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Dermatitis herpetiformis Primary Lesions

Pemphigoid Secondary lesions

Pemphigus Investigations

Bullous Diseases Red Rash

Scabies Urticaria

Infestations Types of urticaria

Hirsutism and Hypertrichosis Reactive Erythemas

Alopecia Map Eczema

of
Rosacea Contents Types of eczema

Acne Presentation Bacterial infections

Acne Staphylococcal infections

Hypopigmentation Varicella zoster

Hyperpigmentation Herpes simplex

Pityriasis rosea Viral warts

Lichen planus Dermatophyte infections (Tinea)

Psoriasis Treatment and DDx Fungal Infections

Psoriasis Presentation Psoriasis

Maen K. Abu Househ | Reviewed by Reem Al-qudah

 Eczema
Poikiloderma is a combination of
atrophy, reticulate Erthyroderma is a generalized Psoriasis
hyperpigmentation and redness of skin that may be Lichen
telangiectasia. scaling (exfoliative planus
erythroderma) or smooth.
Cutaneous
Lymphoma
Horn is a keratin projection that is
taller than it is broad.
Erythema is redness caused by Urticaria

Rosacea Telangiectasia is the visible vascular dilatation. cellulitis

Topical dilatation of small cutaneous blood
steroids vessels. Acne
A papule is a small solid elevation
of skin, less than 0.5 cm in Lichen
A comedo is a plug of greasy diameter. planus
keratin wedged in a dilated
pilosebaceous orifice. Open Psoriasis
comedones are blackheads . The A plaque is an elevated area of
follicle opening of a closed comedo skin greater than 2 cm in diameter Pityriasis
is nearly covered over by skin so but without substantial depth. rosea
that it looks like a pinhead-sized,
ivory-coloured papule.
A macule is a small flat area, less Freckles
than 5 mm in diameter, of altered
colour or texture. lentigines
A burrow is a linear or curvilinear
Scabies papule, with some scaling, caused
by a scabies mite. Herpes
A vesicle is a circumscribed simplex
elevation of skin, less than 0.5 cm
Melasma in diameter, and containing fluid. Chicken
A patch is a large macule. pox
vitiligo

A bulla is a circumscribed Pemphigus

A haematoma is a swelling from elevation of skin over 0.5 cm in
gross bleeding. Primary diameter and containing fluid. Pemphigoid

lesions
Trauma An ecchymosis (bruise) is a larger Acne
extravasation of blood into the skin A pustule is a visible accumulation
Post Pustular
surgery and deeper structures. of pus in the skin.
psoriasis

The term purpura describes a An abscess is a localized

larger macule or papule of blood in
HSP the skin. Such blood-filled lesions
do not blanch if a glass lens is
pushed against them
Vasculitis
Petechiae are pinhead-sized
Clotting macules of blood in the skin.
disorder
A papilloma is a nipple-like
projection from the skin.
A tumour is harder to define as
the term is based more correctly
on microscopic pathology than on
clinical morphology. We keep it
here as a convenient term to
describe an enlargement of the
tissues by normal or pathological
material or cells that form a mass,
usually more than 1 cm in
diameter. Because the word
tumourcan scare patients,
tumours may courteously be called
large nodules , especially if they
are not malignant.
collection of pus in a cavity, more
than 1 cm in diameter. Abscesses Conglobate
are usually nodules, and the term acne
purulent bullais sometimes used
Carbuncle
to describe a pus-filled blister that
is situated on top of the skin rather
than within it.
A wheal is an elevated white
compressible evanescent area
produced by dermal oedema. It is
often surrounded by a red
axon-mediated flare. Although
usually less than 2 cm in diameter,
some wheals are huge.
Angioedema is a diffuse swelling
caused by oedema extending to
the subcutaneous tissue.
A nodule is a solid mass in the
skin, usually greater than 0.5 cm in Erythema
diameter, in both width and depth, nodosum
which can be seen to be elevated
PAN
(exophytic) or can be palpated
(endophytic).

3/25/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah Primary lesions

 Pigmentation, either more or less
than surrounding skin, can develop
after lesions heal.
A stria (stretch mark) is a
Steroids streak-like linear atrophic pink,
purple or white lesion of the skin
Pregnancy
caused by changes in the
connective tissue.
Lichenification is an area of
Eczema
thickened skin with increased
markings.
Atrophy is a thinning of skin
caused by diminution of the
epidermis, dermis or subcutaneous
Topical fat. When the epidermis is atrophic
steroids it may crinkle like cigarette paper,
Lichen appear thin and translucent, and
sclerosus lose normal surface markings.
Blood vessels may be easy to see
in both epidermal and dermal
atrophy.
Acne A scar is a result of healing, where
normal structures are permanently
Keloid
replaced by fibrous tissue.
A sinus is a cavity or channel that
permits the escape of pus or fluid.
3/23/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Secondary lesions
A scale is a flake arising from the Psoriasis
horny layer. Scales may be seen
on the surface of many primary Lichen
planus
lesions
A keratosis is a horn-like
thickening of the stratum corneum.
A crust may look like a scale, but Impetigo
is composed of dried blood or
Ecthyma
tissue fluid.
An ulcer is an area of skin from
Secondary which the whole of the epidermis
and at least the upper part of the
lesions dermis has been lost. Ulcers may
extend into subcutaneous fat, and
heal with scarring.
An erosion is an area of skin
denuded by a complete or partial Eczema
loss of only the epidermis. Pemphigus
Erosions heal without scarring.
An excoriation is an ulcer or Scabies
erosion produced by scratching.
Eczema
Eczema
A fissure is a slit in the skin.
 Tinea capitis Green on shaft of hair

P.versicolor Golden yellow

Biopsy
Pitrysporum Orange

Prick Test Coral pink

Erythrasma
Diagnosis
Blue
Patch tests Pseudomonas
Woods light
Hypopigmentation
Pigmentary
magnifying lens disorders Chalky white
Depigmentation appearance

Dermatology Poor Poor prognosis

enhancement
Investigations Deep lesion
Dermatoscopy
Prognosis Hyperpigmentation Good Good prognosis
enhancement
Superficial lesion
Giant multinucleated cells Herpes
simplex
Tzanck smear
Acantholysis Scraping
Pemphigus Skin

Nail Clipping
name given to the technique in which a Samples
glass slide or clear plastic spoon is KOH
Hair Plucked hair
pressed on vascular lesions to blanch
them and verify that their redness is Diascopy
caused by vasodilatation and to unmask KOH is keratinolytic
their underlying colour
We see hyphae and spores

3/25/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Dermatology Investigations

 Urticaria <24h

1-2 Weeks
Erythema Multiforme Acrofacial
Target lesions

Blanchable 4-6 Weeks

Non-scaly Shines
Erythema nodosum Painful
Nodules
Bruises on resolving

Vasculitis
Non-Blanchable Bleeding disorder

Red Rash Commonest

ill Defined Eczema skin disease

Unilateral Fungal infections

Psoriasis Commonest

Scaly Purple
Margins
Pruritic
Well Defined
5P Papule
Bilateral Lichen Planus
Plane
Polygonal

Pityriasis 2-10 weeks

3/25/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Red Rash

 an elevated white
compressible evanescent
area produced by dermal
50% of patients with oedema. It is often
chronic urticaria and reaction pink, surrounded by a red
angioedema will be pattern itchy or axon-mediated flare.
clear in 5 years Course results burning Although usually less than
in swellings 2 cm in diameter, some
50% of those with wheals are huge.
urticaria only will Wheals
clear within 6 months
Lesions last less than 24h

Types
of increased capillary
Urticaria release of
histamine permeability
mast cell degranulation
Vasculitis
ESR antibodies against (IgE) receptor
Cause
Investigations chronic urticaria
Parasitic
infections chemical
Eosinophilia
trauma
direct degranulation
complement activation
Insect bites
Urticaria
Erythema multiforme Acute
longer than 24 h, Disease not lesion last
Divided into
blanch incompletely urticarial more than 6 weeks
vasculitis Chronic
leave bruising

dermatitis
herpetiformis sudden appearance
Bullous
bullous pemphigoid Differential pink itchy wheals
Disease
diagnosis
most disappear within few hours
Sharp margin
resolve centrally
Fever to take up an
erysipelas
more red annular shape
may enlarge rapidly
anabolic steroids
as a prophilaxis wheals may cover
most of the skin
C1 inhibitor Hereditary surface
concentrate as a angioedema anaphylactic reaction
treatment Presentation
few wheals
chronic urticaria
depression
edema of subcutaneous tissues
acute anaphylactic
reactions Complications less demarcated
asphyxiation less red
oedema of
the larynx junctions between skin
Angioedema and mucous membranes
Sites peri-orbital, peri-oral
and genital
accompanies chronic urticaria

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Urticaria

 hepatitis, areas exposed to cold cycling
infectious
mononucleosis Viral reproduced by holding an ice cube, in a
thin plastic bag to avoid wetting, against
Infection
Bacterial forearm skin for 10 mins
Cold
Mycoplasma Avoid Cold
Intestinal parasites Treatment Protective clothing
Endogenous
Antihistamines
Connective tissue disorders
Hypereosinophilic syndrome IgE-mediated
Exclude connective
Hyperthyroidism tissue diseases SLE
Cancer Investigations
CBC, ANA
Lymphomas
Avoid sun exposure
Solar
Protective clothing
IgE mediated or pharmacological
Treatment Sunscreens and sun blocks
Foods Beta-carotene
food Contact
most often around the mouth Antihistamines
additives
Heat
Latex allergy
Anxiety, heat, sexual excitement
or strenuous exercise
non-allergic macules or papules for 10 - 15 min
aspirin Physical Avoid heat
NSAIDs Pharmacological Minimize anxiety
Cholinergic Avoid excessive exercise
ACE
Treatment
Anticholinergics
morphine
Antihistamines
Types Tranquillizers
of
IgE-mediated (type I) Urticaria Aquagenic
Ingestion most common type of physical
Inhalation mast cells releasing extra
histamine after rubbing or
Instillation scratching
Dermographism
Injection Avoid trauma
Insertion Treatment
Antihistamines
Insect bites 10 I
s
Due to Sustained pressure
Infestations
Develop 3-6h later
Infection
May last up to 48h
Infusion Hypersensitivity
kinins
Inunction (contact) Cased by
Delayed Pressure Prostaglandins
Remove cause
feet after walking
Antihistamines
(H1 + H2) Sites hands after clapping
Sympathomimetics buttocks after sitting
Systemic steroids Treatment
(rarely justified) IgG antibodies to IgE or FcIgE
Avoid Autoimmune receptors on mast cells
aspirin-containing
drugs

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Types of Urticaria

 Herpes Simplex
Viral infections, especially:
hepatitis A, B and C
mycoplasma
Bacterial infections

Fungal infections coccidioidomycosis

Urticaria
Causes Parasitic infestations
Drugs
panniculitis Pregnancy
inflammation of the
immunological reaction subcutaneous fat Malignancy, or its treatment with radiotherapy

Bacteria (e.g. streptococci, Idiopathic 50%

tuberculosis, brucellosis,
leprosy, yersinia) Infections symptoms of an upper
respiratory tract infection may precede
Viruses
annular
Mycoplasma
non-scaling plaques
Rickettsia
Acrofacial
Chlamydia
Causes palms, soles
Fungi (especially coccidioidomycosis) Site
forearms and legs
Drugs (e.g. sulphonamides, oral Presentation
contraceptive agents) Face
Systemic disease (e.g. sarcoidosis, lesions enlarge and clear centrally
ulcerative colitis, Crohn
s disease, lesion may begin at the same
Behet s disease) site as the original one
Pregnancy two concentric plaques look like a target lesion
tender red nodule Some lesions blister
Erythema
shins nodosum is a severe variant
Forearms Site fever
thighs, face, breasts Presentation Reactive oral
painful joints Erythemas associated mucosa,
Stevens-Johnson mucous lips
fever syndrome with
Erythema membrane
conjunctivae
multiforme lesions
resolve in 68 weeks pharynx,
walking is difficult Course larynx

cellulitis or abscess appear for 12 weeks

phlebitis Differential diagnosis transiently by
Course grey or brown
Chest x-ray patches
site of resolved lesions
antistreptolysin-O (ASO) titre
Investigations
Serological testing asphyxia
Corneal ulcers
identify and eliminate its cause
blindness anterior uveitis
Bed rest and leg elevation Complications
panophthalmitis
NSAIDs Treatment
urinary retention
antibiotic
Annular Urticaria
Differential diagnosis bullous disorders

Biopsy
PCR
Herpes
Gimsa stain
simplex
Investigations Tzanc smear Giant
multinucleated cells

Mycoplasma Chest x-ray

identify and remove its cause

mild cases antihistamines

IVIg
StevensJohnson If no
Treatment syndrome infection
Ciclosporin

Good nursing care

HSV Valciclovir

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Reactive Erythemas

 absence of a sharp margin
coalescing most common skin conditions
bullae vesicles
epithelial General
oedematous papules disruption features If it does not itch, it is
on pink plaques probably not eczema
itch
intense itching

Weeping and Crusting spongiosis

vesicles early disease the stratum

blistering in the acute corneum remains intact
Acute eczema stages appears as a red, smooth,
redness, papules and swelling Clinical
appearance Intro oedematous plaque
scaling
oedema becomes more severe
less vesicular and exudative
tense blisters appear
more scaly, pigmented worsening
and thickened may weep plasma
dry leathery thickened scaling
increased skin markings Chronic less severe
eczema or chronic epithelial disruption
lichenification
scratching
secondary to
rubbing
activated keratinocyte
more likely to fissure
Eczema Increased proliferation of basal cells

infection secretion of various IL-1

bacterial
colonization cytokines by epidermis
Pathogenesis
Affects sleep IL-8 acts as a chemotactic
Complications factor for neutrophils
sporting
thicken
work
interfere with Hyperproliferation scale
sex lives

spongiosis
Sharply marginated,
strong colour intra-epidermal vesicles
acute stage larger blisters
very scaly
Points of elbows psoriasis or rupture
and knees involved
less spongiosis and vesication
nail and joint changes Papulosquamous
dermatoses Histology thickening of the
Mouth lesions? acanthosis prickle cell layer
Violaceous tinge? lichen
chronic hyperkeratosis
Shiny flat-topped planus
stages
papules? parakeratosis
Differential vasodilatation
Itchy social contacts? Face spared?
diagnosis
infiltration with lymphocytes
Burrows found?
Scabies
Genitals and nipples affected?
lotion to decrease the edema
Annular lesions with
active scaly edges Rest and liquid
applications
asymmetrical Fungal infections Acute weeping eczema
Non-steroidal use
Localized to palms and soles palmoplantar Wet wrap dressing
pustulosis
Topical steroids
Unusually swollen Fucidic acid
angioedema Treatment Subacute eczema
Neomycin
telangectesia Topical steroids
hirsutism Systemic antibiotics
Topical steroids S\E Chronic eczema
dryness ointment to lubricate the skin

Systemic Steroids
Severe Calcineurin inhibitors Tacrolimus

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Eczema

 industrial cases
80% of all cases

bubble bath
lip-licking occur in children

brief contact Strong irritants

Prolonged weak irritants

Cause
Detergents, alkalis, solvents, cutting oils
and abrasive dusts
Past or present atopic dermatitis
doubles the risk of irritant hand eczema Irritant
contact second most common occupational disorder
patients with dry or fair skins dermatitis
are especially vulnerable Chemical plant workers

reversible in the early stages Machine tool setters

Course Men Coach and spray painters
loss of work. Occupational Metal workers
Complications dermatitis
Hairdressers
Atopic eczema Biological scientists
Allergic contact dermatitis Differential diagnosis laboratory workers
Women
Avoidance Nurses
Protection Catering workers
Treatment
Topical steroids
delayed Previous
(type IV) contact is
Excess IgE produced as a response to allergen needed
hypersensitivity
75% begin before 6 months
specific to one chemical
90% before age of 5 years
Characteristics all skin will react to same allergen
On face Sensitization persists indefinitely
Patchy all over the body, Desensitization is seldom possible
sparring napkin area Infancy
Weeping and vesicular Cement
Chrome Paint
Knees and elbows flexural areas
Metals Tatoos
Ankles and wrists
Childhood Types of
Leathery, dry, with excoriations Fake jewellery
Eczema Nickel
Jean studs
Distribution similar to that in childhood
Cosmetics
More Lichenification Adults Well-known
allergens Fragrance mix
Allergic
Chronic Itching and scratching Major contact Medicaments Neomycin
dermatitis
Personal or first degree Rubber
family history of atopy
adhesives
Dry skin Colophony
3 out of Criteria Resins plaster
Atopic
History of eczema 5 minor eczema
Visible flexural eczema eyelids
Onset before 2 years of age certain areas are involved hands
Bacterial superinfections feet
suspected if:
Viral superinfections known contact
Disturb sleep Complications work carries a high risk
Poor growth Patch Test
Investigations
Prick test
High IgE level Avoidance
Investigation
RAST test Topical steroids
Treatment
Moisturizer
Explain and reassure
Avoid exacerbating factors
Weakest to control
Topical
Review their use regularly steroids
Treatment
Avoid potent steroids

S/E: Burning
sensation Tacrolimus

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Types of Eczema

 Affect hair area
irritant in origin
Greasy yellowish scales
aggravated by the use of waterproof plastic pants Presentation most common in adult males
faecal enzymes
may affect infants
ammonia
scalp, ears
prolonged contact Cause
face, eyebrows
overgrowth of yeasts red scaly or exudative eruption associated with
glazed and sore erythema chronic blepharitis
Presentation and otitis externa
sparing of the skin folds
presternal
Superinfection with Candida albicans Napkin Sites
vesicopustules appearing around the (diaper) Dry scaly lesions interscapular areas
periphery of the main eruption dermatitis papules or pustules on the trunk
satellite lesions "pustules Complications
around the rash" armpits, umbilicus
Seborrhoiec Intertriginous lesions groins, or under
infantile seborrhoeic eczema Eczema spectacles or hearing aids
candidiasis Differential diagnosis
not obviously related to seborrhoea
keep this area clean and dry
run in some families
increase the napkin free time
affecting those with a tendency to dandruff
superabsorbent napkins Cause
Treatment overgrowth of yeast
Protective ointments
early sign of AIDS
topical imidazole
Furunculosis
Added
skin is damaged as a result of repeated candida
Complications
rubbing or scratching infection
Intertriginous lesions
habit or in response to stress
single, fixed, itchy, Suppressive
lichenified plaque Topical imidazole
Treatment
neck in women Localized Topical Li
Presentation neurodermatitis
legs in men Site
anogenital area Reaction to bacterial Ag
Potent topical steroids Chronic stress
Causes
occlusive bandaging Types of Not really known
Treatment
break the scratchitch cycle Eczema Limbs of middle aged males
Discoid Multiple lesions
old age Eczema Coined shaped
Presentation
dry skin Vesicular and crusted
over-washing Itchy plaque
low humidity
Risks Topical Steroids
central heating Treatment
Asteatotic Topical Antibiotics
use of diuretics eczema
hypothyroidism
Poor circulation, often but not always
fine red superficial fissures accompanied by obvious venous
Presentation insufficiency
chronic patchy
topical steroid
Presentation
Treatment Gravitational
(stasis) ulcer formation
eczema Complications

Elevation
Diuretics
Treatment
Avoid strong steroids

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Types of Eczema

 diphtheroid skin flora
Overgrowth
symptom-free
macular wrinkled
slightly scaly pink, brown or macerated white areas
armpits
groins
Erythrasma Site
between the toes

larger areas of the trunk may be involved

In diabetics

coral pink fluoresce

On Woods light examination

fusidic acid
Topical
Treatment miconazole

often malaise
first warning
shivering and a fever
skin becomes red
well-defined advancing edge
Blisters may develop on the red plaques
not extending beyond the dermis
If untreated can be fatal
Erysipelas
responds rapidly to systemic penicillin
Causative organisms enter via skin split
Episodes can affect the same area
repeatedly and so lead to persistent
lymphoedema
Minor tinea pedis may
Streptococcal cause recurrent Erysipelas
infections
inflammation of the skin occurs at a
deeper level than erysipelas
subcutaneous tissues are involved
area is more raised and swollen
Bacterial
erythema less marginated than in erysipelas
infections Streptococci, staphylococci or other
Cellulitis organisms may be the cause
elevation
rest
Treatment
systemic
antibiotics Can be IV

Infection of deep Fascia

Necrotizing fasciitis mixture of pathogens

Staphylococcal infections

3/24/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Bacterial infections

 staphylococcal toxin
Follow overgrowth of staph in vagina
Cause
Associated with using tampons.

fever Toxic
rash shock
widespread erythema syndrome
not part of the resident flora
circulatory collapse Presentation
Mostly nostrils
Fingers Staphylococcus aureus
desquamation perineum
Hand Carriage
armpits

Erythema and tenderness staphylococci

followed by the loosening of caused by streptococci
large areas of overlying
epidermis staphylococci
Occurs mostly in children Exfoliative
toxins desmoglein 1
Exfoliative toxins Scalded bullous
Cause skin type toxin is
affects desmoglein 1
localized bullous impetigo
Organism is localized but the toxin is widespread syndrome
Types
Affects only stratum corneum Not local scalded skin syndrome
full thickness
toxic epidermal beta hemolytic
In adults necrolysis
crusted ulcerated type streptococcus
usually drug induced Differential
diagnosis
highly contagious
the erosion is at the stratum corneum
(boils)
thin-walled flaccid clear blister
acute pustular infection of a hair follicle may become pustular
Impetigo
Staphylococcus aureus Rupture leaving yellow exudate and crust
cause Presentation
Multiple lesion Around face
source (carrier)
host ( low immunity as DM and systemic steroids) heals without scarring
predisposing factors
route (skin disease, minor trauma) clear even without treatment
Course
mainly adolescent boys
acute glomerulonephritis
tender red nodule
Staphylococcal Complications
enlarges
May discharge pus
infections Recurrent
search for scalp lice
impetigo
leave a scar Differential
Presentation
diagnosis
Fever and enlarged draining nodes are rare and course
Most patients have one or two boils only Gram stain and culture
suggests a virulent Systemic antibiotics cefalexin
Investigation
staphylococcus appearance of many and
treatment topical antibiotic
minor cases
susceptibility of follicles
Due to
colonization of nares or groins chronic furunculosis
ulcers forming under a crusted surface infection
Cavernous sinus thrombosis Furunculosis crust is blackish
Septicaemia Complications Ecthyma
ulcer is full thickness
if only hidradenitis heals with scarring
suppurativa
the groin and axillae are involved Differential The bacterial pathogens & treatment are similar to those of impetigo
diagnosis group of adjacent hair Staphylococcus aureus
follicles becomes
underlying skin disease General examination deeply infected with
Test the urine for sugar. Full blood count must exclude DM
Investigations
lesions and carrier sites Culture swabs in chronic swollen painful suppurating area
furunculosis Carbuncle
Immunological evaluation discharging pus

simple incision and drainage pain and systemic upset are greater than those of a boil
topical and systemic antibiotics
if it is associated
with fever and Acute episodes Treatment Incision and drainage
systemic symptoms antibiotics

treat carrier sites

appropriate topical Treatment
antiseptic or antibiotic chronic
systemic antibiotic furunculosis
In stubborn cases

Daily bath using an antiseptic soap

Improve hygiene and nutritional state

3/23/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Staphylococcal infections

 varicella-zoster
result of the reactivation
virus that has remained dormant in a
sensory root ganglion
old age
Hodgkin
s disease
AIDS Occur in
leukaemia
spread by the respiratory route
patients with zoster can transmit the virus to others
Slight malaise
start with a burning pain
itchy
followed by erythema
papules
grouped, sometimes blood-filled, vesicles
clear vesicles pink base
over a dermatome
clear vesicles quickly become purulent pustules
a few days burst and crust
Presentation
next few days the lesions
Presentation and crust and then clear
leaving depressed depigmented scars course
characteristically unilateral sometimes leaving
white depressed scars
thoracic segments
centripetal
ophthalmic division Affects commonly Site
Mostly on trunk
trigeminal nerve
Second attacks are rare
Secondary bacterial infection
Pneumonitis
ocular muscles,
Herpes zoster Varicella Secondary infection
facial muscles of skin lesions
Motor nerve involvement
diaphragm Complications Haemorrhagic or
bladder lethal chickenpox
Complications
Zoster of the Varicella Scarring
ophthalmic Smallpox
corneal ulcers and scarring division zoster Differential
diagnosis
Persistent neuralgic pain
Tzanck smear
appendicitis Investigations
before the rash
myocardial infarction Differential
live attenuated
diagnosis vaccine prophylactic

Biopsy or Tzanck smear

Investigations Systemic Patients under 2
Aciclovir or older than 12
to all patients Treatment
Systemic
within the first 5 days of an attack treatment calamine lotion
Otherwise topically
Reduces post-herpetic neuralgia

rest
analgesics supportive
calamine Treatment
carbamazepine
gabapentin systemic post-herpetic
neuralgia
amitriptyline

3/25/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Varicella zoster

 most common
in children
acute gingivostomatitis usually extragenital
type I
soon turning into ulcers
Vesicles mainly on the genitals
scattered over the lips
type II
malaise Cause
through mucous membranes
headache type I route of
infection or abraded skin.
fever With
enlarged virus may become latent
cervical Primary infection
nodes
Herpes encephalitis or meningitis
lasts about 2 weeks
Disseminated herpes simplex
direct inoculation of the virus herpetic
whitlow Eczema herpeticum
pus-filled blisters on a fingertip Complications
recurrent dendritic ulcers leading to
usually transmitted sexually corneal scarring
Primary
cause multiple and painful type II
genital or perianal blisters erythema multiforme
which rapidly ulcerate Presentation
strike in roughly the same place each time sunblock
respiratory tract infections
Herpes cut down the
ultraviolet radiation simplex length of attacks
precipitated by used in the first 24 hrs
menstruation
Aciclovir
when the first tingling
stress cream
Treatment symptoms appear
burning
face
lips sites for those with
widespread or
genitals systemic
Recurrent
involvement
Tingling oral aciclovir
burning Starts with
pain

erythema
clusters of tense vesicles Then
Crusting occurs within 2448 h
whole episode lasts about 12 days

3/25/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Herpes simplex

 smooth
first skin-coloured papule

Then lesion enlarges

And has irregular
hyperkeratotic surface
prevalence is highest in childhood
Gives classic
warty
Common appearance
warts
HPV hands
human papilloma virus Cause
Site face
genitals
salicylic acid often multiple than single
Wart Paint
Keratolytic Painless
applied for at least 3 months
1st choice rough surface
Except on face and
on genital area protrudes only slightly
from the skin
imiquimod
surrounded by a horny collar
podophyllotoxin genital warts Treatment presence of bleeding
Plantar
with liquid nitrogen warts On also
distinguishes
cryotherapy paring interruption
it
from of skin
electrosurgery
corns lines
laser
painful
Scarring
Surgery Contraindicated rough marginated plaques
made up of many small,
Molluscum contagiosum Presentation tightly packed warts
Differential Mosaic soles
Plantar corns
diagnosis Viral warts Sites palms
Condyloma lata
warts around finger nails
Painless

smooth flat-topped
skin-coloured or light brown
Some plantar warts are very painful
most common on
Epidermodysplasia verruciformis the face and brow
Complications
cervical carcinoma Site backs of the hands
Malignant change Plane
warts shaven legs
resolve spontaneously
resolve spontaneously in the healthy people
multiple
within 6 months in 30% painless
within 2 years in 65%.
most common in the beard
Course
Mosaic warts are notoriously slow to spread by shaving
resolve and often resist all treatments Facial warts
ugly but are painless
persist and spread in
immunocompromised condyloma acuminata
cauliflower-like lesions
may coalesce to form
Anogenital huge fungating plague
warts vaginal and anorectal
mucosae may be affected
Must look for other STDs

3/23/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Viral warts

 Trichophyton skin, hair and nail infections
Microsporum skin and hair (athlete
s foot)
most common type of fungal infection
Epidermophyton skin and nails
Cause Risk sharing of wash places
zoophilic Animal to human
Tinea
pedis Soggy interdigital scaling, particularly in
anthopophilic Spread either the fourth and fifth interspace
Human to human three
patterns diffuse dry scaling of the soles

for minor skin infections Recurrent episodes of vesication

miconazole associated with tinea pedis

imidazole
clotrimazole Local initial changes occur at the free edge of the nail
terbinafine Nail becomes crumbly
Tinea
Tinea Capitis of Yellow Discoloration
the Changes Subungual hyperkeratosis
Tinea of the nail nails
Widespread Indications Treatment Separation of the nail
infections Onycholysis plate from its bed

Resistant infections
Systemic usually asymmetrical
Terbinafine
Tinea tinea pedis
Itraconazole of associated with
the unilateral onychomycosis
Drug of choice in
hands powdery scale in the creases
Tinea Capitis Griseofulvin
common
affects men more
In Tinea Capitis
sometimes unilateral
Green fluorescence
on the hair shaft Presentation upper inner thigh is involved
Tinea
Not present in all cases Wood s of the lesions expand slowly
The most common cause
light Dermatophyte groin sharply demarcated plaques with
Trichophyton tonsurans peripheral scaling
gives negative result infections scrotum is usually spared
scaly margin (Tinea ) few vesicles or pustules can occur
Scraping
Skin
Investigations plaques with scaling and erythema most
pronounced at the periphery
Crumbly area Clipping
Nail Tinea of the few vesicles or pustules can occur
Samples
trunk and
limbs lesions expand slowly and healing in the
Plucked hair Hair corporis center leaves a typical ring-like lesion

KOH is keratinolytic disease of children

Use KOH Causing a patch of red scaly
We see hyphae and spores preparation non-scarring hair loss
Fungal Cultures Variant with more intense inflammation
boggy swelling
permanent scarring alopecia inflammation
Tinea
vesication on the sides of the fingers and palms of pustulation
the Kerion
lymphadenopathy
Epidemics of ringworm scalp
Complications Causing permanent scarring hair loss
(Capitis)
Masking of usuall signs of
Infection by mistreatment Must be
with topical steroids looks like a carbuncle differentiated
tinea incognito
yellowish crusts
Favus
Causing permanent scarring hair loss

3/23/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Dermatophyte infections (Tinea)
 Candida albicans is a classic opportunistic pathogen
obesity
old name: tinea versicolor
moisture
regarded as non-infectious
maceration
commensal yeasts
immobility Pityrosporum orbiculare
Cause Overgrowth
diabetes
Carboxylic acids released by the
pregnancy organisms inhibit the increase in
use of broad-spectrum antibiotics pigment production by melanocytes

contraceptive pill superficial scaly patches

predisposing
Immunosuppression fine wrinkling
factors
Leucopenia slightly itchy
Thymic tumours fawn or pink on non-tanned skin
Low serum iron Presentation paler than the surrounding skin
after exposure to sunlight
Endocrinopathy
upper trunk
Immersion in water Site
can become widespread
Cold hands
Untreated lesions persist
Poor hygiene
Pityriasis slow to regain their former colour
whitish adherent plaque with Treatment
erythematous base, in denture wearers versicolor
Oral candidiasis
border is clearly defined
in body folds, erythema and maceration Candidiasis scaling is absent
with satellite papulopustules Candida intertrigo lesions are larger
Vitiligo
Differential
Genital candidiasis Fungal diagnosis
Affect limbs and face more
usually bacterial Infections depigmentation is
Acute more complete
Staph. Aureus

Candida branched hyphae

and spores
proximal and sometimes the lateral nail folds
cuticles are lost
Presentation Scrapings KOH
spaghetti and
meatballs
small amounts of pus can be expressed Paronychia Investigations appearance
nail plate becomes ridged and discoloured chronic
wet work wood's light golden yellow

poor peripheral circulation Predisposing factors

imidazole group
vulval candidiasis Treatment topical preparation
systemic and topical antifungal
Chronic mucocutaneous candidiasis
Systemic candidiasis

culture Swabs
Investigation
Predisposing factors should be sought and eliminated
Amphotericin, nystatin and the imidazole Treatment

3/25/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Fungal Infections

 Induction of new lesion in normal
skin by trauma or scratching
Warts chronic, non-infectious, inflammatory
Kbner
Psoriasis phenomenon
+ve in well-defined salmonpink plaques bearing large
Lichen planus Trauma Intro adherent silvery centrally attached scales
Vitiligo Affects white people mainly

guttate
psoriasis one affected parent has a 16%
beta-haemolytic streptococci
genetic predisposition rises to 50% if both
Infection
explosive forms HIV hidden antigens
environmental trigger
in postpartum
have a rebound excessive number of
improves in pregnancy Precipitating germinative cells
Hormonal factors enter the cell cycle
hypothyroidism
growth fraction is almost
hypocalcemia
Cause 100% compared with 30%
hyperproliferation in normal skin
Improves of keratinocytes
Sunlight Normally
turnover time
key is greatly 30-60 days
Antimalarials, beta-blockers
abnormalities shortened Becomes
withdrawal of systemic 10 days
steroids or potent Drugs

rebound topical steroids neutrophils
inflammatory cell infiltrate Th17
Palmoplantar Pustular Psoriasis Cigarette smoking lymphocytes
T1
and alcohol

exacerbations nuclei retained in the horny layer

Emotion Parakeratosis
Irregular thickening of the epidermis
Usually diagnosed clinically
Munro
Biopsy Histology in stratum
Epidermal polymorphonuclear leucocyte infiltrates
guttate psoriasis corneum
Throat swabbing for
beta-haemolytic streptococci Dilated and tortuous capillary loops in the dermal papillae

Fungal infections Psoriasis T-lymphocyte infiltrate in upper dermis

Skin scrapings and nail clippings

Arthropathy Distal arthritis Most charecteristic

Radiology
Single joint
Dermatology Life Investigations Oligoarthritis
Arthropathy
Quality Instrument Most common
DLQI
Questionnaire Complications Polyarthritis

Psoriasis Area Erythrodermia

and Severity
Metabolic syndrome
Index Severity
scaliness assessment IHD

erythema PASI
thickness quantifies
Presentation
>10% severe extent

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Psoriasis

 psoriasiform spread most common type
outside the napkin Napkin well demarcated
psoriasis
pink or red
recurrent episodes large, centrally adherent,
of pustulation Acute generalized silverywhite, polygonal scales
Plaque
pustular psoriasis Less pattern
common elbows
withdrawal of potent topical or patterns knees
systemic steroids Symmetrical sites
lower back
skin becomes universally scalp
and uniformly red Erythrodermic
Malaise psoriasis children and adolescents
shivering Triggered by streptococcal tonsillitis
Guttate
drop-shaped

generalized redness of skin Psoriasis pattern small round red macules

that may be scaling (exfoliative Then scales develop
erythroderma)
Presentation
Areas of scaling are interspersed with normal skin
Eczema
overflows just beyond the scalp margin
Psoriasis Scalp
Causes Common Significant hair loss is rare
cutaneous lymphoma
patterns
Drug allergy Thimble pitting
Erythroderma
onycholysis separation of the nail from the nail bed
Sepsis
Dehydration Nails subungual hyperkeratosis
Complications
poor thermal control Oil drop sign
high output heart failure Splinter hemorrhage

submammary, axillary and anogenital

not scaly
glistening sharply demarcated
Flexures red plaques with fissuring.
appearance of punctate most common in women and elderly
bleeding spots when psoriasis
scales are scraped off negative auspitz sign
Auspitz sign
poorly demarcated
Less erythematous
painful fissures on fingers
Palms and soles
pustules
negative auspitz sign

3/12/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Psoriasis Presentation

 Explanation and reassurance
Calcipotriol
Tacalcitol
Vitamin D analogue
less well defined mild to moderate
exudative or crusted psoriasis
Discoid
lack thick scales eczema retinoids Tazarotene
Don't favor extensor surfaces
face, ears,
more diffuse genitals
less lumpy
limited and
choiceareas flexures
overflowing the scalp
margins and interspersed Topical
Seborrhoeic patients who cannot use
with normal skin in psoriasis Treatment
eczema vitamin D analogues
not so sharply marginated
corticosteroids scalp,
ear, face, eyebrows Sites palms and
unresponsive
psoriasis soles
confused with guttate psoriasis
Differential minor localized psoriasis
lesions are oval diagnosis
Salicylic acid short periods
run along rib lines
Christmas tree Treatment Dithranol
Pityriasis
Scaling is of rosea Coal tar
collarette type
Acute Phototoxicity
herald plaque Psoriasis UV
S/E
Skin cancer
confined to the upper trunk Treatment
2ndry syphilis and DDx When Severe
Cutaneous t-cell lymphoma photochemotherapy
more asymmetrical retinoids Acitretin
obvious tinea of neighboring skin
Tinea Liver failure
Pitting is not seen unguium methotrexate
Nails are crumbly and discoloured
Systemic Renal failure
S/E
ciclosporin HTN

hydroxyurea
Sulfasalazine
never use systemic steroids for psoriasis

resistant cases
Combined

3/12/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Psoriasis Treatment and DDx
 difficult
Stop them
if drugs are suspected

extensive involvement
mediated immunologically
nail destruction
Systemic steroid
painful and erosive oral
genetic susceptibility
reduce pruritus
photochemotherapy
Treatment
alopecia areata
Oral ciclosporin
associated with
acitretin Resistant cases vitiligo
autoimmune disorders
For itching ulcerative colitis
Antihistamines

Usually asymptotic
plain
corticosteroid Mucous
Topical
tacrolimus If symptomatic membrane purple
5p's pruritic
Individual lesions may last for many months papule
For many years polygonal
hypertrophic variant

become darker Course violaceous

flatter intensely itchy
leave discrete As lesions resolve flat-topped
brown or grey papules
macules wrists
on extremities
legs

white streaky pattern on the

Wickham
s surface of these papules
striae
Lichen lacy lines
planus dots
in mouth white plaques
Investigations
Ulcers SCC
Presentation
genital skin
Since patients rub
excoriations are and not scratch
uncommon
biopsy
Groves Longitudinal
other papulosquamous diseases
inward advance
Gold and other of skin over the
heavy metals Drug nail plate
nails Ptyrigium
eruption Differential diagnosis
Thinning
discoid lupus erythematosus
destruction
Oral candidiasis
patchy scarring alopecia.
Scalp
Nail and hair loss can be permanent
squamous cell carcinoma Complications
ulcerative form

3/12/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Lichen planus

 herpes virus 7
Cause reactivation of herpes virus 6.

herald plaque precedes the generalized eruption

Subsequent lesions enlarge
systemic symptoms such as aching and tiredness Common during winter
Course
eruption lasts 210 weeks affects children and young adults

resolves spontaneously second attacks are rare

larger than later lesions
leaving hyperpigmented patches
Rounder
Pityriasis At first herald or

motherplaque Redder
No Cure
rosea more scaly
topical steroid
smaller plaques appear
calamine lotion
Treatment On trunk mainly
Sunlight For itching After several days
Presentation
also on neck and extremities
UVB
ointment reduces scaling are oval
salmon pink

tinea corporis delicate adherent peripherally

scaling
pityriasis versicolor collarette scales
plaques Christmas tree
guttate psoriasis
Differential diagnosis
axes run down and
secondary syphilis
configuration out from the spine
gold along the lines
captopril drug eruption of the ribs

3/12/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Pityriasis rosea

 PIGMENTED
Phaeomelanins
trichochromes Tyrosine>>
phenylalanine>> Lichen planus
Eumelanins
Eczema
Melanin is made within melanosomes Secondary syphilis
Melanocytes inject melanin to nearby keratinocytes Pi: Post-inflammatory
Systemic sclerosis
all together for Epidermal melanin unit Melanin Lichen and macular amyloidosis
Don't have more melanocytes
Cryotherapy
melanocytes produce more and larger melanosomes
Blacks
broken down less rapidly
seen most often in the
Melanin red-haired or blond person
Oxyhaemoglobin sharply demarcated
Control of skin color
Carotene brownginger macules
usually less than 5 mm
Photosensitizing drugs become darker with sun exposure
D: Drugs
Increased melanin is
Freckles seen in the basal layer
acquired without any increase in the
symmetrical hypermelanosis Histopathology number of melanocytes
face without elongation
on sun-exposed skin of the rete ridges
well defined Only sunscreens
No treatment needed
edges may be scalloped
common in women light or dark brown macules
becomes darker after exposure to the sun TE: 1 mm to 1 cm
Trauma
Pregnancy Melasma irregular outline
and
sunlight Exogenous On areas not
Simple in exposed to sun
oral contraceptives causes
children on mucous
thyroid dysfunction
G: Genetic Simple membranes
photosensitizing drugs and
senile Senile after middle age
sunscreen or on the backs of the hands
hydroquinone Treatment solar
bleaching agents Hyper on the face
Lentigines "liver spots"
pigmentation
Malabsorption increase in the number
N: Nevi | Nutrition of melanocytes
Pigmented naevi Histopathology
elongation of the rete ridges

Treatment is usually
Addison
s disease Only sunscreens
unnecessary
Cushing
s syndrome
E: Endocrine PeutzJeghers syndrome
Pregnancy
Multiple in Cronkhite-Canada Syndrome
Renal failure
LEOPARD syndrome
Xeroderma pigmentosum
Biliary cirrhosis autosomal dominant
M: Medical/Metabolic
Haemochromatosis around the lips
PeutzJeghers lentigines buccal mucosa, gums, hard palate
Malignant melanoma syndrome hands and feet
M: Malignancy
polyposis of the small intestine

3/15/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Hyper pigmentation

 cell-mediated autoimmune attack
Cause
Trauma and sunburn can precipitate both types

acrofacial variant
starts after the second decade
A PIGMENTED family history in 30%
common generalized
types DM 1
Associated with thyroid disorders
pernicious anaemia
rare segmental

hydroxychloroquine D: Drugs sharply defined

symmetrical
backs of the hands
Trauma T: wrists
Sites fronts of knees
neck
Halo naevus N: around body orifices
Generalized hair of the scalp and beard
type may depigment too
Hypopituitarism E: Endocrine Clinical Induction of new lesion in normal
course skin by trauma or scratching

Malignant melanoma Vitiligo

M: Malignancy Kbner
A: Autoimmune phenomenon Warts
Vitiligo +ve in
Psoriasis
oculocutaneous albinism
Lichen planus
defect in the synthesis or packaging of
melanin in the melanocyte Hypo occasionally, they repigment
spontaneously from the hair follicles
little or no melanin is made pigmentation
Segmental
Iris type Spontaneous repigmentation occurs more often
Affects Albinism
Skin G: Genetic
whole epidermis is white depigmenting chemicals

have poor sight, photophobia Pityriasis versicolor

Differential diagnosis
and a rotatory nystagmus Post-inflammatory
Phenylketonuria leprosy
ChediakHigashi syndrome: Sun avoidance and screening
preparations
for 12 months
topical corticosteroid
Eczema strength should be gradually tapered
Pityriasis alba tacrolimus ointment
calcineurin inhibitors
Psoriasis Treatment
PUVA
Sarcoidosis Pi: Post-inflammatory
transplant
Lupus erythematosus completely and irreversibly
Lichen sclerosus et atrophicus extensive vitiligo monobenzyl
depigmented by
Cryotherapy hydroquinone

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Hypo pigmentation

 comedones Mild

Papules
Moderate
Pustules
According
Nodules to severity
Cysts Severe
Scars

Topical
Isotretinoin
Adapalene Retinoids
Mild disorder of the pilosebaceous apparatus
Tazarotene
comedones
Azelaic acid
papules
Topical and systemic pustules
clindamycin lesions nodules
Topical Intro
erythromycin Cysts
antibiotics
zinc & Scars
erythromycin
Nearly all teenagers
Minocycline
clears by the age of 2325
Prevalence
Doxycycline years in 90% of patients
GIT upset
Photosensitivity Poral occlusion
Hepatotoxicity Bacterial
colonization of duct Propionibacterium acnes
Teeth staining systemic
Tetracycline Pathogenesis
antibiotics
dental hypoplasia S/E Dermal inflammation
Pigmentation Increased Sebum secretion rate
Increased ICP Moderate
contraindicated Presentation
in children and
pregnancy Systemic
exclude a pyogenic infection
In all females Treatment Cultures
High estrogen low progesterone LH:FSH 2.5:1
LH
Anti androgens
Diane-35 FSH
just given for females Hormonal
dehydroepiandrosterone
antiandrogen ketoconazole sulphate
Investigations Hormones
androstenedione
antiandrogen spironolactone 17-hydroxyprogesterone

For PCOS metformin

Acne urinary free cortisol

Pelvic U/S
Systemic CT
Imaging
Depression MRI
Hepatotoxicity
Teratogenic
comedones absent
Most imp. Dryness of Mucous
LIPS Rosacea only face
membranes and skin
Differential Hidradenitis axillae and groin
Triglycerides
Hyperlipidemia diagnosis suppurativa
Pancreatitis
S/E Pseudofolliculitis
photosensitivity
folliculitis
muscle aches Severe
Isotretinoin
Hair loss
poor night-time vision
hearing loss
Headache
Increased ICP

CBC
Fasting lipid profile Monitoring
LFT
Used alone with no other antibiotic
Cosmetic camouflage

3/13/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Acne

 clitoromegaly Face
Site Upper trunk
deepening of voice Systemic Androgen-secreting
breast atrophy virilization tumours Seborrhoea

Cutaneous virilization Open comedones

Common type closed comedones
dominated by papulopustules papules, nodules
and cysts
suddenly
Corticosteroids Depressed or hypertrophic scarring

androgens hyperpigmentation can follow

anabolic steroids
gonadotrophins Drug
ball
Progesterone induced Nodules
oral
containing contraceptives E.G.. Cysts
Severe form
lithium Conglobate Scar
iodides abscesses or cysts with
intercommunicating sinuses
bromides
anticonvulsants leaves deeply pitted or
hypertrophic scars

conglobate acne
ambiguous genitalia
Congenital adrenal hyperplasia fever
salt-wasting Fulminans
joint pains
+
High (ESR)
Acne
Presentation soon after birth

hirsutism common in males

Infantile
Acne Cutaneous last up to 3 years
male-pattern balding virilization
Polycystic Due to maternal androgens
ovarian
oligomenorrhoea
syndrome
obesity only comedons

Glucose intolerance Tars

Exogenous chlorinated hydrocarbons

on the trunk oily cosmetics

Sweat causes follicular occlusion Tropical Can cause OR exacerbate acne

Common in white ppl traveling to the tropics

common in young girls
Excoriated
With obsessional picking or rubbing
mainly in women
limited to the chin
Late onset
Nodular and cystic
stubborn

3/13/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Acne Presentation

 avoidance of exacerbating factors + sunscreens
tetracyclines
papulopustular
Erythromycin
2 Types erythematotelangiectatic
Topical metronidazole papulopustular Intro
metronidazole rosacea affects the usually women
stubborn
systemic
isotretinoin rosacea Treatment face of adults

vascular lasers Erythematotelangiectatic peak incidence is in the thirties

rosacea

surgical excision
Still Unknown
cryotherapy rhinophymas
Demodex folliculorum

no erythema and Helicobacter pylori

telangiectases Cause Warmth
comedones spicy food
Involves face, back Acne
Seen in those who flush easily alcohol
and shoulders
embarrassment
Seborrhoeic eczema
perioral dermatitis Differential diagnosis
centre of forehead
systemic lupus erythematosus cheeks
photodermatitis nose
Sites
menopausal symptoms chin
Superior vena periorbital and perioral areas are spared
flushing
caval obstruction
Intermittent flushing
followed by a fixed erythema and telangiectases.
blepharitis
papules
conjunctivitis
Eye
Rosacea papulopustules
keratitis Lesions plaques
hyperplasia of the nodules
sebaceous glands
and connective has no comedones or seborrhoea
tissue on the nose usually symmetrical
Course
common in males Rhinophyma Complications
Prolonged course with
below the eyes exacerbations and remissions

on the forehead Lymphoedema Heat

Sun exposure
develop a
rebound flare of spicy food
some patients Exacerbating factors
pustules treated with alcohol
potent topical embarrassment
steroids
Vascular features
erythematotelangiectatic predominate
Erythema
rosacea
Telangiectasia
Important Inflammatory features
Swelling predominate
features papulopustular
Papules rosacea

Pustules

3/16/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Rosacea

 T-cells
autoimmune Loss of open
thyroid disease hair follicles
vitiligo Burns
Associated with
atopy radiodermatitis

affects 10% of those with Down

s syndrome Aplasia cutis
Kerion
patch of hair loss
Scaring carbuncle
With no scaring
Scaring Cicatricial basal
Skin colored
and cell carcinoma
Not scaly non-scaring lichen planus
Well defined margin
Localized lupus erythematosus
No specific arrangement
sarcoidosis
Scalp
Alopecia areata
beard
Distribution is variable Presentation Androgenetic
eyelashes
Hair-pulling habit
eyebrows non-scaring
Traction alopecia

exclamation-mark localized
non-inflammatory
hairs and tinea capitis
broken hair that is Alopecia diffuse
4 mm long , less Pathognomonic areata Telogen effluvium
pigmented and
thinner proximally hypopituitarism

unpredictable hypo- or hyperthyroidism

Endocrine
onset before puberty hypoparathyroidism

association with high androgenic states

atopy or Down s
antimitotic agents
syndrome
poor
retinoids
unusually widespread prognostic
features Course Drug-induced anticoagulants
involvement of the diffuse
scalp margin vitamin A excess
Recurrent
Alopecia oral contraceptives
more than 3 months duration Androgenetic
nail envolvement Iron deficiency
Differential diagnosis Severe chronic illness
Intradermal/intralesional Corticosteroid Malnutrition
Topical corticosteroids Diffuse type of alopecia areata
Minoxidil
Treatment
PUVA male-pattern baldness
Contact sensitizer clearly familial
Male-pattern baldness
childbirth from the temples
in men
Surgery
triggered by any
haemorrhage Presentation more diffuse
severe illness women
severe dieting
anxiety
synchronize catagen Androgenetic Complications
alopecia
So large number of hairs are lost together
Telogen Scalp surgery, hair
23 months after the provoking illness effluvium transplants and wigs
Beau
s lines on nails minoxidil
Beau s lines: Antiandrogens
Transverse grove due to Associated with
Treatment decreased libido
slow growth
erectile dysfunction
Finasteride
reassured that their hair
altered prostate-specific
fall will be temporary
antigen levels
Treatment

3/15/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Alopecia

 decrease weight and exercise
underlying disorder must be treated Cushing syndrome
androgen producing tumors
waxing or shaving Adrenal
congenital adrenal hyperplasia
Plucking should probably be avoided Treatment
androgen producing tumors
Laser
serum testosterone
Oral antiandrogens
LH:FSH 2.5:1
electrolysis
Poly cystic sex hormone-binding globulin
ovarian dehydroepiandrosterone
occurs in childhood; Causes Ovarian syndrome sulphate (DHEA-S)
features of virilization
androstenedione
sudden or recent onset done
if Pelvic U/S
menstrual irregularity
or cessation lipid profile
fasting glucose
serum testosterone
Drugs
2.5:1 Hirsutism
LH:FSH Racial / Familial
sex hormone-binding globulin idiopathic
dehydroepiandrosterone sulphate Investigations
androstenedione on beard
17-alpha hydroxyprogestrone chest
Presentation Excess hair shoulder-tips
prolactin
around the nipples
Pelvic U/S
male pattern of pubic hair
Transvaginal ovarian ultrasound
lipid profile
fasting glucose

3/15/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Hirsutism

 Head lice
P. humanus capitis

Body lice
P. humanus corporis Lice 10% of children

Pubic lice few or no symptoms

Phthirus pubis still common peak between the ages of 4 and 11
more common in girls than boys
sexual contact
Spread 34 mm in length
about 10 adult lice
greyish
Severe itching in the pubic area Cause
Eggs (nits) stuck to the hair shafts
eczematization
secondary infection followed by
head-to-head contact
small bluegrey macules Spread
Presentation shared combs or hats
shiny translucent nits are less obvious
than those of head lice is mainly around
Pubic the sides and
spread most extensively in hairy males back of the
and may even affect the eyelashes lice
scalp
Coexistant STD main symptom is itching later it spreads
Investigations generally over
Presentation
the scalp
and
Carbaryl
course take several months to develop
permethrin
Scratching and secondary infection soon follow
malathion Treatment Head lice hair becomes matted and smelly
Infestation of the eyelashes is
Draining lymph nodes often enlarge
particularly hard to treat
Secondary bacterial
Complications
now uncommon
infested bedding or clothing recurrent impetigo Search for lice
Spread
Differential diagnosis Search for lice
crusted eczema
Self-neglect is usually obvious Infestations
widespread itching Presentation Malathion
Results in excoriations and crusts and course
Topical carbaryl
Skin is thickened synthetic pyrethroids
eczematized vagabond
s toothcomb
disease
pigmented chronic Body lice severe secondary infection
systemic antibiotic
untreated
lymphadenopathy cases Treatment
Pillow cases,
towels, hats and
burrows scabies laundered or dry cleaned
scarves
Differential diagnosis
Systemic infestations resisting
Clothing should be examined topical treatment
Investigations ivermectin

permethrin
lindane Treatment

3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Infestations

 Incubation for 1 month
treat all members of the family and sexual contacts
too, whether they are itching or not Sarcoptes scabiei hominis

permethrin Adult mites are 0.30.4 mm long

malathion close bodily contact
Cause Transmission
Applied with paintbrush scabicide
second application, a week after the first
Treatment produce two or three oval eggs
fertilized female turn into sexually mature mites in 2-3 weeks.
calamine lotion Residual itching may last for several days,
or even a few weeks Caused by sensitization to the mites or their products
Itch
Ordinary laundering deals satisfactorily with clothing
and sheets. Mites die in clothing unworn for 1 week.
For 46 weeks no itching

Severe itching
Only scabies shows characteristic burrows Differential diagnosis first infestation thereafter
bad at night
Many people itch
with pustulation
itching starts within a day or two
glomerulonephritis Secondary infection
Scabies second attack victims already have immunity
Persistent itchy red nodules excoriated
Venereal disease eczematized
Complications Result
Presentation urticarial papules
crusted eruption
vast numbers of mites sides of the fingers
finger webs
mental retardation Crusted (Norwegian) scabies
IN sides of the hand
immunosuppression
wrists
Sites of burrows
elbows, ankles and feet
persists indefinitely unless treated Course nipples and genitals
Only in infancy does scabies affect the face
greywhite
On the genitals, burrows are associated with
slightly scaly erythematous rubbery nodules
Linear or cervelinear papules Burrows are
Pathognomonic for Scabies

3/19/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Scabies

 tend to be tense
cold and friction injury
Subepidermal intact
bulla may contain blood
Penicillamine drugs within the prickle
cell layer
thin roofs
Pemphigus
Intra-epidermal rupture easily
Location of bullae bulla
Pemphigoid Autoimmune leave an oozing
denuded surface
Dermatitis herpetiformis
beneath the
stratum
Bullous corneum

Blisters in diabetes and renal disease

Diseases Subcorneal
bulla
thinner roofs
rupture more easily

Porphyria cutanea tarda impetigo

Ecthyma

bullous lupus erythematosus Infections herpes simplex

herpes zoster

Genetic vesicular tinea pedis

epidermolysis bullosa

Acute dermatitis

3/16/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Bullous Diseases

 potent topical steroids
Mild

prednisolone or prednisone
acute phase Treatment Autoimmune
Intro
dosage is reduced as soon as possible mainly affecting the elderly

Immunosuppressives
IgG mediate
subepidermal blister At Basement membrane
filled with eosinophils Biopsy BP230
Bind to
linear band of IgG and C3 along
Cause BP180
the basement membrane Complement is then activated
Direct
immunofluorescence
But UV play a part
antibodies that bind to
Investigations Usually no precipitating factors
normal skin at the
basement membrane
chronic
in 70% of patients Indirect immunofluorescence
itchy
titre does not correlate with clinical
disease activity
Pemphigoid blistering
smooth, itching red plaques
Lesion in which tense vesicles and bullae form
Differential diagnosis Presentation
flexures are often affected

much discomfort Nikolsky test is negative

loss of fluid old age

Complication
need for high steroid dose
S/E of Systemic steroids and high risk
immunosuppressives low serum albumin levels

self-limiting
Course
treatment can often be stopped after 1-2 years

3/16/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Pemphigoid

 life-threatening
severe
it affects middle age

small doses of systemic corticosteroids 3/4 of cases

topical corticosteroids In superficial pemphigus rare
Pemphigus vegetans
pemphigus vulgaris
high doses of systemic steroids
common in Ashkenazi
azathioprine Jews, Mediterraneans and Indian
gold salts
generalized foliaceus
mmunosuppressives Treatment superficial pemphigus
cyclophosphamide
localized erythematosus
mycophenylate mofetil Types
penicillamine
plasmapheresis Drug eruption
intravenous immunoglobulin thymoma
paraneoplastic
Dapsone pemphigus Castleman
s tumour
lymphoma
vesicles are intra-epidermal
rounded keratinocytes floating freely IgG mediated
within the blister cavity Biopsy
Acantholysis desmoglein 3
Cause All are autoimmune main antigens
desmoglein 1
intercellular epidermal
deposits of IgG and C3 Direct
immunofluorescence Trunk
On skin flexures
serum from a patient with pemphigus contains flaccid blisters
antibodies that bind to the desmogleins in the Investigations scalp
desmosomes of normal epidermis In mouth
Indirect
immunofluorescence
Pemphigus Most patients develop the mouth lesions first
ELISA blisters rupture easily
correlates loosely with clinical activity Pemphigus Leaves widespread painful erosions
titre of these antibodies vulgaris
Shearing stresses on normal skin
acantholysis can cause new erosions
Positive Nikolsky sign
Tzank smear also positive in toxic epidermal necrolysis
Presentation
heaped-up, cauliflower-like weeping areas
pyoderma Vegetans variant are present in the groin and body folds
impetigo
Widespread so superficial
ecthyma erosions Blisters
epidermolysis bullosa pemphigus rupture so easily
foliaceus Dominated more by weeping and crusting erosions than by blisters
Aphthous ulcer Differential diagnosis
Behet
s disease facial lesions
Mouth ulcers pemphigus erythematosus
herpes simplex infection pink, rough and scaly
patient is in poor health bcoz of the diseases it self
bacterial or fungal infections
Scalp erosions
Course is prolonged
Due to high dose of steroids and immunosuppressives 15%
mortality rate
severe oral ulcers make eating painful Complications Course
1/3 go into remission after 3 years
dehydration and electrolytes imbalance
Superficial pemphigus is less severe

3/16/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Pemphigus

 chronic
secondary eczematous dermatitis
dapsone Intro very itchy 'dermatitis'

sulfapyridine erupt in groups

gluten-free diet Treatment subepidermal vesicles
herpetiformis

Resolves later than enteropathy with

Gluten free diet Autoimmune
epidermal
subepidermal blister Antibodies transglutaminase
neutrophils packing the against
Biopsy
adjacent dermal papillae
Can be asymptomatic
IgA patchy
granular deposits of Investigations Always associated
C3 Direct Cause with Gluten-sensitive involves only the
in the dermal papillae immunofluorescence enteropathy proximal small
intestine
anti-endomysial antibodies
tissue transglutaminase
tissue transglutaminase Serum antibody tests
reticulin
Other serum antibodies gliadin
diarrhoea
Dermatitis endomysium
abdominal pain,
herpetiformis
anaemia
Complications mainly affects adults
malabsorption
extremely itchy
Decreased risk with
Gluten free diet often broken by
Small bowel lymphomas scratching

grouped vesicles shows only grouped

excoriations
Prolonged unless treated
Presentation urticated papules
Resolves later than enteropathy with Course
Gluten free diet elbows
knees
Site buttocks
shoulders

secondary eczematous dermatitis develops

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3/16/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Dermatitis herpetiformis