Differential Diagnosis and Signs in Dermatology

Dear colleagues,

This is a collection of differential diagnosis lists from previous morphology sessions, other lists,
uptodate, and dermatology books (Ex. Bolognia, differential diagnosis for the dermatologist,
dermtological differential diagnosis and pearls, dermatology simplified outlines and mnemonics). This
document also includes signs related to dermatology. If you have any further differentials to add or if
you have any comments/corrections please e-mail me salsukait@gmail.com. I will try to keep
updating the list regularly with your valuable contributuons.

Best regards,

Sarah Alsukait, MBBS

R3 dermatology resident

(Last updated 12/2018)

o Differential Diagnosis List

Clinical presentation Differential diagnosis

o Mnemonic “ALLLL-CAMMMPPS”
• Amyloidosis (systemic)
• Lepromatous leprosy
• Leishmaniasis
Leonine faces • Lipoid proteinosis
• Leukemia cutis (B-CLL)
• Cutaneous lymphoma (T-cell, rarely b-cell)
• Actinic reticuloid form of chronic actinic dermatitis
• Mucinosis (scleromyxedema)
• Multicenteric reticulihistiocytosis
• Mastocytosis (nodular)
• Progresstive nodular histiocytosis
• Pachydermoperiostosis
• Sarcoidosis

Source: bolognia

o Neoplastic disorders:
• NK/T-cell lymphoma, SCC, BCC, olfactory neuroblastoma,
salivary gland tumors, rhabdomyosarcoma, chondrosarcoma,
other sarcomas
o Inflammatory disorders:
Nasal destruction or • Relapsing polychondritis, granulomatous with polyangitis
deformity (Wegnder), sarcoidosis, SAVI (STING-associated vasculopathy
with onset in infancy), PLAID (PLC-G2 associated antibody
deficiency and immune dysregulation)
o Infectious disorders:
• Bacterial (rhinoscleroma, glanders, noma, syphilis, yaws)
• Myobacterial (leprosy, TB; lupus vulgaris)
• Fungal (paracocciodomycosis > other dimorphic fungal
infections, aspergillosis, zygomycosis)
• Parasitic (mucocutaneous leishmaniasis “espundia”, amebiasis
due to free-living organisms, rhinosporidosis)
• Other etiologies (substance abuse ex. Cocaine, nasal myiasis,
factitious/traumatic including trigeminal trophic syndrome)

Source: bolognia
Saddle nose deformity o Mnemonic “Snorting Cocaine off one’s WRIST gives one a saddle
nose”
• Cocaine
• Wegener’s granulomatosis
• Relapsing polychondritis
• Infectious chondritis (leprosy)
• Syphilis (congenital or tertiary)
• Trauma
• Other: rothmond-thompson syndrome, conradi-hunermann-
happle syndrome, hypohidrotic ectodermal dysplasia
Acral distribution o Mnemonic “ACRAL Bs”
• A (Artery; emboli i.e. cholesterol, clot, septic)
• C (Cryoglobulinemia, cryofibrogenemia)
• R (Raynaud phenomenon)
• A (Antiphospholipid syndrome)
• L (Lupus “chilblain”)
• Bs (Buerger disease, bazex syndrome, bywaters “RA”)

o Mnemonic “BANGELS.coms”
• Blastomycosis
• Atypical mycobacterial infections “esp. M. marinum > M.
cholera, M. kansasii”, anthrax
• Nocardiosis
• Glanders (burkholderia mallei)
• Ecthyma
Sporotrichoid pattern • Leishmaniasis, Langerhans cell histiocytosis
• Sporotrichosis
• Cat scratch disease (Bartonella henslae), cowpox,
coccidiomycosis
• Malignancy (amelanotic melanoma, lymphoma)
• Others: tularemia, tuberculosis, pyogenic infections (ex. Staph
aureus, strep pyogenes)

o Mnemonic “CAT N SPLAT”

• Cat scratch disease
• Atypical mycobacteria (Esp. M. marinum)
• Tuberculosis
• Nocardia, neoplasia (amelanotic melanoma, lymphoma)
• Sporotrichosis
• Phaeohyphomycoses, pyogenic infections
• Leishmaniasis, Langerhans cell histiocytosis
• Anthrax
• Tularemia

Serpiginous pattern o Mnemonic “LE PIE”

• Larva migrans
• Elastosis perforins serpignosa
• Porokeratosis
• Icthyosis linearis circumflexia (double-edged scale)
• Erythrokeratoderma variabilis

Mitten hands • Dystrophic EB

deformity • EBA
• Congenital erythropoietic porphyria
• Leprosy
• Harlequin icthyosis
• Multicentric reticulohistiocytosis
• Congenital insensitivity to pain
 o Mnemonic “ALL DEMON Fly Past”
• Alkaptonuria
Blue sclera • Down syndrome
• Ehler Danlos syndrome
• Marfans syndrome
• Osteogenesis imperfecta
• Nevus of ota
• Fanconi’s anemia
• Pseudoxanthoma elasticum

Source: ETAS study guide

Angioid Streaks o Mnemonic “APPLES”

• Anemia, sickle cell
• Pseudoxanthoma elasticum
• Pagets disease of the bone
• Lead poisoning
• Ehlers Danlos
• Sclerosus tuberous

Source: ETAS study guide

o Arthritis:
• Rheumatoid arthritis, gouty tophi
Nodules around joints o Infectious:
• Papulonecrotic tuberculid
o Metabolic:
• Xanthoma tuberosum, calcinosis cutis
o Neoplastic:
• Myxoid cysts
o Miscellaneous:
• Erythema elevatum diutinum, reticulohistiocytosis

o Mnemonic “KELLOIDS MB”

• Keloid
• Kaposi sarcoma
• Lobomycosis
Keloid-like • DFSP, DF
• Keloidal sarcoidosis
• Morphea
• Keloidal BCC

o Diseases associated with keloids:

• Rubenstein-taybi syndrome
• Goeminne syndrome
• Ehler danlos syndrome
• Bethlem myopathy
 o Non-malignant mnemonic “MR FAB FEETS”
• Menopause, migraine “neurologic disorders”
• Rosacea
• Food, fish poisoning (scromboid fish)
• Alcohol, amphetamine, arsenic toxicity, autonomic dysfunction,
anaphylaxis
• Bromocriptine, other drugs ex. CCB, ACEI, nitrate, cholinergic
Flushing agonists, cyclosporine, nicotinic acid
• Fever, Frey syndrome (auriculotemporal syndrome)
• Emotions
• Exercise
• Thyrotoxicosis
• Serotonin syndrome

o Malignant mnemonic “Red pineapple made me cry”

• Renal cell carcinoma (prostaglandin-secreting)
• Pheochromocytoma, pancreatic tumors (ex. VIPomas),
polycythemia, POEMS syndrome
• Medullary thyroid carcinoma
• Mastocytosis
• Carcinoid syndrome

o Inflammatory skin diseases

• Rosacea, perioral dermatitis
• Seborrheic dermatitis
• Dermatitis (atopic, contact, and photocontact)
o Photosensitive disorders
• Sunburn
Malar/facial erythema • PMLE
• Drug-induced photosensivity (phototoxic/photoallergic)
• Acute lupus
• DM
• Pemphigus erythematosus (pemphigus foliaceous)
• Porphyria
o Infectious disorders
• Erysipelas, cellulitis
• Post-kala-azar dermal leishmaniasis
o Systemic disorders
• Homocystinuria
• Bloom syndrome
• Rosai-Dorfman disease

• Varicella zoster
Varioliform scars • Acne vulgaris, acne necrotica
• PLEVA
• Hydroa-vacciniforme
• Atrophia maculosa varioliformis cutis
• Degos (malignant atrophic papulosis)
• Lymphomatoid papulosis
• Papulonecrotic tuberculid
• Small pox
Cribriform scar
• Pyoderma gangrenosum
• Hay-wells syndrome
• Goltz syndrome
• Blastomycosis

• Lichen sclerosis et atrophicans

• Morphea
• Morpheaform BCC
Scar-like dermatoses • Malignant atrophic papulosis (degos)
• Idiopathic guttate hypomelanosis
• DEB (pasini variant)
• Desmoplastic trichoepithelioma

• Sarcoidosis
• Crohn’s disease
• Cutaneous endometriosis
• SCC, BCC, Melanoma
• Lupus vulgaris, verruca, molluscum contagiosum, leishmania
Dermatoses with scar recidivans
predilection • Pseudoxanthoma elasticum
• Granuloma annulare
• Xanthoma
• Dermatofibroma , DFSP
• Koebner in scars: psoriasis, LP, Lichen sclerosus et atrophicans,
PRP

• Acne vulgaris
• Keratosis pilaris atrophicans
• Hydroa vacciniforme
Scars over the face • Lipoid proteinosis
• Erythropoeitic protophria
• Dowling degos
• Atrophoderma vermiculatum

• Comedonal acne (acne vulgaris, acne conglobata, chloracne,

infantile acne)
• Hidradenitis suppurativa
Comedones • Nevus comedonicus
• Favre-Racouchot syndrome
• Dowling degos disease
• Familial dyskeratotic comedones

• Lichen planus
• Lichen planus-like keratosis
Lichenoid eruptions • Lichenoid GVHD
• Lichenoid drug eruptions
• Lichenoid contact dermatitis: paraphenylenediamine, amalgam,
gold, nickel, amino glycoside antibiotics, musk ambrette
Islands of sparing • PRP (classic)
• CTCL/Sezary syndrome
• Papuloerythroderma of Ofuji
• Icthyosis with confetti
• Erythrodermic sarcoidosis
• Viral hemorrhagic fevers

o Erythroderma in adults
“Mnemonic; pretty please don’t make beets, dear”
• Psoriasis, PRP
• Paraneoplastic, papuloerythroderma of Ofuji
• Dermatitis (atopic, contact, seborrheic, stasis, chronic actinic)
• MF/CTCL (sezary > erythrodermic MF)
• Bullous dermatoses (PF, BP, paraneoplastic pemphigus)
• Drug reactions
• Idiopathic
• Other: Inherited itchyoses
hypereosinophilic syndrome, crusted scabies, lichen planus,
GVHD, autoimmune CTD “acute or subacute lupus, juvenile DM”,
dermatophyte infection, primary immunodeficiencies,
sarcoidosis, mastocytosis, Langerhans cell histiocytosis, other t-
cell hematologic malignancies.
o Erythroderma in neonates and infants
Erythroderma
• Inherited itchyoses; epidermolytic itchyosis, congenital
icthyosiform erythroderma, netherton syndrome, conradi-
hunermann-happle syndrome
• Immunodeficiencies; omenn syndrome, wiskott-aldrich
syndrome, other forms of SCID, agammaglobulinemia,
complement deficiencies, IPEX syndrome
• Primary dermatoses; atopic dermatitis, seborrheic dermatitis,
psoriasis
• Drug reaction
• Infections; staphylococcal scalded skin syndrome, neonatal
“toxic shock-like” exanthematous disease, congenital cutaneous
candidiasis
• Others; PRP, GVHD, diffuse cutaneous mastocytosis, rare
icthyoses “KID syndrome, sjogren-larsson syndrome, neutral
lipid storage disease with icthyosis”, AEC syndrome, nutritional
dermatitis

• Spontaneous urticaria
• Urticarial vasculitis
• Urticated stage of bullous pemphigoid
Urticated lesions • Insect bite
• Sweet syndrome
• Mastocytosis
• PMLE
• FDE
 o Mnemonic “Bengal D”
• Blue rubber bleb nevi
• Eccrine spiradenoma
• Neuroma, neurolemoma
• Glomus tumor
• Angiolipoma, angioleiomyoma
• Leiomyoma cutis
• Dercum disease

Painful lesions o Mnemonic “BLEND AN EGG”

• Blue rubber bleb nevi
• Leiomyoma cutis
• Eccrine spiradenoma
• Dermatofibroma, dercum disease
• Angiolipoma, angioleiomyoma
• Neurilemmoma, neuroma
• Endometrioma
• Glomus tumor
• Granular cell tumor

o Mnemonic “Space BM”

• Spitz nevus
• Pyogenic gangrenosum
• Amelanotic melanoma
• Eccrine poroma
Red nodule
• Merkle cell carcinoma
• Bacillary angiomatosis
• B-cell lymphoma
• Other: orf’s milker nodule, juvenile xanthogranuloma, atypical
fibroxanthoma, malignant fibrous histiocytoma

Hemorrhagic crusts • Herpes simplex

over the vermilion lips • Herpes zoster
• EM major,
• SJS/TEN
• Pemphigus Vulgaris, Paraneoplastic pemphigus
• Contact cheilitis

Source: bolognia

• Lupus tumidus
• Jessner’s lymphocytic infiltrate
• Pseudolymphoma
Infiltrative/indurated • Lymphoma
lesions over the face • PMLE
• Granuloma faciale
• Granulomatous rosacea
• Sarcoidosis
 • Granuloma annulare
• Sarcoidosis
• Foreign body granuloma
• Amyloidosis
• Mucinosis
• Deep erythema annulare centrifugum
• Well’s syndrome
Infiltrative/indurated • Lymphoma, pseudolymphoma, leukemia cutis, metastasis
plaques • Jessner’s lymphocytic infiltrate
• Lupus tumidus
• Reticular erythematous mucinosis (REM)
• DFSP
• Kaposi sarcoma
• Myobacterial infections (lupus vulgaris, leprosy)
• Deep fungal infections
• Leishmaniasis

• Lipoma
• Epidermoid or pilar cyst
• Lymph node
• Soft tissue tumor (ex. Neurofibroma, schwanoma,
angioleiomyoma, nodular fasciitis)
• Metastasis, lymphoma, leukemia cutis
• Rheumatoid nodule (elbow or extensor joints)
Dermal/subcutaneous
• Fibromatosis (palm or sole)
nodule in an adult
• Ganglion cyst (wrist or ankle)
• Burn out cyst due to hidradenitis suppurativa (major body
fluid)
• Soft tissue sarcoma
• Deposition (myxoma, calcinosis cutis)
• Adnexal tumor (pilomatricoma)
• Onchocercoma
Source: bolognia

• Pilar cyst
• Cylidroma
• Spiradenoma
Scalp nodule
• Nodular BCC
• Pyogenic granuloma
• Syringocystadenoma papilliferum

• Cutaneous larva migrans

• Dirofilariasis
• Fascioliasis
• Gnathostomiasis
Creeping eruption • Hookworm infestation
• Loaiasis
• Paragonimiasis
• Scabies
• Sparganosis
• Strongyloidiasis
 • Erythema annulare centrifugum
• Erythema gyratum repens
• Erythema marginatum
• Erythema migrans
Migratory lesion
• Erythrokeratodermia variabilis
• Juvenile rheumatoid arthritis
• Necrolytic migratory erythema
• Urticaria

• Demoid cysts (MC cause of congenital midline nasal mass)

• Cephaloceles
• Nasal glioma
• Dermal sinuses
• Epidermoid cyst
Midline mass, nose
• Hemangioma
• Leukemia cutis
• Lymphoma
• Rhabdomyosarcoma
• Venous malformation

o Developmental defects;
• Cephaloceles
• Nasal glioma
• Dermoid cysts
• Nasolacrimal duct cyst
• Lymphatic malformation
o Other cysts;
• Epidermoid cyst
• Pilomatricoma
• Ethmoid mucocele
o Benign neoplasms and hamartomas;
• Infantile hemangioma
Nasal masses
• Hemangiopericytoma
presenting at birth or
• Neurofibroma
during infancy
• Melanotic neuroectodermal tumor of infancy
• Hamartomas
• Teratomas
o Malignant neoplasms;
• Rhabdomyosarcoma
• Fibrosarcoma
• Osteosarcoma
• Neuroblastoma
• Dermal sinuses
• Leukemia cutis
• Lymphoma

Source: bolognia
 o Inherited causes
• Piebaldism (midline frontal)
• Waardenburg syndrome (primarily midline frontal)
• Tuberous sclerosis
• Neurofibromatosis type 1 (overlying a neurofibroma)

o Acquired causes
Poliosis circumscripta • Alopecia areata (primarily initial cycle of growth)
• Vitiligo
• Halo nevus
• Angora hair nevus
• Vogt koyangi harada syndrome
• Post-infectious (ex. zoster)
• Post-traumatic
• Post-inflammatory (ex. discoid lupus, blepharitis)
• Alezzandrini syndrome
• Melanoma-associated leukoderma (spontaneous or following
immunotherapy)
• Drugs (imiquimoid, prostaglandin analogue latanoprost with
eyelash poliosis, tyrosine kinase inhibitors “ex. cetuximab,
imatinib”. chloroquine)

Source: bolognia

• Idiopathic guttate hypomelanosis

• PLC
• Lichen sclerosus
• Achromic verruca planae (minimally elevated flat-topped
papules)
• Leukoderma punctate (after puva therapy)
• Disseminated hypopigmented keratosis (post puva therapy)
Guttate leukoderma
(minimally elevated flat-topped papules)
• Vitiligo ponctue
• Darier disease (admitted with keratotic lesions)
• Confetti-like lesions of TS
• Xeroderma pigmentosum
• In associated with punctate PPK (Cole disease)
• Pitryasis alba
• Tinea versicolor
• Frictional lichenoid dermatosis (minimally elevated flat-topped
papules)
• Clear cell papulosis (minimally elevated flat-topped papules)

Source: bolognia

• Segmental nevus depigmentosus/pigmentary mosaicism

• Multiple nevus depigmentosus
Child with 3 or more • PIH
hypomelanotic • Piepaldism
macules/patches • Vitiligo
• TS

Source: bolognia
 o Childhood
• Focal dermal hypoplasia (Goltz’s syndrome)
• Hypomelanosis of Ito/linear nevoid hypopigmentation
• Incontinentia pigmenti (stage IV)
• Nevus depigmentosus
• Linear darier disease
• Epidermal nevus
• Conradi-Hunermann-Happle syndrome

o Acquired
• Lichen striatus
• Linear lichen sclerosus
• Segmental vitiligo
• Pigmentary demarcation line (type C)
• Epidermal nevus
• Intralesional steroids
• Morphea
Linear
hypopigmentation Other differential diagnosis categories

o Lesions usually follow lines of Blaschko

• Hypomelanosis of Ito/linear nevoid hypopigmentation
• Lichen striatus
• Focal dermal hypoplasia (Goltz syndrome)
• Menkes kinky hair disease (female carrier)
• Conradi-Hunermann-Happle syndrome
• Epidermal nevus
• Linear lichen sclerosus
o Lesions may follow lines of Blaschko
• Segmental vitiligo
• Segmental ash leaf spot
• Incontinentia pigmenti (stage 4)
o Lesions do not follow lines of Blaschko
• Linear hypopigmentation secondary to intralesional steroids
• Pigmentary demarcation lines, type C

Source: bolognia

o Mnemonic “Vitiligo nevus PATCH”

• Vitiligo
• Nevus depigmentosus, nevus anemicus, halo nevus
• Pityriasis alba, post-inflammatory hypopigmentation,
piebaldism, pinta
• Age-related (e.g. idiopathic guttate hypomelanosis)
White spots • Tinea versicolor
• Tuberous sclerosis (ash-leaf macules)
• Congenital birthmark (e.g. hypomelanosis of Ito)
• Hansen’s disease (leprosy)
• Other: hypopigmented sarcoid, hypopigmented CTCL,
leukoderma (leukoderma of melanoma, chemical leukoderma,
drug induced leukoderma, leukoderma of scleroderma), late
stages of treponematosis and onchoceciasis
 o Eyes, skin and hair:
• OCA
• Hermansky-pudlak syndrome
• Chediak-higashi syndrome
• Cross syndrome
• Tietz syndrome
• Phenylketonuria
• Histidinemia
Diffuse pigmentary
• Homocystinuria
dilution at birth or
o Skin and hair:
during infancy
• Menkes syndrome
• Griscelli syndrome
• Nutritional deficiencies (ex. Selenium, copper)
• Ectodermal dysplasia
• Apert syndrome
• Pseudothalidomide syndrome
• Sialic acid storage disease

Source: bolognia

o Follow Blaschko line

• Inherited or early onset;
! Linear and whorled nevoid hypermelanosis
! IP stage 3
! Early epidermal nevus
! CALMs of McCune Albright syndrome (more often broad
bands or block-like)
! Goltz syndrome
! Conradi-hunermann-happle syndrome
! X-linked hypohidrotic ectodermal dysplasia
! Chimerism (more often block-like or ill-defined pattern)
! X-linked reticulate pigmentary disorder
• Acquired/often later onset
! Linear LP
! Linear LP pigmentosus
Linear ! Linear FDE
hyperpigmentation ! Linear atrophoderma of Moulin
! Possibly linear morphea
! PIH due to blaschkitis
! Linear biphasic cutaneous amyloidosis

o Does not follow the lines of Blaschko

• Pigmentary demarcation lines
• Linea nigra
• Phytophotodermatitis
• Flagellate hyperpigmentation
• Serpentine supravenous hyperpigmentation (ex. From phlebitis,
IV drug use, systemic sclerosis
• Linear post-inflammatory hyperpigmentation (excoriations,
trauma/abuse, burns, ACD “esp. plants”, koebnerized lesions
“ex. Psoriasis, lichen planus”, coining)

Source: bolognia
 • Bleomycin
Flagellate • Shitake dermatitis (mushroom)
• Persistent plaques of still disease (adult onset)
• Dermatomyositis
• Abuse
• Dermatographisim
• Phytophotodermatitis
• Jelly fish sting
• Poison ivy dermatitis
• Digitated lesion of small plaque parapsoriasis

o Infancy and childhood

• Dyskeratosis congenita
• Naegali–Franceschetti–Jadassohn syndrome
• Dermatopathia pigmentosa reticularis
• Dyschromatosis hereditaria universalis
• X-linked reticulate pigmentary disorder
• EBS with mottled pigmentation
• Fanconi anemia
• Mendes de costa
• Cantu syndrome
Reticulated
hyperpigmentation
o Adolescence and adulthood
• Confluent & reticulated papillomatosis (elevated and rough)
• Erythema ab igne
• Dirty neck in atopic dermatitis
• Prurigo pigmentosa
• Dowling–Degos disease (DDD), Galli–Galli disease (acantholytic
variant DDD), Haber syndrome (rosacea like plus DDD
features), pigmento reticularis facei et colli (possible variant of
DDD)
• Reticulate acropigmentation of Kitamura
• Mitochondrial disorders
• Cantu syndrome
• PIH (Lichenoid dermatoses ex. LPP, contact dermatitis ex.
Benzyl peroxide)
• Drug-induced (diltiazem on sun-exposed, 5-FU, bleomycin)
• Dyschromic amyloidosis cutis

Source: bolognia

• Dermal melanocytosis (ex. mongolian spot, Ito/Ota/blue nevus)

• Fixed drug eruption
• Argyria (silver deposition)
• Chrysiasis (gold depostition)
Blue-gray • Minocycline pigmentation, other drugs (hydroxychloroquine,
pigmentation chloroquine, imipramine, thorazine, amiodarone, clofazimine)
• Ochronosis (accumulation of homogentisic acid due to defect in
H.A. oxidase), exogenous ochronosis from hydroquinone use
• Tattoo (graphite, etc.)
• Erythema dyschromicum perstans (Ashy dermatosis)
• Maculae cerulae (said to be seen with pediculosis pubis)
Lesions following
Langer lines • Pityriasis rosea
• Ashy dermatosis
• Kaposi sarcoma
• Lesar trelat sign
• PLC

• Lichen striatus
• Epidermal nevus
• ILVEN (inflammatory linear verrucous epidermal nevus)
• Linear and whorled hypermelanosis
• Hypomelanosis of Ito
• Incontinentia pigmenti
• Focal dermal hypoplasia (Goltz syndrome)
Lesions following
• Conradi-Hunermann Syndrome
blaschko lines
• CHILD “Congenital Hemidysplasia with Icthyosiform nevus and
Limb Defects”
• Porokeratotic eccrine ostial and dermal duct nevus
• Linear versions of non-linear diseases: psoriasis, Darier’s,
porokeratosis, Hailey-Hailey, LP
• Female carriers of X-linked recessive disorders: menke’s kinky
hair, partington amyloidosis

o Mnemonic (ABCDEPR)
• Pits only:
! Basal cell nevus syndrome
! Basaloid follicular hamartoma syndrome
Palmar pits and ! Ectodermal dysplasia
keratosis • Pits and keratoses:
! Arsenical keratosis
! Keratosis punctuate of palmar creases (punctate
keratosis of palmar creases)
! Porokeratotic eccrine ostial and dermal duct nevus
! Darier
! Acrokeratosis verruciformis of hopf
! Pitted keratolysis
! Associated with Dupuytren contracture
• Keratoses but may leave a pit upon removal of the keratotic
plug:
! Porokeratosis palmaris et planteris (punctate
porokeratoses)
! Punctate keratoses of palms and soles (punctate PPK)
! Cowden’s syndrome
! Reticulated acropigmentation of kitamura
! Warts
 • Chronic renal failure
• Graft-vs-host disease
• HIV infection
• Hyperparathyroidism
• Hypothyroidism
• Leprosy
Acquired ichthyosis • Sarcoidosis
• Malnutrition
• Mycosis fungoides
• Systemic lupus erythematosus
• Systemic lymphomas
• Medications (ex. cimetidine, clofazamine, hydroxyurea,
isoniazid, nicotinic acid, retinoids, statins)

• Lichen planus (lacy white plaques of MM with LP), lichenoid

drug eruption (medication hx), lupus erythematosus (clinical
setting), GVHD (clinical setting)
Desquamative • Autoimmune bullous disorders (erosions, ulcers, and
gingivitis vesicles/bullae of MM); MMP (smooth but irregular ulcers), PV,
PNP (ragged ulcers)> EBA, BP, LABD
• EM, FDE (erosions, ulcers, and some vesicles/bullae of MM,
recurrent episodes)
• Contact dermatitis (allergic or irritant)
• Lichenoid contact stomatitis, lichenoid foreign body gingivitis
• Chronic ulcerative stomatitis

Source: bolognia

o Common:
• Actinic
• Irritant contact
• Atopic

Cheilitis o Less common:

• Allergic contact
• Candidal cheilitis
• LP and GVHD
• Granulomatous cheilitis

Source: bolognia

• Verrucae
• Focal epithelial hyperplasia (Heck’s disease)
• Traumatic fibromas
Oral papilloma • Mucosal neuromas of MEN 2B
• Papillomas of Goltz syndrome
• Papular lesions of lipoid proteinosis
• Tuberous sclerosis, papillomas of CD
 o Systemic medications:
• Common "anticonvulsants (ex. phenytoin), CCB (ex. nifedipine),
cyclosporine”
• Uncommon "antibiotics (erythromycin, cotrimoxazole),
Gingival enlargement sertraline, lithium, OCPs, estrogen, amphetamines"
(hypertrophy, o Local inflammatory factors (periodontal disease, poor oral hygiene)
hyperplasia) o Hormone-related (pregnancy, acromegaly)
o Granulomatous (orofacial granulomatosis, crohn’s, sarcoidosis)
o Wegner’s granulomatosis
o Vitamin C deficiency (scurvy)
o Multiple gingival fibromas (tuberous sclerosis, Cowden disease,
hereditary gingival fibromatosis)
o Leukemia (AML, AMML> other leukemia)
o Other malignancies; Kaposi sarcoma, metastases esp. breast
carcinoma, prostate, colon, kidney, or lung
o Deposition (primary systemic amyloidosis, infantile systemic
hyalinosis, mucopolysaccharidoses, fucosidosis, Fabry disease)

Source: bolognia

o Developmental:
• Congenital inclusion cysts (bohn nodules on alveolar ridge,
Epstein pearls on palate), orus palatinus/mandibularis, lingual
thyroidL dermoid cyst, nasolabial cysts, enteric duplication cyst,
lymphoepithelial cyst, lymphatic/vascular malformation

o Reactive/inflammatory:
• Mucocele, fibroma, oral melanoacanthoma, eosinophilic ulcer,
PG, peripheral giant cell granuloma, necrotizing sialometaplasia,
nodular fasciitis

o Benign salivary gland neoplasms:

• Pleomorphic adenoma, monomorphic adenoma, papillary
Intra-oral tumors and
cystadenoma
tumor-like lesions
• Other benign neoplasms:
• Squamous papilloma, infantile hemangioma, angiomyoma,
myofibroma, hemangiopericytoma, granular cell tumor,
neurofibroma, schwannoma, ameloblastoma, lipoma, melanotic
neuroectodermal tumor of infancy, palisaded encapsulated
neuroma

o Malignant neoplasms:
• Salivary neoplasms; adenoid cystic carcinoma, mucoepidermoid
carcinoma, adenocarcinoma
• SCC, Melanoma, lymphoma, KS, plastocytoma,
rhabdomyosarcoma, osteosarcoma, fibrosarcoma, liposarcoma

Source: bolognia
 o Causes/differential diagnosis:
• Idiopathic
• Underlying systemic disorder (IBD, celiac disease, SLE, HIV,
Behcet, reactive arthritis, cyclic neutropenia, PFAPA, hereditary
Recurrent apthae periodic fever syndromes, MAGIC syndrome, autoimmune
bullous disease, oral erosive LP, drug-induced “ex. Nicorandil”)
• EM, FDE, contact stomatitis, recurrent herpes simplex, trauma
• Nutritional disorder (B12, folate, or iron)

Source: bolognia/uptodate

o Acute:
• Angioedema
• Ascher syndrome
• Allergic / irritant contact dermatitis
• Dental abscess, odontogenic infection
• Trauma & lip contusion
• Herpes labialis

Lip swelling o Chronic:

• Primary: Cheilitis granulomatosa, Melkersson–Rosenthal,
Actinic Cheilitis
• Systemic: Crohn disease, sarcoidosis, orofacial granulomatosis
• Infectious: TB , leishmaniasis, rhinoscleroma
• Neoplasms: Salivary gland tumours, hemangioma,
lymphangioma, microcytic adnexal carcinoma, paraffinoma ,
SCC
• Metabolic: Acromegaly & myxedema, amyloidosis

• Relapsing polycondritis
• Pseudolympoma
• Arthropoid reaction
Erythematous ear • Lymphoma
swelling • Hemangioma
• AV malformation
• Rosacea
• Leprosy

• Bcc
• SCC
• AK
• Horn
Ear nodule • Keratoakanthoma
• Chondrodermatitis nodularis helicis
• Gouty tophi
• Calcinosis cutis
• Reactive perforating collagenosis
 • Earlobe dermatitis- nickle earrings
• Discoid Lupus
• Acanthoma fissuratum “spectacle frame acanthoma”
• Relapsing polychondritis- beefy red cartilaginous portion with
normal earlobe
• Gouty tophi
Things with a • Ochronosis- lack of homogentisic acid oxidase in alkaptonuria
predilection for ear causes HA deposition in cartilage
• Lepromatous leprosy- M leprae likes cool temperatures ex. ear
• Chondrodermatitis nodularis helicans
• Angiolymphoid hyperplasia with eosinophilia
• Pseudocyst of the Auricle
• Ramsay-Hunt syndrome-HSV of the ear, cranial nerves 7 & 8
• Chiclero Ulcer- leishmaniasis of the ear

• Atrophoderma of Pasini and Pierini: loss of dermal connective

tissue, “cliff-like” border
• Anetoderma: loss of elastic tissue “macular atrophy”
• Lupus Profundus (lupus panniculitis): deep nodules heal with
depressions from loss of panniculus
Depressed/indented
• Panniculitis: any form can heal with depressions/indentations
lesion
• Morphea: firm, sclerotic, “bound down” plaques, sometimes
depressed below surrounding skin
• Lipodystrophy
• Steroid Atrophy: mostly s/p local injection
• Scars

• Neoplastic/cysts:
Eruptive syringoma, multiple vellus hair cysts, steatocystoma
multiplex, histiocytosis, mastocytosis
• Inflammatory/granulomatous:
Dermal papules
Papular GA, sarcoidosis, dermal hypersensitivity reaction,
(multiple)
papular urticaria, insect bites
• Depositional/infectious:
Papular mucinosis, eruptive xanthoma, lichen amyloidosis,
papular syphilis

• Tinea pedis
• Candida
Toe web scale • Erythrasma
• Gram negative web space infection
 o Endogenous:
• AD
• Seborrheic dermatitis
• Ocular rosacea
• DM>lupus
Eyelid dermatitis
o Exogenous:
• ACD (fragrances, preservatives, topical abx, metals,
~airborne)
• ICD

Source: bolognia

• Urticaria
• Urticarial drug reactions
• Arthropod bites and papular urticarial
• Urticaria multiforme
• Serum sickness-like reaction
• Autoinflammatoru disease (ex. Periodic fevers)
• Still disease (adult onset)
Urticaria
• Schnitzler syndrome
• Viral exanthema
• Kawasaki disease
• Sweet syndrome
• Urticarial phase of bullous pemphigoid
• Urticarial vasculitis
• Urticaria pigmentosa (urticarial upon rubbing)

• MF
• Sarcoidosis
• Secondary syphilis
• HIV
Great mimickers
• Histiocytosis
• Cutaneous lupus
• Drug eruption
• Leishmania

• Malignancies (BCC, SCC, nasal NK/T-cell lymphoma)

• Infections (Chronic herpes simplex, leishmania spp., dimorphic
fungi)
Non-healing facial
• Inflammatory disorders (Granulomatosis with polyangitis
ulcer
"Wegner", pyoderma gangernosum)
• Factitial disease

Source: bolognia
 o Mnemonic “VITAMIN H”
• Vascular:
! Arteriosclerosis, emboli (bacterial, cholesterol),
hypertension
! Vasculopathies (livedoid vasculopathy, Buerger’s disease)
! Vaso-occlusive (cryoglobulinemia, cryofibrinogenemia,
calciphylaxis, oxalosis)
! Hypercoagulable states (protein S or C deficiency, factor V
leiden, antithrombin III deficiency, APS)
! Venous
• Infectious:
! Bacterial (ecthyma, ecthyma gangrenosum, anthrax,
actinomycosis, septic emboli, gram negative, anaerobic,
treponemal)
! Mycobacterial (leprosy, atypical mycobacteria, lupus
vulgaris)
! Viral
! Fungal (dimorphic, opportunistic)
! Parasitic (leishmaniasis, amebiasis)
• Traumatic:
! Burns, cold injury, radiation, trauma, pressure, factitial, bites
and stings
• Arterial
• Metabolic:
! Calcinosis cutis, gout, LAD, Werner’s syndrome (AD),
Ulcers
prolidase deficiency (AR), klinefelter syndrome
• Medications:
! Hydroxyurea “lower limbs”
! MTX “psoriatic plaques”
! Warfarin “fatty areas”
! Heparin “sites of injection and distant sites”
! All-trans-retinoid-acid
! SC injection “IFN, glatiramer acetate”
! IM injection “NSAIDS, penicillin, hydroxyzine, citamin K,
chlorpheniramine, bismuth salts”
• Idiopathic/Inflammatory:
! PG
! Vasculitis (behcet, idiopathic, HSP, RA, mixed
cryoglobulinemia, lupus, PAN, wegner)
! Systemic sclerosis, raynaud
! NLD
! Panniculitis (AAT, erythema induratum, pancreatic)
• Neoplastic:
! BCC, SCC, metastases, KS, angiosarcoma, CTCL, BCL
• Neuropathic:
! DM, leprosy, tabes doraslis, syringomyelia
• Hematologic:
! SCA, thalassemia, spherocytosis, thrombocytosis,
polycythemia

Source: bolognia/uptodate
 • Diabetes mellitus
• Leprosy
• Necrotizing fasciitis
• Polyneuropathy
• Tabes doralis
Painless ulcer
• Syringomyelia
• Lymphogranuloma venereum
• Anthrax
• Syphilitic chancre/gumma
• Trigeminal trophic ulcer

o Infectious etiologies;
• Sexually transmitted;
! Painful; herpes simplex, chancroid (Haemophilus ducreyi)
! Painless; syphilitic chance (Treponema pallidum),
lymphogranuloma venereum (Chlamydia trachomatis),
granuloma inguinale (klebsiella granulomatis)
! HIV
• Non-sexually transmitted;
! Genital apthae (reactive non-sexually related acute genital
ulcers triggered by infections ex. EBV/CMV/mycoplasma)
! Tuberculosis, candidiasis, impetigo
o Non-infectious etiologies;
Genital • Lichen sclerosus, erosive lichen planus
erosions/ulcers • Acquired bullous: PV, BP, MMP, LABD, EBA, EM
• Inherited bullous: HHD, EB
• Drug: SJS, FDE, TEC
• SCC, intraepithelial neoplasia, other malignancies
• Zoon plasma cell balanitis/vulvitis
• Complex apthosis; behcet, IBD
• Crohn’s disease
• EMPD
• LCH
• Necrolytic migratory erythema
• Acrodermatitis enteropathica
• Trauma

Source: bolognia/uptodate

o Mnemonic “FAINT with psoriatic lesion balanitis)

• FDE, SJS, TEN, EM major, other drug-related (ex. Foscarnet
causing penile ulcers), Folliculitis
• ACD/ICD, angiokeratoma, acrochordons
• Infections (STDs/non-STD ulcers, warts, condylomata lata),
Penile/scrotal lesions Idiopathic scrotal calcionosis
• Neoplasms (ex. SCC, EMPD, bowenoid papulosis)
• Trauma, Tyson glands (ecotopic sebaceous glands)
• Psoriasis, PRP, pearly penile papules
• Lichen planus, lichen nitidus, lichen sclerosus,
• Zoon’s balanitis, circinate balanitis (reactive arthritis),
Bannayan-Riley-Ruvalcaba syndrome (penile lentigines)
 • Infectious: HSV, CMV (Iimmunocompromised), coxsackie (hand,
foot & mouth), herpangina, acute HIV, syphilitic
chancre/mucous patch, histoplasmosis, paracoccidiomycosis
• Inflammatory: Aphthae stomatitis, SLE, Behcet, lichen planus,
erythema multiforme major, SJS, FDE, hyper-eosinohplic
syndrome, eosinophlic ulcer of the oral mucosa, wegner’s
granulomatosis (oral), Marshall syndrome, hereditary periodic
fever syndromes, chronic GVHD, primary immunodeficiencies
Oral (+/- genital
(ex. hyperIgM), cyclic neutropenia, PFAFA syndrome, MAGIC
ulcers)
syndrome
• Malignant: SCC
• Drugs: ex. Methotrexate, chemotherapy/radiotherapy-induced
oral mucositis, nicorandil
• GI: IBD, celiac, bowel associated-dermatosis-arthritis syndrome
• Bullous: pemphigoid (ex. cicatricial pemphigoid), pemphigus
(ex. Pemphigus vulgaris, paraneoplastic pemphigus)
• Trauma, contact stomatitis

• Hemorrhage: trauma, solar (actinic) purpura, medication-

related (i.e. aspirin, topical or systemic corticosteroids),
thrombocytopenia and platelet dysfunction, coagulopathies,
viral exanthems (e.g. enterovirus, parvovirus B19), scurvy,
primary systemic amyloidosis
• Thromboses: hypercoagulable state (e.g. antiphospholipid
antibody), livedoid vasculopathy, purpura fulminans (e.g. due to
sepsis/DIC), heparin necrosis,warfarin (Coumadin®) necrosis,
Purpuric
thrombotic thrombocytopenic purpura. hemolytic uremic
macules/patches
syndrome, paroxysmal nocturnal hemoglobinuria
• Emboli: cholesterol, cardiac (infective endocarditis ≫
myxomatous or marantic), fat, air
• Cold-related gelling: cryoglobulins (primarily type I)
• Inflammation: pigmented purpura (capillaritis),
hypergammaglobulinemic purpura of Waldenström
• Infection: lucio phenomenon (leprosy), strongyloidiasis

Source: bolognia

• Infectious: SBE, RMSF, Gonococcemia, sepsis, hep C-

cryoglobulinemia
• Collagen vascular: LCV, PAN, SLE, Wegner
• Emboli: left atrial myxoma, cholesterol emboli, aneurysm
Purpura (Acral) • Vaso-occlusive: atherosclerosis, antiphospholipid syndrome,
sneddon syndrome
• Dysproteinemia: cryoglobulinemia, cryofibrinogenmia,
waldenstrom macroglobulinemia
• Physical: pernio/chillblains, frostbite
 • Vasculitis
• Arthropod bites
• Morbilliform drug eruption with hemorrhage in dependent sites
• EM
• PLEVA
Palpable purpura • Infectious emboli (septic vasculitis) due to bacteria (ex. N.
meningococcus; acute meningococcemia), rickettsiae, fungi (Ex.
Rhizopus)
• Lichenoid capilliritis (pigmented purpura)
• Cellulitis

Source: bolognia

o Congenital: cutis marmorata telangiectatica congenita

o Acquired:
• Vasospasm: physiologic, primary/idiopathic, autoimmune CTD
(ex. SLE), Raynaud (ex. SSc)
• Vessel wall: Vasculitis “PAN, cryoglobulinemic (type 1),
autoimmune CTD (ex. SLE, RA, Sjogren)”, calciphylaxis, Sneddon
syndrome, Adenosine deaminase 2 def, Livedoid vasculpathy
• Intra-luminal:
- Increased blood components: thrombocythemia, polycythemia
- Abnormal proteins: cryoglobulinemia, cryofibrinogenemia,
cold agglutinins, paraproproteinemia
Livedo-reticularis
- Hypercoagulability: APS, protein C/S/Antithrombin III
deficiency, Factor V Leiden mutation, homocystinuria, DIC, TTP
- Embolic: cholesterol, septic, atrial myxoma, nitrogen
(decompression sickness), carbon dioxide arterography
- Hyperoxaluria
- Intralymphatic histiocytosis
• Infections: ex. Hep C “vasculitis”, mycoplasma spp.”cold
aggultinins”, syphilis, TB, rheumatic fever
• Neoplasms: pheochromocytoma
• Drug-induced: amantadine, noreepi, interferon
• Neurologic: reflex sympathic dystrophy, paralysis, moyamoya

Source: bolognia

• Arterial occlusive disease, including atherosclerosis

• Diabetes mellitus
• Thromboangiitis obliterans (Buerger disease)
• Systemic sclerosis
• Emboli (e.g. cholesterol, septic)
• Cryoglobulinemia (type I) > cryofibrinogenemia or cold
agglutinin disease
Digital gangrene
• Thrombosis (e.g. antiphospholipid syndrome, purpura
fulminans, myeloproliferative thrombocytosis)
• Calciphylaxis
• Hypereosinophilic syndrome
• Paraneoplastic acral vascular syndrome (e.g. with lung or
ovarian carcinoma)

Source: bolognia
 • Infectious: fungal (disseminated candidiasis, aspergillosis,
fusarium, mucromycosis), bacterial (anthrax, necrotizing
fasciitis, ecthyma gangrenosum, meningococcemia, vibrio,
clostriudium perfringes, secondary syphilis, scrub typhus,
tularemia, rickettsial infections), viral (cowpox, orf), parasites
(leishmania)
• Bites (brown recluse spider)
• Vascular: emboli (cholesterol, septic), APS, purpura fulminans,
myeloproliferative thrombocytosis, buerger’s disease, arterial
occlusive disease, vasculitis (ex. PAN), cryoglobulinemia (type
1)> cryofibrinogenemia
Gangrenous or
• Drugs: warfarin necrosis, heparin necrosis
blackish eschar
• Other: calciphylaxis, systemic sclerosis, Raynaud, PG,
hypereosinophilic syndrome, burn
• Neoplastic: SCC, metastasis

o Mnemonic “CAGERS” for black eschar differential

• Clostridium
• Aspergillus (Deep fungal)/Anthrax
• Group B strep
• Ecthyma gangrenosum
• Ricketssial spotter fevers
• Spider bite

o Structural vasculopathies;
• Large and medium BVs (thoracic outlet syndrome, takayasu
arteritis, atherosclerosis of brachiocephalic trunk, Buerger
disease, crutch pressure)
• Small BVs (SSc, SLE, DM, overlap syndromes, cold injury,
vibration disease, chemotherapy, vinyl chloride disease, arsenic
poisoning)

o Normal blood vessels with abnormal blood elements;

• Cryoglobulinemia, cryofibrinogenemia, cold aggulutinin
• Myeloproliferative (ex. Essential thrombocythemia)
Raynaud ‘s
o Normal blood vessels with abnormal vasomotion;
• Primary idiopathic
• Drug-induced (ergot alkaloids, bromocriptine, interferon,
estrogen, CsA, sympathomimetic, cocaine, nicotine, clonidine)
• Carpal tunnel syndrome
• Pheochromocytoma
• Carcinoid syndrome
• Reflex sympathetic dystrophy
• Other vasospatic disorders (Ex. migraine, prinzmetal

Source: bolognia

Skin lesions induced by
non-freezing cold
exposure
Source: bolognia
Red transient eruption
Transient exanthem
with fever and arthritis
Itchy red bumps
Darier sign
• Acrocyanosis (associated conditions; erytheromelalgia,
cryoproteins, anorexia nervosa)
• Pernio
• Raynaud (associated conditions; AI-CTD, blood dyscrasias,
drugs, trauma)
• Livedo reticularis (associated conditions; AI-CTD, hematologic
disorders, vascular occlusive diseases, infections, medications)
• Cold panniculitis
• Cold urticarial (associations; cryoproteins, infections,familial
cold autoinflammatory syndromes)
• Chilblain lupus
• “Pulling boat hands”
• Retiform purpura due to cryoproteins (cryoglobulin,
cryofibrinogen)
• Cold agglutinins (associations; infections ex. EBV, CMV,
lymphoproliferative disorders)
• Cold hemolysins (infections ex. Viral, syphilis)
• Carcinoid syndrome
• Pheochromocytoma
• Urticaria
• Erythromelalgia
• Still’s disease
• Raynaud’s
• Rheumatic fever
• Rheumatic fever
• Urticarial vasculitis
• Serum-sickness like reaction
• Hereditary periodic fever syndrome
• Scabies
• Atopic dermatitis
• Insect bite reaction
• DH
• Contact dermatitis
• Grover
• Papular urticarial/dermatographism
• Prurigo simplex
• Dermal hypersensivity reaction
• Cutaneous mastocytosis
• Leukemia cutis, Lymphoma (CTCL, NHL)
• JXG
• LCH
• Papular urticarial
 o Annular scaly plaques
• Tinea corporis
• PR
• Annular LP
• Annular psoriasis
• Annular CTCL
• Annular secondary syphilis
• EAC (superficial)
• SCLE, neonatal LE
• Porokeratosis
• Erythema gyratum repens
• Elastosis perforans sepiginosa
• Lichen scrofulosorum (tuberculid)

o Annular non-scaly plaques

• Granuloma annulare
• Actinic granuloma, granuloma faciale
• Annular elastolytic giant cell granuloma
• Annular sarcoidosis
• Leprosy (borderline or tuberculoid)
• TB (lupus vulgaris)
• Lupus tumidus, Jessner’s lymphocytic infiltrate
• Annular urticarial
• Urticaria vasculitis
Annular lesions • Erythema migrans
• Erythema marginatum
• EAC (deep)
• EM
• Annular erythema of infancy
• Neutrophilic sebaceous adenitis
• Interstitial granulomatous dermatitis
• Annular lichenoid dermatitis of youth
• Drug eruption

o Annular vesicles/pustules
• Linear IgA dermatosis
• Sneddon-Wilkinson disease
• Annular pustular psoriasis
• Eosinophilic pustular folliculitis

o Purpuric
• Purpura annularis telangiectoides
• Acute hemorrhagic edema of infancy
• HSP
• Urticarial vasculitis

o Perforating
• Elastosis perforans serpiginosa

Source: bolognia/uptodate
 o Mnemonic “PLEAS MET”
• Psoriasis
• PLC
• PR
• Parapsoriasis
• PRP
• Lichen planus/lichenoid reactions
• Eczema
Red and scaly
• AK
(papulosquamous)
• SCLE
• Syphilis
• Seborrheic dermatitis
• MF
• Medication (Drug eruptions)
• EAC
• Tinea corporis
• Tinea versicolor

o Ostraceous/micaceous scale; psoriasis

o Mica-like/wafer-like scale; PLC
o Collarette scale;PR
o Sandpaper-like gritty scale; AK
o Greasy scale; seborrheic dermatitis
o Trailing scale; EAC (superficial)
o Leading scale; tinea corporis
o Furfuraceous/powdery/bran-like; tinea versicolor
o Ribbon-like/cornoid lamella; porokeratosis
Types of scales
• Double-edged scale; icthyosis linearis circumflexa
• Icthyosiform scale; icthyosis vulgaris
o Corrugated/ridged scale; bullous icthyosiform erythroderma
o Plate-like (armor plate)/lamellar scale; lamellar icthyosis
o Cornflake scale; pemphigus foliaceous
o Crack-like/craquele; eczema craquele
o Exfoliative scales; drug reaction
o Follicular scales; KP

Source: Fitzpatrick/bolognia/uptodate/”scars in dermatology” ijdvl

o Childhood
• IP stage 2
• ILVEN
• CHILD syndrome
• Conradi-hunermann syndrome
• Epidermal nevus
Scaly/raised linear
o Acquired
lesions
• Linear psoriasis
• Linear LP, Lichen striatus
• Linear porokeratosis
• Linear darier
• Linear lupus
• HSV, warts
 • Psoriasis
• Lichen planus
• Lichen nitidus
• Cutaneous small vessel vasculitis
• Still disease
• Lichen sclerosus
• Vitiligo
• Eruptive xanthoma
• Sweet’s syndrome
• EM
• PRP
• Systemic onset JRA
Disorders that display • Perforating disorders
koebner phenomenon
o Boyd-Nelder classification of the Koebner phenomenon
• Category I (true koebnerization)
Psoriasis, lichen planus, vitiligo
• Category II (pseudo-koebnerization)
Warts, molluscum contagiosum, pyoderma gangrenosum
• Category III (occasional lesions)
Darier disease, erythema multiforme, Behcet’s disease, KS
• Category IV (poor or questionable-induced processes)
Pemphigus vulgaris, eczema, lichen nitidus, DH

o Reverse koebnerization: reverse koebnerization is seen when an

area of psoriasis clears following injury

• Candidiasis
• Darier’s disease
• Dyskeratosis congenital
• Frictional keratosis
• Oral florid papillomatosis
Oral leukoplakia
• Oral hairy leukoplakia
• Pachyonychia congenital
• Proliferative verrucous neoplasia
• Squamous cell carcinoma
• White sponge nevus

• Melasma, melasma like DLE

• PIH
• PDL
• LP pigmentosus, actinic LP
• Ashy dermatosis (rarely to involve face, usually spare it )
Facial pigmentation • Bilateral nevus of ota (hori’s nevi)
• Erytheromelanosis facei
• Pigmented contact dermatitis
• Exogenous ochronosis (hydroquinone)
• FDE
• Drug induced (minocycline, amidarone)
 • Erythrasma
• LP pigmentosus
• Acanthosis nigrican s
Axillary pigmentation
• Alkaptonuria
• Dowling degos (reticulated)
• NF crowe’s sign (axillary freckling)

• DPN
• Sarcoidosis
• Syringoma
• Acne agminata (lupus miliaris disseminata facei)
• Amyloid (usually with purpura)
Periorbital • Granulomatous rosacea
papules/facial papules • Hidrocystoma (apocrine, eccrine)
• Periorificial dermatitis (granulomatous or non-granulomatous
variants)
• Xanthelasma
• Trichoepithelioma
• Tricholemmoma

• Basal cell carcinoma

• Acrochordon, DPN
• Dermatofibroma
• Verruca vulgaris / plana, molluscum contagiosum
• Syringoma
• Melanocytic nevi
Flesh-colored facial • Trichoepithelioma, trichofolliculoma
papules • Neurofibroma
• Nevus lipomatous superficialis
• Colloid milium
• Sebaceous hyperplasia
• Metastatic lesions
• Lipoid proteinosis
• Hidrocystoma (Apocrine, Eccrine)

• Keratosis pilaris
• Lichen planopilaris (follicular lichen planus)
• Pityriasis rubra pilaris (“nutmeg grater”)
• Follicular eczema
• Phrynoderma (vitamin A deficiency): “toad-skin”
• Lichen spinulosus
• Follicular mucinosis (alopecia mucinosa)
Follicular papules
• CTCL
• Perforating folliculitis
• Kyrle’s disease (both follicular and non-follicular papules)
• Traumatic anserine folliculosis (“traumatic gooseflesh”)- at sites
of repeated pressure
• Disseminated recurrent infundibulofolliculitis
• Reactive follicular hyperkeratosis:
• Myeloma, lymphoma, AIDS, Crohn’s disease
 • Fungal infections: cryptococcosis, coccidiomycosis,
histoplasmosis, penicillosis
• Molluscum contagiosum
• Sebaceous hyperplasia
• Varicella/herpes zoster, herpes simplex, eczema herpeticum
Umbilicated lesions
• Smallpox, monkey pox, milker’s nodule, orf
• Hydroa vacciniforme
• Umbilicated GA
• Neutrophilic palisading dermatitis
• Chronic LP

• Infectious: papulonecrotic TB, scabies, varicella,

meningococcus, gonococcus, sporotrichosis, tularemia
• Traumatic: facticial, insect bite
Papulonecrotic
• Idiopathic: lymphomatoid papulosis, PLEVA, Degos’ disease,
prurigo nodularis
• Vascular: vasculitis, PAN, Wegner’s

• Malignancy:
CTCL, parapsoriasis (poikloderma atrophicans vasculare)
• CTD/autoimmune:
Lupus, DM, MCTD, chronic GVHD
• Genodermatosis:
Rothmund-thomson, bloom syndrome, dyskeratosis
Poikloderma 31igerians31, cockayne, kindler, werner’s, XP, hereditary
sclerosing poikloderma of weary, ataxia telangictasie,
poikloderma with neutropenia, goltz syndrome
• Infection:
Lyme (acrodermatitis chronic atrophicans)
• Physical agents: actinic damage, poikloderma of civatte, chronic
radio-dermatitis, steroid overuse

• HS, acne conglobate, pilonidal sinus

• Cutaneous Crohn’s disease
• Pyoderma faciale
• Infectious diseases: mycetoma, actinomycosis, nocardiosis,
scrofuloderma, bacterial lymphadenitis, coccidioidomycosis,
botromycosis, chromoblastomycosis, myiasis,
Draining/sinus tracts lymphogranuloma venerum, osteomyelitis, sporotrichosis,
syphilitic gumma, prothecosis
• Panniculitis: alpha one antitrypsin deficiency, pancreatic
panniculitis, erythema induratum
• Dental sinus, bronchogenic cyst, enterocutaneous fistula, pre-
auricular sinus
• Lymphoma
 • Candidiasis
• Deep fungal (blastomycosis, sporotrichosis)
• Folliculitis: bacterial (gram negative, hot tub), viral (herpetic),
fungal (tinea barbae, majocchi granuloma, malassezia, candida)
• Eosinophilic folliculitis (non-infectious, mostly HIV-related)
• Impetigo
• Acne
• Rosacea
• Pustular psoriasis
• Impetigo herpetiformis (pustular psoriasis of pregnancy)
• Reiter’s syndrome
Pustules
• Pustular drug eruption (AGEP)
• Subcorneal pustular dermatoses (Sneddon-Wilkinson disease)
• IgA pemphigus
• Neutrophilic dermatoses: Sweets, Behcets, pyoderma
gangrenosum, bowel bypass
• Acropustulosis of infancy
• Erythema toxicum neonatorum
• Transient neonatal pustular melanosis
• SSSS
• Pustular miliaria
• Drug induced ex. Bromide, iodide, lithium, steroid

• Pustular psoriasis
• Impetiginzed eczema
• ID reaction
• Tinea
• Candida
• HSV
Pustules in palm and
• Scabies
soles
• Impetigo
• Reiter disease (reactive arthritis)
• Gonorrhea (hemorrhagic and pustules)
• AGEP, sneddon wilkenson
• Dyshidriform pemphigus
• Secondary syphilis

• Generalized pustular psoriasis

Generalized pustular • AGEP
eruption • IgA pemphigus
• Sneddon Wilkinson disease

• Grzybowski syndrome
Multiple • Ferguson-Smith syndrome
keratoacanthomas • Muir-Torre syndrome
• BRAF inhibitor medications
 • Allergic contact dermatitis
• Tylosis
• Acquired plantar keratoderma (keratoderma climactericum)
• Juvenile plantar dermatosis
• Tinea pedis (athlete’s foot)
• Psoriasis
Dermatitis of the foot • Dyshidrotic ecema
• Palmoplantar pustulosis
• Sezary syndrome
• Others:
Atopic dermatitis, irritant contact dermatitis, PRP, acrokeratosis
paraneoplastica, keratoderma blennorrhagicum,
inherited/acquired PPK, crusted scabies

Source: bolognia

• Atopic dermatitis
• Palmoplantar plaque psoriasis
• Palmoplantar pustulosis
• Dyshidrotic eczema
• Allergic contact dermatitis
Dermatitis of the hands
• Irritant contact dermatitis
• Tinea
• Id reaction
• Superimposed S. aureus

Source: bolognia

• Acral mycosis fungoides

• Acrokeratosis paraneoplastica, paraneoplastic keratoderma
• Aquagenic keratoderma
• Arsenical 33igerians
• Calluses/corns
• Confluent HPV infection
• Dyshidrotic eczema
• Eczema
• HIV related
• Psoriasis
• Secondary syphilis
• Sezary syndrome
Acquired PPK
• Systemic lupus erythematosus
• Howell–Evans syndrome
• Hypothyroidism-related keratoderma
• Keratoderma blenorrhagicum
• Keratoderma climactericum
• Leprosy
• Lichen planus
• Norwegian scabies
• Obesity associated
• Pityriasis rubra pilaris
• Tinea manuum/pedis
• Tripe palms
• Tuberculosis verrucosa cutis
 • Self-improving collodion ichthyosis
• Lamellar ichthyosis
• Congenital ichthyosiform erythroderma
• Trichothiodystrophy
• Sjögren–Larsson syndrome
• Infantile Gaucher disease
Collodion baby
• Ichthyosis, intellectual disability, and spastic quadriplegia
• Ectodermal dysplasias (Eds)
• Neutral lipid storage disease
• Conradi–Hünermann–Happle syndrome
• Hay-well syndrome

Source: bolognia

o Mnemonic “HI Blueberry Muffin”

• Hematologic disorders: Hereditary spherocytosis, Rhesus
hemolytic anemia, ABO blood group incompatibility, Twin-twin
transfusion syndrome , chronic fetomaternal hemorrhage,
severe internal bleeding (ICH), severe and chronic prentatal
anemia
• Infections: TORCH (toxoplasmosis, rubella, CMV, HSV),
Blueberry muffin baby coxsackievirus, parovirus
• Benign: multiple hemangiomas
• Malignancy/proliferative states: Congenital
leukemia, Neuroblastoma, Congenital
rhabdomyosarcoma, Langerhans cell histiocytosis , congenital
alveolar rhabdomyosarcoma, hemangiomatosis
• Rarely neonatal lupus

Source: bolognia

• Congenital cutis laxa

Michelin tire baby • Diffuse nevus lipomatosis
• Smooth muscle hamartoma

o Mnemonic “UHAAAALTS”
• Ulerythema ophryogenes
• Hypothyroidism (queen anne’s sign)
• Alopecia areata
• Atopic Dermatitis
• Anhidrotic Ectodermal Dysplasia
Loss of lateral eyebrow
• Alopecia Mucinosa
(Heroghe’s sign)
• Leprosy, lepromatous
• Trichotillomania
• Syphilis
• Other: erythroderma, familial eyebrow 34igerians34, self-
induced or factitical plucking, monilethrix, rothmund thomson ,
noonan, rubinstein tybi syndrome
 • Mosaicism: NF1 “coast of California”, McCune-Albright ”coast of
Maine”
• RASopathies: Legius, Noonan, LEOPARD
• Other: Ataxia telangiectasia, Fanconi syndrome, Bloom
CALMs
syndrome, Rubinstein-Taybi syndrome, Bannayan-Riley-
Ruvalcab
• Tumor predisposition: NF2, TS
• Others: PIH

o Constitutional;
• Familial
• Adrenal SAHA syndrome
• Ovarian SAHA syndrome
• Hyper-prolactinemia

o Endocrine organ-based:
• Adrenal (congenital adrenal hyperplasia, cushing’s syndrome,
adrenal tumors)
• Ovarian (PCOS, hyperthecosis, ovarian tumors)
Hirsutism • Pituitary (cushing disease, prolactin-secreting pituitary
adenoma, psychogenic drugs)

o Ecotopic hormone production:

• ACTH ex. Small cell lung cancer/carcinoid tumor
• HCG ex choriocarcinoma

o Drugs:
• Anabolic steroids (ex. Danazol)
• OCPs of nonsteroidal progestogen type

Source: bolognia

o Congenital:
• Increased hair is the major feature:
Congenital hypertrichosis lanuginose, universal hypertrichosis,
ambras syndrome
• Generalized hypertrichosis with extracutaneous features:
Congenital generalized hypertrichosis with/without gingival
hyperplasia (HCT3), x-linked hypertrichosis, cantu syndrome,
zimmermamm-laband syndrome, coffin-siris syndrome,
Generalized hyper-
schinzel-giedion midface retraction syndrome, gorlin-chaudry-
trichosis
moss syndrome, barber-say syndrome
o Acquired:
• Acquired hypertrichosis lanuginose, drug-induced (most
common; minixodil, phenytoin, cyclosporine), hypothyroidisim,
malnutrition, CNS disorder, POEMS, prepubertal hypertrichosis,
androgen excess disorders (CAH or tumors), advanced HIV
infection, juvenile dermatomyositis, acromegaly

Source: bolognia
 o Congenital:
• Smooth muscle hamartoma
• Congenital melanocytic nevi
• Plexiform neurofibromas
• Becker melanosis
• Fibrous hamartoma of infancy
• Tufted angioma,
• Dermal dendrocyte hamartoma
• Eccrine angiomatous hamartoma
• Nevoid hypertrichosis (primary or secondary)
• Hair collar sign and spinal dysraphism
• Localized hypertrichosis in hereditary systemic diseases (ex.
Hypertrichosis in sun-exposed areas in porphyria,
hypertrichosis in low frontal hairline and unibrow in cornelia
de lange)
Localized hyper-
trichosis o Acquired:
• Post-trauma/friction/irritation (ex. Over fractured limb after
plaster cast, or posterior neck in people who bear heavy
weights)
• Vaccination sites, varicella scars, wart removal site, and laser
epilation (transient localized hypertrichosis)
• Overlying lipoatrophy following lupus panniculitis, resolving
lesions of psoriasis and morphea
• Post-PUVA
• Topical CS, tacrolimus, mercury/iodine creams, sites of
repeated irritation from anthralin, prostaglandin analogues (ex.
Latanoprost)
• Localized hypertrichosis in acquired systemic disease (ex.
Juvenile DM with infrapatellar hypertrichosis, pretibial
myxedema hypertrichosis, indurated plaques of rosai-dorfman
disease, areas affected by reflex sympathetic dystrophy)

o Scarring:
• Lymphocytic (DLE, LLP/FFA, pseudopelade, CCCA, alopecia
mucinosa, KFSD, GVHD)
• Neutrophilic (FD, DC)
• Mixed (acne keloidalis, acne necrotica, erosive pustular
dermatosis)
Alopecia • Other (cicatricial pemphigoid, busulfan-induced alopecia, tinea
capitis “keroin”, late traction alopecia)

o Non-scarring (mnemonic; 4A 5T 1S):

• 4 A: AA, AGA, loose anagen syndrome, anagen effluvium
• 5T: TE, trichtillomania, tractional alopecia (early), temporal
triangular alopecia, tinea capitis
• 1S: Secondary syphilis
 • Acne keloidalis, dissecting cellulitis, folliculitis decalvans
• Chronic lupus erythematosus, lichen planopilaris, CCCA
Tufted folliculitis • Immunobullous disorders
• Thermal burns
• Inflammatory tinea capitis

o Cerebriform melanocytes (intradermal) nevus of the scalp,

pachydermoperiostosis, dissecting cellulitis, systemic amyloidosis,
beare-stevenson cutis gyrata syndrome, acanthosis nigricans of the
neck, acromegaly, multiple cylindromas, connective tissue nevus,
cutis laxa, lipedematous alopecia

o Three categories:
Cutis verticis gyrata • Primary essential (no association)
• Primary non-essential (neurologic abnormalities,
ophthalmologic abnormalities)
• Secondary (diseases dermal infilitration;
acromegaly/pseudoacromegaly, myxedema, insulin resistance,
turner and noonan after resolution of intrauterine lymphedema,
fragile x, klinefelter, TS, HyperIgE, graves, paraneoplastic due to
metastatis, syphilis)

Source: bolognia

• Common:
Irritant contact dermatitis (spares folds, more convex surfaces)
Candidiasis (satellite pustules, favors folds and genitalia)
Seborrheic dermatitis (favors folds, other flexural areas, scalp)

• Less common:
Bullous impetigo
Streptococcal perianal dermatitis (perianal area and folds, no
satellite pustules)
Psoriasis (shiny in folds, scaly on convex surfaces)
Allergic contact dermatitis (holster distribution secondary to
rubber additives in diaper elastics, may affect folds if reaction to
baby wipes or topical preparations)
Diaper eruption Atopic dermatitis (favors skin at diaper margin, convex surfaces,
generally relative sparing of diaper area)

• Rare:
Acrodermatitis enteropathica
Langerhan cell histiocytosis
Other infections (ex. Congenital syphilis, dermatophytosis)
Granular parakeratosis
Early Kawasaki disease
Granuloma gluteale infantum/adultorum
Jacquet erosive diaper dermatitis
Necrolytic migratory erythema (adults)
Extramammary paget disease (Adult)

Source: bolognia
 • Tinea cruris, candida, erythrasma
• Intertrigo, allergic contact dermatitis
• Hailey-hailey disease , atypical darier
• Granular parakeratosis
• Langerhan cell histiocytosis
• Inverse psoriasis, inverse LP, inverse PR,
• Seborrheic dermatitis
• Dowling-degos (reticulated pigmented anomaly of the flexures)
Intertriginous folds in • Inverse tinea versicolor
adults • Bowenoid papulosis
• Extra-mammary paget’s disease
• Zinc deficiency
• Necrolytic migratory erythema (glucagenoma)
• Toxic erythema of chemotherapy
• Symmetric drug related intertrigo and flexural exanthema
• Pemphigus vegetans
• Cutaneous crohn’s disease

Source: bolognia

• Acanthosis nigricans
• Axillary granular parakeratosis
• Allergic Contact dermatitis
• Crowe’s sign of neurofibromatosis
• Dowling–Degos disease
• Erythrasma
• Fox–Fordyce disease
• Granulomatous slack skin
• Hailey–Hailey disease
Axillae • Hidradenitis suppurativa
• Inverse pityriasis rosea
• Inverse psoriasis
• Lymphangiectasias
• Pemphigus
• Plane xanthoma
• Pseudoxanthoma elasticum
• Seborrheic dermatitis
• Tinea versicolor
• Trichomycosis axillaris

• Candidiasis
• Darier’s disease
• Hailey–Hailey disease
• Inflammatory breast cancer
Infra-mammary • Intertrigo
• Inverse psoriasis
• Paget’s disease
• Seborrheic dermatitis
• Tinea corporis
 • Seborrheic dermatitis
• Darier
• Grover
• Pemphigus foliaceus (fogo selvage)
• LCH
Seborrheic • Tinea versicolor
distribution • Pityrosporum folliculitis
• Bullous impetigo
• Acne
• Miliaria rubra
• Confluent and reticulated papilomatosis
• REM

• Eruptive syringoma
Skin colored • Steatocytoma multiplex
nodules/papules in a • Eruptive velds hair
seborrheic distribution • DRIF
• Papular mucinosis

Twenty nail dystrophy • Alopecia areata, lichen planus, psoriasis, atopic dermatitis

Nail pitting • Psoriasis, alopecia areata, eczema

• Tumors: SCC, subungal exostoses > melanoma, fibromas

• Metabolic/systemic: hyperthyroidisim > yellow nail syndrome,
PCT, pseudoporphyria
• Drugs: tetracycline > fluoroquinolones, taxanes, psoralens,
NSAIDs, PDT
Onycholysis • Infections: candida, dermatophytes, HPV > scabies, saprophytes
• Skin diseases: psoriasis > LP, eczema, pompholyx, blistering
diseases (PV, EB), ectodermal dysplasia, sarcoidosis, LCH, PRP,
darier, keratosis lichenoides chronica
• Environmental: UV radiation, trauma, exposures to irritants or
water > allergens ex. Formaldehyde

o Mnemonic “SAWS”
• Seborrheic keratosis
• Actinic keratosis
Cutaneous horn
• Wart (verruca vulgaris)
• SCC (ex. keratoacanthoma, SCCIS, and verrucous carcinoma)
• Unusual: BCC (rarely), tricholemmoma
 • Melanocyte activation:
Racial
Trauma (manicure, nail biting/onychotillomania, friction,
primarily in toenails)
Drugs (cancer chemotherapeutic agent, zidovudine, psoralens)
Radiation
Pregnancy
Laugier–Hunziker syndrome
Longitudinal Peutz–Jeghers syndrome
melanonychia Addison disease
HIV infection
Postinflammatory ”lichen planus, pustular psoriasis,
onychomycosis (T. rubrum and Scytalidium spp.)”
• Non-melanocytic tumors:
Bowen disease Onychopapilloma Onychomatricoma
• Melanocyte hyperplasia/neoplasia:
Nail matrix lentigo Nail matrix nevus Nail matrix melanoma

Source: bolognia

• Warts
• Verrucous carcinoma
• Halogenoderma
Verrucous lesions • Deep fungal infections (blasts, chromo, coccidio, crypto)
• Mycobacterial infections (M. marinum)
• Tuberculosis verrucosa cutis (prosector’s wart)
• Verruciform xanthoma

• Papular mucinoses (lichen myxedematous)

• Nodular/lichen amyloidosis
• Lipoid proteinosis
Waxy papules
• Pretibial myxedema
• Adnexal tumors (if primarily on the face)
• Darier’s

• Congenital syphilis
Teeth, pegged • Incontinentia pigmenti
• Anhidrotic ectodermal dysplasia

• Basal cell nevus syndrome

Teeth, pitting • Tuberous sclerosis
• Junctional EB (herlitz)

• Trauma
• TSC
Pachydermodactyly
• Atrophie maculosa varioliformis cutis
• Carpal tunnel syndrome
 • Bullous pemphigoid
• Porphyria Cutanea Tarda
• Drug-Induced pemphigoid
• Pseudoporphyria
• Herpes Gestationis (BP of pregnancy)
• Bullous lupus
• Cicatricial (mucous membrane) pemphigoid
• Bullous amyloid
Bullae, tense • Bullous Lichen Planus (lichen planus pemphigoides)
• Bullous diabeticorum
• Linear IgA
• Bullous mastocytosis
• Epidermolysis Bullosa Acquisita
• Trauma (burns, friction, edema)
• Congenital Epidermolysis Bullosa
• Bullous tinea
• Chronic bullous disease of childhood

• Pemphigus vulgaris
• Bullous impetigo
• Pemphigus foliaceous
• Candidiasis
• Pemphigus vegetans
• Bullous scabies
Bullae, flaccid (or
• Pemphigus erythematosus
erosions)
• SJS/TEN (subepidermal, but often just see sloughing)
• IgA pemphigus
• DH (subepiderm, but often see erosions from scratching)
• Paraneoplastic pemphigus
• Pyoderma gangrenosum, bullous/superficial variants
• Hailey-Hailey (benign familial pemphigus)

• Blue nevus, nevus of ota (blue-brown)

• Malignant melanoma, Kaposi’s sarcoma (dark blue or purple),
Lymphangiosarcoma of Stewart and
• Neurofibroma, hydrocystoma
Blue lesions
• Histiocytoma
• Thrombosed plantar wart
• Granuloma telangiectaticum (blue-black)
• Treves (dusky blue to red)

o Mnemonic “AAA”
Macroglossia • Amyloidosis
• Angioedema
• Acromegaly
 • Acrochordon
Fleshy exophytic • Intradermal nevus
papule • Neurofibroma

Solitary nodule in a • Spitz nevus

child • JXG
• Mastocytoma

• Vascular: cutis maromorata, cutis maromorata telangiectatica

congenital, reticulated CM, livedo reticularis, reticulate purpura,
infantile hemangioma (with minimal or arrest growth),
• Infectious: parovirus (fifth’s disease/erythema infectiosum),
Reticulated erythema
erythema marginatum (rheumatic fever), congenital rubella
• Other: still’s disease, erythema ab igne (more
brown/violaceous), REM, calciphylaxis (red-violaceous before
ulcerating), type III mid-dermal elastolysis

Cystic papules on • Acne

teenager’s chest • Eruptive vellus hair cysts
• Steatocystoma multiplex

• Seborrheic dermatitis
Facial eruption in a • Atopic dermatitis
neonate • Neonatal lupus
• Less likely; psoriasis, LCH

Solitary scalp plaque in • Aplasia cutis congenital

a neonate • Nevus sebaceous

• Allergic reaction to tattoo dye

Dermal papules in a • Sarcoidosis
tattoo • Keloids/scarring
• Atypical mycobacterial infections

• Tuberous sclerosis
Multiple angiofibromas • MEN-I
• Case reports; cowden’s, birt-hogg-dube

Erosions/blisters on • Acute contact dermatitis (poison ivy)

dorsal hands • Porphyria cutanea tarda, pseudoporphyria
• EBA, bullous lupus, EBS
 • Tuberculosis
• Atypical mycobacterial infection
• Deep fungal infection (chromomycosis, blastomycosis)
• Leishmaniasis
Vegetating/granulating
• Mycetoma
/ulcerating plaques
• Neoplasms (SCC, sarcomas, metastatic)
• Pyoderma gangrenosum
• Gummas (TB, syphilis)
• Halogenoderma (from bromides, iodides)

• Stasis dermatitis
• Asteatotic eczema
• Pyoderma gangrenosum
• Leukocytoclastic vasculitis
• Pigmented purpuric dermatitis (Schamberg’s)
• NLD
• Pretibial myxedema
Lesions involving the • Erythema nodosum
shins • Diabetic dermopathy (shin spots)
• Lichen amyloidosis
• Hypertrophic lichen planus
• Lipodermatosclerosis
• DSAP
• Icthyosiform sarcoid
• Pseudo-kaposi’s sarcoma (acroangiodermatitis)
• Pancreatic panniculitis

• Blaschkoid/nevoid (mosaicism)
• Dermatomal
Categories of linear • Autoinoculation
diseases • Lymphatic/sporotrichoid
• “Outside jobs” ex. Contact dermatitis, koebnerized
• Phlebitis

• Bubonic plague
• Lymphogranuloma venereum
• Streptococcal/staphylococcal adenitis
• Chancroid, syphilis
• Primary inoculation tuberculosis/atypical mycobacterium
Ulceroglandular • Cat scratch disease
diseases (ulcers with • Tularemia
lymphadenitis) • Brucella
• Animal bite (Pasteurella multocida)
• Rat bite fever (Spirillum minus)
• Melioidosis
• Glanders
• Anthrax
• Sporotrichosis
 • Infectious: fungal, TB, verruca plana/vulgaris
• Traumatic: callus/corn
• Medicinal: arsenic, lithium
• Metabolic: phrynoderma (vitamin A deficiency)
• Idiopathic:
! Confluent reticulate papillomatosis, epidermal nevus,
Hyperkeratotic papule follicular LP, KP, keratosis punctate, lichen spinulosis, lichen
striatus, localized epidermolytic hyperkeratosis
! Perforating: elastosis perforans serpiginosa, Kyrle’s disease,
perforating folliculitis
! PRP
• Neoplastic: AK, cutaneous horn, keratoacanthoma, SK
• Congenital: acrokeratosis verruciformis of Hopf, darier’s disease

• Infectious: molluscum contagiosum, syphilis, lichen

scrofulosorum (tuberculid), verruca plana
• Traumatic: frictional (in atopics)
• Allergic: LSC
Lichenoid papules • Medicinal: lichenoid drug
• Idiopathic: lichen amyloidosis, lichen myxedematous, lichen
nitidus, lichen planus, lichen ruber moniliformis, lichen
sclerosis et atrophicans, lichen spinolosus, lichen striatus,
papular GA, sarcoidosis

• Infectious: lupus vulgaris

• Idiopathic: NLD
• Neoplastic: eruptive xanthoas, nevus lipomatosis, nevus
Yellow papules
sebaceous, sebaceous hyperplasia, xanthogranuloma, xanthoma
• Congenital: focal dermal hypoplasia (XD)
• Pseudoxantoma elasticum (AD, AR)

• Vascular: lymphangioma circumscriptum

• Infectious: dermatophyte, bullous impetigo, rickettsial pox,
HFMD, herpes simplex/zoster, kaposi’s varicelliform eruption,
milker’s nodule, orf, smallpox, vaccine, varicella
• Traumatic: burn, insect bites
Vesicle/bulla • Allergic: dyshidrosis
• Medicinal: drugs, bullous FDE, TEN
• Idiopathic: herpes gestationis, bullous LP/LP pemphigoides,
pemphigus, PLEVA, PCT, SLE
• Neoplastic: urticarial pigmentosa
• Congenital: darier’s, EBD/EBS, IP

• Infectious: herpes simplex/zoster

Grouped • Allergic: dermatitis venenata
vesiculobullae • Idiopathic: BP, DH, EBS, PV
• Neoplastic: lymphangioma circumscriptum
 • Infectious: gonococcemia, meningiococcemia, herpes simplex,
herpes zoster, smallpox, rickettsial pox, erysipeloid, ecthyma
Hemorrhagic gangernosum
vesiclobullae • Idiopathic: EM, PCT, CSVV, HSP, DH, BP, hydroa vacciniforme
• Vascular: lymphangioma circumscriptum, lymphatic
malformations

o Inflammatory purpura:
• Vasculitis
! Dermal vessels: IgA vasculitis
! Dermal and subcutaneous vessels: mixed cryoglobulinemia,
rheumatic vasculitides (LE, RA), PAN, microscopic
polyangitis, Churg-Strauss syndrome
• Dermal vessel inflammation/occlusuion/constriction
! Livedoid vasculopathy
! Septic vasculitis
! Chillblains (pernio)
! PG

o Non-inflammatory retiform purpura:

• Platelet-related thrombopathy occlusion:
! Heparin induced thrombocytopenia (HITS), thrombocytosis
secondary to myeloproliferative disorders, paroxysmal
nocturnal hemoglobuinuria, TTP
• Cold-related precipitation or agglutination:
! Cryoglobulinemia, cryofibrinogenemia, cold agglutinins
• Organisms growing in vessels occlusion:
Retiform purpura ! Vessel-invasive fungi (ex. Mucor, aspergillus), ecthyma
gangrenosum (ex. Pseudomonas), disseminated
strongloidiasis, lucio phenomenon of Hansen disease,
rickettsial spotted fevers
• Systemic alteration in control of coagulation:
! Protein C/S related, APS, levamisole-adulterated cocaine
• Vascular coagulopathy:
! Livedoid vasculopathy, degos disease, sneddon syndrome,
ADA2 deficiency
• Embolization or crystal deposition
! Cholesterol emboli > rarely “oxalate crystal deposition,
maranitic endocarditis, atrial myxoma, crystal globulins,
hypereosinophilic syndrome”
• Reticulocyte, RBC occlusion
! Sickle cell disease
! Severe malaria
• Miscellaneous
! Cutaneous calciphylaxis
! Brown recluse spider bite reaction
! Intravascular B-cell lymphoma
! Hydroxyurea (rare)
o Signs in Dermatology

References:
Freiman A, Kalia S, O’Brien EA. Dermatologic signs. J Cutan Med Surg. 2006;10:175–82
Madke B, Nayak C. Eponymous signs in dermatology. Indian Dermatol Online J. 2012;3(3):159-65.

Clinical sign Significance/description

- Granulomatous nodules generally, leishmaniasis, lupus miliaris

Apple jelly (diascopy)
disseminates faciei, lupus vulgaris, sarcoidosis

Antenna sign - KP (individual follicles show a long strand of keratin glinting when
examined in tangentially incident light)

- Dermatofibroma (dimple over the lesion)

Dimple sign
- Albright’s dimple sign; albright’s hereditary osteodystrophy (dimple
(Fitzpatrick sign)
over the knuckle of 4th metacarpal enhanced by clenching the fist)

- Direct vs. marginal

Nikoskiy sign - PF, PV, SSS, SJS, TEN

- Bullous drug eruption, SJS, TEN, negative in pemphigus/pemphigoid

Pseudo-nikolsky sign

- Neurofibromas, syphilitic chancre, old pigmented nevi

Buttonhole sign

- Scleroderma neck sign (ridging of neck skin on extending the head

Barnett’s sign
with a visible and palpable light band over platysma)

Branham’s - AV fistula (slowing of HR in response to manual compression)

“Nicoladoni” sign

Breakfast, lunch, and - Bed bugs bites

dinner sign

Braverman’s sign - CTD; fine telangiectasias around the nail (periungually)

- Psoriasis
Auspitz sign

Asboe-Hansen sign - Pemphigus, and bullous pemphigoid

(blister spread)

- Malar erythema (lupus)

- Butterfly-shaped sparing of mid-scapular region in patients having
Butterfly sign prurigo nodularis with neurodermatitis as they are unable to reach the
region for scratching
 - Chronic bullous disease of childhood
Cluster of jewels

- Kyrle and flegel disease (polygonal irregular configuration)

Corn-flake sign

Crowe’s sign - Neurofibromatosis type 1 (axillary freckling)

- Periumbilical bruising after intraperitoneal hemorrhage due to acute

Cullen’s sign hemorrhagic pancreatitis or ruptured ecotopic pregnancy

- Papules around the nail fold in multicenteric reticulohistiocytosis

Coral bead sign

- Alopecia areata (normal-looking hairs tapered at the proximal end in

Coudability sign the perilesional hair-bearing scalp and can easily be made to kink when
bent or pushed inward)

- Around the flanks due to hemorrhagic pancreatitis and

Grey turner sign intraperitoneal bleeding

- Urtication, flare and swelling due to histamine release

Darier’s sign - Urticaria pigmentosa/mastocytosis, insect bite reaction, JXG, leukemia
cutis, and LCH.

- Increase in induration and piloerection after stroking

Pseudo-darier sign
- Smooth muscle hamartoma, Becker’s nevus

- Papuloerythroderma of ofuji (generalized erythroderma with sparing

Deck chair sign
of the abdominal folds), cutaneous waldernstrom macroglobulinemia

Dirty neck sign - Chronic AD

- Scleromyxedema
Doughnut sign

- Dermatitis artifact
Drip sign

- Congenital syphilis
Dubois sign
- Syphilitic chancre on the coronal border of the pre-pucial skin in an
uncircumscribed male, whereupon on retracting the foreskin the entire
Dory-flop sign
ulcer flips out all at once because it is too hard to bend due to
underlying button like induration
 - Atopy
Dennie-morgan folds

- Contact dermatitis to a substance applied with hand to the face/neck

Ear lobe sign

- Kwashiorkor
Enamel paint sign

Exclamation hair sign - AA

- Sharply demarcated alternating bands of normally pigmented and

hypopigmented zone of hair indicating episodes seen in kwashiorkor-
Flag sign
or marasmus-type malnutrition, high MTX doses, and post
chemotherapy.

- Diagonal crease in the earlobes of adults has been associated with an

Frank sign
increased risk for atherosclerotic heart disease

- Hairs over the occipital area are mostly spared in trichotillomania and
Friar tuck sign
is referred as Friar Tuck sign.

- Rubella; enanthem of dull-red macules or petechiae in soft palate.

Forchheimer’s sign

- Ehler danlos syndrome; ability to touch the tip of the nose with tongue
Gorlin’s sign

- DM
Gottron’s sign

- Lymphogranuloma venerum; enlargement of both inguinal and

femoral group of LN separated by Poupart’s ligament causing a groove.

Groove sign - Eosinophilic fasciitis (Shulman’s syndrome) where there is a linear

groove or indentation along the superficial veins of the medial aspect of
upper extremity

- Ectopic neural tissue taking the form of smooth dome-shaped hairless

nodules with a collar of hypertrichosis

- Neural tube defects, aplasia cutis congenital, encephalocele,

Hair collar sign meningocele, hetertrophic brain tissue, rudimentary meningocele
Hairy palm sign - Histopathological finding in prurigo nodularis as if biopsy taken from
the palm.

- Trichtillomania; vertically oriented split of hair shaft and

proteinaceous material and erythrocytes are present in the split
Hamburger sign
resembling a hamburger within a bun.

- PR; when skin is stretched across the long axis of the herald patch, the
scale is noted to be finer, and attached at one end, which tends to fold
Hanging curtain sign
across the line of the stretch.

- DM (ddx: aldosterone producing tumors, contact dermatitis,

Heliotrope sign
toxoplasmosis, trichinosis)

- Loss of lateral one third of eyebrows (superciliary madarosis)

- AD, Trichtillomania, ectodermal dysplasia, AA, alopecia mucinosa,
Hertoghe sign
leprosy, syphilis, ulerythema ophryogenes, systemic sclerosis,
hypothyroidisim, myxedema, ectodermal dysplasia, normal in elderly

Hoagland’s sign - Upper lid edema with infectious mononucleosis

- DM
Holster sign

- Subungal melanoma extension to proximal or lateral nail fold

Hutchinson sign - Micro-Hutchinson's sign: pigmentation of the periungual tissues that

could not be seen with the naked eye and can be visualized by
dermoscopy

- The presence of small, discrete, vesicles either flaccid or tense that

become secondarily infected and pus accumulates in the lower half of
the pustule. It is a clinical sign seen in pyodermas and secondarily
Hypopon sign
infected vesicobullous disorders, where there is a transverse fluid level
comprising of purulent material at the bottom when the patient is in a
standing position.

- Presence or illusion of pigment in perinychium

Pseudo-Hutchinson

- Vesicle on tip of nose with HZV suggestive of ophthalmologic

Hutchinson’s nose
involvement
sign
Hutchinson’s teeth - Congenital syphilis

Jellinek sign
- Hyperthyroidism (eyelid pigmentation)

- Chronic lymphedema; inability to pinch or pick up a fold of skin at the

Kaposi-Stemmer sign base of the second toe because of its thickness

- Inability to retract the lower eye-lid in patients of progressive systemic

Ingram’s sign
sclerosis due to underlying sclerosis

- Measles
Koplick spots

- Eruptive SK with internal malignancy

Leser-trelat sign

Love’s sign - Exact localization of tenderness with a pin head in glomus tumor

- Patient having delusions of parasitosis (acarophobia, entomophobia)

Matchbox sign collects skin debris with mistaken belief that such collected material
contains alleged parasite in a matchbox, tissue paper, or small container.

- Fordyce's disease; the presence of ectopically located sebaceous

glands on the lips, oral mucosa and less commonly on gums. Prominent
Meffert’s sign
lip involvement can result in a lipstick like mark left on the rim of a glass
mug after consuming a hot beverage.

- It is a sign used to distinguish between erysipelas and cellulitis of the

Milian’s ear sign facial region, where there is involvement of ear in erysipelas and
sparing in cellulitis, as there is no deeper dermal and subcutaneous fat

- It is seen in Raynaud's phenomenon associated with systemic

Mizutani’s sign
sclerosis. This sign refers to disappearance of the peaked contour on
(round finger pad
fingerpads and replacement with a hemisphere-like fingertip contour
sign)
especially on ring fingers.

Muehrcke’s sign - Hypoalbuminemia or chemotherapy

- Hyperpigmentation on the neck due to pellagra

Necklace of Casal sign

- Airborne CD, severe AD, exfoliative dermatitis

Nose sign (sparing)
Nazzaro’s sign - Follicular hairy hyperkeratosis (horny follicular spicules) commonly
located on the face which shows compact follicle bound hyperkeratosis
is a rare but found in multiple myeloma.

- Blue-black pigmentation in the sclera near insertion of rectus muscle

Osler’s sign
in patients who have Alkaptonuria (Endogenous ochronosis).

- Linear petechial eruption in the skin folds esp on the ante-cubital fossa
Pasita’s sign and axillary fold seen in streptococcal scarlet fever.

Patrick Yesudian sign - Palmar freckling) seen in type 1 neurofibromatosis

Pitaluga’s sign - Acquired hypertrichosis of eyelashes due to Kala-azar

- Histopathological finding where there is appearance of a small vessel

Promontory sign protruding into an abnormal vascular space described in Kaposi
sarcoma, and patch and plaque stage of angiosarcoma.

- In young women and girls having from vitiligo the original white color
Punshi’s sign of vitiligo macules turns to red-pink during menstruation and after the
menstruation, it turns to the original colour

- It is seen in nail lichen planus, in which the nail splits and elevates
Pup-tent sign
longitudinally with downward angle of lateral nail edge

- Psoriasis
Oil-drop sign

- Deep dermal tenderness on pressing palmar papules in secondary

Ollendrof’s sign
syphilis

- Nevus of ota in periorbital area persistence post laser therapy

Panda’s sign

- Scarlet fever
Pasita’s sign

- PG, behcet, wegner, sweet, eosinophilic pustular folliculitis, bowel-

Pathergy bypass syndrome

- Pemphigus vegetans; cerebriform tongue showing the typical sulci and

Premalatha sign gyri pattern over the dorsum of the tongue
Racoon sign - Neonatal lupus erythematosus with erythematous, slightly scaly
eruption on the face and periorbital skin.
-Postproctoscopic periorbital purpura in patients having systemic
amyloidosis
- Basal skull fracture

- Chagas disease (unilateral swelling of eyelids and orbit after

Romana sign conjunctival inoculation)

- Interstitial granulomatous dermatitis with arthritis (Ackerman’s

syndrome); thick indurated inflammatory cord like structure that
Rope sign
extends from the lateral trunk to the axillae

- Scleroderma
Round fingered sign

- Bulimia nervosa; crusted callosity on knuckles of dominant hand due

Russell’s sign to self-induced vomiting.

- In dermatophytosis, fungi are present in the horny layer between two

zones of cornified cells, the upper being orthokeratotic and lower
Sandwich sign
consisting partially parakeratotic cells.

- This sign is to be elicited in patients having pityriasis versicolor,

Scratch sign (coup
wherein the barely perceptible scales are made to stand out by
d’ongle sign)
scratching the lesion with fingernail.

- ACD to nickel in posterior thighs

School chair sign

- DM
Shawl sign

Samitz’s sign - DM; dystrophic and ragged cuticle

- Scarring of the concha due to DLE

Shuster’s sign

- Fifth disease
Slapped cheek sign

- Arachnodactyly marker in marfan’s syndrome; thumbs protrude from

Sternberg thumb sign the clenched fist beyond the ulnar border of hand

Shoulder pad sign

- Systemic amyloidosis
 Toy-soldier sign - Linear aggregation of neoplastic lymphocytes along the dermal–
epidermal junction seen in histopathology of mycosis fungoides

- Pilomatricoma
Tent sign

Tin-tack sign (carpet - DLE (adherent scale is removed from DLE lesion, the undersurface
tack sign/cat tongue shows horny plugs)
sign)

- Recurrent migratory superficial thrombophlebitis of cutaneous veins

Trousseau sign

- Also referred to as ‘’acanthosis palmaris’’; associated with internal

Tripe palms malignancy

- Melanoma
Ugly duckling sign

- Marfan syndrome; unusual ability to touch the umbilicus with the right
Umbilical sign hand, crossing the back, and approaching from the left side, indicating
increased length of upper extremity

V-sign - DM

- Old World cutaneous leishmaniasis; lesion starts as a small nontender

Volacno sign papule, which enlarges in size and ulcerates in the centre. The border of
the crusted ulcer often has an erythematous rim.

- Ulnar nerve paralysis due to leprosy; the little finger assumes the
Wartenberg’s sign position of constant abduction secondary to paralysis of adductor digiti
minimi and is considered the earliest sign of ulnar nerve affection.

- Livedo reticularis with acute and chronic pancreatitis

Walzel sign

- Post. Cervical LAD in African trypanosomiasis

Winterbottom’s sign

- Psoriasis
Woronoff’s ring

- Congenital syphilis; bilateral, symmetrical, and well-defined

Wimberger’s sign metaphyseal defects on the medial surface of upper tibia, can result in
pseudoparalysis

Wood’s light findings

 o Pigmentary;
• Vitiligo; chalk white to dull-bluish white
• Ash leaf spots: enhancement of hypopigmentation
• Epidermal melanin hyperpigmentation: brown color enhancement
• Dermal melanin hyperpigmentation: difference in color of lesional
vs nonlesional becomes less obvious

o Infectious
Wood’s light
• Pseudomonas: Green
• Corynebacterium (erythrasma): coral red
• P. acne: orange-red (in comdeones)
• Pityriasis (tinea versicolor) due to malassezia: yellowish-white,
yellow-green, golden, copper-orange
• Tinea capitis (microsporum): blue-green to yellow-green
• Favus (trichophyton scholenleini): blue-white

Source: bolongnia