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Ddx Flashcards

1
Q

Hypopigmented lesions

A 
Pit Alba
Post inflamm
Leprosy
Pit versic
Pinta 
Yaws
Leishmaniasis
Syphilis
CTCL
Melanoma
Halo naevus
Naevoid hypopigmentation
Idiopathic guttate hypomeanosis
Hydroquinone 
Arsenic 
Sarcoid 
Vitiligo
Lichen striatus
Lichen sclerosis
CTDz
Laser/ trauma
Addisons 
Hyperthyroid
B12 def 
Genetic causes: tuberous sclerosis, piebaldism, waardenbergs, VKH
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2
Q

Pigmentation of hands and feet

A

Vit B12 def (+ nail streaks)
Cronkhite Canada Synd (+ mucosal)
Peutz jeghers (+ mucosal)
Laugier hunziker (+ mucosal, + nails in 60%)
Kitamura reticulate acropigmemtation (palmar pits AD)
Acropigmentation of Dohi (+hypopigmentation)
Acromelanosis progressiva of infants (gone by puberty)
Addisons

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3
Q

Nail pigmentation

A 
Racial pigmentation
LP
Fungal, bact, candida
SCC, bowens, MM, naevus
Drugs: cytotoxics, antibiotics, antimalarials
Poisons
Radiation
Haematoma 
PUVA
Vit  B12 def
Addisons
PCT
Haemochromatosis
Lauginer hunziker syndrome
Peutz jeghers
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4
Q

Reticulate hyperpigmentation

A 
Erythema ab igne 
Incontinenti pigmenti (XL)
Dyskeratosis congenita (XL)
Dowling degos dz (AD)
Galli galli (variant of Dowling degos)
Habers dz
Naegeli franceschetti jadassohn 
Kitamura reticulate acropigmentation 
Bleomycin 
Shiitake mushroom
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5
Q

Papulonecrotic eruptions

A 
Vasculitis 
PLEVA
Lymphomatoid papulosis 
Papulonecrotic tuberculoid
Varicella (chicken pox)
Insect bites
Anthrax
Acne excoriae or purigo nodularis
Degos disease (an occlusive arteriopathy affecting small vessels)
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6
Q

Psoriasiform lesions - looks like psoriasis

A 
Psoriasis
Psoriasiform drug eruption
Chronic eczema 
LSC
Lupus
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7
Q

Pityriasiform eruption - distribution resembles pit rosea

Note Pityriasis refers to fine scale where pityriasiform frees to distribution of pit rosea

A

Pit rosea (remember: herald patch has an inward facing scale collaret)

Secondary Syphilis

Pityriasiform drug eruption- gold, antibiotics, metronidazole

Guttate pso

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8
Q

Eczematous pattern

A

All eczemas
Lichen striatus
Tinea

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9
Q

Lichenoid conditions: resembles lichen planus- violaceous discolouration and hyperpigmentation

A 
LP
Ashydermatoses
Erythema dyschromium perstans
Lichenoid drug
GVHD
Lupus
DM
Lichen sclerosis
Lichen striatus
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10
Q

Sclerodermoid presentations

A 
Scleroderma
Toxins/ drugs: vinyl Cl, toluene, bleomycin, silicosis, oils
Morphoea
CREST
Nephrogenic systemic fibrosis (gadolinium dye)
Lipodermatosclerosis
Late GVHD
Eosinophilic fasciitis
PCT/ Carcinoid/ PKU
Scleromyxoedema
Scleredema (inc of buscke)
Poikiloderma (Radiation/ CTVL)
Neoplasia / Paraneoplastic
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11
Q

Vegetating lesions in the flexures

A 
Cutaneous crohns
Pyoderma vegetans
Pemphigus vegetans
Bullous dz: hailey-hailey, dariers, BP
Infections: amoebiasis, TB, LVG, GRanuloma inguinale, candida
Halogenoderma (Iodine)
Nutritional def: Zn, EFA, Pellagra
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12
Q

Papulosquamous

5 Ps & 3 Ls

A 
Psoriasis (& Reiters)
Pityriasis: PRP, rosea, versicolor, alba, lichenoides
Parapsoriasis & MF
Post inflammatory; eczema & Seb derm
Periorificial; syphilis, TB, Zn def

Lupus
LP
Loose epidermis: ichthyosis

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13
Q

Hypopigmented patches

A 
Pityriasis Alba
Post inflam
Seb derm
Pit Versic, Leprosy, Pinta, Yaws, Leishmaniasis, Syphilis
Sarcoidosis
CTCL, MM, Halo naevus, naevoid hypopigmentation
Hydroquinine, Arsnic
Vitaligo
Laser, cryo, trauma
Addisons, hypothyroid
Kwashiorkor, b12 def
TS, Piebaldism, waardenbergs, VKH, Woolf syndrome
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14
Q

Ichthyosiform eruption

A 
Congenital ichthyosis
Nutritional deficiencies
Sarcoidosis
Asteatosis
Drugs
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15
Q

Morphologic configurations of lesions

A 
Annular
Polycyclic- many circles (parts/ whole)
Linear
Discrete groups
Generalised
Herpetiform
Sporotrichoid
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16
Q

Keratoses

A 
Arsnic
Actinic
Stucco
Seborrhoeic
Dariers
Grovers
Lupus
LP
Porokerstosis
Flegels
KP & variants
Perforating dz: RPC, EPS, PXE, renal failure
Eruptive KA
17
Q

Keratolytic agents

A 
Sal acid
Lactic acid
Urea
Propylene glycol
Glycolic acid (AHA)
Retinoic acid

Prof Z’s mix for keratoderma:
6% sal + 10% lact + 10% urea + 20% PG in cream base

If the keratolytics don’t help keratoderma consider Acetretin PO

18
Q

Punctuate keratoderma

A 
Arsenic- irregular in size & shape
Dariers
Gorlins
Cowdens
Lupus
LP
Porokerstosis
Flegels dz
Perforating disease- curls dz
Inherited punctuate keratoderma
Rothmond Thompson Synd
EB
Acrokeratosis Verruciformis
Psoriasis
Reiters
Syphilis, Yaws, scabies, tinea
Warts
Paraneoplastic Ca lung/ stomach
19
Q

Diffuse keratoderma

A 
Tinea
Psoriasis
PRP
Reiters 
Chronic Eczema 
Keratoderma climactericum- post menopausal
Women around the heel & wtb areas
Yaws, scabies, candida
Sarcoidosis
Bazex syndrome
Ca oesophagus 
Beta blockers
Antiepeliptics
Inherited genoderm: 
Acrokeratosis Verruciformis 
Dyskeratosis congenita 
Pachyonychia congenita
Ectodermal dysplasia 
Mal de meleda
20
Q

Clinical presentations of GRanuloma annulare

A

Annular GA (classic)

Generalised GA:

  • Papular
  • Micropapular

Perforating - fingertips

Subcutaneous GA- kids

Giant plaque form of GA - very similar clinically to morohoea

Actinic GA

21
Q

Histological variants of GA

A 
Diffuse interstitial
Elastolytic
Sarcoidal 3%
Subcutaneous 
Perforating
Typical palisading necrobiotic granuloma
22
Q

Causes of comedones

A 
Acne vulgaris
Favre racouchot: nodular elastosis with cysts and comedones
Chloracne 
HS 
Aperts Synd
Familial diffuse comedone Synd 
Familial dyskeratotic comedone Synd 
Dowling Degos
Dariers Dz
Keratosis Pilaris Atrophicans
Atrophiderma vermiculata
Transverse nasal groove
Naevi: comedonal n, linear basal cell n, porokeratotic eccrine & ostial duct n
23
Q

Urticarial lesions

A 
Infection: tooth, uti, worms, bact, viral, scabies
Mastocytosis
Wells syndrome
Underlying leukaemia or PRVera
Drugs
Immune
Physical
Puppp 
Thyroid dz
Nutritional def  
Immune causes see other list 
Muckle-Wells disease
24
Q

Urticaria immune causes

A 
IgE autoab 
CTD: SLE, urticarial vasculitis
Hypereosinophilic syndrome
Wells syndrome
Prodrome of BP
Auto inflammatory Synd: cryopyrin associated periodic syndrome- CAPS (muckle wells, familial cold urticaria, NOMID)
25
Q

Autosomal dominant auto inflammatory syndromes

A

TRAPS: TNF Rc ass periodic Synd

CAPS: cryopyrin ass periodic Synd
> muckle wells
> familial cold auto inflam Synd
> NOMID: neonatal onset multi system inflam disease

PAPA: Pyogenic arthritis, PG & acne

PGA: paediatric granulomatous arthritis

26
Q

Autosomal recessive auto inflammatory syndromes

A 
Familial Mediterranean Synd>> (ass w: recurrent fever, cellulitis & abdo px)
Hyper IgD Synd
Mevalonic aciduria 
DIRA: deficiency of il1 rc antagonist
Marjeed Synd
Early onset IBDz
27
Q

Cellulitis like plaques of the lower legs

A 
Cellulitis
Erysipelas
Atypical mycobacterium
Deep fungi infn
Sarcoidosis
Lymphoma
Drug
Cold
Trauma
Auto inflammatory Synd: familial Mediterranean fever, TRAPS
Paniculitis
EN
28
Q

Sporotrichoid spread microorganisms

A 
BACTERIAL
Norcardia*
Cat scratch
Tularemia 
Glanders
Staph aureus 
MYCOBACTERIA 
TB
Atypical mycobacteria 
- marinum
- chelonei 
- fortuitum
- kansasii
DEEP FUNGAL
Sporotrichosis*
Blastomycosis
Chromoblastomycisis
Histoplasmosis
Coccidioidomycosis 
PROTOZOA 
American Leishmaniasis (old world leishmaniasis does not cause sporotrichoid spread)

ALGAE
Protothecosis

  • these can ulcerate!!
    Important: syphilis is NOT sporotrichoid spread
29
Q

Photosensitive eruptions

A 
Idiopathic:
Polymorphous light eruption
Actinic prurigo
Solar urticaria
Hydroa vacciniforme
Chronic actinic dermatitis
Metabolic/ nutritional:
Pellagra (def B3/ niacin)
Carcinoid (def B3)
Hartnup (def B3)
Kwashiorkor (def B3)
Isoniazid (depletes B3)
Porphyria: PCT, VP

CT Dz:
Lupus
Dermatomyositis

External agents:
Psoralens: lime, bergamot, orange, fig, parsley, celery
Dyes: methylene blue, rose Bengal
Coal tars
Photo drug: photo toxic & photo allergic
Drugs: tetracyclines, thiazides, naprosyn, griseofulvin, isotretinoin
Photo contact
Phytophoto
Fragrance

Photo aggravated dermstoses:
Rosacea
AD
Pemphigus foliaceous
Dariers
REM
Jessners
LP Actinicus
DSAP
Congenital 
XP
Blooms
Cockaynes
Rothmund Thompson
PIBIDS
Chronic granulomatous disease
30
Q

Targetoid lesions

A 
EM
Fixed drug
Urticaria
Kawasaki
Puppp 
Pemphigus gestationis 
Vasculitis 
Rowell syndrome- EM like lesions of lupus
PMLE
31
Q

Panniculitis

A

Common causes:
EN
Erythema induratum (inc TB)
Vasculitis: nodular, PAN

Less commonly:
Infn: deep fungi, TB, atyp MB, bact, toxocariasis
Granulomatous: sarcoidosis, NLD, GA
Neoplastic: lymphoma, tumours
Immune: lupus, scleroderma, eosinophilic fasciitis
Drug: PO steroids
Physical: artefactual, cold, trauma
Metabolic: a1AT def, pancreatic
32
Q

Annular erythema

A 
Erythema gyratum repens 
Erythema annulare centrifcum
Tinea 
SCLE , neonatal LE
GA
Sarcoid 
Urticaria
Fixed drug eruption
Giant plaque form morohoea 
Psoriasis/ eczema/ Seb derm
Erythema chronicus migrans - Lyme dz
Necrolytic migratory erythema - glucagonoma
DA 
Erythema marginatum- rheumatic fever
DFSP
CTCL
Leprosy 
Deep fungal
Tb 
Stills
33
Q

Indiltrates

“Cells and substances”

A

Cells:

Neutrophils- EED, sweets, PG, granuloma facials, autoinflammatory syndromes (PAPA, PASH, DITRA, CANDLE)

Lymphocytes: PMLE, jessners, leukaemia cutis, lymphoma, leukaemia

Eosinophils: wells, hyper eosinophilic syndrome, insect bite

Mast cells

Histocytes

Xanthomas

Substances:

Mucinoses

Hyaline: amyloid, systemic hyalinosis, lipoid proteinosis, colloid

Glycolipid: farbers, fabrys, Niemann pick, stiff skin

Calcium
Urate
Cholesterol

34
Q

Infections that cause Ulcers

A 
Bacteria: staph & strep, (ecthyma), pseudomonas, diphtheria 
Mycobacteria
Fungi
Viral: HSV, CMV, cowpox, orf, millers nodule, mollucsa
Chlamydia
Rickettsia
Protozoa
Algae: protothecosis
35
Q

Ulcers + regional LN caused by animal contact

A 
Anthrax
Tularemia
Cat scratch
Plague
Spirillum minor rat bite fever
Pasturella multocida (cat and dogs)
36
Q

Animal contact causing lesion plus regional LN

A

Glanders
Meliodosis
Capnocytophagia canimorsus- dog bite or human bites!
Staph/ strep
Typhus: scrub and tick
Trypanosomiasis: African and American (chagus dz)

Ddx (1 decks)

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