2/13 Dermatologic Dx and Trmt Flashcards
Primary Lesions
Macule
Patch
Papule
Plaque
Nodule
Tumor
Wheal
Vesicle
Bulla
Pustule
Secondary Lesions
Scale
Crust
Erosion
Ulcer
Fissure
Scar
Atrophy
Special Lesions
Excoriation
Comedone (Open, Closed)
Milia
Burrow
Lichenification
Telangiectasia
Petechiae
Purpura
What is this?
(defining characteristics + examples)
Macule
circumscribed, flat discoloration of skin up to 0.5 cm;
Inflammatory: produced by vasodilation of superficial vessels
Intrinsic pigment deposition; ex: freckles
Extrinsic pigment deposition; ex: tattoos
Ex: café au lait spots in neurofibromatosis 1 , Peutz-Jegher’s syndrome, melanoma
What is this?
(defining characteristics + examples)
Patch
circumscribed, flat discoloration of skin larger than 0.5 cm
ex: melisma, tinea versicolor
What is this?
(defining characteristics + examples)
Papule
circumscribed, elevated, superficial, solid lesion, up to 0.5 cm; usually broader than it is thick
ex: cutaneous sarcoidsosis, eruptive xanthomas, lichen spinulosis, mulluscum contagiosum, neurofibromas
What is this?
(defining characteristics + examples)
Nodule
circumscribed, palpable, solid, round, or ellipsoidal lesion, larger than 0.5 cm (dermal or subcutaneous; most are greater than 1cm and up to 4-5cm)
Ex: soft nodules of neurofibromatosis, nodules of mycobacterium marinum, prurigo nodules with overlying scale
What is this?
(defining characteristics + examples)
Plaque
circumscribed, elevated, superficial, solid lesion larger 0.5 cm
ex: necrosis lipoidica diabeticorum, granuloma annulare, urticarial
What is a tumor?
(defining characteristics + examples)
proliferation of cells or tissues, either benign or malignant. Any of the other primary and secondary terms may be appropriate in the initial description of a tumor; e.g., nodule or plaque. A large nodule is often referred to as a tumor. There are no size specificities for tumor.
What is this?
(defining characteristics + examples)
Wheal
a special type of papule or plaque which is the response of the skin to histamine release and is characterized by the classic three features (triple response of Lewis) of edema, erythema, and a flare. The edema fluid is bound, which contrasts this lesion with the vesicle and bulla. A wheal is transitory or evanescent, seldom remaining in one location for more than 3 or 4 hours.
What is this?
(defining characteristics + examples)
Vesicle
circumscribed collection of free clear, fluid, less than 0.5cm; fluid can be clear, serous, hemorrhagic, or pus-filled
ex: miliaria crystallina, dyshidrotic dermatitis, leukocytoclastic vasculitis, herpes zoster (chicken pox)
What is this?
(defining characteristics + examples)
Bulla
circumscribed collection of free clear, fluid greater than 0.5cm; fluid can be clear, serous, hemorrhagic, or pus-filled
ex: herpes gestationis, toxic epidermal necrolysis, contact dermatitis, IgA dermatosis
What is this?
(defining characteristics + examples)
Pustule
circumscribed collections of pus (contains leukocytes and free fluid) which are variable in size, but less than 0.5cm
ex: pustular psoriasis , steroid/medication-induced acne, folliculitis
What is this?
(defining characteristics + examples)
Scale
Excess stratum corneum (most superficial layer of skin) that accumulates in flakes or plates, i.e., keratin. Usually white or grey color. Example: Psoriasis
What is this?
(defining characteristics + examples)
Crust
collections of dried serum, blood, or purulent exudate, and cellular debris dries on the skin surface– “scab”. Usually yellow-brown when formed from purulent exudate, red-black when formed by blood
Ex: atopic dermatitis, impetigo
What is this?
(defining characteristics + examples)
Atrophy
depression in the skin resulting from thinning of the epidermis, dermis, or subcutaneous fat.
Ex: morphea, anteoderma, lichen sclerosus,
What is this?
(defining characteristics + examples)
Erosion
localized losses of epidermis. Usually, some superficial dermal tissue loss as well, but superficial or thin in comparison to ulcers and heals without scarring.
Ex: disseminated herpes infection in immunocompromised patient, pemphigus, vesicant exposure
What is this?
(defining characteristics + examples)
Ulcer
loss of epidermis plus variable degrees of the dermis. Variable in depth, size, and shape. Heal with scarring.
Ex: pyoderma gangrenosum, disseminated herpes infection in immunocompromised patient, stasis dermatitis
What is this?
(defining characteristics + examples)
Fissure
linear losses of epidermis and dermis which have sharply defined, abrupt walls; a slit
What is this?
(defining characteristics + examples)
Scar
abnormal formations of connective tissue replacing tissue lost or altered by some pathologic process. Always implies dermal damage. Cicatrix is a synonym. Types:
Atrophic: thinned
Hypertrophic (keloid)
Striae: a stretch mark
What is this?
(defining characteristics + examples)
Excoriation
erosions caused by scratching. Often linear distribution or fingernail size.
What is this?
(defining characteristics + examples)
Comedone
plugs of sebaceous and keratinous material lodged in the openings of the pilosebaceous follicles. The primary lesions of acne vulgaris. Commonly known as blackheads and whiteheads.
Open comedo: a “blackhead”- an open follicle stuffed with sebaceous and keratinous material.
Closed comedo: a “white head” follicular dilatation not as marked; skin appears to cover the follicular orifice.
What is this?
(defining characteristics + examples)
Milia
small, superficial keratin cysts
What is a burrow?
(defining characteristics + examples)
linear or curvilinear papule that house parasites such as the scabies mite
What is this?
(defining characteristics + examples)
Lichenification
areas of thickened epidermis. The major sign of the thickening is increased prominence of the skin lines, although scaling and low grade inflammation are usually seen as well
What is this?
(defining characteristics + examples)
Telangiectasia
dilations of superficial cutaneous vessels. Often linear or branch-like; will blanch
ex: rosacea, essential Telangiectasia
What is this?
(defining characteristics + examples)
Erythema
Localized redness of the skin or mucosa; will blanch (color change is due to increase blood flow, not leakage of blood into the skin as in purpura)
Ex: erysipelas, dermatomyositis, early lyme disease
What is this?
(defining characteristics + examples)
Erythroderma
Generalized redness that may be associated with desqsumation (normal process in which the cornified/outermost layer of the epidermis is sloughed in fine scales or sheets); will blanch (color change is due to increase blood flow, not leakage of blood into the skin as in purpura)
Ex: scalded skin syndrome, pityriasis, rubra pilaris, erythrodermic psoriasis
What is this?
(defining characteristics + examples)
Ecchymosis
Extravasation of blood into the skin or mucous membranes; areas of flat color change my progress from blue-black to brown-yellow- or green; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin
Ex: bruise, steroid purpura, purpura fulminans
What is this?
(defining characteristics + examples)
Petechiae
circumscribed deposits of blood or blood pigments that result from tiny hemorrhages; less than 0.5cm but usually smaller, 1-2mm macules; usually brown in color; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin
ex: Rocky mountain spotted fever, subacute bacterial endocarditis
What is this?
(defining characteristics + examples)
Purpura
circumscribed deposits of blood or blood pigments greater than 0.5cm; usually palpable; violaceous in color; does NOT blanch (blood has leaked outside of the vessels into the surrounding skin
ex: acute meningococcemia, Henoch-Schoenlein purpura, vasculitis
How are skin/exams lesions characterized?
Patient description (age, sex, color, general state of health)
Distribution (generalized, localized, bilateral, symmetrical vs asymmetrical, patchy)
Arrangement (discrete, confluent, grouped, well/ill-defined)
Configuration or shape
Primary vs Secondary
Characteristics/Quality(size, shape, color, primary lesions, secondary lesions)
Involvement of the mucous, hair, nails?
what term describes these lesions?
(disk-like, targetoid, or annular)
targetoid
(annular = cleared in center, like a ring or donut)
what term describes these lesions?
(Itchy, polycyclic, arcuate, or whorled)
polycyclic
what is the primary lesion?
(papule, plaque, macule, patch)
Plaque.
Due to scale, could have some flaking off if you scraped.
Larger than 1/2 cm, palpable.
What is the secondary lesion?
(erythema, scale, crust, kissing)
Scale.
Remember scale is a skin product, crust is a blood product.
Crust may be blood (scab) or serous (like a popped blister)
what color is this lesion?
(pink, bright red, red and white, violaceous)
bright red.
what is the morphology of this lesion?
(serpiginous, annular, whorled, linear)
serpiginous
what is the primary lesion?
(macule, papule, vesicle, blister)
Vesicle
(blister is not a derm word, papule is not fluid-filled, macule is flat)
morphology of these vesicles?
(arcuate, grouped, clumped, serpiginous)
Grouped.
(clumped is not a derm word)
This is a good example where the description can help the diagnosis. a 3cm plaque of grouped vesicles localized to the forearm is very suggestive of shingles.
definition of a plaque?
anything palpable on the skin greater than 1/2 cm.
May be a collection of grouped vesicles as below (shingles). He called this a “3 cm plaque consisting of grouped vesicles”
morphology of these urticaria?
(arcuate, grouped, linear, serpiginous)
linear
arcuate = semi-circular
morphology seen here?
(arcuate, polycyclic, serpiginous, reticulate)
reticulate
what is the morphology seen here?
(arcuate, whorled, serpiginous, reticulate, crazy-pants)
Whorled
what is this morphology
(annular, papular, half-circular, serpiginous)
annular
what is this lesion? (the black marks)
(papule, plaque, open comedone, closed comedone)
open comedone
what is this lesion? (the raised oval ones)
(papule, plaque, cyst, ulcer)
cyst
what is the secondary lesion?
(erosion, ulcer, fissure, atrophy)
atrophy
what is this secondary lesion? (the dark areas within the red zone)
(scar, cyst, crust, scale)
crust
what is the lesion on the cheek?
(purpura, petchiae, telangiectasia, burrow)
telangiectasia
what lesion is near the lateral canthus?
lichenification, open comedone, patch, plaque
plaque
best description for these non-blanching lesions?
papules, eccymoses, telangiectasias, petechiae
petechiae
morphology of this skin finding?
purpuric, retiform, polycyclic, annular
retiform
best descr for these non-blanching lesions?
vesicles, pustules, palpable purpura, eccymoses
palpable purpura
This patient has….
redness, acral erythroderma, acral erythema, aches and pains
acral erythema
best description for these lesions?
vesicle, nodule, bump, painful
nodule
morphology of this rash?
annular, whorled, polycyclic, targetoid
annular AND polycyclic
the shape of this plaque is…
round, annular, targetoid, crescentic
annular
the secondary lesion is….
excoriation, erosion, ulcer, scale, nasty
ulcer.
and nasty.
