Dermatology Flashcards
Nodular BCC
Pearly nodule
May have central ulceration
Blood vessels across surface
Superficial BCC
Younger, upper trunk, shoulders
Slightly scaly, irregular plaque
Multiple microerosions
Actinic keratosis (Also: solar keratosis)
Flat or thickened papule or plaque
white/yellow, scaly, warty or horny surface
skin colour, red or pigmented
tender or asymptomatic
Actinic cheilitis
Diffuse or patchy dryness and variable
thickening of lower lip
Grover disease (Transient acantholytic dermatosis/sweat rash)
Most common in men >50
Sometimes follows sweating, heat stress
Frequently itchy, may be asymptomatic
Red crusted papules on central back/mid-chest
Intramammary Paget disease (also called Paget disease of the nipple)
Uncommon skin cancer characterised by a chronic
eczema-like rash of the nipple and
adjacent areolar skin.
Associated with underlying breast cancer
Extramammary Paget disease
Uncommon skin cancer characterised by
chronic eczema-like rash of anogenital regions of
men and women most commonly occurs in the vulva
of women aged between 50-60 years
mild to intense itching
Chondrodermatitis nodularis helicis (Winkler disease)
Tender lump in cartilaginous portion of ear
Lichen simplex chronicus
Itch due to another condition results in repetitive scratching and rubbing
Asteatotic eczema (‘lack of oil’)
Crazy-paving appearance
Diamond-shaped plates of skin are separated from each other by red bands forming a network.
Pompholyx
A form of hand/foot eczema characterised by vesicles or bullae (blisters). In many cases it appears to be related to sweating, as flares often occur during hot weather, humid conditions, or following emotional upset. Can cause intense itch/burning/nail pitting and ridges. Address hyperhydrosis (absorbent socks, antiperspirants), c/s
Exfoliative keratolysis/keratolysis exfoliativa
Focal peeling of the palms and less often the soles.
Nodular prurigo/Prurigo nodularis
Very itchy firm lumps
Keratosis pilaris
Outer aspect of both upper arms.
Also occur on the thighs, buttocks, cheeks, and less often on the forearms and upper back
Not itchy
Pityriasis alba
It often presents following sun exposure,
Lesions 0.5 – 5cm can be scaly
Erythrodermic psoriasis. (1/3 of erythroderma)
Red dry skin all over the body.
Occurs in setting of worsening or unstable psoriasis.
Pityriasis rosea
Characterised by an initial single larger patch followed by similar, smaller oval red patches that are located
Mainly on the chest and back
Lichen planus
Symptoms can range from none (uncommon) to intense itch
Papules and polygonal plaques are shiny, flat-topped and firm on palpation
Most often front of the wrists, lower back, and ankles.
New papules and plaques often have a purple or violet hue
Plaques are crossed by fine white lines
called ………… striae.
Lichen sclerosis
Genital & perianal areas.
White crinkled or thickened patches of skin that have a tendency to scar
Can be extremely itchy and/or sore
The clitoris may be buried (phimosis).
The labia minora resorb/shrink.
The entrance to the vagina tightens
Impetigo
Characterised by pustules and honey-
coloured crusted erosions
Pityriasis versicolor (also tinea versicolor)
Trunk, neck, and/or arms. The patches may be coppery brown, paler than surrounding skin, or pink.
Kerion
Most often on scalp (tinea capitis)
Hidradenitis suppurativa
Affects apocrine gland-bearing skin in the axillae, in the groin, and under the breasts.
It is characterised by recurrent boil-like nodules and abscesses that culminate in pus-like discharge, difficult-to-heal open wounds (sinuses) and scarring
Erythema nodosum
Red lumps on shins, around knees or ankles, ranging in size from cherry to grapefruit.
Hot & painful. May be associated with a number of causes incl: throat infections, sarcoidosis, TB, pregnancy, OCP, NSAIDs & inflammatory bowel disease
Henoch-Schonlein purpura
Often preceded by URTI.
Tetrad of signs: rash, arthritis, abdo pain, kidney impairment.
Red spots or bumps become palpable purpura - buttocks, lower legs, elbows, knees
Cutaneous larva migrans
Humans can be infected with the larvae by walking barefoot on sandy beaches or contacting moist soft soil that have been contaminated with animal faeces
Larvae migrate under the skin’s surface and cause itchy red lines or tracks
Bullous pemphigoid
People >50yrs, rarer in younger people
Severe itch & large bullae
Dermatitis herpetiformis
Symmetrically distributed lesions most commonly on scalp, shoulders, buttocks, elbows and knees.
Extremely itchy papules and vesicles on normal or reddened skin
May be associated gastrointestinal symptoms
Polymorphous light eruption
Occurs in Northern Europeans holidaying in the Mediterranean
The arms, the back of the hands, the V of the neck, the chest and lower legs/feet may be affected, but the face is usually spared
Crops of 2–5 mm pink or red papules
Persists for several days, and often longer if the affected skin is exposed to more sunlight
Burning sensation or itch
Telogen effluvium
temporary hair loss due to shedding of resting hair after some shock to the system (illness, surgery, weight loss..)
Digital myxoid pseudocyst
Arises from degeneration in the connective tissue on the top of the last segment of the finger
Toxic erythema of the newborn (erythema toxicum neonatorum)
Often begins on the face and spreads to affect the trunk and limbs.
Otherwise well infant
Tuberous sclerosis
Hamartomas in many organs, but particularly the skin, brain, eye, kidney and heart.
Skin lesions, epileptic seizures and developmental delay/behavioural problems are the main features of this condition
Pyoderma gangrenosum
A rapidly enlarging, very painful ulcer
Associations with rheumatoid arthritis, IBD, leukaemia and monoclonal gammopathy
Chillblains
Itchy and/or tender red or purple bumps that
occur as a reaction to cold.
Orf
Occurs in sheep farmers, shearers, butchers
Small, firm, red or reddish-blue lump enlarges to form a flat-topped, blood-tinged pustule or blister.
2cm -5cm diameter
Often tender
Generally solitary or few in number.
Most commonly on the fingers, hands or forearms but can appear on the face
Milker’s nodule
Dairy farmers or vets who examine the mouths of animals
Small, red, raised, flat-topped spots develop.
Within a week they appear as red-blue, firm, slightly tender blisters or nodules (lumps),
usually between 2 and 5 in number
Usually on the hands, particularly the fingers, but occasionally the face
The top of the nodules often develops a greyish skin and a small crust
Guttate psoriasis
A shower of red, scaly tear drops on the trunk and
upper arms and thighs. The rash comes on very quickly,
usually within a couple of days, and may follow a
streptococcal infection of the throat
Keratoacanthoma
Erupts in sun damaged skin, solid core filled with keratin.
Molluscum contagiosum
There are several ways it can spread.
Direct skin-to-skin contact
Indirect contact via shared towels or other items
Auto-inoculation into another site by scratching or shaving
Sexual transmission in adults
The papules may persist for up to 2 years or longer.
In children, about half of cases have cleared by
12 months, and two-thirds by 18 months, with or without treatment.
Dermatofibroma (cutaneous fibrous histiocytoma)
Benign fibrous nodule that most often arises on the skin of the lower legs.
Periorificial dermatitis
Groups of itchy or tender small red papules around eyes,
nostrils, mouth. Mainly adult women, often using inhaled
or topical c/s, can also be induced by cosmetic creams,
sunscreen, OCP.
Allergic contact dermatitis
Itchy reaction to material, arises hours after contact eg Nickel, preservatives, rubber, dye, adhesives.
Affected skin may be red and itchy, swollen and blistered, or dry and bumpy
Confined to the site of contact
Irritant contact dermatitis
Due to irritants - water, saliva (children), soaps, detergents, solvents, acids, alkalis, and friction
Most often affecting cleaners, hairdressers and food handlers.
Well demarcated red patch with a glazed surface, but there may be swelling, blistering and scaling of the damaged area
Chickenpox
Itchy red papules progressing to vesicles on the
stomach, back and face, and then spreading to other parts of the body. Blisters can also arise inside the mouth
Pruritic
Additional symptoms such as high fever, headache, cold-like symptoms, vomiting and diarrhoea
Seborrhoeic dermatitis
Affects scalp, face (creases around the nose, behind ears, within eyebrows) and upper trunk. Salmon-pink, thin, scaly, and ill defined plaques in skin fold on both sides of the face.
Petal or ring shaped flaky patches on hair line and on anterior chest. Associated blepharitis
Rosacea
Chronic facial rash usually affecting 30-60yo.
Red papules and sometimes pustules on the nose, forehead, cheeks and chin
Symptoms include frequent flushing, red face due to redness and telangiectasia aggravated by sun, alcohol, hot or spicy food,
Worse with corticosteroids
Associated blepharitis
Erythema infectiosum
Mild fever and headache at first then rash
a few days later with firm red cheeks (feel burning hot)
- lasts 2 to 4 days, followed by a pink lace-like rash on
the limbs and sometimes the trunk
Rash can persist for up to six weeks at least intermittently
Roseola infantum (exanthem subitum)
Children 6 months - 3 years
High fever lasting for 3-5 days, sore throat runny nose, cough, irritability and tiredness
As the fever subsides a rash (exanthem) may appear on the face and body
Small rose-pink or red raised spots (2–5 mm in diameter) that blanch
Mainly affects trunk and rarely spreads to involve neck, face, arms and legs
May fade within a few hours or persist for as long as 2 days
Rubella
Slight fever, sore throat, runny nose and malaise (may occur prior to appearance of rash)
Characterised by rash, retroauricular, occipital and posterior cervical lymph nodes and fever
Rash
Begins on the face and spreads to the neck, trunk and extremities
Pink or light red spots about 2–3 mm in size.
Lasts up to 5 days (average is 3 days).
May or may not be itchy
Measles
Cough, coryza, conjunctivitis. Koplik spots on oral mucosa.
A red blotchy non itchy rash appears on the face and behind on the ears by the third day of the illness, spreads to the trunk, and becomes more generalised over the next few days.
Hand foot and mouth disease
Mild fever, sore throat and loss of appetite.
Malaise, swollen lymph glands, and mild diarrhoea may be present.
Lesions on the dorsal and palmar surfaces of the hands and feet.
Small vesicles and ulcers in and around the mouth, palate, and pharynx - painful
Red macules and papules
Erythema multiforme
triggered by viral infections (usu HSV - cold sores),
also M.pneumoniae.
Typical target lesions. The lesions are first seen
on the backs of hands and/or tops of feet, and
then spread along the limbs towards the trunk.
Dark red centre, pale pink ring (oedema), outermost
bright red ring. Typical lesions may be few in number.
Kobner phenomenon.
Stevens-Johnson syndrome/Toxic Epidermal Necrolysis
Flu-like prodrome followed by abrupt onset of a
tender/painful red skin rash. Blisters then merge to
form sheets of skin detachment, exposing red,
oozing dermis. Nikolsky sign. Mucosal involvement
is prominent and severe.
Staphylococcal Scalded Skin Syndrome
Young children (neonates), usu <5yo. starts with fever,
irritability and widespread redness of the skin.
Within 24-48 hours fluid-filled blisters form.
These rupture easily, leaving an area that looks like a burn or scald
Nikolsky sign (gentle strokes result in exfoliation)
Melasma/Chloasma
blotchy, brownish facial pigmentation.
RF: Sun exposure, pregnancy, hormone treatments,
medications, hypothyroidism
Granuloma Annulare
May be associated with autoimmune thyroiditis, diabetes, hyperlipidaemia, HIV, lymphoma
Usually affects the fingers or the backs of both hands, but is also common on top of the foot or ankle, and over one or both elbows.
Centre of each ring is often a little depressed
Plaques tend to slowly change shape, size and position
Necrobiosis lipoidica
Can affect insulin dependent diabetics,
although it may occur in non-diabetic subjects as well.
One or more tender yellowish brown patches develop
slowly on the lower legs over several months
Centre of the patch becomes shiny, pale, thinned,
with telangiectasia
Blue naevus
Halo naevus
Scarlet fever
It affects people who have recently had a sore throat
(strep throat) or school sores (impetigo).
Sudden fever associated with sore throat, cervical
lymphadenopathy, headache, nausea, vomiting,
loss of appetite, swollen and red tongue,
abdominal pain, body aches, and malaise.
Characteristic rash appears 12–48 hours after the start of the fever.
The rash usually starts below the ears, neck, chest, armpits and groin before spreading to the rest of the body over 24 hours
Rash looks like sunburn with goose pimples with
rough sandpaper-like feel.
Pastia lines (ruptured capillaries in body folds)
Peeling occurs as rash fades
Rheumatic fever
A complication of scarlet fever. ARF generally
develops several weeks after an episode of
streptococcal pharyngitis; sometimes after impetigo.
Fever
Arthralgia
Raised ESR > 30 or CRP > 30
ECG prolonged PR interval
migratory polyarthritis (knees ankles, elbows and wrists)
carditis,
Sydenham chorea
Annular erythema
subcutaneous nodules (uncommon)
Pyogenic granuloma
Shiny red mass with a raspberry-like or raw minced meat appearance
Rapidly increase in sizeover a period of a few days to weeks to anywhere between 2mm and 2cm in diameter
