Language of Dermatology Flashcards
Define External Medicine
Includes all coverings of the body which are directly exposed to the outside world including: skin, hair, scalp, nails, nailfolds, mucous, semi-mucous membranes
Internal and external factors affecting tissues exposed to the outside world
Internal: disease, infection, inflammation, allergy, neoplasms, other External: disease, infection, allergy, temperature, electromagnetic radiation, atmosphere
What is the value of labs in dermatology?
Not as useful as other in other medical disciplines and often unnecessary. Clinical abilities determines Dx and Tx
The complete morphological description of a skin lesion/condition must include the following 4 elements:
- Type of lesion (1* or 2*) 2. Color/shape/texture 3. Configuration 4. Distribution/location
Define primary lesion
Lesions that appear as a direct result of the pathologic process
What is a macule?
small spot, not palpable, <1 cm
What is a patch?
Large spot, not palpable, > 1 cm. A patch arises de novo or through coalescence of macules
What is a papule?
Small bump, superficial, elevated, less than 1 cm
What is a plaque?
Large pump, superficial, elevated, > 1cm A plaque arises de novo or as the result of coalescence of papules.
What is a nodule?
Has significant deep component, small bump, less than 1 cm
What is a tumor?
Significant deep component, large bump > 1 cm
(important to distinguish this use of ‘tumor’ from nondermatologic use describing neoplasms)
What is a vesicle?
small bubble, fluid-filled, usually superficial, less than 0.5 cm
What is a bulla?
Large bubble, fluid-filled, can be superficial or deep,
>0.5 cm (vesiculobullous lesions are almost always clinically important)
What is a pustule?
pus-containing bubble, often categorized according to whether or not the are related to hair follicles)
Compare follicular vs non-follicular pustules
Follicular: Infection and inflammation that involves one or more hair follicles. Generally indicative of a local infection. Divided into:
- folliculitis: superficial, generally multiple
- furuncle: deeper form of folliculitis
- carbuncle: ‘boil,’ deeper, multiple follicles coalescing
Non-follicular pustule: may indicate systemic infection
What is a cyst?
a sac containing fluid or semi-solid material (cells or cell products)
What is a wheal/hive?
Short-lived (<24 hrs), edematous, well circumscribed papules or plaques seen in urticaria
What is a burrow?
Small threadlike curvilinear papule that is virtually pathognomonic of scabies
What is a comedone?
Acne that is formed around follicles. Can be open (blackhead) or closed (whitehead)
What is atrophy?
Thinning of the epidermal or dermal tissue
What is a hypertrophic scar? What is a keloid?
hypertrophic scar: do not overgrow the original boundaries Keloids: Can extend beyond the original boundaries and are more chronic in nature
What is fibrosis/sclerosis?
dermal scarring/thickening reactions
What are petechia, purpura, ecchymosis?
red cells outside the vessel walls that are non-blanchable
What is telangiectasia?
dilated, superficial dermal vessels
What is a milium?
A small, superficial cyst containing keratin (usually less than 1 to 2 mm in size)
What is a secondary lesion?
Lesions that appear as a result of alteration or evolution of a primary lesion (e.g. from rubbing, scratching or necrosis)
What is a scale?
Accumulation or excess shedding of stratum corneum, very important characteristic in DDx since its presence implies that the epidermis is at least involved in the process; typically present in conditions with epidermal inflammation such as psoriasis, tinea, eczema
What is a crust?
dried exudate (e.g. blood, serum, pus) on the skin surface
What is excoriation?
loss of skin due to scratching or picking
What is lichenification?
an increase in skin lines/creases produced by chronic rubbing
What is maceration?
Raw, moist, wet tissue
What is a fissure?
A linear crack in the skin; often very painful
What is an erosion?
Superficial open wound with loss of epidermis or mucosa only. Usually heals without scarring.
What is an ulcer?
deeper open wound with partial or complete loss of dermis or submucosa, usually heals with scarring.
What is ‘papulosquamous’?
elevated lesions and scales. E.g. with psoriasis.
Example of a papulopustular lesion
Rosacea
Example of a muculopapular lesion
Certain drug eruptions, viral exanthemas (widespread rash)
Example of nodulocystic lesions
Severe acne
Example of noduloulcerative lesions
Deep fungal infections
What are the dermatologic terms for: red, purple
Red: erythematous Purple: violaceous
What does the term ‘pigmented’ mean in derm?
Brown, black, grey. Strictly speaking, any lesion that has color is pigmented but the concept of a pigmented lesion is often reserved for brown, black or grey.
Difference between hypopigmented and depigmented
Hypopigmented: decrease in normal brown, black Depigmented: total absence of normal brown, black (e.g. with vitiligo)
What does ‘yellow’ suggest in derm?
Presence of a lipid (e.g. xanthelasma, sebaceous hyerplasia) or jaundice
How do we describe the shape/texture of lesions in derm?
Describe the margins (well-demarcated? or poorly circumscribed?) Describe the number of sides, pattern. Describe the surface: smooth? rough?
Define the following: polygonal, targetoid, umbilicated, serpignious and verrucous lesions.
Polygonal: many-sided, as in a polygon
Targetoid: like a ‘bulls-eye’ as in erythema multiforme
Umbilicated: lesion with a central dell (e.g. molluscum contagiosum, varicella
Serpiginous??
Verrucous: warty-like surfuce texture
How do we describe the configuration of a lesion?
Linear, annular, arcuate (curved), polycyclic, reticulate (lacy, net-like), grouped, zosteriform/dermatomal (i.e. distributed along dermatomal lines)
How do we describe the distribution/location?
* Where is/are the lesion(s)?
* Flexural? extensor?
* symmetric?
* Localized, widespread or generalized?
* erythroderma: >90% of body is red and inflamed +/- scaling
What is alopecia?
Hair loss
What is Koebenerization/Koebner phenomenon?
typical lesions induced via scratching/trauma
What is pathergy?
Production of a pustule via minimal trauma.
History taking questions that are SPECIFIC to derm
Associated cutaneous symptoms: ask about pruritus, pain, other cutenous Ask about current skin care practices
What is involved in a cutaneous examination?
Looking at all skin including folds and interdigital webs
Which mucous and semi-mucous membranes do we examine?
Oral, external auditory meatus, conjunctiva, external nares, external genitalia and perianal region
Additional parts of the derm exam
Look at nails and nail apparatus Hair: including scalp, eyebrows, eyelashes, beard
What is the utility of a KOH microscopic exam?
Looks for dermatophytes and yeast
What is a Woods light?
Aka UVA, blacklight. Fluoresecence of erythrasma, vitiligo, tinea capitis
What is a dermoscope used for?
Evaluation of pigmented lesions
What do we use to look for scabies?
Scabies oil
What is a Tzanck smear used for?
For HSV, zoster and varicella
What is darkfield examination used for?
Syphilis
What is patch testing?
Done for cutaneous contact allergy- distinct from internal allergy testing performed by an allergist (scratch/prick test) for type I IgE hypersensitivity reactions
Name each of these lesions:
Name each of these:
