RASH Flashcards
– flat lesion ,usually a circumscribed change of colour
Macule
a broad papule, or confluence of papules, plateau-like lesion that is greater in its diameter than in its depth.
Patch
– small , solid, elevated lesion
Papule
– a lesion slightly raised over a larger area
Plaque
– a large , solid , palpable and elevated lesion
Nodule –
– an elevated lesion ,fluid filled
Blister
– depressed lesion with loss of surface epithelium
Ulcer
– non raised red-brown non blanchable lesions
Petechiae
a circumscribed, fluid-containing, epidermal elevation generally considered less than either 5 or 10mm in diameter at the widest point
Vesicles-
-a rounded or irregularly shaped blister containing serous or seropurulent fluid, equal to or greater than either 5 or 10mm
Bulla
are flat-topped, palpable lesions of variable size, duration, and configuration that represent dermal collections of edema fluid.
Wheals
-consist of compressed layers of stratum corneum cells that are retained on the skin surface
Scale
____ involve focal loss of the epidermis, and they heal without scarring.
Erosions
_______ extend into the dermis and tend to heal with scarring.
Ulcers
______consist of matted, retained accumulations of blood, serum, pus, and epithelial debris on the surface of a weeping lesion.
Crust
____________is a thickening of skin with accentuation of normal skin lines that is caused by chronic irritation (rubbing, scratching) or inflammation
Lichenification
_________ -Ulcerated lesions inflicted by scratching are often linear or angular in configuration
Excoriation
___ - dermal thickening causing the cutaneous surface to feel thicker and firmer.
Induration
__________ - refers to a loss of tissue, and can be epidermal, dermal, or subcutaneous. With epidermal atrophy, the skin appears thin, translucent, and wrinkled.
Atrophy
___________ - softening and turning white of the skin due to being consistently wet.
Maceration
_______ is a flat lesion; it is not elevated and it is not depressed ,it is a different color than the surrounding normal skin.
White, brown, and red are the most common color changes
appear in many shapes.
macule
When a macule is larger than 5mm in diameter, it is called
a patch.
A freckle is an example of a
a macule
papule
is a small, solid, elevated skin lesion less than 0.5cm in diameter.
The top can be flat, pointed, or rounded.
seen in many skin diseases, including acne, fungal infections, and lichen planus.
papule
PUSTULE
is a small elevation of the skin containing cloudy or purulent material usually consisting of necrotic inflammatory cells.
These can be either white or red.
PUSTULE
vesicle
is a small fluid-filled blister
Less than 5 mm in size
vesicle
BULLA
- fluid-filled blister more than 5 mm (about 3/16 inch) in diameter with thin walls.
bulla
are caused by splitting or cracking
Fissures
An ________ is a discontinuity of the skin exhibiting incomplete loss of the epidermis a lesion that is moist, circumscribed, and usually depressed
erosion
An_____ is a discontinuity of the skin exhibiting complete loss of the epidermis and often portions of the dermis and even subcutaneous fat.[
ulcer
PETECHIAE
petechiae
one to two mm in size
These are less than 0.5 cm even in the later stages of the disease.
At any stage, they do not have a diameter of more than 3 mm.
PETECHIAE
purpura
A hemorrhagic area in the skin.
The area of bleeding within the skin
is greater than 3 millimeters in diameter
Early type is red and becomes darker, then purple, and brown-yellow as it fades.
It does not blanch when touched.
Purpura
ex. immune thrombocytopenic purpura and Schonlein-Henoch purpura.
Ecchymoses
A macular red or purple hemorrhage in skin or mucous membrane more than 2 mm in diameter.
Ecchymosis
Note: Ex. Dissiminated intravascular coagulopathy
_____________ typically presents in term neonates aged 3 days to 2 weeks
The pustules from below the stratum corneum or deeper in the epidermis and represents collection of eosinophils that also accumulate around the upper portion of pilosebaceous follicle
It is a is a benign self-limited eruption occurring primarily in healthy newborns in the early neonatal period.
It is characterized by macular erythema, papules, vesicles, and pustules, and it resolves without permanent sequelae
Erythema toxicum neonatorum (ETN)
________ – a superficial epidermal inclusion cysts that contain laminated keratinized material
Lesion is firm papule, 1-2mm in diameter and pearly opalescent white
Milia
inflammation of the upper layers of the skin, causing itching, blisters, redness, swelling, and often oozing, scabbing, and scaling
Known causes include contact with a particular substance, certain drugs, constant scratching, and fungal infection
DERMITITIS
skin inflammation caused by direct contact with a particular substance
rash is confined to a specific area, and often has clearly defined boundaries
CONTACT DERMATITIS
CONTACT DERMATITIS
CONTACT DERMATITIS
–
◦accounts for 80% of all cases of contact dermatitis
◦ occurs when a chemical substance causes direct damage to the skin
◦ symptoms are more painful than itchy
◦ Typical irritating substances are acids, alkalis (such as drain cleaners), solvents (such as acetone in nail polish remover), strong soaps, and plants (such as poinsettias and peppers)
Irritant Contact Dermatitis
◦Example diaper dermatitis
–
◦is a reaction by the body’s immune system to a substance contacting the skin.
◦substances found in plants such as poison ivy, rubber (latex), antibiotics, fragrances, preservatives, and some metals (such as nickel and cobalt)
◦ People may use (or be exposed to) substances for years without a problem, then suddenly develop an allergic reaction.
Allergic Contact Dermatitis
–
◦results only after a person touches certain substances and then exposes the skin to sunlight
◦Such substances include sunscreens, aftershave lotions, certain perfumes, antibiotics, coal tar
**Photoallergic or Phototoxic Contact Dermatitis **
Photoallergic or Phototoxic Contact Dermatitis
______ can be used to determine the cause of dermatitis (small patches containing substances that commonly cause dermatitis are placed on the skin for 1 to 2 days to see whether a rash develops beneath one of them)
Patch testing
chronic, itchy inflammation of the upper layers of the skin
Infants may develop red, oozing, crusted rashes on the face, scalp, diaper area, hands, arms, feet, or legs
ATOPIC DERMATITIS
ATOPIC DERMATITIS
Diagnosis – typical pattern of rash
(+) family history of allergy
(+) history of asthma, food allergy
Cows milk allegy
Atophic march
ATOPIC DERMATITIS
Treatment
◦Avoiding contact with substances known to irritate the skin or foods that the person is sensitive to skin should be kept moist
◦emoillients
◦Specific treatments include applying a corticosteroid ointment or cream, immune system-modulating drug such as tacrolimus
◦For severe cases, the immune system can be suppressed with cyclosporine
is chronic inflammation that causes yellow, greasy scales to form on the scalp and face and occasionally on other areas.
The cause is unknown.
occurs most often in infants, usually within the first 3 months of life
more common among males, often familial, and is worse in cold weather
Seborrheic Dermatitis
Seborrheic dermatitis
usually begins gradually, causing dry or greasy scaling of the scalp with itching but without hair loss.
In more severe cases, yellowish to reddish scaly pimples appear along the hairline, behind the ears, in the ear canal, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.
SEBORRHEIC DERMATITIS
In infants younger than 1 month of age, seborrheic dermatitis may produce a thick, yellow, crusted scalp rash (cradle cap) and sometimes yellow scaling behind the ears and red pimples on the face.
seborrheic dermatitis
________________is characterized by joined patches of erythema and scaling mainly seen on the convex surfaces, with the skin folds spared
Generic rash or irritant diaper dermatitis (IDD)
DIAPER DERMATITIS
Some insects inject formic acid which can cause an immediate skin reaction often resulting in redness and swelling in the injured area
Itching, painful and may stimulate a dangerous allergic reaction called anaphylaxis for at-risk patients
INSECT BITES AND STINGS
inflammation on the lower legs from pooling of blood and fluid
It tends to occur in people who have varicose (dilated, twisted) veins and swelling (edema).
STATIS DERMATITIS
STASIS DERMATITIS
Characterized by itchy blisters on the palms and sides of the fingers and sometimes on the soles of the feet.
Also called dyshidrosis, which means “abnormal sweating”
Unknown cause
fungal infection, contact dermatitis, or stress may be a factor as well as some ingested substances such as nickel, chromium, and cobalt.
The blisters are often scaly, red, and oozing.
Pompholyx comes and goes in attacks that last 2 to 3 weeks.
POMPHOLYX
POMPHOLYX
Wet compresses with potassium permanganate or aluminum acetate (Burow’s solution) may help the blisters resolve.
Strong topical corticosteroids, tacrolimus
phototherapy
is an itchy rash that is often worsened with bathing or at night.
It is spread by close bodily contact such as sleeping together or sharing of clothing.
Mites can survive for several days in clothes, bedding, and dust
SCABIES
What is the etiololic agent of scabies?
It is caused by a mite (Sarcoptes scabiei) that burrows beneath the top layer of skin.
SCABIES
is a viral infection of the skin or occasionally of the mucous membranes
Caused by a DNA poxvirus
most common in children aged one to ten years old.[
Their lesions are flesh-colored, dome-shaped, and pearly in appearance.
They are often 1–5 millimeters in diameter, with a dimpled center.
Molluscum contagiosum
MOLLUSCUM CONTAGIOSUM
MOLLUSCUM CONTAGIOSUM
Very common superficial infection of the skin.
It can be divided into non-bullous and bullous forms.
>The non-bullous types represent about 70%.
◦The infecting organism is usually Staphylococcus aureus or a beta-haemolytic streptococcus
◦Usually the predisposing factor is a breach of the skin
>bullous impetigo may affect intact skin and is almost invariably caused by S. aureus.
It is more common in hot areas where sweating can macerate the skin
IMPETIGO
usually start as tiny pustules that evolve rapidly into honey-coloured crusted plaques
◦Usually on exposed areas of the face and extremities where bites, abrasions, lacerations, scratches, burns or trauma have occurred.
◦It spreads rapidly.
◦There is little or no surrounding erythema or edema.
◦ Regional lymph nodes are often enlarged.
NON-BULLOUS LESION
have a thin roof and tend to rupture spontaneously.
◦They are usually on the face, trunk, extremities, buttocks, or perineal regions.
◦They are more likely to occur on top of other disease
◦There is little erythema
◦Usually no regional lymphadenopathy
BULLOUS TYPE OF LESION
This is a variant of Bullous type
superficial, intraepidermal, vesiculopustular infection (and the most common skin infection in children).
Impetigo contagiosa
Impetigo contagiosa
_______is a toxin-mediated erythroderma and involves the sloughing off of the epidermal layer of the skin.
Bullous impetigo
This term is usually applied to infection occurring in pre-existing wounds.
Impetigo can also present as folliculitis, which is considered to be impetigo of the hair follicles caused by S. aureus.
Common impetigo
COMMON IMPETIGO
is a deeper, ulcerated impetigo infection, often occurring with lymphadenitis.
The infection is caused by group A streptococci or Staphylococcus aureus.
ECTHYMA
ECTHYMA
__________ is a distinctive dermatological eruption featuring iris or target lesions.
The minor form is an acute, self-limiting disease that affects the skin but mucous membranes little
The major form has more involvement of both skin and mucosa and is a potentially life-threatening condition.
Erythema multiforme (EM)
NOTE :
It is considered by some as being part of a spectrum of disease which includes, in order of severity, EM,Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
A common cause of erythema multiforme (EM) is ___________
Other infections have also been implicated, ranging from viruses (for example, measles, mumps, adenoviruses and influenza) to bacterial infections (for example, pneumonia, syphilis and typhoid).
It is associated with a number of infections, including streptococcus, tuberculosis and BCG immunization
herpes simplex infection
there may be no prodrome or a mild upper respiratory tract infection.
◦The rash starts abruptly, usually within 3 days. It starts on the extremities, being symmetrical and spreading centrally.
Involvement of the mucosa may be marked in _____.
EM major
Erythema Multiforme
The iris or target lesion is the classical feature of the disease.
Initially, there is a dull red macule or urticarial plaque that enlarges slightly up to 2 cm over 24-48 hours. In the middle, a small papule, vesicle, or bulla develops, flattens, and then may clear.
The intermediate ring forms and becomes raised, pale, and edematous.
The periphery slowly becomes violaceous and forms a typical concentric target lesion.
Some lesions are atypical targets with only 2 concentric rings. Polycyclic or arcuate lesions may occur.
Köbner’s phenomenon may occur.
This is where a lesion occurs along the line of trauma and it is typical of psoriasis and lichen planus
ERYTHEMA MULTIFORME
_________is a disorder of the pilosebaceous follicles found in the face and upper trunk.
At puberty, androgens increase the production of sebum from enlarged sebaceous glands that become blocked and infected with ______________ causing an inflammatory reaction.
Comedones (follicles impacted and distended by incompletely desquamated keratinocytes and sebum) may be open (blackheads) or closed (whiteheads). Inflammation leads to papules, pustules and nodules.
Acne vulgaris Propionibacterium acnes (P. acnes)
_____________ infections are fungal infections caused by dermatophytes - a group of fungi that invade and grow in dead keratin.
Several species commonly invade human keratin and these belong to: Epidermophyton, Microsporum and Trichophyton genera.
They tend to grow outwards on skin producing a ring like pattern, hence the term ‘ringworm’.
Dermatophytosis (tinea)
Itching, rash and nail discolouration are the most common symptoms of tinea infection.
Hair loss occurs with tinea capitis (mainly a disease of children).
Complications such as secondary infection (cellulitis and impetigo) can lead to symptoms.
It occurs in immunocompromised patients.
TINEA
__________
◦It affects particularly the web of the toe where skin may be macerated and erythematous.
◦It commonly affects plantar surface of the foot.
◦ Erythema, vesicles and pustules can occur.
Tinea pedis:
_________
Usually occurs in men.
Often tolerated for some time before presentation.
Typically erythematous with central clearing and raised edge
Tinea cruris:
TINEA CRURIS
______
◦The skin lesions have annular scaly plaques with raised edges.
◦There may be vesicles and pustules.
◦Typically lesions are on exposed skin of trunk, arms and legs (see Differential diagnosis).
◦More unusually the lesions can appear as overlapping concentric circles (tinea imbricate) or even herpetiform subcorneal vesicles or pustules (bullous
Tinea corporis:
Tinea Corporis
__________
Usually with tinea pedis.
Typically just affects one hand.
Scaling and redness are prominent.
Incorrect diagnosis and use of steroid may eventually exacerbate the infection.
Tinea manuum:
Tinea manuum
______
Affects the beard area.
Redness, scaling and pustules are common.
Tinea barbae:
Tinea barbae
_______
◦It can cause hair loss with broken hairs at the surface.
◦Clinical appearance is variable.
Tinea capitis:
Tinea Capitis
_______________
◦Onycholysis or separation of the nail from the nail bed commonly occurs.
◦Nail dystrophy with thickening and discolouration of the nail develops.
Tinea unguium (onychomycosis):
___________ is useful for tinea capitis especially.
Ultraviolet light (Wood’s light)
Acute, self-limiting skin condition.
A primary plaque (‘herald patch’) is followed by a distinctive, generalised itchy rash 1-2 weeks later.
The rash lasts for approximately 2-6 weeks.
Lesions are typically oval, dull pink and appear in a ‘Christmas tree’ distribution, usually on the trunk and the upper arms and legs
PITYRIASIS ROSEA
PITYRIASIS ROSEA
a rheumatic disease of unknown cause, is characterized by autoantibodies directed against self antigens, leading to inflammatory damage of many target organs including the joints, kidneys, blood-forming cells, and the central nervous system
The diagnosis of lupus is confirmed by the combination of clinical and laboratory manifestations revealing multisystem disease. The presence of 4 of 11 criteria
SLE
Malar rash SLE
Photosensitive rash SLE
discoid rash SLE
What is the classic triad of HSP
“classic triad“= Purpura, arthritis and abdominal pain
____________________is a systemic vasculitis (inflammation of blood vessels) and is characterized by deposition of immune complexes containing the antibody IgA.
HSP
HSP
abnormally low platelet count(thrombocytopenia) of no known cause (idiopathic).
related to the production of antibodies against platelets
immune thrombocytopenic purpura or immune thrombocytopenia are terms also used.
Oftenit is asymptomatic (devoid of obvious symptoms) and can be discovered incidentally, but a very low platelet count can lead to an increased risk of bleeding and purpura (large skin bruises).
ITP
an immune-complex-mediated hypersensitivity complex.
It ranges from mild skin and mucous membrane lesions to a severe, sometimes fatal systemic disorder.
Ocular symptom:ulcerative conjunctivitis, keratitis, iritis, uveitis, and sometimes blindness.
Steven Johnson Syndrom
Drug most commonly associated in SJS
allopurinol.
SJS
Often starts with a non-specific upper respiratory tract infection, which may be associated with fever, sore throat, chills, headache, arthralgia, vomiting and diarrhea, and malaise.
Mucocutaneous lesions develop suddenly and clusters of outbreaks last from 2-4 weeks. The lesions are usually not pruritic.
Mouth involvement may be severe
Respiratory involvement may cause a cough productive of a thick purulent sputum.
Patients with genitourinary involvement may complain of dysuria or an inability to pass urine.
SJS
is an acute-onset, potentially life-threatening, idiosyncratic mucocutaneous reaction, usually occurring after commencement of a new medication.
Widespread full-thickness epidermal necrosis develops, producing erythema, large blisters and/or exfoliation of large sheets of skin, leaving a raw base.
The skin has an appearance similar to a scald.
It usually affects the trunk, face and one or more mucous membranes
Toxic Epidermal Necrolysis
Note: There is thought to be an immune complex-mediated hypersensitivity reaction to the presence of toxic drug metabolites which accumulate in the skin.
Infection, malignancy and vaccination have also been suggested as other possible etiologies.
There may be no obvious trigger (idiopathic toxic epidermal necrolysis (TEN)).
An ill-defined red ‘burning/painful’ macular or papular rash then develops, spreading from the face or the upper trunkBullae form and then coalesce
The epidermis can then slough in sheets.
The Nikolsky sign: if areas of seemingly normal skin between lesions are rubbed, the epidermis easily separates from its underlying surface.
Toxic Epidermal Necrolysis
____________appear on the skin as wheals which are red, very itchy, smoothly elevated areas of skin often with a blanched center.
They appear in varying shapes and sizes, from a few millimeters to several inches in diameter anywhere on the body.
One hallmark of hives is their tendency to change size rapidly and to move around, disappearing in one place and reappearing in other places, often in a matter of hours. Individual hives usually last no longer than 24 hour
Hives (medically known as urticaria)
Urticaria
ANGIOEDEMA
____________ is the rapid swelling (edema) ofthe dermis, subcutaneous tissue,mucosa and submucosal tissues.
Cases where angioedema progresses rapidly should be treated as a medical emergency as airway obstruction and suffocation can occur.
Epinephrine may be lifesaving when the cause of angioedema is allergic
Angioedemaor Quincke’s edema
