1: Fundamentals of Clinical Dermatology Flashcards
What type of scale is described as ‘ichthyosiform’ and what are its characteristics?
The ichthyosiform scale appears as regular, polygonal plates arranged in parallel rows or diamond patterns, resembling fish-like tessellations.
What is the significance of the Apple-jelly sign in dermatology?
The Apple-jelly sign indicates a yellowish hue produced from pressure on the lesion with a glass slide, and it is noted in granulomatous processes.
What does the Fitzpatrick (dimple) sign indicate in dermatological assessment?
The Fitzpatrick (dimple) sign indicates dimpling of the skin with lateral compression of the lesion, characteristic of dermatofibroma.
What are the characteristics of seborrheic scales in dermatology?
Seborrheic scales are described as thick, waxy or greasy, yellow-to-brown flakes that can accumulate on the skin surface, often associated with seborrheic dermatitis.
What is the size and topography of a macule?
A macule is less than 1 cm in size and has a flat topography.
Describe the characteristics of a plaque in dermatology.
A plaque is greater than or equal to 1 cm, raised, and has solid content, often presenting as a cutaneous horn.
What is the difference between a vesicle and a bulla?
A vesicle is less than 1 cm and contains fluid, while a bulla is greater than or equal to 1 cm and also contains fluid.
What is the significance of the ‘Asboe-Hansen sign’?
The Asboe-Hansen sign indicates lateral extension of a blister with downward pressure, noted in blistering disorders above the basement membrane zone.
What is the ‘Darier sign’ and its significance?
The Darier sign is a urticarial wheal produced in a lesion after firm rubbing, noted in urticaria pigmentosa and rarely with cutaneous lymphoma or histiocytosis.
What is the description of ‘seborrheic’ scales?
Seborrheic scales are thick, waxy or greasy, yellow-to-brown flakes.
What is the clinical significance of the ‘Nikolskiy sign’?
The Nikolskiy sign indicates lateral pressure on unblistered skin resulting in shearing of the epidermis, noted in blistering disorders above the basement membrane zone.
What type of scale is described as ‘lamellar’?
Lamellar scales appear as thin large plates or shields attached in the middle and looser around the edges.
What is the content of a pustule?
A pustule contains fluid (pus) and is less than 1 cm in size with a raised topography.
What is the topography of an erosion in dermatology?
An erosion has a depressed topography and can vary in size.
What type of scale is associated with psoriasis?
Psoriasiform scales are silvery and brittle, forming plates in several loose sheets, resembling micaceous scale.
What is the significance of the ‘Buttonhole sign’?
The Buttonhole sign indicates a flesh-colored, soft papule that feels as though it can be pushed through a ‘buttonhole’ into the skin, noted in neurofibroma.
What is the description of ‘follicular’ scales?
Follicular scales appear as keratotic plugs, spines, or filaments.
What is the clinical significance of the ‘Pseudo-Darier sign’?
The Pseudo-Darier sign indicates transient induration of a lesion or piloerection after rubbing, noted in congenital smooth muscle hamartoma.
What is the content of a nodule in dermatology?
A nodule contains solid or fluid content and is greater than or equal to 1 cm in size with a raised topography.
What type of scale is described as ‘gritty’?
Gritty scales are densely adherent and have a sandpaper texture, often associated with bulla.
What is the significance of the ‘Carpet tack sign’?
The Carpet tack sign indicates horny plugs at the undersurface of scale removed from a lesion, noted in lesions of chronic cutaneous lupus.
What is the description of ‘crust’ in dermatology?
Crusts are dried exudates that can form on the surface of lesions, often seen in various skin conditions.
What is the clinical significance of the ‘Auspit sign’?
The Auspit sign indicates pinpoint bleeding at the tops of ruptured capillaries with forcible removal of outer scales from a psoriatic plaque, not entirely sensitive or specific for psoriasis.
What is the description of ‘keratotic’ scales?
Keratotic scales appear thick, compact, and adhere to the stratum corneum.
What is the clinical significance of the ‘Dermatographism’ sign?
Dermatographism is noted when firmly stroking unaffected skin produces a wheal along the shape of the stroke, representing a physical urticaria.
What is the description of ‘pityriasisform’ scales?
Pityriasisform scales are small and branched, often associated with conditions like seborrheic dermatitis.
What is the significance of the ‘Wickham striae’?
Wickham striae are noted as a lacy white pattern overlying violaceous flat-topped papules, often associated with lichen planus.
What is the content of a vesicle?
A vesicle contains fluid (serum, blood, lymph) and is less than 1 cm in size with a raised topography.
What is the clinical significance of the ‘Shellac-like’ scale?
Shellac-like scales are shiny with a sheet-like desquamating edge, like peeling paint, often seen in various skin conditions.
What is the description of ‘ichthyosiform’ scales?
Ichthyosiform scales are regular, polygonal plates arranged in parallel rows or diamond patterns, resembling fish-like tessellations.
What is the description of ‘lamellar’ scales?
Lamellar scales appear as thin large plates or shields attached in the middle and looser around the edges, often seen in conditions like psoriasis.
What is the description of ‘seborrheic’ scales?
Seborrheic scales are thick, waxy or greasy, yellow-to-brown flakes, often associated with seborrheic dermatitis.
What are the different aspects of history taking in dermatologic diagnosis?
What are recommended tools for complete skin examination?
What layers of the skin are affected when lesions are flat-topped or planar papules and plaques?
Epidermis and superficial dermis.
What layers of the skin are affected when lesions are dome-shaped or nodular?
Deep dermis or subcutis.
What layer of the skin is affected when lesions are scaling or crusting?
Epidermis.
What layer of the skin is affected when palpable lesions have smooth, intact surface?
Purely dermal or subcutaneous.
It pertains to the combination of primary morphology and secondary change (or absence of it).
Reaction pattern.
This primary lesion can be sessile, pedunculated, dome-shaped, flat-topped, filiform, mamillated, acuminate (conical), or umbilicated.
Papule.
What are the types of nodules based on depth?
Epidermal
Epidermal-dermal
Dermal-subdermal
Subdermal
What descriptors can be used for nodule texture?
Firm, soft, boggy, fluctuant.
What descriptors can be used for nodule surface?
Smooth, keratotic, ulcerated, fungating.
This primary lesion, sometimes under nodule, pertains to a more irregularly shaped mass.
Tumor.
Give some diagnostic examples and underlying pathology of lesions that are color WHITE.
Give some diagnostic examples and underlying pathology of lesions that are color BLACK.
The brown color of melanocytic nevus and melasma is due to?
Melanin.
Give some diagnostic examples and underlying pathology of lesions that are color RED-BROWN.
Give some diagnostic examples and underlying pathology of lesions that are color RED.
Give examples of pink or salmon lesions and their underlying pathology.
Give an example of an orange-colored lesion and its underlying pathology.
Give some diagnostic examples and underlying pathology of lesions that are color YELLOW.
Give some diagnostic examples and underlying pathology of lesions that are color GREEN.
Give some diagnostic examples and underlying pathology of lesions that are color BLUE/GRAY.
Give an example of a violet to lilac-colored lesion and its underlying pathology.
Give some diagnostic examples and underlying pathology of lesions that are color PLUM.
What are the diseases that exhibit PAPULOSQUAMOUS reaction pattern and how do you differentiate them (toolbox)?
What are the diseases that exhibit ECZEMATOUS reaction pattern and how do you differentiate them (toolbox)?
What are the diseases that exhibit VESICULOBULLOUS reaction pattern and how do you differentiate them (toolbox)?
What are the diseases that exhibit DERMAL “PLUS” reaction pattern and how do you differentiate them (toolbox)?
What are the diseases that exhibit MACULAR reaction pattern and how do you differentiate them (toolbox)?
What are the diseases that exhibit DERMAL reaction pattern and how do you differentiate them (toolbox)?
What are the diseases that exhibit SUBCUTANEOUS reaction pattern and how do you differentiate them (toolbox)?
What are the diseases that exhibit PURPURIC reaction pattern and how do you differentiate them (toolbox)?
What are the diseases that exhibit ERYTHEMAS and how do you differentiate them (toolbox)?
What are the aspects of physical examination in dermatologic diagnosis?
Describe the primary morphology of lesions in terms of size, topography and contents.
What type of scale?
Craquelé / Xerotic.
What type of scale?
Cutaneous horn.
What type of scale?
Exfoliative / Desquamative.
What type of scale?
Follicular.
What type of scale?
Gritty.
What type of scale?
Ichthyosiform.
What type of scale?
Keratotic / Hyperkeratotic.
What type of scale?
Lamellar
What type of scale?
Pityriasiform.
What type of scale?
Psoriasiform (micaceous and ostraceous).
What type of scale?
Seborrheic.
What type of scale?
Shellac-like.
What type of scale?
Wickham striae.
Melanin in the dermis, either within melanocytes or extracellular, may appear brown, gray, or blue. This is known as the?
Tyndall effect.
This term describes an individual macule, patch, papule, or plaque.
Shape.
This refers to shapes made from the arrangement of individual primary lesions in relation to one another.
Configuration.
Give examples of diseases with lesions that are ANNULAR.
granuloma annulare
tinea corporis
erythema annulare centrifugum
Give examples of diseases with lesions that are ROUND / NUMMULAR / DISCOID.
nummular eczema
plaque-type psoriasis
discoid lupus
Give examples of diseases with lesions that are ARCUATE.
urticaria
subacute cutaneous lupus erythematosus
Give examples of diseases with lesions that are LINEAR in shape.
Scabies
Poison ivy dermatitis
Bleomycin pigmentation
Give examples of diseases with lesions that are LINEAR in configuration.
Lichen nitidus
Lichen planus
A term pertaining to lesion shape similar to a land mass; edges are reminiscent of a coastline.
Geographic.
Give examples of diseases with lesions that are RETICULAR / RETIFORM.
Livedo reticularis
Cutis marmorata
Give an example of a disease with lesions that are SERPIGINOUS.
Cutaneous larva migrans
A term pertaining to a lesion having multiple angulated edges, resembling a star.
Stellate.
Give an example of a disease with lesions that have TYPICAL TARGETS.
Erythema multiforme.
Have 3 zones:
- a dark red-purple or dusky center, encircled by
- a paler pink zone, followed by
- a rim
of darker erythema.
Describe atypical targets. Give an example of what disease may exhibit this.
Atypical targets have just 2 zones,
a dark or dusky center with a paler pink rim. It may be seen in Stevens-Johnson syndrome.
A term pertaining to lesion configuration like marble cake, with 2 distinct colors interspersed in a wavy pattern; usually seen in mosaic disorders in which cells of differing genotypes are interspersed.
Whorled.
Give examples of diseases with lesions that are WHORLED.
Incontinentia pigmenti
Hypomelanosis of Ito
Linear and whorled nevoid hypermelanosis
Give an example of a disease with lesions that are GROUPED / HERPETIFORM.
Herpes simplex virus reactivation
A term describing sparse lesions that are irregularly distributed.
Scattered
Give examples of diseases with lesions that are POLYCYCLIC.
urticaria
subacute cutaneous lupus erythematosus
Give an example of a disease with lesions that have a DERMATOMAL / ZOSTERIFORM distribution.
Herpes zoster
This term describes a distribution following lines of skin cell migration
during embryogenesis; generally longitudinally oriented on the limbs and circumferential on the trunk,
but curvilinear rather than perfectly linear. It implies a mosaic disorder.
Give examples of diseases with this distribution.
Blaschkoid
E.g:
incontinentia pigmenti
inflammatory linear verrucous epidermal nevus
This term describes a distribution lying
along the distribution of a lymph vessel; implies an infectious agent that is spreading centrally from an
acral site.
Give an example of a disease with this distribution.
Lymphangitic
E.g:
staphylococcal or streptococcal cellulitis.
When individual papules or nodules
lie along the distribution of a lymphatic network, it suggests a particular infectious differential. This pattern is termed?
Sporotrichoid.
This term describes a distribution occurring in areas usually not covered by clothing, namely the face, dorsal hands, and a triangular area corresponding to the opening of a V-neck shirt on the upper chest.
Give examples of diseases with this distribution.
Sun Exposed/Photodistributed
E.g:
photodermatitis
subacute cutaneous lupus erythematosus
polymorphous light eruption
squamous cell carcinoma
This term means the sun-exposed skin has a more dense distribution of lesions compared to non-sun-exposed skin.
Photo-accentuated.
This term describes a distribution occurring in areas usually covered by one or more layers of clothing; usually a dermatosis that is improved by sun exposure.
Sun Protected
E.g:
parapsoriasis
mycosis fungoides
This term describes a distribution occurring in distal locations, such as on the hands, feet, wrists, ankles, ears, or penis.
Acral
This term describes a distribution occurring on the trunk or central body.
Truncal
This term describes a distribution occurring over the dorsal extremities, overlying the extensor muscles, knees, or elbows.
Give an example of a disease with this distribution.
Extensor
E.g:
Psoriasis
This term describes a distribution overlying the flexor muscles of the extremities, the antecubital and popliteal fossae.
Give an example of a disease with this distribution.
Flexor
E.g:
Childhood atopic dermatitis
This term describes a distribution occurring in the skin folds, where
2 skin surfaces are in contact, namely the axillae, inguinal folds, inner thighs, inframammary skin, and under an abdominal pannus; often related to moisture and heat generated in these areas.
Intertriginous
This term describes a distribution favoring the hair-bearing locations
of the skin, including scalp, eyebrows, beard, central chest, axillae, genitals. Also often favors the nasolabial and postauricular creases.
Seborrheic
This term describes a distribution of papules centered around hair follicles.
Follicular
This term describes a distribution of lesions confined to a single body location.
Localized
This term describes a distribution of lesions that are widespread.
Generalized.
A generalized eruption consisting of inflammatory (red) lesions is called?
Exanthem (rash)
This term describes a distribution of lesions occurring with mirror image symmetry on both sides of the body.
Bilateral symmetric
This term describes a distribution of lesions involving the entire cutaneous surface.
Give examples of diseases with this distribution.
Universal
E.g:
Erythroderma
Alopecia universalis
These refer to blanching red-pink macules, patches, papules, or plaques, or a combination, usually without surface change.
Erythemas.
In _____ eruptions, the primary lesion is a relatively thin or flat-topped papule or plaque with
scale. Crust or lichenification is usually not present. Histopathologically, these processes involve the epidermis and superficial to mid-dermis. Individual
papules or plaques are typically well demarcated, and there is often normal skin visible between each discrete
papule or plaque.
Papulosquamous
_____ eruptions consist of thin erythematous papules and plaques with epidermal change. On the surface of an acute eczematous process, there is enough epidermal spongiosis (edema between keratinocytes) to cause the formation of serous crust-
ing, microvesicles, or sometimes frank bullae. When microvesicles collapse, they form characteristic tiny
round crusts often admixed with scale and subtle or overt fissuring. When subacute to chronic, the surface is often dry, scaly, fissured, and/or lichenified from rubbing or scratching. Their primary lesions are typically ill-demarcated and individual lesions vary widely in their size and spacing.
Eczematous
What are some clues to vesiculobullous reaction patterns?
- When small ruptured vesicles are grouped together, as in herpes simplex, they form crust with “scalloped” edges.
- Erosions with “mauserung”
desquamation, a rumpled rim of epidermis hanging from the erosion’s edge - Milia, which can result from
healing of deeper blisters
This reaction pattern pertains to dermally infiltrated papules, nodules or plaques with surface change: hyperkeratotic scale, crust,
vesicles, pustules, erosion, or ulceration.
Dermal “Plus”
These are red or purple macules, patches, papules, or plaques that result from bleeding into the skin.
Because blood has extravasated, they do not blanch when pressure is applied. They may range in color
from true red to red-purple or magenta to red-brown
(“cayenne pepper”).
Purpura
Purpuric macules are sometimes called?
Petechiae
Purpuric patches are sometimes called?
Ecchymoses
Ecchymosis may overlie a
plaque or nodule from dermal or subdermal hemorrhage, known as?
Hematoma
Purpuric papules, or “palpable purpura,” typically represent inflammation of small vessels associated with hemorrhage. These are seen in what conditions?
- leukocytoclastic vasculitis, a coagulopathy affecting small vessels
- cryoglobulinemia
- very small emboli
Purpuric plaques represent ischemia, embolism, infarction, intravascular infection, or inflammation of what size of vessels, that may lead to necrosis
of the overlying epidermis?
Small-medium or medium vessels.
Pink purpuric papules usually involve what size of vessels?
Medium
Purpura may be accompanied by pink, red, or purple net-like (“retiform”) hyperemia, called?
Livedo
_____ erythemas are exanthems that
are typically consist of diffuse symmetric blanching pink, red, or magenta macules and papules.
Morbilliform
_____ erythemas are annular, arcuate, or polycyclic blanching pink to red plaques. They generally do not have surface change, with the exception of _____ which exhibits prototypical “trailing scale.”
Figurate
Erythema annulare centrifugum
_____ erythemas are pink, blanching
macules, papules, or plaques, often exhibiting a characteristic “wheal and flare” appearance, with blanching of the skin surrounding the primary
lesion.
Urticarial
_____ erythemas have at least 2 zones of color, with a darker center compared to the periphery.
The center often has a “dusky,” or gray-violet, hue, owing to epidermal necrosis, or vesiculates as the
necrotic epidermis detaches.
Targetoid
If the overlying epidermis on apurpuric plaque becomes necrotic, _____, _____, and/or _____ may form at the
surface. Give an example of a condition where this could be seen.
Bullae, ulcer, and/or eschar
