Derm Flashcards
Keratinization disorders
Inherited and attributed to X-linked ichthyosis or excessive scaling of the skin
Mechanibullous disorders
Such as epidermolysis bullosa are caused by defects of collagen and proteins.
Macule
<1cm diameter, flat, non palpable, circumscribed, discolored
Brown - freckle, junctionall nevus, lentigo malasma
blue- Mongolian spot, ochronosis
Red - drug eruption, viral exanthema, secondary syphilis
Hypopigment - vitiligo
Dioscopy
Compression usually through applying a microscope slide with pressure to help identify a lesion of vascular origin
http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/IMAGES/leischne/scan71.JPG
Patch
> 1cm diameter, flat, non palpable, irregular shape, discolored
Brown- lg freckle, junctional nevus, lentigo, melasma
Blue - Mongolian spot, ochronosis
Red- syphilis, drug eruption, viral exanthema
Papule
<1 cm in diameter, raised, palpable and firm
Light colored - flat wart, millium, sebaceious hyperplasia
Blue - venous lake, lichen planus, melanoma
Brown, seborrheic kerratosis, melanoma, dermatofibroma, nevi
Red - acne, cherry angioma, early follculitis, psoriasis, urticaria
nodule
> 1cm, raised, solid
often warts, xanthoma, prirgo nodularis, neurofirbromatosis,
plaque
> 1cm, raised, superficial, flat-topped and rough
often psoriasis, discoid lupus, tinea corporis, eczema, seborrheic dermatitis
tumor
large nodule
ex. metastatic carcinoma or sporotrichosis
vesicle
<1cm, superficially raised and filled with serous fluid
ex, herpes simplex, herpes zoster, erythema multiforme, impetigo
bulla
> 1cm vesicle
ex. pemphigus, herpes gestationis, fixed drug eruption
pustule
raised, superficial, filled with cloudy, purulent fluid
ex acne, candidiasis, rosacea, impetigo, folliculitis
wheal
raised, irregular area of edema, solid, transient, variable size
ex, hives, cholinergic urticaria, angioedema, dermatographism
cyst
raised, circumscribed, encapsulated with a wall and lumen, filled with liquid or semisolid
ex. digital mucus, epidermal inclusion, pilar
scale
irregular formation of exfoliated, keratinized cells, irregular shape and size
ex psoriasis, tinea versicolor, pityriasis rosacea, seborrheic dermatitis
crust
dried serum, blood or exudate, slightly elevated
ex impetego, tinea capitis, acute eczematous inflammation
lichenification
thickened epidermis with accentuated skin lines caused by rubbing
ex lichen simplex chronicus
scar
thin or thick fibrous tissue, following dermal injury
fissure
linea break in skin through epidermis and dermis
ex. hand dermatitis, intertrigo
excoriation
hollowed-out area of all or portion of epidermis with depressed appearance
ex eczema, insect bite, acne excorie
erosion
localized loss of epidermis, heals without scarring
ex herpes simplex, perieche
ulcer
loss of epidemis and dermis, variations in size
ex decubitus, stasis ulcer, facititial ulcer, pyoderma gangreosum
atrophy
depression resulting from loss of epidermis and or dermis
ex morphea, striae, aging, dermatomyositis, topical and intralesional steroids
burrow
a narrow, elevated channel produced by the parasite scabes
telangiectasia
superficial dilated blood vessel
ex rosacea, side effect of topical steroids
petechiae
<1 cm circumscribed deposit of blood
ex gonococcemia, meningococcemia
purpura
> 1cm circumscribed deposit of blood
ex. senile traumatic purpura
nummular arrangement pattern
coin shaped
ex numular eczema
annular arrangement pattern
circular or ring shaped
ex tinea corporis
linear arrangement pattern
line formation
arciform arrangement pattern
arch shaped
ex drug reaction
grouped arrangement pattern
occurring closely together
ex herpes zoster
gyrate arrangement pattern
convoluted, serpinigous shape (wavy, serpant-like)
ex creeping eruption
pediculosis capitis
head lice
longitudinal ridging of nail bed
age related change
nail pitting
manifestation of psoriasis
thickening, opacification, crumbling of nail
signs of fungal infection (KOH test)
separation of nail plate from nail bed
trauma related or Pseudamonas
pigmented longitudinal bands on nail bed
common among blacks but can also be a sign of acral melanoma
alopecia areata
autoimmune cell mediated problem affecting any hair grown surface, occurring in 1-5cm rounded or oval patches
Nikolsky’s sign
shearing away of the epidermis from the dermis with lateral pressure (ex blisters)
PQRST
precipitating factors, quality, radiation, severity, timing
infectious diseases associated with skin changes
chickenpox, measles, impetigo, pityriasis rosacea
common chronic skin problems
acne, rosacea, psoriasis, eczema
other systems for which disorder may effects the skin
cardiovascular, respiratory, hepatic, immunologic and endocrine
adrenocorticosteroids - possible effects on the skin
urticaria, atrophy/thinning acne, facial erthema, allergic dermatitis, petechiae, ecchymoses
ex methylprednisolone, prednisone, corticotropin,
carbamezapin - possible effects on the skin
pruritic rash, roxic epidermal necrolysis, Stevens Johnsons syndrome
valproate - possible effects on the skin
alopecia
phenytoin sodium - possible effects on the skin
Morbilliform (measles like) rash, excessive hair growth
ethosuximide (anticonvulsant) - possible effects on the skin
urticaria, pruritis and erythematous rashes
chloroquine phosphate (antimalarial) - possible effects on the skin
pruritis, pigmentary changes, lichen planus-like eruptions
neomycin sulfate - possible effects on the skin
hypoesthesia, hyperesthesia, urticaria, erythematous swelling, hyperpigmentation, patchy hyperkeratosis, alopecia
busulfan (antineoplastic) - possible effects on the skin
cheilosis, melanoderma, urticaria, dry skin, alopecia, anhidrosis
cyclophosphamide - possible effects on the skin
pigmientary chianges (both skin and nails) and alopecia
barbituates (pentobarbitol or phenobarbitol)- possible effects on the skin
urticaria, varied rashes
cephalosporins - possible effects on the skin
rash, pruritis, urticaria, erythema multiforme
gold salts - possible effects on the skin
rash, pruritus, photosensitivity, urticaria
NSAIDS - possible effects on the skin
rash, pruritis, erythema multiforme, Stevens-Johnson Syndrome, photosensitivity
Oral antidiabetics - possible effects on the skin
photosensitivity, varied eruptions
penicillins - possible effects on the skin
urticaria, erythema, maculopapular rash, pruritis
phenothiazines - possible effects on the skin (chlopromazine HCL, thioridiazine HCL, trifluoperozine HCL)
urticaria, pruritisu, dermatoses, photosensitivity, erythema, eczema, exfoliative dermatitis
sulfonamides - possible effects on the skin
rash, pruritis, erythema nodosum, erythema multiforme, Stevens-Johnson Syndrome, exfoliative dermatitis, photosensitivity
tetracyclines - possible effects on the skin
photosensitivity
allopurinol - poss. effects on the skin
pruritis, maculopapular rash, exfoliative dermatitis, urticaria, erythematous dermatitis
captopril - possible effects on the skin
maculopapular rash, pruritis, erythema
oral contraceptive - possible effects on the skin
maculopapular rash, pruritis, erythema, urticaria
thiazide diuretics - possible effects on the skin
photosensitivity
lithium - possible effects on the skin
acne
warfarin - possible effects on the skin
skin necrosis
conditions assoc. with bronze pigmentation changes
Addison’s Dz (primary adrenal insuffuciency), hemochromatosis
conditions assoc. with tan pigment changes
chloasma (pregnancy), lupus, scleroderma, ichthyosis, sprue, tinea versicolor
conditions assoc. with yellow pigment change
uremia, jaundice, hepatic diseases, carotenemia
conditions assoc. with dusky blue pigment change
arsenic poisoning, cyanosis
conditions assoc. with red pigment change
polycythemia
conditions assoc. with pallor
anemia, vitiligo, ablinism
common causes of dry skin
winter weather, dehydration, myxedema, chronic nephritis, older age
HSV 1 and HSV 2
a viral condition, affecting skin and mucosa, may be a recurring lesion in teh same location, usually consisiting of multple vesicles, clustered and often precended by tender erythema or prodromal Sx. Common sites are perioral/ perigential. Primary episode often accompanied by fever, fatigue, lymphadenopathy. Usually diagnosed based on history and presentation. progress from an area of redness to form a vesicle, then become pustular, then ulcerate.
Herpetic Whitlow
a herpetic lesion on the finger - usually the result of self-contamination
varciella-zoster
varizella-zoster virus causes chickenpox, a common childhood Dz. Onset is usually noticed with skin lesions, which first appear scattered on the truck and then extend to extremities. progress from an area of redness to form a vesicle, then become pustular, then ulcerate. Intensely pruritic. Systemic Sx can be sever, complications include pneumonia, encephalitis and death.
herpes zoster (shingles)
caused by the varicella zoster virus, reactivated, in adults and immune compromised. Lesions are often preceded by neuralgia and discomfort, as well as malaise. Lesions appear as reddened macules, then progress to clusters of vesicles and then ulcerate, crusting over. They are distributed over dermatomes, usually facial, thoracic or sacral. healing is followed by post-herpectic neuralgia. Lymphadenopathy accompanies lesions. Dissemination occurs mostly in the immune compromised.
seborrhea and dandruff
usually located on head and trunk, at sebaceous gland sites.
erythematous plaques with dry or oily scales
psoriasis
usually found on knees, elbows, buttocks
chronic, well demarcated erythematous plaques with silver scale
pityriasis rosacea
usually located on natural skin lines of the trunk
typical presentation with a herald patch, 3-4 cm oval plaque at onset which is followed by numerous smaller <1cm plaques with collarette scale
often found in young adults, can be accompanies by systemic symptoms of malaise, fever, arthralgia, etc. 50-75 % have pruritis. May occur after URI.
rosacea
occurs on face
papules, pustules and no comedones
lichen planus
affects extremities
pruritic, polyangular, planar, purple papules, has a lacy surface
Impetigo
face, neck and lesions on extremities
obs thin, erythematous bullous vesicles or pustules that heal with honey-colored crust
herpes simples
orolabial, genital
expanding erosions with pain, an active vesicular boarder and scalloped periphery
dyshidrosis
symmetrically, palms, lateral fingers and toes, soles of feet
sudden eruption of highly pruritic vesicles tha tare deep-seated with clear fluid, followed by ring of scale and peeling
xanthelasma
hyperplasia of eyelid skin, yellow plaques
corn
hyperplasia of feet, occurring over bony prominance
mollulscum
hyperplasia of skin on trunk, extremities, face, whit firm flesh-colored dome shaped papule with central ubilication
verruca
hyperplastic lesion son hands, elbows knees, feet, epidermal proliferations, single , multiple or convfluent
actinic keratosis
premalignant dz, often on head, neck, dorsal hands, poorly defined hyperemia with adherent scales
keratoacanthoma
premalignant dz on dorsal hands
solitary, dull, red nodule with central keratotic plug
dysplastic nevus
premalignant dz, anywhere, often on trunkand upper extremities
multiple, atypical nevi with increased incidence of melanoma
seborheic keratosis
benign neoplasm, anywhere on body
variable in color, waxy surface, stuck-on appearance
mole
benign neoplasm, located anywhere often sun-exposed areas,
clusters of nevus cells arranged at various levels in the skin
lipoma
begign neoplasm, can be anywhere
usually solitary soft, well-defined tumor
dermatofibroma
benign neoplasm of legs
solitary domes shaped, fixed, pink to brown colored lesion. lateral pressure causes dimpling
keloid
benign neoplasm, often anetorior chest, shoulders, neck
large raised scare that extends into adjacent normal skin
hemangioma
benign neo of head and neck
rapid growth, stabilization and involution of red to purple vascular neoplasm
SCALDA
Acronyms for lesion description Size/shape/texture Color Arrangement Lesion type (primary, secondary) Distribution Always check mucous membranes, nails, hair, intertriginous areas, odor
neurofibroma
benign neoplasm, follows course of peripheral nerves
dermal and subQ tumores increase with age
