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71 Cards in this Set

  • Front
  • Back
describe morphology
flat, non-palpable lesions, usu <10 mm dia
patch = large macule

ex - freckles, tattoos, port-wine stains, rashes of rickettsial infections, rubella, measles
describe morphology
elevated lesions, usu <10mm dia, can be palpated

ex - nevi, warts, lichen planus, insect bites, seborrheic and actinic keratoses, some lesions of acne and skin cancers
describe morphology
palpable lesions >10mm in dia, elevated or depressed
may be flat-topped or rounded

ex - psoriasis lesions, granuloma annulare
describe morphology
firm, papules or lesions, extend into dermis or subcutaneous tissue

ex - cysts, lipomas, fibromas
describe morphology
small, clear, fluid-filled blisters <10mm in dia

ex - herpes/varicella, acute allergic contact dermatitis, autoimmune blistering disorders
describe morphology
clear fluid-filled blisters >10mm in dia

ex - burns, bites, irritant, allergic contact dermatitis, drug rxns, inherited disorders of skin fragility, **pemphigus vulgaris and bullous pemphigoid
describe morphology
vesicles that contain pus

ex - may arise in some inflammatory diseases (pustular psoriasis), folliculitis
describe morphology
urticaria (wheals or hives)
elevated lesions caused by localized edema, typically last <24h

common ex - hypersensitivity to drugs, stings, bites, autoimmunity
less common ex - physical stimuli (e.g. temp, pressure, sunlight)
describe morphology
heaped-up accumulations of horny epithelium

ex - psoriasis, pityriasis rosea, seborrheic dermatitis, fungal infxns, chronic dermatitis of any type
describe morphology
crusts (scabs)
consist of dried blood, serum or pus

can occur in inflammatory or infections skin diseases

**honey colored crusts = impetigo/staph aureus
describe morphology
open areas of skin resulting from loss of epidermis
can be traumatic, inflammatory, infectious

**excorations --> linear or abnormally shaped erosions caused by scratching, rubbing, picking
describe morphology
result from loss of epidermis and part/all of dermis

ex - venous stasis dermatitis, physical trauma, infections, vasculitis

describe morphology
petechiae (around the bruised ankle)
non-blanchable punctate foci of hemorrhage

ex - platelet abnormalities, vasculitis, infections (rocky mt spotted fever, meningococcemia)
describe morphology
larger area of hemorrhage, may be palpable
may indicate coagulopathy

large areas of purpura may be called ecchymoses (bruises)

**palpable purpura --> hallmark of leukocytoclastic vasculitis
describe morphology
thinning of skin, may appear dry and wrinkled

ex - chronic sun exposure, aging, inflammatory/neoplastic skin diseases (SLE, cutaneous T-cell lymphoma), long-term use of potent topical corticosteroids
describe morphology
areas of fibrosis, replace normal skin after injury
some become hypertrophic or thickened/raised

**keloids = hypertrophic scars extending beyond original wound margin
describe morphology
telangiectasias (this is on/in basal cell carcinoma)
focus of small, permanently dilated blood vessels

ex - most often idiopathic, rosacea, systemic diseases (esp scleroderma), inherited diseases, long-term therapy c topical fluorinated corticosteroids
describe secondary morphology
linear lesion
take on the shape of a straight line

ex - contact dermatitis, linear epidermal nevi, lichen striatus
describe secondary morphology
annular lesions
rings w/ central clearing

ex - granuloma annulare, some drug eruptions, some dermatophyte infections (ringworm), secondary syphilis
describe secondary morphology
nummular lesions
circular or coin-shaped

ex - nummular eczema

**differentiate from ringworm --> history of atopy, skin biopsy
describe secondary morphology
target lesions (bull's eye, iris)
ring w/ central duskiness

classic for erythema multiforme
describe secondary morphology
serpiginous lesions
linear, branched, curving elements

ex - some fungal and parasitic infxns (cutaneous larva migrans)
describe secondary morphology
reticulated lesions
lacy or networked pattern

ex - cutis marmorata, livedo reticularis
describe secondary morphology
grouped papules or vesicles arranged like those of herpes simplex infection
describe secondary morphology
clustered in a dermatomal distribution similar to herpes zoster
describe texture
verrucous lesions
irregular, pebbly, rough surface

ex - warts, seborrheic keratoses
describe texture
thickening of skin with accentuation of normal skin marking

**results from repeated rubbing
describe texture
deep thickening of skin
hard, resistant feeling.

caused by edema, infection, infiltration

ex - panniculitis, skin infections, cutaneous metastatic cancer
describe texture
central indentation, usually viral

ex - herpes simplex, molluscum contagiosum (pictured)
describe texture
yellowish, waxy lesions

ex - occur in lipid disorders
describe location/distribution
frequently affects scalp, extensor surfaces of elbows and knees, umbilicus, gluteal cleft
describe location/distribution
lichen planus
frequently on wrists, forearms, genitals, lower legs
describe location/distribution
may be patchy and isolated or may group around distal extremities and face

**the darker skin is this patient's normal hue
describe location/distribution
chronic cutaneous lupus erythematosus - malar rash
characteristic lesions on sun-exposed skin of face, especially forehead, nose, conchal bowl of ear
describe location/distribution
hidradentis suppurativa
involves skin containing high density of apocrine glands --> axillae, groin, under breasts
describe color
red skin (erythema)
results from many inflammatory or infectious diseases
cutaneous tumors often pink or red
superficial vascular lesions may appear red (port wine)
describe color
orange skin
most often seen in hypercarotenemia, usually benign condition of carotene deposition after excess dietary ingestion of B-carotene
**white sclera!

**yellow skin is typical of jaundice, xanthelasmas and xanthomas, pseudoxanthoma elasticum
describe color
green fingernails

suggests Pseudomonas aeruginosa infxn
describe color
violet skin
may result from cutaneous hemorrhage or vasculitis

purple = vascular lesions or tumors (Kaposi's, hemangiomas)
lilac color of eyelids or heliotrope eruption = dermatomyositis
describe color
violet skin
may result from cutaneous hemorrhage or vasculitis

purple = vascular lesions or tumors (Kaposi's, hemangiomas)
lilac color of eyelids or heliotrope eruption = dermatomyositis
describe color
shades of blue/silver/grey
result from deposition of drugs or metals in the skin

minocycline, amiodarone, silver

ischemic skin = purple/blue
deep dermal nevi = blue
describe color
black skin
may be melanocytic, including nevi and melanoma

black eschars = collections of dead skin that can arise from vascular infarctions --> infxn
describe this clinical sign
appearance of urticarial wheal after focal pressure

up to 5% of normal pts exhibit this sign
describe this clinical sign
darier's sign
rapid swelling of lesion when stroked

occurs in pts with urticaria pigmentosa or mastocytosis
describe this clinical sign
nikolsky's sign
epidermal shearing occurring w/ gentle lateral pressure on seemingly uninvolved skin in pts w/ toxic epidermal necrolysis and some autoimmune bullous diseases
describe this clinical sign
auspitz sign
pinpoint bleeding after scale is removed from plaques in psoriasis
This is a lesion found on a 60 y/o farmer. How would you definitively diagnose it?
obtain good hx, skin screening for similar lesions.

this is actinic keratosis - punch biopsy for definitive dx
describe this clinical sign
koebner phenomenon
development of lesions within area of trauma

frequently exhibited in psoriasis
Describe this lesion. What do you think caused it?
wheal with central puncture --> allergic reaction to bee sting
What do you suspect caused this?
tick bite --> rocky mountain spotted fever
What do you suspect caused this?
tick bite --> rocky mountain spotted fever
Rash due to mistreatment of ___ with ___.
mono with amoxicillin

misdiagnosed as strep
This is a typical childhood illness that has recently started to decrease in occurence due to vaccination. Dx?
varicella, chicken pox
This childhood illness was thought to be eradicated by immunizations, but has shown reoccurrence in college populations. Dx?
measles --> booster now recommended.
Dx? Organism responsible? Tx?
acne vulgaris --> Propionibacterium acnes

systemic tx --> erythromycin/minocycline
comedolytic agents --> benzoyl peroxide/tretinoin
6 m/o presents with rash, has been mouth breather since birth.

What is Dx? What test would be abnormal in this pt?
atopic dermatitis (type I hypersensitivity rxn) --> RIST test (used to measure IgE) would be elevated
30 y/o man with pruritic, hypopigmented rash.

Dx? Workup? Tx?
Dx - Tinea versicolor

Workup - KOH prep

Tx - Ketoconazole tablets
32 y/o HIV+ male

Initial work-up? Dx?
KOH prep

Dx - Malassezia furfur
32 y/o female taking OCPs

**pmhrt does not cause this!
seborrheic keratosis
2 y/o developed these lesions on face over past 3 days. afebrile.

(due to group A strep)
56 y/o pt who has a recent onset of focal seizures of the simple partial type due to meningioma.

what does this pt have?
What is the name of this macular lesion?
café-au-lait spots

**commonly associated with neurofibromatosis
pruritic lesions on 9 y/o

what is dx? initial work-up?
do KOH prep from scrapings of the leading edge of lesion

pt has Tinea corporis (ringworm)

*spaghetti + meatballs on slide
lesion on the face of a 54 y/o farmer.

dx? work-up?
nodular melanoma / exicisional biopsy of lesion
What would cause these lesions?
pathognomonic erythematous rash in pattern of bull's eye --> Lyme disease

**erythema migrans!!
This is the rash on the shoulder of a 9-mo-old. What is your diagnosis?
prickly heat

result of blocked sweat ducts --> heat rash looks liks small red or pink pimples
Dx and Tx of this nodule?
Dx - dermatofibroma
common benign skin tumor - small, slow-growing, firm, consists of proliferation of scar-like tissue

Tx - simple excision is curative
The skin lesion noted on this patient's nose is a classic example of...?
basal cell carcinoma

usu appears as "sore that doesn't heal" --> bleeding/scabbing sore
most often on face and neck
locally invasive, don't metastasize

tx - scrape/burn/excise
Dx and Tx?
Dx - poison ivy

Tx - topical steroids, oral prednisone, IM decadron/kenalong if severe, anti-histamine for itching
What would be a high index of suspicion for a differential in this child if he had a low grade fever and flu-like symptoms?
fifth's disease (parvo B19)

**slapped face