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Derma Table Review
Derma Table Review
Derma Table Review
FLAT LESIONS
1. MACULE - Flat discoloration
- < 1 cm
2. PATCH - Larger (> 1cm) macule
- Ex. vitiligo, nevus flammeus
ELEVATED SUPERFICIAL
3. PAPULE - Elevated, circumscribed, solid
- No visible fluid
- < 1cm in size
- May appear white (milia), red (eczema), yellowish
(xanthoma), black (melanoma)
- Usually found in the dermis
o Opening of sweat ducts
o Root of hair follicles
- If associated w/ scales: papulosquamous
- May last for a year
- Papules that are equidistant: follicular papules (ma y also see
hair sticking out)
4. PLAQUE - Broad papule or confluence of papules
- >1cm
- Center may be depressed or may have normal skin
- May also be centrally depressed
ELEVATED DEEP -
5. NODULE - Large papule (>1cm)
- Deep on palpation (centered in dermis and subcutaneous fat)
6. TUMOR - Soft/firm, fixed/movable, elevated/deep/pedunculated
(fibromas)
- Usually >2cm
- Usually round
7. WHEALS (HIVES) - Plateau – like, edematous elevations
- Evanescent (do not last > 1 day)
- Associated with angioedema
- May be pink to red, surrounded by a flare of macular
erythema
- May be discrete/coalesce
- Prototype lesion of urticaria
- Dermatographism or pressure – induced whealing may be
seen
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FLUID – CONTAINING
8. VESICLES (BLISTERS) – superficial - Circumscribed, fluid – containing
- Epidermal
- May contain serous fluid or blood mixed with serum
- Apex may be rounded, acuminate, or umbilicated
- < 1cm size (usually 1 – 10mm)
- May arise directly from macule/papule and may develop into
bullae or pustules
- When vesicles rupture, it may form an erosion.
- Findings
o Umbilicated: eczema herpeticum
o Grouped: herpes zoster
o Linear: allergic contact dermatitis from uroshiol
(poison ivy)
- If with seropurulent contents -> vesicopustules
- May consist of a single cavity (unilocular) or multiple
compartments (multilocular) containing fluid
9. BULLAE – superficial/deep - >1cm
- Round/irregularly shaped blisters containing
serous/seropurulent fluid
- Usually unilocular
- If superficial (epidermal), it may have thin walls = prone to
rupture
o Remnants of the thin wall may form a crust
- If subepidermal, usually tense; ulceration & scarring may
result
- Nikolsky’s sign: diagnostic maneuver of putting lateral
pressure on unblistered skin in a bullous eruption & having
the epithelium sheared off
- Asboe – Hansen’s sign: extension of a blister to adjacent
unblisteredskin when pressure is put on top of the blister
- Hemorrhagic bullae may be seen in : pemphigus, herpes
zoster, severe bullous drug reactions, lichen sclerosus et
atrophicus
10. PUSTULES - Small elevations of the skin which contain pus (necrotic Ex. acne
inflammatory cells)
- May see neutrophils
- With inflammatory areola
- Usually white or yellow centrally (may be red if with blood)
- May originate as pustules or papules or vesicles (may
represent a transitory early stage – papulopustules or
vesicopustules)
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SECONDARY LESIONS: altered by external factors (ex. scratching); modified by evolution, regression, trauma or other external factors
1. SCALES (exfoliation) - Implies a pathologic process in epidermis Fine & branny or powdery: Tinea versicolor
- Parakeratosis (persistence of nuclei in keratinocytes in Coarser: eczema, ichthyosis
stratum corneum of skin) often present Stratified: scalded skin syndrome & infection –
- Dry, greasy, laminated masses of keratin associated desquamations (scarlet fever)
- We normally shed little amounts of stratum corneum Silvery squames (due to trapping of air between
- Occurs due to: layers): psoriasis – described as plaque with thick
o Rapid epidermal cell formation scales
o Interruption in the normal process of keratinization
-
2. CRUSTS/SCABS - Dried serum, pus, ,or blood with epithelial/bacterial debris Dry, superficial, golden – yellow: impetigo
- When removed, there is erosion/ulcer/wound underneath Hard and tough: third – degree burns
Elevated brown/black/green masses: late
syphilis (oyster – shell crusts: rupia)
3. EXCORIATIONS & ABRASIONS Excoriations
- Punctate/linear abrasions
- Superficial (usually only involves epidermis but may reach
papillary dermis)
- Due to scratching with fingernails in an effort to reduce
itchiness
- Inflammatory areola
- May allow entry of microorganisms -> may cause crusting,
pustules, cellulitis & enlargement of neighboring lymph
glands
- Elevated, long & deep excoriations = severe pruritus
(except lichen planus where there is severe pruritus but rare
excorations)
Abrasions
- If due to mechanical trauma or constant friction
4. FISSURES (CRACKS/CLEFTS) - Linear cleft in epidermis or dermis following skin lines
- Common in skin that is thickened & inelastic from frequent
inflammation & dryness (especially in areas of frequent
movement)
o Ex. tips & flexural creases of thumb, fingers, palms;
edges of heels; clefts between fingers & toes, angles
of mouth, lips, nares, auricles, anus
- May be single or multiple
- Exposure to cold, wind, water, or cleaning products may
produce a stinging burning sensation = indicates microscopic
fissuring
o Referred to as chapping (chapped lips)
- Pain often produced by movement of the parts involved ->
may open, deepen or form new fissures
- Painful but NOT bacterial! No need for oral antibiotics. May
apply topical antibiotics or wait it out
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5. EROSIONS - Produced by a loss of all or portions of the epidermis alone
- Heals without a scar
6. ULCERS - Rounded or irregularly shaped excavations due to complete
loss of epidermis + some part of the dermis
- Heal with scarring
7. SCARS - Composed of new connective tissue that replaced the lost
substance in the dermis or deeper parts as a result of
injury/disease, as part of the normal reparative process
- Shape & size determined by form of previous destruction
- May be diagnostic
o Lichen planus & discoid lupus erythematosus: same
inflammation anatomically but DLE produces
scarring as it resolves while LP rarely does
- May be atrophic or fibrotic (keloid)
- May also present as discoloration
o True discolorations disappear with time or tx
o Discolorations due to a scar: do not disappear; they
only improve
- Scars will have no skin lines & follicular openings making
them appear shiny
**Anything that involves the dermis will leave a scar. Bleeding also indicates that you have reached the dermis.
**Laser: used as a treatment for some skin lesions because it can penetrate up to the dermis without damaging the epidermis
**Things to discuss when describing skin lesions: count, color, size, characteristic configuration, location, surface, elevation, discrete/coalescing
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1A & 1B: NAIL LESIONS
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Predilection
Factors
Dermatophyte Yellow discoloration Fungal infection by a Scrape on top of nail: Oral: Onychomycosis is fungal
onychomycosis Nail becomes thick & dermatophyte do KOH test & look Itraconazole infection of the nail
brittle due to for long, septate Ketoconazole –
keratin T. rubrum – most hyphae only give for 10 Onycholysis is separation
Nail may separate cases days for tinea of the nail from the nail bed
from nail bed If subungual: get versicolor due to
May involve skin of keratin under brittle hepatotoxicity 3 types:
the toe & soles nail Terbinafine 1. Distal subungual
(scaling, Fluconazole – most common
erythematous, well – REMEMBER: KOH is - usually caused
defined patches may not highly reliable 2 – 4mos: time by T rubrum
appear) because it has poor needed to grow
Usually starts distally yield since keratin fingernails 2. White superficial
going proximally has to be dissolved to 4 – 6 mos: grow - leukonychia
actually see the toenails trichophytica
Superficial without T. mentagrophyte hyphae - usually due to T
paronychial mentagrophytes
inflammation - invasion of
Chalky white spots on Duration of anti – toenail plate on
or in the nail plate that fungal treatment nail surface
is easily shaved off 3. Proximal
subungual
Asymptomatic in the - involves nail
nails (reservoir for plate from
infection); Px will proximal nailfold
usually complain of - usually due to T
the alipunga than the rubrum & T
changes in the nail megninii
- may be an
indication of HIV
infection
Candida Pain or swelling in Candida albicans Fingernails See Anticandidal Check proximal part first
onychomycosis proximal fold commonly pseudohyphae/yeasts agents + topical when treating candida
Pink & tender Common in affected corticosteroid
Described as a yucky homemakers, and Avoidance of wet With paronychia (swelling
nail frequent/prolonged work & other of nail fold; pressing on it
Gradual thickening & exposure of hands irritants makes fluid come out)
brownish to water If topical tx fail,
discoloration of nail give oral
plates Usually seen in DM fluconazole 1x/wk
px or itraconazole
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Produces destruction
of the nail & massive
nailbed
hyperkeratosis
**Remember, it is very important to differentiate a dermatophyte type of onychomycosis from a candidal one.
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Predilection
Factors
Psoriatic Pits on the nails 86.5% of patients Characterized by Intralesional Features of psoriasis:
onychomycosis Furrows/transverse have psoriatic pitting of nails + injection of 1. Distal
depressions (Beau’s arthritis symptoms of Triamcinolone onycholysis
lines) dermatophyte acetonide 2. Brittle
Nail bed splinter onychomycosis suspension, 3 – 5 3. Nail pits
hemorrhages mg/ml 4. Oil spots
Yellowish green The px usually comes
discoloration may with psoriatic plaques Topical 1% 5 –F U
occur in area of in other parts of the solution, MTX,
onycholysis body (ex. scalp) PUVA,
Oil spots (start in the cyclosporine or
middle) acitretin
Pathology is in the
nail plate
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2A: ERYTHEMATOUS LESIONS: Non Scaly Papules
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Factors Predilection
Miliaria Rubra Discrete, extremely Retention of sweat as Infants due to Control temperature to Non – follicular Problem in kids
(prickly heat, pruritic, a result of occlusion immature eccrine decrease sweating distribution due to itching
heat rash) erythematous of eccrine sweat ducts gland Good aeration - No hair is (may present
papulovesicles and pores Anhydrous lanolin – coming out, with bacterial
May also become Antecubital & popliteal resolves occlusion of therefore does infection
confluent S. epidermidis fossae, trunk, pores not involve hair already)
inframmary areas, Calamine lotion follicles
Accompanied by abdomen (waistline), Antihistamines
prickling, burning, or inguinal region -> Topical corticosteroids
tingling sensation areas usually
macerated due to
impedance in the
evaporation of
moisture
Scabies Pruritic papular Sarcoptes scabei (itch Young children See mite under Permethrin 5% cream Features of scabies: May be
lesions, excoriations mite, causative M=F microscope (usually - safest, most effective 1. Circle of Hebra mistaken for
& burrows w/c house organism) burrows in stratum (C/I: pregnancy) 2. Nocturnal itch Langerhans cell
the female mite & her Circle of Hebra: corneum & deposits - apply neck – down 3. Contact w/ histiocytosis
young (burrows appear Close personal axillae, elbow, eggs here) because most lesions are person at home
as slightly elevated, contact, fomites flexures, wrists, hands, here Suspect scabies
grayish, tortuous lines (clothing, bedsheet) crotch Majority of mites - treat all household Reinfections may occur if more than 1
in the skin) Finger webs found on hands & contacts earlier and in more famly member
Immunocompromised, wrists - repeat after 1 week severe forms has pruritus
institutionalized, Scalp & face spared Less frequently in (wait for eggs to hatch
Vesicle or pustule malnourished patients (adults) (decreasing order): again) In animal or
containing mite may Entire cutaneous elbows, genitalia, zoonotic
be seen at end of surface involved buttocks, axillae 6 – 10% precipitated scabies,
burrow (infants) sulphur in petrolatum burrows are
India ink or gentian - safe in pregnancy usually absent &
Presentation: violet applied to - doesn’t smell good is self – limited
F – itching of nipples infested area =
M – itchy papules on allows identification Ivermectin – not used
scrotum & penis of burrows easily
2 – 4 wks after
infection:
sensitization period
Give keratolytics to
slough off corneum w/
hopes of removing
comedones
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Factors Predilection
PEDICULOSIS
(Phthiriasis)
Pediculosis Intense pruritus of Pediculus humanus Children (but may also GOAL: eliminate both lice
Capitis the scalp w/ posterior var. capitis (head occur in adults) & ova
cervical louse) Problem: Knockdown
lymphadenopathy Permethrin (most widely Resistance (common
Affected hair used pediculicide) mechanism of resistance
becomes lustreless & - Some that manifests as lack of
dry association with immobilization of lice
Visible nits – whitish congenital
concretions on the leukemia in
hair shaft but most permethrin Secondary complications
common in the abuse with impetigo &
retroauricular area furunculosis – common
Pyrethrins + piperonyl during itching
butoxide
Supported by finding
lice in the seams of
clothing or in
beddings
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SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Factors Predilection
Pediculosis Nits are attached to Phthirus pubis Adults If diagnosed with Permethrin
pubis (crabs) hairs at an acute crabs, search for
angle Transmission through Genital region & other STDs Pyrethrins combined w/
sexual intercourse & hypogastrium piperonyl butoxide
See sky blue close physical hairy areas of the legs,
macules (maculae contact; not abdomen, chest, arms, Enzymatic egg remover
ceruleae) in side of infrequently from axillae (rare) (Clear)
trunk and inner bedding
aspects of thighs Retreatment in 1 week
(due to altered blood recommended
pigments)
INSECT BITES Immediate reaction: CLASS INSECTA a) Pruritus: camphor, Recurrent bacterial
inflammatory reaction Order Lepidoptera menthol lotions, gel infection may be due to
at the site of the (caterpillar, moth) formulations, topical insect bites
punctured skin, to Order Hemiptera anesthetic preparations
the insect’s venom or (bedbug, reduviid b) Persistent bite
saliva containing bugs) reactions: topical
histamine, enzymes, Order Anoplura corticosteroid
agglutinins, (louse) preparations
serotonin, formic Order Diptera c) If topical agents fail,
acid, or kinins. (mosquito, flies) give intralesional injection
Accompanied by Order Coleoptera of corticosteroids or
pruritic local (beetles) excision of pruritic nodule
erythema & edema Order Hymenoptera
(bees, wasps, ants) Prevention: Protective
Delayed reaction: Order Siphonaptera clothing & inset repellant
host’s immune (fleas)
response to
proteinaceous
allergens
Present as pruritic
red papules typically
with a surrounding
swelling & a central
punctum (minute
round spot indicating
an opening)
Bedbug Several Cimex lectularius: Arms, legs, ace Diascopic exam Topical antipruritics or
bites/Cimicosis erythematous most common in shows hemorrhagic corticosteroids
(Order papules or urticarial temperate dot (site of bite) in Zinc lotion with 2 – 4%
Hemiptera) lesions grouped C hempiterus: tropical the middle of most polidocanol or 1%
together or in rows climates lesions methanol
(breakfast, lunch, Severe cases: systemic
dinner) Suspected vectors for antihistamines
Chagas’ disease &
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Hepa B Eliminate bird nests & bat
roosts, cracks & crevices
Often infest bats & Treat area with
birds & usually reside insecticide (dichlorvos &
in cracks & crevices permethrin)
and descend to feed
while victim sleeps Permethrin –
impregnated bednets:
effective in tropical
climates
Reduviid bites Typically painless Poor housing Exposed areas of skin
(Order Romana’s sign: conditions
Hemiptera) unilateral eye
swelling after a
nighttime encounter
with Trypanosoma
cruzi (transmitted by
feces & rubbed into
bite)
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Factors Predilection
Mosquito bites Multiple pruritic often Moisture, warmth, Exposed areas of the Antipruritics/corticosteroid Secondary infection
(Order Diptera) excoriated papules CO2, estrogens, lactic body; arms & legs creams common in children
acid in sweat, drinking Oral antihistamines
Bullous reaction alcohol attract Insect repellatns (diethyl Mosquito bites are a
(culicosis bullosa) mosquitos toluamide) common cause of papular
urticaria & may also play
Large blisters Protective clothing & a role in reactivation of
(pemphigus mosquito netting latent EBV infection
hystericus) Attack mosquito habitats
(sprays/disposing Severe local reactions
stagnant water) seen in young children,
immunodeficient
individuals
Flea Multiple, irregularly 4 species that most Legs & covered body Diascopic exam: Topical & systemic
bites/Pulicosis distributed wheals & commonly attack regions (waist) central hemorrhagic antipruritic treatment;
(Order papules that are humans: bite site (purpura corticosteroids
Siphonaptera) grouped and may be 1. Cat flea pulicosa) Pet grooming :D
arranged in zigzag (Ctenocepha Insect repellent
lines lides felis)
2. Human flea
Hypersensitive (pulex
reactions appear as irritans)
nodules or bullae 3. Dog flea (C
canis)
4. Oriental rat
flea
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(Xenopsylla
cheopis)
Usually present in
houses with cats or
dogs
Ant bites (Order Painful stings within Any body part Ice packs
Hymenoptera) seconds of bite Oral antihistamines
accompanied by Topical antipruritics or
whealing corticosteroids
SKIN LESION Description Cause/Precipitatin Age & Area of Diagnosis Treatment Also know this
g Factors/Risk Predilection
Factors
Furuncle (boil)/ Furuncle S aureus Nape, axillae, Warm compress may arrest Vs. acne: furuncle is extremely
Caruncle Acute, round, tender, buttocks (but may early furuncles painful
circumscribed Predisposing occur anywhere)
perifollicular factors: Penicillinase – resistant Furuncle is deep so topical meds
staphylococcal abscess; Disruption of skin penicillin or 1st gen will not work
nodular & with central surface integrity cephalosporin (1 – 2g/day)
suppuration (pressure, irritation, – oral! Similarities between erysipelas &
friction, dermatitis, furuncle:
Carbuncle shaving, etc) Bactobran – applied to 1. + signs of inflammation
2 or more confluent anterior nares to prevent 2. Painful
furuncles, w/ separate Systemic disorders recurrence (apply daily for 5 3. Acute
heads (alcoholism, days)
malnutrition, blood
Lesions begin in hair dyscrasias, If localized with definite
follicles, continue by immunosuppression) fluctuation: incision &
autoinoculation (carriers drainage DO NOT do I & D if
in nose/groin) Atopic dermatitis acutely inflamed, give
(predisposes If lesion is in EAC, upper lip moist heat instead.
Most will undergo central individual to carrier or nose, I & D will only be
necrosis & rupture thru state) done if antibiotics fail
skin
Nasal carriers are at To eradicate carrier state:
risk for chronic 1. Daily use of
furunculosis chlorhexidine wash
2. Rifampin +
Dicloxacillin (10
days)
3. Sulfa – TMP for
MRSA (10 days)
4. Low dose
clindamycin (3 mos)
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2C: ERYTHEMATOUS LESIONS: Non – Scaly Plaques
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Fixed Drug Begins as a red patch that Medications taken Young boys Stop taking Features:
Eruption (FDE) soon evolves to an intermittently offending drug. 1. Normal stratum corneum
iris/target lesion (~1cm), Oral & genital 2. Chronic changes in
identical to erythema HLA – B22 mucosa (50%) dermis:
multiforme & may - NSAIDS: a. Papillary fibrosis
eventually blister & erode usually lips b. Pigment
- Sulfa – incontinence
Known as “fixed” because TMP: 3. Eosinophils & neutrophils
it occurs at the same site usually 4. No anesthesia or
w/ every exposure to genital hyposthesia
medication
With first intake of drug:
Usually causes 1. Redness
prolonged/permanent 2. Hyperpigmentation
postinflammatory 3. Redness + increasing size
hyperpigmentation + pruritus
Early & First lesion: solitary, ill – Cheeks, upper arms, Usually no/few bacilli Peripheral nerves not enlarged
Indeterminate defined hypopigmented thigh, buttocks No plaques/nodules
Leprosy patch w/ slight anesthesia
(indeterminate Few cases stay in this state; most
because course of 90% initially present with will become lepromatous,
disease cannot be numbness (cutaneous borderline, or tuberculoid. Some
predicted yet)
findings may appear years may spontaneously resolve.
later)
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
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Tuberculoid Typical lesion: large, Face, limbs, trunk High chance for Features:
Leprosy (TT) erythematous plaque w/ a spontaneous cure 1. Presence of palpable
sharply defined & elevated over the years induration & neurologic
border that slopes down to findings differentiates
a flattened atrophic center indeterminate from
(saucer right side up) tuberculoid lesions
2. Lesions are
Lesions are solitary or few anesthetic/hypesthetic,
in number (< 5) because anhidrotic.
cell – mediated immunity 3. Superficial peripheral
is high nerves serving/proximal to
lesion = enlarged/tender
Paucibacillary (visible in greater auricular
nerve & superficial
Nerve involvement is early peroneal nerve)
& permanent (may cause
muscle atrophy)
Borderline Lesions similar to
Tuberculoid tuberculoid lesions except
Leprosy (BT) they are smaller & more
numerous
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Phototoxic Exaggerated sunburn Phototoxic agents: Sun – exposed areas: Topical agent: clinical Symptomatic tx: Onset: minutes to hours after
Dermatitis reaction: erythema, edema, - Coal tar - Face Systemic agent: corticosteroids exposure; usually occurs after
vesicles, bullae, burning, (cosmetics, drugs, - V of neck clinical + phototests 1st exposure
stinging dyes, insecticides, - Extensors of Avoid sun exposure
Frequently resolves with disinfectants) upper Protective clothing is
hyperpigmentation - Furocoumarins in extremities essential
plants - Dorsum of Sunscreen with broadest
Mechanism: Direct tissue - Bergapten (lotion, hands UVA coverage
injury aftershave) - Often lower
- Yellow cadmium legs & feet
sulfide (tattoos)
- Drugs:
doxycycline,
naproxen,
ibuprofen,
amiodarone,
phenothiazine
Photoallergic “Rash” Photoallergic agents: Sun – exposed areas: Topical agent: Same Onset: 24 – 48hrs after
Dermatitis - Drugs: - Face photopatch tests exposure
Usually eczematous phenothiazines, - V of neck Systemic agent:
lesions & pruritic chlorpromazine, - Extensors of clinical + phototests; No occurrence after 1st
quinidine, upper photopatch tests exposure
Mechanism: Type IV sulfonylureas, extremities
delayed hypersensitivity NSAIDs - Dorsum of
reaction - Topical hands
antimicrobials/ Often lower legs & feet
antibacterial
soaps(hexachloro
phene, bithionol)
- Sunscreens
(PABA,
benzophenones)
- Fragrances (must
ambrette, 6 –
methylcoumarin)
- Aftershave (oil of
sandalwood)
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2E: ERYTHEMATOUS LESIONS with Eczema
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Atopic Hallmark of AD: pruritus Risk factors: Adults: flexural Topical therapy Associated features &
Dermatitis (itching usually precedes 1. Polygenic lichenification 1. Corticosteroids – complications:
lesions) inheritance/person Infants: facial & dominant method of 1. Dennie – Morgan folds
al or family hx of extensors tx for AD - Linear transverse fold
Diagnostic criteria of atopic disease - Potent steroid below edge of lower
Hanifin & Rajka: 2. Environmental during eyelids
Major criteria: factors weekend, milder 2. Hertoghe’s sign
Pruritus 3. High level of IgE steroid during - Thinning of lateral
Typical morphology & antibodies to the week eyebrows
distribution (adults: flexural, housemites 2. Calcineurin inhibitors 3. Headlight sign
infants: facial & extensors) (Tacrolimus) – - Perioral, perinasal &
Chronically relapsing alternative to periorbital pallor
dermatitis steroids 4. Pityriasis alba
Personal or family hx of - Subclinical dermatitis
atopic disease Systemic therapy - Poorly marginated,
1. Antihistamines – for hypopig mented
Minor criteria (at least 3): sedative effect slightly scaly patches
Xerosis 2. Antistaph antibiotics 5. Keratosis pilaris
Ichthyosis during flares - Horny follicular
Elevated serum IgE (cephalosporins & lesions
Early age of onset semisynthetic - Refractory to tx
Nipple eczema penicillins)
Cheilitis 3. Systemic steroids –
Recurrent conjunctivitis only for controlling
Dennie – Morgan folds acute exacerbations
Keratoconus 4. Azathioprine,
Anterior subcapsular mycophenolate
cataract mofetil,
Periorbital darkening methotrexate – for
Pityriasis alba debilitating disease
Itch when sweating unresponsive to
Blanching phenomenon other tx
White dermographism 5. Phototherapy –
Food hypersensitivity hospital based; good
Susceptibility to infection (S for control of severe
aureus, eczema AD
herpeticum – HSV 1, HIV)
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SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Infantile AD 60% present in 1st yr of life Worsened after 2 mos – 2 yrs of age Blinded food Partial remission during
(usually >2 mos of age) immunizations & viral challenges summer & relapse during
infections Assays for food – winter (due to therapeutic
Usually begins as erythema Cheek, scalp, neck, specific IgE effects of UVB and humidity
& scaling of cheek forehead, wrists, Prick testing & aggravation by wool & dry
extensor extremities air)
Lesions may be papular or (areas involved
Evaporation barrier
exudative correlates with immediately after bathing
capacity of child to White petrolatum
scratch/rub site & with Aquaphor & vegetable
baby’s activities like shortening
crawling) Protection of affected part
from scratching & rubbing
Childhood AD Less exudative - Antecubital & popliteal Scratching impulse is usually
Often lichenified, indurated fossa, flexor wrists, beyond control of px (itching is
plaques eyelids, face, neck same as lichen simplex
chronicus -> compelling,
Itch – scratch cycle: paroxysmal) – inability to feel
Pruritus leads to scratching pain during paroxysms
& scratching causes
secondary changes that Severe AD (>50% body
causes itching surface area involved) –
associated with growth
retardation
- Topical calcineurin
inhibitors
(macrolactams)/photo
therapy may allow for
rebound growth
Adult AD Localized, erythematous, 1. Wet work Adolescents: Dermatitis is uncommon Itching usually occurs in
scaly, papular, exudative, - Especially Antecubital & popliteal after middle life response to heat/stress, during
or lichenified plaques implicated in hand fossa, front & sides of the evening when trying to
eczema neck, forehead, area Topical corticosteroid: relax, or at night
st
Staphylococcal colonization 2. After birth of 1 child around eyes mainstay of tx
is universal 3. Soaps Avoid extremes of cold & Flares may be due to acute
Adults: chronic hand heat emotional stress (decreases
Hand dermatitis: most eczema is common Avoid overbathing itch threshold)
common problem for adults Tepid showers, not hot
w/ hx of AD Mild stigmata of dry skin &
irritation remain even after
recovery
LALALA-LALAϋ
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Seborrheic Moist plaques w/ chronic, Pityrosporum ovale Scalp, eyebrows, Differentiate from Antifungal agents Dandruff (pityriasis sicca) –
Dermatitis superficial, inflammatory eyelids, nasolabial psoriasis (more (Ketoconazole) & topical mild form of SD
disease of the skin creases, lips, ears, severe scaling, + calcinearia inhibitors -
sterna area, axillae, Auspitz sign: removal mainstay Lesions may become
Scaling on an submammary folds, of scales discloses generalized -> generalized
erythematous base + umbilicus, groin, bleeding points, nail Corticosteroid creams, exfoliative erythroderma/
severe itching gluteal crease pitting) gels, sprays, foam erythroderma desquamativum
(esp in infants)
Cradle cap – seen in Be careful with use of
infants as steroids due to side Atopic D has more severe
yellow/brown scaling effect of steroid rosacea itching than seborrheic
lesions of the scalp
with adherent epithelial
debris
Nummular Discrete, coin - shaped, Emotional stress Young adulthood & old Initial tx: simple soaking Recurrent staph infection may
Eczema well – circumscribed Alcohol age & greasing w/ occlusive be present
erythematous, edematous, Atopy ointment OR application
vesicular & crusted plaques Trauma (Koebner’s Lower legs, dorsa of of potent steroid As new lesions appear, old
phenomenon) hands, extensor Antihistamine lesions expand by tiny
+ Koebner’s phenomenon: surfaces of arms Antibiotics if w/ staph papulovesicular satellite
formation of lesions after infection lesions at the periphery fusing
trauma Lower legs (older men) Intralesional or systemic with the main plaque
Trunk, hands, fingers steroids (if refractory to
Severe, paroxysmal & (younger females) topical meds) May be very similar to AD but
nocturnal pruritus different in site of predilection
& presentation (coin shaped).
Although AD may be
nummular in adolescents, AD
is more chronic & lichenified.
Infectious Widespread dermatitis or Cause of the distant Antibiotics Usually develops about a:
Eczematous/ dermatitis distant from a dermatitis is not the same Oral glucocorticoids - Discharging abscess
Autosensitiza- local inflammatory focus as the cause of the local - Ulcer
tion one - Sinus
Dermatitis Generalized acute - Fistula
vesicular eruptions Autosensitization to the
associated with chronic discharge
eczema of the legs w/ or
w/o ulceration Precipitating factors:
- Diabetics w/ non –
Often in linear configuration healing wounds
- Chronic otitis
media, eye, nose,
vaginal discharge
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SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Contact
Dermatitis
Irritant CD Inflammatory reaction to a Acids Hands Topical steroids This is a non – allergic
substance that causes Alkaline materials (betamethasone, inflammatory response. No
eruptions in most people (soaps/detergents) Lesions sharply clobetasol propionate) previous exposure necessary.
Solvents circumscribed to
Hallmark: Pain & burning! Diaper contact area; no Effect is evident w/in mins/hrs
distant lesions
Lesions: necrosis & Acute: direct cytotoxic
ulceration damage to keratinocytes
Hallmark: Itch!
Inframammary area in
obese women: most
frequent site of
intertriginous
candidiasis
Groin: fungal infection
Stasis Erythema/yellowish/ light Venous insufficiency Elderly (rarely occurs Symptom relief Swelling may be noted late in
Eczema brown pigmentation of before 5th decade of Tx of underlying venous the afternoon with
lower 1/3 of legs esp Persons with heart failure, life) insufficiency spontaneous resolution in the
superior to medial varicose veins, recent Emollients – for pruritus morning
malleolus trauma of legs – greater Lower 1/3 of lower leg & eczema
risk (superior to medial Topical corticosteroids
Hyperpigmentation due to malleolus) Support stockings
melanin & hemosiderin
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Lichen Paroxysmal pruritus Chronic rubbing & Nuchal area (female), Goal: cessation of With habitual itch – scratch
Simplex scratching scalp, ankle, lower pruritus cycle
Chronicus Criss – cross pattern: legs, upper thighs,
(Neuroderma- between is a mosaic Associated with topic or exterior forearms, Stop scratching!
titis composed of flat – topped, allergic contact dermatitis, vulva, pubis, anal area, Cover affected areas at
Circumscripta) shiny, smooth, quadrilateral anxiety, nervousness, scrotum, groin night to prevent
facets (lichenification) depression scratching while asleep
Topical steroids:
Circumscribed, lichenified, Clobetasol propionate,
pruritic patches betamethasone
dipropionate
Excoriated papules cream/ointment – used
(sometimes w/ bleeding), initially
slightly scaly & moist, rarely Triamcinolone
nodular suspension
Prurigo Multiple severe itching Unknown Any age but mainly in Visual examination Initial tx: intralesional or
Nodularis nodules (pea – sized or adults (20 – 60 y/o) Biopsy topical administration of
larger; 3 – 20mm) Atopic dermatitis, anemia, M=F Blood tests, liver, steroids
Hep C, pregnancy, stress, kidney, thyroid fxn
Chronic disease, lesions etc. Anterior surfaces of tests Other measures:
evolve slowly thighs & legs Keep in cool areas,
Chronic renal failure: Forearms, trunk, neck avoid hot baths or
Symmetrical & usually most common internal showers and wool
linear arrangement cause of pruritus clothing
Use soap only in axilla
& inguinal area
Antihistamines
Antipruritic
lotions/emollients
PUVA
Vit D3, tacrolimus
Cryotherapy
Prurigo Mitis Mild form of chronic Worsened after Early childhood Blinded food Same
dermatitis characterized by immunizations & viral challenges
recurrent, intensely itching infections Assays for food –
papules & nodules specific IgE
Prick testing
Severe itching ->
excoriation, eczematisation
LALALA-LALAϋ
2F: ERYTHEMATOUS LESIONS: Papulosquamous Disease
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Tinea Capitis Scalp ringworm Pathogenic dermatophytes Children Wood’s light Griseofulvin (2 – 4 mos) Kerion celsii: deep tender
(Except: Epidermophyton Boys > Girls Fungal fluorescence Terbinafine (for boggy plaques exuding pus;
Incubation period: 2 – 4 floccosum &Trichophyton Fluorescent tricophyton infections; 1 cause scarring & permanent
days concentricum) Scalp, glabrous skin, substance: pteridine – 4 wks) alopecia
eyelids, lashes (+) if bright green or Itraconazole/fluconazole
Most common: T tonsurans yellow green (2 – 3 wks) Favus: concave, sulfur –
& M canis Selenium sulfide yellow crusts around loose,
10 – 2% KOH solution shampoo or wiry hairs; atrophic scarring
Findings: pattern of ketoconazole shampoo results to smooth, glossy,
endothrix/ ectothrix (adjunct) paper – white patch
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
TINEA PEDIS Dermatophytosis of the feet T rubrum – cause Late childhood to young Dry toes thoroughly May become a portal of entry
(athlete’s foot) majority of infection; adulthood after bathing for lymphangitis when
Characterized by erythema, usually non – Younger indvls: Good antiseptic powder pyogenic cocci infect fissures
scaling, vesicular & crusted inflammatory type inflammatory Fungicides between toes & in the vesicles
patch spreading Older: non - inflammatory
peripherally with partial T mentagrophytes – M>F
central clearing cause inflammatory
lesions Site: usually 3rd toe web
Most common fungal Distribution: usually
disease Risk factors: bilateral; may involve one
Hyperhidrosis (sweat hand, both feet
Chronic w/ exacerbations in between toes and soles)
hot weather Hot, humid weather
Occlusive footear
T rubrum Moccasin type lesions: This type of lesion may also be
non – inflammatory type w/ caused by E floccosum
dull erythema &
pronounced scaling that
may involve entire sole and
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sides of foot =
moccasin/sandal
appearance
T mentagro - A. Inflammatory/ bullous C. White superficial
phytes type onychomycosis
- Plantar arch &
along sides of feet
- Burning/itching
sensation
- Least common
- Involves sole,
instep, webspaces
B. Interdigital type
- Erythema, scaling,
maceration extend
up to dermis
- Complicated by
secondary
bacterial infection
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
TINEA Dermatophytosis of the T rubrum – more Direct microscopic Oral antifungal agents
MANUM hands common; produces dry, exam of scrapings (topical don’t usually
scaly erythematous type (instep, heel, sides work because of the
Dry, scaly, erythematous Unilateral if associated with of foot, palms) thick palmar stratum
type OR moist, vesicular, T mentagrophytes – tinea pedis & cruris corneum) –
eczematous type dermatophytosis of hand Often associated with tinea 10 – 20% KOH Griseofulvin, terbinafine,
secondary to tinea of feet; unguium of fingernails (if solution itraconazole,
produces vesicular type; chronic) Fungal culture fluconazole
both hands involved
Prevention:
Dry toes thoroughly
after bathing
Good antiseptic powder
between toes (tolnaftate
or zeasorb powder)
Plain talc, cornstarch
dusted into socks
PITYRIASIS Usually begins with single 2 Unknown 15 – 40 y/o KOH wet mount Supportive Usually asymptomatic but may
ROSEA – 4cm thin oval plaque w/ Some evidence points to a F>M Growth on Topical CS or be pruritic & have
fine collarette of scale viral cause – reactivation Mycosel/Saboraud antihistamines for constitutional symptoms
inside the periphery of HHV7 & HHV6 agar plates associated pruritus
(herald patch/mother UV treatment may
patch) Spring & autumn months expedite involution of
lesions
Salmon – colored papules
& macules., oval/circinate
patches, covered with finely
LALALA-LALAϋ
crinkled, dry epidermis that
often desquamate
TINEA Hypopigmented, Malassezia furfur (skin Sterna region, sides of Wood’s light exam Anti – fungal agents Hypopigmentation may persist
VERSICOLOR coalescing, scaly macules lesions area produced chest, abdomen, back, Culture (rarely used (selenium sulfide, for wks/mos after fungal
(due to abnormally small & when in hyphal phase) pubis, neck, intertriginous for dx) imidazoles, triazoles, disease is cured
poorly melanised areas, oily areas of skin sulfur preparations,
melanosomes) in dark skin Risk factors: salicylic acid, benzoyl Most cost effective tx:
Genetic predisposition Face & scalp (usually in peroxide, etc) selenium sulfide & zinc
Hyperpigmented on pale Warm, humid envt infants & pyrithione soap
skin Immunosuppression immunocompromised px) Ketoconazole:
Malnutrition 400mg/1x a month
Cushing disease Itraconazole: 200mg for
7 days
Terbinafine: topical
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
PSORIASIS Common, chronic, Unknown Mean: 27 y/o Depends on site, Koebner’s phenomenon:
recurrent, inflammatory severity, duration, age appearance of lesions at areas
disease of the skin Scalp, nails, extensor of injuries
surfaces of limbs Topical:
Round, circumscribed, (shins), elbows, knees, - Corticosteroids Auspitz’s sign: bleeding points
erythematous, dry scaling umbilical & sacral - Tars secondary to thinning of
plaques of various sizes, region - Vit D epidermis over dermal
covered by gray or silvery - Salicylic acid papillae; bleeding upon
white imbricated lamellar - UV removal of scales
scales - Tazarotene
Woronoff ring: concentric
Symmetrical, solitary Systemic blanching of erythematous skin
macule to > 100 macules - CS near periphery of healing
- Methotrexate psoriatic plaque
May be accompanied by
itching/burning
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Verruca Benign epidermal HPV type 1, 2, 4, 27, 57, 5 – 20 y/o Generally self – limited Usually asymptomatic:
vulgaris proliferations 63 painless & no itching
(common wart) Hands, peri – ungal In the Phils:
Elevated round papules w/ Transmission: simple (esp in nail biters), Electrocautery (complete Larger than verruca plana
a rough grayish surface direct contact; elbows, knees, plantar removal)
(“verrucous”) autoinoculation surfaces, anogenital - Give xylocaine No dermatoglyphics
- If in palms & areas before doing (fingerprint folds) – in calluses,
soles, not very Predisposing factors: this because these lines are accentuated
verrucous Frequent immersion of warts in palms
hands in water are painful
Linear configuration of (makes skin soft, easier (many pain
verruca for virus to enter) receptors –
Meat handlers Meissner &
See black dots Pacini)
(thrombosed dilated Topical keratolytics
capillaries) on surface (salicylic acid/lactic acid
preparations)
Verruca Plana Flat – topped papules that HPV type 3, 10, 28, 41 Children & young adults Light cryotherapy (may W/ Koebnerization (also
(flat warts) are slightly erythematous produce loss of color) – found in psoriasis) – tend to
Transmission: direct Forehead, cheeks, because nitrogen can form linear, slightly raised
Brown on light skin & contact & autoinoculation nose, neck, dorsa of cause death of papular lesions
hyperpigmented on dark (in men who shave hands, wrists, elbows or melanocytes in colored
skin beards, women who knees skin Lesions are small and
shave their legs) numerous & spread fast
Multiple & grouped Topical salicylic acid
(may cause burning of Of all HPV infections, flat warts
No rough surface, no black normal skin = apply have the highest rate of
dots petroleum jelly) spontaneous remission
Topical tretinoin
Molluscum Painless, itching not Poxvirus (MCV 1 – 4) Usually in kids, sexually If px is healthy: usually DO NOT DO CAUTERY. Do
contagiosum prominent MCV 1: children active individuals, self – limited curettage! Scrape off infected
MCV 2: HIV immunosuppressed px area with curette w/c will
Smooth surface, firm, (HIV infected) Kids: no tx OR topical remove abnormal tissue. Try to
dome – shaped pearly tretinoin/cantharidin (4 – 6 also remove the molluscum
papules (3 – 5mm) with Kids: face, trunk, hrs) body
Adults: cryotherapy or
central umbilication extremities
curettage; sexual partners
Adults: lower abdomen, should be examined
upper thighs, penile Immunosuppressed:
shaft in men aggressive tx with HAART;
Immunosuppressed: curettage or core removal w/
face (cheeks, neck, blade; cantharone or 100%
eyelids), genitalia trichloroacetic acid;
cryotherapy
4: PUSTULAR DISEASE
LALALA-LALAϋ
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Acne Vulgaris Comedo as basic lesion Propionibacterium acnes Adolescents (15 – 18 See acne vulgaris (p. 8)
(review nalang y/o)
:D) Follicular disease w/ a
keratinous plug Involution of disease
before 25 y/o
Miliaria Distinct, superficial Preceded by another No particular age Usually self – limited Recurrent episodes may be a
Pustulosa pustules that are dermatitis that has Place px in cool envt sign of type I
independent of the hair produced injury, Intertriginous areas, Circulating air fans pseudohypoaldosteronism
follicle destruction, or blocking flexure surfaces of Anhydrous lanolin – help (salt – losing crises may
of the sweat duct extremities, scrotum, resolve occlusion of precipitate miliaria pustulosa or
Pruritic back of bedridden px pores & helps restore rubra)
Commonly associated normal sweat secretions
diseases: Hydrophilic ointment Difference from acne: no
Contact dermatitis Soothing, cooling baths keratinous plug
Lichen simplex chronicus Dusting powders
Intertrigo
No need for antibiotics
(because pustules are
sterile; contain non-
pathogenic cocci)
Gram (-) Superficial pustules (3 – Enterobacter, Klebsiella, Anterior nares, face Isotretinoin
Folliculitis 6mm) Proteus, Serratia Sulfa – TMP
Fluctuant, deep – seated
nodules Predisposing factors:
Long term – antibiotic
therapy
Continuous scratching
Occurs in areas of
irritation (shaving,
friction, clothes rubbing)
P Aeruginosa Pruritic, follicular, Usually occurs 1 – 4 Sides of trunk, axilla, Involutes w/in 7 – 14 Some may present with fever
Folliculitis maculopapular, vesicular, days after bathing in hot buttocks, proximal days & prolonged disease (“hot foot
or pustular lesions tub extremities, apocrine syndrome”)
areas of breast & axilla 3rd gen cephalosporins
(oral), fluoroquinolones if
w/ fever
Staphyloco- Atypical plaque S aureus Eyelashes, axilla, pubis, Thorough cleansing of
ccal Pustular erythematous thighs affected area with
Folliculitis follicular lesion antibacterial soap and
water (3x/day)
Deep lesions should be
drained
Mupirocin ointment
topically
st
1 generation
cephalosporin (if
LALALA-LALAϋ
drainage or topical
therapy fail)
Anhydrous formulation of
aluminum chloride (for
chronic folliculitis)
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Superficial Superficial folliculitis w/ thin S aureus Extremities, scalp, face
Pustular – walled pustules at follicle
Folliculitis orifice May secondarily arise in
(impetigo of scratches, insect bites,
Bockhart) Fragile, yellowish – white, other skin injuries
domed pustules
Ecthyma Begins with vesicle or Beta hemolytic Children Lesions may heal but
vesicopustule w/ streptococcus may leave a scar
erythematous base & S aureus Lower extremities,
surrounding halo that shins, dorsal feet Good hygiene
enlarges over days & Predisposing factors: Muciprocin or bacitracin
crusts Uncleanliness ointment
Malnutrition 1st generation
Becomes superficial saucer Trauma cephalosporin or oral
– shaped ulcer with raw IV drug users dicloxacillin
base HIV infection
DM
Indurated ulcer margin;
granulating base may
extend deeply into dermis
Pyogenic Inflammatory reaction of Primary predisposing No particular age Smears of purulent Protection against
Paronychia the nail folds factor: separation of material will confirm trauma & keeping hands
eponychium from nail Folds of skin impression dry
Purulent, painful swelling of plate (due to surrounding nail
tissues around the nail trauma/frequent wetting Acutely inflamed
of hands) pyogenic abscess:
May be acute/chronic Manicure/pedicure incision & drainage (do
this first before giving
Secondary bacterial penicillin or
infection due to: S cephalosporin)
aureus, Strep pyogenes,
Candida albicans Candida (usually
implicated in chronic
paronychia) – topical/oral
antifungal (miconazole) +
topical steroids
Intertriginous Pruritic pink to red Candida albicans No particular age 10% KOH microscopic Goal: reduce
Candidiasis intertriginous moist patches (seen in exam (see inflammation!
surrounded by a thin immunocompromised Inframammary area (for pseudohyphae)
collarrette scale & pustules px,& conditions that favor obese women) Topical terbinafine will
LALALA-LALAϋ
closely adjacent to the growth: warm, moist, Axilla, groin, not work; only AZOLES
patches high skin pH, reduced overhanging abdominal will work
Hallmark: Satellite lesions microbial flora due to folds, intergluteal folds,
on surrounding healthy skin antibiotic therapy), interdigital spaces,
(satellite pustules) obesity, poor hygiene, umbilicus
restrictive clothing
LALALA-LALAϋ
5: VESICULAR
5: VESICULAR DISEASE
DISEASE
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Miliaria Small, clear, very Increased perspiration Neonates ( < 2 wks) Self – limited Impt features to remember:
Crystallina superficial vesicles w/ no Clothing that prevents No medical treatment 1. Rupture spontaneously
inflammatory reaction dissipation of heat & Infants: head, neck, required 2. Normal skin w/
moisture upper trunk Symptom relief (keep px desquamation
Asymptomatic, short – Bedridden px & bundled Adults: trunk in cool envt) 3. No mucosal involvement
lived, self – limited children 4. Acute
5. No target lesions
6. No erythema! – most
important
Impetigo Discrete, thin – walled S aureus (most common) Children Histopathology: Clean area before Impetigo on the scalp:
Contagiosa vesicles that become Streptococci 1. Superficial applying meds complication of pediculosis
pustular & rupture (group B strep – newborn Exposed body parts: inflammation in capitis
impetigo) face, hands, neck, upper part of Systemic antibiotics
Very weepy lesions (fresh extremities (palms & pilosebaceous (semisynthetic penicillins Acute glomerulonephritis –
exudates) covered by Predisposing factors: soles spared) follicles or 1st gen complication following beta
yellow/orange crusts Temperate zones 2. Subcorneal cephalosporins) w/ hemolytic strep skin infection
vesicopustule topical therapy - Usually in kids <
Gyrate pattern/gyrate Sources of infection: 3. Mild inflammation (Bacitracin & muciprocin 6y/o
erythema (round, ring – Kids: pets, dirty in dermis (PMNs, ointment) - Absent in staph
like polycyclic or arcuate) fingernails, other kids edema) impetigo
Adults: barber shops, Recurrent: 10 days
beauty parlors, swimming Rifampin (600mg/d)
pools, etc
Steven – Flat, erythematous, Drug allergy (1day – 3 Oral mucosa & Skin biopsy: Similar to px with Cause of mortality in
Johnson’s purpuric macules that form wks latent period): conjunctiva Lymphocytic infiltrate extensive burn dermatology
Syndrome incomplete “atypical antibiotics, NSAIDs, at dermoepidermal 1. IV immunoglobulin
targets” that may blister allopurinol, junction w/ necrosis of 2. Systemic Px usually go to the hospital
centrally anticonvulsants keratinocytes corticosteroids because of pain
(Erythema multiforme minor (dexamethasone,
may also appear as target methylprednisolone) + Nikolsky sign: application
lesions, may be drug induced, - Stops spread & of very slight pressure causes
and may have the same areas
skin loss the skin to slough off; usually
of predilection. Difference is in
Nikolsky sign) 3. ICU seen in vesicular lesions (due
4. Increase caloric to weakening of intercellular
Evolution of lesions: enteral intake attachments)
Macules -> vesicles & - This is absent in
bullae erythema multiforme
minor because
Fever & influenza like lesions here are
symptoms precede more papular
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eruption/skin lesions 2 causes of mortality in SJS:
(rapidly spread w/in 4 days) 1. Sepsis
2. Electrolyte
Mucosal involvement (>2 imbalance
mucosal surfaces eroded –
oral or conjunctiva) SJS involves less than 10%
body surface. (Toxic
Not pruritic epidermal necrolysis involves
>30% body surface & it’s a
more severe SJS)
Herpes Intraepidermal vesicles HSV 1: orolabial herpes; Tzanck smear – most Drug of choice: Features:
Simplex more common common procedure Acyclovir (oral) 1. Acute
Acantholysis (ballooning HSV 2: genital herpes - Not specific (HSV, 2. Clustered lesions (In
degeneration of epidermal VZV) Indications for oral meds: SJS, not clustered)
cells) Risk factors: - Multinucleated - Recurrence 3. Can have mucosal
Immunocompromised epidermal giant cells - Dissemination involvement
Types of infection: Prior infection (in
Primary infection: virus Occupation (esp in Direct fluorescent immunocompro Other manifestations:
replicates in site of herpetic whitlow) antibody test – more mised) Herpetic whitlow
infection; usually resides in Minor trauma & sun accurate - Infection of digits
trigeminal ganglion exposure - Tenderness &
Viral culture – very erythema of lateral
Nonprimary initial Transmission: intimate accurate & rapid nail fold
episode: initial clinical skin to skin contact, bodily (results ini 48 – 72 hrs) Herpetic
lesion in a person fluids keratoconjunctivitis
previously infected w/ the PCR - Punctate/marginal
virus Skin biopsy keratitis
Serology - May impair vision
Recurrent infection Herpes gladiatorum
- HSV 1
- Seen in wrestlers,
rugby players
- Face, sides of neck,
inner arms
Herpes Sycosis
- Affect primarily the
hair follicle
- Close razor shaving
Recurrent Ecthyma
Multiforme
- Presents with
papules later
become target
lesions in palms,
elbows, knees and
oral mucosa
Neonatal Herpes
- Passage through
birth canal
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- Skin lesions,
microphthalmos,
encephalitis,
chorioretinitis,
intracerebral
calcifications
HSV
Encephalitis/Meningitis
- Headache, fever,
mild photophobia,
autonomic
dysfunction
Orolabial Lesions in mouth: broken 95%: recurrent HSV1 Lips near vermillion If untreated, may last 1 – Upon onset: high fever,
Herpes vesicles that appear as infection border 2 wks lymphadenopathy, malaise
erosions or ulcers covered
w/ white membrane Frequent trigger: UVB
exposure
Frequent manifestation:
cold sore or fever blister
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Herpes Zoster Shingles Reactivation of varicella F>M Tzanck smear Acyclovir Features:
zoster virus Indications: 1. More painful than
Cutaneous eruptions Sensory dorsal root - Immunocompro simplex
frequently preceded by one Risk factors: ganglion cells mised px 2. Dermatomal
to several days of pain in Age - To prevent 3. Not recurrent
affected area Immunosuppression Usual sites: complications in 4. Unilateral w/in
Thoracic (55%) elderly (give 1st distribution of
Papule & plaques of Cranial – trigeminal 3 days) cranial/spinal nerve
erythema -> blisters (20%) - Ophthalmic 5. Neuralgic
Lumbar – 15% involvement
Sacral – 5% Postherpetic Neuralgia
Major complication; occurs 1
Ophthalmic zoster: month after onset of zoster
involvement of infection
ophthalmic division of
5th CN
Ramsay hunt
syndrome:
involvement of facial &
auditory nerves
Scabies See page 7 for complete
details
Features:
1. Pruritic
2. No target lesions
3. No mucosal
involvement
4. Px usually comes
to you the lesion
has been there for
several weeks
duration
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6: BULLOUS DERMATOSIS
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Fixed Drug See p 13/14
Eruption (FDE)
Contact See p. 22
Dermatitis
Bullous Strikingly large, fragile S aureus Any age but usually in Systemic antibiotics
Impetigo bullae newborn infants IV fluid resuscitation
Predisposing factor: - Neonatal type is – if w/ large areas of
Ruptures & leaves Insect bites highly contagious involvement w/
circinate, weepy or Cuts - Begins in 4th – denuded skin from
crusted lesions (impetigo Nursery w/ infected 10th days of life ruptured bullae
circinate) children w/ appearance of
bullae
Other manifestations:
Constitutional symptoms Early: face & hands
appear later Adults: axillae, groin,
Diarrhea w/ green stools hands
Bacteremia, pneumonia, (spares scalp)
or meningitis
Sources:
Andrews’ Clinical Dermatology
Dra. Ismael’s lec
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