IV.

會脫皮,脫屑,結痂

• Tinea [Mycology clinic]

• Psoriasis [Psoriasis clinic]
• Asteatotic eczema (Eczema hiemalis)
• Nummular (Discoid) eczema
• Seborrheic dermatitis
• Atopic dermatitis [Atopic dermatitis clinic]
• Candidiasis [Mycology clinic]
• Keratosis (Lichen) pilaris
• Tinea (Pityriasis) versicolor [Mycology clinic]
• Keratodermia tylodes palmaris progressiva (KTPP)
• Impetigo
• Ichthyosis vulgaris

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IV.1 Tinea [Mycology clinic]

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IV.2 Psoriasis [Psoriasis clinic]

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 IV.3 Asteatotic dermatitis
(eczema hiemalis)

A dry, superficially fissured skin disorder, often on

the shins of the elderly, precipitated by the drying
effect of a cold winter or excess washing.
• Itching and erythematous.
• Dryness and cracking (crazy-paving appearance, cracked
porcelain-like).
• Especially found on the shins.
• Responds primarily to emollients.
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Inflammation and Skin Barrier Dysfunction
(A Chicken and Egg Problem)
Skin Barrier Dysfunction Induced Inflammation

https://www.jacionline.org
/article/S0091-
6749%2820%2930274-
8/fulltext

9
 Inflammation induced Skin Barrier Dysfunction

https://www.frontiersin.org/files/Articles/638325/fmed-08-638325- 10
HTML/image_m/fmed-08-638325-g001.jpg
 Inflammation Signs Skin vs Soft Tissue)

• Epidermis vs (Dermis or Soft Tissues)

• Redness (Redness)
• Oozing, vesicles, (swelling)
• None, (heat)
• Itchiness, (tenderness)
• Scales, lichenification, (none)
 IV.4 Nummular eczema
A morphological description of a lesion
which is circular or oval with clear margin.
· Acute phase: dull-red, oozy, crusted and
itchy.
· Then: less vesicular, more scaly stage.
· Occurs on the legs, arms, dorsum of hands
and trunk.
· Frequent association with dry skin.

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 IV.5 Atopic dermatitis
[Atopic dermatitis clinic]

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 IV.6 Seborrheic dermatitis

Definition: Seborrheic dermatitis is the

morphological term applied to the group of
eruptions arising in subjects of a particular
constitutional make-up. The eruptions are
predominantly localized in areas of greatest
sebaceous activity.
Cause: Pityrosporum ovale (Malassezia furfur)
Adult onset, infantile onset, Zn deficiency, HIV
infection
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Lesions: erythematous patches of various shapes
and sizes with dry or greasy scales, sharply
marginated.

Location: scalp, eyebrows, eyelids, glabella,

nasolabial crease, ala nasi, ears, sternal area,
axillae, submammary fold, umbilicus, groins and
upper middle part of back.

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Seborrheic dermatitis or SLE malar rash?

Level one : Cross nose

Level two: Epidermal inflammation vs

dermal inflammation

Level three: Systemic review of

constellation symptoms and signs

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Tinea Pedis or Pompholyx ?

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IV.6-2 Infantile seborrheic dermatitis
Eczema affecting scalp, face, axillae and napkin
area, which resolves within a few weeks.
· Onset at six weeks of age.
· Non-itchy and apparently not uncomfortable.
· Yellow scales on the scalp （cradle cap) and in
the eyebrows.
· Erythema, scaling and sometimes rawness under
the neck, in the axillae and in the napkin area.
· Resolves within six weeks.
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IV.7 Candidiasis [Mycology clinic]

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 IV.8 Keratosis pilaris
A common disorder of keratinization affecting the
hair follicles which appear plugged. It is most
prominent on the extensor surfaces of the
proximal parts of the limbs.
• Horny plugs on the outer aspects of upper arms
and thighs.
• Does not respond to topical steroids.
• Almost physiological in adolescents.
• Other types are inherited and persistent which is
associated with atopic dermatitis and ichthyosis
vulgaris. 25
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IV.9 Tinea (Pityriasis) versicolor

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IV.10 Keratodermia tylodes palmaris
progressiva (KTPP)

Dry fissured skin disorder on the volar aspect of

hands. Precipitated by housework and cold winter.
Dryness and fissured volar aspect of fingers from
the tip started at the index of using hand
• Frequent in young women

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 IV.11 Impetigo
An acute, contagious and superficial infection of the skin,
due either to Staphylococcus aureus or group A
streptococci or both.
• Impetigo bullosa: blisters which break easily, primarily
due to Staphylococcus aureus of phage group II ,
typically phage 71, which carries exfoliative toxin A and
disrupts the intraepidermal keratinocyte connection
desmoglein 1 (DSG1).
• Impetigo contagiosa: golden crusts, primarily due to
group A streptococci in the past, now increasing due to S.
aureus.
• Rapid spread.
• Often on the face.
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 IV.12 Ichthyosis vulgaris

An autosomal dominantly inherited disorder

resulting in widespread scaling of the skin.
· Small fine white scales.
· Rough surface.
· Extensor surfaces of limb and trunk.
· Sparing of flexures.
· Prominent wrinkling of palms.
· Filaggrin gene mutation
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 V.全身出紅疹

• Toxicodermia
• Viral exanthem (measles, rubella)
• Syphilis
• Pityriasis rosea

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V.1 Toxicodermia (see I.8)

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 V.2-1 Measles
A highly contagious childhood infection by a
paramyxovirus (measles virus), characterized by
fever, coryza, conjunctivitis, Koplik’s spots and
exanthem.
· Coryza, hacking, photophobia, malaise, fever.
· Koplik’s spots: cluster of tiny bluish-white
papules with erythematous areola on buccal
mucosa opposite premolar teeth.
· Erythematous macules and papules becoming
confluent, appearing initially on face.
· Spreading centrifugally and inferiorly to involve
trunk and extremities. Lesions fade to leave
yellow-tan stain or faint desquamation.
· Rising of measles IgM antibody for recent
infection 39
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 V.2-2 Rubella
A childhood rubella virus infection manifested by
morbilliform exanthem and lymphadenopathy.
· Pink morbilliform erythema.
· Initiation on face, spreading inferiorly.
· Petechiae on soft palate (Forcheimer’s sign)
during prodrome.
· Postauricular, suboccipital and posterior cervical
lymphadenopathy.
· Resulting in fetal malformation if occuring in
pregnancy.
· Rising of rubella IgM antibody for recent infection.
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 V.3 Syphilis

An bacterial infections disease caused by

Treponema pallidum.
• A primary painless chancre
• Secondary papulosquamous eruptions on trunk
and often involving palms and soles
• Positive serological tests to TPHA, VDRL & RPR
• Often acquired sex-transmitted but may be
congenital.
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 V.4 Pityriasis rosea
A short-lived condition affecting young adults
which evolves rapidly on the trunk after the initial patch
that heralds the attack.
• Herald patch: the first patch, largest in size.
• Symmetrical, pink, oval, annular plaques with long axis
following the cleavage lines of skin.
Central scales and characteristic collarette scale on the
inner trailing edge of advancing border.
• Restricted to trunk and proximal limbs.
• Duration varies between 2 and 10 weeks.
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Seborrheic dermatitis or impetigo?
Diagnosis? (Staphylococcal
Scalded Skin Syndrome)
Seborrheic dermatitis or impetigo?

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Nummular eczema or impetigo?

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Folliculitis?
Ichthyosis vulgaris or asteatotic
dermatitis?
Ichthyosis vulgaris or asteatotic
dermatitis?
Ichthyosis vulgaris or asteatotic
dermatitis?
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