Skin Diseases Flashcards
What skin disease is characterized by a fast turnover of epidermal cells that does not allow for adequate differentiation of cells? How does it present clinically?
- Psoriasis
- Patient presents with patches of thick, red skin with silvery-white scales that itch or burn, typically on the elbows, knees, scalp, trunk, palms, and soles of the feet.
- Dry, cracked skin that itches or bleeds.
Which autoimmune disease affects elder patients presenting with bullae?
- Bullous pemphigoid
- An autoimmune blistering disease, typically affects older patients.
- Autoantibodies form to antigens directly beneath the basal layer of the epidermis at the dermo-epidermal junction.
- Clinically, presents as tense bullae on an erythema base on the skin.
Skin lesion that is flat, smaller than 1 cm, not filled with any material.
Coul be a freckle too.
Macule
Similar to macule, only equal to or larger than 1 cm.
Patch
A lesion that is raised but may have a depressed center portion. Is superficial with a solid content and is smaller than 1 cm.
Papule
Lesion that is raised but can be also depressed, with a solid content, is well-defined measuring larger or equal to 1 cm. Can sometimes form out of coalesced papules.
Plaque
A raised lesion measuring more or equal to 1 cm with a content that can be either solid or fluid. In contrast with a papule - it is larger and originates deeper.
Nodule
A raised lesion sized less than 1 cm. Of dome or flaccid shape with liquid content that can be clear, serous or hemorrhagic. Often with very thin roof and arises from cleavage at superficial level.
Vesicle
A raised lesion larger or equal 1 cm with a clear, serous or hemorrhagic fluid content. Can be tense or flaccid too.
Bulla (pl. bullae)
A raised lesion of less than one cm, with a purulent content, of superficial depth.
Pustule
Depressed lesion of ANY size with no content. It is a focal loss of epidermal tissue with no loss of dermis. Heals with no scarring. It is seen with some inflammatory diseases. Can be secondary to bulla.
Erosion
A depressed lesion of any size with no content. There is a loss of epidermis and at least a portion of dermis sometimes hypodermis - deeper than just an erosion. Leaves a scar. Can be secondary.
Ulcer
Circumscribed (within limits) of irregular shape and size. Transient (short lasting) <48h. Result of cutaneous edema. Often pale, sometimes red. Often accompanied by itching. Involved in urticaria (hives).
Wheal
Can be of multiple colors with size at least 3 mm.
Ecchymosis (aka bruise)
Of deep red/reddish/purple color. Small, 1-3 mm size. Round and flat. Sometimes found on mucous membranes.
Petechiae
Of deep red/reddish/purple color. Larger than petechiae, irregularly shaped and sometimes palpable.
Purpura
Which three primary lesions are caused by blood leaving vessels and do not blanch when pressure is applied on them?
Ecchymosis, petechiae and purpura.
A secondary lesion due to stratum corneum cells accumulation. It is characterized by flakes that can be large or tiny and adherend or loose.
Scale
A dried exudate (mass) of body fluids. Can be yellow or red from either serous fluid or blood.
Crust
A distinctive thickening of the skin with skin-fold markings. A result of chronic scratching/rubbing.
Lichenification
Bulla and nodule can turn into what secondary lesions?
Erosion and ulcer.
Bulla becomes unroofed and nodule ulcerates.
Erosion that is linear and angular. May be covered with crust. Is caused by scratching.
Excoriation
A lesion on skin caused by past trauma or inflammation. May be erythematous, hypopigmented or hyperpigmented. Hair follicles may be destroyed.
Scar
An acquired loss of substance ex. loss of epidermis. From shiny quality to cigarette paper wrinkling. Can cause depression after loss in subcutaneous tissue or dermis. Underlying vessels may be revealed.
Atrophy
A linear lesion (crack). May be on skin or mucosa. Resulting from an excessive tension or decreased elasticity of the tissue.
Fissure
What is dermatitis?
A broad term describing conditions causing skin inflammation.
What are three commonly acquired nevi?
Which nevi is located between epidermis and dermis layers(does not go below epidermis)?
Junctional Nevi.
Which nevi are found in dermis layer? What cells do they originate from? What color are they?
Dermal nevi, brown raised lesions that develop from melanocytes of dermis.
What kind of lesion is this?
Nevus spilus. Presents from the first year of life. Often hairless brown patch with speckled brown/black macules/papules. Very rare transformation into melanoma.
What kind of lesion is this?
Becker’s nevus. Light brown, slightly elevated, common hair growth, not malignant and its treatment is cosmetic.
What kind of lesion is this?
Halo nevus. Develops characteristic white border around. Most common in children. Consider biopsy if atypical of evolving.
What kind of lesion is this?
Spitz nevus. Rapidly growing, solitary, pink-red papuloNodule. Usually appears suddenly. Can be difficult to distinguish from melanoma - histology exam recommended. Complete excision often recommended, however often unnecessary.
What kind of lesion is this?
Blue nevus. A form of papule or a macule smaller than 1cm. Grey/black or blue appearance makes it hard to distinguish from melanoma.
What kind of lesion is this?
Actinic Keratosis.
Considered pre-cancerous.
Pink or erythematous or thin plaques with rough gritty scale, may be tender. Common in sun exposed areas and often on males. More common with age, fair skin (type I and II) and immunosuppression.
What is this lesion? It is similar to common dermatitis conditions.
Squamous cell carcinoma in situ. Similar to eczema or psoriasis. It is an erythematous, well demarcated, hyperkeratotic patch or plaque.
What kind of lesion is this? What are risk factors of developing it?
Squamous cell carcinoma. It is an erythematous, scaly papulonodule/plaque with adherent white scale, can appear eroded. It is a common type of lesion.
Risk factors of this lesion:
* sun exposure
* male gender
* older age
* fair skin
* genetic syndromes
* immunosuppression
* HPV
* radiation
* arsenic
Possibility to metastasize (~3-4%)-increased risk if immunosuppressed, located on lip/ear, larger size, poorly differentiated.
What kind of lesion is this?
Basal cell carcinoma.
MOST common skin cancer and most common cancer in humans.
Pink pearly papule with a central depression, telangiectasias (arborizing vessels) and rolled borders.
If left untreated they become locally destructive but they are usually slow growing and RARELY metastasize.
What are these lesions?
Seborrheic Keratosis (SK)
How to determine SK from Melanoma?
- Smooth SK’s can mimic a melanoma
- Different surface features of the two lesions
- Melanomas are usually smooth with a variation in height, color and density
- Melanomas do not have cysts on their surfaces. SK’s are uniform in their appearance (dermoscopy).
- When in doubt, biopsy before treating it
right SK left melanoma
What are these lesions?
Dermatosis Papulosa Nigra.
SK type, raised, dome shaped papules.
A benign proliferation of dilated vessels.
What are the treatment for this disease?
Angioma.
Benign proliferation of dilated vessels; well-defined red, purple or black papules or macules
Asymptomatic; increasing number with age
Location: Typically on the trunk (cherry) or face (spider, venous lake).
Continue to monitor. Can be shaved or curetted, electrocautery and pulse dye laser can be used. DO NOT FREEZE the blood vessels.
What are syringomas?
Small sweat duct tumors without malignant potential
Small, flat-topped skin colored papules usually found on the lower eyelid
Treatment: Electrodessication, snip excision, curettage.
Sebaceous Gland Hyperplasia (SGH)
- Small benign tumors that are enlarged sebaceous glands
- Well-defined yellow papules that appear waxy and have a central umbilication/depression. Asymptomatic
- Mainly found on the forehead, cheeks and nose (T-zone)
- SGH with telangiectasia can resemble BCC. Usually SGH are soft and a BCC feels a little firmer. Gently squeezing the SGH will sometimes elicit a small globule of sebum
- Etiology is unknown
What kind of lesion is this? Describe it. What is the treatment?
Lipoma
Benign subcutaneous tumor
Present as soft, round, mobile lesions superficial to the muscle layer
Commonly on the neck and trunk
Can occur on extremities and scalp
Composed of fat cells that clump together
Can contain a fibrous framework (i.e. capsule)
Removed by excision (derm vs. gen surg)
Easier when smaller (done in office setting)
Larger lipomas can create pain and compression-type symptoms – often need removal in the OR
Removal not covered by insurance unless causing a problem
What kind of lesion is this? Describe it. What is the treatment?
Epidermal Cysts
* A.k.a. sebaceous cyst or epidermal inclusion cyst (EIC).
○ Develop in the follicular infundibulum
○ There are other types of cysts too
* Can occur almost anywhere on the body
○ Most common: Face and trunk
* Firm, elevated dermal lesion. Smooth and round. Mobile. Size can vary.
* They usually have a narrow opening (punctum—black dot - think cyst) to the surface of the skin and the opening is keratin filled
* Cysts can rupture into the dermis and an inflammatory reaction occurs.
Treatment
* Incise and drain inflamed, fluctuant cysts
○ Inside: foul-smelling, cheesy material
* Excise larger, bothersome cysts
* Pilar cyst: like epidermal cyst but on the scalp; doesn’t have a punctum
What kind of lesion is this? Describe it. What is the treatment?
Pyogenic Granuloma (pyo-pus, genic-producing).
* This benign vascular lesion grows/develops rapidly, but is painless
* Typically a solitary nodule or papule that can bleed easily
* Most common in kids and young adults
* Location: fingers/toes, head/neck, trunk, lips, mouth (skin and mucous membranes)
○ Oral lesions seen more in women, especially during pregnancy
Treatment
*surgical or shave excision and curettage. Can resolve on their own, but do so slowly
Can look like a type of melanoma. Biopsy!
What kind of lesion is this? Describe it. What is the treatment?
Keratoacanthoma (KA)
* Common “benign” epithelial tumor
* Pink papule or nodule that develops an umbilicated, keratinous core
* Most common sites: hands and arms (sun-exposed areas
* Koebner Phenomenon
* Difficult to distinguish from an SCC, so treated as an SCC.
* Grow rapidly over a few weeks (helps to distinguish form other malignant types - BCC or SCC)
Treatment
Surgical excision
What kind of skin lesion is this? What its etiology and treatment?
Dermatofibroma
* Firm pink to brown papules that tend to have a dimple effect if you squeeze them (may need magnification to see dimple)
* Etiology: usually a result of an inflammatory reaction to a bug bite or trauma
* Commonly found on the lower legs, buttocks and upper arms
Treatment
* Monitor
* Excision
* Shave/punch
* LN2
What is the name for skin tags? What is the treatment?
Acrochordons
Acro-top, chorde-string
Skin-colored to brown pedunculated papules that range from tiny to 1cm in size (texture: fleshy)
Treatment:
Snip excision
Cryotherapy
What is the name of this lesion? What is the treatment?
Cutaneous Horns
Hard keratin projection
Occur more in sun-exposed areas
Differential diagnosis
Hypertrophic actinic keratosis
Wart
Squamous cell carcinoma
50% are benign, 50% are pre-malignant or malignant
Treatment:
Biopsy, concern for an SCC at the base of the lesion
What is the name of this lesion? What is the treatment?
Solar Lentigines
Solar lentigines
Flat, brown macules
4th to 5th decade of life
Gradually appear in sun-exposed areas
Do not fade with cessation of sun exposure
