Skin Abnormalities Flashcards
What are the 3 layers of skin?
- Epidermis
- Dermis: blood vessels, hair follicles, sebaceous glands, sweat glands
- Subcutaneous
What are the appendages of the skin?
- Hair
- Nails
- Sebaceous glands
- Sweat glands
What do sebaceous glands do and where are they located?
- Produce fatty substance onto skin surface through hair follicles
- Present on all skin surfaces except palms and soles
What are the different types of sweat glands and what do they do?
- Eccrine: Widely distributed, open directly onto skin surface, help control body temp (via sweat production)
- Apocrine: Found chiefly in axillary and genital regions, usually open into hair follicles. Can be stimulated by emotional stress. Bacterial decomposition of apocrine sweat causes body odor
What are the key history questions for skin (HPI/ROS)
- Color changes?
- Rashes?
- Lumps?
- Itching?
- Dryness?
- Hair and nail changes?
- Weight changes, fever, chills or difficulty sleeping?
Describe the differences between Central and Peripheral cyanosis
- Central cyanosis: consistent with cardiac or pulmonary disease
- Peripheral cyanosis: may be seen with cold temperature or anxiety
What can be associated with jaundice?
Icterus-conjunctivae
What are the Skin- Color of lesions?
- Flesh-colored: same color as surrounding skin
- Erythematous: variable shades of red (pink, bright red, dull red)
- Violaceous: light violet
- Tan-brown
- Black or blue-black
- White
Describe the Morphology of Primary and Secondary Lesions
- Primary skin lesions: initial presentation, arise from previously normal skin –> Key to diagnosis
- Secondary skin lesions: results from changes to primary lesions –> Usually due to overtreatment, scratching or infection of the primary lesion
What are the Primary skin lesions?
- Flat: Macule or patch
- Palpable: Papule, plaque, nodule, tumor or wheal
- Palpable with contents: Vesicle, bulla, pustule or cyst
Describe a Macule
- <1 cm diameter
- Flat, non-palpable
- Variable color
- Examples: freckles, petechiae
Describe a Patch
- ≥1 cm diameter
- Flat, non-palpable
- Irregular shape
- Examples- Café au lait spots, vitiligo
Describe a Papule
- <1 cm diameter
- Palpable, firm
- Circumscribes
- Flesh-colored, red, brown
- May be confluent and form plaques
- Examples- Molluscum contagiosum, warts, nevi (moles)
Describe Plaque
- ≥ 1 cm diameter
- Elevated, firm, rough
- Circumscribed
- Example- psoriasis
Describe a Nodule
- ≥ 1 cm but <2 cm diameter
- Deeper and firmer than a papule (must palpate to determine)
- Usually round
- Examples- lipoma, some skin cancers
Describe a Tumor
- ≥ 2 cm
- A larger nodule
- Examples- hemangioma, tumors, lipoma
Describe a Wheal
- Irregular, transient, superficial edema
- Examples- mosquito bites, urticaria (hives)/allergic reaction
Describe a Vesicle
- <1 cm diameter
- Well-circumscribed
- Filled with serous fluid
- Examples- Herpes simplex “Dew drops on a rose petal”
Describe a Bulla (plural = bullae)
- ≥ 1 cm diameter
- Well-circumscribed
- Filled with serous fluid
- Examples- blisters, 2nd degree burns
Describe a pustule
- Well-circumscribed
- Elevated, superficial, epidermal
- Filled with pus
- Example- acne
Describe a cyst
-Nodule filled with liquid or semisolid material
What are the Secondary skin lesions?
- Loss of skin surface- erosion, ulcer or fissure
- Material on skin surface- scale or crust
- Other- Excoriation, lichenification or atrophy
Describe Erosion
- Loss of superficial epidermis
- Surfaces is moist but doesn’t bleed
- Heals without scarring
- Examples- ruptured vesicle, atopic dermatitis
Describe an ulcer
- Deeper loss of epidermis and dermis
- Heals with scarring
- Examples- stasis ulcer
Describe a fissure
- Linear crack or break from the epidermis to the dermis
- Examples- atopic dermatitis, tinea pedis, angular cheilitis
Describe a scale
- A thick flake of exfoliated epidermis
- Examples- seborrhea, psoriasis
Describe crust
- Dried residue of serum, pus or blood
- Example- impetigo
Describe excoriation
- Abrasion or scratch mark
- May be linear or rounded
- Usually due to scratching
- Examples- scabies, atopic dermatitis, dry skin
Describe Lichenification
- Thickening and roughening of the skin
- Increased visibility of skin markings
- Examples- atopic dermatitis, chronic dermatitis
Describe atrophy
- Thinning of the skin with loss of normal markings
- Skin looks shinier and more translucent
- Example- striae (stretch marks)
Describe a keloid
- Hypertrophic scarring
- Extends beyond the borders of initial injury
What are the Skin Lesions? Describe if they blanch or not.
Do NOT blanch
- Petechiae
- Purpura
- Ecchymosis
- Cherry angioma
Blanch
- Spider angioma
- Spider veins
- Telangiectasia
- Hemangioma
Describe Petechia (pleural = petechiae)
- 0.1-0.3 cm (1-3 mm) diameter
- Represent blood outside of a vessel
- Round or irregular
- Deep red or purple-red
- Seen with infections and bleeding disorders
- Do NOT blanch
Describe Purpura
- 3-1 cm
- Same as petechiae but larger
- Do NOT blanch
Describe Ecchymosis
- Generally >1 cm diameter
- “Bruise”
- Represent blood outside of vessels due to trauma, bleeding disorders
- Round, oval or irregular borders
- Purple lesions of variable size. Fade to green, yellow, brown
- Does NOT blanch
Describe Cherry angioma
1-3 mm diameter
- Flat or raised
- Red
- Non-pulsatile
- Seen on trunk
- Associated with aging
- Do NOT blanch
Describe Spider angioma
- Very small up to 2 cm diameter
- Central body with surrounding erythema, and radiating legs (spider)
- Seen on face, neck, arm and upper trunk
- Associated with- liver disease, pregnancy
- Do blanch
- A type of telangiectasia
Describe Spider veins
- Very small to several inches
- Variable shape, may resemble spider, be linear or irregular
- Most often seen on legs (varicose veins)
- Blanch with diffuse pressure only
Describe Telangiectasia
- Irregular lines secondary to dilations of capillaries
- Red
- Seen with basal cell skin cancers, sun-damage, rosacea
- Do blanch
Describe Hemangioma
- Irregular lesion secondary to dilation of dermal capillaries
- Red
- Starts as a macule, can progress to plaque or nodule
- Example- “strawberry hemangioma”
Describe Maculopapular lesions
-Macules with papules
-Examples:
♣ Viral exanthems: generalized, erythematous, maculopapular rash
♣ Drug eruptions
Describe Papulosquamous lesions
-Papules with plaques and scales
-Examples
♣ Lichen planus
♣ Pityriasis rosea
Describe Vesiculobullous lesions
- Vesicles and bullae
- Examples: Herpes simplex, Herpes zoster, Pemphigus vulgaris, Serious autoimmune disease affecting skin and mucous membranes
-Associated with a positive Nikolsky’s sign- slight rubbing of the skin results in exfoliation of the outermost layer
Describe Skin lesions- distribution
- Localized: lesions or abnormality appears in one small area
- Regional: lesions appear in a specific region of the body
- Examples- flexor surfaces, extensor surfaces
-Generalized/disseminated- Lesions or abnormality appears widely distributed or in multiple areas simultaneously
Describe the different characteristic distribution of skin lesions
Acne vulgaris: Face, chest, upper back
Atopic Dermatitis: Flexor surface (behind the knees/elbow crease)
Photosensitive eruptions: places exposed to the sun
Pitybiasis rosea: Tank top region and butt
Psoriasis: Knees and elbows
Seborrehic dermatitis: head
Describe Round/discoid lesions
- Coin shaped with no central clearing
- Example- nummular eczema (a form of atopic dermatitis)
- Umbilicated lesions
- Example- seen with molluscum contagiosum
Describe Oval/Ovoid lesions
-Example- Pityriasis rosea
Describe Annular lesions
- Round; active margins with central clearing
- Seen with tinea (fungal) infections
Describe shape/arrangement of lesions
- Dermatomal: Following a nerve segment (Herpes Zoster)
- Linear
- Serpiginous: Cutaneous larva migrans from hookworm larvae)
- Morbilliform: Measles-like (Erythematous maculopapular lesions that become confluent on the face and body)
- Target/targetoid: Pink macules with purple central papules (Erythema multiforme)
Describe Skin borders/margins
- Distinct: Well-demarcated or defined; able to draw a line around the area with confidence
- Indistinct: Poorly defined; borders merge with normal skin
- Active: Margin of lesion shows greater activity than center (Tinea infections)
- Irregular: Margins are notched, not smooth (malignant melanoma)
- Raised borders: Center of lesion is depressed compared to edge (Basal cell carcinoma)
What are the ABCDEs of Melanoma?
A- Asymmetrical shape B- Borders (irregular) C- Color (variation) D- Diameter (> 6mm, pencil eraser) E- Evolving
