week 5 skin

Question 1

• What is erythema Nodosum? Causes?

Answer 1

o inflammation of the skin and subQ tissue (panniculitis) characterized by tender, red nodules on the shins
o Cause: infections, drugs, malignancy, inflammatory/granulomatous dx (sarcoidosis)

Question 2

• What are ssx of erythema Nodosum? Epidem?

Answer 2

o Ssx: indurated nodules that look like bruises, gradually changing color, with successive crops of nodules. Nodules are very painful. Mostly pretibial. Systemic symptoms such as fever, malaise, joint pain. spontaneous resolution in about 6 weeks.
o Age: peaks at 20-30 but can occur at any age. F>M (6x)

Question 3

• How is erythema Nodosum diagnosed? Ddx?

Answer 3

o By H & P, but must look for underlying disorder. Biopsy, ESR, CRP ANA, CBC, chest x-ray (sarcoid), ASO-titer (anti-streptolysin O) or pharyngeal culture (for group A beta-hemolytic strep).
o DDx: vasculitis, pretibial myxedema, lymphoma

Question 4

• What is a sweating disorder? Ssx? Dx? Ddx?

Answer 4

o Miliaria: (heat rash) Accumulation of sweat beneath eccrine sweat ducts results in obstruction by keratin at the level of the stratum corneum.
o Ssx: Pruritus is common. More in kids/babies. Small red papules with mild itching, occasional pustules
o Dx: Hx&P
o Ddx: baby acne

Question 5

• What are the bacterial skin infections?

Answer 5

o Cellulitis; cutaneous abscess; erysipelas; erysipeloid; erythrasma; folliculitis; furuncle; carbuncle; impetigo

Question 6

• What is cellulitis? Causes?

Answer 6

o acute bacterial infection of the skin
o Causes: most common in adults S. aureus, GAS. Children Hib, GAS, S. aureus. Varies with location. Immunocompromise will predispose. IV drug use

Question 7

• What are ssx of cellulitis? Distribution?

Answer 7

o Ssx: local erythema, heat, edema and tenderness, with lymphangitis and regional lymphadenopathy. Systemic symptoms, if present, include fever, chills, tachycardia, headache, hypotension or delirium (may precede skin sxs).
o Distribution: Adults- lower leg most common. Children cheeks, periorbital, head, neck

Question 8

• How is cellulitis diagnosed? Ddx?

Answer 8

o Diagnosis: by H & P. CBC. Culture of exudates or aspirate. Blood cultures if immune compromised. Blood cultures of infected tissue if not responding to therapy.
o DDX: DVT, gout, CPPD, septic arthritis, stasis dermatitis, insect bite, erysipelas

Question 9

• What is a cutaneous abscess? Ssx? Dx? Ddx?

Answer 9

o localized collection of pus under the skin
o ssx: Painful, tender, indurated and erythematous, varying in size from 1-3 cm typically, but mb larger. May be accompanied by local cellulitis, lymphangitis, LAD, fever.
o Dx: by H & P, CBC. Gram stain or culture in immunocompromised patients.
o DDX: hidradenitis suppuritiva, ruptured epidermal cysts

Question 10

• What is erysipelas? Cause? Complications?

Answer 10

o superficial cellulitis with dermal lymphatic involvement (streaking)
o Cause: GAS, immunocompromised
o Complications: scarlet fever, fat necrosis, gangrene. Sudden onset

Question 11

• What are ssx of erysipelas? Distribution?

Answer 11

o Ssx: Shiny, raised, indurated and plaque-like lesions with distinct margins. Commonly high fever, chills, and malaise, or maybe no systemic symptoms. It has sharp borders, raised, red (deep), hot plaque that spreads rapidly. Regional LAD and tenderness, and may see vesicles, bullae, petechiae. Itching, burning, and pain may be severe. Red, painful streaks along lymph
o Distribution: Legs most common, then face

Question 12

• How is erysipelas diagnosed? Ddx?

Answer 12

o By H & P, CBC, blood culture in toxic-appearing patients. Direct culture is often not useful
o DDX: Face – herpes zoster, contact derm.

Question 13

• What is erysipeloid?

Answer 13

o Like erysipelas except a different bacteria (Erysipelothrix). Violet on the hands and forearms and is not hot, though may be tender with fever and malaise. Rare.

Question 14

• What is erythrasma? Ssx? Dx? Ddx?

Answer 14

o Superficial intertriginous infection with Corynebacterium.
o Ssx: Occurs in toe webs, between fingers, genitals (pink or brown patches) with scaling, fissuring and maceration. May be patchy on the trunk.
o Dx: Coral red fluorescence with Wood’s lamp, no hyphae, skin scraping w/KOH
o DDX: tinea, candida

Question 15

• What is folliculitis? Causes? Ssx?

Answer 15

o Inflammation of the hair follicle. Many different types
o Cause: S. aureus, fungal, persistent trauma, systemic corticosteroids
o Ssx: Pustule or inflammatory nodule that surrounds a hair follicle. Superficial or deep. Mild itching or pain. Abrupt onset May be chronic.

Question 16

• What is “Hot tub” Folliculitis?

Answer 16

caused by Pseudomonas following exposure to contaminated water. High rate of infxn in kids. Occurs 8hrs-5days post hot tub. Trunk, groin most common

Question 17

• What is distribution of folliculitis? Dx? Ddx?

Answer 17

o Distribution: buttocks, upper legs, face, neck, sternum and upper outer arms most common but can be anywhere except hands and feet
o Dx: by examination. KOH to r/o dermatophyte
o DDX: acne, follicular keratosis,

Question 18

What is a furuncle? Ssx? Age?

Answer 18

o acute tender nodules, caused by S. aureus.
o Ssx: A deep dermal or subq, red, swollen and painful mass and drains to the surface. Pustule 5-30 mm with central necrosis and pus discharge. May be recurrent. A ruptured lesion heals with deep violaceous scar. Afebrile
o Age: uncommon in children

Question 19

• What is distribution of a furuncle? Sx? Ddx?

Answer 19

o Distribution: neck, under breasts, buttocks, groin most common
o Dx: by examination. Culture may be beneficial dt MRSA
o Ddx: Folliculitis, Hidradenitis suppurativa, insect/spider bite, ruptured pilar cyst, cystic acne

Question 20

• What is a carbuncle? Ssx? Dx?

Answer 20

o Cluster of furuncles with multiple draining orifices.
o Ssx: Usu on neck, face, breasts and buttocks. Uncomfortable and may be painful, accompanied by fever.
o Dx: by examination. Culture if recurrent or immunocompromised.

Question 21

• What is impetigo? Causes? Ssx?

Answer 21

o superficial acute skin infection with crusting
o Cause: S. pyogenes, S. aureus. Warm moist climate, poor hygiene
o Ssx: Clusters of vesicles or pustules that rupture and develop honey colored crust. Scaling borders. Satellite lesions often present. May see regional LA. May be pruritic.

Question 22

• What is distribution of impetigo? Age? Dx? Ddx?

Answer 22

o Distribution: face, shins, extensor surface of forearms
o Age: common in children
o Dx: by examination. Culture is more common now dt MRSA.
o DDX: atopic, contact dermatitis, perioral dermatitis, herpes simplex, herpes zoster, tinea

Question 23

• What are the fungal skin infections?

Answer 23

o Candidiasis; dermatophytoses; tinea versicolor

Question 24

• What is candidiasis? Causes? Ssx?

Answer 24

o Skin infection with Candida sp, most often Candida albicans (70-80%).
o Causes: Immunosuppression, sugar dysregulation, antibiotics, oral contraceptives
o Ssx: intertriginous, erythematous, well-demarcated, pruritic patches of varying sizes and shapes. Surface is often glistening. Intense inflammation with satellite lesions around the main area.

Question 25

• What are the types of candidiasis? Dx? Ddx?

Answer 25

o Many different types based on location: Balanitis, Diaper Dermatitis, Intertrigo, Vulvovaginitis, Oropharyngeal
o Dx: By examination, presence of yeast and pseudohyphae on KOH prep, fungal culture or DNA probe.
o DDx: changes with location. Dermatophytoses, allergic derm, herpes, molluscum, psoriasis, contact derm, strep cellulites, seborrheic derm, erythrasma,

Question 26

• What is dermatophytoses? Ssx? Dx?

Answer 26

o fungal infections of keratin in the skin and nails. Caused by Epidermophyton, Microsporum, and Trichophyton.
o Vary by site. Recurrent with little or no inflammation. Mildly pruritic, erythematous scaling lesions.
Dx: by appearance, Wood’s Lamp, skin scraping and a KOH prep

Question 27

What are the types of tinea?

Answer 27

o Barbae, capitis, corporis, cruris, pedis
o Dermatotyphid reaction
o Versicolor

Question 28

• What is tinea barbae? Dx?

Answer 28

o Tinea barbae: uncommon. Develops slowly. 2 patterns- ringworm and follicular. Pruritic, at time painful and swollen. Secondary bacterial infections can occur.
o Dx: Examine skin scraping and plucked hair with KOH (hairs will come out easily if fungal infxn) fungal cultures and biopsy can be helpful.

Question 29

• What causes tinea capitis? Epidem? 4 patterns? Ssx? Ddx?

Answer 29

o caused by Trichophyton tonsurans.
o Epidem: More common in African Americans and Hispanic and those living in close proximity. Children most effected.
o 4 patterns- seborrheic derm, inflammatory, “black dot” pattern and pustular. s/sx change with each.
o Ssx: KOH examination of lesional hairs demonstrates fungal hyphae arranged in a longitudinal direction within the hair shafts. Culture can be performed on Sabouraud’s medium and Wood’s lamp examination of infected hairs reveals a characteristic sliver-blue fluorescence
o DDX: psoriasis, seborrheic dermatitis

Question 30

• What are ssx of tinea corporis? Dx? Ddx?

Answer 30

o Ssx: pruritic, circular or oval, erythematous, scaling patch/plaque that spreads centrifugally. Central clearing follows, while the active advancing border, a few millimeters wide, retains its red color and with cross lighting can be seen to be slightly raised.
o Dx: KOH will show hyphae, culture may be necessary
o DDX: pityriasis rosea, drug eruptions, nummular dermatitis, erythema multiforme, tinea versicolor, psoriasis

Question 31

• What causes Tinea cruris (“jock itch”)? Ssx? Sex? Dx? Ddx?

Answer 31

o Causes: Obesity, diabetes and immunodeficient states.
o Ssx: erythematous patch high on the inner aspect of one or both thighs (opposite the scrotum in men). It spreads centrifugally, with partial central clearing and a slightly elevated, erythematous, sharply demarcated border that may show tiny vesicles that are visible only with a hand glass, spares the scrotum.
o M>F
o Dx: KOH prep from scraping of an active border.
o DDX: contact dermatitis, psoriasis, Candida, erythrasma, seborrheic derm

Question 32

• What is Tinea pedis (“athlete’s foot”)? Dx? Ddx?

Answer 32

o common. intensely pruritic, sometimes painful, erythematous vesicles or bullae between the toes or on the soles, frequently extending up the instep. Unilateral or bilateral. Secondary eruptions at distant sites, called an Id reaction, examine hands.
o Dx: skin scarping.
o DDX: dyshidrotic eczema, contact dermatitis, psoriasis

Question 33

• What is the Dermatophytid Reaction (“id” reaction)?

Answer 33

o distant site inflammatory reaction during fungal infection. Sterile.

Question 34

• What is tinea versicolor? Ssx? Distribution? Dx? Ddx?

Answer 34

o superficial fungus infection with Malassezia furfur (a saprophysic yeast)
o ssx: hypopigmented, hyperpigmented, or erythematous macules with scaling patches. Lesions are asx.
o Distribution: trunk and proximal upper extremities
o Dx: Direct microscopy shows “spaghetti and meatballs” appearance of broad hyphae and clusters of budding cells, Wood’s lamp will reveal yellow to yellow-green fluorescence in some cases
o DDX: Vitiligo, pityriasis rosea, tinea corporis, Seborrheic dermatitis, Erythrasma

Question 35

• What are the parasitic skin infections?

Answer 35

o Cutaneous larva migrans; lice (pediculosis); scabies

Question 36

• What causes cutaneous larva migrans (“Creeping eruption”)? Ssx? Distribution? Dx? Ddx?

Answer 36

o caused by hookworm larva (Ancylostoma) from dog and cat excrement.
o Ssx: intense pruritis, erythema and papules at site of entry, winding tail of inflammation- serpiginous. usually occurs about 3 weeks after exposure.
o Distribution: feet/ankles, buttocks, backs of legs and back
o Dx: history and appearance, CBC can show eosinophila, CXR
o DDX: scabies

Question 37

• What is lice (pediculosis)? Ssx? Distribution? Dx? Ddx?

Answer 37

o Wingless, blood sucking insects that infect the head (Pediculus humanus capitius), body (Pediculosis humanus corporis), or pubis (Phthirus pubis).
o Ssx: Severe pruritis. May see excoriations from scratching. Red puncta from bites. Nits on hair shaft 1cm from scalp- gray/white. May see brown specks of excrement on skin or clothing.
o Distribution: scalp, body hair, pubic hair
o Dx: Demonstration of living lice in wet hair using a fine-toothed comb. Also will fluoresce under Wood’s lamp.
o DDx: seborrheic derm, impetigo, insect bites

Question 38

• What is scabies? Ssx? Distribution? Dx? Ddx?

Answer 38

o Infection of skin with scabies mite Sarcoptes.
o Ssx: Burrows are fine, wavy lines in the skin 2-10 mm long, covered often by lichenified skin. Intensely pruritic, esp at night. May also see erythematous papules without many burrows. Others in family/living quarters will be affected. Itching will continue after treatment due to allergic response not active infestation.
o Distribution: hands, arms, feet, gluteal fold, axilla, back of the knees
o Dx: Burrows are pathognomonic. May do microscopic examination of burrow scrapings. Apply mineral oil to the burrow, vesicle or papule and scrape with a #15 blade, prepare slide. Dx is often made only by Hx and PE.
o DDX: insect bites, fungus, eczema, folliculitis, impetigo

Question 39

• What are the viral skin dzs?

Answer 39

o Molluscum contagiosum; warts (verrucae vulgaris); varicella; herpes simplex; zoster; roseola infantum; hand foot and mouth dz; viral exanthems; measles; rubella

Question 40

• What is collsucum contagiosum? Ssx? Age? Distribution? Dx? Ddx?

Answer 40

o caused by pox virus in epidermal cells
o ssx: Smooth flesh colored umbilicated dome, hard; cheesy core; may become inflamed or secondarily infected. Asx. Up to 15 mm in diameter in immunocompromised. Lesions persist for 6-9 months
o Age- Any but more common 3-9yrs
o Distribution: face, arms, chest, genitals (when sexually transmitted)
o Dx: By appearance. Biopsy will show “molluscum bodies” in keratinocytes. Biopsy should be used in immunocompromised pts
o DDX: Folliculitis, milia, verrucae

Question 41

• What are warts (verrucae vulgaris)? 6 types? How are they diagnosed?

Answer 41

o Benign contagious neoplasms caused by HPV
o Common, filiform; flat; plantar; mosaic; condylloma accuminata
o Dx: By appearance, biopsy if necessary- esp if it doesn’t respond to tx to r/o squamous cell carcinoma

Question 42

• What is the common wart? Ssx? Distribution? Age?

Answer 42

o verruca vulgaris: dome shaped, round or irregular, rough; colors can be gray, yellow, brown, black, skin colored; 2-10 cm. Skin lines are interrupted by hyperkeratosis. Black puncta when scraped with pinpoint bleeding
o Usually asx.
o Distribution: hands, knees, genitalia, feet.
o Age- any but peak at 12-16yrs

Question 43

• What is a filiform wart? Flat wart? Plantar wart?

Answer 43

o Filiform: long narrow small warts, soft, seen on eyelids, face, neck
o Flat: Smooth, flat, yellow brown or flesh colored; 2-3 mm; backs of hands, lower legs and face
o Plantar: soles of the feet; single or multiple; painful and callused. Different from corns/calluses – black puncta present.

Question 44

• What is mosaic wart? Condylloma accumianta?

Answer 44

o Mosaic: multiple plantar warts
o Condylloma accuminata (genital warts): soft moist papules or plaques on perineum, external genitalia, anus, vagina, cervix;

Question 45

• What is varicella? Ssx? Distribution?

Answer 45

o chickenpox): acute highly contagious vesicular eruption caused by a primary infection with varicella (HHV-3).
o Ssx: Prodrome (more in kids > 10) with malaise, chills, headache, sore throat, anorexia and dry mouth. Then the rash starts and itching is severe. Lesions are papules, macules, vesicles, pustules and crusts all at the same time.
o Distribution: begins on trunk and spreads to face and extremities. Most lesions present of trunk Lesions can occur in mouth and vagina

Question 46

• When is varicella infectious? Impact of vaccine?

Answer 46

o Infectious from 2 days before the lesions appear till all lesions crust over.
o 20% of pt’s vaccinated will still get varicella- although it is atypical dz- maculopapular rash

Question 47

• How is varicella diagnosed? Ddx?

Answer 47

o Dx: Characteristic rash. Culture or Tzanck smear in questionable cases
o DDX: other viral diseases, contact dermatitis, zoster, folliculitis, impetigo

Question 48

• What is herpes simplex? Ssx? Distribution?

Answer 48

o recurrent viral infection with intraepidermal infection by HSV 1 or 2.
o Ssx: Single or clustered vesicles. Systemic symptoms with primary infections: fever, malaise, myalgia, headache and regional LA. Prodromal period of tingling or discomfort in many, then appearance of small vesicles on a red base. They rupture and ulcerate. Often painful. They dry up and are completely healed in about 2-6 weeks. Recurrent infection often follows physical or emotional stress
o Distribution: mouth, eyes, genitals

Question 49

• What is herpetic whitlow? Dx of HSV? Ddx?

Answer 49

o Herpetic whitlow: infects distal phalanx with a very painful lesion that swells.
o Dx: characteristic lesions. Tzanck smear (superficial scraping from newly ruptured vesicle, then stained, showing multinucleated giant cells). Definitive dx is with culture of freshly ulcerated lesion.
o DDX: impetigo, eczema, zoster, hand foot and mouth dz, aphthous stomatitis

Question 50

• What is herpes zoster? Ssx?

Answer 50

o shingles: latent varicella (HHV type 3) infection
o ssx: Virus remains in the nerve roots and erupts along the associated dermatome. May start with radicular pain and itching for 2-3 days, followed by herpetic rash. May see systemic symptoms. There may be severe pain, scarring, or post herpetic neuralgia (sharp, intermittent, or constant) which can be debilitating. Lesions usually lasts about 5 days. Pain may last weeks, months, years, or indefinitely.

Question 51

• What is Distribution of zoster? Dx? Ddx?

Answer 51

o Distribution: follows dermatome, which can be variable but almost never crosses the midline
o Dx: pathognomonic rash. Tzanck Smear, differentiate virus by culture.
o DDX: changes with stage of dz. Before rash onset: MI, pleurisy, migraine. After lesions appear: HSV, primary varicella

Question 52

• What is roseola infantum? Ssx?

Answer 52

o Exanthem subitum: Infection of infants or young children with HHV-6 (or 7).
o Ssx: 10 day incubation, with 3-5 days of high fever which subsides when the rash appears. May see febrile convulsions. Child is generally alert and active. Cervical and posterior cervical LAD. Rash is present for a few hours to a few days, and possibly unnoticed. Rash may only occur 30% of time.

Question 53

• What is distribution of roseola infantum? Age? Dx? Ddx?

Answer 53

o Distribution: Prominent macular rash on chest and abdomen, less so on face and extremities
o Age: 90% <2yrs
o Dx: Hx and PE, virologic studies in immunocompromised or atypical dz
o DDX: Measles, Rubella, Enteroviral infections, Erythema infectiosum, Scarlet fever, drug allergy

Question 54

• What is hand foot and mouth dz? Ssx? Distribution? Age? Dx? Ddx?

Answer 54

o Febrile disorder caused by Coxsackie virus
o Ssx: vesicular eruption of skin and mucosa (3-6mm), may have fever, myalgia, LA, abd pn, lack of appetite, poor nursing (dt pn). Lesions in mouth are painful. Lesions heal in 7 days
o Dist: buccal mucosa, tongue, palms of hands and feet, occasionally buttocks or genitals.
o Age: <5yrs most common
o Dx: Hx & PE.
o DDX: varicella, herpes, herpangina, aphthous stomatitis

Question 55

• What is viral exanthems?

Answer 55

o by blood borne viruses initiating a vascular response in the skin. Most present with a prodrome of fever and malaise.

Question 56

• What is measles? How is it spread? Incubation? Complications?

Answer 56

o Rubeola, Morbilli: Extremely communicable viral infection by a paramyxovirus.
o Spread by secretions from nose, mouth, throat during prodromal and early eruptive phase.
o Has an incubation time of about 7-14 days, with prodrome around the 9th day.
o Complications: encephalitis and secondary infection.

Question 57

• What are ssx of measles? Distribution?

Answer 57

o Ssx: prodrome with 3-4 days of fever, coryza, conjunctivitis and photophobia, cough and Koplik spots (these are 1 to 3 mm whitish, grayish, or bluish elevations with an erythematous base on buccal and vaginal surface). Rash appears after 2-3 days of initial symptoms and is morbilliform, maculopapular, and blanching. Lasts 5-6 days.
o Dist: begins on the face and spreading cephalocaudally and centrifugally to involve the neck, upper trunk, lower trunk, and extremities

Question 58

• How is measles diagnosed? Ddx?

Answer 58

o Dx: Clinical – identification of Koplik spots or rash. BUT! In countries with very low measles prevalence, diagnosis should consist of evaluation of paired acute and convalescent sera for anti-measles IgM and IgG; at least fourfold increase in anti-measles antibody titer is indicative of infection CBC (Leukopenia, T-cell cytopenia, and thrombocytopenia). CXR(may demonstrate interstitial pneumonitis)
o DDX: during prodrome: many. During rash: Scarlet fever, rubella, drug reactions, roseola, erythema infectiosum, Rocky Mountain spotted fever, infectious mononucleosis, Kawasaki disease, toxic shock syndrome.

Question 59

• What is rubella? Ssx?

Answer 59

o German Measles: Infection caused by the RNA Rubella virus.
o Ssx:: Usually mild incubation about 14-21 days, with brief prodrome of fever and malaise, with a similar fainter rash, starting on the face and moving downward. Rash is more pinpoint pink maculopapules, and may have petechiae on the soft palate. Very mild dz and may be asx. Does not darken or coalesce.

Question 60

• What is distribution of rubella? Dx? Ddx?

Answer 60

o Dist: first appears on the face, spreads caudally to the trunk and extremities, and becomes generalized within 24 hours
o Dx: Characteristic LAD and rash. Only need lab dx in pregnant women and newborns- rubella-specific IgM antibodies using an enzyme immunoassay (EIA)
o DDX: measles, scarlet fever, drug rashes, erythema infectiosum

Question 61

• What are the pigmentation disorders?

Answer 61

o Vitiligo; hyperpigmentation; melisma/chloasma; lentigines

Question 62

• What is vitiligo? Ssx? Associated with?

Answer 62

o Idiopathic condition lacking in melanocytes
o Ssx: Pigmented areas that are sharply demarcated and often symmetric. Spots are white with no scale. Patchy and irregular, ranging from focal spots, to entire body segments, or most of skin surface.
o Associated with autoimmune diseases such as thyroid disease, pernicious anemia, systemic lupus erythematosus, and Addison’s disease

Question 63

• How is vitiligo diagnosed? Ddx?

Answer 63

o Dx: obvious on examination. Lesions accentuated under Wood’s Lamp in light skinned pts. thyroid function, CBC, and fasting blood glucose level
o DDX: tinea versicolor, Postinflammatory hypopigmentation, Chemically induced depigmentation, Pityriasis alba

Question 64

• What are the hyperpigmentation disorders?

Answer 64

o Multiple causes, may be focal or diffuse.

o Include melisma, lentigenes

Question 65

• What is melisma/chloasma? Ddx?

Answer 65

o macular hyperpigmentation of the face usually seen in pregnant women or using OCP, more in dark skinned races, resulting from an increase in melanin due to estrogen stimulation and UV light. Sharply delineated patches usually on the face. Fades incompletely when the cause is removed.
o DDX: post inflammatory hyperpigmentation

Question 66

• What are lentigines?

Answer 66

o Lentigo, singular: flat, tan or brown spots on sun-exposed areas, usu face or back of hands. Due to chronic sun exposure.

Question 67

• What are the hair disorders?

Answer 67

o Alopecia; hirsuitism

Question 68

• What is alopecia? 2 classifications? Dx?

Answer 68

o Baldness
o Non-scarring; scarring
o Dx: examine ratio of anagen and telogen hairs to assess if there is normal ratio of resting hairs. Occasional biopsy needed. Look for underlying cause with appropriate labs.

Question 69

• What are the 7 types of non-scarring alopecia?

Answer 69

o Male pattern baldness: androgenic
o Female pattern: androgenic, starts around menopause.
o Diffuse: dx by pulling 2-3 dozen hairs- if >5 hairs with the bud come out. Triggered by weight loss, stress, pregnancy (or after pregnancy), illness.
o Toxic: related to chemotherapeutic drugs
o Alopecia areata: autoimmune, toxic, genes, infections, drugs, and vaccinations, have been implicated in triggering episodes of alopecia areata. severe stress, especially emotional stress, can precipitate. S/Sx smooth, circular, discrete areas of complete hair loss that develop over a period of a few weeks. Can be whole body.
o Trichotillomania- a psychological disorder related to OCD where pt pulls out hair
o Tinea capitis- see notes above.

Question 70

• What is Scarring alopecia?

Answer 70

o Cutaneous lupus, deep bacterial infection, ulcers, granulomas, syphilis, tinea

Question 71

• What is hirsuitism? Dx?

Answer 71

o excess hair in females in areas not normally hairy.
o Dx: Serum free/total testosterone, DHEA sulfate, FSH, LH, prolactin, TSH (to check for presence of thyroid dysfunction). Often related to PCOS

Question 72

• What are the nail disorders?

Answer 72

o Onychomycosis; paronychial infections

Question 73

• What is onychomycosis? Cause?

Answer 73

o Fungal infection of nail plate and/or bed
o usually caused by dermatophytes but can also be caused by yeast. Risks for developing are older age, swimming, tinea pedis, psoriasis, diabetes, immunodeficiency, genetic predisposition, and living with family members who have onychomycosis

Question 74

• What are ssx of onychomycosis? Sx? Ddx?

Answer 74

o Ssx: Nails have asx patches of white, brown, or yellow discoloration and deformity, and may thicken.
o Dx: by appearance, KOH microscopy, if negative then nail culture or histopathologic examination of nail plate clippings
o DDX: Nail dystrophies: psoriasis, eczematous conditions, senile ischemia (onychogryphosis), trauma, lichen planus, iron deficiency

Question 75

• What is Paronychial infections? Ssx? Dx?

Answer 75

o periungual infection
o ssx: develops along nail margin, becomes painful, warm, erythematous, and swollen. Pus along the nail margin, or beneath the nail.
o Dx: by examination.

Question 76

• What are the types of benign tumors?

Answer 76

o Dermatofibroma; epidermal cyst; keloid; lipoma; nevi’ seborrheic keratosis; arcochordon; some vascular lesions

Question 77

• What is dermatofibroma? Ssx? Distribution? Age? Ddx?

Answer 77

o a benign proliferation of fibroblasts
o ssx: epidermal thickening and hyperpigmentation; small red to brown papule. Does not grow. Usually a solitary lesion but can have up to 10 at one time. Can follow an insect bite or trauma. firm lesions, 0.3 to 1.0 cm in diameter, that are nontender and that dimple when pinched together
o Dist: most often on lower extremity
o Age: adults
o DDX: nevi, basal cell carcinoma. if continues to grow consider dermatofibroma protuberans (malignant)

Question 78

• What is an epidermal cyst? Ssx? Distribution? Ddx?

Answer 78

o epidermally lined cyst containing keratinous material in the dermis
o ssx: contains keratin; firm flesh colored moveable nodule in the skin, 1-3 cm w/ often with a central punctum; insignificant, non tender, unless it ruptures.
o Dist: face, base of ears, and trunk
o DDX: sebaceous cysts , lipoma, if very firm r/o malignancy or if there are multiples in strange locations r/o Gardner’s syndrome which is epidermal cysts associated with colon cancer.

Question 79

• What is a keoild? Ssx? Epidem? Dx? Ddx?

Answer 79

o excess fibroblastic proliferation following trauma and scarring;
o ssx: elevated, shiny, firm protuberant nodule on the site of injury. Can have claw like extensions.
o African and Asian descent are most susceptible to the development of keloids
o Dx: by appearance.
o DDX: Hypertrophic scar- stays confined to original wound margin

Question 80

• What is lipoma? Epidem? Ssx? Distribution? Dx? Ddx?

Answer 80

o subcutaneous nodules of adipocytes
o More common in women. May have one or more.
o ssx: rubbery nodule below dermis that is moveable. Usu asx. Overlying skin is normal. Varies in size. Grows very slowly
o Dist: trunk, forearms, and neck
o Dx: Hx & PE. If it is rapidly enlarging, or is firm rather than soft, a biopsy is indicated.
o DDX: Epidermal cysts.

Question 81

• What are nevi? Dx? Ddx?

Answer 81

o moles: circumscribed, often pigmented or flesh colored macules, papules or nodules composed of melanocytes.
o Dx: H&P, always biopsy suspicious lesions (changing or irregular borders, color changes, painful, or bleeding/ulcerating/itching)
o DDX: melanoma, seborrheic keratosis, skin tag, wart

Question 82

• What is seborrheic keratosis? Ssx? Distribution? Age? Ddx?

Answer 82

o benign neoplasm resulting in pigmented superficial lesions that usually appear warty, or may be smooth papules.
o Ssx: “stuck on,’’ warty, well-circumscribed, often scaly hyperpigmented lesions located most commonly on the. Close inspection with a hand lens often will demonstrate the presence of horn cysts or dark keratin plugs. Lesions should almost be able to be picked off with a no. 15 blade. Number of lesions ranges from 1-100’s.
o Dist: trunk, face, and upper extremities
o Age: generally in older adults but not a rule
o DDX: warts, nevi, melanoma, pigmented basal cell carcinoma.

Question 83

• What is acrochordon? Ssx? Distribution? Dx? Ddx?

Answer 83

o pedunculated fibroma or skin tag (lots of different names)
o ssx: asx, fleshy skin tumor; skin colored or pigmented. Can be pedunculated lesions on narrow stalks. Soft. Can get irritated by friction and bleed. Perianal skin tags are common in patients with Crohn’s disease
o Dist: neck, axilla, groin, under breasts, eyelids
o Dx: appearance
o DDX: warts, nevi, neurofibromas

Question 84

• What are the skin cancers?

Answer 84

o BCC; malignant melanoma; SCC

Question 85

• What is BCC? Ssx? 3 forms?

Answer 85

o Superficial, slow growing papule or nodule that derives from epidermal basal cells.
o Ssx: Highly variable appearance from a small shiny, firm almost translucent nodule to crusty flat lesions to what looks like dermatitis.
o 3 forms: nodular (60%), superficial (30%), and morpheaform (10%)
o Nodular usually starts as a papule that slowly grows and develops into a “rodent ulcer” with a shiny pearly border, telangiectasia and a central ulcer. Alternately crust and heal.
o Superficial has a slightly scaly papule or plaque that is light red in color; the lesion may be atrophic in the center and usually is rimmed with fine translucent micropapules.
o Morpheaform lesions are smooth, flesh-colored, or very lightly erythematous papules or plaques that are frequently atrophic

Question 86

• What is age of BCC? Distribution? Dx? Ddx?

Answer 86

o Age: any but more common >40
o Dist: face, neck and scalp most common, then shoulders and arms (think sun)
o Dx: Biopsy
o DDX: nevi, seborrheic keratosis, dermatitis, scars, molluscum, squamous cell carcinoma

Question 87

• What is malignant melanoma? Ssx? Warning ssx? Major and minor?

Answer 87

o Arises in melanocytes in skin & mucus mem., eye, or CNS.
o Ssx: Vary a great deal in appearance but usually pigmented
o Warning SSx of melanoma development in previously benign-appearing mole: use the ABCDE rule and/or the revised Glasgow seven-point checklist (1 major requires referral)
o Major: Change in size/new lesion, shape, color
o Minor: Diameter >=7mm, Inflammation, Crusting or bleeding, Sensory change

Question 88

• What are the types of melanoma?

Answer 88

o lentigo-maligna melanoma (15% of melanoma): slow onset and progression. on face or sun exposed areas; 2-6 cm flat, tan or brown macule with darker spots, irregular border and surface, or a plaque with raised indurated edges, colored spots, nodules
o Superficial spreading (2/3 of melanoma): arise from a pre-existing lesion. diagnosed when smaller than lentigo melanoma. Mostly on women’s legs and men’s torsos. Plaque with irregular raised, indurated, tan or brown areas, with white, red black or blue-black spots.
o Nodular: dark protuberant papule or plaque varying in color; grows fast; may not be pigmented
o Acrolentiginous: Arise in areas of non-hair bearing skin; soles, palms, and subungual skin

Question 89

• How is melanoma diagnosed? Ddx?

Answer 89

o Dx: biopsy

o DDX: basal cell carcinoma, seborrheic keratosis, benign nevi/lentigo, dermatofibroma, warts

Question 90

• What is SCC? Ssx? Distribution? Dx? Ddx?

Answer 90

o malignant tumor of epithelial keratinocytes that invades the dermis.
o Ssx: Usu on sun exposed areas; Appearance is highly variable, but usu starts as a red papule or plaque with a scaly rough surface, or sometimes is nodular like a wart. Can form cutaneous horns. Eventually ulcerates or bleeds, invades tissue and can metastasize.
o Dist: sun exposed areas
o Dx: Biopsy
o DDX: actinic keratosis, seborrheic keratosis, basal cell carcinoma.

Question 91

What are 6 types of Nevi?

Answer 91

o	Lentigo: 
o	Junctional nevus:
o	Compound nevus:
o	Intradermal nevus: elevated;
o	Halo nevus:
o	Atypical/Dysplastic nevus:

Question 92

What is a lentigo nevus?

Answer 92

o Lentigo: hyperpigmented macule due to increased melanocytes; darker, sparser, does not darken or multiply with sun. <4mm
o

Question 93

what is a junctional nevus?

Answer 93

o Junctional nevus: light brown-black. usually flat but can be slightly raised, pigmented; 1-10 mm; palms, soles, genitals.
o

Question 94

what is a compound nevus?

Answer 94

o Compound nevus: light to dark brown, smooth and dome-shaped or papillomatous , may be very elevated; involved epidermis and dermis. 3-6 mm.
o

Question 95

what is a intradermal nevus?

Answer 95

o Intradermal nevus: elevated; flesh colored to brown; smooth, dome-shaped, papillomatous, or pedunculated with a soft, rubbery texture. Can be hairy or warty. Occasionally, they have speckles of brown pigmentation or pseudo-horn cysts 3-6 mm.
o

Question 96

what is a halo nevus?

Answer 96

o Halo nevus: pigmented compound or intradermal nevus; surrounded by a halo of depigmented skin; immune phenomenon

Question 97

What is an atypical nevus?

Answer 97

o Atypical/Dysplastic nevus: irregular pigmented nevus from tan to dark brown; indistinct borders, mild asymmetry, can be flat or elevated areas in the same mole; may be genetic; large (>6 mm) and mostly on covered areas; usually see many on the person. Use the “ABCDEF” to assess– pt at greater risk for melanoma

Question 98

What is the glasgow 7 point checklist for melanoma?

Answer 98

Major: change in size, shape, color
minor: diameter >7mm, inflammation, oozing, change in sensation