Derm Flashcards

Question

Secondary morphology - reticulated

Answer 1

lacy pattern

Answer 2

Verrucous – irregular surface (cauliflowery) Lichenification: epidermal thickening with accentuation of skin lines due to chronic irritation Induration: dermal thickening; skin feels hard and rough Umbilicated: with a central indentation

Answer 3

``` Single versus multiple lesions Presence on particular body parts may be significant Random versus patterned distribution Symmetric or asymmetric distribution Sun-exposed areas versus not Crosses midline? ```

Answer 4

Red (Erythematous); increased blood flow to the skin Orange: hypercarotenemia Yellow: jaundice, heavy metal poisoning, myxedema, uremia Green: in fingernails, suggests pseudomonas Violet: darkening cutaneous hemorrhage, vasculitis Gray/blue skin: cyanosis, metal deposits Black: melanocytic lesions, infection, arterial insufficiency White: tinea, Pityriasis alba, vitiligo

Answer 5

Urticaria after stroking the skin

Answer 6

pressure to indicate blanching (hemorrhagic lesions dunt blanch, but inflammatory lesions do)

Answer 7

stroking lesion causes intense and sudden erythema and wheal formation

Answer 8

bullae formation and erosion following gentle traction pressure

Answer 9

pinpoint bleeding after removal of plaque (psoriasis)

Answer 10

Lesions within areas of trauma

Answer 11

Itching is stimulated by chemical and physical stimulation of cutaneous nerve endings. Stimulus may be external or internal. Several mediators of itching exist: histamine, kallekrein, and various peptidases. Etiology: Dry skin most common cause History: must include drug and occupational/hobby exposures Testing: biopsy, CBC, liver, kidney, thyroid function, evaluation for underlying malignancy, immunoglobulins Itching may occur with or without an associated skin eruption, which may help determine the cause.

Answer 12

Acute vs Chronic: >6 weeks duration? Migratory, erythematous pruritic plaques. Mostly involves release of histamine. Etiology: viral/bacterial infection, IgE allergy, medications esp NSAIDS. Rare- autoimmune dz, malignancy History: duration, triggers, frequency, concomitant sxs (GI). Always ask about resp system. Also – use of drugs, travel and family history PE: Complete examination of skin, sign of infections or systemic disease. Testing: CBC, Immunoglobulins to foods, ANA or thyroid studies may be appropriate. Biopsy if uncertain.

Answer 13

Obstruction of the pilosebaceous unit presenting with comedones (whiteheads = closed; blackheads = open), papules, pustules, inflamed nodules, superficial pus filled cysts and sometimes deep purulent sacs. Common on face, back, chest, and upper arms from puberty - ~35yrs, M>F. Etiology: androgen stimulus, sebum, bacteria interaction, drug induction, diet (milk, sugar, bromine) S/Sxs: comedones, papules, pustules, nodules, cysts (actually very rare). Dx: H & P, comedones and often several stages of lesions. Grade by severity (mild = 5 cysts or >125 lesions) Labs - Serum total/free testosterone w/DHT, FSH, LH, DHEA-S. Bacterial and fungal cultures can be done to r/o infectious folliculitis DDX: rosacea (no comedones), perioral dermatitis, drug eruptions, folliculitis (yeast or bacterial, keratosis pilaris, Pseudofolliculitis barbae and acne keloidalis nuchae (in African Americans)

Answer 14

chronic inflammatory disorder characterized by facial flushing, telangiectasias, erythema, papules, pustules, and possibly rhinophyma. Ages 30-60, fair complexions, and blushers. Distribution: Most on the central area of the face and scalp Hx: Pts have increased susceptibility to recurrent flushing reactions that may be provoked by a variety of stimuli including hot or spicy foods, drinking alcohol, temperature extremes, and emotional reactions. Pt’s may have eye involvement such as include foreign body sensation and burning, telangiectasia and irregularity of lid margins, meibomian gland dysfunction (posterior blepharitis), keratitis, conjunctivitis, and episcleritis Etiology: “Idiopathic” although pts have a higher infection rates of H. Pylori and small intestinal bacterial overgrowth (SIBO) S/Sxs: Stages: - “Pre-rosacea” - Vascular phase - Inflammatory phase-papules, pustules, nodules and cysts present - Late-stage/rhinophyma Dx: one or more of the following primary features: flushing (transient erythema), Nontransient erythem, Papules and pustules, Telangiectasia and one or more of the following secondary features: Burning or stinging, Plaque, Dry appearance, Edema, Ocular manifestation, Peripheral location, Phymatous changes DDX: SLE, discoid lupus, acne vulgaris, drug eruptions, granulomas, perioral derm, infectious folliculitis, seborrheic dermatitis, carcinoid, chronic topical glucocorticoids

Answer 15

Chronic pruritic bullous eruptions. Uncommon. Distribution: trunk, lower legs, extremity flexures, and axillary and inguinal folds Age >60 Etiology: Autoimmune, drug induced from furosemide, captopril and NSAIDS S/Sxs: prodromal phase maybe with pruritic eczematous, papular, or urticaria-like skin lesions that become tense bullae Negative Nikolsky’s sign May see urticaria early that turns dusky annular lesions Bullae form on top of erythematous plaques and rupture in about 1 week leaving an eroded base Pruritis common. Associated with dementia, Parkinson’s disease, and unipolar or bipolar Dx: H & P, skin biopsy (from edge of intact blister) shows subepidermal bulla with infiltrate of eosinophils- direct immunofluorescence (Gold Standard) of skin shows IgG and/or C3 in a linear band in basement membrane, serum antibody titers- Anti-BP180 antibodies. Biopsy must be done to dx DDX: pemphigus vulgaris, dermatitis herpetiformis, erythema multiforme, drug eruptions

Answer 16

Autoimmune, chronic, recurring, intensely itchy, with symmetrical groups of inflamed vesicles, papules and hives. Distribution: Symmetrical extensor aspects, sacrum, base of head or generalized. Age 20-50 Gender male:female 2:1 Etiology: Autoimmune, celiac dz (asx), also associated with thyroid disorders S/Sxs: Burning, severe stinging and itching, and last for weeks to years. DX: H & P, skin biopsy of lesion and adjacent normal skin, shows subepidermal clefting and papillary dermal tips w/neutrophils and eosinophils. Direct immunofluorenscence is gold stand for dx. IgA deposition. Labs- TTG, anti-endomysial Ab, jejunal bx for celiac dx DDX: pemphigus, bullous pemphigoid, dermatitis, herpes, insect bites, scabies

Answer 17

potentially fatal blistering disease. Rare Distribution: Oral lesions often precede skin lesions in 50-70%, then found on groin, scalp, abd, back, upper legs, axilla and umbilicus. Age >60, F>M Incidence highest in Ashkenazi Jews Etiology: Autoimmune S/Sxs: Flaccid bullae, various sizes, on the skin and mucus membranes. Skin shears off easily, leaving painful erosions. Positive Nikolsky’s sign. Dx: H & P and biopsy. Biopsy shows intraepidermal bulla or speration of epidermal cells, eosinophil infiltrate, IgG, complement C3. Immunofluorescence from edge of fresh lesion and adjacent normal area. Serum anti-Dsg 3 and anti-Dsg 1 Ab- titers relate to dz activity. Nikolsky’s sign present. Hospitalization almost universally required. 15% mortality rate DDX: Herpes simplex and zoster, bullous pemphigoid, canker sores, paraneoplastic pemphigus (must do bx to exclude)

Answer 18

epidermal thickening from pressure or friction; feet and toes Calluses: usu asymptomatic, intact skin lines Corns: mb painful with pressure, yellowish core when pared, interrupts skin lines

Answer 19

Scaling and flaking of skin, a range of types Age- improves and can resolve with age Distribution: shins, outer arms most common. Inherited ichthyoses: Autosomal Dominant and X-linked. excessive accumulation of scales on skin. Resembles cracked pavement. Accentuated palmar creases DX: H&P - No biopsy needed DDx- dry skin, acquired ichthyosis (related to infection or systemic disease, sudden onset

Answer 20

keratinization disorder where horny plugs fill the openings of the hair follicles Age usually worse in children and resolved or improves with adulthood More common in atopy Etiology: Nutritional deficiency, genetic S/Sxs: keratotic follicular papules on lateral aspects of the upper arms, thighs and buttocks. On the face in children (can be confused with acne). Skin feels rough like sandpaper.

Answer 21

Immune-mediated skin inflammation, with typically a genetic component Age: begins very young- distribution changes Infantile phase (2months-2year) cheeks, perioral, scalp, extensor tops of feet and elbows with exudates Childhood phase (2-12) flexural surfaces, lichenification Adult phase (12-adult) flexural, hands, upper eyelids or patchy and diffuse over whole body Etiology: genetic component (Atopy), food and environmental allergies; Aggravated by dry skin, wool, sweating, allergens, tight clothing, emotional stress, nutritional deficiency, SIBO S/Sxs: red, weeping, crusted lesions on face, spread to neck, extremities, abdomen, flexor surfaces of elbow and knee, buttocks, neck, hands. Pruritic (intense), lichenification. May have palmar hyperlinearity, keratosis pilaris, hand/foot involvement, cheilitis, increased susceptibility to cutaneous infections Dx: H & P. culture and sensitivity if infection is suspected. Eosinohila can occur. Food allergy/sensitivity testing- especially in children, vitamin D, GI assessment (dysbiosis, 3hr lactulose breath test for methane, hydrogen) DDX: seborrheic derm, contact derm, nummular derm, Candida, scabies, tinea

Answer 22

Acute inflammation of skin caused by irritants or allergens Etiology: exposure Irritant contact derm: Chemicals, soap, acids, alkaline chemicals, oils, water, woods dust, fiberglass or body fluids. Allergic contact derm: Hypersensitivity reaction with an initial sensitization, then reaction on re-exposure. Drugs (this is big! Neomycin, bacitracin, hydrocortisone), latex, metals, cosmetics, lotion, sunscreen, nail polish, or fragrances. Also poison ivy, oak, sumac are types. S/Sxs: ICD - hands often effected, both the dorsal and palmar surfaces. Around mouth of chronic lip lickers. Erythema, dryness, painful cracking or fissuring. Acute may have papules with weeping and edema, chronic may have lichenification, excoriations and scaling. ACD - intensely pruritic. Mild erythema to hemorrhage, vesiculization and ulceration. Dx: H & P (including occupation, hobbies, household duties, travel, topical exposures). Patch testing when ACD doesn’t respond to treatment DDX: seborrheic derm, atopic derm, nummular derm, tinea

Answer 23

chronic pruritis that causes an extreme scratch-itch-scratch cycle without demonstrable cause. S/Sxs: pruritis, dry scaling skin, hyperpigmentation, erythematous, violaceous, lichenified plaques in irregular shapes. Most common areas are back of neck, wrists, ankles and public region, usually not present on back, abd, face or upper leges Dx: H & P, KOH wet mount (to differentiate from tinea), biopsy, patch testing to identify role of allergens DDX: tinea, lichen planus, psoriasis

Answer 24

Inflammation of the skin in a coin-shaped pattern. Mostly mid-aged pts with dry skin. Idiopathic, often with no hx of eczema gradual onset. M>W S/Sxs: exceedingly pruritic, inflamed coin shaped lesions, vesicular, crusting and scaling, as well as pruritic. Extensor surfaces, buttocks and trunk. Often begins on the legs. 1-50 lesions can be present Dx: H & P, patch testing can be positive, culture can reveal Staph aureus, biopsy, KOH wet mount DDX: Psoriasis, Tinea corporis, cutanous T Cell lymphoma scabies, seborrheic dermatitis, fungus, Paget’s disease when on the breast.

Answer 25

Inflammation of skin in high-density areas of sebaceous glands (scalp, eyebrows, eyelids, face) Biphasic incidence 2-12 months then during adolescence and adulthood, that peaks between 30-50. M>W. Etiology- speculated that Malazzezia fungi may play a role, nutritional deficiency Increases susceptibility in HIV+(may be presenting sign), Parkinson’s and the use of neuroleptic medications S/Sxs: gradual onset, well demarcated erythematous plaques with greasy-looking, yellowish scales distributed on areas rich in sebaceous glands such as the scalp, the external ear, the center of the face, eyebrows, axillae, nasolabial folds, the upper part of the trunk, and the intertriginous areas. May see papules. No hair loss. Cradle cap in newborns. Dx: H & P, KOH and fungal culture may be indicated DDX: atopic dermatitis, contact dermatitis, psoriasis (may overlap), tinea, cutaneous lupus, rosacea

Answer 26

Persistent dermatitis of the lower legs, especially the ankle, secondary to chronic venous insufficiency S/Sxs: Brown pigmentation over time, bronze. Often edema and petechiae. Then erythema, fissured, dry or weeping, crusting. Pruritic. May see varicosities, and cellulitis. Often develop stasis ulcers that do not heal, and may penetrate to the bone. Pt complains of heaviness/aching in leg that is agg by walking/standing. Legs are often swollen at the end of the day. Secondary infxn with Staph aureus is common. Hx may include DVT, surgery, trauma or ulceration Dx: H & P. veinous studies, ankle brachial index, if DVT hx should check protein S, C, factor V Leiden, fibrinogen, and homocystiene levels DDX: cellulitis, contact dermatitis, tinea

Answer 27

An idiopathic, recurrent photodermatitis that occurs after sun exposure Age: all ages, all races, all genders although most common in young W S/Sx-lesions appear 2hrs-5days after sun exposure. Burning, itching, erythema to exposed skin. 3 types: papular, plaque or papulovesicular. Lesions persist 7-10 days Dx: H &P. ANA, anti-SSA, anti-SSB to distinguish from SLE DDX: SLE, photodrug rxn, porphyria tarda, solar urticaria

Answer 28

precancerous neoplasm due to UV exposure Distribution: face, lips, backs of hand, shoulders, legs (think sun) Age: increases with age, usu in blondes or red-heads with light skin (skin type I and II) S/Sx: Rough scaling macule, papule or plaque; 1-10 mm; reddish/pink, ill-marginated with rough scale, with time develop a thin, adherent transparent scale- this becomes thicker and more yellow over time and forms horns Dx: biopsy to distinguish from squamous cell carcinoma DDX: seborrheic keratoses, squamous cell carcinoma

Answer 29

chronic recurring inflammation of epidermis and dermis with increased epidermal proliferation resulting in scaling. Immune mediated. Distribution: Scalp, extensor surfaces, buttocks, and back but may also be seen in the nails, eyebrows, axilla, umbilicus and anogenital region. Age: Biphasic 20 -30 and 50-60. M=W Etiology: genetics, environmental triggers, infection, physical or psychological stress, and medications. Smoking, obesity and HIV predispose S/Sxs: dry, sharply demarcated, erythematous papules and plaques topped with silvery scales. May itch but usually asx. Limited or systemic. Better in the summer. 7 different types - Plaque psoriasis (classic) - Guttate psoriasis (sudden appearance of many papules on the trunk ass w/Strep A or steroid withdrawl) - Pustular psoriasis(small pustules on palms and soles) - Inverse psoriasis (found on flexor surfaces and intertriginous areas) - Nail psoriasis - Generalized Pustular (generalized pustules w/fever-emergency) - Erythrodermic psoriasis (total body redness with chills and skin pain-emergency) May see systemic signs of arthritis, fever, chills, and deformed nails(pitting). Comes and goes. Dx: H & P, Auspitz sign. Biopsy rarely necessary but will thickening of epidermis. DDX: seborrheic dermatitis, eczema, pityriasis rosea, tinea capitus, squamous cell carcinoma, dermatophytoses, cutaneous lupus, dermatitis, lichen simplex chronicus

Answer 30

acute, self limited, mild inflammatory, scaling skin disease. Age: young adults Distribution: trunk Etiology: possibly reactivation of HHV-7, or primary infxn with HHV-6, -8 or H1N1 flu S/Sxs: Prodrome of headache, malaise, and pharyngitis may occur in some cases, but except for itching, usually asx. Oval, minimally elevated scaling papules and plaques. “Herald” patch. “Christmas tree” distribution. Can persist for months. Dx: by examination. DDX: tinea corporis, tinea versicolor, drug eruptions, psoriasis, syphilis

Answer 31

Recurrent itching, inflammation with small, discrete angular papules that can coalesce. Uncommon Age: >5. W>M Distribution: ankles, wrists, pubic region, lips, mouth. Uncommon on trunk, upper legs, face and head Etiology: unknown, Hep C may play a role S/Sxs: Papules are 2-4 mm, with angular borders, and a violaceous color. Oral lesions. May see severe itching. Abrupt or gradual onset, with symmetrical distribution on flexor surfaces, trunk, genitals, Koebner phenomenon. “purple, polygonal pruritic papules”. New lesions are pink/white but change to the PPPP, surface shows lacy reticulated pattern of whitish lines. Lesions that persist become thicker and dark red. Dx: by examination, biopsy- accumulation of PMN’s and T-cell mediated cytotoxic rxn against basal cell keratinocytes. Antibodies to Hepatitis C are detected in 16% of cutaneous LP and 30% with mucosal involvement. DDX: leukoplakia, candidiasis, herpes stomatitis, carcinoma, aphthous ulcers, erythema multiforme, psoriasis, discoid lupus, drug eruptions

Answer 32

a common condition that that immune mediated Causes: most common drugs are penicillin, sulfonamides, quinidine but almost any drug can induce S/Sx: depends on type - Exanthems. Most common. Antibiotics cause. Mildly pruritis measles-like (morbilliform) rash, macules or papules. Symmetric distribution almost always on trunk and extremities. Can occur on palms/soles/mucus membranes. Age- not common in infants- all other ages equal. Hx should include EBV, CMV for amoxicillin. - Urticaria: common and IgE-mediated. Antibiotics often cause. Also non IgE mediated- NSAIDS often cause. Pruritis, burning of palm/soles. May also have systemic sx such as flushing, fatigue, numbness of tongue, bronchospasm, N/V, palpitations, hypotension. - Pustular: ‘acne’ on arms and legs. - Fixed drug eruptions: circular and recurring at same site. Can also be generalized. Erythematous patch, plaque, bulla or erosion. Occurs within hours of ingestion. Many classes of drugs implicated. - Pigmentations: gray, brown, black, orange, blue. Many drugs and they are all different as to which color change they can induce. Dx: H&P. CBC-eosinophils DDx: too many to list.

Answer 33

inflammatory reaction characterized by “target” lesions Distribution: dorsal/palmar hands, soles, forearms, feet, face, elbows, knees, penis and vulva, mucus membranes. Age: 50% F Etiology: drugs(many), infections (HSV or mycoplasma), immunization, autoimmune dz, malignancy or unknown - Major: w/ mucosal involvement (ano genital, oral, ocular) - Minor w/out mucosal involvement. S/Sxs: onset 3-5 days, often resolved in 2 weeks. Can recur. erythema, edema, bullous lesions, of sudden onset mainly on face and extremities. Symmetrical annular lesions, bulls-eye, target, or iris forms. Pruritic, painful and sometimes see systemic symptoms like fever, weakness, malaise. Can be mild to very severe Dx: Hx &P. biopsy is non-specific but will show PMN infiltrate, edema. HSV serology/PCR, M. pneumonia serology/PCR DDX: urticaria, drug eruptions, bullous pemphigoid, pemphigus, dermatitis herpetiformis, aphthous stomatitis, herpes stomatitis

Answer 34

inflammation of the skin and subQ tissue (panniculitis) characterized by tender, red nodules on the shins Age: peaks at 20-30 but can occur at any age. F>M (6x) Etiology: infections, drugs, malignancy, inflammatory/granulomatous dx (sarcoidosis) S/Sxs: indurated nodules that look like bruises, gradually changing color, with successive crops of nodules. Nodules are very painful. Mostly pretibial. Systemic symptoms such as fever, malaise, joint pain. spontaneous resolution in about 6 weeks. Dx: By H & P, but must look for underlying disorder. Biopsy, ESR, CRP ANA, CBC, chest x-ray (sarcoid), ASO-titer or pharyngeal culture (for group A beta-hemolytic strep). DDx: vasculitis, pretibial myxedema, lymphoma

Derm Flashcards

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