- Perfumes

- Metal
- Relation to menses or
Need to master: pregnancy
● History ○ Medications
● Physical Examination ■ Self Medication (OTC)
■ Consult
TAKING THE HISTORY ■ Oral or topical
● Chief Complaint: ■ Dose and Frequency
○ Primary Lesion + Site ■ Response to Treatment
■ Papules over the cheeks ● Review of Systems: Pertinent positives and negatives
■ Generalized Wheals ● Past Medical History
■ Ulcer over the sacral area ○ HPN, DM, Asthma, Atopy, TB, Allergies
■ Pruritus or rashes is a major no-no! ○ Drug Usage: maintenance meds, vitamins,
● To get a very good dermatological history, you have herbal/food supplements, teas
to note the following: ● Personal and Social History
○ Duration ○ Soap and topical agents
■ When the condition was first noted ○ Smoking, alcohol, illicit drugs
■ Dates of recurrences or remissions ● Family History
○ Periodicity ○ Infections: Similar lesions in other close personal
■ Constant? contacts (e.g. household, sexual, playmates,
■ Waxing and waning? school)
■ Worse at night? ○ Genetic: Similar lesions in other family
- Scabies = worse at night, members, not necessarily with close personal
contact
nocturnal pruritus
○ Exposure: Viral, Varicella, household, sxual,
○ Evolution
playmates/School: Molluscum Contagiosum
■ How it looked when it first started
■ How the lesions progressed over time?
PHYSICAL EXAMINATION
- Increase in size?
- Increase in number?
Things you’ll need:
- Increase erythema and
● White penlight
scaling
● Tape measure
○ Location
● Magnifying glass
■ Where lesions were first noted?
● BP apparatus and stethoscope, thermometer
■ How they spread?
○ Symptoms
Inspection of Skin
■ Pruritus
● Adequate lighting
■ Pain
● Adequate skin exposure of the ff: axillae, buttocks,
■ Bleeding
perineum, back of thighs, inner upper thighs
■ Asymptomatic
● Use of examination room: accompanied by another person
○ Severity
if patient is of opposite sex and also accompanied by
■ Grade severity of pain or pruritus
parents or guardian if pediatric patient
■ 10- point scale
■ Mild, moderate or severe
○ Exacerbating Factors
■ In relation to:
- Sun exposure, heat, cold
- Trauma
- Exposure to topical products
- Plants
 Wheals
BASIC LESIONS - Evanescent, edematous
elevations of various sizes
- Evanescent usually
PRIMARY LESIONS SECONDARY LESIONS
resolve within the day or
Macule Scale after 24 hours
Patch Crust - Dermatographism -
Papule Excoriation pressure induced whealing
Plaque Fissure can be seen
Pustule Erosion
Vesicles
Vesicle Ulcer
- Fluid containing epidermal
Bulla Lichenification
elevation with 1cm in size
Nodule Atrophy
- Know content of the fluid
Cyst, Tumor Telangiectasia
(clear, yellow, to
serosanguinous fluid)
PRIMARY LESIONS

Herpes Zoster

Bullae
- Fluid containing epidermal
elevation >1cm in size
- Know content of the fluid

Macule Patch
- Flat, non-palpable lesions - Greater than 1 cm in size
that are less than 1 cm in - Ex: Vitiligo Bullous Cellulitis
size
Pustule
- Not skin-colored
- Small elevations containing
- Ex: Ephelides
purulent material
- Similar to vesicles in size
and shape
- Usually have an
inflammatory area around
Acne Vulgaris
the lesions

Molluscum Contagiosum
Papules
- Circumscribed elevations
from pinhead to 1 cm in size
Psoriasis
Plaques
- Broad papules with more
than 1 cm in diameter
Nodule
- Elevations that are larger
than 1 cm in diameter
- Upon palpation, they feel
deeper because they are
located in the dermis or
subcutaneous fat
Sebaceous Cyst
SECONDARY LESIONS
Lichenification
- Normal markings of the
Scales skin that become
- Pathologic process in the exaggerated
epidermis - Leathery in texture
- Dry, greasy, laminated - Usually from chronic
masses of keratin scratching, rubbing or any
- vary in thickness and color friction
that can help in diagnosing
the lesions
Atrophy
- thinning and loss of elasticity
Crust of the skin
- Dried serum, pus, or blood
with epithelial/bacterial
debris
- When removed, there is an
erosion/ ulcer/ wound
underneath
- Impetigo: yellowish crusts Telangiectasia
Impetigo contagiosa
- Persistent dilatations of
Fissures small capillaries in the
- Linear cracks that superficial dermis
commonly occurs in - Visible as fine, bright,
thickened and very dry nonpulsatile red lines or
skin netlike patterns on the skin

Erosions
- Loss of epidermis alone CONFIGURATION or SHAPE
- Usually seen in SJS or
vesicles after rupture
- Heals without a scar Herpes Zoster

- Unilateral grouped vesicles

and bullae located on a
Ulcer dermatomal level
- Complete loss of epidermis
and some dermis that are
usually seen in sacral ulcers
or stasis ulcers
Tinea Corporis
- Heals with scarring
- Annular plaque with
central clearing
- Complete circle
Excoriations
- Mechanical trauma
inducing skin damage
- Usually caused by
scratching
- Usually very pruritic
 Nummular Eczema
- Round-shaped
- Usually in lower extremities

Erythema Multiforme
- The typical target (iris)
lesion has three concentric
color zones:
1. Central dusky purpura
2. Elevated, edematous,
pale ring
3. Surrounding macular
erythema

Pityriasis Rosea *Give high steroids for the elderly

- Distributed along the lines
*Do not give potent steroids in inframammary, axilla, inguinal area
of cleavage
- Langer’s Lines *Side Effects of Corticosteroids: acneiform eruption,
hyperpigmentation, hypertrichosis

DRY CHRONIC ECZEMA

WRITING THE CORRECT SKIN PE
LICHEN SIMPLEX CHRONICUS

Case: 48 y/o female who complains of 4 year history of intensely

pruritic plaques over both anterior lower legs.
 NAIL CHANGES

ONYCHOMYCOSIS

DISTAL SUBUNGUAL

● Primarily involves the distal nailbed

and hyponychium, with secondary
involvement of underside of nail plate
of fingernails and toenails
● Usually caused by T. rubrum
● Result of long-continued rubbing and scratching, more ● Most commonly given in OPD!
vigorously than a normal pain threshold would permit
● Skin becomes thickened and leathery
PROXIMAL SUBUNGUAL

PRURIGO NODULARIS ● Involves nail plate from proximal nail

fold
● T. rubrum, T. megninii
Case: 14 y/o male who complains of intensely pruritic lesion over ● May be an indication of HIV infection
extremities.

WHITE SUPERFICIAL

● Leukonychia trichophytica
● Invasion of toenail plate on the surface
of the nail
● T. mentagrophytes
● Small chalky white spots on nail plate

Treatment:
Primary Lesion: NODULE
Multiple erythematous to hyperpigmented nodules/papules
● Pruritus: paroxysmal, relieved only by scratching to the point
of damaging the skin, usually inducing bleeding and often
scarring
● Cause: unknown, multiple factors may contribute such as
atopic dermatitis or insect bites
Treatment and Prevention:
● Patient education to stop scratching
● Moisturizers for pruritus
● Potent steroids may be used as well as intralesional
steroids
● Fingernails will completely grow within 6-8 months while
toenails grow in 12 months which is also the duration of
treatment
● Topical Antifungals: Clotrimazole, Amorolfine
● Systemic Antifungals - preferred!
○ Terbinafine 250mg/tab OD x 6-8 wks (12-16 wks)
○ Itraconazole 200mg/cap BID x 1 wk per month
x 2 mos (3-4 mos)
○ Fluconazole 150-300mg/tab 1x/wk x 6-12 mos
○ Candidal onychomycosis: azoles
○ Precaution: liver disease; LFTs → request first for
SGPT
 Case: 7 y/o nail biter who complains of acute swelling of the nail NAIL PITS BEAU’S LINES
folds Horizontal ridging of nails

ACUTE PARONYCHIA TREATMENT:

- Always consider bacterial
infection which may produce - Generally hard to treat since
local redness, swelling, and most treatments should
pain especially after history include systemic drugs to be
of trauma effective
ONYCHODYSTROPHY - Topical or intralesional re
Disfigurement of the nail plate found to be less effective
from severe hyperkeratosis and more burdensome

HAIR CHANGES
Case: 43 y/p male with erythematous plaques with thick white
scales over trunk and extensors, arthritis and disfigured nails

● The stages of hair growth are the anagen, catagen, and

telogen phases.
○ ANAGEN – hair growth
ONYCHOLYSIS ○ CATAGEN – follicle regression/cessation
○ TELOGEN – rest
- separation of the nail from ○ EXOGEN – hair shedding
the nail bed ● Each strand of hair on the human body is at its own
- Very common signs of
stage of development.
psoriasis
● Once the cycle is complete, it restarts and a new strand of
hair begins to form
● The rate or speed of hair growth is about 1.25 cm or 0.5 in per month, or about 15 cm or 6 in per year
● Number of hair shed daily: 100-150
● Hair is present on all surfaces EXCEPT:
NAIL PSORIASIS
○ Palms and soles
○ Labia minora
○ Glans
○ Prepuce
○ Lips
○ Nails
 ALOPECIA AREATA
Case: A 24-year-old male who presented with a hairless patch
over the scalp

● Characteristic exclamation point hairs, smooth hairless

patch that is well-demarcated
● The condition is thought to be a systemic autoimmune
disorder in which the body attacks its own follicles and
suppresses or stops hair growth
● It occurs more frequently in people who have affected
family members, suggesting heredity may be a factor
especially if positive for family history for other
autoimmune diseases

Hair pull test:

● grasping 40-
60 hairs firmly between the
thumb and forefinger
followed by a slow pull that
causes minimal discomfort
to the patient
● A count of more than 4-6
strands of hairs is
abnormal

ERYTHEMATOUS LESIONS
TELOGEN EFFLUVIUM
NON-SCALY INFLAMMATORY PAPULES

MILIARIA RUBRA
- Acute pruritic papules
developed after hot day
- Retention of sweat as a
result of occlusion of sweat
glands
- Discrete pruritic
erythematous vesicles
with prickling
intertriginous
- Hot humid climate
 SCABIES

- Multiple, erythematous
papules on interdigits,
buttocks
- Nocturnal pruritus close
personal contacts with
similar symptoms
- Distribution: Circle of Hebra

CIRCLE OF HEBRA
- Imaginary circle with main
sites of involvement: axilla,
elbow, flexures, wrist, hands
and crotch
Treatment:
- Close contacts should be
treated
- Permethrin 5% lotion, apply
neck down. Do once a week
for 2 weeks
- Spray insecticides, treat all
household contacts

INSECT BITES
- With central punctum

ACNE VULGARIS
- Polymorphic lesions,
multiple erythematous
papules
- Open and closed
comedones, papules,
pustules, nodules, often
scars
- Chronic inflammatory
disease of the pilosebaceous
follicles
- Comedo - primary lesion
- Sites of predilection: face,
neck, upper trunk and upper
arms.
 A. White head or closed comedones if papules are
yellowish.
B. Blackhead or open comedo if papules are with dilated
central opening filled with blalened/oxidized keratin
C. Inflammatory lesions: papules and pustules or with
erythema and edema.
D. These may enlarge, becoming nodular and may
coalesce into plaques draining serosanguinous or
yellowish pus.

NON-INFLAMMATORY: Open and Closed Comedones

INFLAMMATORY: Papules and Nodules
 Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

Treatment: disease that will manifest

- Non-inflammatory lesions: topical retinoids → follicular Initial clinical lesions: single hypopigmented patch with slight
keratinization → keratolytics anaesthesia= indeterminate
- Inflammed lesions: benzoyl peroxide, intralesional
steroids, systemic antibiotics
- Antibiotics: Doxycycline and Limecycline - given for 3-4
months; advise to drink water due to side effect of
esophagitis; do not stay in sun for a long time
- Nodular: oral isotretinoin; only drug that can reduce
sebum production; SE is drying of skin
- GOAL: Prevent scarring!!!

PEDICULOSIS CAPITIS
- Attached to the shaft
- Ova near scalp usually
visible, far from the scalp
empty
- Retroauricular and occipital
region
- Treatment: Permethrin
Shampoo, applied on dry
hair leave for 10-15 minutes,
once a week for 2 weeks,
use fine toothed comb
NON-SCALY INFLAMMATORY NODULES
FURUNCLE
- Acute, round tender,
erythematous nodule with
central suppuration
- Oral antibiotics
CARBUNCLE
- Confluent of furuncles
- Oral antibiotics
HANSEN’S DISEASE
- This system uses clinical and histopathological features, and
the different categories correlate with the activity of the host
immune response
- Ridley’s construct is a six-member spectrum, ranging from
high resistance to low resistance
- Polar Tuberculoid and Polar Lepromatous Leprosy are
clinically stable, but between the poles, the host’s
granulomatous posture may change, as indicated by arrows
- The borderline states are unstable immunologically and can
be complicated by reactions
TUBERCULOID LEPROSY (TT)
- Strong cell-mediated
immunity as MANIFESTED by
a spontaneous cure and
absence of downgrading
- Well-defined erythematous,
annular plaque with central
clearing
- CAN BE A
DIFFERENTIAL
DIAGNOSIS FOR TINEA
CORPORIS
- “Saucer-shaped”
- Firmly indurated, scaly,
dry, hairless, anesthetic/
hyposthetic
- Solitary or few lesions,
asymmetrically distributed
- + peripheral nerve
enlargement (Superficial
peripheral nerves serving or
proximal to the lesion may
be enlarged)

- Mycobacterium leprae
- Cooler areas of the body (sparing midline and scalp); grows
best at 30 deg C
- Close contact, nasal secretions
- Biopsy with Fite faraco stain
- Immunologic spectrum (TT-BT-BB-BL-LL)
- May present with broad spectrum of clinical diseases
- Cell-mediated immunity determines the form of Hansen’s
Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

BORDERLINE TUBERCULOID
LEPROSY (BT)
- IMMUNOLOGIC RESISTANCE
is strong enough to restrain
the infection but
INSUFFICIENT for self-cure
- Multiple asymmetric, sharply
marginated papules and
plaques with “pseudopods”
and “satellite lesions” and
there is impaired sensation
- In contrast to tuberculoid
leprosy – there is less
erythema, induration and
scaling

BORDERLINE LEPROSY (BB)

- immunologic midpoint of
the granulomatous
spectrum
- The most unstable area
patients quickly up or
downgrade
- Annular, large plaques with
sharply marginated
borders with islands of
normal skin giving the
“swiss cheese appearance”

BORDERLINE LEPROMATOUS
LEPROSY (BL)
- Resistance too low to
restrain M. leprae
proliferation but sufficient
for tissue destructive
inflammation
Classic dimorphic lesion:
- Outer border: poorly
marginated
- Inner border: sharply
marginated
- “Inverted saucer-shape”
- Highest prevalence of
nerve trunk palsies

LEPROMATOUS LEPROSY (LL)

- ALWAYS symmetrical with
poorly defined nodules
- In lepromatous leprosy, the
diminished cell mediated
immunity permits
UNRESTRICTED BACILLARY
REPLICATION and widely
disseminated multiorgan
 disease
- It is characterized by poorly-
defined, skin colored to
erythematous papules and
nodules that are
symmetrically distributed
- Nerve disease is bilaterally
symmetric, usually in a
stocking glove pattern

PIN PRICK TEST

- To check for anesthesia using the blunt and sharp edges of the
needle

PERIPHERAL NERVE CHANGES

- Nerve Enlargement
- Sensory impairment
- Nerve Trunk palsies
- Sensory and motor loss, weakness, atrophy, contractures
- Autonomic nerve damage results to anhidrosis of palms and
soles
- Sensory function is the earliest affected followed by muscle
weakness and wasting and atrophic changes or contractures
- Limb deformities and chronic ulceration and scarring on hands
and feet as a result of trauma to areas with loss of sensation
(no protective sensation)
- Sensory loss begins in the cooler areas (here m leprae
preferentially grows) then progresses on the basis of relative
skin temp
- Earliest deficits occur in distal extremities
- LE: lateral lower extremities
- UE: dorsa of hands, extensor forearms
- Sparing of palms, soles, antecubital and popliteal fossa–
relatively warm surfaces
 Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

Nerve involvement mainly

affects the more superficial
nerve trunks such as the
following:
- Ulnar, median, radial,
common peroneal,
posterior tibial, and greater
auricular nerve

ADVERSE EFFECTS OF ANTI-LEPROSY DRUGS

DAPSONE
- hemolytic anemia
- Methemoglobinemia
- psychiatric problems (psychosis) rarely

CLOFAZIMINE
- red-brown discoloration of the skin, conjunctivae
- red urine, stools, sputum, sweat & tears
- dryness of skin

RIFAMPICIN
- red urine
- hepatitis**
- thrombocytopenia**
- psychosis**
- decreases effectiveness of systemic steroids
-
**These serious side effects are not usually seen with once a
month dosage
 NON-SCALY INFLAMMATORY PLAQUES

FURUNCLE WITH CELLULITIS

- Solitary, erythematous,
tender nodule surrounded
by a tender, ill-defined
erythematous patch
- Involves dermal lymphatics

ERYSIPELAS
- Acute infection of GAS
involving the superficial
dermal lymphatics
- Well- defined erythematous
plaque involving the deeper
subcutaneous layer
- Heat, pain and swelling w/
malaise, systemic symptoms:
fevr, chills, headache,
vomiting
- Sites: legs, face
- TX: oral antibiotics for 10
days

FIXED DRUG ERUPTION

- Recur at the same site after
exposure to the same
medication; but can have
multiple lesions
- One or few lesions can
present anywhere but 50%
occurs in oral and genital
mucosa
- Red patch—target lesion
Note: If you get a patient with TINEA CORPORIS, your differential
diagnosis can be:
- TUBERCULOID LEPROSY (TT)
- And then tell your panel that you palpated for any nerve
enlargement, did pin prick test to check for anesthesia
to rule out TT
VASCULAR REACTIONS (ERYTHEMAS AND PURPURIC LESIONS)
SUNBURN
- Harmful rays of the sun:
UVB-BAD (280-320nm)
wavelength of radiation
from the sun for sunburn is
308nm ;
- 9am and 3-4pm because it is
during this time that your
shadow is shorter than your
height
- SUNSCREEN:
SPF (sun protection factor) is a
relative measure of how long
a sunscreen will protect you
from ultraviolet (UV) B rays
Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

PHOTOSENSITIVITY depends on the size of blood

- Covered areas are not vessels involved;
affected; involved are your postcapillary venules
face, v-neck, extensors of - Sites of Predilection:
extremities; spares the dependent areas
nasolabial folds and chin - BIOPSY- confirm the
diagnosis- Leukocytoclastic
purpura
- Advise patient to rest; leg
elevation; antihistamine to
block vasodilatation and halt
trapping of the immune
complexes

Do DIASCOPY
- test for blanchability
- Differentiate between a
blanching erythema and
non-blanching purpura
by pressing with a glass
slide
- Blanching = increased blood
flow (erythema and
erythroderma)
- Non-blanching =
extravasation of RBCs into
the skin (Petechiae,
MORBILLIFORM DRUG ecchymosis, and palpable
ERUPTION / purpura)
MACULOPAPULAR RASH
- Multiple erythematous
macules, patches and ERYTHEMATOUS LESIONS WITH ECZEMA
plaques seen on the
trunk caused by drugs
taken within last 8 weeks HANIFIN AND RAJKA CRITERIA
- Most common form of an
Adverse Drug Reaction
- Lesions usually present on
the groin and axilla then
generalizing in 1 or 2
days
- Face is spared
- Pruritus in drug induced VS
viral exanthem
- Viral Diseases causing
morbilliform rashes:
roseola and rubella
VASCULITIS
- Inflammation of the blood
vessels
- Type III hypersensitivity
reaction – immune complex
deposition on the blood
vessels
- Leukocytoclastic vasculitis –
purpura that are elevated;
 Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

ATOPIC DERMATITIS
• Infantile AD (age <2 years)
• typically develops after the
second month of life
• often initially appearing as
papules and papulo-
vesicles on the cheeks
(often sparing the central
face)
• Involvement of the scalp,
neck, extensor aspects of the
extremities, and trunk can also
occur, usually with sparing of
the diaper area

- Erythematous papules and

plaques on the face and
cheeks, extremities extensor,
sparing of inguinal areas
- In contrast to SEBORRHEIC
DERMATITIS: involves
eyebrows and mid facial area
- Yellow, greasy scales
- Usually seen in first three
months
CHILDHOOD ATOPIC
DERMATITIS
• In childhood AD (age 2 to 12
years),
• the lesions are less exudative
and tend to become lichenified
• The classic sites of
predilection are the antecubital
and popliteal fossae

ADULT ATOPIC DERMATITIS

• Adult/adolescent AD (age
>12 years)
• also features subacute to
chronic, lichenified lesions,
• and involvement of
the flexural folds
typically continues
- Antecubital and popliteal
fossa, flexural areas

Cornerstone of Treatment:
- EMOLLIENTS - most important
- CLASS 6 TO 7 STEROIDS FOR INFANTS -
Hydrocortisone BID on the affected areas
- MID-POTENT BETAMETHASONE FOR ADULTS
- Pro-active Treatment - even when there is no lesion,
give on weekends
- Reactive Treatment - treat when there is a lesion give
BID for 1 week
- Management gear towards the main problem of atopic
 dermatitis which is Dry skin + inflammation.
- Basic treatment with moisturizers is necessary

SEBORRHEIC DERMATITIS
- Scaly patches + erythema
- Scale: yellow greasy
appearance
- Scalp, eyebrows, glabella,
ears, postauricular areas,
nasolabial creases
- Sternal area, upper back,
axillae, submammary folds,
umbilicus, groin, gluteal
crease
- Dandruff: mild form –
pityriasis sicca
- DDx: Scalp psoriasis
- Usually seen in first 3
months, atopic is more
chronic

For intense SD, rule out

immunodeficient states:
HIV, immunosuppressive drugs

DIFFERENTIAL DIAGNOSIS:
PSORIASIS
- Scalp, eyebrows, glabella,
ears, postauricular areas,
nasolabial creases
- In psoriasis, lesions extends
beyond the hairline
- Seborrheic Dermatitis is
confined to seborrheic areas
and hairline
 Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

CONTACT DERMATITIS

ALLERGIC: nickel, perfume, rubber, adhesives,

IRRITANT: alkali/acids; most common: detergent

Irritant contact dermatitis

Secondary to detergent

Irritant contact dermatitis

Secondary to rubber slippers

Irritant contact dermatitis

Secondary to Henna tattoo
PPD- Para phenylenediamine-
synthetic coal tar dye

Irritant contact dermatitis

Secondary to adhesives
 Perfume allergy
Nickel allergy, sometimes
may be accompanied by
secondary bacterial infection

For patients with Allergic contact dermatitis,

The most important part of treatment is to advise patient to avoid
the allergenic product.
Treatment also includes: topical corticosteroids, antihistamines
and NSS

NUMMULAR ECZEMA
May initially start as papules
and vesicles coalescing into
annular oozing or dry plaques
usually located on the lower
extremities

INTERTRIGO
Body folds are prone to this
inflammatory lesions because
of high skin temperature,
moisture/ maceration from
sweating and friction to
adjacent skin

DIFFERENTIAL DIAGNOSIS:
tinea cruris: plaque w/ well
defined erythematous border
Candidal intertrigo: satellite
lesions
Irritant CD: elderly diapers;
urine, feces
Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

PAPULOSQUAMOUS DISEASE

PSORIASIS
- Sharply marginated, raised,
red, plaque with scaly
surface
- Silvery white scale
- Symmetry of lesions
- Extensor distribution

Auspitz Sign
Bleeding points appear after
the scale is removed due to
trauma that signifies to the
dilated capillaries in the lesion

Psoriasis plaques can appear at

any part of the body but are
generally distributed
symmetrically over elbows and
knees ; and scalp may be the
most common site of
involvement

TINEA PEDIS
- macerated plaques on
interdigits; may present
with bullae
- caused by T.
mentagrophytes
(interdigitale) presents as 3
distinct appearances
1. Multilocular bullae
involving the plantar arch
and sides of feet
2. Erythema and desq
between toes
3. White superficial
onychomycosis

TINEA CRURIS ET CORPORIS

Characterized by annular
erythematous plaques with
advancing scaling edge
Progressive central clearing
 TINEA VERSICOLOR

Multiple hyperpigmented,
hypopigmented, erythematous
papules and plaques usually on
the trunk area

Produces a spectrum of clinical

presentations and colors that
include
(1) red to fawn-colored
macules, patches, or follicular
papules that are predominantly
caused by a hyperemic
inflammatory response;
(2) hypopigmented lesions; and
(3) tan to dark brown
macules and patches.
Melanocyte damage appears to
be the basis for
hypopigmentation

KOH test:
Tinea Corporis: long, septated hyphae w spores corporis
Tinea Versicolor: spaghetti and meatballs
Candida: pseudohyphae

PITYRIASIS ROSEA

Distribution- lines of cleavage/

hanging curtain sign/ Christmas
pattern sign

Caused by HHV 6 ; lesions seen

until 3 months

Usually begins with a herald

patch with collarette scaling---
followed in 1-2 weeks of
successive crop of lesions that
spread rapidly
 Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

VERRUCA PLANTARIS
Spontaneously resolves after 3-
8 weeks Papules and plaques with
rough surface and black dots
- HPV 1,2,4,27,57

Warts have a hard ‘warty’ or

SKIN-COLORED PAPULES/NODULES ‘verrucous’ surface. You can
often see a tiny black dot in
the middle of each scaly spot,
due to a thrombosed capillary
blood vessel.

Mosaic warts on the sole of

the foot are in clusters over
an area sometimes several
centimetres in diameter

Differential Diagnosis
Callous: seen in friction sites;
exaggerated skin
lines/markings

Koebnerization
- Forming linear, raised
VERRUCA VULGARIS papular lesions
Multiple hyperpigmented - At least 2-3 months—tx
round papules with rough trial
grayish surface on hands and - Goals-remove wart, reduce
feet scarring, induce lifelong
immunity
Common in butchers, - ECT, cryotherapy–
prolonged immersion in destructive,
water immunotherapy, SA,
cantharidin( 24 hrs, blister
Tiny black dots– thrombosed 24-72 hrs, q 2-3 weeks)
dilated capillaries - Recalcitrant—bleomycin-
inject until wart blanches
- Surgical
VERRUCA FILIFORMIS
long slender, upward MOLLUSCUM
projection – common in face CONTAGIOSUM
and neck - Multiple skin colored
papules with central
umbilication;
- Caused by Poxvirus
- playmates with similar
lesion
Treatment:
- Nick curettage
- Cantharidin
- Tretinoin
Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

MILIA - If infected, treat first with

- Cysts lined with epidermis antibiotics
and filled with keratin. 1-4
mm ACROCHORDON
- Primary (spontaneous): - fibroepithelial papilloma,
50% - skin tag
- Newborns- face- nose - Skin colored or
scalp, upper back– hyperpigmented
resolve over a few weeks pedunculated papules
- Adults/children: cheeks - commonly located in
and eyelid - tend to areas of friction: axilla,
persist inframammary area, and
- Milia are thought to result neck
from pilosebaceous or - may increase in number
eccrine sweat duct plugging when patient is gaining
- Treatment: Milia weight or during
Extraction, removes keratin pregnancy and may be
related to growth-
SYRINGOMA hormone like activity of
- Skin colored papules on insulin
eyelids and periorbital area - Treatment is snip
- Differentiation of excision, clipped off with
intradermal eccrine ducts. electrocautery
Eccrine gland proliferation
- Local factors, including XANTHELASMA
ductal obstruction by - Xanthelasma palpebrum:
keratin plugs leading to most common type of
ductal proliferation, may xanthoma
play a role in pathogenesis - Lesions arise
- Tx: electrocautery or symmetrically on upper
chemical peels and lower eyelids
- Lesions are soft, velvety,
EPIDERMOID CYST yellow, flat papules or
- aka follicular cyst- keratin plaques
cyst, epidermal cyst, - May or may not be
epidermal inclusion cyst, associated with
or an epithelial cyst, is a hyperlipidaemia
keratin-filled epithelial- - Advised the patient for
lined cyst. The term work-up- (Labs: Lipid
sebaceous cyst is a profile)
misnomer, as these cysts
do not involve sebaceous
glands, nor do they contain PUSTULAR DISEASE
sebum.
- most commonly the result
of plugged pilosebaceous PUSTULE
units. - Small elevations of the
- They are dermal or skin containing purulent
subcutaneous mobile material
nodules with a central - Inflammation of the
punctum pilosebaceous unit
- foul smelling cheesy - Follicular or non-follicular
debris may be expressed - Similar to vesicles in shape
- Cysts are usually slow < 1cm with inflammatory
growing and asymptomatic. areola
- Treatment is excision - Pustules may coalesce into
plaques or may evolve
into
Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

VESICULAR DISEASE
a furuncle, carbuncle, and
abscess
- Tx: Oral antibiotics HERPES SIMPLEX
OROLABIAL HERPES
FOLLICULITIS HSV-1-
- Inflammation of the follicles Recurrent HSV-grouped
- It is superficial as vesicles on an erythematous
compared to the furuncle base, may also appear as
- Most common etiologic erosions
agent is Staphylococcus • HSV-1 reactivates most
aureus commonly in trigeminal
- Sites of predilection are ganglia
hair- bearing areas such as • HSV-2 reactivates most
the scalp, axilla, pubis commonly in sacral ganglia
- In immuno compromised
individuals, this coalesce Triggers
into plaques and may be • Emotional stress, illness, sun
polymicrobial which will lead exposure, surgery, facial
to resistance to the typical cosmetic procedures
antibiotics • Oral-genital contact
- Treatment
includes: Systemic HERPES ZOSTER
antibiotics, - Seen in a unilateral
compresses, and dermatomal level
prophylactic topical - multiple, clear fluid-filled
antibiotics once active vesicles on an erythematous
inflammation is resolved base on (location and
laterality)
CANDIDAL INTERTRIGO - Caused by reactivation of
- Intertrigo is a pruritic VZV
intertriginous eruption - Hutchinson sign - vesicles on
- When caused by Candida the tip and the side of the
albicans, it is called candidal nose– indicates external
intertrigo division of the nasociliary
- Sites of predilection: groins branch (eye and side and tip
or armpits; buttocks; of the nose)
inframammary folds; - Impaired corneal sensation =
abdominal folds and neurotrophic keratitis and
umbilicus. chronic ulceration
- Lesions: pink to - Complication-ipsilateral
erythematous moist patches facial paralysis
with tiny, superficial, white
pustules closely adjacent to BULLOUS IMPETIGO
the patches. These are - Caused by Staphylococcus
satellite pustules as pointed aureus;
by the arrows in this picture. - Common sites include the
- Treatment: topical candidal face and hands
preparations sometimes - May start as flaccid bullae
with mid-strength that rupture to form honey –
corticosteroid for rapid colored crusts and erosions
relief
- This may recur
 Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

BULLOUS DERMATITIS

Generalized vitiligo is the most common, characterized by

widespread distribution and symmetry.
Clinical types include: Focal, Segmental, Mucosal, Acrofacial,
Generalized Vitiligo, and Universal Vitiligo

- Separation at various levels:

- Epidermis -> intraepidermal blister -> FLACCID
- Dermal-epidermal interface -> subepidermal
blister -> TENSE
- Topical CS are the most effective first line monotherapy
and it is best combined with phototherapy
- Topical CI shows slightly inferior results compared with
topical CS. It is best with the use of Light and laser
HYPOPIGMENTED/ DEPIGMENTED LESIONS
therapy ( Indicated for long intermittent use)
- Vitamin D3 analog are effective and maybe use as
adjunct for topical CS
VITILIGO
- Narrow Band UVB for more generalized lesions
- Depigmented lesions
- Important to advise patient for Cover up with make-up
- There is autoimmune
and sunscreens
destruction of melanocytes
- Most cases occur
sporadically and only about
15-20% of patients have one
or more affected first degree
relatives
- An autoimmune disease that is associated with other
autoimmune diseases in about 20%–30% of patients, most
frequently autoimmune thyroid disease (Hashimoto’s
thyroiditis or Graves disease), rheumatoid arthritis, psoriasis,
type 1 diabetes (usually adult-onset), pernicious anemia,
systemic lupus erythematosus, and Addison’s disease.
- Tx: Steroids (side effects: acne, striae), Calcineurin inhibitors,
and Phototherapy
 Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

A very important spring and summer and fade

DIFFERENTIAL DIAGNOSIS is during the winter period
Post-Inflammatory - They appear in early
Leukoderma childhood
- Cutaneous inflammation
may produce loss or
dysfunction of melanocytes,
BROWN/BLACK PAPULES/PLAQUES resulting in depigmentation
or hypopigmentation
- It may present after an BENIGN NEVUS
existing inflammatory
dermatoses.- ICD, atopic,
SLE, ACD
- Size and shape of lesions
usually correlates with the
distribution and
configuration of the original
inflammatory dermatosis,
and the colour ranges from
hypopigmentation to
depigmentation

● Common (also called typical) acquired nevomelanocytic nevi

develop after birth, slowly enlarge symmetrically, stabilize, and
after a period of time may regress.
HYPERPIGMENTED MACULES/PATCHES
● They are proliferation of melanocytes on the skin.
● categorized based on location of cells: cells in the
MELASMA epidermis (junctional), dermis (intradermal), or both areas
- two predisposing factors: (compound).
sun exposure and hormones
- Sun exposure and sun
damage—this is the most
important avoidable risk
factor
- In pregnancy the pigment
often fades a few months
after delivery
- Hormone treatments—oral
contraceptive pills
containing estrogen and/or
progesterone and certain
medications and cosmetic as
these may cause a
phototoxic reaction that
triggers melasma

EPHELIDES/FRECKLES ● flatter and darker lesions have a more prominent

- small light brown macules junctional melanocytic component, whereas
appearing in sun-exposed ● More elevated and less pigmented lesions tend to have
skin of fair- skinned
a prominent intradermal nevus component
individuals
- often those with red or
blond hair and Celtic
ancestry
- more pronounced during
Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

JUNCTIONAL NEVUS
- Flatter and darker
- have groups or nests of
nevus cells at the junction of
the epidermis (outer layer of
the skin) and the dermis
(inner layer)
- tend to be flat colourful
moles.

COMPOUND NEVI
- More elevated and lighter
in color
- Majority are harmless
- may continue to appear and
disappear throughout life,
but most develop during
childhood and early
adulthood.
- New or growing nevi in
older individuals are more
worrisome.

SEBORRHEIC KERATOSIS
- most common benign
epidermal tumor of the skin
- lesions usually begin as
well- circumscribed, dull,
flat, tan, or brown patches.
- become more papular,
taking on a waxy, verrucous,
or stuck- on appearance
- may be multiple especially in
elderly and appearing on the
sun-exposed areas.
- If in doubt, do biopsy to rule
out malignancy.
- Sudden eruption may follow
an exfoliative dermatitis,
erythrodermic psoriasis, or
an erythrodermic drug
eruption. These lesions may
be transient.
- SIGN OF LESER
TRELAT: sudden
eruption of numerous
seborrheic keratoses in
an adult.
- This may signify an
underlying malignancy and
in 60% of cases it is due to a
GI malignancy.
DERMATOSIS PAPULOSA
NIGRA
- Relatively common in Asians
- presents as multiple, small,
1-5mm diameter, smooth,
firm, black or dark brown
papules on face and neck
- Small seborrheic keratosis
- Likely to be genetically
determined with 40-50%
having a family
- Can advise for observation

BASAL CELL CARCINOMA

- Any friable, non-healing
lesion should raise the
suspicion of skin cancer.
- usually develops on sun-
exposed areas of the head
and neck but can occur
anywhere on the body.
- It is characterized by
ulceration,
telangiectasias, and
the presence of a
rolled border.

SQUAMOUS CELL CARCINOMA

- Second most common form
of skin cancer
- Major risk factors: chronic,
long-term sun exposure
- Human papilloma virus (16,
1,8, 31, 35) play a role in
SCCs on the genitalia and
periungual.
- Other risk factors are :
Immunosupression, scars,
burns and presence of
precursor lesions namely
actinic keratosis and bowen
diease)
- The sites of predilection are
areas which have had sun
exposure – face, lower lip,
scalp, neck, dorsal area of
the forearms.
- can metastasize and has a
high mortality rate.
 Oral Revalida Review 2019
DERMATOLOGY
Lecturer: Franchesca Marie D. Ilagan, MD

Treatment:
- Hypertrophic scars are more responsive and
generally flatten with time
- Intralesional injection of Triamcinolone - first line
treatment
- Surgery not recommended for keloids because they
often recur as larger lesions

FIBROSIS
HOW TO PRESENT A DERMA CASE
● Presentation of Salient Features
KELOIDS ○ History
- predilection for developing ○ Dermatologic PE
keloids at sites of increased ○ Site of Predilection
tension, such as the ● Differential Diagnoses
shoulders, sternum, ● Pathogenesis
mandible, and arms
● Ancillaries
- commonly affect the earlobes
- tissue extends beyond the ● Management
borders of the original wound,
- does not usually regress
SAMPLE CASE # 1
spontaneously
- tends to recur after excision.

HYPERTROPHIC SCAR
- Surface borders are always
smooth and regular
- Do not expand beyond the
boundaries of initial injury
- May undergo partial ● 4 y/o male, 3 months history
spontaneous resolution ● (+) similar lesions among siblings
SALIENT FEATURES
- Children > Adults
- Discrete, smooth, dome-shaped, flesh-colored papules
with central umbilication
- Face, trunk, extremities,
genitalia DIFFERENTIAL DIAGNOSES
- Skin-colored to erythematous papules
PATHOGENESIS
- MC virus: Poxvirus
- Transmission: direct skin or mucous membrane contact;
sexually transmitted
ANCILLARIES
MANAGEMENT
- Nick curettage
- Cantharidin
- Cryotherapy
- Immunotherapy