Kodas Flashcards by A Blake

elastosis perforans serpiginosa

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PRP

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CARP

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phytophotoderm

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TEN

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pityriasis lichenoides

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pityriasis lichenoides, PIH

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chronic GVHD

epidermal lichen planus-like changes on the posterior neck and upper aspect of the back

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lichen nitidus, isomorphic phenomenon

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Flaccid blisters and erosion as a result of a ruptured bulla

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pemphigus foliaceus

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synblepharon in cicatricial pemphigoid

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Chronic bullous disease of childhood

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Epidermolysis bullosa acquisita

IgG against NC1 domain of Type 7 collagen (anchoring fibrils)

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Darier’s

ATPA2 –> SERCA2 in endo reticulum*
typical seborrheic distribution of brown, keratotic papules*
also see: palmar pits; longitudinal red/white nail streaks w/”V “ notching; hard palate cobblestoning*

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Hailey Hailey

ATP2C1 –> hSPCA1 in Golgi

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DLE

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tumid lupus

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acute cutaneous lupus

presence of small erosions can aid in clinical ddx

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papulosquamous SCLE

Anti-Ro/SSA*
Complement deficiencies (C1, C2, C4)*
HLA-B8 and HLA-DR3 assoc*

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Bullous SLE

Ab to NC1 & NC2 domains of Type 7 collagen*
dramatic response to dapsone in a few days*

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Lymphocytic infiltrate of Jessner

CD8 predominance

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dermatomyositis

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mechanic's hands - dermatomyositis

Cuticular hypertrophy, splinter hemorrhages, periungual telangiectasias - dermatomyositis

relapsing polychondritis ## Footnote * autoab to Type 2 collagen* * HLA-DR4*

rheumatoid nodules

Still's disease ## Footnote * increased IL-1 production* * episodic high fevers + rash corresponding w/fever spikes*

morphea

linear morphea

Marked atrophy of subcutaneous structures, including bone - Parry Romberg Syndrome

Hemiatrophy of the tongue - Parry Romberg Syndrome

Early edematous phase of systemic sclerosis

The “salt and pepper” sign. Leukoderma with retention of perifollicular pigmentation in systemic sclerosis.

Hyperpigmented sclerotic plaques of nephrogenic fibrosing dermopathy ## Footnote *2-4 weeks post-gadolinium contrast exposure in pt w/AKI or CKD*

Scleral plaques in a patient less than 45 years of age - minor criterion for nephrogenic systemic fibrosis

disseminated GA

Necrobiosis lipoidica

Necrobiotic xanthogranuloma ## Footnote *in a patient with a paraproteinemia*

Cutaneous Crohn's disease

Sarcoidosis

* Sarcoidosis – lupus pernio* * note the notching of the nasal rim*

Langerhans cell histiocytosis ## Footnote *seborrheic dermatitis-like eruption with hemorrhage*

Juvenile xanthogranuloma

Benign cephalic histiocytosis

Multicentric reticulohistiocytosis

Xanthoma disseminatum, sclerotic form

Eruptive xanthomas due to hypertriglyceridemia

Xanthomas of palmar striae

plane xanthoma

Neutrophilic dermatosis

Sweet's syndrome

Behcet's

Erythema gyratum repens

Lupus miliaris disseminatus faciei

Fox-Fordyce disease

PCT

Hepatoerythropoietic porphyria ## Footnote *Hypertrichosis and severe scarring, resulting in clinical appearance similar to congenital erythropoietic porphyria*

Congenital erythropoietic porphyria ## Footnote *Vesicles, bullae, and crusts on sun-exposed areas*

Lichen amyloidosis ## Footnote *Keratotic, hyperpigmented plaques on the legs*

Acute hemorrhagic edema

strawberry gingiva of Wegener's

cutaneous PAN ## Footnote *Livedo reticularis of the abdomen and lower extremities with multiple small “punched out” ulcers*

Kawasaki disease ## Footnote *Lip erythema, fissuring, and bleeding*

Atrophie blanche from livedoid vasculopathy

Dissecting cellulitis of the scalp

Lichen planus pigmentosus of the face

Linear and whorled nevoid hypermelanosis

Subcutaneous fat necrosis

Transient neonatal pustular melanosis

Dermal melanosis

Membranous aplasia cutis with a subtle hair-collar sign

Neonatal herpes simplex virus

Congenital candidiasis

Lacy eruption on extensor arm of child with parvovirus B19 infection

Hand-foot-and-mouth disease

Gianotti-Crosti syndrome ## Footnote *Grouped red papules on leg of child with EBV infection*

McCune-Albright syndrome ## Footnote *Large, segmental café-au-lait macules with “coast of Maine” border*

Peutz-Jeghers

EB simplex, localized type ## Footnote *Note superficial blistering w/both intact bullae and denuded skin. Tends to be limited to palms/soles*

Recessive dystrophic epidermolysis bullosa in a neonate

LUMBAR (SACRAL) syndrome

Sturge-Weber syndrome ## Footnote *diffuse capillary hemangioma in the distribution of the ophthalmic, nasociliary, and maxillary branches of the trigeminal nerve*

Microcystic lymphatic malformation ## Footnote *irregularly-grouped, translucent, and red papules*

Cutis marmorata telangiectatica congenita

Pachyonychia congenita

hypohidrotic ectodermal dysplasia ## Footnote *Note the flat nasal bridge, depressed nasal tip, sparse hair (scalp, eyebrows, and eyelashes), peg-shaped teeth, full lips, and sebaceous hyperplasia.*

Trichorrhexis nodosa

Trichorrhexis invaginata in Netherton syndrome

acrodermatitis enteropathica

Cutis laxa / generalized elastolysis

Pseudoxanthoma elasticum

Goltz syndrome / focal dermal hypoplasia ## Footnote *(usually lethal in males - this one probably mosaic)*

von Recklinghausen's neurofibromatosis

axillary freckling / Crowe's sign in von Recklinghausen's neurofibromatosis

Facial angiofibromas in tuberous sclerosis

Periungual fibrous nodules (Koenen's tumors) in tuberous sclerosis

Incontinentia pigmenti

Progeria syndrome

Xeroderma pigmentosum

regularly-spaced giant melanosomes in the hair shaft of Chediak-Higashi syndrome

irregularly-spaced giant melanosomes in the hair shaft of Griscelli syndrome

Collodion baby

Lamellar ichthyosis phenotype of ARCI

Netherton Syndrome ## Footnote *Erythroderma, hypotrichosis, and areas with ichthyosis linearis circumflexa*

Conradi-Hünermann syndrome ## Footnote *pattern of scale along Blaschko's lines*

CHILD Syndrome ## Footnote *Unilateral erythema and scale with ipsilateral limb defects*

Conradi-Hünermann syndrome ## Footnote *Thick, psoriasiform scaling overlying erythema; also w/chondrodysplasia punctata*

Unna–Thost syndrome

Vohwinkel's ## Footnote *Mutilating keratoderma*

urticaria pigmentosa

Eczema herpeticum

Staphylococcal scalded skin syndrome

Erysipelas

Superficial infection of the skin with Pseudomonas

meningococcemia ## Footnote *stellate purpura with a central gunmetal-gray hue*

Secondary syphilis

Mycetoma (N. brasiliensis)

Bartonella henselae Warthin-Starry stain

Chromoblastomycosis

Histoplasmosis ## Footnote *PAS-positive intracellular yeast*

Blastomycosis ## Footnote *Direct microscopy: budding yeast w/wide fusion base*

Coccidioidomycosis

Coccidioidomycosis ## Footnote *giant cell containing small spherules*

Paracoccidioidomycosis

aspergillus

Zygomycosis (mucor)

Tungiasis

Smooth nodular cutaneous leishmaniasis

Leishmaniasis

Romaña sign in acute Chagas disease

seabather's eruption ## Footnote *larvae of Linuche unguiculata*

Cimex spp. (bedbugs)

Loxosceles reclusa (brown recluse spider)

Linear plaques, erythema, and edema following contact w/Portuguese man-of-war tentacles

porokeratosis

Porokeratotic eccrine ostial and dermal duct nevus ## Footnote *Markedly hyperkeratotic spines arise from dilated eccrine ostia*

Verrucous carcinoma

MAC

Leiomyoma

MF, tumor stage

Alopecia mucinosa

Lymphomatoid papulosis

Congenital dermatofibrosarcoma protuberans

Collagenomas

angiosarcoma

Seborrheic keratosis ## Footnote *milia-like cysts (white dots), comedo-like openings (black targetoid circles)*

Dermatofibroma ## Footnote *central white patch (asterisk) and subtle pigment network (arrows)*

Basal cell carcinoma ## Footnote *arborizing blood vessels, blue-gray blotches (asterisks), and ulceration (circle)*

Basal cell carcinoma ## Footnote *Leaf like areas (3 o'clock to 6 o'clock at periphery)*

Pyogenic granuloma ## Footnote *homogenous red color with red lacunae*

Keratoacanthoma ## Footnote *classic hairpin-shaped vessels (arrows), white background (hyperkeratosis of keratinizing tumor), central crust*

Pigmented Bowen's disease ## Footnote *well-circumscribed glomeruloid vessels (circle) with closely-packed tiny brown dots (arrows)*

Clear cell acanthoma ## Footnote *this pattern of dotted vessels is rather typical*

Typical acquired nevus

Reed nevus ## Footnote *classic starburst pattern (regular streaks at periphery of heavily pigmented and symmetric small macule)*

Acral nevus ## Footnote *parallel furrow pattern*

Acral melanoma ## Footnote *parallel ridge pattern*

Melanoma ## Footnote *annular-granular structures make up rhomboidal structures (arrow); confluent rhomboidal structures make up the gray pseudonetwork (circle)*

Melanoma ## Footnote *atypical pigment network (circle), irregular dots and globules (asterisks), irregular streaks (black arrows), irregular blotches (white arrows), blue-white structures centrally*

Trichodiscomas and fibrofolliculomas and acrochordons in Birt-Hogg-Dubé

HHT ## Footnote *multiple telangiectasias on tongue and lip*

Bullous diabeticorum

NLD

Pretibial myxedema

PXE ## Footnote *Lax skin and redundant folds on the anterior neck*

Pyoderma gangrenosum

pyostomatitis vegetans ## Footnote *erythematous oral mucosa with overlying yellow pustules*

scurvy ## Footnote *perifollicular purpura and follicular hyperkeratosis*

Bazex syndrome ## Footnote *nail dystrophy and erythematous to violaceous plaques*

erythema gyratum repens

Extramammary Paget disease

Increased lanugo hair on the nose and face of a man with underlying metastatic prostate cancer

necrolytic migratory erythema

NXG

paraneoplastic pemphigus

Large, thin, yellow-orange plaque in a patient with monoclonal gammopathy

Tripe palms ## Footnote * alone --\> lung CA* * + acanthosis nigricans --\> gastric CA*

epidermolytic ichthyosis

lymphocytoma ## Footnote *borrellia*

alternaria "beaver tail"

erythrasma

nevus sebaceous w/trichoblastomas

post-efudex reaction

pretibial myxedema

SCLE

SCLE w/secondary hemorrhage

SCLE

sarcoid

dissecting cellulitis

metastatic melanoma w/possible primary on back

BCC

zoster

sarcoid (lupus pernio)

psoriasis

sarcoidosis

antiphospholipidd syndrome

lichen planus

necrosis 2/2 vasculopathy from levamisole-contaminated cocaine

melasma

argyria

zoster

calciphylaxis

secondary excoriation

acute ACD

atypical mycobacteria w/sporotrichoid spread

koebnerized lichen planus

papular mucinosis

epidermal nevus

ACD to PPD

erythema migrans

lichen planus

acute ACD

psoriasis

pemphigus vulgaris

annular pustular psoriasis

bullous pemphigoid

cutaneous small vessel vasculitis

polyarteritis nodosa

cutaneous lymphoid hyperplasia

eruptive xanthomas

lichen planopilaris

linear morphea

erythema nodosum

pancreatic panniculitis

Small superficial melanoma asymmetry of color and structure, atypical network, and blue-white structures

Larger, thick melanoma prominant blue-white veil and few irregular black globules/areas

small facial melanoma in situ (lentigo maligna) typified by gray granules around hair follicles

Acral melanoma in situ characteristic parallel-ridge pattern

Melanoma in situ asymmetry of color/structure, atypical network, blue-white structures intermingled with dotted vessels

Melanoma 0.5 mm in depth atypical pigment network, blue-white structures

Melanoma 0.8 mm in depth asymmetry of color/structure, irregular dots and globules, blue-white structures, and peripheral irregular streaks

Melanoma 1.3 mm in depth blue-white veil, atypical vascular pattern (signs of increased tumor thickness); remnants of atypical pigment network and irregular brown globules

acquired nevus

congenital nevus

reed nevus

blue nevus

Small superficial melanoma asymmetry of color/structure, atypical network, blue-white structures, and irregular streaks at periphery

Large thick melanoma prominent blue–white veil *Combination of blue color + irregular black-brown dots, globules, and blotches is highly specific for thick melanoma*

Small facial melanoma in situ (lentigo maligna) gray color and rhomboidal structures

Melanoma in situ asymmetry of color/structure, atypical network, blue-white structures, irregular black dots and globules (at the upper side of the lesion)

Melanoma 0.5 mm thick atypical pigment network and regression structures (areas of pigment loss and bluish pepper-like granules corresponding to melanophages)

Melanoma 0.75 mm thick asymmetry of color and structure, atypical network, irregular streaks at the periphery, irregular dots and globules (upper side), and blue-white structures especially in center

Melanoma 0.9 mm thick. palpable area / blue-white veil (increased tumor thickness), irregular dots and globules (upper side), irregular streaks at periphery, and uneven brown to black pigmented areas (blotches)

acquired nevus

congenital nevus

reed nevus

pigmented BCC

Angiokeratoma red–black lacunae, well-demarcated roundish structures

dermatofibroma central white patch, peripheral delicate pseudo-network

amelanotic melanoma central ulceration, polymorphic vascular structures (combination of dotted + linear-irregular vessels), and milky-red color in background

Nodular basal cell carcinoma striking arborizing vessels

Spitz nevus dotted vessels and typical negative pigment network (reticular depigmentation) at periphery

Bowen disease clusters of glomerular vessels; in combination with superficial scales, are highly specific for the dx

Pigmented basal cell carcinoma typical leaf-like areas (islands of brown-gray) and blue-gray globules

Seborrheic keratosis typical milia-like cysts (white shining dots/globules) and comedo-like openings (black targetoid globules)

Angiokeratoma red-blue lacunae, well-demarcated roundish structures

dermatofibroma characteristic central white patch and peripheral delicate network

amelanotic melanoma polymorphic vascular structures, milky-red color in background

Nodular basal cell carcinoma arborizing vessels and blue-gray globules

Spitz nevus dotted vessels and typical reticular depigmentation

Bowen disease clusters of dotted/glomerular vessels + superficial scale

intradermal melanocytic nevus typical comma-shaped vessels

Clear cell acanthoma dotted vessels, linearly arranged as strings of pearls

Well-differentiated squamous cell carcinoma white keratin masses, white circles and clods, and polymorphic vessels

Molluscum contagiosum peripheral arborizing vessels superimposed on white background Amorphous yellow clods are typically seen in the center

Scabies characteristic “jet with contrail” structure, corresponding to anterior part of mite (arrow) and burrow behind it

psoriasis regular dotted vessels

lichen planus dotted vessels at the border of typical whitish lines and clods, which closely resemble Wickham striae found in oral mucosa

alopecia areata typical follicular yellow dots

infantile pustular psoriasis

periungual wart

zoster in V1 and V2 distribution

pemphigus vulgaris

bullous pemphigoid

epidermolytic ichthyosis

TEN

oculocutaneous albinism

cutaneous small vessel vasculitis

vitiligo

alopecia areata

TEN

albinism

insect bites

dermographism

atopic derm

prurigo simplex, prurigo nodularis, and angulated ulcerations

prurigo nodularis

pemphigoid nodularis

lichen simplex chronicus

Xerosis and scratching in a patient with ESRD undergoing hemodialysis

brachioradial pruritus

trigeminal trophic syndrome

Complex regional pain syndrome with scaling and erosions of the fingertips

prurigo nodularis superimposed on atopic derm

linear excoriations and xerosis

prurigo nodularis

Prurigo nodularis

Lichen simplex chronicus of scrotum

Xerosis and scratching in a patient with renal insufficiency undergoing hemodialysis

Extreme xerosis a/w pruritus in HIV-infected patient

Notalgia paresthetica

brachioradial pruritus

Trigeminal trophic syndrome

excoriations and scars in delusions of parasitosis

nail-biting and cuticle-picking

Trichotillomania

acne excoriee

Dermatitis artefacta

Non-suicidal self-injury

Bite fibroma from years of cheek chewing

Habit-tic deformity of the thumbnail

Dermatitis artefacta

Excoriation (skin-picking) disorder

scars from excoriation (skin-picking) disorder

annular psoriasis plaques

psoriasis

Palmoplantar psoriasis

psoriasis

Guttate psoriasis

Guttate psoriasis w/koebnerization

Guttate psoriasis w/sunburn-related koebnerization

Generalized pustular psoriasis

Annular pustular psoriasis

Pustulosis of the palms

Acrodermatitis continua of Hallopeau

Scalp psoriasis

Inverse psoriasis

Nail psoriasis

Psoriatic arthritis

keratoderma blennorrhagicum in reactive arthritis

Sneddon-Wilkinson disease (subcorneal pustular dermatosis)

Sneddon-Wilkinson disease (subcorneal pustular dermatosis) ## Footnote *significant overlap w/pustular psoriasis*

papulosquamous penile lesions in reactive arthritis

psoriasis

generalized pustular psoriasis

Annular pustular psoriasis

Sneddon-Wilkinson disease

Small plaque parapsoriasis

Large plaque parapsoriasis

PLEVA

PLC

PLC (can appear to overlap w/PLEVA)

PLC

Pityriasis rubra pilaris

Circumscribed juvenile PRP (type IV)

Pityriasis rosea

Follicular accentuation of pityriasis rosea in darkly pigmented skin

Pityriasis rosea

Granular parakeratosis involving the axilla ## Footnote *Coalescing brown papules w/hyperkeratosis, slight maceration*

Digitate small plaque parapsoriasis

PLEVA / PLC

PRP

Pityriasis rubra pilaris-like presentation in Wong variant of juvenile dermatomyositis

Pityriasis rosea

Inverse pityriasis rosea

Cowden's

steroid atrophy

poikilodermatous MF

chemo nails

erythroderma with desquamation

Ectropion in the setting of erythroderma

Psoriatic erythroderma

Erythroderma due to atopic dermatitis

Idiopathic erythroderma

Erythroderma due to pityriasis rubra pilaris

Erythroderma secondary to pityriasis rubra pilaris

erythroderma due to Sezary syndrome

Erythroderma due to pemphigus foliaceus

Erythroderma with desquamation

psoriasis ## Footnote *pitting and onycholysis w/proximal rim of inflammation*

Psoriatic erythroderma

Lichen planus

Koebnerization of lichen planus into the site of excision of saphenous vein

Lichen planus with postinflammatory hyperpigmentation

Annular lichen planus

Exanthematous lichen planus

Atrophic lichen planus of the lower extremities

Bullous lichen planus on the shin

Lichen planus pemphigoides

Hypertrophic lichen planus

Inverse lichen planus

Lichen planus pigmentosus – intertriginous variant

Lichen planopilaris

Linear lichen planus

Nail lichen planus

Oral lichen planus

Lichenoid drug eruption

lichen striatus

Lichen nitidus

Erythema dyschromicum perstans

Keratosis lichenoides chronica

Lichen striatus

Postinflammatory hypopigmentation in atopic dermatitis

Infantile atopic dermatitis on the extensor arms

Infantile atopic dermatitis

Flexural atopic dermatitis

atopic dermatitis

Chronic atopic dermatitis

severe atopic dermatitis

atopic dermatitis ## Footnote *Chronic papular lesions resulting from habitual rubbing and scratching in the setting of longstanding disease*

atopic dermatitis ## Footnote *Prurigo lesions presenting as firm, dome-shaped papules and nodules with central hemorrhagic crust*

nummular atopic dermatitis

Atopic cheilitis

Nipple eczema

Numerous punctate and a few linear excoriations in an area of papular eczema

Keratosis pilaris

infected hand dermatitis in a patient with atopic dermatitis

Pityriasis alba

Eczema herpeticum

Postinflammatory pigmentary alteration in atopic dermatitis

Infantile atopic dermatitis

Childhood atopic dermatitis

Atopic dermatitis in childhood exacerbated by Malassezia

Keratosis pilaris rubra

Severe chronic hand dermatitis in atopic dermatitis

Infantile seborrheic dermatitis

seborrheic dermatitis

inverse psoriasis

tinea cruris

candidiasis

erythrasma

granular parakeratosis

Darier's

cutaneous crohns

langerhans cell histiocytosis

extramammary paget

Asteatotic eczema

Id reaction due to ACD to nickel

Nummular dermatitis

Autosensitization dermatitis in venous ulceration

stasis dermatitis ## Footnote *microangiopathy and chronic inflammation*

stasis dermatitis

Dyshidrotic eczema

Juvenile plantar dermatosis

seborrheic dermatitis

Seborrheic dermatitis-like eruption due to dermatomyositis

Asteatotic eczema

Nummular dermatitis

dyshidrotic eczema

Infectious eczematous dermatitis

irritant dermatitis

candidiasis

psoriasis

Streptococcal perianal dermatitis

Bullous impetigo

Acrodermatitis enteropathica

langerhans cell histiocytosis

Allergic contact dermatitis

Chronic allergic contact dermatitis

chronic allergic contact dermatitis

Acute allergic contact dermatitis to shoes

Chronic allergic contact dermatitis to shoe

Acute vesiculobullous allergic contact dermatitis

Acute allergic contact dermatitis w/prominent edema

chronic allergic contact dermatitis

Allergic contact dermatitis due to aloe-containing cream

Allergic contact dermatitis due to cashew nut shell oil

eyelid dermatitis (ACD)

Allergic contact dermatitis to fragrance found in cologne

Allergic contact dermatitis to nickel

Allergic contact dermatitis to p-phenylenediamine in a temporary tattoo

Systemic contact dermatitis

Airborne contact dermatitis

Chronic allergic contact dermatitis leading to hand dermatitis ## Footnote *This golfer wore one leather glove and had + patch tests to potassium dichromate and a piece of his glove*

chronic allergic contact dermatitis ## Footnote *In this bowler, allergen was colophony contained within a tackifier*

Acute allergic contact dermatitis ## Footnote *Obvious edema of shaft plus subtle crusts of glans due to tiger balm*

Acute vesiculobullous allergic contact dermatitis ## Footnote *caused by the plant Grevillea which grows in Australia*

Acute vesiculobullous allergic contact dermatitis ## Footnote *due to compound benzoin tincture; note the geometric shape*

Chronic allergic contact dermatitis due to glutaraldehyde

Facial dermatitis due to nickel in cell phone ## Footnote *demonstrated by + dimethylglyoxime test*

Allergic contact dermatitis to neomycin

Allergic contact dermatitis to p-phenylenediamine in a temporary tattoo

Airborne contact dermatitis

Bilateral irritant contact dermatitis of the feet and ankles due to chronic occlusive footwear

Bilateral irritant contact dermatitis of the palms secondary to repeated contact with paint solvents

Irritant contact dermatitis of the hands due to chronic exposure to disinfectants

Irritant contact dermatitis lip-licking habit; note involvement of vermilion and cutaneous lips as well as perioral region

Allergic contact dermatitis to oxybenzone with involvement of the upper and lower lips

Moderately severe irritant contact dermatitis of the hands due to chronic exposure to disinfecting solutions and antiseptics

dyshidrotic (pompholyx) pattern of eczema ## Footnote *--\> allergic contact dermatitis to chromate found in cement and contact urticaria to latex gloves*

Cement burns ## Footnote *Ulcerations on the fingertips of a construction worker exposed to wet cement*

Fiberglass dermatitis

Positive prick test with commercial latex extract (L) ## Footnote *Histamine (H) and saline (C) controls are appropriately positive and negative*

Chloracne ## Footnote *primary ddx: folliculotropic MF*

Vibration White Finger * vasoconstriction & endothelial damage 2/2 to exposure to vibration @ 30 - 300 Hz (chainsaws, pneumatic tools)* * Associated transient loss of sensation; possible permanent finger neuropathy & pain in affected limb*

Stinging nettle (Urtica dioica) ## Footnote *Note trichomes on both stem and leaf surfaces*

Broken trichome from stinging nettle (Urtica dioica) ## Footnote *A bubble is visible where urticating chemicals are found (histamine, serotonin, acetylcholine)*

Microscopic appearance of glochids from Opuntia microdasys (prickly pear) ## Footnote *mechanical irritant*

Prickly pear (Opuntia ficus-indica)

Prickly pear (Opuntia ficus-indica) fruit ## Footnote *Fine spines and glochids are visible*

Bullous phase of phytophotodermatitis

Giant hogweed (Heracleum mantegazzianum) -- apiaceae ## Footnote *phytophotodermatitis*

Compound umbel of giant hogweed -- apiaciae ## Footnote *phytophotodermatitis*

Phytophotodermatitis

poison ivy

western poison oak

eastern poison oak

poison sumac

Shrub-type poison ivy

Climbing vine of poison ivy

Shrub-type poison ivy ## Footnote *Leaf trauma allows urushiol to reach surface, oxidize, and turn black*

Leaves and seeds of Ginkgo biloba ## Footnote *only the fresh seed covering contains the allergen, ginkgolic acid, which cross-reacts with urushiol*

Typical composite flower heads of members of the family Asteraceae (Compositae) ## Footnote *Allergens: sesquiterpene lactones*

Poison ivy (Toxicodendron radicans) dermatitis

Poison ivy dermatitis

Widespread erythema and edema a/w intense pruritus after carrying logs of poisonwood tree (Metopium toxiferum) of family Anacardiaceae

“Black-spot” poison ivy dermatitis ## Footnote *polymerized plant oleoresin*

Weed-whacker dermatitis - widespread spotted pattern

Airborne contact dermatitis ## Footnote *farmer from Gujarat, India allergic to sesquiterpene lactones in Parthenium hysterophorus*

chronic, lichenified, hyperkeratotic dermatitis caused by allergy to Peruvian lily and tulipalin

Wheals (urticaria)

Angioedema

Symptomatic immediate dermographism

Delayed pressure urticaria

Cold urticaria ## Footnote *Wheals developed after placement of an ice cube for 10 minutes, followed by rewarming*

Cholinergic urticaria after hot bath provocation * small, monomorphic wheals that are symmetrically distributed* * vs adrenergic: blanched vasoconstricted skin surrounding small pink* *wheals induced by sudden stress*

Urticarial vasculitis ## Footnote *Lesions look like spontaneous urticaria but last longer and may bruise*

Urticaria in a young child ## Footnote *This is sometimes misdiagnosed as EM d/t dusky centers - some clinicians call it urticaria multiforme. Unlike EM, central clearing can occur as lesions expand*

Urticaria

Erythema annulare centrifugum

Erythema annulare centrifugum, deep form

Erythema annulare centrifugum

urticaria

erythema marginatum (rheumatic fever)

Annular erythema of infancy

erythema migrans

Disseminated erythema migrans

erythema gyratum repens

Resolving pityriasis rubra pilaris ## Footnote *can resemble erythema gyratum repens*

EM - edematous/urticarial

EM - urticarial with central crusting

EM - erythematous plaques with dusky centers

EM - classic targetoid

EM - isomorphic response with crust formation

EM ## Footnote *the dusky or crusted centers help to differentiate from morbilliform drug eruption*

Mucosal involvement in EM major

Mucosal involvement in *mycoplasma-*associated EM major

Acute annular urticaria / urticaria multiforme in an infant (misdiagnosed as EM)

Mucosal involvement in SJS

Characteristic dusky red color of the early macular eruption in TEN

TEN

epidermal detachment of palmar skin in TEN

TEN

SJS/TEN

SJS/TEN ## Footnote *close-up of epidermal detachment, likened to wet cigarette paper*

TEN

sequelae of TEN ## Footnote *Symblepharon, erosion of lower lateral eyelid margin and sparse eyelashes; the patient also had entropion with an ingrowth of eyelashes and pebble-like scarring of facial skin*

sequelae of TEN ## Footnote *Larger irregular areas of hypopigmented scarring*

sequelae of TEN ## Footnote *Nail dystrophy: longitudinal ridging and fissuring, fragility, and distal notching*

early SJS

SJS/TEN

Childhood SJS secondary to TMP-SMX

TEN

resolving TEN

Methotrexate toxicity ## Footnote *Increased serum MTX levels 2/2 decreased renal excretion can cause epidermal necrosis*

Urticaria secondary to penicillin

Morbilliform (exanthematous) drug eruption induced by amoxillin

Morbilliform (exanthematous) drug eruption ## Footnote *lesions on lower extremities can become petechial or purpuric due to dependency*

Morbilliform (exanthematous) drug eruption induced by phenobarbital

DRESS due to carbamazepine

Serum sickness due to antithymocyte globulin

AGEP - secondary to cephalosporin

AGEP - secondary to amoxicillin

Iododerma

Neutrophilic eccrine hidradenitis

Fixed drug eruption

bullous fixed drug eruption

generalized bullous fixed drug eruption

fixed drug eruption

PIH after fixed drug eruption

Phototoxic reaction 2/2 methotrexate

Photolichenoid drug eruption due to HCTZ

Horizontal melanonychia due to 5-fluorouracil

Toxic erythema of chemotherapy due to cytarabine, with acral erythema involving plantar surface

Inflammation surrounding SK in pt receiving paclitaxel

Raynaud phenomenon and digital necrosis due to systemic bleomycin

flagellate erythematous urticarial plaques due to systemic bleomycin

Toxic erythema of chemotherapy (fludarabine + busulfan)

Papulopustular (acneiform) reactions to EGFR inhibitors

Papulopustular (acneiform) reaction to EGFR inhibitors

Exanthematous (morbilliform) reaction to lenalidomide with accentuation at sites of bortezomib injections

SJS/TEN overlap due to ipilimumab

Inflammation of AKs due to IV interleukin-2

Heparin-induced thrombocytopenia with thrombosis

Cutaneous discoloration due to amiodarone

Psoriasiform eruption due to TNF-α inhibitor

Local reaction to vitamin K injections

Exanthemaotus drug eruption due to a cephalosporin

Exanthemaotus drug eruption due to phenobarbital

AGEP 2/2 metronidazole

SJS

Bullous fixed drug eruption

Ulceration due to extravasation of doxorubicin

Papulopustular (acneiform) reaction to an EGFR inhibitor

Round to oval petechiae, \<3 mm in diameter

Solar (actinic) purpura in sites of actinic damage + trauma

Palpable purpura due to cutaneous small vessel vasculitis

Non-inflammatory (bland) retiform purpura and hemorrhagic bullae in DIC

Schamberg disease ## Footnote *oval yellow-brown patches containing pinpoint "cayenne pepper" petechiae*

Purpura annularis telangiectodes of Majocchi ## Footnote *1-3 cm annular plaques containing punctate petechiae/telangiectasias; may slowly expand*

Pigmented purpuric lichenoid dermatitis of Gougerot and Blum ## Footnote *Schamberg-like lesions + purpuric lichenoid papules*

lichen aureus

Pigmented purpuric lichenoid dermatitis of Gougerot and Blum

Granulomatous pigmented purpura

Schamberg disease ## Footnote *Discrete yellow-brown and -pink patches with superimposed petechiae*

stasis purpura ## Footnote *Petechiae superimposed on more diffuse hemosiderin deposits in venous HTN*

Purpura annularis telangiectodes of Majocchi ## Footnote *annular plaques w/cayenne pepper petechiae in border*

Eczematid-like purpura ## Footnote *often presents with pruritus*

Linear pigmented purpuric dermatosis ## Footnote *linear array of yellow-brown macules and patches w/superimposed petechiae and small, red-brown purpuric papules*

Hypergammaglobulinemic purpura of Waldenström

Mondor Syndrome of Superficial Thrombophlebitis ## Footnote * classically: anterolateral thoracoabdominal wall* * up to 10% have underlying breast carcinoma*

Linear pigmented purpura

Heparin necrosis at site of SQ heparin injection

retiform purpura of Type I cryoglobulinemia in multiple myeloma (IgG type)

Areas of necrosis within the areas of retiform purpura of Type I cryoglobulinemia in multiple myeloma (IgG type)

classic acral purpura of Type I cryoglobulinemia in multiple myeloma (IgG type)

Ecthyma gangrenosum ## Footnote *syndrome of occlusion by organisms (usually bacterial, classically pseudomonas) proliferating in adventitia of SQ blood vessels*

Livedo reticularis in cholesterol embolus

Livedo reticularis and retiform purpura in cholesterol embolus

Purpura of the digits in warfarin blue toe syndrome

Several irregularly shaped ulcers with eschars surrounded by retiform purpura, caused by cholesterol embolus

Protein C deficiency in an infant ## Footnote *cutaneous microvascular occlusion; presents hours to 5 days after birth and fatal if untreated*

warfarin necrosis

Antiphospholipid antibody syndrome

Antiphospholipid antibody syndrome with atrophie blanche-like scarring

livedo racemosa in Sneddon Syndrome ## Footnote *neurocutaneous syndrome w/persistent and usually widespread livedo racemosa, labile hypertension, and CNS disease*

Livedo racemosa ## Footnote *Sneddon syndrome; also AR adenosine deaminase 2 deficiency*

Livedoid vasculopathy ## Footnote *primary idiopathic OR secondary to vascular / thrombotic disease*

Malignant atrophic papulosis / Degos disease ## Footnote *rare, chronic, thrombo-obliterative vasculopathy --\> erythematous papules with central porcelain-white atrophy and surrounding teleangiectatic rim; + GI and CNS involvement*

retiform purpura and necrosis with livedo reticularis in the setting of intravascular B-cell lymphoma

Cutaneous small vessel vasculitis

Cutaneous small vessel vasculitis, targetoid form

Cutaneous small vessel vasculitis with hemorrhagic vesicles

Cutaneous small vessel vasculitis with annular morphology

Cutaneous small vessel vasculitis

Cutaneous small vessel vasculitis with morbilliform appearance

Cutaneous small vessel vasculitis a/w Sjogren's

Cutaneous small vessel vasculitis a/w RA

Cutaneous small vessel vasculitis a/w relapsing polychondritis with myelodysplasia

Cutaneous small vessel vasculitis a/w *strep mitis* endocarditis

Henoch-Schonlein purpura / IgA vasculitis

vesiculobullous variant of Henoch-Schonlein purpura / IgA vasculitis

Henoch-Schonlein purpura / IgA vasculitis

Acute hemorrhagic edema of infancy (CSVV)

Urticarial vasculitis

Erythema elevatum diutinum ## Footnote *immune complex deposition*

Erythema elevatum diutinum

Erythema elevatum diutinum, late-stage

Cryoglobulinemic vasculitis

Microscopic polyangiitis ## Footnote *no granulomas*

PG-like ulcer in granulomatosis with polyangiitis (Wegener's)

tongue ulceration in granulomatosis with polyangiitis (Wegener's)

subungual infarcts in granulomatosis with polyangiitis (Wegener's)

palpable purpura in granulomatosis with polyangiitis (Wegener's)

palpable purpura in eosinophilic granulomatosis with polyangiitis (Churg–Strauss)

purpuric (vasculitic) palmar plaques in eosinophilic granulomatosis with polyangiitis (Churg–Strauss)

crusted papules in eosinophilic granulomatosis with polyangiitis (Churg–Strauss)

retiform purpura in systemic polyarteritis nodosa

nodules and livedo racemosa in cutaneous polyarteritis nodosa

livedo reticularis in cutaneous polyarteritis nodosa

Temporal arteritis

digital cutaneous small vessel vasculitis

Granuloma faciale (w/eosinophilia)

papuloerythroderma of Ofuji ## Footnote *a/w malignancy (especially T-cell lymphoma and gastric carcinoma)*

Wells syndrome / eosinophilic fasciitis

Sweet syndrome

Sweet syndrome, pseudocellulitic

Sweet syndrome with pseudomammillated plaques

Sweet syndrome – ocular involvement

Neutrophilic dermatosis of the dorsal hands ## Footnote *Clinically and histologically, there is overlap with Sweet syndrome and bullous PG*

Bullous pyoderma gangrenosum

Pyostomatitis vegetans in ulcerative colitis

vegetative PG following skin trauma

Pyoderma gangrenosum

pustular/nodular pyoderma gangrenosum

inflammatory pyoderma gangrenosum

pyoderma gangrenosum

healing pyoderma gangrenosum with cribriform scarring

Peristomal pyoderma gangrenosum

postsurgical pyoderma gangrenosum

Pyoderma gangrenosum in a patient with PAPA syndrome

Behcet disease

pathergy in Behcet disease (IV site)

Iritis and cutaneous pustular vasculitis in Behcet disease

Bowel-associated dermatosis-arthritis syndrome

Sweet syndrome

Pathergy in a patient with pyoderma gangrenosum (IV site)

Sweet syndrome

Neutrophilic dermatosis of the dorsal hands

pyoderma gangrenosum

Peristomal pyoderma gangrenosum

Behcet disease

Bowel-associated dermatosis-arthritis syndrome

Onychotillomania w/physiologic melanonychia

DSAP

pesudocyst of auricle

periungual fibromas (TS)

trigeminal trophic syndrome

acquired acrodermatitis enteropathica

keloid

ochronosis

fungal melanonychia

Darier's

multicentric reticulohistiocytosis

Pemphigoid gestationis

Polymorphic eruption of pregnancy

Pemphigoid gestationis – histologic features of early lesion Focal subepidermal vesicle, superficial and mid-dermal perivascular and interstitial mixed inflamm infiltrate. Eos seen w/i blister cavity and epidermis.

Pemphigoid gestationis – DIF Linear deposits of C3 along BMZ

Polymorphic eruption of pregnancy – histologic features. In this early lesion: superficial and deep perivascular and interstitial lymphohistiocytic infiltrate w/i dermis. Also w/numerous eos.

Intrahepatic cholestasis of pregnancy Marked pruritus leads to secondary skin lesions that vary based on disease duration--subtle linear excoriations and prurigo simplex early on

Intrahepatic cholestasis of pregnancy Marked pruritus leads to secondary skin lesions that vary based on disease duration--pronounced prurigo nodularis

Atopic eruption of pregnancy

Well-demarcated linea nigra in a patient with polymorphic eruption of pregnancy

Palmar erythema (physiologic in pregnancy)

Gingival pyogenic granuloma (physiologic in pregnancy)

Pemphigoid gestationis

Pemphigus vulgaris sera containing anti-desmoglein 3 (anti-Dsg3) IgG alone stain the cell surfaces in the lower epidermis.

Pemphigus vulgaris sera containing both anti-Dsg3 IgG and anti-Dsg1 IgG stain the cell surfaces throughout the epidermis.

Pemphigus foliaceus sera, which contain only anti-Dsg1 IgG, stain cell surfaces throughout the epidermis, but more intensely in the superficial layers

Pemphigus vulgaris – oral involvement

Pemphigus vulgaris

Pemphigus vulgaris -- rare dyshidrosiform variant

Pemphigus vegetans

Pemphigus foliaceus

Pemphigus foliaceus -- cornflake scale

Pemphigus erythematosus. Erythematous plaques with scale-crust and erosions on the nose and malar area of the face

Paraneoplastic pemphigus ## Footnote *characteristic clinical feature: severe intractable stomatitis w/multiple erosions; may resemble erosive oral lichen planus*

paraneoplastic pemphigus

IgA pemphigus – subcorneal pustular dermatosis type

Pemphigus vulgaris Blisters show suprabasilar acantholysis with a few acantholytic cells in the blister cavity

Pemphigus vulgaris ## Footnote *Blisters in the mouth rarely remain intact, so blister roof is often not seen. Diagnosis can be made by the location of the split w/i epithelium, presence of acantholytic cells, and “tombstone” basal cells*

Pemphigus foliaceus ## Footnote *B/c of blister fragility, roof may become detached. The split is in the upper spinous layer of epidermis and acantholytic cells are readily apparent.*

Paraneoplastic pemphigus ## Footnote *Areas of suprabasilar acantholysis as well as interface dermatitis w/basal cell vacuolar change, necrotic keratinocytes, and lymphocytes w/i epidermis*

IgA pemphigus ## Footnote *Intraepidermal pustule w/neutrophils subcorneally in the subcorneal pustular dermatosis type (A), and w/i entire epidermis in intraepidermal neutrophilic type (B)*

Bullous pemphigoid

Bullous pemphigoid – urticarial presentation

Bullous pemphigoid – eczematous presentation

Bullous pemphigoid – nonspecific lesions d/t pruritus

dyshidrosiform BP

pemphigoid vegetans

TEN-like BP

Childhood bullous pemphigoid

Bullous pemphigoid localized to a psoriatic plaque

Urticarial phase of bullous pemphigoid Eos in dermis + epidermis (eosinophilic spongiosis) Some eos lined up @ DEJ, which is a typical finding in urticarial stage of BP

Bullous pemphigoid ## Footnote *Subepidermal blister containing fibrin, eos, and mononuclear cells*

IIF of BP ## Footnote *Circulating IgG autoantibodies bind to epidermal side (roof ) of salt-induced split (arrows); artificial separation indicated by asterisk*

IgG autoantibodies in EBA, anti-laminin γ1 pemphigoid (AKA anti-p200 pemphigoid), and certain forms of MMP (Ab to laminin 332) react w/dermal side (floor) of blister (arrows)

Mucous membrane (cicatricial) pemphigoid ## Footnote *Desquamative gingivitis w/erythema and erosions of gingival margins. Note sloughing of mucosa w/shaggy margins*

Mucous membrane (cicatricial) pemphigoid ## Footnote *Chronic erosions on hard palate w/irregular borders; sloughing of mucosa superiorly*

MMP progression ## Footnote * A. Erosion/erythema of lower medial eyelid margin + scale-crust of inner canthus & lower eyelid* * B. 3mo later: ectropion & thickening of the lower eyelid + erosions* * C. 6mo later: smaller erosions but + scarring and milia* * D. 7yr later: more scarring w/significant shortening of inferior fornix d/t symblepharon*

MMP ## Footnote *Typical ocular involvement: fibrous tracts, rep. partial or incomplete symblepharon*

MMP, Brunsting–Perry variant ## Footnote *Crusted erosion on the lower cheek within an oval area of inflammation and scar*

MMP, Brunsting–Perry variant ## Footnote *Involvement of scalp w/scarring and atrophy resulting in alopecia*

Epidermolysis bullosa acquisita – mechanobullous presentation ## Footnote *Milia and scarring that favor sites of trauma overlying joints, a/w skin fragility*

Epidermolysis bullosa acquisita – inflammatory bullous pemphigoid-like presentation

Epidermolysis bullosa acquisita – oral involvement

Bullous pemphigoid – progression of disease

Bullous pemphigoid

urticarial BP

eczematous BP

MMP

MMP w/scalp involvement

Dermatitis herpetiformis

Dermatitis herpetiformis ## Footnote *Subepidermal clefts; collections of neuts w/i dermal papillae. Scattered eos.*

Dermatitis herpetiformis, DIF ## Footnote A. Granular IgA deposition along DEJ of normal-appearing skin adjacent to lesion B. Granular deposition of epidermal transglutaminase (TG3) w/i dermal papillae, which co-localizes w/IgA

Linear IgA bullous dermatosis

Linear IgA bullous dermatosis, DIF ## Footnote *linear pattern of IgA present perilesionally*

Drug-induced linear IgA bullous dermatosis

Linear IgA bullous dermatosis

Linear IgA bullous dermatosis *Subepidermal blister filled w/neuts**. Neuts & few eos also present w/i underlying dermis*

Linear IgA bullous dermatosis

localized EB simplex

Generalized intermediate epidermolysis bullosa simplex

Dominant dystrophic epidermolysis bullosa

Acral peeling skin syndrome

Generalized severe epidermolysis bullosa simplex

Generalized severe junctional epidermolysis bullosa

Dystrophic epidermolysis bullosa, pruriginosa

Generalized severe recessive dystrophic epidermolysis bullosa

Large squamous cell carcinoma on the ankle of a yougman with generalized severe recessive dystrophic epidermolysis bullosa

Large acquired melanocytic nevus at a site of blistering in a teenager with junctional epidermolysis bullosa

Skin fragility-ectodermal dysplasia syndrome due to plakophilin 1 deficiency

SAVI (STING-associated vasculopathy w/onset in infancy). ## Footnote *This vasculopathic genetic disorder can result in digital resorption resembling that of recessive dystrophic EB*

Kindler syndrome ## Footnote *Poikiloderma of the face and neck with “skip” areas*

Kindler syndrome ## Footnote *Erythema and atrophy on the dorsal hand*

Kindler syndrome ## Footnote *Wrinkling d/t atrophy and fusion btwn 4th & 5th toes. This pt also had ectropion and urethral strictures.*

Generalized severe epidermolysis bullosa simplex

Skin fragility-ectodermal dysplasia syndrome due to plakophilin 1 deficiency

Palmar keratoderma in skin fragility-ectodermal dysplasia syndrome due to plakophilin 1 deficiency

Bullosis diabeticorum ## Footnote *Note the absence of erythema or edema in the surrounding tissue*

Coma bullae ## Footnote *Blisters developed in an area of pressure in a previously comatose patient*

Neurologic blisters Tense blisters on dorsal fingers on the hemiplegic side in a patient with hx CVA

Bulla due to prolonged immobilization ## Footnote *Following a hip fracture, pt was immobilized on the floor for 2 days. Detection of characteristic sweat gland necrosis aided in dx*

Bullous variant of cutaneous small vessel vasculitis

Ofloxacin-induced linear IgA bullous dermatosis

Bullous insect bite reaction

Exaggerated insect bite-like reactions in a patient with chronic lymphocytic leukemia

Edema bullae on the thigh of an infant

Bullous bug bite reaction ## Footnote *In addition to intense papillary dermal edema, there is a prominent perivascular mononuclear cell infiltrate in the upper and mid dermis. Note the basket-weave pattern of the stratum corneum, suggesting an acute process*

Fracture blisters

Friction blisters ## Footnote *Tense blisters that developed on the shin of the author after continuous rubbing against a ski boot*

Bullous variant of cutaneous small vessel vasculitis