Basic Dermatology

Question 1

Stasis dermatitis

Answer 1

Typically from VI, bilateral, pitting edema, non-tender

Question 2

Contact dermatitis

Answer 2

Confined to area of allergen, history of some change, can be unilateral or bilateral dependent on contact

Question 3

Advancing cellulitis

Answer 3

Diffuse inflammation of connective tissue caused by bacteria, area is red, hot and painful

Question 4

Rashes

Answer 4

Temporary eruptions: heat, childhood diseases, diapers, drugs

Question 5

Lesions

Answer 5

Pathologic or traumatic loss of normal tissue continuity, structure or function

Question 6

Primary lesions

Answer 6

First to appear, identification is the most important
Includes: macules, patches, papules, plaques, nodules, tumors, wheals, vesicles, bullae, and pustules

Question 7

Macule

Answer 7

Small, up to 1 cm
- non-palpable, flat, change in skin color

Question 8

Patch

Answer 8

Macule, larger than 1 cm
- Non-palpable, flat, change in skin color

Question 9

Papule

Answer 9

Up to 0.5 cm
- palpable, elevated solid mass

Question 10

Plaque

Answer 10

Palpable elevated region of skin

Question 11

Nodule

Answer 11

Palpable, solid mass
- 0.5-2.0 cm, deeper and firmer than papule

Question 12

Tumor

Answer 12

Palpable, solid mass
- Larger than 2.0 cm

Question 13

Vesicle

Answer 13

Superficial elevation, formed by fluid residing in a space between tissue layers
- up to 0.5 cm, filled with serous fluid

Question 14

Bulla

Answer 14

Vesicle >0.5 cm, filled with serous fluid

Question 15

Pustule

Answer 15

Superficial elevation, formed by purulent material residing in a space between tissue layers, varies in size

Question 16

Primary lesions may progress to…

Answer 16

Secondary lesions via trauma, regression or other factors
- Usually depressed and manifest below the plane of the skin; scales, crusts, excoriations/abrasions, fissures, erosions, ulcers, and scars

Question 17

Scales

Answer 17

Dry or greasy laminated masses of keratin, vary in size and color
- pathologic exfoliation involving the epidermis

Question 18

Crusts

Answer 18

Dried blood, serum, or pus mixed with epithelial and bacterial debris, vary in size, shape, thickness, color and composition
- commonly referred to as scabs

Question 19

Excoriations/abrasions

Answer 19

Linear or punctate abrasion produced by mechanical trauma often associated with pruitus and scratching

Question 20

Fissures

Answer 20

Linear crack or cleft through the epidermis and often into dermis, vary in shape, size, and moisture content
- commonly occur in thickened and inelastic skin due to dryness and inflammation

Question 21

Erosions

Answer 21

Loss of portions or all of the epidermis only, heal without scar tissue
- sometimes areas are referred to as denuded

Question 22

Ulcers

Answer 22

Vary in size, and etiology, excavation involving complete loss of the epidermis and a portion of the dermis
- usually heal with scar formation

Question 23

Scars

Answer 23

Collagen and connective tissue that replaces lost dermis, size and shape dependent upon etiology and level of tissue destruction
- hypertrophic and keloid scare are pathological

Question 24

Eczema and dermatitis

Answer 24

• inflammatory skin response to an agent
  -Eczema: endogenous disease, chronic skin disorder that involves scaly and itchy rashes
• Dermatitis: exogenous disorders, irritant, allergy
• involves the epidermis and dermis
• xerosus (dry skin)
• poorly defined red patches, papules, and plaques, with or without scales
• skin may be edematous with excoriation from scratching

Question 25

Lichenification

Answer 25

Thickening of the skin seen in chronic cases (neck, flexor surfaces, eyelids, forehead, face, dorsum of hands and feet)

Question 26

Psoriasis

Answer 26

- chronic, recurrent, inflammatory disease - cause is unknown, there is an inherited tendency - round, circumscribed, erythematous, dry, scaling, plaques, size varies, covered by silvery white scales - often found on scalp, nails, extensor surfaces of the extremities, elbows, knees, umbilical region, and sacral region - alteration of the cell kinetics or keratinocytes; cell cycles reduced from 311 hours to 36 hours, results in 28 times the normal production of epidermal cells - can be nonpustular or pustular (palms and soles, can be entire surface life-threatening)

Question 27

Pyoderma gangrenosum

Answer 27

- Ulcerative skin condition that is rapidly evolving, chronic and severely debilitating - 50% idiopathic - 50% associated with systemic diseases: crohns, ulcerative colitis, chronic active hepatitis, lupus, seronegative arthritis, monoclonal gammapathy, and malignancies Four types: ulcerative, pustular, bulbous, vegetative

Question 28

Pyoderma gangrenosum management

Answer 28

- essential to uncover underling cause, diagnosis usually made after traditional interventions have failed - mistaken for venous or pressure ulcer and treatment fails in this case

Question 29

Mongolian spots

Answer 29

Congenital blue-gray macular lesions that benign - found on infants of Asia orgin - not to be confused with bruising or concerns of child abuse

Question 30

Nevi

Answer 30

Aka moles appear in early childhood and peak in young adulthood - light to dark brown, flat or round, with or without hair, 1-2 mm in size - need to differentiate from malignant melanoma

Question 31

Capillary hemangiomas

Answer 31

- occur most often in children or soon after birth at about 5th year of life - soft bright red to deep purple, vascular nodules or plaques - disorder of blood vessels that are benign

Question 32

Port-wine stains (nevus flammeus)

Answer 32

- irregularly shaped, red, macular, vascular malformations of dermal blood vessels, present at birth - do not spontaneously resolve - found on neck, fore-head, near the nose or eyelids - may worsen over lifetime - should not be mistaken for burns or abuse - benign

Question 33

Cherry angiomas

Answer 33

- very common, asymptomatic, bright red - domed vascular lesions found on the trunk - tiny, small and benign - seen in older patients

Question 34

Seborrehic keratosis

Answer 34

- most common of the benign epithelial tumors - seen in elderly patients - initially flat, well-demarcated, small brown-pigmented areas - with time become raised and darker in color, soft, crumbly surface

Question 35

Skin tags

Answer 35

- also known as cutaneous papillomas or fibromas - seen in older and obese patients - soft, round, skin-colored, tan or brown benign tumors - can range in size from 1mm to 10 mm

Question 36

Lipomas

Answer 36

- benign tumors of fatty tissue, can be single or multiple - develop slowly, soft, rounded, movable beneath overlying skin - cause unknown, fat can herniate through the tissue layers

Question 37

Dermatofibromas

Answer 37

- button-like dermal nodules - commonly found on the extremities - may be domed or depressed below the plane of surrounding skin - dimple sign; lateral compression with the thumb and index finger produces a dimpling effect with the lesion

Question 38

Vitiligo

Answer 38

- appears in all races - chronic disease, highly variable - macular depigmentation (loss of melanocytes) - common on face, neck, axillae, extremities

Question 39

Basal cell carcinoma

Answer 39

- most common form of skin cancer - limited capacity to metastasize - commonly found on head, neck and face (sun exposed areas)

Question 40

Squamous cell carcinoma

Answer 40

- malignant tumor of the outer epidermis - metastasize more readily than BCC Two types: intraepidermal, invasive - keratosis, scaly, elevated lesions, irregular borders, and shallow central ulcers

Question 41

Malignant melanoma

Answer 41

- rapidly progressing, metastatic form of cancer involves the melanocytes - early recognition and treatment increases survival - prognosis dependent on thickness of tumor and level of invasion into surrounding tissues; most dangerous Think red, white and blue Red; inflammation White; scar tissue formation Blue; melanoma growth

Question 42

ABCDEFG

Answer 42

Asymmetry Borders irregular Color variegated Diameter greater than 6mm (size of pencil eraser) Evolving overtime Elevated from skin surface Firm to touch Growing

Question 43

Criteria for suspicious lesions

Answer 43

Rapid growth over a few weeks or months Changed in pigmentation Inflamed, erythematous margin Irregular, ragged borders Weeping Crust formation Bleeding Pruritis; itching

Question 44

Necrotizing fasciitis

Answer 44

Rapidly advancing infection along the fascial plane can lead to amputation - medical emergency

Question 45

Pilonidal cyst

Answer 45

Wound that opened at the superior portion of the gluteal cleft usually due to growth of an embedded hair; hair growth will cause inflammation and infection resulting in an abscess