5 Derm Flashcards
Red swollen foot DDX
Cellulitis, DVT, gout, CPPD, stasis dermatitis, septic arthritis (must r/o)
PE to do with cellulitis…
Check lymph! Check regional lymph nodes and look for streaking (lymphangitis)
Guaranteed quiz question
Erythema Nodosum
Indurated nodules that look like bruises, slowly change color. Shins. must look for underlying disorder.
Inflammation of skin and subQ tissue (panniculitis)
Intertriginous
Creases: armpits, inguinal folds, under the breasts, between toes/fingers
(Erythasma lives here)
Balanitis
Candidiasis on penis/groin
Miliaria
Heat rash. Accumulation of sweat beneath eccrine sweat ducts –> keratin obstruction. Pruritis. Small red papules. Children/babies
Cellulitis
Acute bacterial infection of the skin. PE…
Immuno compromised. Distribution: lower leg, children–cheeks, perioribital (EMERGENCY), head, neck
Cutaneous abscess
Localized collection of pus under skin. Painful, tender, induration
Erysipelas
Superficial cellulitis with dermal lymphatic involvement (streaking). Shiny, raised, indurated, plaque like lesions. Legs (then face)
Erysipeloid
Violaceous on hands and forearms. Rare
Erythasma
Superficial intertriginous infxn with Corynebacterium. Dx: Wood’s lamp, skin scraping
Folliculitis
Inflammation of hair follicle. S aureus, fungal, trauma, corticosteroids. Pustule or inflammatory nodule. If from hot tub–pseudomonas
Furuncle
Boil. Acute tender nodules. S aureus. Drains to the surface. Culture to r/o MRSA.
Carbuncle
Cluster of furuncles with multiple draining orifices. More systemic symptoms.
Impetigo
Superficial acute skin infection with honey colored crusting. Clusters of vesicles or pustules that rupture.
Candidiasis
Intertriginous, erythematous, well-demarcated, pruritic patches. Satellite lesions.
Dermatophytoses
Fungal infxn of keratin in skin and nails. Tinea….
Tinea barbae
Beard fungus. Pruritic, painful, swollen
Tinea capitis
Fungus that can cause hair loss. More common in African and Hispanic descent
Tinea corporis
Pruritic, circular/oval, erythematous, scaling. Slightly raised, pale in middle
Tinea cruris
Jock itch. Causes: obesity, diabetes, immunodeficient. Partial central clearing, slightly elevated, erythematous active border
Tinea pedis
Athletes foot. Common. Intensely pruritic. Erythematous vesicles or bullae between toes or on soles.
Tinea versicolor
Superficial fungus infection with Melassezia furfur. Hypo/hyper pigmented macules with scaling patches. Trunk and proximal upper extremities.
Cutaneous larva migrans
Creeping eruption. Caused by hookworm larva. Intensely pruritic, erythema, serpinginous. DDX: scabies
Lice
Pediculosis. Wingless, blood sucking insects. Head. Nits “glued on” shaft 1cm from scalp.m
Scabies
Infection of skin with mite. Burrows are pathognomic. Wavy lines with papules.
Hands, arms (feet, gluteal fold, axilla, back of knees)
Molluscum contagiosum
2-10 lesions. Caused by pox virus in epidermal cells. Esp ages 3-9yrs. Smooth, flesh colored, umbilicated, indurated. Self-limiting
Warts
Verrucae vulgaris. Benign, contagious, caused by HPV.
Common wart
Dome, round, or irregular. 2-10mm. Usually asx. Skin lines interrupted by hyper keratosis. Black puncta when scraped with pinpoint bleeding.
Filiform wart
Long, narrow, soft. Eyelids, face, neck
Flat wart
Smooth, flat, yellow, brown, flesh colored. 2-3mm
Plantar wart
Soles of feet. Single or multiple. Painful and callused. Black puncta present.
Mosaic wart
Multiple plantar warts
Condylloma accuminata
Genital warts. Soft, moist papules or plaques on perineum, external genitalia, anus, vagina, cervix
Varicella
Chicken pox. Acute, highly contagious vesicular eruption caused by primary infxn with HHV. Papules, macules, vesicles, pustules, crusts.
Herpes simplex
Recurrent viral infxn w intraepidermal infxn by HSV. Herpes hurt. Ulcerated/weakling lesions. Outbreaks following stress.
Herpes zoster
Shingles. Latent varicella infxn. Virus remains in nerve roots and erupts along the dermatome. Systems sxs, severe pain.
Roseola infantum
Infxn of infants or young children. 3-5 days high fever –>rash on chest and abdomen (only for few hours)
Hand Foot and Mouth Disease
Febrile disorder caused by Coxsackie virus. Vesicular eruptions of skin and mucosa. Fever, myalgia, abdominal pain, loss of appetite
Viral exanthems
Blood borne viruses–> vascular response. Raised maculopapular rash, e.g. Rosella infantum.
DDX: hives
Measles
One of most communicable dzs! Spread by secretions from nose, mouth, throat. Prodrome with fever, coryza, conjuctivitis, photophobia, cough, Koplik spots.
Rash is morbilliform, maculopapular, blanching
Rubella
Mild incubation, brief prod rime of fever/malaise. Rash is pinpoint pink maculopapular, may have petechiae on soft palate.
A teratogen!
Vitiligo
Idiopathic condition lacking in melanocytes. Sharply demarcated, patchy and irregular. Spots are white with no scale.
Assoc w auto immune dzs, e.g. Thyroid, pernicious anemia, systemic lupus erythematosus, Addisons
Hyperpigmentation
Melasma/chloasma: macular, pregnant women or OCP. Sharply delineated patches on face. “Mask of pregnancy”
Lentigines: flat, tan or brown spots dt chronic sun exposure
Alopecia
Male/female pattern–androgen excess (“load of hooey”)
Diffuse– weight loss, nutritional def, thyroid disorder, stress, pregnancy
Toxic–chemo
Alopecia areata–autoimmune, toxic, drugs, infxns, severe stress
Scarring aplopecia
Cutaneous lupus, deep bacterial infxn, ulcers, granulomas, syphilis, tinea
Hirsutism
Excess hair in females. Dx by serum free testosterone
Onychomycosis
Fungal infxn of nail plate or bed. Caused by dermatophytes or yeast
Paronychial infxns
Periungual infxn. Develops along nail margin, becomes painful, warm, erythematous, swollen.
Dermatofibroma
Benign proliferation of fibroblasts. Epidermal thickening and hyperpigmentation, small red to brown papule
Epidermal cyst
Cyst w keratinous material in the dermis. Firm, flesh colored, movable nodule its central punctum
Keloid
Excess fibroblastic proliferation following trauma and scarring. E,elated, shiny, firm protuberant nodule. African and Asian descent prone
Lipoma
Subcutaneous nodules of adipocytes. More common in F. Rubbery, movable nodule, below dermis.
Nevi
Moles. Pigmented or flesh colored macules, papules, or nodules composed of melanocytes.
Lentigo
Hyper pigmented macule dt increased melanocytes. Darker, sparser, does not darken with sun
Junctional nevus
Light brown-black. Usu flat but can be raised. 1-10mm. Palms, soles, genitals
Compound nevus
Light to dark brown, smooth and dome shaped or papillomatous.
Intradermal nevus
Elevated, flesh colored to brown. May have speckles of brown pigmentation, 3-6mm
Halo nevus
Pigmented compound or intrudermal nevus, halo of depigmented skin. Immune phenomenon
Atypical/dysplastic nevus
Irregular, pigmented nevus from tan to dark brown. Irregular pigment. ABCDEF. Large, >6mm on covered areas
Seborrheic keratosis
Benign neoplasm—>pigmented superficial lesions that appear warty or smooth papules. “Stuck on”, scaly.
Acrochordon
Pendunculated fibroma, soft. “Skin tag”. Perianal common in pts with Chron’s
Basal cell carcinoma
Superficial, slow growing papule or nodule. Small, shiny, firm translucent–> crusty, flat lesions.
Nodular-60%. Papule that –> rodent ulcer
Superficial-30%
Morpheaform-10%
Malignant melanoma
Arises in melanocytes in skin and mucus membranes, eyes or CNS. ABCDEF. Usu pigmented
Glasgow 7 point checklist: (1 major, or 2 minor = referral)
Major: change in size/new lesion, change in shape, in color
Minor: diameters >=7mm, inflammation, crusting/bleeding, sensory change
Lentigo-malignant melanoma
15%. Slow onset and progression on face or sun exposed areas. 2-6cm, flat, tan or brown w darker spots
Superficial spreading melanoma
2/3 of melanoma. Arise from preexisting lesion. Mostly on women’s legs and men’s torsos. Plaque
Nodular melanoma
Dark protuberant papule or plaque varying in color. Grows fast. May not be pigmented
Acrolentiginous
Arise in areas of non-hair bearing skin: soles, palms, subungual skin
Squamous cell carcinoma
Malignant tumor of epithelial keratinocytes that invades the dermis. Usu on sun exposed areas. Starts as red papule with scaly rough surface or is nodular. Can form horns. Eventually ulcerates/bleeds and can metastasize
Big lump DDX
Cutaneous abcess, ruptured epidermal cyst, lipoma, keloid
Small red papules DDX
Baby acne, miliaria
Plaques on face DDX
Herpes zoster, Rosacea, erysipelas, contact dermatitis
Intertriginous DDx
Erythrasma, tinea (pedis, cruris), candidiasis
Pustules
Acne vulgaris, Rosacea, impetigo, folliculitis, candidiasis, insect bite, furuncles, carbuncle, drug eruption
Crusting vesicles
Impetigo, herpes simplex, herpes zoster, atopic dermatitis
Scalp DDX
Tinea capitis, love, seborrheic dermatitis
Groin DDX
Tinea cruris, candidiasis, molloscum, erythrasma, warts
Body DDX
Drug eruptions, pityriasis rosea, tinea versicolor, erythema multiforme, vitiligo
Serpinginous DDX
Cutaneous larva migrans, scabies
Feet DDX
Plantar wart, tinea pedis
Eyelids DDX
Filiform wart, acrochordon
Flat brown macule DDX
Flat wart, lentigo
Warty thing DDX
Mosaic wart, seborrheic keratosis, actinic keratosis
Vesicular rash DDX
Varicella, contact dermatitis, herpes zoster, acne vulgaris, impetigo, drug eruption, herpes simplex
Red macular rash DDX
Roseola infantum, measles, rubella, drug eruption
Vesicular eruption DDX
Varicella, herpes, aphthous stomatitis
Hypopigmented DDX
Tinea versicolor, vitiligo, pityriasis alba
Hyper pigmented DDX
Pregnancy, OCP, lentigines
Alopecia DDX
Male pattern, female pattern, alopecia areata, tinea capitis, trichotillomania
Nails DDX
Onychomycosis, trauma, psoriasis
Red brown papules DDX
Dermatofibroma, nevi, basal cell carcinoma, keloid, acrochordons
Tumors DDx
Nevi, seborrheic keratosis, molloscum, scc, malignant melanoma, bcc, actinic keratosis
Morbilliform
Looks like measles
