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CS - Dermatology
Y2S1B1
| Diagnosis | Features | DDx | Tx |
|---|---|---|---|
| Malignant melanoma | thickness defines survival rate | excise, refer to oncologist | |
| Amelanotic melanoma | dx delayed b/c presentation is pink/red | dermal nevus, BCC | |
| Acral lentiginous melanoma | most/least common in dark/light skin on hands/feet/nails of men | solar lentigo, nevus, pigmented actinic keratosis, Bowen's disease, longitudinal pigmented band | |
| Lentigo maligna and lentigo maligna melanoma | flat lesions w/irregular pigment; develops slowly into cancer over years in sun; drops into dermis | pigmented actinic keratosis, solar lentigo, Bowen's disease | |
| Nodular melanoma | extremities; evolve vertically over months-years | pigmented BCC, angiokeratoma, hemangioma, traumatized nevus, pyogenic granuloma | |
| Superficial spreading melanoma | most common subtype of melanoma; spreads laterally from a preexisting lesion before developing nodules; Men - back; Women - lower legs | nevi, atypical nevi, seborrheic keratosis, solar lentigo | |
| Melanoma: A, B, C, D E | asymmetry, border irregularity, color (red, blue, black, white), diameter (>6mm/pencil eraser), evolving (getting bigger?); If tender, bleeding or ulceration --> poor prognosis | (blank) | (blank) |
| Melanoma: non-skin findings | regional lymph node adenopathy | (blank) | (blank) |
| Melanoma: risk factors | fair skin, presence of atypical nevi, personal Hx, family Hx, Hx of severe burns (>3 blistering burns), large congenital nevus | (blank) | (blank) |
| Melanoma: frequency | malignancy of melanocytes most commonly arising in skin; #8 cancer in US; #1 in women 25-29; #2 in women 30-35; 1 in 75 people | (blank) | (blank) |
| Atypical mole syndrome | Auto dom w/variable penetrance, but inc risk of melanoma; new nevi after age 30 on sun/no sun surfaces! suspicious nevi; check for ocular melanoma | benign nevi and melanoma (use A, B, C, D, Es of melanoma) | photograph and watch nevi; education |
| Nevi | (blank) | (blank) | shave/excise for biopsy when >2 ABCDEs change |
| Dermal melanocytosis (Mongolian spot) | blue/black baby sacral patch | (blank) | (blank) |
| Becker's nevus | brown/tan patch that develops hair during puberty (hamartoma of smooth muscle) | (blank) | (blank) |
| Congenital melanocytic nevus | dark brown raised plaques w/irregular surface and inc terminal hairs at birth/infancy; 6% develop malignant melanoma if >20cm | (blank) | (blank) |
| Recurrent nevus | irregular pigment w/in a scar at any age | (blank) | (blank) |
| Halo nevus | annular hypopigmented ring around pigmented papule/nodule/macule during adolescence | check family Hx for vitiligo | some will repigment |
| Spitz nevus | preadolescent red-pink domed papule | dermatofibroma (dimple sign) | (blank) |
| Nevus spilus | pre-adult tan patch w/cafe au lait spots | (blank) | (blank) |
| Blue nevi | birth/childhood solitary blue papule/nodule | (blank) | (blank) |
| Intradermal nevi | post-puberty; elevated to pedunculated; fleshy | (blank) | (blank) |
| Compound nevus | pigmented papules/nodules; get thicker in late childhood | (blank) | (blank) |
| Junctional nevus | flat/slightly raised macule/patch in children | (blank) | (blank) |
| Nevi | hamartoma/benign skin tumor composed of melanocytes; body doesn't make moles after age 35 | (blank) | (blank) |
| Seborrheic keratosis | benign epidermal proliferation; waxy stuck-on papules | (blank) | shave, cryo, curettage |
| Sign of Leser Trelat | rapid eruption of multiple widespread seborrheic keratoses due to internal malignancy | (blank) | (blank) |
| Acrochordans | skin tags; fleshy papules in neck/skin folds; associated w/ cancer; predisposing factors: fat | verruca, dermal nevus | cryo, snip, electrocautery |
| Dermatofibroma | benign firm dermal papule on extremities; dimples when pinched laterally | nevus, epidermal inclusion cyst, scar, melanoma, dermatofibroma sarcoma protuberans | excision, shave epidermal portion |
| Keloids | "scar" that extends beyond initial site of injury; upper body/chest | dermatofibroma, sarcoma protuberans, sarcoidosis, hypertrophic scar | steroids (topical/intralesional), Sx |
| Nevus sebaceus | congenital lesion on scalp; orange/bubbly worsens during puberty; (possible triad: epilepsy, MR, nevus sebaceous); low incidence of skin cancers | linear epidermal nevus | excision; take annual pictures |
| Chondrodermatitis nodularis helicis | tender, persistant papule on lateral helical rim in sunlovers | actinic keratosis, squamous cell/basal cell carcinoma | eliminate pressure; corticosteroids, removal |
| Epidermal cyst | cystic papule filled w/keratin from hair follicle infundibulum d/t trauma or genetics; non-skin findings: Gardner's syndrome inclusion cyst and colon cancer | (blank) | incision, drainage, excision |
| Pilar cyst | firm, Mobile, keratin-filled papule/nodule from outer root sheath of hair in scalp | (blank) | incise/drain/excise |
| Sebaceous hyperplasia | common benign overgrowth of sebaceous gland on face w/central umilication and telangectasias | basal cell carcinoma, keratocanthoma, molluscum contagiosum | removal |
| Syringoma | benign overgrowth of eccrine sweat glands on eyelids, upper chest, vulva; associated w/Down syndrome; can be blue from side angle | hair tumor, verruca plana, sebaceous hyperplasia, sarcoidosis, xanthelasma (cholesterol tumor) | leave it alone or removal |
| Hemangiomas | benign neoplasm of vascular tissue in 1st year of life; most common vascular tumor in infancy; F>M; neck/head; | Resolution rule: 10% by 1yr, 30/3, 50/5, 70/7, 100/10; Non-skin findings: CHF, organ system failure, Kasabach-Merritt syndrome | Watch and wait; if hoarse/difficult to breath; send to surgery |
| Strawberry/capillary hemangioma | true neoplasm of endothelial cells | (blank) | (blank) |
| Cavernous hemangioma | venous malformation (dilitation of immune system) | (blank) | (blank) |
| Hemangioma lesion progression | 1. rapid growth (double/triple in wks), 2. stabilization (dormant for many years), 3. involution (gray center) | (blank) | (blank) |
| Vascular malformations | classified by type of tissue affected (capillary, venous, arterial, lymphatic, combo) | (blank) | (blank) |
| Nevus Flammeus (salmon patch) | pink midline patch/macule; "angel kiss" of "stork bite on 25-40% newborns; Port-wine stains; inc # of dilated capillaries/venules in dermis | (blank) | glabella fades, nuchal persists; laser |
| Nevus anemicus | pale/irregular macule d/t catecholamines on chest (F>M) | vitiligo | none required |
| Cavernous hemangioma | venous malform; blue | (blank) | (blank) |
| Lymphangioma | frog-egg appearance; neoplasm of dilated lymph vessels; communicates w/ deeper structures and spreads | (blank) | excision d/t deep component |
| Cherry angioma | benign neoplasm in adulthood of capillaries/PCV in papillary dermis; associated w/malignancy - sign of leser-trelat | pyogenic granuloma, angiokeratoma | (blank) |
| Angiokeratoma | benign hyperkeratotic vascular papule; 4 variants | kaposi's sarcoma, pyogenic granuloma, pigmented BCC, SCC | removal |
| Angiokeratoma of Fordyce | most common type; scrotum/vulva in middle age; inc venous pressure | (blank) | (blank) |
| Papular angiokeratoma | blue/black solitary lesion on legs of young adults; thrombosed vessels may be visible | melanoma | (blank) |
| Angiokeratoma corporis diffusum | rarest variant; bathing suit distribution at puberty; associated with underlying disease (metabolic); confluent purple papules/nodules in genital area, buttock, lower abs | (blank) | (blank) |
| Venous lake | dark blue/purple soft cystic papule on mucosa of lip; partially blanchable w/pressure | herpes, cavernous hemangioma, Maffucci's syndrome, blue rubber bleb syndrome; melanoma (if it doesn't blanch out) | (blank) |
| Pyogenic granuloma | common in Children and Pregnant women; yellow-red friable vascular papule overgrowth w/scale or crust that BLEEDS | traumatized hemangioma, bacillary hemangiomatosis, kaposi's sarcoma, angiosarcoma | removal |
| Kaposi's sarcoma | malignant tumor of lymphatic endothelial cells from herpes virus type 8; | (blank) | (blank) |
| Classic Kaposi's | old jewish/greek/italian men; lesions on lower extremities progress to upper | (blank) | cancer therapy |
| Endemic African Kaposi's | most common tumor in central Africa: Cutaneous (M >40 on limbs) and Lymphatic (aggressive in kids) forms | (blank) | cancer therapy |
| Kaposi's associated w/immunosuppression | transplants; M>F; aggressive involving lymphatics, mucosa, viseral organs | (blank) | cancer therapy; withdraw immunosupressive drugs |
| Kaposi's epidemic/AIDS related | most common tumor in HIV (20% of all AIDS pts); multifocal purple marks; generalized lymphadenopathy at presentation; progress to GI and lungs | stasis dermatitis, pyogenic granuloma, hemangioma | (blank) |
| Telangiectasias: Spider angiomas - nevus araneus | small dilated venules, capillaries, arterioles; signal of underlying disease (liver disease or pregnancy) | (blank) | (blank) |
| Telangectasias - Heretidary Hemorrhagic (Olser-Rendu-Weber syndrome) | Auto dom; epistaxis, visceral arteriovenous malformations on lips, tongue, nasal mucosa, appendages | (blank) | (blank) |
| Telangiectasias - Ataxia (Louis-Bar Syndrome) | Auto rec; defect in DNA repair of sister chromatids/inc sensitivity to ionizing radiation; ataxia, immune dysfxnl; telangiectasias on conjunctiva, face, neck, trunk; cafe au lait; death due to lymphoreticular malignancy/infection | (blank) | (blank) |
| Unilateral nevoid telangiectasia syndrome | numerous and thread-like on unilateral dermatome (trigeminal, C3 or C4); Acquired form: elevated estrogen; Congenital form: M>F | (blank) | (blank) |
| Telangiectasias: Scleroderma and CREST syndrome | mats on chest, face, hands, palms | (blank) | (blank) |
| Generalized essential telangiectasias | widespread, idiopathic, F over 30yo; lower extremities progress to head; auto dom? | (blank) | (blank) |
| Connective Tissue Diseases | Group of illnesses characterized by affecting multiple organ systems w/no typical pattern of onset, duration or progression, aka: Autoimmune diseases | Lupus erythematosus, dermatomyositis/polymyositis, scleroderma | (blank) |
| Lupus erythematosus | periods of exacerbations and remissions, W>M; common in African American and Hispanic pops | (blank) | (blank) |
| Lupus erythematosus criteria (4 +) | malar rash, discoid rash, anti-dsDNA, anti-Sm, anti-phospholipid A/B, oral ulcers, arthritis (nonerosive >2 joints), serositis, +ANA, photosensitive, proteinuria/cellular casts, neurologic disorder, hematologic disorder | (blank) | (blank) |
| Lupus erythematosus subsets | 1. Chronic cutaneous (discoid) lupus (DLE), 2. Subacute cutaneous lupus (SCLE), 3. Acute cutaneous lupus erythematosus, 4. Neonatoal lupus erythematosus, 5. drug induced lupus | (blank) | (blank) |
| Chronic Cutaneous LE | Face, ears (CONCHAL BOWL, scalp); SCARRING w/alopecia; limited to skin only; F in 30s; UV light/trauma exacerbate; carpet tack undersurface | sarcoidosis, lichen planopilaris (scalp); Jessner's lymphocytic infiltrate; rosacea; leukemia/lymphoma | Negative: ANA, anti-Sm and anti-dsDNA |
| Subacute Cutaneous LE | No SCARRING; white females; sudden annular or papulosquamous appearance after sun; features of both chronic cutaneous and active LE; trunk, dorsal upper extremity (spares joints and volar surface); drugs induce (hydrochlorothiazide, Ca-channel blockers) | drug eruption, dermatomyositis, secondary syphilis, psoriasis, seborrheic dermatitis on face, tinea corporis | ANA negative; 30% anti-dsDNA+; Positive: anti-Ro or anti-La; can have babies with neonatal LE associated w/ heart block |
| Acute Cutaneous LE | serious multisystem disease; W in 30s/40s; UV induces/exacerbates; systemic symptoms; drugs produce lupus-like syndrome (anticonvulsants, procainamide, hydralazine); butterfly; nail fold telangeictasias, alopecia, urticaria, Raynaud's phenom | contact dermatitis, rosacea, erytispelas, seborrheic cermatitis, tinea, polymorphous light eruption | Positive: ANA, anti-dsDNA, anti-Sm, anti-Ro, anti-La, anti-U1RNP; Negative: anti-histone ssDNA |
| Positive anti-dsDNA | 30-70% in nucleoplasmic or homogenous pattern; is diagnositic for LE; associated with nephritis | (blank) | (blank) |
| Positive anti-Sm | 15-30%; nucleoplasmic or speckled pattern; associated with U1RNP ab | (blank) | (blank) |
| Positive histones | 95% of drug induced LE; associated with anti-dsDNA | (blank) | (blank) |
| Positive anti-Ro | 24-60% of LE; SCLE, neonatal LE and LE with C2 and C4 def - 88-96% Sjogren's Syndrome | (blank) | (blank) |
| Positive anti-La | 9-34% of LE; in 90% of mother's of neonatal LE babies | (blank) | (blank) |
| Positive U1RNP | 30-40% of LE associated with anti-Sm; ~100% MCTD pts | (blank) | (blank) |
| Drug Induced LE | cutaneous/systemic symptoms d/t medication (hydralazine, procainamide, isoniazid, methyldopa, monocycline, valproate, ca-channel blockers, Interferon, IL-2) | older pts after months of drug therapy; arthralgias/itis of sm joints and systemic probs; 25-50% have skin lesions; No CNS involvement, butferfly rash, alopecia, mucosal ulcers or discoid lesions | Lamisil and stop drug; Positive; anti-ssDNA/histone, possibly ANA; Negative: anti-dsDNA; acute hepatitis w/minocycline |
| Treatments of Lupus Erythematosus | sunscreens (SPF45/50, UVA/B); topical/intralesional/oral corticosteroids; antimalarials; MTX azathioprine, thalidomide, acitretin, isoteinoin | (blank) | (blank) |
| Neonatal lupus erythematosus | transfer of autoantibodies to fetus across placenta; SCLE-like cutaneous eruption; 3RD DEGREE CONGENITAL HEART BLOCK; cardiomyopathy, cholestatic hepatitis, thrombocytopenia | skin findings w/in 1st month; erythematous plaques w/central atrophy; "owl-eye" rash; heals w/o scarring w/in 6 months | Same as LE; Pacemaker |
| Autoantibodies responsible for neonatal LE | maternal IgG anti-Ro (95%), anti-La, or anti-U1RNP | (blank) | (blank) |
| Dermatomyositis/Polymyositis | rare inflammatory muscle disease w/ or w/o skin manifestations; children or adults >40 | 5 classifications (polymyositis, dermatomyositis, PM/DM w/malignancy; childhood PM/DM, PM or DM w/collagen vascular dx | (blank) |
| Polymyositis | insidious onset of proximal, symmetric muscel weakness of hips/thighs (can't get out of chair); distal strength and deep tendon reflexes are OK | (blank) | (blank) |
| Dermatomyositis | proximal muscle weakness w/eruption on skin | 4 courses (acute, chronic, recurrent, cyclic); associated w/malignancy (LOOK FOR CANCER in pts >40) | (blank) |
| Amyopathic Dermatomyosits | cutaneous changes ONLY | normal muscle enzymes in serum, but myositis on EMG or muscle biopsy | (blank) |
| Dermatomyositis Pathognomonic Skin Finding | Heliotrope rash; eyelid discoloration (look hard for it) | psoriasis (scaly scalp); Tcell lymphoma; lupus; polymorphous light eruption; contact dermatitis; atopic dermatitis | oral corticosteroids; MTX; Physical therapy; antimalarials (hydroxychloroquine); skin and muscle biopsy; evaluation for malignancy (6x greater risk of malignancy in 1st year) |
| Gottron's Papules | 60-80% of pts w/ dermatomyositis; rash on finger joints; differentiates from lupus | (blank) | (blank) |
| Periungual telangectasias | dermatomyositis - proximal nailfold w/thick hyperkeratoic irregular cuticles | (blank) | (blank) |
| Poikiloderma | dermatomyositis - mottled white/brown pigment on sun exposed skin w/dermal atrophy | (blank) | (blank) |
| Scaly red scalp | dermatomyositis | confused w/ psoriasis or seborrheic dermatitis | (blank) |
| Childhood dermatomyositis | nonsupporative; symmetric weakness and rash, vasculitis of GI and myocardium | skin findings same as adult (gottron's papules, heliotrope rash, periungual erythema, poikolderma, scaly scalp, violacious patches) | (blank) |
| Scleroderma | progressive sclerosis of skin/visceral organs; vasculopathy; autoantibodies | (blank) | (blank) |
| Scleroderma subtypes | systemic, localized, chemical-induced scleroderma-like condition; eosinophilic fascitis pseudoscleroderma | (blank) | (blank) |
| Systemic Sclerosis | Diffuse scleroderma or CREST syndrome | Criteria: proximal sclerosis, nail pits and loss of digit fat pads; bibasalar pulmonary fibrosis | (blank) |
| Diffuse scleroderma | PRESENTATION: skin thickening (beak deformity) and/or Raynaud's phenomenon (white, blue, red); telangiectatic mats; 3 stages of disease | complications: GI tract and alveolar fibrosis/atrophy; renal disease and hypertension --> Major cause of death; myocardial fibrosis resulting in arrhythmias | No good Tx: manage infx and skin breakdowns; anti-Scl70 and anti-ACA (anti-centromere Ab) |
| Edematous phase of scleroderma | skin thickened and swollen w/non-pitting edema | (blank) | (blank) |
| Indurative phase of scleroderma | skin becoms hardened and thickened and motion is greatly restricted | (blank) | (blank) |
| Atrophic phase of scleroderma | ulcerations, telangiectasias, atrophy w/smooth shiny appearance producing claw deformity and loss of terminal phalanges | (blank) | (blank) |
| CREST | more benign, chronic and localized varient of scleroderma; calcinosis, raynaud's, esophageal dysmotility, sclerodactyly, telangiectasia | CALCINOSIS is characteristic; DDx - telangiectasia hereditaria hemorrhagica | (blank) |
| Localized scleroderma (Morphea) | localized area of sclerosis on skin; NOT associated w/Raynaud's, organ involvement or acrosclerosis; common in F>30yo | violaceous - purple indurated plaques that progress to thick/white hairless flat plaques | (blank) |
| Linear Scleroderma | linear bands of sclerotic skin that affect joints F>>>>M; d/t surgery or trauma | (blank) | PT, MTX; eosinophils elevate in 50%; ANA, anti-ssDNA |
| Linear scleroderma - en coup de sabre | frontoparietal face and scalp regions; follows Blaschko's lines | (blank) | (blank) |
| Acute Eczematous Inflammation | Erythema, inflamed, edema, vesicles; itchy, often weeping/oozing | Allergic contact, irritant rxn, atopic aczema, dermatitis | If wet then dry …dry then wet |
| Subacute Eczema | Mild – Mod Erythema,Scaling, itchy , excoriation; Eruption > 1 wk, if tender then possible 2nd infection | Fungal infx, Allergic contact, irritant rxn, atopic aczema, dermatitis | Topical & oral CCsteriods, moisturizers, AB’s |
| Chronic Eczema | Red,scaly thicken skin; Habit scratching, | Lichen simplex chronicus, ddx from psoriasis wh/ has edema & thicken skin, stopic dermatitis | Topical CCCS – interalesional injections, antihistamines |
| Lichen Simplex Chronicus ( Thicken skin) | Thicken skin due to habitual scratching; Located on limbs, wrist, ankles, posterior neck, | Rule out fungal infx, hand eczema from chemical,allergic exposure, genetic | Stop itching, put tape on it, Topical & oral CCsteriods, moisturizers, AB’s, eliminate antibacterial soap, use waxes to keep in moisture, superglue to seal lesion |
| Asteatotic Eczema | Ill defined Erythema, proceeds to plaques (hands & legs), abnormal dryness; Dry, thin desquamation, progressing to weeping, crusting plaque, worse in winter | Subacute dermatitis, cellulites, contact, atopic, allergic dermatitis | Topical & oral CCsteriods, moisturizers, AB’s, wet dressings |
| Chapped Fissured Feet | Erythema, scaling; tender feet, in kids most often, seasonal | Tinea pedis, psoriasis, allergic rxn | Keep feet dry, thick emollient, topical CCS |
| Allergic Contact Dermatitis | Vesicles, redness, edema, extreme itch, Poison ivy; Delayed hypersensitivity rxn – Tcell rxn after 2nd exposure | Irritant contact, atopic dermatitis | Topical & oral CCsteriod, |
| Irritant contact Dermatitis | Erythema, dryness, cracking, fissuring, juicy papules& vesicles on weeping patches; Tender and burning, lichen and excoriation of skin | Dryness & inflame by repeated exposure to mild irritant | Topical & oral CCsteriods, moisturizers |
| Finger Eczema | Dry scaling, tender, fissued, stops at DIP joint; Limited to 1-2 fingers , seasonal | Psoriasis, allergy, candida infx, due to Allergic contact, chemical irritants, friction | Topical & oral CC.steriods, moisturizers, tar creams & lactic acid creams |
| Keratolysis Exfoliativa | Simultaneous scaling from several pts. On palms & soles enlarging centrifugally; | Unknown cause, seasonal variation | None resolves in 1-3 wks |
| Nummular Eczema | Sharply demarcated scaling round plaques on trunk & extremities, coin shaped red lesions, w/ imflammation; Pruritic, onset in older adults | Psoriasis, Tinea | Topical & oral CCsteriods, moisturizers, AB’s, oral antihistamines |
| Pompholyx | Small deep seated, itchty , tender vesicles on palms, lateral fingers & plantar feet; A vesicular eruption occurs on hands & feet, scaling and peeling following vesicle eruption | Pustular Psoriasis, Tinea ( Id rxn), allergic contact | None |
| Prurigo Nodularis | Numerous, hyperpigmented lichen nodules – highy pruritic; Idopathic nodular form of lichen simplex chronicus, lesion caused by chronic scratching, common in adults, diabetics, atopic people | Drug rxn, hypothyroidism, HIV, malignancy, liver dis. | Topical & tape CCsteriods, interalesional CCS injections, cryotherapy, excision, antihistamine, light therapy PUVA |
| Stasis Dermatitis | Edema, thick, dry fissured , excoriated skin, brown leg discoloration, dilated tortuous vv; Inflam & scaling of legs due to impaired venous circulation, history of DVT | Contact dermatitis, cellulitis | Compression stockings, wet compresses, topical/oral CCsteriods, moisturizers, AB’s, oral antihistamines |
| Venous Leg Ulcer | Pitting edema, sharp, sloping borders w/ crust on a moist base, woody texture of skin, varicose veins; Common in elderly females, after min. trauma, assoc. w/ venous insuficency, mildly painful | Arterial or neuropathic ulcer, pyoderma gengrenosum, infx, | Compression stockings, Topical & oral CCsteriods, moisturizers, surgical debridement, metronidazole gel, pentoxfylline, skin grafing, wet compresses |
| Atopic Dermatitis – Lots of detail on this – these are the highlights – look over rest yourself | Abrupt onset w/ Erythema, severe pruritus, recurrent, symmetrical eruptions, infants: checks, scalp, perioral, kids – flexural, adults – hands, eyelids, patchy; High incidence in kids autosomal dominant – elevated T-cells hypersensitive langerhan cells | Contact dermatitis, scabies, tinea, immune deficiency & congenital | Topical CCsteriods, moisturizers, Oral AB’s, wet compresses, Topical immunomodulators, oral antihistamines |
| Ichthyosis Vulgaris | Dry, small rectangular scales on the extensor extremities, lower legs effected, accentuated palmar creases; Autosomal dominant disorder, onset early-mid childhood – worsens in winter & dry climate – defect in filaggrin precursor to collagen | Dry skin, acquired ichthyosis & X-linked | Moisturizers/ emollients , increase environmental humidity |
| Keratosis Pilaris | Pinpoint follicular papulars w/ red halo, sandpaper texture; Rough monomorphic follicular based papules on upper arms and lateral thighs, follicular plugging | Acne | Topical retinoids, urea and ammoniuym lactate creams , topical CCSteriods |
| Pityriasis Alba | White round macules and patches w/ fine scaling; Common asymptomatic, scaly hypo-pigmented, indistinct patches, on faces & arms of kids & adolescent. | Tinea versicolor, vitiligo | Mild topical CCS, |
| Psoriasis | Well demarcated erythemas based – silver white scaling plaques and papules, pitting, macules, onycholysis of nails , in web spaces axilla, grown – Pustules on erthyematous base; Papulosquamous disease effecting skin, nails & joints, immuno aberr of Tcells | Eczema, Seborrheic dermatitis, tinea capitis, lichen simplex complex, candida infx, syphilis, pityriasis rosea | Topical CCS, topical Vit D, Tar prep’s, anthralin, retinoids, salicyclic acid, topical immunomodulatory agents, Photo therapy, methotrexate, cyclosporine |
| Seborrheic Drematitis | Greasy, yellowish scale on the scalp, erythematous, yellow-red macules & patches w/ scales; Common chronic inflame eruption on face, scalp & inter-triginous – in babies cradle cap – can be sign of other systemic disease – occurs over time from yeast in sk | Infants: atopic, zinc deficiency,histiocytosis | |
| Grover’s Disease | Red-brown papulopustules & keratotic papules, mild – mod itching; Acquired, uncommon persistent eruption effects chest, lower ribcage, upper back, lumbar area , itchy brown patches, gender predilection, self limiting | Acne, candidiasis, eczema, dermatitis, miliaria, impetigo, bites, pitryiasis rosacea | Diagnosis; biopsy, Avoid hot sweaty temp’s, topical moisturer, anti-itch med’s, topical CCS, Antihistamines, Vit A, Isotretinoin , CCS |
| Pityriasis Rosea | Herald patch – well demarcated orange/red papules and Macules peripherally scaling annular or oval patch - many in skin lines of trunk/limbs; Common, benign asymptomatic viral eruption on trunk, possible viral infx, herald patch/dissemintes/resolves 1-2mo | Tinea corporis, 2nd syphilis , nummular eczema, psoriasis | Topical CCS, Antihistamine, UV light tx |
| Lichen Planus – (patchy eruptions of small firm papules | Pruritic, flat topped, polygonal, purple papules-lacy; Wickham Striae; Itchy inflam eruption of flexural surfaces & mucous membranes; etiology : HIV, HCV, drugs. Forms; palmoplantar, hypertrophic, follicular, oral, nail | Lupus, pityriasis, popular eczema, Lichen simplex, stasis dermatitis, 2nd syphilis, pemphigus | Antihistamines, top CCS, intralesional CCS, retinoids, Griseofulvin – antifungal, Dapson – AB, Azathioprine – immune suppressant, hydroxycholorquine – immune suppress |
| Lichen Sclerosus at Atrophicus | White atrophic plaques, w/ wrinkled cig. Paper appearance, purpura, contracted cicatrix; Chronic , uncommon painful thinning go the skin in genital area- post menopausal women. Symptoms; pruritus, dysuria, dyspareuria, assoc w/ cancer due to chronic infla | Leukoplakia | Top CCS, intralesional CCS, retinoids, emollients, surgery |
| Pityriasis Lichenoides | PLC - Itchy brown/red papules w/ fine mica – like scales on trunk; PLEVA: Crops of red/brw pauples w/ violaceous ctr evolves into ulcerated pap/ pustules – crust over; Benign 2 forms; Varioliformis Acuta (PLEVA) - in kids & Chronica (PLC) – adults | Pityriasis rosea, syphilis, scabies, varicella, insect bites | Erthromycin, PUVA – light tx, tetracycline, Gold – IM inject, Methotrexate, CCS, Dapsone - |
| Acne Vulgaris | Inflam / nodules & noninflam lesions – closed pores; Etiology; microcomedome – gland at hair follicule – oils clog and gets inflam | Rosacea. Many types of acne; infantile, excoriated, senile comedomes, milia – little white bumps – plugged exocrine gland, steroid rxn, chem. Exposure, Gram – AB induced, neonatal | Determine type of lesion for tx; retinoids, top AB’s, top benzoyl peroxide, surgery , intralesional CCS. Oral AB’s , contraceptives, CCS, Isotretinoin – acutane for cystic scarring (regulated now) |
| Acne fulminans | Subtype of vulgaris | (blank) | (blank) |
| Acne conglobata | Subtype of vulgaris; Part of follicular triad – severe cyst that has 2 openings on face, back and chest | (blank) | (blank) |
| Pyoderma faciale | Subtype of vulgaris; Variant that is confined to face and is common in females – have very red face | (blank) | (blank) |
| Perioral Dermatitis | Pinpoint erythematous papules & pustules on eczematous plaque; Prurtic, red eruption around mouth, nose & eyes. Women> men, stress induced. Etiology; bacterial , top CCS, & moisturizers | Acne, seborrheic dermatitis, atopic | Oral & Top AB’s & CCS - avoid drying agents. Ab’s - tetracycline |
| Rosacea | Telang-eye lid, pap/pustules, cyst/nodules, Red, thick oily, ocular signs, Rhinoplima – nose thick/distorted; adult facial eruption w/ vascular & acne forms. No. European, stress exacerbates; blood shot eyes, flushing & red component to skin | Acne, pustular tinea, lupus erythematous, folliculitis, perioral dermatitis | Sunscreens, cover skin exposure, top AB’s , oral AB’s , Isotretinoin, CO2 surgery, Pulsed dye / laser |
| Hidradenitis Suppurativa | Double comedome, tracts, painful abscesses; Etiology; occlusion of follicle due to increased stickiness of keratinocytes, Chronic suppurative scarring eruption in axillae, anogenital, inframamillary regions – F>M; Familial clusters – puberty onset | Acne, furuncle, carbuncle – painful localized bacterial infx that has openings wh/ pus discharges | Intralesion CCS, AB’s contraceptives, Isotretinoin, surgical excision, plastic surgery – Incision & drainage. |
| Miliaria subtypes; | General: inflam papule due to occlusion of sweat ducts | (blank) | (blank) |
| Miliaria crystallina | Grouped or single clear vesicles; Occlusion of sweat duct at level of skin, red bumps can occur on baby from overheating | (blank) | Cool compresses & ventilation |
| Miliaria rubra | Papules & vesicles w/ red halo or patch of red skin; Occlusion of intrepidermal section of eccrine sweat duct | (blank) | Anti-inflam lotion, keep cool |
| Miliaria profunda | White papules on red base - Occlusion of dermal portion of eccrine sweat duct – occurs after multiple bouts of miliaria rubra | (blank) | Anhydrous lanolin, isotretinoin |
| Verruca Vulgaris | flesh color (moist/velvety in genitals) hands face, legs are flat topped papules papules & plaques on feet , can be fingerlike hyperkeratotic on neck/face; – black pinpoints are bld vessals. Tranmission – direct contact - STD in adults | Acne, callus, corns, pearly penile papules | Duct tape, salicyclic acid, retinoids, liq nitrogen, 5-flurouracil cream, Electrodessication & curetting, laser & radiation |
| Molluscum Contagiosum | Domes/flesh color umbilicated papules w/ peripheral erythema – may progess to pustule; Self limited viral infx, on skin by poxvirus . Transmission – direct contact , STD in adults | Verruca, herpes, fungal infx, in HIV | Currettage – top salicyclic acid – liq nitro, tape, retinoids, immunomodulators, cantharidine |
| Herpes Simplex | Grped vesicles on erythematous base b/f crusting; eruption lasts up to wks; Acute,recurrent infx by type 1 or II; direct contact; STD; Asymptomatic Vs systemic symptoms. Can be brought on by trauma, has prodromal symptoms | Disseminated zoster, herpes simplex, eczema herpeticum, impetigo, folliculitis | Topic antipruritic lotions, oral antiviral med’s – valtrex, IV viral med’s - Varicella zoster immune globulin vaccine |
| Herpes Zoster- Shingles | Grped vesicles on erythamatous base in 1-2 adjacent dermatomes, usually wont cross midline; Cut viral infx in dermatones d/t reactivation of the varicella zoster virus. Stress; elderly Prodomal symptoms - painful! | Herpes Simplex Complications; post herpetic neuralgia – have prolonged pain after outbreak – use Neurotin/ Elavil – med’s for pain | Cool compress, top. Capsaicin, CCS, Antiviral’s, Amitriptyline – pain, Neurtoin, Narcotics |
| Hand, Foot & Mouth Disease | Painful erosions of oral cavity, Red macules that progress to pale oval vesicles, w/ red areolae on palms & soles, squared; Contagious viral infx, of skin hands, feet, moutn from coxsacky virus, prodromal symptoms | Herpangian, Aphthous stomatitis, herpetic gingivostomatitis, | Isolation, symptomatic tx’s, oral antiviral meds |
| Impetigo | Thin roofed bullae/vesicles/pustules w/clear-cloudy fluid – thick honey colored crusts; Common contagious superficial sink infx, Staph Aureus, Steptococcus, occurs after minor skin injury – colonization of nose, warm climates, poor hygiene | Herpes Simplex | Topical AB ointment, oral AB’s – Keflex |
| Cellulitis | Erythema, edema, indurated (hardened) plaque, vesicles/bullae; Infx of dermis & sub Q tissue w/ red, painful edema. May develop at sites of trauma, pt’s w/ renal problems, IDDM, immune compromised – predisposed. Recurrent episodes – skin integrity is gone | Stasis Dermatitis, Thrombophlebitis, DVT, erythema nodosum | Cool compress, elevation of limb, oral AB’s – levoquine or IV if needed |
| Erysipelas | Firm tender, red, well demarcated plaques; lower legs, face, ears. Streaked lymphangitis; Acute superfic infx of dermis, prodromal sympt’s; Group A strept, Staph Aureus, Pneumoccoccus, Klebselia, Yersinia & Haemophilus Influ. | Cellulites, usually from IDDM, Heart problems common | Oral AB’s |
| Folliculitis | Dome shaped pustules and erythematous papules centered over hair follicles; Inflam of hair follicle; abrupt onset itchy, spreads quickly, on hair bearing areas | Sub types; Eosinophilic folliculitis – HIV; Gram Neg- cause Hot tub – pseudomonas; Mechanical/occlusional – clothes rubbing; Steriod – 2nd to steroid use; Pityrosproium – fungi that is on face, scalp | Antibacterial soaps, Top AB’s, top antifungal/ yeast agents, AB’s and oral antifungal agents |
| Pseudofolliculitis Barbae | Many inflam pap/pustules around hair follicles; hypertropic/keloidal scarring may occur; Foreign body inflam rxn in hair bearing areas – hairs grows back into skin. Race predilection – blacks, get scarring from chronic outbreaks | Acne, folliculitis | Removal of hair, stop shaving, topical AB’s, oral AB’s, intralesional CCS, laser hair removal |
| Furuncle (boils) & Carbuncles | Subcut, erythema, tender nodule; multiple openings. On back of neck, upper back, lateral thighs; Furuncles – walled off, deep painful, firm fluctuant mass of pus; Carbuncles – painful, deep interconnected, aggregate of infxed follicles | Rupture EIC, cystic acne, hidrandenitis supprativa | Warm, moist compress, incision & drainage, oral & topical AB’s |
| Pseudomonas Folliculitis | Multiple red, round urticarial plaques w/ central papule or pustule; Acute infx of hair follicle w/ exposure to cont. water – hot tubs. Pseudomonas (bug) – children; appears 8hrs-5d after exposure | Staphylococcal folliculitis, hives, insect bite | Wet compresses, Oral AB’s |
| Otitis Externa | Erythema & edema of external auditory canal w/wo yellow crustin & debris. Pain maybe mild & dull to sharp & constant; Acute inflam of ext auditory canal w/ 2nd infx. Systemic symptoms. Malignant otitis externa – common in IDDM and may need IV AB’s | (blank) | Acetic acid soln – vinager & H2O after swimming, Topical CCS & AB’s solutions, IV AB’s if needed |
| Candidiasis (candida albicans; part of normal flora) | overgrowth on skin/mucosal areas w/depressed immune system (IDDM); primary lesion-pustule; red, denuded plaques w/satellite pustules; Commonly found btw fingers of bartenders | molluscum contagiosum, genital warts, psoriasis, eczema, herpes simplex | (blank) |
| Candidial balanitis | w/ or w/o sexual transmission; Phimosis-cannot withdraw foreskin; red pap/pustules rupture into erosions/ulcers/fissures | molluscum contagiosum, genital warts, psoriasis, eczema, herpes simplex (do a viral culture of KOH slide) | topical antifungal agents, topical corticosteroids, oral antifungals (clean behind foreskin) |
| Diaper dermatitis | acute candidial infx of superficial skin; contact irritant diaper dermatitis; candidiasis, atopic dermatitis, psoriasiform dermatitis, seborrheic dermatitis | streptococcal anal cellulitis, staphylococcyl impetigo | minimize exposure to wetness, barrier cream, topical antifungal/corticosteroid/antibacterial agent |
| Candidial Intertrigo | infx of large skin fold w/overgrowth of candidial sp; pustules that denude/macerate on apposing surfaces with most/scaly border; painful fissures in skin crease | psoriasis, seborrheic dermatitis, intertrigo, erythrasma, eczema, bacterial folliculitis | moist compress, topical antifungals/corticosteroids; minimise moisture |
| Tinea Versicolor | d/t lipophilic yeast Pityrosporum orbiculare exposure in moist places (tanning beds/sports bras); multiple hypo-hyperpigmented circular scaling macules on upper trunk; looks like spaghetti/meatballs on KOH | malazma (pregnancy rash); vitiligo-turns white w/wood's light; pityriasis alba; seborrheic dermatitis, secondary syphilis, pityriasis rosea, nummular eczema, guttate psoriasis | selenium sulfide lotion, topical antifungals, salicylic acid soaps, oral antifungals |
| Pityrosporum folliculitis | infx of hair follicle w/Pityrosporum orbiculare; multiple asymptomatic follicular domed pustules on upper back/chest (doesn't respond like acne) | acne, bacterial folliculitis, scabies | selenium sulfide shampoo, topical antifungals, oral antifungals |
| Onychomycosis | infx of nail plate w/fungal sp. d/t age, trauma, health conditions; | psoriais, leukonychia, habit-tick, trauma onycholysis (repeated water exposure - psuedomonas growth), eczema | Dx via nail culture or KOH; good local nail care; topical antifungals (not very effective); oral antifungals (lamisil/sporonax/diflucan/griseofulvin); remove nail plate |
| Distal subungual onychomycosis | trichophyton rubrum | (blank) | (blank) |
| White superficial onychomycosis | trichophyton mentagrophytes | (blank) | (blank) |
| Proximal subungual onychomycosis | trichophyton rubrum --> Get an HIV test | (blank) | (blank) |
| Candidal onychomycosis | candida albicans | (blank) | (blank) |
| Other causes of onychomycosis | asperigillus, cephalosporium, fusarium, scopulariopsis | (blank) | (blank) |
| Angular cheilitis (Perleche) | inflam of oral commissres d/t saliva irritation/maceration w/secondary yeast overgrowth; d/t mouth breathing, bad dentures, compulsive lip licking, aging, weight loss, loss of teeth; erythema/eczematous fissuring plaques w/ or w/o satellite pap/pustules | (blank) | avoid exacerbating factors; topical antifungals/corticosteroids/antibiotics |
| Cutaneous fungal infections | infx of stratum corneum w/ dermatophytes (microsporum, trichophyton, epidermophyton) | Origin of species (zoophilic, geophilic or less inflammatory anthropaphilic (humans); type of inflammation; type of hair invasion (endothrix-inside hair shaft, hair falls out; OR ectothrix-shredding of hair); | Dx - skin scrape for KOH, culture, wood's light |
| Tinea pedis | dermatophyte infx of foot d/t warmth/sweating; Subtypes: acute vesicular, Moccassin-type, Interdigital; maceration/fissureing of webs; dry scaly orange-red plaques at edge; hyperkeratotic palm or sole; vesicles/bullae on thick red scaly patch | Psoriasis, eczema, chapped-fissured feet | topical or oral antifungals, wet compresses, topical corticosteroids |
| Tinea Cruris | dermatophyte infx of crural folds d/t warm/moist environment; well-demarcated red-brown, scaly plaques extending out from crural fold | intertrigo, psoriasis, erythrasma | topical antifungals/corticosteroids, oral antifungals, absorbent powders |
| Tinea Corpus and Tinea Faciei | dermatophyte infx of trunk/limbs and face; subtypes - Classic Ringworm and Majocchi's Granuloma (T. rubrum)-more inflammatory if from zoophilic sp. | nummular eczema, pityriasis rosea, psoriasis | Topical or oral antifungals; topical corticosteroids or antibiotics, oral antibiotics |
| Tinea manuum | dermatophyte infx of hands; subtypes: Classic Ringworm and Chronic Scaling | hand eczema, psoriasis, dyshidrosis, psoriasis, contact dermatitis | topical antifungals, topical keratolytic agents, oral antifungals |
| Tinea Incognito | dermatophyte infx of skin w/clinical presentation altered by use of topical corticosteroid products; infx waxes and wanes, but never clears completely; ill-defined red-pink plaques/patches w/ or w/o scaling and areas of clearing | eczema, folliculitis, pityriais rosea, rosacea, psoriasis, nummular eczema | stop offending corticosteroid, topical or oral antifungals, wet compress |
| Tinea capitus | dermatophyte infx of hair shaft or stratum corneum of scalp d/t wood's light negative endothrix Trichophyton tonsuran (90%); microsporum canis is wood's light positive; subtypes: Inflammatory, Seborrheic dermatitis, Non-inflammatory (blk dot), Pustular | Seborrheic dermatitis, psoriasis, eczema, tinea amaintacea | Dx: hair KOH, culture, Wood's light exam; Tx: oral antifungals |
| Tinea barbae | dermatophyte infx of hair on face d/t T. mentagrophytes and T. verrucosum; annular scaling, edematous boggy tender plaques | bacterial folliculitis, furunculosis, pseudofolliculitis barbae, rosacea, acne | topical or oral antifungals, oral antibiotics |
| Basal Cell Carcinoma | MOST COMMON skin cancer-Nodular, Superficial, Morpheaform, Pigmented, Micronodular; well-demarc, flesh-pink/red or multiclored pearly papule w/telangectasias, central ulcer, orange scale/crust flat-top plaque; ill-defined whitish waxy papule/plaque | (non-skin findings: basal cell nevus syndrome); DDx: Seborrheic keratosis, sebaceous hyperplasia, melanoma, scar, actinic keratosis, squamous cell carcinoma, chondrodermatitis nodularis helicis | Dx: skin biopsy; Tx: cryo (scar), dissection/excision; Moh's micrographic surgery --> USE for NOSES; radiation; topical immunomodulatory agents (aldera); photodynamic therapy |
| Actinic Keratosis (peels, "horns") | common, pre-cancerous hyperkeratotic, scaling plaque in sun-exposed areas on fair skin; face, ears, neck, scalp, forearms and dorsal hands; poorly-defined orange/red papules/plaques w/ yellow-white hyperkeratotic scale; Actinic kelitis-lips of smokers | seborrheic dermatitis, rosacea, psoriasis, seborrheic keratosis, squamous cell carcinoma, lentigo (sun freckles), lentigo maligna melanoma | cryo; topical 5-fluorouracil "ugly" cream; topical immunomodulators (aldera) - can cause untreated areas to erupt; topical diclofenac (popular); shave/dissection (difficult); CO2 laser-lips |
| Squamous cell carcinoma | 2nd most common skin cancer; invasive cutaneous malignancy arising from keratinocytes of skin and mucous membranes; light skin; caused by sun, HPV and veruca; metastasis via ear and lip; orange hyperkeratotic scale, ill-defined papules/plaques, cut horns | actinic keratosis, superficial basal cell carcinoma, seborrheic keratosis, chrondromatitis nodularis helicis | electrodissection/excision (scars); Moh's micrographic surgery, radiation, cryo |
| Bowen's Disease | cutaneous malignancy arising from keratinocytes of skin/mucous membrane; Erythroplasia of Queyrat on penis; red, flat plaques w/adherent white/yellow scale | superficial basal cell carcinoma, actinic keratosis, inflammed seborrheic keratosis, psoriasis, chronic eczematous dermatitis | topical 5-fluorouracil, topical immunomodulators, electrodissection/excision |
| Leukoplakia | chronic condition of white patches/plaques that occur on oral mucosa w/o definitive Dx; association w/cancer; small, well-defined translucent-white papules that progress to plaques; often seen in dentist's office | candidiasis, oral hairy cell leukoplakia, frictional hyperkeratosis, lichen planus, white sponge nevus, squamous cell carcinoma | stop tobacco products, biopsy, topical 5-fluorouracil, cryo, electrosurgery |
| Paget's Disease | intraductal carcinomal of breast presenting on skin; MOST COMMON cutaneous presentation of breast cancer; red, sharply demarcated eczematous scaling plaque involving nipple, areola, and surrounding skin | nipple eczema, erosive adenomatosis of nipple, superficial basal cell carcinoma, tinea, candidal infx, atopic dermatitis, contact dermatitis | breast and node exam mammography, referral to surgeon to treat underlying cancer |
| Extramammary Paget's Disease | intraepidermal malignancy involving anogeital or axillary skin; adenocarcinoma w/in epidermal apocrine glands; associated w/urogenital, rectal carcinomas and transitional cell cancer of urethra and bladder; red-white/gray scale w/velvety surface, borders | eczematous dermatitis, lichen simplex chronicus, intertrigo, candidiasis, tinea, Bowen's disease, amelanotic melanoma | wide local excision, Moh's micrographic surgery, lymph node dissection, radiotherapy |
| Cutaneous metastasis | malignant tumor cells in cutaneous tissue which migrated from a malignancy in other organ system; may be primary presenting complaint; firm, sudden appearance of painless nodules that grow fast and can be flesh-black color; | (blank) | directed at primary tumor |
| lung cancer metastasis | chest wall | (blank) | (blank) |
| colon and rectal carcinoma metastasis | belly button (orange/red tumor in umbilicus); "Sister Mary Joseph's nodule" | (blank) | (blank) |
| Melanoma metastasis | black nodule | (blank) | (blank) |
| Renal cell carcinoma metastasis | head | (blank) | (blank) |
| Oral squamous cell carcinoma metastasis | neck | (blank) | (blank) |
| Neuroblastoma metastasis | anywhere on body; "Blueberry Muffin Baby" | (blank) | (blank) |
| Lymphoma metastasis | present on skin; poor prognosis | (blank) | (blank) |
| Erythema Multiforme | common, acute, recurrent inflammatory disease d/t: infections (herpes simples or Mycoplasma pneumonia), contact allergens, drugs, CT disease, physical agents, pregnancy or malignancy; | preceded by fever, malaise, or irritation at site of erruption; evolution and resolution w/in 1month; target lesions on hands/feet, bullae/erosions on mucosal surfaces, urticarial plaques | topical or oral corticosteroids, prevention of infx/outbreaks |
| Stevens-Johnson Syndrome | erythema multiforme major; Symmetric, severe, vesicobullous eruption of 2 mucosal membranes; self-limiting w/resolutionin 4wks; infx d/t herpes simplex, mycoplasm, meds in children and young adults | Anticonvulsant hypersensitivity syndrome, paraneoplastic pemphigus, pemphigus vulgaris, TEN, herpetic gingivostomatitis | Dx: skin biopsy/immunofluorescence; Tx: supprotive (hydration and soft diet); viscous xylocain or benadryl (oral erosions), consult ophthalmology; cool, wet compress; underlying bacterial infx; oral corticosteroids |
| Drugs associated with SJS | phenytoin, phenobarbital, carbamazepine, sulfonamides, aminopenicillins | (blank) | (blank) |
| Skin findings in SJS | erythematous papules/vesicles on purpuric macule "target lesions"; bullae w/gray-yellow fibrinous exudate and hemorrhagic crust on mucosal surfaces; ocular conjunctivitis w/ or w/o purulence | (blank) | (blank) |
| Non-skin findings in SJS | fever, pneumonitis and bronchitis (mostly); renal failure (uncommon) | (blank) | (blank) |
| Toxic Epidermal Necrolysis | Rare; life-threatening EXFOLIATIVE disease of skin and mucosal membranes (up to 100%); mortality rate is 25-50%; d/t drugs 80%, immunizations, viral, mycoplasmal infx, strep infx; Greater risk in AIDS and Lupus | staphylococcal scalded skin syndrome, graft-vs-host diease, staphylococcal toxic shoch syndrome, Kawasaki syndrome, acute paraneoplastic pemphigus, SJS | Dx:skin biopsy, liver fxn tests, CNC, urinalysis; Tx: stop all new meds, supportive care--burn center (IV fluids, pain control, nutrition, PT), oral corticosteroids, IVIG |
| Drugs associated with Toxic Epidermal Necrolysis | hydrantoins, barbituates, carbamezepine, sulfonamides, allopurinal, NSAIDs, cephalosporins, fluoroquinolines | (blank) | (blank) |
| Skin findings in Toxic Epidermal Necrolysis | targetoid papules and bullae develop suddenly on erythematous skin; Nikolsky's sign is positive (if you pull the bullae, entire thickness of skin follows) | (blank) | (blank) |
| Non-skin findings in Toxic Epidermal Necrolysis | fever, myalgias, malaise, ocular symptoms, upper airway damage, hypovolemia, wound infx/sepsis, urethritis, urinary retention, prerenal azotemia | (blank) | (blank) |
| Erythema Nodosum | nodular hypersensitivity eruption to antigenic stimuli found on extensor surfaces; d/t Nonmycobacterial infections (strep, coccidiodomycosis, chlamydia, mycoplasma, medications) and Noninfectious Inflammatory Diseases (sarcoidosis, enteropathies, HVB, TB) | F 5x> M; Prodrome-fevers, malaise, arthralgias, URI symptoms | (blank) |
| Erythema Nodosum Disease Course | lesion lasts 2 wks, but new lesions appear up to 6wks with recurrence and remissions; red, ill-defined nodular swelling on SHINS w/edema of LOWER LEG; evolution into painful, hard, indurated plaques; plaques fade | cellulitis, infected insect bites, minor trauma, nodular vasculitis, Henoch-Schonlein pupura, Wever-Christian panniculitis, superficial and deep thrombophlebitis, panniculitis secondary to pancreatic cancer, erythema induratum | Dx: biopsy, ASO titer, Chest x-ray, PPD, ESR, stool culture, RF; Tx: symptomatic releif, NSAIDs, compression, potassium iodide, oral corticosteroids, dapsone |
| Leukocytoclastic Vasculitis | inflammation of post-capillary venules mediated by immune complex deposition; d/t Meds (after 7-21days), Infections (strep, URI, hep A, B, C), CT Disease, Malignancy, or Systemic Illness; prodrome-malaise, fever, myalgias, joint pain | thrombocytopenia purpura, drug eruption, disseminated intravascular coagulation, purpura fulminans, septic vasculitis, septic emboli, bacteremia | ID and remove triggers, oral anti-histamines, NSAIDs, oral corticosteroids, colchicine, dapsone, cyclophosphamide, MTX, azathioprine |
| Leukocytoclastic Vasculitis | lesions appear in crops and last 1-2wks; healing with SCARS; may involve other organ systems; orange non-blanchable hemorrhagic macules that progress to papules; purpura develops when macules coalesce, vesicles and bulla may develop and ulcerate | Dx: biopsy, throat culture, ASO titer, ESR, platelet count, CBC, serum creatinine, UA, ANA, c-ANCA, hepB core Ab, hep C ab, cryoglobulins, CH50, RF | (blank) |
| Henoch-Schonlein Purpura | common vasculitic syndrome seen in childhood d/t strep or viral URI; prodrome-fever, malaise, anorexia; Classic Triad-1.purpuric rash, 2. abdominal cramps, 3. hematuria; palpable purpura on extensor surfaces of lower limbs/buttocks/scrotal swellling | entrapment of circulating immnune complexes in vessels of skin, GI, kidneys; runs a benign and self-limited course; DDx: leukocytoclastic vasculitis | Dx: biopsy, throat culture, UA, intestinal ultrasound, renal biopsy, serum IgG; Tx: stop offending antigen, oral corticosteroids, dapsone, plasmapheresis; Nephritis may require long-term care |
| Schamberg's Disease | lymph capillaritis; uknown etiology; lower limbs; M>F; develops slowly-years; drug-induced variant quick onset/may resolve (d/t acetominophen, ampicillin, diuretics, NSAIDs); irreg orang/brwn non-blanch macules; cayenne pepper spots; itch/scale/erythema | Chronic venous stasis, cutaneous Tcell lymphoma, nummular eczema, scurvy, senile purpura, trauma | Dx: skin biopsy, inflam/hemorrhage w/o necrosis of vessels; Tx: watch and wait, cosmetics, mild topical corticosteroids, pentoxifylline |
| Sweet's Syndrome | acute, idiopathic inflammatory response characterized by multiple discrete tender erythematous indurated papules; prodome-fever, malaise, Leukocytosis; Adults M 3.7x >F; d/t URI (viral or bacterial); malignancy in 15-20%; medications | erythema nodosum, erythema multiforme, adverse drug reaction, urticaria | oral corticosteroids, minocycline, oral potassium iodide, colchicine, dapsone, clofazimine, NSAIDs, cyclosporin |
| Sweet's syndrome systemic symptoms | fever, malaise, arthralgias/arthritis, oral aphthae, conjunctivitis/iridocyclitis | (blank) | Dx: biopsy, neutrophilic infiltrate in papillary and reticular dermis; CBC-elevated white count, elevated ESR, |
| Sweet's syndrome skin findings | sudden onset of painful, erythematous indurated papules/nodules with yellowish central discoloration; lesion may coalesce into plaques on head, neck, legs, hands | (blank) | (blank) |
| Acanthosis Nigricans | Divided into 2 Forms: Advanced intenral malignancy, and 2. DIABETICS (dark skin/bad diet) | thickened, velvety, hyperpigmented lesions | (blank) |
| Pretibial Myxedema | manifestation of Grave's Disease (hypothyroidism); localized infiltrative scaly thick induration of skin; orange peel texture | (blank) | (blank) |
| Digital Clubbing | association with interstitial lung diease (COPD) and congenital heart diease; softening and periungual erythema of nail beds; buldge of distal phalanx and curvature of nails | (blank) | (blank) |
| Erythema Nodosum | associated with Infections, Drugs, Malignancies, and Inflammatory conditions; panniculitis pink-dusty red firm nodules on pretibial surfaces | (blank) | Tx: underlying cause, NSAIDs, potassium iodide |
| Systemic AIDS | Most commonly present with Kaposi sarcoma and yeast candidiasis on tongue | oral hairy leukoplakia - white growth on tongue d/t EBV | (blank) |
| Treatment of Lice Infestations | Pyrethrins with Piperonyl Butoxide Solution | (blank) | (blank) |
| Treatment of Mite Bites | oral antihistamines (hydroxizine) 3-4x daily; topical steroids (fluocinonide) for itching; secondary bacterial infx-antibiotics | (blank) | (blank) |
| Black widow toxin | neurotoxin | (blank) | (blank) |
| Brown recluse toxin | hemolytic; necrolytic | (blank) | (blank) |
| Scabies | mite (sarcoptes scabiei) burrows into dermis between fingers, under breasts and on head of penis; tan linear ridges; very itchy | Nodular scabies can form keloids on infants | Kwell lotion, lindane |
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