Week 4: Dermatology Flashcards
Macule
flat, non palpable color change, variable shape
Papule
elevated, palpable
Plaque
elevated plateau-like lesion greater than 10 mm; superficial
Nodule
firm papule, palpable, extends into dermis or subcutaneous tissue
Tumor
large nodule greater than 10 mm
Vesicle
fluid-filled blister less than 10 mm (clear fluid)
Bullae
vesicles larger than 10 mm
Pustule
elevated lesion containing pus
Urticaria (wheals or hives)
transient elevated lesion due to localized edema; feels kind of damp/fluidy
Scale
accumulation of epithelium; dry, whitish
Crust
dried pus, blood or serous exudate on the surface; usually due to broken pustules or vesicles
Erosion
loss of epidermis
Excoration
linear erosion usually caused by scratching
Ulcer
deeper erosions involving the dermis; (bleeding and scaring)
Petechiae
small non-blanchable punctuate foci of hemorrhage (vascular rash)
Purpura
larger area or hemorrhage, maybe palpable (bruises or ecchymosis: a coalesced petechia patch)
Atrophy
paper thin wrinkled and dry-appearing skin
Scar
fibrous tissue replacement after injury
Telangiectasia
dilated superficial blood vessels
What are the 6 categories used to describe and chart a lesion?
Secondary morphology/configuration (shape of single lesion or cluster of lesions) Texture Location and distribution Color Other Clinical Signs Diagnostic Tests
Annular
rings with central clearing
Nummular
circular
Target
rings with central duskiness
Serpiginous
fungal and parasitic infections
Reticulated
lacy pattern
Verrucous
irregular surface
Lichenification
epidermal thickening with accentuation of skin lines due to chronic irritation
Induration
dermal thickening; skin feels hard and rough
Umbilicated
with a central indentation
Red (Erythema), indicates……
increased blood flow to the skin
Orange indicates……
hypercarotenemia
Yellow indicates…….
jaundice, heavy metal poisoning, myxedema, uremia
Green indicates…….
in fingernails suggests pseudomonas
Violet indicates…..
darkening cutaneous hemorrhage, vasculitis
Gray/blue skin indicates……..
cyanosis; metal deposits
Black indicates…….
melanocytic lesions, infection or arterial insufficiency
White indicates……..
tinea, Pityriasis alba, vitiligo
Dermatographism
urticaria after stroking the skin
Diascopy
pressure to indicate blanching (hemorrhagic lesions don’t blanch, inflammatory lesions do)
Darier’s sign
stroking lesions causes intense and sudden erythema and wheal formation
Nikolsky’s sign
bullae formation and erosion following gentle traction pressure
Auspitz’ sign
pinpoint bleeding after removal of plaques
Koebner’s phenomenon
development of lesions with areas of trauma
What two diagnostic tests are used regarding fungi?
Wood’s lamp and KOH test
A pruritus diagnosis must include what in it’s history?
Drug and occupational/hobby exposures
What is the most common cause of pruritus?
Dry skin
What is pruritus?
Itching of the skin
What testing can be done for a pt. with pruritus?
Biopsy, CBC, liver, kidney, thyroid function, evaluation for underlying malignancy, immunoglobulins
What is Urticaria?
Migratory, erythematous pruritic plaques mostly involving release of histamine.
What determines acute vs. chronic urticaria?
> 6 weeks duration
Etiology of Urticaria?
Viral/bacterial infection, IgE allergy, medications (NSAIDs), rare autoimmune dz, malignancy
What are important aspects of the history to gather with Urticaria?
Duration, triggers, frequency, concomitant symptoms (GI), always ask about respiratory system, use of drugs, travel and family history
What testing should be done with Urticaria?
CBC, Immunoglobulins to foods, ANA or thyroid studies, biopsy if uncertain
What PE should be done in a Urticaria case?
Complete examination of the skin; look for signs of infection and systemic disease
What does acne vulgaris present (s/sx) with?
Comedones, papules, pustules, inflamed nodules, superficial pus filled cysts and sometimes deep purulent sacs.
What are dietary causes for acne vulgaris?
Dairy, sugar and bromine
What are the grading criteria for acne vulgarism?
Mild = 5 cysts or 125 lesions
Name the chronic inflammatory disorder characterized by facial flushing, telangiectasias, erythema, papules, pustules and possible rhinopyma?
Rosacea
Pts with Rosacea have higher infection rates of __________ and __________
Pts with Rosacea have higher infection rates of H. Pylori and SIBO
What are some triggers for rosacea episodes?
hot or spicy foods
drinking alcohol
temperature extremes
emotional reactions
What are the stages of Rosacea?
Pre-rosacea
Vascular phase
Inflammatory phase: papules, pustules, nodules and cycts present
Late stage/rhinophyma
Rosacea must display one primary and one secondary feature. Name possibilities for each of those.
Primary: Flushing, non-transient erythema, papules and pustules, telangiectasia
Secondary: Burning or stinging, plaque, dry appearance, edema, ocular manifestation, peripheral location, phymatous changes
Name this uncommon, chronic pruritic bullous disease.
Bullous pemphigoid
What do all bullous diseases have in common?
Autoimmune causes
What causes outside of autoimmunity does bullous pemphigoid have?
Drug induced from furosemide, captopril and NSAIDS
Does bullous pemphigoid have a positive or negative Nikolsky’s sign?
Negative
What does the prodromal phase of bullous pemphigoid look like?
Pruritic eczematous papular or uticaria-like skin lesions that become tense bullae
What is the distribution pattern for bullous pemphigoid?
Trunk, lower legs, extremity flexures, axillary and inguinal folds
What is bullous pemphigoid associated with and what is the age range affected?
Associated with dementia, parkinson’s disease and unipolar/bipolar
Age>60
What diagnostic criteria are used for bullous pemphigoid?
Biopsy: shows sub epidermal bulla with infiltrate of eosinophils;
Direct immunofluorescence (GOLD STANDARD) of skin shows IgG and/or C# in a linear band in basement membrane.
What disease presents in ages 20-50; male:female __(?)___; as chronic, recurring, intensely itchy with symmetrical groups of inflamed vesicles, papules and hives?
What disease presents in ages 20-50; male:female 2:1; as chronic, recurring, intensely itchy with symmetrical groups of inflamed vesicles, papules and hives?
Dermatitis herpetiformis
Dermatitis herpetiformis is caused by autoimmune diseases, especially _________ and also associated with ________ disorders
Dermatitis herpetiformis is caused by autoimmune diseases, especially celiac disease (even asx) and associated with thyroid disorders.
What is the distribution of dermatitis herpetiformis?
symmetrical extensor aspects, sacrum, base of head or generalized (rare)
How is dermatitis herpetiformis diagnosed?
Skin biopsy of lesions and adjacent skin = sub epidermal clefting and papillary dermal tips w/neutrophils and eosinophils;
Direct immunoflorescence is a GOLD STANDARD: IgA deposition
Pemphigus vulgaris is ________________ with the highest incidence occurring in ___________.
Pemphigus vulgaris is a rare potentially fatal (15%) blistering disease with the highest incidence occurring in Ashkenazi Jews.
Pemphigus vulgaris’ distribution
Oral lesions precede skin lesions in 50-70%; then found on groin, scalp, abd, back, upper legs, axilla and umbilicus
How is pemphigus vulgaris diagnosed?
Biopsy = intradermal bulla or separation of epidermal cells
Immunfluorescence from edge of fresh lesion
Nikolsky’s sign (+)
Epidermal thickening that is usually asymptomatic with intact skin lines
Callus
Epidermal thickening that maybe painful with pressure that has a yellowish core when pared and interrupts skin lines
Corn
Scaling and flaking of skin is called……
Ichthyosis
What are characteristics of inherited Ichthyosis?
Autosomal Dominant and X-linked; resembles cracked pavement; accentuated palmar creases
What is the distribution of ichthyosis?
shins and outer arms
What is required for diagnosis?
H and PE
No biopsy
What happens during Keratosis pillaris?
Horny plugs fill the openings of hair follicles: follicular papules on lateral aspects of upper arms, thighs and buttocks. On the face of children (sandpaper skin)
What are causes of keratosis pillaris?
Nutritional deficiency, or genetic
Name and describe the causes of this immune-mediated skin inflammation with a genetic component?
Atopid Dermatitis
Causes: Genetics (atopy), food and environmental allergies, aggravated by dry skin, wool, sweating, allergens, tight clothing, emotional stress, nutritional
