Exam 1: Dermatology Flashcards
Macule
Lesion is flat and small <1 cm
Ex: Mobiliform drug eruption, tinea versicolor, Benign melanocytic nevi, malignant melanoma
Patch
Lesion is flat and large >1 cm
Ex: seborrheic dermatitis, vitiligo, tinea cruris
Papule
Lesion is raised, small <1 cm, and not fluid filled
Ex: Basal cell carcinoma, skin tags, molluscum contagiosum, guttate psoriasis
Plaque
Lesion is raised, large >1 cm, but not fluid filled
Ex: Plaque psoriasis, atopic dermatitis, herald patch of pityriasis rosea, nummular dermatitis
Vesicle
Lesion is raised, small <1 cm, and filled with fluid
Ex: herpes Simplex virus, herpes zoster or shingles, rhus dermatitis or allergic contact dermatitis from poison ivy
Bulla
Lesion is raised, large >1 cm, and filled with fluid
Ex: Bullous fixed drug eruption, insect bites, and inherited skin fertility disorder
Good descriptions of skin findings include what 8 elements?
NUMBER- Solitary or multiple; estimate of total number
SIZE- Measured in millimeters or centimeters
COLOR- Including erythematous if blanching; if non-blanching, vascular-like cherry angiomas and vascular malformations, petechiae, or Purpera
SHAPE- Circular, oval, annular, nummular, or polygonal
TEXTURE- Smooth, flashy, verrucous or warty, keratotic; greasy if scaly
PRIMARY LESION- flat, a macule or patch; a papule or plaque; or fluid filled, a vesicle or bulla (May also be erosions, ulcers, nodules, ecchymosis, petechiae, and palpable Purpera)
LOCATION- Including measured distance from other landmarks
CONFIGURATION- Grouped, annular, linear
Blanching lesions
Are erythematous and suggest inflammation
Scaly can be ____, ____, or _____.
Include examples
1-Greasy (seborrheic dermatitis or seborrheic keratosis)
2-Dry and fine (tinea pedis)
3-Hard and keratotic (actinic keratosis or SCC)
Alopecia
Hair loss. Can be diffuse, patchy, or total.
The most common cause of diffuse hair thinning:
Male and female pattern baldness
What type of alopecia should be referred to a dermatologist?
Scarring alopecia
Sparse hair is seen in what condition?
Hypothyroidism
Fine, silky hair is seen in what condition?
Hyperthyroidism
What is the ABCDE – EFG rule and what does it stand for?
It is a method to teach clinicians and patients about features suspicious for melanoma. If 2 people or more of these are present, risk for melanoma increases and biopsy should be considered.
ASSYMETRY – of one side of mole compared to the other
BORDER IRREGULARITY – especially if ragged, notched, or blurred
COLOR VARIATIONS – more than 2 colors, especially blue-black, white (loss of pigment d/t regression), or red (inflammatory reaction to abnormal cells)
DIAMETER greater than 6 mm - approximately the size of a pencil eraser
EVOLVING- or changing rapidly in size, symptoms, or morphology
ELEVATED
FIRM to palpation
GROWING progressively over several weeks
Is a homogeneous blue color in a blue nevus concerning for melanoma?
No. Blue or black color within a larger pigmented lesion is concerning for melanoma.
Early melanomas may be ____, and many benign lesions are ______. (Sizes)
Early melanomas may be <6 mm and many benign lesions are >6mm.
What are signs of chronic sun damage?
Numerous solar lentigines on the shoulder and upper back,
Many melanocytic nevi,
Solar elastosis (yellow, thickened skin with bumps, wrinkles, or furrowing),
Cutis rhomboidalis nuchae (leathery thickened skin on the posterior neck), and
Actinic Purpera.
What is the best defense against skin cancers?
Avoid ultraviolet radiation exposure by limiting time in the sun, avoiding midday sun, using sunscreen, and wearing some protective clothing with long sleeves and hats with white brims. Avoid indoor tanning, especially children, and teens, and young adults.
Hair shedding at the roots is common in what two conditions?
Telogen affluvium and alopecia areata
Hair breaks along the shaft suggest what?
Damage from hair care or tinea capitis
What are causes of generalized itching, without apparent rash?
Dry skin, pregnancy, uremia, jaundice, lymphomas and leukemia, drug reactions, and less commonly polycythemia vera and thyroid disease.
Pallor indicates _____
Anemia
Cyanosis can indicate:
Decreased oxygen in the blood or decreased blood flow in response to a cold environment
Jaundice, or yellowing of the skin, results from:
Increased bilirubin
Possible internal causes of diffuse non-scarring hair shedding in young women are:
Iron-deficiency anemia and hyper- or hypothyroidism
Local redness of the skin warns of:
Impending necrosis
Although some deep pressure sores develop without antecedent redness.
Pustule
Small palpable collection of neutrophils or keratin that appears white
Ex: Acne vulgaris, Bacterial folliculitis
Furuncle
Inflamed hair follicle; multiple for ankles together form a carbuncle.
Ex: Abscesses (fluctuant deep infection)
Nodule
Larger and deeper than a papule.
Ex: Dermatofibroma, keloid
Subcutaneous mass/cyst
Whether mobile or fixed, cysts are encapsulated collections of fluid or semisolid.
Ex: Epidermal inclusion cyst, pilar cyst, lipoma
Wheal
Area of localized dermal edema that evanesces (comes and goes) within a period of 1-2 days.
Ex: the essential primary lesion of urticaria, PPD test
Burrow
Small linear or serpiginous pathways in the epidermis created by the scabies mite
Ex: scabies
What is the precursor of squamous cell carcinoma?
Actinic keratosis
Spider angioma
COLOR/SIZE: fiery red; from very small to 2 cm
SHAPE: Central body, sometimes raised, surrounded by erythema and radiating legs
PULSATILITY and EFFECT OF PRESSURE: Often seen in center of the spider when pressure with a glass slide is applied; pressure on the body causes blanching of the spider
DISTRIBUTION: Face, neck, arms, and upper trunk; almost never below the waist
SIGNIFICANCE: Single spider angiomas are normal and are common on the face and chest; also seen in pregnancy and liver disease
Cherry angioma
COLOR/SIZE: Bright or ruby red; may become purpleish with age; 1 to 3 mm
SHAPE: Round, flat, or sometimes raised; maybe surrounded by a pale halo
PULSATILITY and EFFECT OF PRESSURE: Absent; may show partial blanching, especially if pressure applied with edge of a pinpoint
DISTRIBUTION: Trunk; also extremities
SIGNIFICANCE: None; increases in size and number with aging
Spider vein
COLOR/SIZE: Bluish; size variable, from very small to several inches
SHAPE: Variable; may resemble a spider or be linear, irregular, cascading
PULSATILITY and EFFECT OF PRESSURE: Absent; pressure over the center does not cause blanching, but diffuse pressure blanches the veins
DISTRIBUTION: Most often on the legs, near veins; also on the anterior chest
SIGNIFICANCE: Often accompanies increased pressure in the superficial veins, as in varicose veins
Petechiae/Purpera
COLOR/SIZE: Deep red or reddish purple, fading away over time; petechiae, 1 to 3 mm; Purpera are larger
SHAPE: Rounded, sometimes irregular; flat
PULSATILITY and EFFECT OF PRESSURE: Absent; no affect from pressure
DISTRIBUTION: Variable
SIGNIFICANCE: Blood outside the vessels; may suggest a bleeding disorder, or if petechiae, emboli to skin; palpable Purpera in vasculitis
Ecchymosis
COLOR/SIZE: Purple or purpleish blue, fading to green, yellow, and brown with time; ariable size, larger than petechiae, >3 mm
SHAPE: Rounded, oval, or irregular; may have a central subcutaneous flat nodule (a hematoma)
PULSATILITY and EFFECT OF PRESSURE: Absent; no effect from pressure
DISTRIBUTION: Variable
SIGNIFICANCE: Blood outside the vessels; often secondary to bruising or trauma; also seen and bleeding disorders
Solar lentigo
Light brown and uniform in color but may be asymmetric.
Bilaterally symmetric brown macules located on sun-exposed to skin, including the face, shoulders, and arms and hands
Solar elastosis
Yellowish white macules or papules in sun exposed skin, especially on the forehead
Actinic Purpera
Ecchymosis limited to the dorsal forearms and hands but not extending above the “shirt sleeve” line on the upper arm.
Purple patches or macules that fade over time. These spots and patches come from blood that has leaked through poorly supported capillaries and spread within the dermis.
Poikiloderma
Red patches in sun damaged areas, especially the V of the neck, and lateral neck (usually sparing the shadow inferior to the chin) with fine telangiectasias, and both hyper- and hypopigmentation
Wrinkles
Increased sun damage and tanning leads to deeper wrinkles at an earlier age
Cutis rhomboidalis nuchae
Deep wrinkles on the posterior neck that “criss-cross”
Acral melanoma
Rapid change or evolution helps detect acral melanoma.
Consider biopsies if >7 mm, rapidly growing, or concerning features on dermoscopy
Acral nevus
Likely benign if <7 mm and has a reassurance pattern on dermoscopy, such as the parallel furrow or Lattice patterns
Blue nevus
Blue nevi have a homogeneous blue-gray appearance, clinically and dermoscopy
Seborrheic keratosis
Often have a verrucous texture.
Appear like a “Stuck-on” or flattened ball of wax.
May be darkly pigmented
May crumble or bleed if picked.
Specific features on dermoscopy such as milia-like cysts or comedome-like openings are reassuring if present.
May be erythematous if inflamed.
Mimics SCC
Actinic keratosis
Often easier to feel then to see.
Superficial keratotic populous “come and go” on some damaged skin
Cutaneous horn/ keratotic scale
The protypic keratotic scale of actinic keratoses and SCC is formed by keratin and can result in a cutaneous horn.
Cutaneous horns should generally be biopsied to rule out SCC.
Warts
Usually skin-colored to pink, texture more verrucous then keratotic.
May be filiform.
Often have a hemorrhagic punk day that can be seen with a magnifying glass or dermascope
Mimics cutaneous horn/ keratotic scale
Telogen Effluvium
Overall, the patient’s scalp and hair distribution appear normal, but a positive hair pull test reveals most hairs have telogen bulbs.
Anagen Effluvium
There is diffuse hair loss from the roots. The hair pull test shows few if any hairs with telogen bulbs.
Alopecia Areata
Focal hair loss.
There is sudden onset of cleary demarcated, usually localized, round or oval patches of hair loss leaving smooth skin without hairs, in children and young adults. There is no visible scaling or erythema.