Clinical Perspectives In Skin Changes - Dr. Tyler Flashcards
Nodule is what and examples
papule or lesion that extends into the dermis and SUBQ,
- cysyts
- lipomas
- fibromas
when do you see vesicles
acute allergic contact dermatitis
dermatitis herpetiform
chicken pox (at different stages)
when do you nee pustules
bacterial infections
folliulitis
pustular psoriasis
when do I see Bullae
blister bigger then 10mm irritant contact dermatitis allergic contact dermatitis burns / bites drug reactions pemphigous vulgaris**, bullous pemphigoid**
I see Petichiae when
foci of hemorrhage
from platelet problems, vasiculitis, infections, Rocky Mountain spotted fever, Rickettsia
Purpura is seen when
PALPABLE : ** Leukocytoclastic vasiculitis , palpable, vasculitis
NON-PALPABLE : hemorrhage, microvascular occlusions + ischemic hemorrhage
(can be seen in coagulopathy)
urticaria
wheals, hives
elevated
pruretic, red, sharp boarders*
usually from hypersensitivity, bites, drugs, autoimmunity, usually lasts up to 24hrs
Scale
Excessive accumulation of stratum corneum (flaking of skin)
Crust
dried body fluid (serous = yellow, hemorrhagic = red)
Excoriation
linear defects in epidermis (usually from scratching)
Erosion
Loss of epidermis , with dermis in tackt
Ulcer
full thickness destruction of epidermic and dermis
Fissure
linear break in epidermis usually along skin lines
Lichenification
visible thickening in skin causing accentuated skin fold markings
Atrophy
loss of substance (depressed or shiny delicate skin on epidermis)
Nummular
Annular
coin like circular
ring like with clear center(fungal)
Target lesions is seen in what
Erythema multiforme
Seroinginous lesions
linear, branched, curving (parasitic)
Reticulated lesions
lacy, network looking
Herpetiform
groups of papules or vesicles (Herpes)
Herpesvirus 1 and 2
stomatits (lip), GU lesions, Bell’s palsy, encephalitis
Herpes Varicella rash
pruritic, centrifugal, papular changing to vesicular to pustular to crusting all at once
= chicken pox or shingles
Herpes Zoster rash
tingling pain, eruption of vesicles in dermatome distribution, pustules, crusting,
- usually on face and shoulders
what is something that a person with Herpes zoster can get
Post- herpetic neuralgia
Meningitis SX
fever, H,V, delirium,
= Petechial rash (skin and oral)
= + Brudzinski, + Kernig sign
= purulent spinal fluid (GRAM - diplococci)
rash in meningitis
perichiae
disseminated intravascular coagulation (DIC) can happen especially if patient is in septic shock = Purpura fulminans
Seborrheic Keratosis
benign papules + plaques, brown, black, velvety, warty surface (3mm - 20mm)
= look stuck on
= no tx needed (can be mistaken as melanoma)
Actinic Keratosis
macules and papules (0.2cm - 0.6cm) =flesh colored pink, some hyperpigmentation = sandpaper = tender = sunexposed areas = premalignant, can become SCC
rosacea
red papules all over face (red papule rash)
overgrowth of nose epithelium
Seborrheic dermatitis
scalp, face, chest, umbilicus, back, eyelids, GU,
= yellow dandruff oily
= pruritus
= high it parkinsons disease
BCC looks like what
pearly papule, red, 6mm or bigger
= sun exposed areas
= nonhealing ulcer
= 2nd most common skin cancer
risk of BCC
history of bleeding
intense intermittent sun exposure esp light skinned
SCC looks like what
nonhealing ulcer or warty nodule = from long-term sun exposure = ear, temple, lip, oral, GU (can metastasize) = common in light skinned transplant pts = most common skin cancer
Psoriasis looks like
thick, well demarcated salmon color plaque
= silvery scale on top
= EXTENSOR muscels, scalp, palms, feet
= pitting nails
inverse psoriasis
on flexor muscels
psoriasis is associated with what
- metabolic syndrome
- Cardiovascular disease
- 30% have psoriatic arthritis
how does psoriasis happen
chronic inflammation of papulosquamous and immune mediated skin disorder
what makes psoriasis come or worse
stress koebner phenomena (trauma) cold, hot infection (strep, HIV) mediactions (NSAIDS, sterioids, antimalaria)
erythema migrans
bulls eye lesions
Borrelia burgdorferi = lymes disease
erythema multiforme
target lesions
can have a bullae
halo around it, center is red patch/plaque
rings of light then dark red around
what causes erythema multiforme
Herpes Simplex
Mycoplasma pneumoniae
SLE looks like
pruritis
sensitive to sunlight
arthralgia, myalgia, fatigue, malaise, fever, night sweats, headache, hair loss, visual changes (diffuse nonscarring nondescript lesions)
= butterfly rash
Dermatomyositis
chronic immune mediated disorder of skin and proximal skeletal muscles
= pruritus and rash looks like other dermatitis
= usually associated with celiac disease
= scarly red patches in scalp, knuckles (Gottrons papules)
= difficulty climbing stairs or raising arms
= photosensitive
pt with dermatomyositis are in risk for
malignancy
acanthosis nigracans
velvet like hyperpigmented plaques lateral neck of DM
Pretibial myxedema
pink, waxy, indurated plaque on lower leg (looks like a wet shiny raw leg)
= Graves disease (hyperthyroidism)
Erythema nodosum
non-granulomatous lesions
= associated with sarcadosis*
= usually anterior tibia (lower legs)
= tender, red, subcutaneous nodule
Erythema infectiosum
Parovirus B15, fifth disease
= fiery slapped cheek appearence, circumoral pallor
= lacy rash (trunk limbs)
= malaise, H, D, pruritus , fever before rash**
scarlet fever
strawberry tongue **
= from toxin B-hemolytic strep (usually from exudative pharyngitis)
=sunburn like rash, fine red papules = sandpaper skin **
Streptococcal pharyngitis
strep, sudden onset feverm sore throat, pain swallowing, tneder cervical LN, malaise, N
purulaent exudate, red pharynx, tonsilsm soft palate
= Centor clinical criteris = fever, tneder cervical LN, NO cough, pharyngotonsillar exudate**
Measles
fever malaise, conjunctivities, coryza, COUGH, rash, KOPLIK SPOTS (befroe teh other body rash comes)
blanching skin red rash (dots on trunk and can move to extremities)
Nikolsky sign
some lateral pressure on skin cases epidermis to slough or blister to rupture
(pulling away with 2 fingers on either side of blister only not on blister the skin next to it)
where is Nikolsky sign seen
Pemphigoid Vulgaris (NOT pemphigus bullous)
Bullous pemphigoid
starts on legs then spreads after years
elderly
usually from UV exposure, drugs like PCN
- Type 2 hypersensitive
Pemphigoid vulgaris
autoimmune, large superfiical loose bullae peel off leaving denuded skin
oral mucosa and skin
Vasculitis
inflammation and damage to BVs
= small vessels in epidermis
= medium vessels in dermis
large BV vasculitis
giant cell arteritis
polymyalgia rheumatica
aortitis
Takayasu arteritis
Medium vaculitis
=polyarteritis nodosa = NO ANCA autoantibodies**
=Granulomatosis
small vasculitis
= Hypersensitivity vasculitis =IgA =Cryoglobulinemia =Goodpasture syndrome =Anti-Glomerular BM
most important determinant is dx prognosis of melanoma
tissue depth
