Skin Changes in Skin, Blood, and Lymph Flashcards
Five illnesses that manifest with a diffuse maculopapular rash
1) measles
2) rubella
3) erythema infectiosum
4) infectious mononucleosis
5) lyme disease
Prodrome of measles (4)
1) fever
2) cough
3) coryza
4) conjunctivitis
Describe rash of measles
- brick red, irregular maculopapular
- appears 3-4 days after onset of prodrome
- begins on the face and proceeds “downward and outward”, affecting palms and soles last
- lasts 3 - 5 days
What PEx finding is pathgnomonic with measles?
koplik spots
Symptoms of rubella
- enlargement of cerival, suboccipital, and postauricular glands
- rash of 2 - 3 days duration
Rash associated with rubella
- erythematous macules and papules appearing initially on the face and speading to the trunk, arms, and legs within 24 hours
- rash lasts 2 - 3 days
- desquamation may follow resolution of rash
Disease association erythema infectiosum
Parvovirus B19 infection, “fifith disease”
Describe rash of “fifth disease”
- fiery red “slapped cheek” appearance
- circumoral pallor
- subsequent lacy, maculopapular, evanescent rash on the trunk and limbs
Sx besides rash in fifth disease (3)
- malaise
- headache
- pruritus
- (little fever)
common cause of myocarditis in childhood
parvovirus B19
What can parvovirus B19 mimic?
autoimmune states
(lupus, systemic sclerosis, antiphospholipid syndrome, vasculitis)
Sx Parvovirus infection in adults (3)
- eczema-like rash
- inflammatory arthritis
- premature labor/hydrops/fetal loss in pregnancy
Rash associated with Lyme disease
erythema migrans,
a flat or slightly raised red lesion that expands with central clearing
Stage 1 of Lyme Disease
Early localized infection
Erythema migrans
(flat or slightly raised red lesion at the bite site ~1 week after tick bite)
common in areas of tight clothing (groin, thigh, axilla)
Lyme disease stage 2
Early disseminated infection
Bacteremia
- malaise, fever, fatigue, headache, neck pain
- secondary skin lesions (similar to primary lesion but smaller)
- myopericardiditis, neuro manifestations, conjunctivitis
Lyme disease stage 3
Late persistent infection (months to years later)
- arthritis
- neurologic manifestations
- acrodermatitis chronicum atrophicans (resembles scleroderma_
Cause of infectious mononucleosis
Epstein Barr virus
How is EBV transmitted?
By saliva, but also genital secretions
Symptoms of infectious mononucleosis
- malaise, fever, (exudative) sore throat
- palatal petechiae, lymphadenopathy, splenomegaly
- occasionally a maculopapular rash
Lab testing for mono
+ heterophile agglutination test (Monospot)
atypical large lymphocytes in blood smear
What is Hoagland sign and when is it seen?
transient bilateral upper lid edema;
Mononucleosis
Infections that cause peripheral skin eruptions (4)
1) meningococcemia
2) rocky mountain spotted fever
3) secondary syphilis
4) hand/foot/mouth disease
Cause of Rocky mountain spotted fever &
route of transmission
Rickettsia rickettsii
Parasite of ticks, transmitted by tick bites
Describe rash associated with Rocky mountain spotted fever
Begins as faint macule that progresses to large maculopapules & petechiae
Rash starts of wrists & ankles, characteristically involves palms & soles
spreads to arms, legs, & trunk
Desribe rash of secondary syphillis
Rash: diffuse (may include palms & soles)
macular, papular, pustular, and combinations
Condyloma lata
Mucous patches: painless, silvery ulcerations`
Skin infections related to Coxsackie infection
1) hand-foot-mouth disease
2) herpangina
Describe rash of Hand-foot-mouth
Stomatitis
Vesicular rash on hands & feet
vesicles erode and form “football-shaped” eroisions surrounded by erythematous halo
Infections that cause desquamative skin changes (3)
1) toxic shock syndrome
2) scarlet fever
3) erythema multiforme
Organism that causes of Toxic Shock syndrome
Strains of staphylococci
Describe rash of toxic shock syndrome
Diffuse macular erythematous rash
(w/ nonpurlulent conjunctivitis)
Desquamation of palms and soles is typical with recovery
Rash associated with Scarlet fever
Generalized, punctate, red:
prominent on neck, in axillae, groin, and skin folds
circumoral pallor
Fine desquamation involves hands & feet
Infections related to erythema multiforme (2)
1) Herpes simplex virus
2) Mycoplasma pneumoniae
Describe erythema multiforme rash
Rare cutaneous or mucocutaneous eruption characterized by “target” lesions
predominantly on the face & extremities
Non-cutaneous lesions associated with erythema multiforme
mucosal lesions are present in up to 70%, usually in oral cavity
predilection for the lips
Describe the rash of varicella
Highly contagious exanthem, most often occurs in childhood
Usually begins on face and scalp, spreads rapidly to the trunk
Relative sparing of extremities
vesicles, pustules, and crusts
***Lesions in all stages of healing present at the same time**
Cause of pemphigus
autoimmune disease
Describe lesions of pemphigus
can be pruritic or painful
exposure to UV radiation may excacerbate disease
Primary lesion is a flaccid blister which may occur anywhere, but typically not the palms and soles
Infections that cause petechial & purpuric lesions (3)
1) gonococcemia
2) meningococcemia
3) thrombotic thrombocytopenic purpura
Classic triad of gonoccemia
1) dermatitis
2) migratory polyarthritis
3) tenosynovitis
Cutaneous lesions associated with gonoccemia
Hemmorrhagic vesicopustules on an erythematous base
located on the palms and soles
Lesions may develop necrotic centers (“gun metal gray”)
Rash associated with acute meningococcemia
classic petechial rash
(in severe cases, with DIC, necrosis of skin and underlying tissue may necessitate amputation –> purpura fulminans)
Describe rash of chronic meningococcemia
rose-colored macules and papules
*rash may wax and wane with periodic fevers
Pentad associated with Thrombotic Thrombocytopenic Purpura
1) microangiopathic autoimmune hemolytic anemia
2) thrombocytopenia (petechial lesions)
3) neurologic symptoms
4) fever
5) renal failure
Palpable vs. Nonpalpable Purpuric disorders
Most common form of skin cancer
basal cell carcinoma
Describe appearance basal cell carcinoma and typical location
Waxy, “pearly” appearance, with telangiectatic vessels easily visible
Usually on the back, chest, and lower legs
Describe appearance squamous cell carcinoma of the skin
nonhealing ulcer or warty nodule
appear as small, red, conical, hard nodules that occasionally ulcerate
Precursor lesion to SCC
actinic keratosis
Mutation associated with melanoma
p16
Most common locations of melanoma
Back for men
Lower extremities followed by trunk for women
Screening tool for melanoma
A - asymmetry
B - border
C - color (black, blue, white)
D - diameter ( >5mm)
E - evolution
*color carries the greatest sensitivity and specificity for metastatic potential
