Clinical Perspectives in Skin Changes

Question 1

a patient presents with a papular rash, what are the 4 broad potential causes?

Answer 1

viral, bacterial, toxin induced (poison oak), or drug effect

Question 2

what is important in determining the cause of a maculopapular or papular rash?

Answer 2

history and PE–> location, onset, and associated clinical findings

Question 3

if a patient presents with a maculopapular rash and the morphology is flat, what could it be?

Answer 3

macule or a patch

Question 4

if a patient presents with a maculopapular rash and the morphology is raised, what could it be?

Answer 4

papule, nodule, or plaque

Question 5

if a patient presents with a maculopapular rash and the morphology is fluid-filled, what could it be?

Answer 5

vesicle, pustule, bulla

Question 6

how does the color of a maculopapular rash indicate severity?

Answer 6

pink–> red–> purple–> black (least to most severe)

Question 7

what are some examples of secondary changes that can be seen with maculopapular rashes?

Answer 7

crust, scale, erosion, and ulceration

Question 8

what are the red flags associated with maculopapular rashes?

Answer 8

skin pain, blisters/desquamation, mucous membrane involvement, extensive body surface area, and purpura

Question 9

how does the skin manifestation of measles present?

Answer 9

erythematous macules and papules with symmetrical diffuse distribution (centrifugal distribution)

Question 10

provide diagnostic consideration in a patient with a vesicular rash?

Answer 10

history and PE are important; could be herpesvirus 1 and 2 or herpes zoster

Question 11

what are the typical presentations of herpesvirus 1 and 2?

Answer 11

spectrum of illness: stromatitis, urogenital lesions, Bell palsy, or encephalitis

Question 12

what are the two infections associated with herpes zoster?

Answer 12

varicella rash and zoster rash

Question 13

how does varicella rash present?

Answer 13

pruritic, centrifugal, papular changing to vesicular, pustular, and finally crusting; lesions appear at all stages at once

Question 14

how does zoster rash present?

Answer 14

tingling, pain, eruption of vesicles in a dermatomal distribution, evolving to pustules and then crusting; unilateral

Question 15

in diagnosing a patient presenting with meningeal inflammation and infection, describe potential skin manifestations associated with or due to various etiologies of meningitis.

Answer 15

petechial rash on skin and mucous membranes; DIC is an important complication of meningococcal infection and is typically present in toxic patients with ecchymotic skin lesions

Question 16

what are the ecchymotic skin lesions called in patients with meningitis infections with DIC complications?

Answer 16

purpura fulminans

Question 17

if a patient presents with skin lesions all over their body, how would you differentiate between seborrheic keratosis and actinic keratoses?

Answer 17

seborrheic keratosis presents as beige to brown or even black benign papules; actinic keratoses present as flesh-colored, pink, or slightly hyperpigmented that feel like sandpaper and are tender to palpation

Question 18

what is actinic keratoses considered to be?

Answer 18

premalignant; may progress to become squamous cell carcinoma

Question 19

if a patient presents with a skin rash to their face, how can you tell the difference between rosacea and seborrheic dermatitis?

Answer 19

rosacea is a more papular/ inflammatory presentation; seborrheic dermatitis is more flakey and looks like dandruff into the hairline

Question 20

who often has seborrheic dermatitis?

Answer 20

patients with parkinson disease, HIV infected patients, and patients who become acutely ill often

Question 21

What is the most common skin cancer?

Answer 21

BCC

Question 22

how does BCC appear?

Answer 22

pearly papule; history of bleeding

Question 23

how does SCC appear?

Answer 23

as a nonhealing ulcer or warty nodule

Question 24

what SCC has much higher rates of recurrence or metastasis and require special management?

Answer 24

SCC of the ear, temple, lip, oral cavity, tongue, and genitalia

Question 25

what are the clinical features of the skin presentation of psoriasis?

Answer 25

thick, well-demarcated salmon colored plaques with overlying silvery scale

Question 26

what is psoriasis associated with?

Answer 26

metabolic syndrome and increased risk of cardiovascular disease

Question 27

what are some factors that trigger psoriasis?

Answer 27

stress, physical trauma to the skin, infections, or some medications

Question 28

what causes erythema migrans?

Answer 28

Borrelia burgdorferi (lyme disease)

Question 29

what does eryhema migrans look like?

Answer 29

Bull’s eye lesion

Question 30

when you see or hear erythema multiform, what should you think?

Answer 30

herpes simples and mycoplasma pneumoniae as the most associated infections

Question 31

what is dermatomyositis?

Answer 31

a rare chronic immune-mediated disorder that affects the skin and/or proximal skeletal muscles

Question 32

patients with dermatomyositis have an increased risk of what? and what is it often associated with?

Answer 32

increased risk of malignancy; it is often associated with celiac disease

Question 33

what are the pathognomonic findings of dermatomyositis?

Answer 33

periorbital erythema and Gottron’s papules

Question 34

what are Gottron’s papules?

Answer 34

violaceous papules over the joints of the dorsal hands

Question 35

what is pretibial myxedema?

Answer 35

pinky, waxy, indurated plaque on the lower leg of a patient with Grave’s disease and hyperthyroidism

Question 36

what is erythema nodosum associated with?

Answer 36

sarcoidosis

Question 37

what is erythema infectiosum (fifth disease)?

Answer 37

characterized by fiery red slapped cheek; lacy maculopapular rash on trunk and limbs; systemic symptoms and fever are mostly abated by time of rash appearance

Question 38

the rash of scarlet fever look like what?

Answer 38

diffusely erythematous and resembles a sun burn; sandpaper consistency; blanches under pressure

Question 39

what is pathognomonic for measles?

Answer 39

Koplik spots

Question 40

what is nikolsky sign?

Answer 40

slight lateral pressure on the skin causes sloughing of the epidermis

Question 41

when is nikolsky sign negative?

Answer 41

bullous pemphigoid

Question 42

when is nikolsky sign positive?

Answer 42

pemphigus vulgaris

Question 43

how is bullous pemphigoid described?

Answer 43

type 2 hypersensitivity reaction

Question 44

how is pemphigus vulgaris described?

Answer 44

autoimmune disease