Skin Lesions and Rashes

Question 1

Melasma - appearance

Answer 1

Melasma (aka Mask of Pregnancy)
Hyperpigmented patches typically on sun-exposed areas-cheeks, upperlip, nasal bridgeand forehead

Moth-eaten appearance, feathery edge

Question 2

Melasma contributing factors, treatment?

Answer 2

Contributing factors
Hyperestrogenism (pregnancy, contraception)
oThyroid autoimmunity
oUltraviolet radiation
oAnti-epileptic medications

Rarely reported in males

Usually resolves within a year of delivery
Limit sun exposure and use UVA/UVB SPF 30 or higher
Consider topical bleaching creams –if OK with OB

Question 3

Atopic Eruptions of Pregnancy (AEP)

3 types?

treatment?

Answer 3

Eczema of Pregnancy
Prurigo of Pregnancy “Prurigo” = condition that itches(aka “pruritus”)
Folliculitis of Pregnancy

Low strength topical steroid +/-systemic antihistamine if OK w/ OB

Question 4

Linea Gravidarum, aka Linea Nigra (latin for blackline)

What is it? When is it seen?

Treatment?

Answer 4

Midline abdomen
Increased likelihood in darker complections
2nd or 3rd trimester
Clinical dx as are all the pregnancy related skin changes

Tends to fade after delivery, but may not completely resolve
Reassurance, no meds recommended

Question 5

Acne Vulgaris

Answer 5

Chronic inflammatory disease of pilosebaceous follicles

Question 6

Atopic Dermatitis (eczema):

Answer 6

Chronic, relapsing, pruritic condition often associated with allergic rhinitis and/or asthma;
tends to run in families;

Symptoms include intense pruritis (itching) leading to excoriated skin lesions and lichenification;

Lesions are susceptible to secondary infections (Staph aureus) impetigo.

Question 7

Seborrheic dermatosis: aka seborrheic dermatitis

Answer 7

Ranges from ‘dandruff’ to fulminant rash.
Dryness, pruritus, erythema, and fine, greasy scaling lesions;
Characteristically on scalp, eyebrows, glabella, nasolabial folds, ears, eyelid margins.

Occurs in 2-5% of adults

Infantile variant: Cradle-cap

Question 8

Seborrheic Keratosis

Answer 8

Stuck-on appearance with a course waxy scale; may appear verrucous; well circumscribed;

Color is variable even within a single lesion; variesfrom tan to pink to dark brown to black.

Age: Increasedincidence and number with increasing age; common in middle-aged and elderly

May start as a flat lesion and grow to a specific size
Verrucous (warty) scaly lesion
With trauma, surface lesion may fall off and regrow in the same site.

Question 9

Dermatofibroma

Answer 9

Firm 0.5 –2 cm papules or nodule
Colors: flesh, tan, pink, yellowish, blue, brown, red or black
Typically round or ovoid with well-defined border

Typically on extremities especially the legs

Squeezing the margin, the lesion with dimple –the ‘dimple sign’ or ‘Fitzpatrick sign’ which confirms the diagnosis

Question 10

Rosacea

Answer 10

Chronic inflammatory condition with relapsing-remitting course

Facial flushing and localized erythema, telangiectasias, papules, and pustules on the nose, cheeks, brow and chin.
Nasolabial folds are typically spared.

One variant affects the nose primarily with inflammation edema and sebaceous hyperplasia resulting in an enlarged, cobblestoned appearance (rhinophyma).

Question 11

Sebaceous Cyst or Epidermoid cyst

Answer 11

Cyst wall composed of squamous epithelium containing macerated keratin and lipid-ric debris

Commonly located on face, trunk, extremities, in the mouth or on the genitals

Occurs in all ages

Usually asymptomatic unless they become infected
Dome-shaped, firm, flesh-colored nodule
Usually has a pore-like opening (central punctum)

The contents of the cyst have a distinctive foul odor

Question 12

Nevus (mole)

Answer 12

Age: typically arise during childhood, adolescence or very early adulthood

During pregnancy may darken and become more noticeable
The appearance of a new pigmented lesion in adulthood is less common after the age of 50

The appearance is dependent on the location of the melanocytic nests. Junctional nevi are flat (macular). Compound nevi are elevated relative to the surrounding skin(popular)

Question 13

Erythema Multiforme

Answer 13

Classic target lesions

Well-defined, circular, erythematous macules or papules that are < 3 cm
3 distinct color zones and a central zone that has bulla or crust
Appears violaceous on dark skinned individualsCan appear on palms and soles

Classically, first appear in symmetrical distribution on acral sites and progress in a centripetal fashion.

Question 14

Eruptive Xanthoma

Answer 14

Appear abruptly—rapid onset with all lesions at the same stage of development
Pruritusor pain may be present
Dome shaped yellow-orange, firm papules and associated redness

Dark-skinned individuals may appear as tan to dark brown; erythema is difficult to identify

Question 15

Dermatomyositis

Answer 15

Multiple skin changes are possible (heliotrope rash)

Systemic manifestations include fatigue, malaise, myalgias
Proximal muscle weakness (difficulty rising from chair)
Dysphagia due to esophageal muscle involvement

Respiratory: 15-30% of patients have some level of pulmonary involvement

Cardiac: tachy-or bradycardia, bundle branch block, cardiomegaly, CHF

Question 16

Nail fold telangiectasia:

Answer 16

erythema and telangectasias at the base of the nails with prominent capillary loops - indicates malignancy

Question 17

Actinic keratosis(AK) OR Solar keratosis

Answer 17

Pre-cancerous lesion found on sun-exposed areas
Usually begin as ‘rough’ localized lesions

Develops a characteristic white-to-yellow surface scale

May coalesce to form plaques

Generally asymptomatic

Age:increase in frequency of appearance with age

Location: sun exposed areas

Question 18

Solar Lentigo:

Answer 18

AKA senile lentigo, age spot or liver spot
Benign pigmented macule related to ultraviolet radiation most often as sunexposure

Associated with multiple sunburns in fair-skinned individuals

Smooth, flat macules
Hyperpigmented, tan to brown

Question 19

Basal Cell Carcinoma(BCC)

Answer 19

Most common cancer of the skin

M > W

Increased incidence with age
Sun exposed area; 85% appear on the head and neck region;
The most common site is the nose.
Smooth pearly papule or nodule with rolled borders and overlying telangiectasia; ulceration and pigmentation can occur.

Question 20

Infiltrating BCC

Answer 20

May present as slightly raised or depressed, indurated, thin, pink to white scar-like plaque with possible scale, crust, erosionand overlying telangiectasias.

Question 21

Superficial BCC

Answer 21

Well defined red patch or thin plaque with or without scale, crust, and rolled borders

Expands horizontally over time

Several superficial changes such as atrophy hypopigmentation, or associated pigmentation may be seen.

Question 22

Melanoma

Answer 22

Age: Median age at diagnosis is 60’s
Location: any skin with melanocytes
Most melanomas are pigmented
Morphology varies: flat, nodular; macule or patch
Can appear on palms, soles or nail

Question 23

Cutaneous Squamous Cell CA(cSCC)

Answer 23

Presence of Actinic keratosis (AK) indicates an individual is at higher risk of developing SCC

Fair/lighter skin types are 80X more likely
Age: increase with age; average onset mid-60’s
Location:any skin surface including mucosa but most common areas are sun-exposed: head, neck, arms and hands
Can also arise from scars or chronic ulcers (non-healing lesions)

Presentation:variable; hyperkaeratotic papule or nodule; may be smooth, plaque-like, exophytic, or papillamotous; color is variable; secondary changes such as scale, crust, erosion and ulceration may be present.