FITZPATRICK DERMATOLOGY 9TH ED Flashcards by Sharmaine Lozano

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Acne conglobata

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Dennie-Morgan Folds of atopic dermatitis

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Eczema herpeticum.

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Nummular Dermatitis

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Seborrheic dermatitis

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Cradle cap or infantile seborrheic dermatitis.

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Seborrheic dermatitis of the chest.

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Seborrheic dermatitis of the upper back.

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Seborrheic dermatitis of the ear: external canal, concha bowl, and auricle.

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Seborrheic dermatitis

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Pityriasis amiantacea.

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What do you call the hypopigmented ring surrounding individual psoriatic lesions?

What is it usually associated with?

Woronoff Ring

usually associated with treatment, most commonly UV radiation or topical corticosteroids

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Elephantine psoriasis of the lower extremities
- uncommon form characterized by thickly scaling, large plaques, usually on the lower extremities

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What shape of psoriasis lesions are these?

Rupioid psoriasis refers to lesions in the shape of a cone or limpet. Ostraceous psoriasis, an infrequently used term, refers to a ringlike, hyperkeratotic concave lesion, resembling an oyster shell

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von Zumbusch-type generalized pustular psoriasis

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What part of the nail is affected in this finding?

Proximal Matrix

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islands of normal skin “nappes claires” in pityriasis rubra pilaris

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Circumscribed juvenile pityriasis rubra pilaris type IV.

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Large-plaque parapsoriasis.

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Large-plaque parapsoriasis. Retiform variant.

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Small-plaque parapsoriasis. Digitate dermatosis variant.

Pityriasis lichenoides chronica. Polymorphous appearance ranging from early erythematous papules to scaling brown-red lesions and tan-brown involuting, flat papules, and macules.

Pityriasis lichenoides et varioliformis acuta.

pityriasis rosea

Lichen planus

Annular lichen planus

Hypertrophic lichen planus.

Vesiculobullous lichen planus.

Lichen planus pigmentosus Multiple, wellmarginated, hyperpigmented, dark-brown macules located along the neck, with sparing of the face. The macules coalesce to form a slightly retiform pattern. This patient had involvement of the intertriginous regions and negative patch testing results.

Lichen planopilaris

Mucosal lichen planus

Lichen nitidus

Lichen Striatus

granuloma annulare

Lupus pernio

Sweet syndrome

Pyoderma Gangrenosum

Subcorneal pustular dermatosis.

Granuloma Faciale

Hereditary Angioedema

Telangiectasia macularis eruptive perstans.

Erythema multiforme

Epidermal Necrolysis

Fixed Drug Eruption

ERYTHEMA ANNULARE CENTRIFUGUM

erythema annulare centrifugum

ERYTHEMA GYRATUM REPENS

Ulerythema ophryogenes

Atrophoderma vermiculatum

Trichodysplasia spinulosa

Hailey-Hailey disease

Porokeratosis

Pemphigus Vulgaris

Pemphigus Vegetans

Pemphigus foliaceus

Paraneoplastic Pemphigus

chronic bullous disease of childhood

Dermatitis Herpetiformis

acute cutaneous lupus erythematosus

Subacute cutaneous lupus erythematosus (SCLE)

discoid lupus erythematosus

Lupus erythematosus panniculitis.

Heliotrope sign. Violaceous to pink erythema and edema on the upper eyelid. Dermatomyositis

Gottron Papules Dermatomyositis

Shawl sign Dermatomyositis

Gottron Sign

Ovoid palatal patch Dermatomyositis

Scleroderma

Lichen sclerosus

En coup de sabre. Linear morphea

Morphea profunda: involved areas have “cobblestone” appearance with subcutaneous atrophy.

Lichen sclerosus

Scleromyxedema

Relapsing polychondritis

Anetoderma

Middermal elastolysis

Atrophoderma of Pasini and Pierini.

Atrophoderma vermiculatum.

Ulerythema ophryogenes.

Acquired perforating dermatosis.

Acquired perforating dermatosis, acquired elastosis perforans serpiginosa type

Marfan Syndrome

Pseudoxanthoma elasticum

Cutis Laxa

Erythema Nodosum

Erythema induratum

lipodermatosclerosis

incontinentia pigmenti.

segmental variant of vitiligo.

Piebaldism

Ash-leaf macules in tuberous sclerosis.

Incontinentia pigmenti

NEVUS OF OTA

Nevus of Ito

Mongolian spots

Peutz-Jeghers syndrome.

LEOPARD (lentigines, electrocardiogram conduction defects, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retardation of growth, and sensorineural deafness) syndrome

Acanthosis nigricans

erythema ab igne

Nevus of Hori

Nevus of Becker

Café-au-lait macule may occur spontaneously or as part of a genodermatosis like NF1 and McCune-Albright syndrome.

Melasma

Riehl melanosis

ERYTHEMA DYSCHROMICUM PERSTANS

rhinophyma

Fox-Fordyce disease

hidradenitis suppurativa

alopecia areata totalis

Frontal fibrosing alopecia.

Central centrifugal cicatricial alopecia.

Folliculitis decalvans.

Dissecting cellulitis.

Acne keloidalis nuchae.

Traction alopecia.

trichorrhexis nodosa. splayed paint brush bristle appearance (Fig. 89-1), which is caused by a breach in the cuticle leading to exposure of the fibers and increasing their susceptibility to fracture

Tiger tail pattern seen with trichostasis in trichothiodystrophy

Pili torti

TRICHORRHEXIS INVAGINATA

MONILETHRIX Typical beaded appearance

uncombable hair syndrome.

Wooly hair syndrome

Hirsutism

Hypertrichosis

Can be seen in?

Muehrcke lines Hypoalbuminemia

Melanonychia

Splinter hemorrhages

Pterygium in nail lichen planus.

Onychogryphosis

Pterygium inversum

Onychomadesis

Trachyonychia

Onychoschizia lamellar splitting of the nail at its free end

Onychorrhexis Multiple longitudinal fissures, often associated with nail thinning and ridges

Onychocryptosis

Retronychia

, Pincer nails

Acrodermatitis continua suppurativa of Hallopeau.

White superficial onychomycosis

Yellow nail syndrome.

Half-and-half nail Assoc with chronic renal failure

Pachyonychia congenita.

Congenital malalignment of the big toenail.

Onychomatricoma

Fibrokeratoma

Glomus tumor.

Subungual exostosis

Subungual melanoma with Hutchinson sign.

Heliotrope sign. Violaceous to pink erythema and edema on the upper eyelid. Seen in Dermatomyositis

Shawl sign. Pink to red thin patches and plaques, often with thin white scale, on the upper posterior back characteristic of the shawl sign. Dermatomyositis

V-neck sign. Red, ill-defined telangiectatic patches on the upper chest. Dermatomyositis

Gottron papules. Light pink, ill-defined papules over the proximal and distal interphalangeal joints, few with central umbilication. Deep red erythema, edema of the proximal nailfolds, and dilated nailfold capillaries are evident. Dermatomyositis

Gottron sign. Ill-defined violaceous erythema on the knees is seen, which has follicular accentuation in this patient. Dermatomyositis

Holster sign. On the lateral thigh are ill-defined pink papules coalescing into plaques are seen with scale and follicular accentuation. Dermatomyositis

Ovoid palatal patch. This symmetric violaceous patch is seen symmetrically across the posterior hard palate and may aid in distinguishing dermatomyositis from other cutaneous eruptions, namely lupus.

“Red on white.” Reticulated white macules surrounded by telangiectatic red macules are seen on the distal thigh and knee. This cutaneous finding is specific to dermatomyositis and is valuable in differentiating dermatomyositis from cutaneous lupus.

Erythromelanosis Follicularis Faciei et Colli ( EFFC) - hyperpigmentation in addition to erythema and follicular papules in KP

Hypereosinophilic syndrome. Mucosal erosions and ulcers of the mouth (A) and glans penis (B); conjunctival irritation (C).

**Wells syndrome. ** A, Early lesion with erythema and edema. B, An arcuate plaques and pigmentation. C, Late lesion resembling morphea.

Angiolymphoid hyperplasia with eosinophilia. A, Multiple grouped brown nodules. B, Reddish papules.

Kimura disease. Solitary brownish nodules and multiple papules.

**Eosinophilic pustular folliculitis. ** A, Itchy reddish papules and pustules on the cheek. B, An HIVassociated case with itchy red papules on the upper arm, shoulder, and back.

Granuloma faciale. Raised edematous plaques on cheek showing prominent follicular ostia.

Granuloma faciale. Single plaque on the temple showing prominent follicular ostia and central dell.

A, Generalized granuloma annulare. Small papular lesions that are too small to exhibit annular configuration. B, Multiple annular lesions on the lower arm.

Localized granuloma annulare with nodule on the hand of a child.

1. Diagnosis 2. Causative agent

herpetic gingivostomatitis HSV1

labial herpes

facial herpes simplex

genital herpes

Herpetic Whitlow

1. diagnosis 2. causative agent

Eczema herpeticum usually a manifestation of **primary HSV-1 **infection in a child with atopic dermatitis

1. Diagnosis 2. Causative agent

Varicella Varicella-Zoster Virus

1. Diagnosis 2. Most frequent dermatomes affected

1. Herpes Zoster 2. T3 - L2

1. Diagnosis 2. Identify the sign 3. Nerve involved

1. Ophthalmic herpes zoster 2. Hutchinson sign 3. nasociliary branch of the ophthalmic division of trigeminal nerve

1. Identify the syndrome 2. causative agent 3. nerve affected

1. Ramsey Hunt Syndrome 2. Varicella-Zoster Virus 3. facial and auditory nerves ## Footnote * Facial palsy in combination with herpes zoster of the external ear, ear canal, or tympanic membrane, with or without tinnitus, vertigo, and deafness * Ear and external auditory canal are innervated by the 5th, 7th, 9th, and 10th cranial nerves and by the upper cervical nerves, and the facial nerve anastomoses with all of them

1. Diagnosis 2. Area of predilection 3. Lesional histiocytes are positive for what stain?

1. Juvenile xanthogranuloma 2. face, neck, upper trunk 3. stabillin-1

1. Give the diagnosis of this N-LCH 2. stains positive 3. characteristic finding in histopath

1. GENERALIZED ERUPTIVE HISTIOCYTOMA 2. Macrophages are positive for **CD68 and stabilin-1**, and negative for CD1a, CD34, and S100B. 3. The papillary dermis is infiltrated by mostly small, nonlipidized cells and few lymphocytes underneath a **Grenz zone**, which is **characteristic for GEH**

On histopathology, this tumor show **vascular tufts of tightly packed capillaries,** randomly dispersed throughout the dermis in a typical **“cannonball distribution” **with crescentic spaces surrounding the vascular tufts, and lymphatic-like spaces within the tumor stroma

tufted angioma ## Footnote (-) GLUT1 It is CD31+; D2-40, LYVE1, and PROX1 lymphatic markers, are only partially positive in surrounding vessels, helping distinguish TA from KHE

1. Diagnosis 2. most common associated malignancy

1. acanthosis nigricans 2. gastric CA

1. acanthosis nigricans 2. gastric CA Acanthosis nigricans. A, Verrucous and papillomatous growths of the vermilion border of the lip. B, Velvety thickening of the tongue. (A and B are not the same patient.)

1. diagnosis 2. most common malignancy associated 3. most common malignancy associated if with acanthosis nigricans

1. Tripe palms 2. Lung CA 3. Gastric CA

1. Identify the sign 2. Most commonly associated malignancy 3. 2nd MC associated malignancy

1. Leser-Trélat sign 2. Gastric CA 3. lymphoproliferative disorder ## Footnote Lymphoproliferative disorders, including Sézary syndrome, mycosis fungoides, other lymphomas, and leukemia, are the second most common associated malignancies, occurring in approximately 20% of patients

1. Diagnosis 2. Most commonly associated malignancy

1. Erythema gyratum repens 2. Lung CA

1. Diagnosis 2. Most commonly associated malignancy

1. Erythema gyratum repens 2. Lung CA ## Footnote * Numerous serpiginous bands are arranged in a parallel configuration of concentric red swirls over most of the body. This presentation is occasionally referred to as a “wood-grain” appearance. * Even more striking is the relatively rapid rate at which lesions migrate (repens is Latin for creeping), estimated at 1 cm per day. * A fine scale may be found along the trailing edge of erythema * The hands, feet, and face are commonly spared, except for occasional volar hyperkeratosis.

1. Diagnosis 2. Most commonly associated malignancy

1. necrolytic migratory erythema 2. glucagonoma ## Footnote * NME is characteristic and includes intertriginous areas (eg. groin, perineum, buttocks, and lower abdomen), the central face (especially perioral), and distal extremities * Mucosal involvement manifests as angular cheilitis, atrophic glossitis, and stomatitis. Dystrophic nails may accompany the syndrome * Glucagonoma syndrome is characterized by NME, weight loss, sore mouth, diarrhea, diabetes mellitus, deep vein thrombosis, normochromic normocytic anemia, and neuropsychiatric disorders

1. Diagnosis 2. Associated malignancies in men and women

1. Hypertrichosis lanuginosa acquisita 2. Men: lung, colorectal CA Women: colorectal, lung, or breast CA

Identify this variant of metastatic breast carcinoma

Carcinoma en cuirasse ## Footnote leather-like skin changes of sclerosing metastatic breast cancer, known as carcinoma en cuirasse, which may later present as nodules and ulceration

Identify this variant of metastatic breast carcinoma

carcinoma erysipelatoides

1. Diagnosis 2. most important possible sequelae 3. most prevalent mutation

1. Giant congenital melanocytic nevus 2. Melanoma 3. NRAS ## Footnote NRAS mutations are most prevalent in large- and giant-sized CMNs

1. diagnosis 2. common locations 3. what are the 2 variants 4. associated mutation in the sporadic variant

1. nevus spilus 2. trunk and extremities 3. macular and papular variant 4. activating HRAS mutation

1. diagnosis 2. common locations 3. what are the 2 variants

1. Nevus spilus 2. trunk and extremities 3. macular and papular variant

1. diagnosis 2. associated mutation

1. acquired melanocytic nevi 2. BRAF mutation

1. diagnosis 2. possible sequelae 3. these are more frequent in patients with what syndrome?

1. Halo nevus 2. vitiligo, melanoma 3. Turner syndrome

1. diagnosis 2. mutation present 3. variant with elevated risk for development of melanoma 4. related lesions 5. areas of predilection

1. blue nevus 2. GNAQ/GNA11 3. cellular blue nevus 4. nevus of Ota/Ito, Mongolian spot, dermal dendritic hamartoma 5. dorsal hands and feet, scalp, and buttocks or sacral skin

1. Diagnosis 2. associated mutation

1. Spitz nevi 2. HRAS A, Pink plaque, which appeared de novo over an 8-week period, becoming more elevated with time, in the preauricular area of a 4-year-old white boy. B, Dome-shaped pink papule, which appeared de novo over a 2-week interval 4 months before, on the forehead of a 5-year-old white boy. C, **Agminated Spitz tumors**. Numerous grouped pink papules and plaques, appearing at age 6 months, on the face of a 4-year-old white boy.

Lentigo simplex. A, Acquired darkly pigmented lentigines on the vulva of a 13-year-old white girl who has lentigines, atrial myxomas, mucocutaneous myxomas, and blue nevi (LAMB, myxoma syndrome, Carney complex). B, Multiple lentigines on the lips of the same patient. This patient died in her mid-20s of a malignant schwannoma.

Agminated lentigines. A, Grouping of small light brown macules, present since age 14 years, on the right side of the shaft and glans penis of a 17-year-old healthy white male patient. B, Grouping of small, light brown macules, present for at least 6 years, on the right cheek of a healthy 10-year-old African American male patient. C, Grouping of small, light-brown macules, present since age 2 years, on the right neck and supraclavicular area of a 13-year-old healthy white female patient.

Solar lentigo. A, Uncountable solar lentigines on the back of a 30-year-old white man, appearing initially during early childhood after multiple sunburns. B, High magnification of lentigines in (A) showing lightbrown macules with markedly irregular outlines (arrowheads).

1. diagnosis 2. criteria for diagnosis

Dysplastic Nevus diameter in one dimension at least 5 mm + prominent flat component + two of three other features: 1. irregular asymmetric outline 2. indistinct borders, 3. variable pigmentation

Capillary malformation

Arteriovenous malformation

1. diagnosis 2. associated syndromes where this can be observed

1. stork bite, angel’s kiss, salmon patch, **nevus simplex, **or nevus flammeus neonatorum 2. Beckwith-Wiedemann and Rubinstein-Taybi syndromes ## Footnote These lesions (with the exception of the Unna nevus) disappear spontaneously around the age of 1 to 4 years.

Unna nevus *nevus simplex on the occiput

1. identify the lesion 2. when present in the frontopalpebral area especially in the upper inner eyelid, it can be a possible part of what syndrome? 3. What is oftern present as ophthalmologic manifestation? 4. possible sequelae

1. capillary malformation 2. Sturge-Weber syndrome 3. glaucoma 4. epilepsy and mental retardation

capillary malformation: darkening and thickening with time. A, At age 6 months. B, At age 33 years. C, Development of pyogenic granuloma. D, Soft tissue hypertrophy. E, Mucosal hypertrophy.

capillary malformation

**Verrucous venous malformation (**previously known as **verrucous hemangioma**) on the lower extremity, causing oozing. It is purple-red in color and slightly raised, with hyperkeratosis.

Various v**enous malformations**. A. Of the soft palate, causing sleeping apnea. B and C, Of the knee, causing hemarthroses; confirmed by T2-weighted images. D. Of the mucosal eyelid. E and F, Of the cheek, causing facial asymmetry and pain.

**Venous malformations (VMs). ** A, Extensive hemifacial VM causing soft tissue hypertrophy and lip deformation in a 6-month-old boy. B, Histologically, VM consists of ectatic venous-like channels with anomalies in mural cells (hematoxylin and eosin). C, Superficial glomuvenous malformation of the inner thigh. Note the presence of mural glomus cells on histology (hematoxylin and eosin). D, Mucosal VM involving the lower lip and floor of the mouth.

Stage 2 arteriovenous malformation

arteriovenous malformation

Different skin manifestations of systemic vasculitis. A, Purpura. B, Bullae. C, Ulcer.

A, A patient with **polyarteritis nodosa** with “starburst” livedo made up of a cluster of nodular lesions. B, Histopathology of skin lesions in polyarteritis nodosa showing segmental necrotizing arteritis.

Livedo reticularis

1. Diagnosis 2. Hallmark noncutaneous finding 3. most classic symptom

1. Obstructive peripheral arterial disease 2. decreased or absent pulses 3. intermittent claudication An ulcer is seen on the medial aspect of the foot at the base of the great toe. A, Foot pallor with elevation of limb suggests severe ischemia. B, Foot erythema with the leg in a dependent position, termed dependent rubor, also suggests severe ischemia.

livedo reticularis

1. Diagnosis 2. What testing should be performed on all patients presenting with this condition?

1. livedo racemosa 2. Antiphospholipid antibody testing

Intense erythema of the feet with associated burning pain. 1. Diagnosis? 2. What is the gene mutation reported in patients with inherited form of this condition? 3. Give 1 trigger 4. Relieving factor

1. **erythromelalgia**. 2. SCN9A 3. exercise, ambient temperature, or the use of heavy blankets at night. The episodes also can be triggered by dependency of the limb, wearing socks, or tight shoes, and sometimes with the ingestion of alcohol or spicy foods 4. cold exposure (eg, standing on a cold floor) or immersion in ice water often relieves the flares

Stasis dermatitis

Venous ulceration in an area of lipodermatosclerosis

Atrophie blanche

Venous ulceration with stasis dermatitis, edema, and varicosities.

Lymphedema

1. Diagnosis 2. Associated lipid abnormality

1. Eruptive xanthomas 2. sever hypertriglyceridemia

Tuberous xanthomas

Tuberoeruprive/ Tuberous xanthomas

xanthelasma palpebrarum or xanthelasma

palmar xanthoma/ xanthoma striatum palmare

tuberoeruptive/tuberous xanthoma

1. Diagnosis 2. This may be seen in what type of dyslipidemia? 3. What is the associated defect?

1. xanthoma striatum palmare/ palmar xanthoma 2. Type III dyslipidemia 3. Apo E2/2 defect

1. Diagnosis 2. This may be seen in what type of dyslipidemia? 3. What is the associated defect?

1. Tendinous xanthoma 2. Type IIa (familial hypercholesterolemia or familial defective apolipoprotein B100) 3. LDL receptor or apoB defect

plane xanthoma

1. diagnosis 2. causative organism 3. Treatment options

1. Sporotrichosis. 2. Sporothrix schenckii, S. brasiliensis, Sporothrix brasiliensis, Sporothrix globosa, Sporothrix luriei, Sporothrix mexicana 3. Itraconazole, terbinafine, SSKI

1. diagnosis 2. causative organism 3. Treatment options

1. Mycetoma/ Maduromycosis/ Madura foot 3. Eumycetoma: * Ketoconazole 200 mg * Itraconazole 200 mg * Voriconazole 200 to 400 mg daily × several months Actinomycetoma: * Dapsone + streptomycin * Sulfamethoxazole-trimethoprim + rifampin or streptomycin

1. diagnosis 2. causative organism 3. Treatment options

1. Chromoblastomycosis (chromomycosis) 2. Fosecaea pedrosoi, Cladophialophora carrionii - MC causes Tretment options: * Itraconazole 200 mg once daily or * Terbinaﬁne 250 mg once daily or * IV amphotericin B (up to 1 mg/kg/day) * Treatment continued for several months, until clinical resolution

1. diagnosis? 2. causative agent 3. most common clinical manifestation of disease

1. **Cryptococcosis, disseminated**. 2. Cryptococcus neoformans and Cryptococcus gattii 3. meningoencephalitis

Hunterian chancre or ulcus durum primary stage of syphilis ## Footnote * The chancre starts as a dusky red macule that evolves into a papule and then a roundto-oval ulcer * ranges in diameter from a few millimeters to 2 cm and is sharply demarcated with regular, raised borders that are indurated, giving the lesion a cartilaginous feel. * The base is usually clean, and the chancre is classically painless.

Secondary syphilis lesions on palm and moth-eaten alopecia of secondary syphilis ## Footnote nonscarring alopecia

plantar lesions of secondary syphilis extending to the lateral aspect of the foot.

Annular plaques of secondary syphilis on the face, colloquially referred to as “nickels and dimes.”

what do you call confluence of mucous patches on the tongue in patients with secondary syphilis ? Mucous patches can be present elsewhere in the oral cavity, on other mucous membranes (such as on the genitalia), or at the corners of the mouth, where they appear as “split papules,” with an erosion traversing the center

plaques fauchée en prairie ## Footnote Mucous patches are teeming with spirochetes and, hence, highly infectious

1. Identify the lesion 2. What stage of syphilis is this observed

1. condyloma lata 2. secondary syphilis

1. identify the dental finding 2. this is seen in what condition?

1. Hutchinson teeth - The presence of small, notched, pegshaped upper incisors 2. late congenital syphilis

1. diagnosis 2. sign positive in this condition

1. smooth muscle hamartoma 2. pseudo-Darier sign (transient piloerection following rubbing)

Rudimentary polydactyly ## Footnote solitary nodular lesion at the ulnar site of the fifth finger since birth or early childhood

Superficial spreading melanoma,

lentigo maligna melanoma

amelanotic nodular melanoma

pigmented nodular melanoma

acral lentiginous melanoma

subungual melanoma

superficial spreading melanomas

Mucosal melanomas

Patch lesions of mycosis fungoides

mycosis fungoides

cutaneous T-cell lymphoma

Folliculotropic mycosis fungoides ## Footnote Note follicular localization and resulting hair loss. B, Outer root sheath of hair follicle is disrupted by T cells and mucin deposition, which leads to small cystic spaces.

Clue: Variant of Mycosis Fungoides

Pagetoid reticulosis ## Footnote * present with a solitary psoriasiform or hyperkeratotic patch or plaque, which is usually localized on the extremities and is slowly progressive * Unlike in classic MF, extracutaneous dissemination has not been observed. * shows** more prominent epidermotropism and nuclear pleomorphism** compared with unilesional MF, and more commonly shows a CD8+ phenotype * manifests more often as a **hyperkeratotic lesion.**

Granulomatous slack skin

1. diagnosis 2. Identify the triad of this syndrome

Sézary syndrome 1. diffuse erythroderma, 2. generalized lymphadenopathy, 3. circulating malignant T cells with cerebriform nuclei, so-called Sézary cells

clue: cutaneous lymphoma

Lymphomatoid papulosis

Lepromatous leprosy. Papules, nodules, and infiltration on the ear of a child. He had also many lesions on other parts of the skin

Lepromatous leprosy histoid or Wade leprosy. Presence of nodules, which may be disseminated or scattered, some resembling molluscum contagiosum lesions, as in the picture, but note the presence of a nodule on the right nipple, and also some infiltration with a claw formation on the left hand.

Lepromatous leprosy. Diffuse infiltration of the skin.

Leonine facies. Lepromatous patient with diffuse nodules and infiltration on the face, resulting in a lion’s face appearance.

Borderline-tuberculoid leprosy. Presence of various hypochromic annular lesions, with papules and infiltration on the periphery, located on the buttocks and thighs of a child.

Borderline-borderline leprosy. Two foveolar lesions on the upper dorsal thorax.

Borderline-lepromatous leprosy. Foveolar and nodular infiltrated lesions

Lagophthalmos on the right eye.

**Acute meningococcemia** may be accompanied by petechial lesions of the skin (A), mucous membranes and conjunctiva (B)

**Acute meningococcemia **with disseminated intravascular coagulation may produce purpura fulminans, characterized by retiform purpura and necrosis of the skin (A), which may progress to gangrene of the digits and distal extremities (B).

Green nail syndrome, or chloronychia ## Footnote Pseudomonas green nail syndrome often occurs in those with preexisting onycholysis, especially when frequently submerged in fresh water.

1. diagnosis? 2. etiologic agent

1. ecthyma gangrenosum 2. pseudomonas aeruginosa ## Footnote This patient with ecthyma gangrenosum has multifocal gunmetal gray, necrotic ulcers scattered across the suprapubic area with halos of erythema.

**Bacillary angiomatosis** may be solitary or multifocal, and feature angiomatous papules and nodules with smooth (A) or verrucous (B) surfaces that may ulcerate and occasionally bleed. (Image A, Reproduced from Claasens S, Schwartz IS, Jordaan HF, et al. Bacillary angiomatosis presenting with polymorphic skin lesions. IDCases. 2016;6:77-78; Image B

**Verruga peruana** features eruptive crops of angiomatous nodular and/or verrucous lesions, which may be pedunculated or sessile, ranging from red to purple and varying from a few millimeters to several centimeters in size.

1. diagnosis 2. causative agent 3. what are the pathognomonic cells seen in histopath?

1. **Rhinoscleroma** 2. Klebsiella rhinoscleromatis 3. Mikulicz cells - large vacuolated histiocytes containing K. rhinoscleromatis.

Porphyria Cutanea Tarda ## Footnote Characteristic skin lesions in PCT occur most commonly on the dorsal hands and are indistinguishable from those seen in other blistering cutaneous porphyrias (especially variegate porphyria) and pseudoporphyria. A, Blisters (short black arrow) often form after minor trauma, rupture to leave superficial ulcerations that may crust over (short white arrows) and leave atropic areas (long arrows) that heal slowly. B, Blisters are fragile, so often the only lesions present are chronic, such as erosions, crusts and scarring.

INVERSE PSORIASIS

Guttate Psoriasis This form of psoriasis has the strongest association to HLA-Cw6, 5 and streptococcal throat infection

Erythema elevatum diutinum

Typical pathognomonic papules of malignant atrophic papulosis (Degos disease) with a porcelainwhite center and an erythematous raised border.

Lichen Striatus

1. diagnosis 2. keratinocytes are rich in what substance? 3. stain that can highlight these

1. clear cell acanthoma. 2. Glycogen 3. Periodic Acid-Schiff ## Footnote Diastase sensitive

Chondrodermatitis Nodularis Helicis

1. Diagnosis 2. syndromic associations

1. Keratinocytic epidermal nevus 2. HRAS/FGFR3 mutation, Proteus syndrome and Type 2 segmental Cowden disease

**Nevus unius lateris,** a more extensive variant of keratinocytic epidermal nevi that is limited to one side of the body. ## Footnote Bilateral subtype is called ichthyosis hystrix

1. Diagnosis 2. Syndromic association

1. Inflammatory linear verrucous epidermal nevus (ILVEN) 2. CHILD syndrome (congenital hemidysplasia with ichthyosiform nevus and limb defects)

1. Diagnosis 2. MC benign neoplasm associated with it 3. MC malignant neoplasm associated with it 4. more than 90% harbor this mutation 5. Syndromes associated with it

1. Nevus Sebaceous (other sources: Nevus sebaceus) 2. Trichoblastoma and syringocystadenoma papilliferum 3. Basal cell carcinoma 4. HRAS mutation 5. Schimmelpenning syndrome and phakomatosis pigmentokeratotica

1. Diagnosis 2. potential regulator of follicular homeostasis that has been postulated to be defective in this condition

1. Nevus comedonicus 2. NEK9 kinase

1. Diagnosis 2. This lesion arise from what part of the hair follicle?

1. pilar cyst/ trichilemmal cyst 2. outer root sheath/ resembles the isthmic portion of the hair follicle

1. diagnosis 2. syndromic associations 3. Stuctures located on the cyst wall

1. Steatocystoma multiplex 2. Alagille syndrome and pachyonychia congenita type II 3. Sebaceous gland