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60 Cards in this Set

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Macule
Primary lesion.
Discrete flat change in color of the skin, < 1.5 cm diameter.

Examples: freckle, lentigo, purpura
Patch
Primary lesion.
Discrete flat lesion, (lg macule) > 1.5 cm diameter
Example: pityriasis rosea, melasma, lentigo
Papule
Primary lesion
Discrete paplable elevation of the skin
< 1 cm diameter, may be dermal, epidermal, or both.
Examples: nevi, seborrheic keratosis, dermofibroma
Nodule
Primary lesion.
Discrete palpable elevation of the skin, may evolve from papule, may involve any level os skin from epidermis to subcutis.
Example: nevi, basal cell carcinoma, keratoacanthoma
Plaque
Primary lesion
Slightly raised lesion, typically with a flat surface
> 1 cm diameter, freq w scales.
Example, psoriasis, mycosis fungoides
Wheal
Primary lesion
Transient pink/red swelling of the skin, often displaying central clearing
Various shapes and sizes, usually pruritic and lasts < 24 hrs.
Ex: urticaria
Tumor
Primary lesion
Large papule or nodule, usually > 1 cm diameter
Ex basal cell carcinoma, squamous cell carcinoma, malignant melanoma
Pustule
Primary lesion
Raised lesion < 0.5 cm diameter containing yellow cloudy fluid (usually infected)
Ex: folliculitis, acne (closed comedones)
Vesicle
Primary lesion
Raised lesion < 0.5 cm diameter containing clear fluid
Ex herpes simplex, herpes zoster, contact (irritant) dermatitis
Bulla
Primary lesion
Vesicle > 0.5 cm diameter
Ex: bullous pemphigoid, contact (irritant) dermatitis, blisters of 2nd degree sunburn
Cyst
Primary lesion
Semi-solid lesion, varies in size from several mm to several cm, may become infected
Ex: sebaceous cyst
Crust
Secondary lesion
Dried exudate that may have been serous, purulent, or hemorrhagic
Ex: impetigo, herpes zoster (late phase)
scale
Secondary lesion
Thin plates of desquamated stratum corneum that flake off rather easily
Ex. xerosis, icthyosis, psoriasis
Excoriation
Secondary lesion
Shallow hemorrhagic excavation; linear or punctate; results from scratching
Ex. contact (irritant) dermatitis
Lichenification
Secondary lesion
Thickening of the skin with exaggeration of the skin creases, hallmark of chronic eczematous dermatitis
Erosion
Secondary lesion.
Partial break in the epidermis.
Ex: herpes simplex or zoster, pemphigus vulgaris
Fissure
Secondary lesion
Linear crack in the epidermis
Ex. Xerosis, angular chelitis, severe eczema
Round/discoid
Coin or ring shaped without central clearing
Ex: nummular eczema
Oval
Ovoid shape
Ex: pityriasis rosea
Annular
Round, active margins with central clearing
Ex. tinea corporis, sarcoidosis
Zosteriform (dermatomal)
Following a nerve or segment of the body
Ex: herpes zoster
Polycyclic
Interlocking or coalesced circles (formed by enlargement of annular lesions)
Ex: psoriasis, urticaria
Linear
In a line
Ex: contact dermatitis
Iris/target lesion
Pink macules with purple central papules
Ex: erythema multiforme
Stellate
Star shaped
Ex: meningococcal septicemia
Serpiginous
Snakelike or wavy line track
Ex: cutanea larva migrans
Reticulate
Netlike or lacy
Ex:
Morbilliform
Confluent and salmon colored
Ex: rubeola
Discrete margin
Well demarcated or defined, able to draw a line around it with confidence
Ex: psoriasis
Indistinct margins
Poorly defined, having borders that merge into normal skin or outlying ill-defined papules
Ex: nummular eczema
Active margin
Margin of lesion shows greater activity than center
Ex: Tinea species eruptions
Irregular margins
Nonsmooth or notched margin
Ex: Malignant melanoma
Border raised above center
Center of lesion is depressed compared to the edge
Ex: Basal cell carcinoma
Advancing borders
Expanding at margins
Ex: cellulitis
Desquamation
Peeling or sloughing of skin
Ex: rash of toxic shock syndrome
Keratotic
Hypertrophic stratum corneum
Ex: calluses, warts
Punctation
Central umbilication or dimpling
Ex: basal cell carcinoma
Telangiectasis
Dilation of superficial blood vessels within lesion -- blanch completely; may be markers of systemic disease.
Relatively permanent
Ex: basal cell carcinoma, actinic keratosis
Arcuate
Partial rings
Ex: syphilis
Multiform
More than one type of shape or lesion
Ex: erythema multiform, psoriasis
7 conditions that always itch
Atopic dermatitis, urticaria, insect bites, scabies, pediculosis, lichen planus, chickenpox
4 conditions that may itch
psoriasis, impetigo, tinea, pityriasis rosea
4 conditions that never itch
Warts, neurofibromatosis, vitiligo, nevi
What is diascopy & when is it used?
clear slide pressed over lesion -- used to eval purpuric lesions
Vascular lesions blanch, blood outside skin (ie petechiae) do not blanch
What is a Wood's light used for?
Examine fungal lesions -- almost all of them fluoresce
Characteristics of rosacea
Vasomotor instability disorder
Sebaceous gland hypertrophy, papules, pustules, persistent eythema, telangiectasis.
Prediliction for the face
Impetigo
Superficial pustular, bullous, or nonbullous eruption followed by crusting (often honey colored).
Staph/strep infection
Folliculitis
Superficial perifollicular papules and pustules.
Any hair-bearing surface, esp. beard, scalp, legs, axillae.
Shaving, hot tub (pseudomonas), contact with mineral oils, occlusive dressings
Furuncle
"Boil"
deep-seated, very tender, inflammatory nodule secondary to a folliculitis.
I&D for culture
Carbuncle
Multiple coalescing furuncles, develops post folliculitis. +/- fever.
Lab: I&D for bact. culture
Erythema infectiosum (Fifth's disease)
"Slapped cheeks" rash - bright red, followed by diffuse maculopapular rash on trunk and extremities. Lacy appearance as exanthems fade.
Assoc with aplastic anemia in children with underlying hemolytic anemias, inf in preg can cause hydrops fetalis.
Parvovirus B-19 -- test for IgM, IgG
Measles
Cough, coryza, conjunctivitis -- the 3 Cs
Koplik spots with fever spike, rash proceeds centripetally. Associated with abd pain, OM, bronchopneumonia
IgM testing, acute and convalescent IgG
Rubella (s/sx & progression)
Tender lympadenopathy of the postauricular and posterior occipital nodes,maculopapular, lacy, and confluent rash, nonpruritic, lasting 3 days.
Rash starts on face -- spreads to trunk and extremities within 24 hrs
IgG in acute, IgM antibody later
Pityriasis rosea
Herald patch comes days to 3 wks before rash
Multiple oval erythematous lesions with inner fine circle of scale. Ovals line up along skin cleavage lines in a Xmas tree pattern.
Spring and fall.
Rash on trunk and proximal extremities -- rarely face

Ck RPR if hx suggestive and rash on soles and palms
Scarlet fever
fine, mildly erythrematous papules and sandpaper rash on trunk
Begins on axillae, groin, and neck.
Circumoral pallor, strawberry tongue, Pastia's lines of linear hyperpigmentation in deep creases.
Post strep
Roseola
High fever 3-4 days in infants and young children with maculopapular rash erupting after. Begins on trunk, spreads rapidly to arms, face, neck and legs,
+ posterior cervical lymphadenopathy
Hand-foot-mouth disease
Coxsackie A-16
Painful white vesicles with surrounding halos
Painful mouth ulcers followed in 24 hrs by vesicles on fingers, palms, toes, and soles.
Assoc sx: low grade fever, sore throat, malaise, cervical and submandibular lymphadenopathy
Lab - Tzanck smear
Candidiasis
Beefy red, well-demarcated plaques, often with scaling edge and satellite lesions

Intertriginous erosions and maceration

Diaper area, skin folds, mucosa, nails & nail folds

Populations: immunocompromised, DM, steroid inhalants, pregnancy, OCPs, abx, steroids
Lab -- KOH, culture
Tinea
Dist & characteristics variable.
Skin - red scaly patches +/- central clearing
Hair -- scaling, hair loss, pustules
Feet -- vesicles or bullae
Population - immunocompromised, systemic steroids, animal contact, hot humid weather with tight clothing/occlusive footwear
Eczema/atopic dermatitis
Char -- erythema, papules, vesicles, scaling, excoriations,crusts, always pruritic
Dist symmetrical in infants and kids, flexural creases
Adults may have discrete round patches or be regionalized
Assoc with personal/fam hx asthma, seasonal allergies, eczema
2ndary colonization with S. aureus or HSV