have lesions in all stages of healing
-
Hutchinson sign
Zoster-occular invovlement
-
Hutchinson sign-nail
- Acular melanoma
- Discoloration of nail or cuticle
-
-
Condyloma Acuminatum
- Genital warts
- Infection caused by human papilloma virus
-
Cauliflower mass
Condyloma acuminatum
-
-
Hpv 16, 18
Cause cervical cancer
-
Kissing lesions
Plantar warts
-
Acanthosis Nigricans
- Thick, velvety plaques
- neck, groin and axillae
- patients w/ abnormal glucose metabolism or malignancy (rare)
-
Granuloma Annulare
- Common skin condition with smooth, discolored plaques
- Most common in children and teenagers, but can occur at any age
- May mimic tinea
-
Hidradenitis Suppurativa
- Inflammatory skin condition affecting areas with apocrine sweat glands
- Recurrent nodules and abscesses that have SINUS TRACTS
-
Hidradenitis Suppurativa - Aggravating factors
- Genetics
- Female > male
- Obesity, PCOS
- Pro-inflammatory cytokines
- Cigarette smoking
- Secondary bacterial infection
-
Epidermal cysts
cystic structure filled with soft, cheese-like keratinous contents
-
Pilar cysts
- small cysts on the scalp
- filled w/ firm, white content
- arise from the hair root sheath
-
Melasma
- Hyperpigmentation of the face
- Typically occurs in women during pregnancy and on OCPs
- More common in darker skin types
-
Pilonidal Disease
- Chronic sinus tract in the sacrococcygeal region
- filled with nests of hair
- May become infected and inflamed
-
Pressure Ulcers
- Bed sores, decubitus ulcers
- Area of reddened skin
- progresses to skin breakdown that results in sores and ulcers
-
Urticaria
- Wheals resulting from edema of the dermal tissue
- Angioedema results from edema of deeper structures
-
Dermatographism
Chronic urticarial
-
Erythema Nodosum
Inflammatory panniculitis with erythematous, deep nodules on the shins
-
Vitiligo
Acquired condition where impaired or absent melanocyte function leads to hypopigmentation of the skin
-
Whickem striae
Lacy white reticulated surface on Lichen Planus
-
Whickem striae
Lichen planus
-
Round patches of hair loss
Aleopecia areata
-
Yellow greasy scale
Seborrheic dermatitis
-
Grouped vesicles on erythematous base
Herpes
-
Velvety plaques
Acnathrosis nigracs
-
Herpatic witlow
Herpes on finger
-
Exclamation point
Aleopecia areata
-
Satellite lesion
Candidiasis
-
Linear vesicles
Rhus dermatitis
-
-
-
Tense bulla on erythematous
Bullus pemphigold
-
-
N ikoski
Blister enlarges when pressed
-
-
Itch that scratches
Eczema
-
-
Flaccid bullae
Pemphigus vulgaris
-
Cradle cap
Seborrheic dermatitis
-
Rolled borders
Basal cell
-
-
Washed out lesions
Lentigo maligna
-
-
-
Kissing toes
Plantar warts
-
-
Lesions in intrafinger webs
Scabies
-
Maceration between toes
Tinea pedis
-
-
Koebener phenomenon
Tauma causes new lesion
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