Lanigan office dermatology Flashcards by Briana Tillman

Macule:

Circumscribed, flat area of altered skin color, under 2 cm in diameter.

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Patch:

Circumscribed, flat
area of altered skin color,
≥2 cm in diameter.

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Papule:

A solid, elevated lesion (no visible fluid) up to 1 cm in diameter.

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Nodule:

A small, abnormal

mass of tissue.

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Plaque:

An elevated
area of skin ≥ 2 cm in
diameter.

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Pustule:

A small, elevated,
circumscribed elevated lesion
that contains purulent exudate.

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Abscess:

A localized collection

of pus.

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Cyst:

A closed epithelium-lined sac that contains liquid or semisolid material.

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Fluctuance:

Yielding to pressure so as to suggest that the lesion contains fluid.

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Wheal:

An evanescent rounded or flat-topped elevation in the skin that is edematous, and often erythematous. The shape may change and these lesions are usually pruritic (itchy).

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Vesicle:

Circumscribed
epidermal elevation in the
skin containing clear fluid,
under ½ cm in diameter.

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Bulla:

Circumscribed epidermal elevation in the skin containing clear fluid, > ½ cm in diameter.

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Open comedone

plug of keratin & sebum within a hair follicle, with a wide opening on the skin surface – “blackhead”.

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Closed comedone

keratin & sebum within
a dilated hair follicle,
with an opening that is
not widely dilated and may rupture – “whitehead”.

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Eschar:

A scab or dry crust.

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Nevus:

Circumscribed
malformation of the skin,
hyperpigmented or with
increased vascularity.

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Morbilliform:

Rash that
resembles the erythematous
maculopapular rash of
measles.

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Blanching:

A lesion that loses

all redness when pressed.

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Petechiae:

Non-blanching
pinpoint flat red spots due to
intradermal hemorrhage, under 3
mm diameter.

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Purpura:

Hemorrhage in the
skin or mucous membrane.
Non-blanching.

Seborrheic Keratosis

Benign papules or plaques
Velvety or waxy surface
“Stuck-on” appearance
No treatment needed

ABCDE’s of Melanoma:

A – Asymmetry
B – Border irregularity
C – Color variegation
D – Diameter >6 mm
E – Evolution

A 17-year-old girl with atopic dermatitis has had a worsening rash x 10 days. She has had increased pruritus x 2 weeks, and now has small painful areas within the involved skin. She has been using moisturizing lotion and triamcinolone ointment without improvement.
Physical exam is remarkable for eczematous plaques with scattered pustules on the trunk, arms, and legs.

What is the most likely cause of this pt’s acute flare?

A – Topical glucocorticoids
B – Escherichia coli infection
C – Staphylococcus aureus infection
D – Group A Streptococcus infection

Staphylococcal Superinfection

Staphylococcus is a common skin colonizer.
Scratching of the skin and breakdown of the skin barrier are may lead to infection from colonizing organisms.
Atopic dermatitis superinfection is most commonly due to Staphylococcus aureus.
Herpetic superinfection is also possible.

What are common locations for psoriasis?

What additional signs or symptoms could you see with this disease?

Scalp, elbows, knees, palms, soles.

Nail pitting, psoriatic arthritis

``` A 15-year-old boy presents with one large scaly patch x 2 weeks. He now has multiple smaller, pink, scaly patches on his back in a “Christmas tree” pattern. What is the diagnosis? ```

Pityriasis rosea Usually self-limited disease that doesn’t require treatment. Consider testing for syphilis in sexually active pts.

``` A 60-year-old man presents with a red, scaly rash on the face. What is the diagnosis? A – Atopic dermatitis B – Seborrheic dermatitis C – Tinea capitis D – Tinea versicolor ```

Seborrheic Dermatitis

A scaling, itchy, waxy red rash; most commonly affects the scalp (dandruff), but also the eyebrows, nasolabial folds, chin, and chest. Possibly an overreaction of the body to Malassezia yeasts that live on the skin. It is common in the elderly or immunosuppressed (especially in pts with HIV). Seborrhea usually does not respond to moisturizers only. Treat with OTC dandruff shampoos or topical ketoconazole cream.

``` A 6-year-old girl comes to your office with a ring-shaped rash. This is: A – Tinea versicolor B – Pityriasis alba C – Lichen planus D – Tinea corporis ```

Tinea Corporis | “Ringworm”

Pruritic, circular erythematous patch with a rim of scale. Usually caused by Trichophyton rubrum. May also be caused by Microsporum in patients with pet exposure. Risk factors: close contact in athletes, contact with animals, immunosuppression.

``` A truncal rash produced a dull yellow fluorescence under wood’s light. The patient’s rash became more prominent with sun tanning. This is: Cornyebacterium. Malassezia. Proprionobacterium. Acanthosis nigricans. ```

Malassezia. Scraping showing “Spaghetti and Meatballs” Tinea versicolor = worsens with Cushings, malnutrition or immunosuppression

``` A 47-year-old man is seen for 3 years of lesions on the scalp and cheeks. He has been treated with topical steroid without improvement. He denies any systemic symptoms. Medical history is unremarkable. Labs: ANA Positive (titer of 1:160) Anti-Ro/SSA antibodies Negative Anti-La/SSB antibodies Negative Anti-dsDNA antibodies Negative Anti-Smith antibodies Negative ```

Discoid Lupus

Localized violaceous red plaques on the face, scalp, and ears. Photosensitive. Chronic scarring & loss of pigmentation. Screen for SLE.

“Pearly” (translucent) telangiectatic papules, which may develop central erosion.

Basal cell carcinoma

Flesh-colored or pink, scaly macules or papules in sun-exposed areas.

Actinic keratosis

Red scaly papules, ulcers, or non-healing nodules on sun-exposed areas

Squamous cell carcinoma

Intertrigo

``` Erythema and fissures in skin folds Caused by heat, moisture, and/or friction More common in obese persons May be complicated by Candida Satellite lesions Treatment: Keep area clean & dry. May also use antifungal powder. ```

Herpes Zoster Ophthalmicus

Because the nasociliary branch innervates the globe, the most serious ocular involvement develops if this branch is affected by zoster. Involvement of the tip of the nose (Hutchinson's sign) is thought to be a predictor of ocular involvement. Urgent ophthalmology consult is indicated. Oral antivirals are also recommended (acyclovir, valacyclovir, or famciclovir).

``` A 13-year-old boy presents with a weeping, yellow-crusted rash around the nose and mouth. This likely represents: A – Impetigo B – Shingles C – Acne D – Erythroderma ```

Impetigo

Most common bacterial infection in children. It is highly contagious. Typically perinasal or perioral. Usually caused by Streptococcus pyogenes or Staphylococcus aureus (including MRSA).

``` Acne Vulgaris Which of the following is involved in acne? A – Corynebacterium diphtheriae B – Corynebacterium minutissimum C – Propionibacterium acnes D – Acinetobacter baumanni E – Arcanobacterium haemolyticum ```

Propionibacterium acnes

``` A 47-year-old man is evaluated for facial erythema. He states his face gets redder and stings when he is out in the sun, gets out of the shower, or drinks hot coffee. He notes that he gets pimples on his cheeks. Which of the following is the most likely diagnosis? A – Acute cutaneous lupus erythematosus B – Periorificial dermatitis C – Rosacea D – Seborrheic dermatitis ```

Rosacea

Chronic skin condition characterized by pink papules, pustules, erythema, and telangiectasias. (No comedones.) Bilateral symmetric distribution on the forehead, cheeks, nose, and chin. Pathogenesis unknown. Alcohol, sun exposure, heat, spicy food, exercise, and other triggers can increase facial erythema but do not cause rosacea.

``` A 23-year-old woman presents with this rash after a ski weekend. She reports that she skied during the day, stayed in a lodge, and used a hot tub there. What is the likely cause of her rash? A – Irritation from ski boots B – Hot tub use C – Bed bugs D – High-altitude dermatosis ```

hot tub use

Folliculitis

Bacterial folliculitis from hot tubs is caused by Pseudomonas aeruginosa. Nonbacterial folliculitis may be caused by friction, oils, or occlusion. Eosinophilic folliculitis is common in patients with AIDS, especially when starting antiretroviral tx.

Pseudofolliculitis

Caused by tightly curled hair on the face. Papules and pustules are seen to the side of follicles. Hair grows out of the side of the follicle & causes inflammation. Tx: antibiotics, glucocorticoids, changes in shaving habits, laser hair removal

``` A 31-year-old man presents with pain on swallowing. Exam findings include white stuff in the back of the mouth. This rash is caused by: A – Candida albicans B – Staphylococcus aureus C – Eosinophilia D – Herpes simplex viru ```

Mucocutaneous Candidiasis

Superficial fungal infection. May affect oral mucosa, anal area, or vulvovaginal area. White, adherent patches on exam.

``` guy with a bunch of wheals had a bee sting 10 minutes ago. He now has evidence of a (an): A. acquired C1 esterase deficiency. B. cholinergic urticaria. C. type 1 IgE reaction. D. vasculitis. E. chronic urticaria. ```

Type 1 IgE reaction

anaphylaxis vs anaphylactoid

Anaphylaxis = IgE mediated mast cell degranulation Anaphylactoid = Non-IgE degranulation (C5a, * CRH, thermal and mechanical stimuli, radiocontrast dyes, opoids, shellfish, etc.)