DERM: Identifying Skin Lesions Flashcards
________ is the most common malignancy of the lip w/95% of cases occuring in the lower lip vermilion border
SCC, likely due to sunlight exposure
This is concerning for
SCC
SCC typically presents as firm scaly papules, plaques, or nodules
painful, shallow, round ulcertations w/ white/yellow bases. They are recurrent and self-limiting and affect only the oral mucosa, not the keratinuzed epithelium of the lips
Aphthous ulcers aka kanker sores
This is most concerning for…
BCC
Most likley dx:
Herpes labialis
Most likely Dx:
Verruca vulgaris
aka Common wart
Well differentiated SCC vs poorly differentiated SCC
Well diff: firm scaly papules/plaque/nodule w or w/out ulceration
Poor diff: beefy red papules or nodules that may bleed or ulcerate
Acute allergic contact dermatitis
note that these lesions have a hx of exposure to external allergens and the lesions are pruritic
The most common skin lesion in general population
BCC
Head or neck 70%
trunk 15%
(BCC or SCC) is more likely in immunosuppressed pts and is more likely to cause neural invasion
SCC
Small vascular tumors composed of abnormal capillaries and granulation tissue. Occur in young adults and particuarly pregnant women.
Pyogenic granuloma
Lipoma vs epidermal inclusion cyst
Lipomas are benign, painless and irregular compared to epidermal inclusion cyst
A high suspicion of ______________ secondary infection should be maintained in pts w/atopic dermatitis who develop sudden onset of vesicles.
Eczema Herpeticum
Overlying HSV infection on top of atopic dermatitis. People w/this have hx of atopy or active atopic dermatitis and then can have an HSV outbreak. Note that pts w/atopic derm have a faulty skin barrer making them particuarly susceptiple to secondary infections in a way that contact dermatitis does not present.
Vesiculobullous disorder characterised by small, tense vesicles on extensor sites (elbow, knees, buttocks) that are extremely pruritic.
Dermtitis herpetiformis, closely associated w/celiac and tx is to avoid gluten.
Tinea corporis, fungal infection normally by Trichophyton rubrum, normally treated w/topical antifungal w/ clotrimazole, terbinafine, or ketoconazole.
Note that there are specific dermatophyte infections:
groin: tinea cruris
foot: tinea pedis
Scalp: tinea capitis
Nail: tinea unguium
Chronic erethematous rash most prominent on convex areas of the face, symptoms include flushing, skin sensitivity, and sometimes telangiectasias or small papules and pustules
Rosacea, there are 4 major kinds. See table.
23 yo female w/recent hx of miscarriage comes in concerned for diffuse hairloss. There is no erythema or scaling of the scalp and over 20% of fibers are pulled out. Most likely cause?
Telogen effluvium. Acute, diffuse, noninflammatory hair loss
34 yo w/ following lesion on neck and groin areas. They occasionally feel itchy:
Acanthosis nigrans
This 34 yo w likely has PCOS and the AN is due to insulin resistance
Hyperkeratotic, hyperpigmented plaques w/velvety texture. Often seen in flexural areas. There are two type of AN: benign or malignant.
dome-shaped papules with central umbilication: likely Molluscum contagiosum.
In kids, its viral and spreads via skin contact, outbreaks on trunk, face, and genitalia.
In adults, its considered an STI.
NOTE THAT DISSEMINATED MC CAN BE SEEN IN IMMUNOCOMPROMISED INDIVIDUALS ie HIV+
In healthy patients, molluscum contagiosum is generally self-limiting and heals spontaneously after several months. However, in immunosuppressed individuals, lesions can be very large, widespread, and persistent. If treatment is indicated (e.g., for sexually transmitted molluscum contagiosum), cryotherapy with liquid nitrogen is usually the first treatment option.
What other disease is this pt likely to have if they are displaying this skin lesion?
1: this skin lesion is pyoderma gangrenosum
2: inflammatory bowel disease like crohns
A neutrophilic dermatosis that manifests with painful, rapidly progressive, erythematous papules and/or pustules that can develop into deep, ulcerated lesions with central necrosis. Associated with inflammatory bowel diseases and autoimmune and hematologic disorders.
Pyoderma Gangrenosum
Characterized by symmetrical, hyperpigmented, velvety plaques in the axilla, groin, and neck. It is associated w/ insulin resistance states (in younger patients) and GI malignancy in older individuals.
Acanthosis Nigrans.
Tinea Corporis
Presents w/ round pruritic plaques that typically form an annual pattern.
Ecthyma
Strep skin infection related to impetigo. It can form eruthematous plaques but presents acute and it often associated w/pusutles and small ulcers.
Nummular eczema
Seen sometimes in the setting of chronically dry skin. Characteristic pruritic, round, scaly, fissured plaque that would fit under a large coin.
1 week old neonate w/rash on back and bilateral groin areas. No fever or new exposures. Swaddled in fleece blanket. No medications.
Milia Rubra
Benign neonatal rash.
Erythematous papular rash on occluded and intertriginous areas.
Rash that may appear at brith to age of 3 days. Presents w/ pustules w/erythematous base on trunk and proximal extremities. Resolves w/in a week
Erythema toxisum neonatorum
Typically presents age 40-60 and mucosal surfaces are almost always affected, oral mucosa being the most common inital site of involvment. These lesions rupture to form erosions.
Pemphigus vulgaris
How can you tell the difference between pemphigus vulgaris and bullous pemphigoid?
Pemp Vulg: erosions, mucosal involvment is common
Bullous: tense bullae, less likely to erode, mucosal involvment is RARE
Net like intercellular igG against desmosomes on immunoflurourescence
Pemphigus vulgaris
Linear IgG against hemidesmosomes along basement membrane
Bullous pemphigoid
Which is more likely, pemphigus vulgaris or bullous pemphigoid: age over 60
bullous pemphigoid
Which is more likely, pemphigus vulgaris or bullous pemphigoid: erosions
pemphiguus vulgaris
Which is more likely, pemphigus vulgaris or bullous pemphigoid: mucosal involvement
Pemphigus vulgaris
Pruritic, purple, polygonal, papules and plaques
Lichen planus
Onychomycosis likely caused by trichophyton rubrum infection
What is the clinical approach to IDing features of melanoma?
Mild pruritis, no fever, chills or pain.
papules w/indented centers
Condylomata acuminata caused by HPV. Lesions are verrucous, papilliform, and are ususally asymtpomatic but can hace mild itching or burning.
Recurrent prritic rash caracterized by deep vesicles that affect palms, soles, and sides of digits.
Chronic, scaly, irregular or annular patches on hands.
Tinea Manuum
Presents with papules, vesicles, and burrows often on hands/web speces/flexural surfaces
scabies
Lichenification fur to chronic allergic contact dermatitis
What is the difference in mechanism between Atopic Dermatitis and Allergic contact dermatitis?
Atopic= type I hypersensitivity
Allergic Contact: type IV hypersensistivity
Pt w/hx of eczema
Bullous impetigo
Yellow greasy scales of the face/scalp, seen in infants
Seborrheic dermatitis
Chronic, scaly, irregular erythematous plaques w/ulceration and central hypopigmentation surrounded by hyperpigmentation.
Discoid Lupus Erethematosus
Pretibial skin in a pt w/diabetes
Necrobiosis lipoidica
Fragile blisters and erosions on dorsum of hands and face
Porphyria cutanea tarda
Systemic Sclerosis
Two likely etiologies of diaper dermatitis
Cutaneous T-cell lymphoma sometims referred to as mycosis fungoides
Irritant Contact Dermatitis
Candidia dermatitis
How can you ID Telogen effluvium from alopecia areata?
Telogen eff is characterized by DIFFUSE not patchy hair loss and is triggered by stressors.
Patchy hairloss not brought on by stress
defined as the abrupt appearance of multiple seborrheic keratoses caused by an associated cancer and the rapid increase in their size and number.
Leser-Trelat, concerning for melanoma
Ecthyma gangrenosum
skin infection often due to Pseudomonas aerginosa
Not to be confused w/pyoderma gangrenosum (ulcers, purulent, associated w/crohns)
Erethema nodosum
What comorbidities are associated with these skin findings:
Inflammatory bowel disease
Erythema nodosum (EN) is an inflammation of subcutaneous fat caused by a delayed hypersensitivity reaction. Women in early adulthood are commonly affected. Most cases are idiopathic, but an association with a variety of diseases, including infections and autoimmune disorders (e.g., ulcerative colitis), is possible. The characteristic lesions are painful nodules on the lower legs (particularly shins). EN is a clinical diagnosis. The condition typically heals spontaneously within a few weeks and, therefore, generally requires no more treatment than supportive care (e.g., analgesia).
Hidradentitis supprativa
Hidradenitis suppurativa is a chronic inflammatory skin condition characterized by recurrent follicular inflammation, typically in the intertriginous areas. Manifestations include painful skin lesions (nodules and abscesses), draining sinus tracts, and scarring; the severity of symptoms varies. The disease typically affects young adults. The exact etiology is unknown but likely multifactorial and thought to involve blockage of hair follicles. Diagnosis is clinical and treatment includes wound care, pain management, and pharmacotherapy. Psychological support may be required for mental health conditions that can be associated with hidradenitis suppurativa. Surgical interventions may be needed for severe and/or recurrent disease. Complications include disfigurement resulting from excessive scarring, bacterial superinfection, and, in affected areas, cutaneous squamous cell carcinoma.
Keratoacanthoma
Diffuse cutaneous scaling, rough dry
Note that LP is usually idiopathic but it is often seen in pts w/hep C and can be drug induced by ACE inhibitors, thiazide diuretics, beta blockers, and hydroxycloroquine.
Plantar warts likely caused by HPV
Presents in children and young adults with friction induced blisters at the palms and soles. Hx might have issues w/ oral blisters as an infant.
Epidermolysis Bullosa Simplex.
There are 4 subtypes (simplex, junctional, dystrophic, and kindler syndrome)
NONSCARRING patchy hair loss with NORMAL underlying scalp
Alopecia areata
Angiofibromas in the malar region, acne not responsive to normal therapy, and hypopigmented macules (ash leaf spots) are characteristic of
tuberous sclerosis
What other disorders should you test for if you have this kind of skin finding?
Vitiligo raises concern for autoimmune thyroid disease
Senile purpura
in older pts w/ no concerns for abuse or bleeding disorder (normal blood bounts and normal coagulations studies)
Inflamed papules and pustules w/ erethema is consistent with what kind of acne?
Inflammatory
Closed or open comedomes on forehead, nose and chin are cinsistent with what kind of acne?
Comedonal
Large nodules that don’t respond to normal acne treatments raises concern for what kind of acne?
Nodular (cystic)
itty bitty at 3 weeks
How can you tell erysipelas from cellulitis?
Erysipelas: RASIED sharp edges, fever early in course
Cellulitis: flat esges, fever later in course
Erysipelas
Pseudofolliculitis barbae
What is the greatest risk factor for this condition?
Tobacco use
Hiradentitis supprativa
Erythrasma, superficial bacterial infection (corynebacterium minutussumum)
Pityriasis rosea
Lentigo, from intraepidermal melanocyte hyperplasia
lower leg. Most concerning for…
SCC.
This would not be BCC even though BCC is most common. BCC presents w/pearly papule, raised borders, not a flat lesion like the one here. Remember that Actinic Keratosis is precursor to SCC and this looks closer to those kinds of lesions.
