Chapter 9 - Scaling Papules, Plaques, and Patches Flashcards
etiology of Discoid Lupus
autoimmune
etiology of Fungus
dermatophyte infection
etiology of Mycosis fungoides
Neoplastic lymphoma
Etiology of Pityriasis Rosea
humuan herpesvirus 6 & 7
etiology of psoriasis
unknown
etiology of Secondary syphilis
spirochete infection
fungal infection - erythematous round annular patch with clear center and scaling serpiginous border, commonly found on trunk and extremities
Tinea capitis
classic ____ = Tinea corporis
ringworm
How do you differentiate between lesions of nummular eczema and a ring worm?
nummular lesions = coin shaped & usually multiple, located on extremities. But usually no central central clearing as seen in a ringworm. KOH prep will be negative for nummular lesions.
How do you differentiate between Pityriasis rose and tine?
Pityriasis rose starts with a single herald patch. The diagnosis will become evident when the generalized eruption develops within a few weeks. KOH negative
Uncommonly impetigo presents in an annular configuration. How would u differentiate this from ringworm?
vesicles, pustules, and crusts in annular lesions should lead one to suspect bacterial rather than fungal.
How do you differentiate Erythema annular centrifugum from ring worm?
Erythema annular centrifugum = scale is inside the elevated border
how do you differentiate granuloma annulare from ringworm?
In granuloma annulare, the border is indurate and is NOT scaling
what is the name of the generalized version of erythema annulare centrifugum
erythema gyratum repens - associated with an internal malignant disease - sometimes diabetes mellitus
Jock Itch - groin rash with erythematous well demarcated patch with a serpiginous scaling border. does not involve the scrotum and penis.
Tinea cruris
Patients with Tinea cruris frequently also have what?
Tinea Pedis (athletes foot)
what are the three major causes of groin rash?
- Tinea cruris
- Candidiasis
- Intertrigo
how would you differentiate between candidiasis and tine cruris?
candidiasis appears bright, intensely erythematous (beefy red) eruptions with poorly defined borders and satellite papules and pustules; scrotum is often affected unlike tine cruris
BOTH KOH POSITIVE
how would you differentiate between intertigo and tinea cruris?
intertigo represents simple irritant dermatitis, most often found in obese patients in whom moisture accumulates between skin folds in the inguinal area, along with friction causes skin irritation. The eruption is not as erythematous as that of candidiassis, and not as sharply demarcated as tine cruris. KOH prep negative
one hand & two feet are involved - dry, unilateral, diffuse scale on one palm always see in conjunction with tine pedis; border on wrist side is often sharply demarcated.
Tinea manuum
how would u differentiate between chronic irritant contact dermatitis, xerosis, and Tinea manuum?
Chronic Irritant Contact Dermatitis & Xerosis =
chronic scaling of the palms, however these conditions involve both hands and the border is generally not well demarcated
How do you differentiate between psoriasis and Tinea manuum?
Psoriasis can affect the palms with sharply demarcated scaling plaques. Usually these plaques are bilateral and more elevated and erythematous than in tines manuum. Often lesions of psoriasis elsewhere on the body support the diagnosis.
the most often involved dermatophytic infection
feet - Tinea pedis
maceration found in the web space (especially last toes) ;interdigital, diffuse, plantar scaling, and vesiculopustular forms = _____ fungal dermatophytic infection
Tinea pedis
appears as a macerated scaling process between the toes - common in patients with sweaty feet
interdigital tinea pedis
extremely common in old patient; asymptomatic; skin of the feet appears dry with diffuse scaling on the soles extending into the sides of the feet; not a sharp demarcated border; moccasin like; nail involvement
Diffuse plantar scaling
vesicles and pustules on the instep of the feet should lead to a suspicion of this type of tine pedis = _____
vesiculopustular form of Tinea Pedis
**rarely see pustules on instep
How can you differentiate between Contact dermatitis and dyshidrotic eczema and Tinea Pedis?
Contact dermatitis and dyshidrotic eczema have vesicles usually smaller and rarely progress to pustules
salmon colored patch usually largest lesion, on trunk, multiple pink/oval patches with “coleratte” scale. Distribution has been likened to that of a CHRISTMAS TREE!!
Pityriasis Rosea
The generalized eruption of Pityriasis Rosea is precede by _____.
a single lesion called the Herald Patch
T/F Pityriasis Rosea is always itchy.
false. can be itchy or not
What is the mosts important diagnosis to consider in the differential diagnosis of Pytyrasis Rosea?
Secondary syphilis - if a patient has no herald patch, if the distal extremities (particularly palms and soles) are involved, or if the patient is systemically ill, a serologic test should be ordered for syphilis
T/F Pityriasis rosea clears spontaneously within 2 week.s
true
The rash of Pityriasis rosea appears to be mediated by ________.
cellular (type 4) immune reaction a possible viral trigger, human herpes viruses 6 & 7
inflammatory response in the skin and mucous membranes to the hematogenously disseminated Treponema palladium spirochete. Rash can appear is MANY WAYS!
Secondary syphilis
What is secondary syphilis known to be called?
the great imitator
secondary syphilis - secondary phase starts ____ weeks after appearance of primary chancre (ulcer). Might have systemic symptoms.
6-12 weeks
when are vesicles and bullae present in secondary syphilis?
in newborn with congenital disease and occasionally in patients with HIV infection
what is the most common lesion of secondary syphilis
scaling papules and small plaques
what color is secondary syphilis and where is it located?
reddish/brown or copper colored; almost always involved palms and soles “HAM COLORED”
What is the general guideline to remember for patients with a generalized rash of unknown origin and systemic complaints,
secondary syphilis should be considered and the patient should be tested!!!!!!
ALWAYS
Secondary syphilis resolves spontaneously within 1-3 months in the immunocompetent host. What diseases are associated with secondary syphilis?
Hepatitis and CNS involvement
if the disease goes to tertiary syphilis = cardiovascular and CNS manifestations
uncommon lymphoma of the skin: lesions result from proliferation of malignant T lymphocytes in dermis which can migrate to the epidermis
Mycosis Fungoides
What is Mycosis Fungoides commonly known as?
Cutaneous T-cell Lymphoma
T/F Mycosis Fungoides is a fungal infection.
FALSE! is NOT!
Who does mycosis fungicides commonly occur in?
adults
When examining of Mycosis Fungoides what would u expect to see?
irregular in shape, peculiar in color (reddish brown, violaceous, or orange) and asymmetric in distribution. elevation depends on stage. patch stage looks like cigarette paper wrinking of the surface.
Other lesions of Mycosis Fungoides may show _______ - a term used to describe a reticulate pattern of hyper pigmentation, hypo pigmentation, and erythema with telangiectasioa.
Poikiloderma
In poikiloderma the epidermis shows _____.
atrophy
____ is very common in advanced disease of Mycosis Fungoides.
Lymphadenopathy; nodules appear and frequently ulcerate
_____ represents a leukemic variant of mycosis fungicides; characterized by total body erythema, lymphadenopathy, high number of mycosis cells in the peripheral circulation.
Sezary syndrome
*Sezary cells = mycosis cells
The most important histological feature is the presence of ______. THese represent collections of lymphocytes many of which are atypical
Pautrier’s microabceses
how long is survival of patients with systemic disease of mycosis fungicides
2 years
uncommon rash, autoimmune diseases that appear as disk shaped purple/pink plaque which accumulates scale as it matures.
White Scale and usually cohesive, so it can be removed in one piece,
SCARING plaques in SUN EXPOSED areas; also involves the hair follicles
Discoid Lupus Erythematosus (DLE)
Who does Discoid Lupus Erthematosus (DLE) is found primarily in _____
young middle aged population
what is the patients complaint with DLE
non-healing lesions usually on sun exposed surface. face is common - look like a scar
DLE is also seen in the scalp which causes a ______.
Scarring alopecia
