Dermatology Flashcards
Layers of epidermis (calfiorniams like getting sun burns)
Corneum Lucidum Granulosum Spinosum Basale
Langerhan cells
Immune surveillance
Merkel cells
Touch sensation in epidermis
Sebaceous gland
Produces sebum into hair follicle, found everywhere except palms and soles
Apocrine glands
Empties into hair follicles, found in axillae and perineum
Eccrine sweat gland
All over body, timportant in temperature regulation.
Macule
Flat,
Patch
Flat, >1cm
Papule
Elevated, palpable,
Plaque
Elevated, palpable, >1cm
Nodule
Deep, palpable,
Tumour
Deep, palpable, >1cm
Vesicle
Fluid filled,
Bulla
Fluid filled, >1cm
Cyst
Epithelial lined collection containing fluid.
Pustule
Elevated lesion containing purulent fluid
Erosion
Disruption of epidermis only. Heals without scarring
Ulcer
Disruption of epidermis, dermis. Heals with scarring.
Indurated
Hard or firm lesion
Wheal
papule/plaque that is blanchable and transient
Crust
Dried fluid
Scale
Excess keratin
Lichenfication
Thickening of skin
Fissure
Linear slit-cleavage
Excoriation
Scratch mark
Xerosis
Dryness f skin, conjunctiva or mucous membranes
Atrophy
Thinning or depression of skin, histological decrease.
Comedones
Collection of sebum and keratin (black and white heads)
Purpura
Extravasation of blood into dermis
Petechia
Pinpoint purpura
Ecchymoses
Larger flat purpura >1cm
Telangiectasia
Dilated superficial blood vessels, blanchable.
Acral
Hand and feet distribution
Annular
Ring shaped pattern
Follicular
Involving follicles
Guttate
Lesions following a “drop-like” pattern
Koebner phenomen
Appearence of lesions in areas of trauma
Koebner phenomen
Appearence of lesions in areas of trauma
Reticular
Lesions following a net-like pattern
Satellite
Lesions outside of primary lesion
Serpiginous
lesions follow a snake-like pattern
Target lesion
Concentric ring lesion
Epidermal cyst
Epidermal cells displaced into dermis, filled with keratin and lipid-rich debris. Central punctum present
Pilar cyst
Thick walled cyst lined with statified epithelium. Appearing under scalp, lack central punctum
Dermoid cyst
Most commonly found at lateral third of eyebrow or midline under nose.
Ganglion cyst
Rubbery and translucent. Originates from joint or tendon sheath.
Milium
Small superficial subepidermal papules occuring on face
Dermatofibroma
Button-like, firm dermal papule/nodule due to benign tumour from fibroblast proliferation in dermis.
Skin tags
Benign outgrowth of skin.
Seborrheic keratosis
Well-demarcated waxy papule with “stuck on” appearence. Common benign epithelial tumour
Actinic keratosis
Ill-defined, scaly erythematous pauples or plaques on background of sun-damaged skin. Gritty sensation.
Rx: liquid nitrogen, 5-flurouracil cream
Keratoacanthoma
Rapidly growing, dome shaped with keratin filled crater. Epitherlial neoplasm, often sponatneously regress within a year.
Rx: excision (same as SCC)
Corns
Firm papule with central, transulcent cone-shaped hard keratin core. Localised hyperkeratosis induced by pressure on hands and feet.
Keloid
Firm, shiny skin-coloured/red-blue papules that arise from cutaneous injury. Extends beyond margins of original injury.
Rx: intralesion steroids, cryotherapy, silicone compression
Ephelides
Freckles, in sun-exposed skin.
Solar lentigo
Liver spot, in sun-exposed skin. Benign melanocytic proliferation in dermalepidermal junction. Elderly people
Mongolian spot
Congenital, fades in childhood usually
Becker’s nevus
Hairy, brown macule patch, onset often in teens.
Nevomelanocytic nevi
Common mole
Junctional - macular, arise at dermal-epidermal junction
Compound - papular, invades papillary dermis
Dermal - skin coloured papule, completely migrated into dermis
Melasma
Dark skin discolouration on sun-exposed areas of face. Common in pregnancy, OCP, HRT users.
Hemangiomas
Vascular tumour of benign proliferation of thick-walled vessels. Soft, compressible, blanches, “bag of worms”.
Appears shortly after birth.
Spider angiomas
Telangectasia, associated with hyperestrogenic state (liver disease, pregnancy, OCP)
Cherry angioma
Bright red dome shaped papule, benign vascular neoplasm.
Pyogenic granuloma
Red dome shaped nodule which is friable. Rapidly developing hemangioma with erosion of epidermis.
Nevus flammeus
Port wine stain present at birth that follows dermatomal distribution. Congenital vascular malformation of dermal capillaries.
Nevus simplex
Salmon patch, pink irregular patches due to congenital dilation of dermal capillaries. Regresses spontaneously
Acne vulgaris
Common acne with comedonal pattern. Common inflammatory pilosebaceous disease.
Rx: erythomycin, clindamycin, isotretinoin, cyproterone (Diane-35)
Rosacea
Chronic acneiform inflammatory skin disease. Flushing, burning sensation, ruddy checks with dome shaped papules. May be exacerbated by heat, cold, wind, stress, sun, alcohol, caffine.
Atopic dermatitis
Subacute or chronic eczema with pruritus, mainly in flexor surfaces.
Rx: fatty cream, aqueous cream, topical steroids, topical calcineurin inhibitors
Contact dermatitis
Cutaneous inflammation caused by external agent. Erythema, pruritus, papulovesicles (allergic), burning (irritant)
Dyshidrotic dermatitis
Papulovesicular dermatits of hands and feet that coalesce into plaques, followed by fissuring.
Rx: topical steroids
Nummular dermatitis
Annular, coin-shaped, prutitic, erythematous plaques.
Seborrheic dermatitis
Greasy, erythematous, scaling. Cause cradle cap in infants.
Rx: olive oil, shampoo
Stasis dermatitis
Persistent inflammation of lower legs with erythema, xerosis, scaling and brownish pigmentation. Associated with venous insufficiency.
Lichen simplex chronicus
Chronic dermatitis from continued rubbing/scratching of skin/lichenfication.
Rx: antihistamines, topical steroids
Lichen planus
Acute or chronic inflammation of mucous membranes or skin characterised by violaceous papules on flexor surfaces. Purple, pruritic, polygonal, peripheral, papules, penis (lacy white reticular network over mucous membranes).
Rx: topical steroids, phototherapy, immunosuppressives
Pityriasis rosea
Acute, self-limiting eruption. Red oval plaques with central scale, “Christmas tree”, “herald” patch initially
Psoriasis
Chronic and recurrent disease, well-circumscribed erythematous plaques with silvery scales on extensor surfaces, bleeds when scale removed.
Rx: steroids, vitamin D analogues, retinoids, coal, saliclicylic acid. Phototherapy, methotrexate, cyclosporin for systemic treatment
Bullous pemphigoid
Chronic autoimmune bullous eruptions. Tense, pruritic, subepidermal bullae on flexor aspects. IgG production against dermal-epidermal BM.
Rx: prednisone, methotrexate
Dermatitis herpetiformis
Grouped papules/vesicles/urticarial wheals on erythematous base on extensor surfaces. Pruritus, burning, stinging. Associated with coeliacs, thyroid disease. IgA antibody.
Rx: gluten free diet, dapsone for pruritus.
Pemphigus vulgaris
Autoimmune blistering, flaccid non-pruritic epidermal bullae, secondary erosions. IgG against epidermal layer.
Rx: prednisone, plasmapheresis
Drug hypersensitivity syndrome
Fever followed by symmetrical bright red exanthematous eruption (may have internal organ involvement). Occurs 10 days after first drug exposure.
Most common: sulfonamides, anticonvulsants
Erythema multiforme
Macules/papules with central vesicle in bull’s eye pattern. Lesions appears within 3 days and last 2 wks.
Rx: symptomatic treatment
Erythema multiforme
Macules/papules with central vesicle in bull’s eye pattern. Lesions appears within 3 days and last 2 wks. Associated with HSV, mycoplasma pneumonia, orf virus.
Rx: symptomatic treatment
Toxic epidermal necrosis
Severe blistering and mucous membrane involvement, diffuse erythema and then necrosis, high fever. Frequently drug related. Rx: 30% mortalitiy, admit to hospital.
Toxic epidermal necrosis
Severe blistering and mucous membrane involvement, diffuse erythema and then necrosis, high fever. Frequently drug related. Rx: 30% mortalitiy, admit to hospital.
Exanthematous eruptions
Morbilliform rash commonly caused by antibiotics.
Fixed drug eruptions
Sharply demarcated erythematous oval patches on skin. Reoccurs on the same location upon subsequent exposure.
Ichthyosis vulgaris
Generalised hyperkeratosis leading to dry skin
Neurofibromatosis Type 1
AD disorder with abnormal proliferation of neural crest elements. Cafe au lait spot Axillary or inguinal freckling Lisch nodules Optic gliomas Neurofibromas
Vitiligo
Primary depigmentation caused by melanocyte destruction. Associated with other auttoimmune disease.
Impetigo vulgaris
Acute infection with honey crusted lesions.
GAS, S aureus or both.
Rx: topical antiseptics and antibiotics.
Bullous impetigo
Thin walled bullae containing yellow/turbid fluid. S. aureus.
Rx: topical antibiotics
Erysipelas
GAS infection involving upper dermis. Confluent, erythematous, well demarcated plaques that are very painful.
Rx: penicillin, cefazolin
Cellulitis
Infection (GAS, S aureus, H influenza) involves lower dermis/subcutaneous fat. unilateral erythematous flat lesion, tender.
Rx: cloxacillin, cefazolin, erythromycin
Superficial folliculitis
Superficial infection of hair follicles. Staph, pseudomonas occasionally.
Rx: antiseptics, topical antibacterial
Furuncles
Boils which are red, tender inflammatory nodules. Involves subcutaneous tissue around hair follicle. S. aureus.
Rx: drainage, topical/systemic abx
Carbuncles
Deep-seated abcess formed by multiple coalescing boils. S. aureus. Rx: drainage and abx
Tinea capitis
Round scaly patches of alopecia on scalp.
Rx: terbinafine for 4-6wks
Tinea corporis
Ring worm, pruritic scaly round plaque with erythematous margin.
Rx: topical clotrimazole, miconazole
Tinea cruris
Jock itch, scaly patch with well-defined curved border.
Rx: topical clotrimazole, miconazole.
Tinea pedis
Athlete’s foot, pruritic scaling/maceration of web spaces.
Rx: topical clotrimazole, miconazole.
Tinea unguium
Onchomycosis, crumbling dystrophic nails with yellowish opaque subungal hyperkeratotic debris.
Rx: terbafine 6wk hands, 12 weeks toes
Scabies
Intense pruritus (nocturnal), linear burrows, urticarial crusted papules. Rx: permethrin cream, antihistamine, change all linens
Lice
Intense pruritic red excoriations, morbilliform rash, nits on hairs.
Rx: permethrin shampoo
Bed bugs
Burning wheals turning to firm papules.
Rx: symptomatic
Herpes simplex
Herpetiform vesicles on erythematous base. May have fever, regional lymphadenopathy, or secondary reactivation. HSV-1 cold sores. HSV-2 sexually transmitted, extremely tender ulcers.
Rx: acyclovir 200mg PO 5x for 10/7
Herpes zoster
Unilateral dermatomal eruption with vesicles, bullae, pustules.
Rx: analgesics (NSAIDs, amitryptiline), valacyclovir for immunocompromised, gabapentin for post-herpetic neurelgia
Molluscum contagiosum
Dome shaped umbilicated pearly papules caused by DNA pox virus.
Verruca
Warts, caused by HPV virus.
Rx: salicylic acid, silver nitrate, occlusive, liquid nitrogen.
Candiasis
Paronychia: painful red swellings of periungal skin.
Intertrigo: erythematous patches in folds with satillite pustules.
Rx: topical or oral miconazole, ketoconazole
Syphilis
Primary: painless chancre.
Secondary: macules/papules flat topped and scaling, condyloma lata, mucous patches.
VDRL testing.
Rx: penicillin IM
Gonococcemia
Disseminated infection with hemorrhagic, tender pustules. Associated fever, arthritis, urethritis, proctitis, pharyngitis, tenosynovitis.
Rx: ceftriaxone
Leukoplakia
Premalignant white plaques with sharply demarcated borders. Associated with smoking and alcohol.
Basal cell carcinoma
Rolled edges, surface telagiectasia.
Malignant melanoma
Lentigo - flat brown staining
Superficial spreading melanoma - irregular, indurated, enlarging plaque
Nodular melanoma - uniformly ulcerated and sharply delinated plaque
Acrolentiginous melanoma - palmar, plantar, subungal skin
Squamous cell carcinoma
Indurated erythematous nodule with surface scale
Non-scarring alopecia
Male pattern balding.
Rx: minoxidil, finasteride, spironolactone for women
Trichotillomania
Compulsive hair pulling
Alopecia areata
Autoimmune patches of complete hair loss, fine stippling on nails. Occurs in episodes and precipitated by stress. Associated with other autoimmune disease.
Scarring alopecia
Irreversible loss of hair follicles with fibrosis. Causes: radiation, burns, fungal, TB leprosy, lichen planus, DLE
Nail clubbing
Loss of nail fold angle.
Associated with: cyanotic heart disease, bacterial endocarditis, pulmonary disorders, GI disorders
Koilonychia
Spoon shaped nails.
Associated with: iron deficiency, malnutrition, diabetes
Onycholysis
Separation of nail plate from nail bed.
Associated with: psoriasis, dermatophytes, thyroid disease
Onychogryphosis
Hypertrophy of nail plate and subungal hyperkeratosis.
Associated with: poor circulation, chronic inflammation, tinea
Onychohemia
Subungal hematoma.
Associated with: trauma
Onychomycosis
Fungal infection of nail. Associated with: HIV, DM, PVD
Onychocryptosis
Ingrown toe nail. Associated with tight fitting shoes, excessive clipping
Nail pitting
Associated with: psorasis, alopecia areata, eczema
Transverse ridging of nails
Beau’s line. Associated with: eczema, chronic paronychia, trauma
Transverse white lines of nails
Associated with: poisons, hypoalbuminea (Muherke’s lines)
Behcet’s disease
Painful apthous ulcers in oral cavity, erythema nodosum
Buerger’s disease
Superficial migratory thrombophlebitis, pallor, gangrene
Dermatomyositis
Helitrope, Grotton’s papules, periungal erythema
Polyarteritis nodosa
Subcutaneous nodules, stellate purpura, livedo reticularis, splinter hemorrhages
Rheumatic fever
Petechia, urticaria, erythema nodosum, rheumatic nodules
Scleroderma
Raynaud’s, nonpitting edema, cutaneous calcification
Systemic lupus erythematous
Malar erythema, discoid rash, hemorrhagic bullae, photosensitivity
Crohn’s disease
Pyoderma gangrenosum, erythema nodosum, granuloma annulare
Addison’s disease
Hyperpigementation, especially mucosa, scars and folds
Cushing’s syndrome
Moon facies, purple striae, acne, hirutism, atrophic skin with telangiectasia
Diabetes mellitus
Infections, pruritus, acanthosis nigracans, granuloma annulare
Hyperthyroidism
Sweaty, nail atrophy, toxic alopecia, pretibial myxedema, oncholysis
Hypothyroidism
Dry skin, coarse hair, brittle nails, myxedema
Adenocarcinoma
- GI
- Cervix/anus/rectum
- Peutz-Jeghers (oral mucosa pigmantation), acanthothsis nigrans
- Paget’s disease (eroding scaling plaques of perineum)
Carcinoma
- Breast
- GI
- Thyroid
- Breast/lung/GU/ovary
- Paget’s disease of breast
- Palmoplantar keratoderma (thick skin palm/soles)
- Sipple’s syndrome (multiple mucosal neuromas)
- Dermatomyositis
Lymphoma
- Hodgkin’s
- ALL
- Ataxia telangiectasia (on pinna, bulbar conjunctiva)
- Ichthyosis (generalised scaling)
Multiple myeloma
Amyloidosis (large smooth tongue with waxy papules on eyelids, nasolabial folds, lips, facial petechiae)
Liver disease
Pruritus, hyperpigmentation, spider nevi, palmar erythema, white nails, porphyria cutanea tarda, xanthomas, jaundice
Renal disease
Pruritus, pigmentation, perforating dermatosis, calciphylaxis
Erythema nodosum
Acute or chronic inflammation of subcutaneous fat, round, red, tender nodules on extensor surfaces.
Drugs associated are OCP and sulfonamides.