Skin Flashcards
How should you describe a skin lesion?
- Distribution/Location
- Configuration
- Color
- Morphology
- Symmetry: uniform, multiform, polygonal
- Size: in cm
- Borders: demarcated, raised, ill defined
- Surrounding tissue: induration, erythema, flaking, scaling
Induration
hardness/fullness from inflammation
Morbilliform
- looks like a measles rash
- rash consists of macular lesions that are red and are usually 2-10 mm in diameter
Papulosquamous
papular rash with scales
Coalesce
grouping distribution
Exantham
macular/papular rash on the trunk
Erythroderma
whole body is red
Scarletiniform
sandpaper rash
Confluent
lesions in so many places they have formed together
Acral
lesions in distal part of the body, like hands/feet/ears
Dermatomal
lesions in a certain dermatome
Extensor
lesion is on the outside portion of the body
Flexor
lesion is on the inside portion of the body, where the skin touches
Follicular
lesions where your hair grows
Generalized distribution
lesions everywhere
Herpeiform
looks viral, vesicular
like herpes
Photosensitive
lesions on sun exposed areas
Seborrheic
lesions on scalp, nasal labial folds, behind ears
Linear configuration
lesions in a line
like with contact dermatitis
Nummular configuration
coined shaped lesions
Target configuration
bulls eye, dusty red in center
like erythema multiform
Gyrate configuration
reticular rash, lacy
Annular configuration
round in nature
Satellite lesion configuration
main area of redness with satellite lesions on the outskirts
Carotenaemia
yellowing of skin, not they eyes
Jaundice
yellowing of skin and sclera
Leukoderma
loss of pigmentation
like with vitiligo
Hyperpigmentation
darker pigmented skin
Hypopigmentation
lighter pigmented skin
Infarcts
dead, blackened skin
Erythema
reddened skin
Violaceous
purple skin
Macule
- a circumscribed, flat, non palpable change in skin color
- up to 1 cm
Patch
- macule larger than 1 cm
Papule
- palpable, elevated, circumscribed, solid mass
- up to 1cm
- caused by superficial thickening of the epidermis
Plaque
- flat, elevated surface
- larger than 0.5cm
- often formed by coalesce of papules
Psoriasis
- Chronic inflammatory papulosquamous disease of unknown etiology
- red, sharply defined, scaly papules that coalesce to form stable round to oval plaques
- silvery white
- may have nail or joint disease
Nodule
- A solid, elevated, firm or soft mass
- less than 1-2 cm
- May be firmer and extend deeper into dermis than papule
Tumor
- A solid elevated firm or soft mass larger than 1-2 cms
- Extending deeper into dermis
- Benign or malignant
Wheals, Uticaria, Hives
A superficial, raised, erythematous, transient lesion with somewhat irregular borders due to localized edema, multiple wheals/hives can coalesce to cause an intensely puritic lesion
Vesicles
- A circumscribed, superficial, elevated cavity
- Contains free fluid
- Clear fluid flows if wall ruptured
- Up to 1 cm in size
Bulla
- Similar to vesicular lesions
- larger usually >1.0cm
- Filled with serous fluid
Pustule
- A pustule is a purulent vesicle.
- It is filled with neutrophils, and may be white, or yellow.
- Not all pustules are infected
Burrow
- A minute, slightly raised tunnel in the epidermis, commonly found on the finger webs and the fingers.
- The burrowing will usually end with a papule, vesicle or pustule.
- Burrowing is found in scabies
Lichenification
- secondary lesion
- thickening and hyper pigmentation of the skin
Crusting
- secondary lesion
- a scab
Dystrophy
- secondary lesion
- a change in formation, usually associated with nails
Excoriation
- secondary lesion
- scratch marks/irritation
Scales
- secondary lesion
- fragments of the skin, flaking off
- different than dry skin
Fissure
- secondary lesion
- a crack, usually from dryness
Ulcer
- secondary lesion
- breakdown of the epidermis
Erosion
- secondary lesion
- superficial loss of epidermis from friction/rubbing
Hypertrophy (keloid)
- secondary lesion
- excessive growth of scar tissue
Granuloma
- secondary lesion
- from chronic or prolonged inflammatory process that leaves a build up of cells
What are vascular lesions from?
Bleeding into the tissue
Petechia
- vascular lesion
- Small 1-3mm deep red or reddish purple macules
- Rounded sometimes irregular in shape
- Indicates blood outside of the vessels
- Do not blanch
Purpura v. Ecchymosis
- A larger macule or papule of blood in the skin
- purpura-from 0.5 to 1 cm
- ecchymosis-more than 1 cm
- maybe benign resulting from trauma or pathological
Meningococcal Infection
- Presents as sudden onset of fever, rash and signs of meningeal inflammation
- Time from onset to sepsis can be less than 24 hours
- Positive Kernig and Brudzinski Sign
- Worrisome signs on presentation are:
- Leg pain
- Cold hands and feet
- Abnormal skin color such as pallor indicating onset of sepsis
Henoch-Schönlein Purpura
- Inflammation and bleeding in the small blood vessels
- self-limiting
- reddish-purple spots on the lower extremities, swollen and sore joints, abdominal pain, or bloody urine
- 90% in kids
Hypersensitivity Vasculitis
- Palpable purpura, Maculopapular rash, can be raised or flats
- from coming in contact with an irritating substance
Immune Thrombocytopenia Purpura
- Isolated thrombocytopenia
- Precedent viral illness
- Development of self-reactive antibodies
- Petechiae, purpura, and easy bruising are expected
Atopic dermatitis (under age 2)
- Eczematous eruption begins with erythema and severe pruritus
- Lesions are red papules, patches of erythema and scaling.
- Acute lesions may be vesicles and there can be serous exudates and crusting in severe cases
- Often extensor surfaces, and symmetric
- Begins early in life, characterized by remission and exacerbation
Atopic dermatitis (ages 2-12)
- Less exudation than infantile
- Usually lichenified plaques
- Flexural distribution, especially antecubital and popliteal fossae, volar aspect of the wrist, ankles and neck
Atopic dermatitis (adult)
- Adult presentation, more localized and lichenified
- similar distribution as childhood, or primarily on the hands and feet
- Thickened skin, increased skin markings, hyperpigmentation
Nummular dermatitis
- Pruritic patches of eczematous dermatitis
- Evidence of papules, scaling and slight crusting
- 1-50 lesions
- Etiology unkown
- “coin shaped” measuring 2-10cm
- Usually trunk and lower extremities and head is spared
Seborrheic Dermatitis
- Erythematous, scaly plaques with some pruritus
- Margins not as sharply demarcated as seen in psoriasis
- Dandruff of scalp, mild form of seborrheic dermatitis
Cradle Cap
- Infantile seborrheic dermatitis
- 3 weeks to 12 mths of age
- Self-limiting
- Unknown etiology
Contact Dermatitis
- Delayed –type 4 hypersensitivity reaction caused by skin contact with allergen
- Characterized by vesicles, edema, redness and often pruritus
- Usually in a linear presentation
Stasis Dermatitis
- Eczematous dermatitis of the legs
- Associated with edema, varicosed/ dilated veins and hyper pigmentation
- Dry, fissured, erythematous skin
- Edema, brown discoloration, erosion or ulceration common.
Rosacea
- Chronic and relapsing inflammatory skin disorder
- Involves the central face
- Occurs in adults 30-60 yrs of age
- Facial erythema, telangiectasia, and inflammatory skin lesions
- No cure, treatment focused on symptom suppression
Impetigo
- Staph Aureus and Streptococcus are usual culprits
- Causes superficial vesicles or pustules which cause erosions resulting in golden-yellow crusts
- Highly contagious
Cellulitis
- Acute diffuse spreading edematous, suppurative inflammation of the dermis and subcutaneous tissue
- Usual gram + organism such as Staph or Strep
- Mode of infection maybe pre-existing lesion, bug bite, shot
- Warm, hard, tender to palpation
Folliculitis
- Upper portion of hair follicle,
- Follicular papule, pustule, erosion or crusting
- Usually gram + organism
- Predisposing factor: shaving hairy regions
Folliculitis v. Furuncle v. Carbuncle
- Folliculitis- 1mm red papule or pustule
- Furuncle- 1cm red papule or nodule
- Carbuncle- several cm in diameter, red plaque
Furuncles/Carbuncles
- Any hair-bearing site.
- Sites of high friction and sweating most typical.
- Furuncle- deep dermal or subcutaneous , red swollen and painful mass that drains through multiple openings.
- Carbuncle –deep tender, firm subcutaneous erythematous papules enlarge to deep nodules
Syphilis
- Secondary syphilis occurs 2-6 months after primary
- Presence of a papulosquamous rash usually on the trunk, palms and soles
Tinea or Dermatophytosis
- Dermatophytes are fungi capable of infecting skin, nail and hair
- Tinea is used for dermatophytosis and is modified according to the anatomic site of infection, i.e. tines pedis
Where is tinea pedis located?
feet
Where is tinea crurus located?
groin
Where is tinea manuum located?
palms
Where is tinea corporis located?
ringworm
Where is tinea facials located?
face
Where is tinea capitis located?
hair
Ringworm/ Tinea Corporis
- Pruritic circular or oval erythematous scaling patch or plaque
- Spread centrifugally
- Central clearing follow
- Borders well delineated and red
- Multiple lesions may run
together - Differential dx nummular eczema
Tinea Versicolor/ Pityriasis Versicolor
- Dermatophyte caused by yeast called Malassezia
- Numerous small, circular, white, scaling papules on the upper trunk
- May involve the upper arms, neck and abdomen.
- Lesions are hypopigmented in tanned skin and pink or salmon colored in untanned skin
Pityriasis Rosea
- Usually occurs b/w the ages of 10-30
- Self-limited rash that is preceded by a ‘herald patch’
- Differential dx: secondary syphilis due to similar truncal presentation, age, papulospquamous lesions
- Christmas tree distribution rash
- Hyperpigmentated rash in dark skin individuals
- Differential dx: syphilis
Molluscum Contagiosum
- Self limiting (usually 1 yr), viral infection, poxvirus
- Skin colored umbilicated papules
- Occurring in children and sexually active adults
- It is transmitted skin to skin contact
Varicella/ Chicken Pox
- Incubation 15 days after exposure
- Prodromal fever, malaise, pharyngitis loss of appetite
- 24 hours later, vesicular rash
- Rash pruritic, successive crops over several days
- Usually starts on the trunk
- New vesicle formation usually stops after 4 days
- Fully crusted by day 6, contagious until fully crusted
- lesions in different stages of development
Varicella/Shingles/Herpes Zoster
- Erythematous papules that quickly develop into grouped vesicles or bullae
- 3-4 days become pustule or hemorrhagic
- Crusting 7-10 days
- Follows usually one dermatome and does not cross the midline
- Acute pain can lead to chronic pain at affected nerve
Acanthosis Nigricans
- Hyperpigmented velvety plaque on the skin
- Intertiginous sites such as neck, axilla are common
- Can be acquired due to insulin resistance or inherited with familiar acanthosis nigricans
Erythema Multiforme
- Acute immune-mediated condition
- Distinctive target-like lesions
- dusky central area or blister, dark red inflammatory zone, surrounded by a pale ring of edema and an erythematous halo
- Multiforme, describes the myriad clinical manifestation that may be observed
Lichen Planus
- a chronic inflammatory disorder that affects the skin, oral cavity and genitalia
- Skin: Flat topped polygonal papules
- Occasionally pruritic
- Etiology unknown; felt to be immunological response
- Self limiting
- May persist for months or years
Acrochordon/Skin Tags
- Soft, skin colored or tan or brown, round, oval or pedunculated, usually in intertriginous areas and neck and eyelids
Seborrheic Keratosis
- Hereditary lesions, do not appear until age 30
- Surface may be smooth, velvety or verrucous
- Lesions are usually papules or plaque
Nevi
- Moles
- Common acquired nevi occur after 6 mths of age
- Increase in number in children and adolescent peak at 30 and then regress
- If over 6 mm- referral
Actinic Keratosis Scalp
- Premalignant Skin Lesion
- Single or multiple discrete dry rough adherent scaly lesions occur on habitually exposed skin
- May develop into squamous cell carcinoma
Squamous Cell Carcinoma
Variety of clinical presentations
Fair skinned adults >60
Can metastasize
Basal Cell Carcinoma
- Most common type of skin cancer
- Locally invasive aggressive destructive lesion
- Rises from the basal layer of the epidermis,
- Limited capacity to metastasize
- Often with telengiectasia
What are the signs of a malignant melanoma?
Asymmetry Border, irregular Color, mottled Diameter, larger than 6mm Evolving, changing mole
Alopecia Areata
- Chronic inflammatory disorder that causes non-scarring hair loss
- Rapid onset in a sharply defined, usually round or oval area
- May be diffuse or patchy or band-like at the margins of the scalp
- Autoimmune and can be associated with thyroiditis and vitiligo
Tinea Capitis
- Round scaling patches of alopecia
- Hairs are broken off
- Usually fungal infection
- Differs from alopecia areata, in that the hair follicle is still present
- Mimics seborrheic dermatitis
Beau’s Line
horizontal line
- break in the nail bed
Melanonychia
vertical line
- darker in color
Terry Nails
no lenula
related to liver disease
Paronychia
- Acute- bacterial infection of the proximal and lateral nail fold
- Rapid onset of pain and swelling
- Pus accumulates behind cuticle
- Chronic- irritant exposure
Pitting
Incidence of nail involvement in psoriasis
Oncychomycosis
- fungal infection from a dermatophyte,
- Skin under nail will flake, nail bed is raised
- Nail surface is soft, dry and powdery and can easily be scraped away
Common skin of older adults
- wrinking
- senile purpua (bruises)
- dry skin (xerosis)
- Senile letingines (liver spots)
