Week 4 Flashcards
1
Q
Nodule
A
firm papule > 10 mm, extending into dermis or subQ tissue
2
Q
Tumor
A
large nodule > 10 mm
3
Q
Vesicle
A
fluid-filled blister < 10 mm
4
Q
Bullae
A
vesicles > 10 mm
5
Q
Pustule
A
elevated pus-containing lesion
6
Q
Urticaria (wheal/hive)
A
transient/soft/elevated lesion d/t localized edema
7
Q
Scale
A
dry, whitish accumulation of epithelium
8
Q
Crust
A
dried pus/blood/exudate on surface d/t broken pustules/vesicles
9
Q
Erosion
A
loss of epidermis
10
Q
Excoriation
A
linear erosion usu d/t scratching
11
Q
Ulcer
A
deeper erosions involving the dermis, bleeding/scarring
12
Q
Purpura
A
area of hemorrhage, mb palpable, doesn’t blanch
13
Q
Atrophy
A
paper-thin wrinkled and dry-appearing skin
14
Q
Scar
A
fibrous tissue replacement after injury
15
Q
Telangiectasia
A
dilated superficial blood vessels
16
Q
Ecchymosis
A
subQ purpura > 1 cm
17
Q
Annular
A
rings with central clearing
18
Q
Nummular
A
circular
19
Q
Target
A
rings w/ central duskiness
20
Q
Serpiginous
A
fungal/parasitic infx
21
Q
Reticulated
A
lacy patter
22
Q
Verrucous
A
irregular surface
23
Q
Lichenification
A
epidermal thickening w/ accentuation of skin lines d/t chronic irritation
24
Q
Induration
A
dermal thickening (hard/rough skin)
25
Umbilicated
raised lesion w/ a central indentation/dimple
26
What is acanthosis nigricans?
thickened/velvety hyperpigmentation of flexural surfaces
27
Sx: acanthosis nigricans
asx
28
Acanthosis nigricans can be associated with ____
insulin resistance (diabetes, obesity), internal malignancy (gastric cancer, estrogens)
29
Dermatographism
urticaria after stroking the skin
30
Diascopy
pressure to indicate blanching
31
Macule
flat non-palpable lesion < 1 cm
32
Darier's sign
stroking lesions; intense/sudden erythema; wheal formation
33
Papule
raised lesion < 10 mm
34
Plaque
raised lesion > 10 mm
35
Patch
flat, non-palpable lesion > 1 cm
36
Nikolsky's sign
bullae formation and erosion d/t gentle traction pressure
37
Auspitz' sign
pinpoint bleeding after removal of plaques
38
Koebner's phenomenon
development of lesions within areas of trauma
39
Wood's lamp
UV light for fungi
40
Skin scraping
used for scabies/fungus
41
Yellow lesion
jaundice, heavy metal poisoning, myxedema, uremia
42
Green lesion
in fingernails, pseudomonas
43
Violet lesion
darkening cutaneous hemorrhage, vasculitis
44
Gray/blue lesion
cyanosis, metal deposits
45
Black lesion
melanocytic lesions, infx, arterial insufficiency
46
White lesion
tinea, pityriasis alba, vitiligo
47
Orange lesion
hypercarotenemia
48
Red lesion
erythema, increased blood flow
49
Pruritus
itching
50
Sx: acne vulgaris
comedones, papules, pustules, inflamed nodules, pyogenic cysts (rare)
51
Etiology: acne vulgaris
androgen stimulus, sebum, bacteria interaction, drug induction, diet
52
DDx: acne vulgaris
rosacea, perioral dermatitis, drug eruptions, folliculitis
53
What are the 3 most common dietary causes of acne vulgaris?
milk, sugar, bromine
54
Population: acne vulgaris
puberty to ~35, M > F
55
Distribution: acne vulgaris
face, chest, back, upper arms
56
Labs: acne vulgaris
serum total/free testosterone w/ DHT, FSH, LH, DHEA-S, bacterial/fungal cultures to r/o infx folliculitis
57
Dx: acne vulgaris
mild - < 30 lesions, mod - 30-125 lesions, severe - > 5 cysts / > 125 lesions
58
Etiology: rosacea
idiopathic, higher rates of H. pylori and SIBO
59
Population: rosacea
30-60, fair complexion, blushers, pts susceptible to flushing episodes d/t stimuli (alcohol, spicy foods, temp extremes, emotions), eye involvement
60
Distribution: rosacea
central area of face and scalp
61
SSx: rosacea
"pre-rosacea" - flushing episodes, vascular phase - frequent flushing, inflammatory phase (papules, pustules, nodules, cysts), late-stage/rhinophyma
62
Dx: rosacea
1 or more primary features: flushing, nontransient erythema, papules/pustules, telangiectasia
1 or more secondary features: burning/stinging, plaques, dry appearance, edema, ocular manifestation, peripheral location, phymatous changes
63
DDx: rosacea
SLE, acne vulgaris, drug eruptions, granulomas, perioral dermatitis, infx folliculitis, seborrheic dermatitis, carcinoid, chronic topical glucocorticoids
64
What is bullous pemphigoid?
chronic pruritic bullous eruptions, uncommon
65
Etiology: bullous pemphigoid
autoimmune, drug-induced (diuretic, NSAIDs)
66
SSx: bullous pemphigoid
prodromal phase (eczematous, pruritic, utricaria-like skin lesions becoming tense bullae), bullae rupture leaving erosions
67
Distribution: bullous pemphigoid
trunk, lower legs, extremity flexures, axillary/inguinal folds
68
Population: bullous pemphigoid
> 60
69
DDx: bullous pemphigoid
pemphigus vulgaris, dermatitis herpetiformis, erythema multiforme, drug eruptions
70
Dx: bullous pemphigoid
H&P, biopsy (subepidermal bullae with eosinophilia), direct immunofluorescence (IgG and/or C3 in basement membrane), serum antibody titers (Anti-BP 180)
71
What is dermatitis herpetiformis
autoimmune, chronic, recurring, intensely pruritic with symmetrical groups of inflamed vesicles/papules/hives
72
Etiology: dermatitis herpetiformis
autoimmune, celiac dz (asx)
73
Distribution: dermatitis herpetiformis
symmetrical extensor aspects, sacrum, base of head
74
Population: dermatitis herpetiformis
20-50, M > F
75
Dx: dermatitis herpetiformis
H&P, biopsy (subepidermal clefting/papillary dermal tips w/ neutrophils and eosinophils), direct immunofluorescence (IgA), TTG, anti-endomysial Ab, jejunal bx
76
DDx: dermatitis herpetiformis
pemphigus, bullous pemphigoid, dermatitis, herpes, insect bites, scabies
77
What is pemphigus vulgaris?
rare, potentially fatal blistering disease
78
Etiology: pemphigus vulgaris
autoimmune
79
SSx: dermatitis hereptiformis
burning, severe stinging/itching, lasting weeks to years
80
Distribution: pemphigus vulgaris
oral lesions often precede skin lesions (50-70%), groin, scalp, abdomen, back, upper legs, axilla, umbilicus
81
Population: pemphigus vulgaris
> 60, F > M, Ashkenazi Jews
82
Dx: pemphigus vulgaris
H&P, biopsy (intraepidermal bulla/separation of epidermal cells, eosinophil infiltrate, IgG, C3), Immunofluorescence, serum anti-Dsg 3 anti-Dsg 1, Nikolsky's sign
83
Prognosis: pemphigus vulgaris
hospitalization universally required, 15% mortality
84
DDx: pemphigus vulgaris
HSV, HZV, bullous pemphigoid, canker sores, paraneoplastic pemphigus (bx to r/o)
85
How are all cornification disorders diagnosed?
H&P
86
What are calluses and corns?
epidermal thickening from pressure or friction
87
Comparison: calluses and corns
calluses - usu asx, intact skin lines
| corns - mb painful w/ pressure, yellowish core, interrupts skin lines
88
What is ichthyosis?
scaling/flaking of skin
89
Distribution: ichthyosis
shins, outer arms most common
90
Distribution: callus/corn
feet, toes
91
DDx: ichthyosis
dry skin, acquired ichthyosis
92
Comparison: acquired vs inherited ichthyosis
acquired - sudden onset
| inherited - gradual onset
93
What is keratosis pilaris?
keratin disorder where horny plugs fill opening of hair follicles
94
Etiology: keratosis pilaris
nutritional deficiency, genetic, more common in atopy
95
SSx: keratosis pilaris
keratotic follicular papules
96
Population: keratosis pilaris
worse in children, resolves/improves w/ adulthood
97
Distribution: keratosis pilaris
upper arms, thighs, buttocks, face in children
98
What is atopic dermatitis?
immune-mediated skin inflammation w/ genetic component usu
99
Etiology: atopic dermatitis
genetics (atopy), food/environmental allergies, aggravations (dry skin, SIBO, stress, allergens, tight clothes, sweating, nutritional deficiencies)
100
SSx: atopic dermatitis
red/weeping/crusted lesions, intense pruritus, lichenification, may have palmar hyperlinearity, keratosis pilaris, hand/foot involvement, chelitis, susceptibility to cutaneous infx
101
Distribution: atopic dermatitis
Infantile phase (cheeks, perioral, scalp, extensor tops of feet/elbow w/ exudate), Childhood phase (flexural surfaces, lichenification), Adult phase (flexural, hands, upper eyelids, diffuse over body)
102
Population: atopic dermatitis
begins very young, parents with atopy
103
Dx: atopic dermatitis
H&P, culture to r/o infx, eosinophilia, food allergy/sensitivity testing, vit D, GI assessment (dysbiosis, 3hr lactulose breath test for methane, hydrogen)
104
DDx: atopic dermatitis
seborrheic dermatitis, contact derm, nummular derm, Candida, scabies, tinea
105
What is contact dermatitis?
acute inflammation of skin caused by irritants or allergens
106
Etiology: contact dermatitis (irritant)
chemicals, soap, acids, alkaline chemicals, oils, water, wood dust, fiberglass, body fluids
107
Etiology: contact dermatitis (allergic)
hypersensitivity rxn, drugs, latex, metals, cosmetics, lotion, sunscreen, nail polish, fragrances, poison ivy/oak
108
SSx: contact dermatitis (irritant)
erythema, dryness, painful cracking/fissuring; when acute, papules w/ weeping/edema; when chronic, lichenification/excoriations/scaling
109
Distribution: contact dermatitis
hands, mouth, wherever body was exposed to allergen
110
SSx: contact dermatitis (allergic)
intense pruritus, mild erythema to hemorrhage, vesiculization, ulceration
111
Dx: contact dermatitis
H&P, patch testing when ACD doesn't respond to treatment
112
DDx: contact dermatitis
seborrheic derm, atopic derm, nummular derm, tinea
113
What is lichen simplex chronicus?
chronic pruritus causing extreme scratch-itch cycle w/o demonstrable cause
114
SSx: lichen simplex chronicus
pruritus, dry/scaling skin, hyperpigmentation, erythematous, violaceous, irregular lichenified plaques
115
Distribution: lichen simplex chronicus
back of neck, wrists, ankles/pubic region, usu NOT present on back, abd, face, upper legs
116
Dx: lichen simplex chronicus
H&P, KOH wet mount to r/o tinea, bx, patch testing to identify allergen
117
DDx: lichen simplex chronicus
tinea, lichen planus, psoriasis
118
What is nummular dermatitis?
inflammation of the skin in a coin-shaped pattern
119
Population: nummular dermatitis
mid-aged w/ dry skin, M > F, no hx of eczema
120
Etiology: nummular dermatitis
idiopathic
121
SSx: nummular dermatitis
intense pruritus, inflamed coin-shaped lesions, vesicles, crusting/scaling
122
Distribution: nummular dermatitis
extensor surfaces, buttocks, trunk, often begins on legs; 1-50 lesions
123
Dx: nummular dermatitis
H&P, patch testing, culture to r/o s. aureus, bx, KOH wet mount
124
DDx: nummular dermatitis
psoriasis, tinea corporis, cutaneous T-cell lymphoma scabies, seborrheic dermatitis, fungus, Paget's dz when on breast
125
What is seborrheic dermatitis?
inflammation of the skin in high-density areas of sebaceous glands (scalp, eyebrows, eyelids, face)
126
Etiology: seborrheic dermatitis
nutritional deficiency, malazzezia fungi
127
SSx: seborrheic dermatitis
gradual onset, well-demarcated/erythematous plaques, greasy-looking/yellow scales, no hair loss, papules possible, cradle cap in newborns
128
Distribution: seborrheic dermatitis
scalp, external ear, center of face, eyebrows, axilla, nasolabial folds, upper trunk, intertriginous areas
129
Population: seborrheic dermatitis
biphasic (infants, adolescence, peeks 30-50), M > F, HIV+/Parkinson's/neuroleptic meds
130
Dx: seborrheic dermatitis
H&P, KOH/fungal culture if indicated
131
DDx: seborrheic dermatitis
atopic derm, contact derm, psoriasis, tinea, cutaneous lupus, rosacea
132
What skin condition can be a presenting sign for HIV?
seborrheic dermatitis
133
What is stasis dermatitis?
persistent dermatitis of the lower legs (esp ankle)
134
Etiology: stasis dermatitis
chronic venous insufficiency
135
SSx: stasis dermatitis
brown pigmentation over time, edema/petechiae, erythema/fissures, dry/weeping/crusting, pruritic; varicosities/cellulitis; stasis ulcers can penetrate to bone; heaviness/aching/edema in legs; 2nd infx w/ s. aureus is common
136
Population: stasis dermatitis
pts with DVT/surgery/trauma/ulceration
137
Dx: stasis dermatitis
H&P, veinous studies, ankle brachial index; if DVT, protein S/C, factor V Leiden, fibrinogen, homocysteine
138
DDx: stasis dermatitis
cellulitis, contact derm, tinea
139
What is polymorphous light eruption?
idiopathic, reccurent photodermatitis following acute sun exposure
140
SSx: polymorphous light eruption
2hrs-5days after sun exposure, burning/itching/erythema to exposed skin, papular/papulovesicular, 7-10 days
141
Population: polymorphous light eruption
all ages/races/genders; most common in young females
142
Dx: polymorphous light eruption
H&P, ANA/anti-SSA/anti-SSB to r/o SLE
143
DDx: polymorphous light eruption
SLE, photodrug rxn, porphyria tarda, solar urticaria
144
What are chronic effects of sunlight associated with aging?
fine/coarse wrinkles, rough/leathery texture, mottled hyperpigmentation, telangiectasia
145
What is actinic keratosis?
precancerous neoplasm d/t UV exposure
146
SSx: actinic keratosis
rough/scaling macule/papule/plaque 1-10 mm, reddish/pink, ill-marginated with rough scale, can develop into thin/adherent transparent scale that becomes thick/yellow/horn-forming
147
Distribution: actinic keratosis
face, lips, backs of hand, shoulders, legs
148
Population: actinic keratosis
increases w/ age, usu in blondes/redheads with light skin (skin type I/II)
149
Dx: actinic keratosis
bx to r/o SCC
150
DDx: actinic keratosis
seborrheic keratoses, SCC
151
What is psoriasis?
chronic recurring inflammation of epidermis/dermis w/ increased epidermal proliferation leading to scaling; immune-related
152
Etiology: psoriasis
genetics, environmental triggers, infx, physical/psychological stress, medications
153
Population: psoriasis
biphasic (20-30 and 50-60), M = W, smoking/obesity/HIV predispose
154
SSx: psoriasis
dry/well-demarcated/erythematous papules/plaques topped with silvery scales; can itch but usu asx; limited/systemic; better in summer; Systemic sxs: arthritis, fever, chills, pitting in nails
155
7 Types of psoriasis
plaque psoriasis (classic), guttate psoriasis (sudden onset w/ strep infx/steroid withdrawal), pustular psoriasis (small pustules on palms/soles), inverse psoriasis (flexor surfaces/intertriginous areas), nail psoriasis, generalized pustular (generalized pustules w/ fever), erythrodermic psoriasis (total body erythema w/ chills/skin pain)
156
Which types of psoriasis are emergencies?
generalized pustular psoriasis, erythrodermic psoriasis
157
Distribution: psoriasis
scalp, extensor surfaces, buttocks, back; nails, eyebrows, axilla, umbilicus, anogenital region
158
Dx: psoriasis
H&P, Auspitz sign, bx w/ thickening of epidermis
159
DDx: psoriasis
seborrheic derm, eczema, pityriasis rosea, tinea capitus, SCC, dermatophytoses, cutaneous lupus, dermatitis, lichen simplex chronicus
160
What should you ask every patient with urticaria?
Do you have any breathing issues or sensations on the lips during itching?
161
How long can it take late stage rosacea to set in?
15 years or more
