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Goljan HY Skin

Ichthyosis vulgaris ↑ thickness of stratum corneum; absent granular layer
Solar lentigo “liver spot” in elderly; increased melanocytes
Senile purpura trauma to fragile vessels on dorsum of hands; normal finding in elderly
Acute eczema weeping rash with vesicles
Chronic eczema dry, thickened, pruritic skin
Atopic dermatitis dry skin, eczema (type I reaction); children - face, intertriginous areas
Allergic contact dermatitis type IV hypersensitivity; poison ivy, nickel rash
Contact photodermatitis tetracycline; rash in sun exposed areas
Superficial dermatophytoses KOH preparation shows fungi located in stratum corneum
Tinea capitis Trichophyton tonsurans MCC (negative Wood’s lamp)
Tinea capitis child with dog Microsporum canis (positive Wood’s lamp)
Tinea versicolor hypopigmentation; Malassezia furfur; “spaghetti” (hyphae)/”meatball” KOH
Seborrheic dermatitis dandruff; Malassezia furfur
Molluscum contagiosum poxvirus; bowl-shaped with central depression filled with keratin
Rubeola Koplik’s spots; Warthin-Finkeldey giant cells
Rubella teratogenic; rash; postauricular adenopathy; arthritis in adults
Parvovirus “slapped face”; RBC aplasia, aplastic anemia (HbSS), spontaneous abortions, arthritis
Roseola HSV-6; high fever and then rash
Toxic shock syndrome toxin-producing S. aureus; tampon wearing; hypotension, desquamating rash
Scarlet fever group A streptococcus with erythrogenic toxin; strawberry tongue
Actinic (solar) keratosis precursor for squamous cell carcinoma; recur when scrapped off
Psoriasis elevated salmon-colored plaques covered by silver-colored scales; nail pitting
Pityriasis rosea herald patch followed by rash in lines of cleavage
Varicella chickenpox; rash at different stages; Reye syndrome association
Herpes zoster vesicular rash following a sensory dermatome
HSV and Varicella-zoster virus remain latent in sensory ganglia
Impetigo group A streptococcus; honey crusted lesions on face
Pemphigus vulgaris autoimmune disease; IgG antibodies against intercellular attachment sites
Pemphigus vulgaris intraepidermal bullae; acantholytic cells; row of tombstones
Bullous pemphigoid autoimmune disease; IgG antibodies against basement membrane
Bullous pemphigoid subepidermal bullae
Pemphigus vulgaris/bullous pemphigoid type II hypersensitivity
Dermatitis herpetiformis autoimmune disease; IgA ICs; subepidermal bullae with neutrophils
Dermatitis herpetiformis association with celiac disease
Erythema multiforme vesicles and bullae; bullseye appearance
Risk factors drugs, M. pneumoniae infection
Stevens Johnson syndrome erythema multiforme involving mouth
Acne vulgaris androgen dependent (receptor on sebaceous glands)
Acne vulgaris Propionibacterium acnes lipases produce fatty acids causing inflammation
Acne rosacea pustular, erythematous lesion on face resembling malar rash
Urticaria type I and III reactions; type I due to mast cell release of histamine (drugs, fire ant bites)
Angioedema subcutaneous swelling
Causes ACE inhibitor (bradykinin); C1 esterase inhibitor deficiency (C2 and C4 decreased)
Sporotrichosis traumatic implantation of Sporothrix fungus into subcutaneous tissue
Causes rose gardener, lobster fisherman (sphagnum moss)
S/S chain of subcutaneous nodules
Tuberculoid leprosy intact cellular immunity (positive lepromin skin test); granulomas; no organisms
S/S autoamputation of digits; skin depigmentation and anesthesia
Lepromatous leprosy defective cellular immunity (negative lepromin skin test); no granulomas
S/S leonine face, erythema nodosum during treatment
Histology Grenz zone (zone free organisms) foamy macrophages with organisms
Rx dapsone
Erythema nodosum painful nodule on shins; subcutaneous fat inflammation
Associations coccidioidomycosis, TB, leprosy
Keratoacanthoma benign neoplasm; mimics squamous cancer; spontaneously resolves
UVB light cancers basal cell carcinoma, squamous cell carcinoma, malignant melanoma
Vitiligo autoimmune destruction melanocytes producing skin depigmentation
Seborrheic keratosis pigmented, wart-like lesion; “stuck on” appearance
Leser-Trelat sign multiple outcroppings seborrheic keratosis; consider stomach cancer
Acanthosis nigricans verrucoid pigmented lesion usually in axilla; associated with gastric cancer
Chloasma pregnancy mask due to increased melanocytes
Nevocellular nevus benign pigmented tumor modified melanocytes
Histology nevus cells proliferate along basal cell area, dermis, or both
Dysplastic nevus precursor for malignant melanoma
Malignant melanoma malignant tumor of melanocytes; most rapidly increasing cancer worldwide
ABCD for melanoma A, asymmetry; B, irregular border; C, color change; D, increased diameter
Risk factors severe sunburn at early age (MC), dysplastic nevi
Radial growth phase spreads laterally in epidermis/superficial dermis but does not result in metastasis
Vertical growth malignant cells penetrate into dermis; potential for metastasis
Lentigo malignant melanoma face of elderly
Superficial spreading melanoma lower extremities, back
Nodular melanoma aggressive tumor with no radial growth phase
Acral lentiginous melanoma palms, soles, under nails; may occur in blacks
Prognosis depends most on depth of invasion
Prevention sunscreen >15
Porphyria cutanea tarda photosensitive bullous disease; deficiency uroporphyrinogen decarboxylase
S/S hypertrichosis, fragile skin, port wine colored urine (uroporphyrins)
Black widow (Latrodectus) envenomation neurotoxin; abdominal muscle cramps
Brown recluse (Loxosceles) envenomation necrotoxin; skin ulcer
Created by: megankirch