APPROACH TO PATIENT Flashcards by SALI BABY

How the condition has spread or developed over time

EVOLUTION

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constant, waxing and waning,
worst at night, worst in winter

PERIODICITY

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if the lesion of the patient with pimple, its in the mid
to lower face, probably

PCOS

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medical conditions associated with skin
disease

diabetes
renal and hepatic disease
infection with HIV or hepatitis viruses
polycystic ovarian
syndrom
lupus
thyroid disease
skin disease (asthma, allergies)

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solid, elevated lesion less than 0.5 cm in size in which a significant portion projects above the plane of the surrounding skin

PAPULE

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Papules surmounted with scale

papulosquamous lesions

ex. Lichen planus

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solid plateau-like elevation that occupies a relatively large surface area in comparison with its height above the normal skin level and has a diameter larger than 0.5 cm

PLAQUE

ex. psoriasis

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Solid, round, or ellipsoidal, palpable lesion that has a
diameter larger than 0.5cm.

NODULE
ex. nodular basal cell
carcinoma.

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Different surfaces of nodules:

smooth, keratotic,
ulcerated, or fungating

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also sometimes included under the heading of
nodule, is a general term for any mass, benign or malignant.

Tumor

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the granulomatous nodular lesion
of tertiary syphilis.

gumma

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a nodule that is ulcerated and bleeding, you have to think of

basal cell carcinoma

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If nodule is fungating, most likely it’s

a verruca vulgaris (or warts)

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encapsulated cavity or sac lined with a true epithelium
that contains fluid or semisolid material

CYST

Can be hard, doughy, fluctuant
hidradenoma.

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a swelling of the skin that is characteristically evanescent, disappearing within hours.

WHEAL

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other name of wheal

also known as hives or urticaria,.

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the result of edema produced by the escape of plasma through vessel walls in the upper portion of the dermis

hives or urticaria

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evanescent or disappearing for less than
24 hours.

Wheal

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deeper, edematous reaction that occurs in areas with very loose dermis and subcutaneous tissue such as the lip, eyelid, or scrotum.

Angioedema

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arises from proliferation of fibrous tissue that replaces previously normal collagen after a wound or ulceration breaches the reticular dermis.

SCAR

if it only involves the epidermis, then it will not
result to scarring and will just result to hypo- or
hyper-pigmentation.

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typically take the form of firm papules,
plaques, or nodules. This will not exceed the wounding area.

Hypertrophic scars

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exceed the area of initial wounding

Keloids

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thin depressed plaques

Atrophic scars

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a hair follicle infundibulum that is dilated and plugged by keratin and lipids.

comedo

Are the non-inflammatory lesions in acne vulgaris.

Inflammatory lesions of acne vulgaris are the
cysts, cystic acne, papules, pustules, etc.

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When the pilosebaceous unit is open to the surface of the skin with a visible keratinaceous plug.

OPEN COMEDO / BLACKHEAD The **black color** of the **comedo** is due to the **oxidized sebaceous content** of the infundibulum (“blackhead”).

the follicular **opening is unapparent** accumulates whitish keratin

CLOSED COMEDO (WHITEHEAD

**hyperkeratotic** **conical** mass of **cornified cells** arising over an abnormally differentiating epidermis

HORN

A clinical example is verruca vulgaris.

HORN or in layman's term: filiform wart

**deposits of calcium** in the **dermis** or subcutaneous tissue may be appreciated as hard, whitish nodules or plaques, with or without visible alteration of the skin’s surface.

CALCINOSIS ex. scleroderma. A clinical example is cutaneous calcinosis in **dermatomyositis**.

is a **moist**, **circumscribed**, **depressed** lesion that results from **loss of a portion** or all of the viable **epidermal** or mucosal epithelium. Does not involve the dermis do not scar unless infected ex. TEN

EROSION

layer of the dermis that is thicker, where collagen is found. Other structures are blood vessels, nerves, and elastin.

Reticular dermis

Is a defect in which the **epidermis** and at least the **upper (papillary) dermis** have been destroyed. Breach of the dermis and destruction of adnexal structures impede reepithelialization, and the defect **heals with scarring.**

ULCERS * A clinical example is pyoderma gangrenosum.

diminution in the size of a cell, tissue, organ, or part of the body.

ATROPHY

An atrophic ____ is glossy, almost transparent, paper thin and wrinkled, and may not retain normal skin lines. Atrophy of the ____ manifests as a depression of the skin

* epidermis * papillary or reticular dermal connective tissue

pepper-and-salt/ salt-and-pepper appearance of the skin.

POIKILODERMA

Refers to the **combination** of atrophy, telangiectasia, and varied pigmentary changes (hyper- and hypo-) over an area of skin.

POIKILODERMA * A clinical example is chronic radiodermatitis.

Is a tract connecting deep suppurative cavities to each other or to the surface of the skin.

SINUS hidradenitis suppurativa.

Are **linear depressions of the skin** that usually measure several centimeters in length and result from changes to the reticular collagen that occur with rapid stretching of the skin.

STRIAE

Is a wavy, threadlike tunnel through the outer portion of the epidermis excavated by a parasite.

BURROW

Refers to a circumscribed or **diffuse** **hardening** or **induration** of the skin that **results from dermal fibrosis**. It is detected more easily by palpation, on which the skin may feel board like, immobile, and difficult to pick up.

SCLEROSIS A clinical example is morphea.

Is **flat**, **even** with the **surface level of surrounding skin**, and perceptible only as an area of color different from the surrounding skin or mucous membrane.

MACULE A clinical example is **lentigo**.

**flat area of skin** or mucous membranes with a **different color** from its surrounding. It is **larger than 0.5 cm,** and it may have a **fine, very thin scale.**

PATCH Clinical examples include vitiligo.

**blanchable** pink to red color of skin or **mucous membrane** that is due to dilatation of arteries and veins in the **papillary and reticular dermi**s.

ERYTHEMA A clinical example is fixed drug eruption.

Is a generalized **deep redness** of the **skin** involving **more than 90% of the body surface within days to weeks**.

ERYTHRODERMA A clinical example is Sezary syndrome

Is **flat plate or flake** arising from the **outermost** layer of the **stratum corneum**. Groups of coherent cornified cells **packed** with **filamentous** **proteins** desquamate in scales.

SCALE, DESQUAMATION (SCALING) A clinical example is psoriasis vulgaris

What is involve in the scale what layer of the skin is involved?

Stratum corneum (outermost layer)

increased transition of keratinocytes from the stratum basale to stratum corneum

Psoriasis vulgaris

Refers to an excessive or thickened **stratum corneum**, often but not always scaly

HYPERKERATOSIS

Are **hardened** **deposits** that result when serum, blood, or purulent exudate dries on the surface of the skin. The **color** of crust is a * **yellow**-**brown** when formed from **dried** **serous** secretion; * **turbid yellowish green** when formed from purulent secretion; and * **reddish-black** when formed from hemorrhagic secretion

CRUSTS (ENCRUSTED EXUDATES)

Are surface excavations of **epidermis** that result from scratching

EXCORIATIONS No involvement of dermis → it will not produce scarring.

Is a **linear of continuity** of the skin’s surface or mucosa that results from excessive tension or decreased elasticity of the involved tissue.

FISSURE

Repeated rubbing of the skin may induce a **reactive thickening of the epidermis**. These changes produce thickened skin with accentuated markings, which may resemble **tree bark**.

LICHENIFICATION A clinical example is lichen simplex chronicus

**excessive accumulation** of scale (hyperkeratosis) that **results in a yellowish thickening** of the skin, usually on the palms or soles, that may be inherited (abnormal keratin formation) or acquired (mechanical stimulation).

KERATODERMA clinical example is **plantar keratoderma** in psoriasis -tenia pedis is a consideration

Implies tissue necrosis, infarction, deep burns, gangrene, or other ulcerating process. It is a **circumscribed**, adherent, hard, black crust on the surface of the skin that is **moist initially,** protein rich, and **avascular**.

ESCHAR A clinical example is thermal burn.

a **fluid-filled cavity** or **elevation** **smaller** than or **equal** to **0.5 cm**

vesicle * Vesicles and bullae arise from cleavage at various levels of the epidermis (intraepidermal) or of the dermal–epidermal interface (subepidermal). ex. blistering aspect of impetigo.

measures larger than 0.5 cm; tense or flaccid weepy blisters

A bulla (blister) A clinical example of bulla is a bullous pemphigoid. * FLACCID, the evolvement or the split of the skin is **superficial**, so its **intraepidermal** involvement. * TENSE blisters, it’s more of the **lower** layers, it’s **subepidermal**.

Is a **circumscribed**, **raised** **cavity** **containing** **pus**. The **purulent** **exudate**, composed of **leukocytes** **with or without** cellular debris, may contain **bacteria** or may be **sterile**.

PUSTULES clinical example is superficial pyoderma

A **deep necrotizing folliculitis** with **suppuration**. It presents as an **inflamed follicle-centered nodule** usually **>1 cm** with a **central necrotic plug** and an overlying pustule.

furuncle

Several furuncles may coalesce to form a ____

carbuncle

is a l**ocalized accumulation of purulent material so deep** in the dermis or subcutaneous tissue that the pus is usually not visible on the surface of the skin. is a pink erythematous, warm, tender, fluctuant nodule

abscess

Extravasation of red blood from cutaneous vessels into skin or mucous membranes results in reddish-purple lesions

PURPURA

The application of pressure with two glass slides

diascopy * The application of pressure with two glass slides (diascopy) on a reddish-purple lesion is a simple and reliable method for differentiating redness due to vascular d**ilatation (erythema**) from redness due to **extravasated erythrocytes (purpura).** * If the **redness** is **non** **blanching** under the pressure of the slide, the lesion is purpuric

are small, pinpoint purpuric macules.

Petechiae

larger, bruise-like purpuric patches. These lesions correspond to a noninflammatory extravasation of blood.

Ecchymoses

Are **persistent** **dilatations** of **small capillaries** in the superficial dermis that are visible as fine, bright, non pulsatile red lines or netlike patterns on the skin

TELANGIECTASIA

Is an **area** of **cutaneous** **necrosis** resulting from a **bland** or **inflammatory** **occlusion** of blood vessels in the skin.

INFARCT A clinical example is cholesterol emboli

**Ring-shaped**; implies that the edge of the lesion differs from the center, either by being raised, scaly, or differing in color (e.g. granuloma annulare, tinea corporis, erythema annulare centrifugum

ANNULAR

**Coin**-shaped; usually round to oval lesion with **uniform morphology from the edges to the center**

ROUND/NUMMULAR/DISCOID

Formed from **coalescing** **circles** , rings, or incomplete rings ( e.g. urticaria, subacute cutaneous lupus erythematosus)

POLYCYCLIC

**Arc-shaped**; often a result of **incomplete formation** of an annular lesion (e.g. urticaria, subcutaneous lupus erythematosus)

ARCUATE

Resembling a straight line; often implies an **external contactant** or **Koebner phenomenon** has occurred in response to scratching

LINEAR

**Net-like or lacy in appearance**, with somewhat regularly spaced rings or partial rings and sparing of intervening skin (e.g. livedo reticularis, cutis marmorata)

RETICULAR

Serpentine or snake-like (e.g. cutaneous larva migrans, in which the larva migrates this way and that through the skin in a wandering pattern

SERPIGINOUS

o Target-like, with at least three distinct$ zones (e.g. erythema multiforme)

TARGETOID

Like marble cake, with **two** **distinct** **colors** interspersed in a **wavy** **pattern**; usually seen in **mosaic disorder**s in which cells of differing genotypes are interspersed

WHORLED (e.g. incontinentia pigmenti, hypomelanosis of Ito, linear and whorled nevoid hypermelanosis)

Lesions clustered together (e.g. classic example is her[es simplex virus 1)

* Grouped/herpetiform

o Irregularly distributed

Scattered