Derm
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| Seb keratosis found anywhere except | palms & soles
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| Seb keratosis variants | dermatosis papulosa nigra (AA pts): on the face; stucco keratosis (older Caucasians): on lower legs, ankles, and dorsal hands / feet
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| Sign of Leser-Trelat: | Sudden eruption of many seborrheic keratoses may be a cutaneous sign of internal malignancy
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| Achrocordon most common in: | women & obese pts
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| Dermatofibroma sites | usually legs, but also trunk & arms
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| Dimple sign & button sign: for: | dermatofibroma
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| Contents: cheesy consistency and a nasty odor: | epidermal cyst
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| organized clusters of melanocyte-derived nevus cells | nevi (moles)
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| These have a life cycle of their own: | nevi
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| Nevus: 3 types | junctional, compound, intradermal
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| Junctional nevus: | clustered at the dermal-epidermal junction (DEJ); Flat or slightly raised, tan or brown, round or oval lesions
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| compound nevus: | Nevus cells found at both the DEJ & in the dermis; Slightly to markedly raised, tan, brown, or black papules.
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| intradermal nevus: | Raised, soft, flesh-colored, tan, or brown papules. Pigment may be arranged in flecks; may see coarse hairs
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| halo nevus | rim of depigmentation; autoimmune; usually repigments; may be assoc w/vitiligo & malignant melanoma
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| spitz nevus | kids (rarely adults); benign, pink, tan, or brown dome-shaped smooth papules; face, scalp, neck, and legs; rapid growth; excision bc melanoma may arise from spitz nevus
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| developmental anomaly appearing as a brown patch, a patch of hair, or both: | becker’s nevus
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| Congenital Melanocytic Nevus: Increased risk of malignant melanoma in: | lesions larger than 20 cm.
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| Ephilides = | freckles
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| Fordyce spots: | Ectopically located sebaceous glands
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| Do not blanch well using diascopy: | cherry angioma
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| Spider angioma: diascopy: | Common, benign, dilatation of superficial bleed vessels; Arteriole perpendicular to skin; radiating vessels easily blanch with diascopy, but central vessel may not, and may pulsate
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| Common papulosquamous lesions (raised/have scale) | Psoriasis; Seborrheic dermatitis; Pityriasis rosea; Lichen planus; Tinea corporis; Syphilis; Drug reaction
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| Seb dermatitis: adults | infreq shampooing; bedridden / chronic ill; PD; persistent cases, check for fungal infxn
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| Causes of lichen planus | Drugs (gold, chloroquine, methyl-dopa, penicillamine); film processing; Bac infxn (secondary syphilis); Post-BMT GVHD
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| Wickham’s stria | lacy-reticulated pattern of white lines on surface; focal areas of epidermal thickening; in lichen planus
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| Lichen planus sites | Most commonly on flexor surface of wrists and forearms; legs above the ankles; lumbar; eyelids; shins, scalp
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| ACD acute vs chronic | Acute: macules, papules, vesicles, bullae; Chronic: lichenified, scaling, fissured lesions
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| Darier sx | rubbing lesion causes urticarial flare
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| Auspitz sx | pinpoint bleeding after scale is removed
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| Nikolsky sx | pushing blister => further separation from dermis
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| Shagreen skin: | oval nevoid plaque; skin pigmented on trunk/back; assoc w/tuberous sclerosis
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| atopic dermatitis: itch-scratch cycle => pruritic circumscribed plaques = | lichen simplex chronicus
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| 5 P's of Lichen planus: | purple, polygonal, pruritic, papule, planar
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| erythematous, annular patch w/central clearing; fine scale: | dermatophytosis
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| varicella zoster is reactivation of VZV that was dormant in: | ganglionic satellite cells
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| Hutchinson sign | VZV; involve trigeminal nerve => eye & nose
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| Ramsay Hunt | VZV; affect external ear, facial palsy, & geniculate
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| Beefy red, sharp bordered rash (patches/plaques) in groin (infants), under breast folds with satellite lesions | Candida
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| Warm, erythematous, tender skin with possible induration or fluctuance | Cellulitis
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| Red, less distinct borders; coral red fluorescence under Wood’s lamp: | Erythrasma (Corynebacterium minutissimum)
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| Distinct, sharp raised demarcated border with fever, chills. Group A Strep | Erysipelas
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| Grouped vesicles on erythematous base | Herpes virus
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| Infant or pediatric w/ grouped vesicles on thumb or “tapioca” vesicles on thumb | Herpetic whitlow
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| Pain preceding vesicular rash in dermatomal pattern | Herpes Zoster (if involved eye = herpes keratitis)
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| if a group of lesions has a dermatomal distribution what disease is it likely to be | herpes zoster (shingles)
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| Honey colored crusts on erythematous base around nose & mouth | Impetigo; tx: mupirocin
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| Small white papules on diffusely red base on buccal mucosa = | Koplik spots: Rubeola (Measles); spots occur before rash
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| Cough, coryza, conjunctivitis | Rubeola (Measles)
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| Pastia’s lines, positive ASO titer | Scarlet fever (Grp A Strep)
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| Strawberry tongue | Scarlet fever (Grp A Strep)
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| Dewdrops on rose petal, pustules & vesicles in crops (different stages of healing), centripetal pattern = | Varicella (Chicken Pox)
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| Christmas tree pattern, erythematous papules w/ oval plaques w/ scaly itchy border. Large oval plaque w/ central clearing & scaly border (herald patch) precedes rash by 1-2 weeks = | Pityriasis rosea (resolves in 6-12 weeks). May tx w/erythromycin stearate 250mg QID x2 weeks to prevent eruption
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| Hypopigmented lesions, white, scaly. Gets worse w/ tanning or sun exposure | Pityriasis Alba
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| Erythematic ring with scaly border & central clearing | Tinea (fungal infection); KOH prep = hyphae
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| spaghetti & meatballs | Tinea (fungal infection
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| Thick, yellow, brittle nails | Onychomycosis. Tx = PO Terbinafine
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| Infant w/ erythematous, scaly crusty lesions at vertex of scalp | Cradle cap – seborrheic dermatitis (Tx in infants w/ baby shampoo, warm olive oil compress, mild Hydrocortisone cream; Adults – selenium sulfide shampoo)
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| Children < 10yo w/ vesicles on pharynx, mouth, hands, feet w/ NO ulceration | Hand-Foot-Mouth disease. Coxksackie Virus
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| Healthy looking < 5yo with lace-like rash on both cheeks – red papules | Erythema infectiosum; “Slapped cheek”, “5th Dz” (parvo B19)
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| Pediatric with high fever then after fever macular rash over trunk and neck. (rash after defervesence) | Roseola infantum (Herpesvirus); Motrin, symptomatic treatment
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| Truncal Rash in pediatric after fever | Roseola infantum (Herpesvirus); Motrin, symptomatic treatment
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| Fever, pharyngitis, “sandpaper” rash over face, neck, trunk, extremities | Scarlet Fever
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| High fever (up to 105F) x 5 days then rash. May have conjunctivitis, cracking, lip fissures | Kawasaki Disease; look for cardiac complications (myocarditis, pericarditis, arteritis, aneurysms)
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| Erythema marginatum | Rheumatic Fever
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| Dark skinned person with “whitening or lightening” of skin. Hx pernicious anemia or other autoimmune disease | Vitiligo. Skin biopsy to diagnose
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| Postauricular & occipital LAD; maculopapular rash on face then spreads = | Rubella (german measles); dx w/paired sera; resolves in 4 days; sx tx
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| Leser-Trelat sx: | Sudden eruption of many seborrheic keratoses may be a cutaneous sign of internal malignancy
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| Dermatofibroma sites | usually legs, but also trunk & arms
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| Dimple sign & button sign: for: | dermatofibroma
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| junctional nevus: | clustered at the dermal-epidermal junction (DEJ); Flat or slightly raised, tan or brown, round or oval lesions
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| compound nevus: | Nevus cells found at both the DEJ & in the dermis; Slightly to markedly raised, tan, brown, or black papules.
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| intradermal nevus: | Raised, soft, flesh-colored, tan, or brown papules. Pigment may be arranged in flecks; may see coarse hairs
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| halo nevus | rim of depigmentation; autoimmune; usually repigments; may be assoc w/vitiligo & malignant melanoma
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| spitz nevus | kids (rarely adults); benign, pink, tan, or brown dome-shaped smooth papules; face, scalp, neck, and legs; rapid growth; excision bc melanoma may arise from spitz nevus
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| developmental anomaly appearing as a brown patch, a patch of hair, or both: | Becker’s nevus
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| Ephilides = | freckles
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| Fordyce spots: | Ectopically located sebaceous glands
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| These do not blanch well using diascopy: | cherry angioma
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| Herpes keratitis tx | NO steroids. Get immediate ophthalmology referral
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| oral candida (thrush) tx | fluconazole, itraconazole, or Ampho B
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| Candidal fungemia tx | life threatening (40% mortality); IV ampho B; add flucytosine if disseminated dz
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| hidradenitis suppurativa mgmt | If abscess: I&D then inject triamcinolone. Abx
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| hidradenitis suppurativa risk factors | obesity, apocrine gland obstruction, FH of acne or hidradenitis suppurativa
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| molluscum contagiosum etiology | Poxvirus (MCV-1 & MCV-2) via skin-skin contact. Mostly kids, adults (via sex) & pts with HIV
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| Cellulitis in kids | H flu: tend to occur on face & neck. S aureus: tend to occur on extremities. GABHS also common organism
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| Cellulitis organisms in adults | S aureus and GABHS
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| Cellulitis tx | If penicillinase producer: Augmentin, dicloxacillin, azithro. If not: Pen VK, Keflex (esp for H flu)
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| Necrotizing fasciitis tx | Oxacillin, nafcillin, or cefazolin IV
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| Tx of sxs (eg, paronychia) in cutaneous candida | Castellani paint
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| Cutaneous candidiasis tx | topical nystatin or imidazole cream QID x14d; if failure: Ketoconazole
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| Most common benign tumors of infancy | Hemangiomas
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| Hemangioma mgmt | Corticosteroids 1stline (Vincristine if resistant). Propranolol. Surgical: cryoablation
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| Sudden enlargement of existing hemangioma with low platelets & coagulopathy = | Kasabach-Merritt syndrome (high mortality). Positive Glut-1 marker helps with dx
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| Port wine stains (PWS) may be associated with: | Sturge-Weber syndrome (PWS in ophthalmic branch of trigeminal nerve) or Klippel-Trenauney-Weber syndrome (Parkes Weber syndrome if AVF)
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