Clinical Perspectives in Skin Changes Flashcards
a patient presents with a papular rash, what are the 4 broad potential causes?
viral, bacterial, toxin induced (poison oak), or drug effect
what is important in determining the cause of a maculopapular or papular rash?
history and PE–> location, onset, and associated clinical findings
if a patient presents with a maculopapular rash and the morphology is flat, what could it be?
macule or a patch
if a patient presents with a maculopapular rash and the morphology is raised, what could it be?
papule, nodule, or plaque
if a patient presents with a maculopapular rash and the morphology is fluid-filled, what could it be?
vesicle, pustule, bulla
how does the color of a maculopapular rash indicate severity?
pink–> red–> purple–> black (least to most severe)
what are some examples of secondary changes that can be seen with maculopapular rashes?
crust, scale, erosion, and ulceration
what are the red flags associated with maculopapular rashes?
skin pain, blisters/desquamation, mucous membrane involvement, extensive body surface area, and purpura
how does the skin manifestation of measles present?
erythematous macules and papules with symmetrical diffuse distribution (centrifugal distribution)
provide diagnostic consideration in a patient with a vesicular rash?
history and PE are important; could be herpesvirus 1 and 2 or herpes zoster
what are the typical presentations of herpesvirus 1 and 2?
spectrum of illness: stromatitis, urogenital lesions, Bell palsy, or encephalitis
what are the two infections associated with herpes zoster?
varicella rash and zoster rash
how does varicella rash present?
pruritic, centrifugal, papular changing to vesicular, pustular, and finally crusting; lesions appear at all stages at once
how does zoster rash present?
tingling, pain, eruption of vesicles in a dermatomal distribution, evolving to pustules and then crusting; unilateral
in diagnosing a patient presenting with meningeal inflammation and infection, describe potential skin manifestations associated with or due to various etiologies of meningitis.
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
what are the ecchymotic skin lesions called in patients with meningitis infections with DIC complications?
purpura fulminans
if a patient presents with skin lesions all over their body, how would you differentiate between seborrheic keratosis and actinic keratoses?
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
what is actinic keratoses considered to be?
premalignant; may progress to become squamous cell carcinoma
if a patient presents with a skin rash to their face, how can you tell the difference between rosacea and seborrheic dermatitis?
rosacea is a more papular/ inflammatory presentation; seborrheic dermatitis is more flakey and looks like dandruff into the hairline
who often has seborrheic dermatitis?
patients with parkinson disease, HIV infected patients, and patients who become acutely ill often
What is the most common skin cancer?
BCC
how does BCC appear?
pearly papule; history of bleeding
how does SCC appear?
as a nonhealing ulcer or warty nodule
what SCC has much higher rates of recurrence or metastasis and require special management?
SCC of the ear, temple, lip, oral cavity, tongue, and genitalia
what are the clinical features of the skin presentation of psoriasis?
thick, well-demarcated salmon colored plaques with overlying silvery scale
what is psoriasis associated with?
metabolic syndrome and increased risk of cardiovascular disease
what are some factors that trigger psoriasis?
stress, physical trauma to the skin, infections, or some medications
what causes erythema migrans?
Borrelia burgdorferi (lyme disease)
what does eryhema migrans look like?
Bull’s eye lesion
when you see or hear erythema multiform, what should you think?
herpes simples and mycoplasma pneumoniae as the most associated infections
what is dermatomyositis?
a rare chronic immune-mediated disorder that affects the skin and/or proximal skeletal muscles
patients with dermatomyositis have an increased risk of what? and what is it often associated with?
increased risk of malignancy; it is often associated with celiac disease
what are the pathognomonic findings of dermatomyositis?
periorbital erythema and Gottron’s papules
what are Gottron’s papules?
violaceous papules over the joints of the dorsal hands
what is pretibial myxedema?
pinky, waxy, indurated plaque on the lower leg of a patient with Grave’s disease and hyperthyroidism
what is erythema nodosum associated with?
sarcoidosis
what is erythema infectiosum (fifth disease)?
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
the rash of scarlet fever look like what?
diffusely erythematous and resembles a sun burn; sandpaper consistency; blanches under pressure
what is pathognomonic for measles?
Koplik spots
what is nikolsky sign?
slight lateral pressure on the skin causes sloughing of the epidermis
when is nikolsky sign negative?
bullous pemphigoid
when is nikolsky sign positive?
pemphigus vulgaris
how is bullous pemphigoid described?
type 2 hypersensitivity reaction
how is pemphigus vulgaris described?
autoimmune disease
