Dermatology Patients Flashcards
Actinic keratosis
result from a clone of abnormal squamous cells caused by UV light-induced gene alteration and therefore only develop on sun-damaged skin. They are the initial lesion in a disease continuum that progresses to invasive squamous cell carcinoma. Ill-defined macules, papules or plaques that are usually asymptomatic.
Alopecia areata
- A non-scarring alopecia (hair loss)
- Occurs as round or oval patches of hair loss
- Short “exclamation point” hairs, broader at the distal end
- Hairs often re-grow with depigmentation
- Clinical subtypes
- Patchy focal
- Ophiasis pattern
- Diffuse variant
- Alopecia totalis
- Alopecia universalis
- Average lifetime risk 1.7%
- Up to 40% have an atopic diathesis (allergic rhinitis, asthma, atopic dermatitis) compared to 20% in the general population
- May be associated with other autoimmune diseases including: thyroid, vitiligo and inflammatory bowel disease
Cherry angiomas
is a benign bright cherry-red, round, palpable angiomas that begin after age 30. Etiology is unknown
Dermatofibromas
is a common cutaneous nodule, more common in women of unknown etiology that usually forms on the extremities.
Epidermolysis Bullosa
an inherited blistering disorder.
Granuloma Annulare
Granulomatous inflammation of the dermis in an annular configuration. May occur in children and adults. Usually localized to acral areas such as the elbows, hands and feet.
Lamellar Ichthyosis
is an autosomal recessive and presents soon after birth and evolves into large quadrilateral dark scales that are free at the edges and adherent at the center. Hair may be sparse and fine.
Lichen Planus
Inflammatory skin disorder which may be associated with hepatitis C infection. On the skin, purple, polygonal, pruritic, papules are noted with lacy white overlay called Wickham’s striae. May also affect the mucosal surfaces (oral lichen planus), nails and may cause a scarring alopecia (lichen planopilaris).
Lipomas
are slow growing, solitary, soft benign mobile tumors of fat.
Lupus erythematosus
a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs). 4 of 11 criteria must be met to make the diagnosis of systemic lupus:
- Malar rash – a rash over the cheeks and nose, often in the shape of a butterfly
- Discoid rash – a rash that appears as red, raised, disk-shaped patches
- Photosensitivity – a reaction to sun or light that causes a skin rash to appear or get worse
- Oral ulcers – sores appearing in the mouth
- Arthritis – joint pain and swelling of two or more joints in which the bones around the joints do not become destroyed
- Serositis – inflammation of the lining around the lungs (pleuritis) or inflammation of the lining around the heart that causes chest pain which is worse with deep breathing (pericarditis)
- Kidney disorder – persistent protein or cellular casts in the urine
- Neurological disorder – seizures or psychosis
- Blood disorder – anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low level of specific white blood cells), or thrombocytopenia (low platelet count)
- Immunologic disorder –anti-DNA or anti-Sm or positive antiphospholipid antibodies
- Abnormal antinuclear antibody (ANA)
There are also skin only forms of lupus:
subacute cutaneous lupus and discoid lupus.
Melasma
Hyperpigmentation, usually on the face, triggered by pregnancy, oral contraceptive pills and hormone replacement therapy.
Morphea
May occur in oval plaques or linear bands. A violaceous or lilac- colored active inflammatory border is a highly characteristic for active morphea
Neurofibromatosis 1 (NF1)
also known as von Recklinghausen NF or Peripheral NF. Occurring in 1:3,000 births, web characterized by multiple cafe-au-lait spots and neurofibromas on or under the skin. Enlargement and deformation of bones and curvature of the spine (scoliosis) may also occur. Occasionally, tumors may develop in the brain, on cranial nerves, or on the spinal cord. About 50% of people with NF also have learning disabilities.
Nevi
are commonly called moles. They are sharply circumscribed and chronic, and brown/black in color, as they are composed of melanocytes. The etiology is unclear. Large congenital nevi are >/= 20 cm at birth and do carry a higher risk of melanoma.
Port wine stain
a congenital vascular malformation of the capillaries which can thicken and darken with age, becoming deeply violaceous and nodular.
Pemphigus Vulgaris
is an autoimmune blistering disease, affecting patients 40-60 years old. Oral lesions are a common site, though superficial bullae can occur anywhere on the body. +Nikolsky’s sign – the epidermis is easily detached from underlying skin.
Psoriasis
is a common skin disorder characterized by excessive proliferation of keratinocytes resulting in the formation of thickened, silver-scaly plaques, itching, and inflammatory changes of the epidermis and dermis. The lesions are symmetric and sharply demarcated and occur mainly on extensor surfaces.
Rosacea
is a common chronic inflammatory facial skin disorder seen in in ages 30-60, females more commen than males. Features include central flushing, erythema, telangiectasias, papule, pustules, ocular lesions, edema and rhinophyma.
Seborrheic keratosis
is a benign wart-like growth on the superficial skin, that appear after age 40 and are often located on the face or trunk. They are painless, and may be yellow, brown, or black with slightly elevated flat surface, round-to oval in shape.
Scleroderma
is a rare multisystem, chronic disorder characterized by tissue fibrosis, small blood vessel vasculopathy and autoimmunity. Dermatologic presentation includes skin thickening on the extremities, face and trunk in a symmetric pattern; salt and pepper discoloration on extremitites, sclerodactyly, Raynaud’s phenomenon, and telangiectases. Systemic findings include esophageal dysmotility, pulmonary fibrosis, joint contractures, ulcerations and calcinosis with CREST.
Solar Lentigo
Brown macule on chronically sun exposed skin. Biopsy would show excess melanocytes compared to normal skin. This is a benign skin change and is commonly referred to as a “liver spot”.
Tinea pedis
also known as athlete’s feet, is causes by a localized fungal infection. The most common symptom is cracked, flaking and peeling skin between the toes. The areas are erythematous and pruritic, and may cause burning and stinging.
Vitiligo
is the result of melanocyte destruct on but the cause is unknown. It is characterized by hypopigmented and depigmented lesions, on sun-exposed skin, body folds and around body orifices. Lesions tend to be bilateral and symmetric. Hair in the affected areas may also be white. This is an acquired anomaly. It may be associated with an autoimmune disease.
• Acquired depigmented patches due to loss of melanocytes
• Incidence: 0.5-2%
• Commonly seen in periorificial and acral locations
• Microscopic finding is a complete absence of melanocytes
• Commonly associated with thyroid disease (up to 30% of all cases)
• Hashimoto’s thyroiditis
• Graves’ disease
• Diabetes Mellitis
• Pernicious Anemia
• Addison’s disease
