Clinical Perspectives in Skin Changes Flashcards
What are the DDx for a maculopapular rash?
- port wine stains
- rickettsial infectionis
- rubella
- measles
- allergic drug eruptions
- lichen planus
- seborrheic keratoses
- actinic keratoses
- acne
- skin cancer
What is a macule?
flat discolored less than cm
papule?
small solid lesion less than cm in diameter raised above srace of skin
Nodule?
larger soid lesion up to 5 cm in diameter
Plaque
flat topped elevation of skin greater than 1 cm
Bulla?
large clear fluid filled lesion greater than 1 cm
Vesicle?
small clear fluid filled lesion less than 1 cm and rasied
wheal?
Transient erythematous and edematous papule or plaque
DDx for nodules?
- cysts
- lipomas
- fibromas
Vesicular rash ddx?
- acute allergic contact dermatitis
- autoimmmune bistering disorders dermatitis herpetiformis
Bullae ddx?
- irritatnt contact dermatitis
- allergic contact dermatitis
- drug reactions
- autoimmune bullous diseases
- pemphigus vulgaris
- bullous pemphigoid
Petechiae vs Purpura
Petechiae:
- non blanchable foci of hemorrhage
- platelet abnormalities
- vasculitis
- rocky mountain spotted fever
Purpura:
- palpable purpura are hallmark of leukocytoclastic vasculitis
- non palpable are hemorrhage or microvascular occlusion with ischemic hemorrhage
- Coagulopathy indicated
Urticaria?
- wheals or hives
- elevated lesions caused by localized edema
- pruritis and red wheals
- hypersensitivity to drugs, stings, bites, AI and physical stimuli like temp pressure and sunlight
- last less than 24 hrs
Full thickness destruction of epidermis into underlying dermis?
Ulcer
Lichenification?
Visible thickening of skin resulting in accentuated skin fold markings
What causes papular rashes?
- Viral
- Bacterial
- Toxin induced
- Drug induced
Herpes 1 and 2?
- Specrum of illnesses involving stomatitis, urogenital lesions, bells palsy and encephalitis
Herpes zoster?
- Varicella rash:
- pruritic centrifugal papular changing to vesicular rash, pustular crusting rash lesions are at all stages
- Zoster rash:
- Tingling pain eruption of vesiclese in a dermatomal distribution evolving to pustules and then crusting
- concerned with potential for post herpetic neuralgia
Skin manifestations of meningitis?
- Petechial rash on skin and mucous membrane
- Purulent spinal fluid with gram neg intracellular and extracellular diplococci
- Culture of CSF fluid, blood, or petechial aspiration confirms diagnosis
DIC in memingitis presents with what type of skin manifestation?
- Purpura fulminans
Seborrheic keratosis?
- benign papules and plaques beige to brown 3-20mm in diameter velvety or warty surface
- Look stuck onto skin
- Extremely common in onder adults may be mistake for melanomas
- no tx is needed
actinic keratoses?
- small macules or papules
- Flesh colored pink or slightly hyperpigmented, feels like sand paper and tender to palpation
- occur on sun exposed parts of body fair complexion people
- Premalignant and may progress to SCC
Describe BCC
- pearly papule
- Erythematous patch greater than 6mm or a non healing ulcer in sun eposed areas
- History of bleeding
- Fair skin people
- Can see telangectasisa in them
SCC ?
- non helaing ulcer or warty nodule
- Skin damage with long term sun exposure
- SCC of ear temple lip oral cavity tongue genitalia
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What is psoriasis What are its comorbidities?
- Chronic inflammatory papulosquamous and immune mediated skin disorder
- associated with joint and cardio comorbidities
- Psoriasis can presnet in many different patterns from scalp to feet and causes psychiatric distress and physical disabilities
What triggers psoriasis?
- Stress
- physical trauma (Koebner phenomenon)
- Cold weather
- Sun or hot weather
- Infections
- Meds
Screening for melanoma>
- Asymmetry
- Border
- Color
- white ischemic
- black necrotic
- blue- superficial but getting deeper
- Diameter
- bigger than 6mm
- Evolution
- Tissue depth (color is related to this) is most significant determinant in prognosis
Erythema migrans is seen in what disease
Borrelia burgdorferia lyme disease
When do you see erythema multiforme?
- Herpes simplex and mycoplasma pneumonia
what is erythema multiforme?
- Target lesion is round pink to red patch
- Three concentric rigns
SLE skin sx?
- Pruritis or increased sun sensitivity
- Cutaneous lesions can appear in discoid lupus and are diffuse non scarring and nondescripit
- Butterfly rash
Systemic sx are arthralgia, myalgia, fatigue, malaise, fevers, chills, night sweats, weight loss, HA, vision changes, diffuse hair loss
What is dermatomyositis?
- Rare chronic immune mediated disorder that affects the skin or proximal skeletal muscles
- dx is missed or delayed bc pruritus and rash are similar to other dermatitis
- Increased risk of malignancy and assoc with Celiac dz
- Pathognomic findings include periorbital erythema (heliotrope), violaceous papuples ofver joints of hands (Gottron’s papules)
Pretibial myxedema?
Pnk waxy indurated plaque on lower legs of patient with Graves dz and hyperthyroidism
Erythema nodosum?
Classic non granulomatous lesion assoc with sarcoidosis, usually on lower extremity on anterior tibial surface
Erythema infectiosum?
- Fiery red slapped cheeks circumoral pallor, and lacy maculopapular rash on trunk and limbs
Scarlet fever?
- toxin producing group A Beta hemolytic streptococci
- evolves from exudative pharyngitis
- Rash of scarlet fever is diffusely erythematous an looks like sunburn with sand papery rash
- Groin and axilla most intense
- Blanches on pressure
- Strawberry tongue
Measles?
- Fever malaise conjunctivitis coryza cough rash Koplik spots
- Koplik spots appear during prodrome phase and are pathognomoic for measles
Nikolsky sign?
- Slight lateral pressure on skin causing sloughing of epidermis
- Positive in pemphigus vulgaris
- Negative in bulllous pemphigoid
Pemphigus vulgaris
- AI
- Results in formation of large superficial loose bullae that peel off and leave denuded skin
- Kickolsky sign positive
- oral mucosal involvment is common
Vasculitis?
- Group of DO characterized by inflammation and damage in blood vessels walls
- Limited to skin or multisystem DO
- Cutaneous vasculaitic diseases are classified small med large and type of vessel
Large vessel vasculitis
- Giant cell arthritis
- Polymyalgia rheumatica
- Takayasu arteritis
- Aortitis
Medium small artery vasculitis?
- Most common anad frequently tested ones:
- Polyarteritis nodosa
- only nodosa not associated with ANCA auto abs
- Eosinophilic granulomaatosis with polyangiitis
- Microscopic polyangiitis
- Microscopic polyangiitis
- Polyarteritis nodosa
