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