derm conditions week 2 Flashcards
1
Q
cellulitis (desc)
A
acute bacterial infection of the skin
2
Q
cellulitis (etio)
A
most common in adults S. aureus, GAS
Children Hib, GAS, S. aureus
3
Q
cellulitis (s/sx)
A
local erythema, heat, edema and tenderness, with lymphangitis and regional LAD
possible systemic fever, chills,
tachycardia, headache, hypotension or delirium (may precede skin sxs)
4
Q
cellulitis (dist)
A
Adults- lower leg most common.
Children cheeks, periorbital, head,
neck
5
Q
cellulitis (dx)
A
H&P (sudden onset)
CBC
Culture exudate
6
Q
cellulitis (ddx)
A
DVT, gout, insect bite, stasis dermatitis
7
Q
cutaneous abscess (desc)
A
localized collection of pus under the skin (mixed with blood and sebum)
8
Q
cutaneous abscess (s/sx)
A
Painful, tender, indurated and erythematous
May be accompanied by local cellulitis, lymphangitis, LAD,
fever.
9
Q
cutaneous abscess (dx)
A
H & P, CBC. Gram stain or culture in immunocompromised patients.
10
Q
cutaneous abscess (ddx)
A
hidradenitis suppurativa, ruptured epidermal (sebaceous) cysts
11
Q
erisypelas (desc)
A
superficial cellulitis with dermal lymphatic involvement (streaking)
12
Q
erisypelas (etio)
A
GAS, immunocompromise
13
Q
erisypelas (s/sx)
A
Shiny, raised, indurated and plaque-like lesions with distinct margins.
It has sharp borders, raised, red(deep), hot plaque that spreads rapidly.
Regional LAD and tenderness, and may see vesicles, bullae, petechiae (uncommon in cellulitis).
Itching, burning, and pain may be severe.
Red, painful streaks along lymph
14
Q
erisypelas (complications)
A
scarlet fever, fat necrosis, gangrene.
15
Q
erisypelas (distribution)
A
legs (#1), face (#2)
16
Q
erisypelas (dx)
A
H & P, CBC, blood culture in toxic-appearing patients. Direct culture is often not useful (b/c it’s in the lymph)
17
Q
erisypelas (ddx)
A
face – herpes zoster, contact derm
18
Q
erisypeloid (desc)
A
like erisypelas superficial cellulitis with dermal lymphatic involvement (streaking)
19
Q
erisypeloid (etio)
A
Erysipelothrix - farm animal bacteria
20
Q
erisypeloid (s/sx)
A
Shiny, raised, red, indurated and plaque-like lesions with distinct margins. – not hot, though may be tender with fever and malaise
21
Q
erisypeloid (dist)
A
hands and forearms
22
Q
erythrasma (desc)
A
Superficial intertriginous infection
23
Q
erythrasma (etio)
A
Cornybacterium
24
Q
erythrasma (s/sx)
A
Occurs in toe webs, between fingers, genitals (pink or brown patches) with
scaling, fissuring and maceration. May be patchy on the trunk.
25
erythrasma (dx)
Coral red fluorescence with Wood’s lamp (unique to this bacteria), no hyphae (distinguishes from candida), skin scraping w/KOH
26
erythrasma (ddx)
tinea, candida
27
folliculitis (dec)
inflamx of the hair follicle (many different types)
28
folliculitis etio()
S. aureus, fungal, pseudomonas, persistent trauma, systemic corticosteriods
29
folliculitis (dist)
buttocks, upper legs, face, neck, sternum and upper outer arms most common but can be anywhere except hands and feet
30
folliculitis (s/sx)
Pustule or inflammatory nodule that surrounds a hair follicle. Superficial or deep. Mild itching or pain. Abrupt onset May be chronic.
31
folliculitis (dx)
By examination. KOH to r/o dermatophyte
32
folliculitis (ddx)
acne, follicular keratosis
33
"hot tub" folliculitis (whole story)
“Hot tub” Folliculitis- caused by Pseudomonas following exposure to contaminated water. High rate of infxn in kids. Occurs 8hrs-5days post hot tub. Trunk, groin most common.
34
furuncle (desc)
boils…acute tender nodules
35
furuncle (etio)
S. aureus
36
furuncle (s/sx)
A deep dermal or subq, red, swollen and painful mass and drains to the surface. Pustule 5-30 mm with central necrosis and pus discharge. May be recurrent. A ruptured lesions heals with deep violaceous scar. afebrile
37
furuncle (dist)
neck, under breasts, buttocks, groin most common
38
furuncle (dx)
by examination. Culture may be beneficial dt MRSA
39
furuncle (ddx)
Folliculitis (smaller), Hidradenitis suppurativa, insect/spider bite, ruptured pilar cyst, cystic acne
40
carbuncle (desc)
Cluster of furuncles with multiple draining orifices.
41
carbuncle (dist)
Usu on neck, face, breasts and buttocks
42
carbuncle (s/sx)
Uncomfortable and may be painful, accompanied by fever.
43
carbuncle (dx)
by examination. Culture if recurrent or immunocompromised.
44
impetigo (desc)
superficial acute skin infection with crusting
45
impetigo (etio)
S. pyogenes, S. aureus. Warm moist climate, poor hygiene
46
impetigo (dist)
face, shins, extensor surface of forearms
47
impetigo (s/sx)
Clusters of vesicles or pustules that rupture and develop honey colored crust. Scaling borders. Satellite lesions often present. May see regional LA. May be pruritic.
48
impetigo (dx)
by examination. Culture is more common now dt MRSA.
49
impetigo (ddx)
atopic, contact dermatitis, perioral dermatitis, herpes simplex, herpes zoster,
tinea
50
candidiasis (desc)
Skin infection with Candida sp, most often Candida albicans (70-80%).
51
candidiasis (etio)
Immunosuppression, sugar dysregulation (fruit and alcohol can even feed the yeast), antibiotics, oral contraceptives
52
candidiasis (dist)
Balanitis, Diaper Dermatitis, Intertrigo,
| Vulvovaginitis, Oropharyngeal
53
candidiasis (s/sx)
intertriginous, erythematous, well-demarcated, pruritic patches of varying sizes and shapes. Surface is often glistening.
Intense inflammation with satellitelesions around the main area
54
candidiasis (dx)
By examination, presence of yeast and pseudohyphae on KOH prep, fungal culture or DNA probe.
55
candidiasis (ddx)
changes with location. Dermatophytoses, allergic derm, herpes, molluscum, psoriasis, contact derm, strep cellulites, seborrheic derm, erythrasma,
56
tinea barbae (desc)
fungal infx of the beard area.
Develops slowly. 2 patterns- ringworm and
follicular.
57
tinea barbae (s/sx)
Pruritic, at time painful and swollen. Secondary bacterial infections can occur. hairs will come out easily if fungal infxn).
58
tinea barbae (dx)
Examine skin scraping and plucked hair with KOH. fungal cultures and biopsy can be helpful.
59
tinea capatis (desc)
More common in African Americans and Hispanic and those living in close proximity. Children most effected.
60
tinea capatis (etio)
Trichophyton tonsurans.
61
tinea capatis (s/sx)
4 patterns- seborrheic derm, inflammatory, “black dot” pattern and
pustular. s/sx change with each.
62
tinea capatis (dx)
KOH examination of lesional hairs demonstrates fungal hyphae arranged in a longitudinal direction within the hair shafts. Culture can be performed on Sabouraud’s medium and Wood’s lamp examination of infected hairs reveals a characteristic sliver-blue fluorescence
63
tinea capatis (ddx)
psoriasis, seborrheic dermatitis
64
tinea corporis (s/sx)
pruritic, circular or oval, erythematous, scaling patch/plaque that spreads centrifugally. Central clearing follows, while the active advancing border, a few millimeters wide, retains its red color and with cross lighting can be seen to be slightly raised
65
tinea corporis (dx)
KOH will show hyphae, culture may be necessary
66
tinea corporis (ddx)
pityriasis rosea, drug eruptions, nummular dermatitis, erythema multiforme, tinea versicolor, psoriasis
67
tinea cruris (etio)
Obesity, diabetes and immunodeficient states
68
tinea cruris (s/sx)
erythematous patch high on the inner aspect of one or both thighs (opposite the scrotum in men). It spreads centrifugally, with partial central clearing and a slightly elevated, erythematous, sharply demarcated border that may show tiny vesicles that are visible only with a hand glass, spares the scrotum.
69
tinea cruris (dx)
KOH prep from scarping of an active
| border
70
tinea cruris (ddx)
contact dermatitis, psoriasis, Candida, erythrasma, seborrheic derm
71
tinea pedis (s/sx)
common. intensely pruritic, sometimes painful, erythematous vesicles or bullae between the toes or on the soles, frequently extending up the instep. Unilateral or bilateral Secondary eruptions at distant sites, called an Id reaction, examine hands.
72
tinea pedis (dx)
skin scraping.
73
tinea pedis (ddx)
dyshidrotic eczema, contact dermatitis, psoriasis
74
tinea versicolor (desc/etio)
superficial fungus infection with Malassezia furfur (a saprophysic yeast). an opportunist - heat pH changes make overgrowth possible
75
tinea versicolor (s/sx)
hypopigmented, hyperpigmented, or erythematous macules with scaling patches. Lesions are asx.
76
tinea versicolor (dist)
trunk and proximal upper extremities
77
tinea versicolor (dx)
Direct microscopy shows “spaghetti and meatballs” appearance of broad hyphae and clusters of budding cells, Wood's lamp will reveal yellow to yellowgreen fluorescence in some cases
78
tinea versicolor (ddx)
Vitiligo, pityriasis rosea, tinea corporis, Seborrheic dermatitis, Erythrasma
79
cutaneous larva migrans (etio)
caused by hookworm larva (Ancylostoma) from dog and cat excrement.
80
cutaneous larva migrans (dist)
feet/ankles, buttocks, backs of legs and back
81
cutaneous larva migrans (s/sx)
intense pruritis, erythema and papules at site of entry, winding tail of inflammation- serpiginous. usually occurs about 3 weeks after exposure.
82
cutaneous larva migrans (dx)
history and appearance, CBC can show eosinophila, CXR
83
cutaneous larva migrans (ddx)
scabies
84
lice (etio/dist)
Wingless, blood sucking insects that infect the head (Pediculus humanus capitius), body(Pediculosis humanus corporis), or pubis (Phthirus pubis).
85
lice (s/sx)
Severe pruritis. May see excoriations from scratching. Red puncta from bites. Nits on hair shaft 1cm from scalp- gray/white. May see brown specks of excrement on skin or clothing.
86
lice (dx)
Demonstration of living lice in wet hair using a fine-toothed comb. Also will fluoresce under Wood’s lamp.
87
lice (ddx)
seborrheic derm, impetigo, insect bites
88
scabies (desc/etio)
Infection of skin with scabies mite Sarcoptes.
89
scabies (dist)
hands, arms, feet, gluteal fold, axilla, back of the kne
90
scabies (s/sx)
Burrows are fine, wavy lines in the skin 2-10 mm long, covered often by lichenified skin. Intensely pruritic, esp at night. May also see erythematous papules without many burrows. Others in family/living quarters will be affected. Itching will continue after treatment due to allergic response not active infestation.
91
scabies (dx)
Burrows are pathognomonic. May do microscopic examination of burrow scrapings. Apply mineral oil to the burrow, vesicle or papule and scrape with a #15 blade, prepare slide. Dx is often made only by Hx and PE.
92
scabies (ddx)
insect bites, fungus, eczema, folliculitis, impetigo
93
herpes simplex (desc/etio)
recurrent viral infection with intraepidermal infection by HSV 1 or 2.
94
herpes simplex (dist)
mouth, eyes, genitals
95
herpes simplex (s/sx)
Single or clustered vesicles. Systemic symptoms with primary infections: fever, malaise, myalgia, headache and regional LA. Prodromal period of tingling or discomfort in many, then appearance of small vesicles on a red base. They rupture and ulcerate. Often painful. They dry up and are completely healed in about 2-6 weeks. Recurrent infection often follows physical or emotional stress
96
herpes simplex (dx)
characteristic lesions. Tzanck smear (superficial scraping from newly ruptured vesicle, then stained, showing multinucleated giant cells). Definitive dx is with culture of freshly ulcerated lesion
97
herpes simplex (ddx)
impetigo (diff color), eczema, zoster (along dermatomes), hand foot and mouth dz, aphthous stomatitis (HSV tends not to go in the mouth)
98
Herpetic whitlow
HSV infects distal phalanx with a very painful lesion that swells.
99
herpes zoster (desc)
latent varicella (HHV type 3) infection
100
herpes zoster (dist)
follows dermatome, which can be variable but almost never crosses the midline
101
herpes zoster (s/sx)
Virus remains in the nerve roots and erupts along the associated dermatome. May start with radicular pain and itching for 2-3 days, followed by herpetic rash. May see systemic symptoms. There may be severe pain, scarring, or post herpetic neuralgia (sharp, intermittent, or constant) which can be debilitating. Lesions usually lasts about 5 days. Pain may last weeks, months, years, or indefinitely.
102
herpes zoster (dx)
pathognomonic rash. Tzanck Smear, differentiate virus by culture.
103
herpes zoster (ddx)
changes with stage of dz. Before rash onset: MI, pleurisy, migraine. After lesions appear: HSV, primary varicella
104
molluscom contagiosum (desc/etio)
ppox virus in epidermal cells. most common ages 3-9
105
molluscom contagiosum (dist)
face, arms, chest, genitals (when sexually transmitted)
106
molluscom contagiosum (s/sx)
Smooth flesh colored umbilicated dome, hard; cheesy core; may become inflamed or secondarily infected. Asx. Up to 15 mm in diameter in immunocompromised. Lesions persist for 6-9 months
107
molluscom contagiosum (dx)
By appearance. Biopsy will show “molluscum bodies” in keratinocytes.
Biopsy should be used in immunocompromised pts
108
molluscom contagiosum (ddx)
folliculitis, milia (keratin plug in skin), verrucae
109
verrucae vulgaris (etio/desc)
Benign contagious neoplasms caused by HPV
110
verrucae vulgaris (dx)
By appearance, biopsy if necessary- esp if it doesn’t respond to tx to r/ ! o squamous cell carcinoma
111
wart subtypes
• Common wart (verruca vulgaris): dome shaped, round or irregular, rough; colors can be gray, yellow, brown, black, skin colored; 2-10 mm. Usually asx. Distribution: hands, knees, genitalia, feet. Age- any but peak at 12-16yrs
o Skin lines are interrupted by hyperkeratosis
o Black puncta when scraped with pinpoint bleeding
• Filiform wart: long narrow small warts, soft, seen on eyelids, face, neck
• Flat wart: Smooth, flat, yellow brown or flesh colored; 2-3 mm; backs of hands, lower legs and face
• Plantar wart: soles of the feet; single or multiple; painful and callused. Different from corns/calluses – black puncta present.
• Mosaic wart: multiple plantar warts
• Condylloma accuminata (genital warts): soft moist papules or plaques on perineum, external genitalia, anus, vagina, cervix;
112
roseola infantum (desc/etio)
Infection of infants or young children with HHV-6. 90%
113
roseola infantum (dist)
Prominent macular rash on chest and abdomen, less so on face and extremities
114
roseola infantum (s/sx)
3-5 days high fever; after fever subsides a sandpapery light red rash may appear for hours to days (only 30% have rash)
115
roseola infantum (dx)
Hx and PE, virologic studies in immunocompromised or atypical dz
116
roseola infantum (ddx)
Measles, Rubella, Enteroviral infections, Erythema infectiosum, Scarlet fever, drug allergy
117
hand, foot & mouth dz (desc/etio)
Febrile disorder caused by Coxsackie virus
118
hand, foot & mouth dz (dist)
buccal mucosa, tongue, palms (ONLY) of hands and feet, occasionally buttocks or genitals.
119
hand, foot & mouth dz (s/sx)
vesicular eruption of skin and mucosa (3-6mm), may have fever, myalgia, LA, abd pn, lack of appetite, poor nursing (dt pn). Lesions in mouth are painful. Lesions heal in 7 days
120
hand, foot & mouth dz (dx)
Hx & PE.
121
hand, foot & mouth dz (ddx)
varicella (doesn't spread like chicken pox), herpes, herpangina, aphthous stomatitis
122
viral exanthems
generic viral red rash by blood borne viruses initiating a vascular response in the skin. Most present with a prodrome of fever and malaise
123
Measles (etio/desc)
Extremely communicable viral infection by a paramyxovirus.
• Spread by secretions from nose, mouth, throat during prodromal and early
eruptive phase. Has an incubation time of about 7-14 days, with prodrome around
the 9th day.
Complications: encephalitis and secondary infection.
124
Measles (dist)
begins on the face and spreading cephalocaudally and centrifugally to involve the neck, upper trunk, lower trunk, and extremities
125
Measles (s/sx)
prodrome with 3-4 days of fever, coryza, conjunctivitis and photophobia (they present as pretty sick),
cough and Koplik spots (these are 1 to 3 mm whitish, grayish, or bluish elevations with an erythematous base on buccal and vaginal surface).
Rash appears after 2-3 days of initial symptoms and is morbilliform (little red bumps), maculopapular, and blanching. Lasts 5-6 days.
126
Measles (dx)
Clinical – identification of Koplik spots or rash
127
Measles (ddx)
during prodrome: many. During rash: Scarlet fever, rubella, drug reactions, roseola, erythema infectiosum, Rocky Mountain spotted fever, infectious
mononucleosis, Kawasaki disease, toxic shock syndrome.
128
rubella (etio/desc)
Infection caused by the RNA Rubella virus.
129
rubella (dist)
first appears on the face, spreads caudally to the trunk and extremities, and becomes generalized within 24 hours
130
rubella (s/sx)
Usually mild incubation about 14-21 days, with brief prodrome of fever and malaise, with a similar fainter rash, starting on the face and moving downward.
131
rubella (dx)
Characteristic LAD and rash. Only need lab dx in pregnant women and newborns- rubella-specific IgM antibodies using an enzyme immunoassay (EIA)
132
rubella (ddx)
measles, scarlet fever, drug rashes, erythema infectiosum
133
vitligo (desc/etio)
Idiopathic condition lacking in melanocytes (skin is healthy just lacking in color). associated w/ autoimmune dz such as thyroid, pernicious anemia, sle, addison's.
134
vitligo (s/sx)
Pigmented areas that are sharply demarcated and often symmetric. Spots are white with no scale. Patchy and irregular, ranging from focal spots, to entire body segments, or most of skin surface.
135
vitligo (dx)
obvious on examination. Lesions accentuated under Wood’s Lamp in light skinned pts. thyroid function, CBC, and fasting blood glucose level
136
vitligo (ddx)
tinea versicolor, Postinflammatory hypopigmentation, Chemically induced depigmentation, Pityriasis alba
137
Melasma/chloasma
macular hyperpigmentation of the face usually seen in pregnant women or using OCP, more in dark skinned races, resulting from an increase in melanin due to estrogen stimulation and UV light. Sharply delineated patches usually on the face. Fades incompletely when the cause is removed.
DDX: post inflammatory hyperpigmentation
138
lentigines
flat, tan or brown sun spots....usu face or back of hands.
139
alopecia (desc)
baldness
140
alopecia (subtypes)
Non-scarring alopecia:
o Male pattern baldness: androgenic
o Female pattern: androgenic, starts around menopause.
o Diffuse: dx by pulling 2-3 dozen hairs- if >5 hairs with the bud come out. Triggered by weight loss, stress, pregnancy (or after pregnancy), illness.
o Toxic: related to chemotherapeutic drugs
o Alopecia areata: autoimmune, toxic, genes, infections, drugs, and vaccinations, have been implicated in triggering episodes of alopecia areata. severe stress, especially emotional stress, can precipitate. S/Sx: smooth, circular, discrete areas of complete hair loss that develop over a period of a few weeks. Can be whole body.
o Trichotillomania- a psych d/o related to OCD where pt pulls out hair
o Tinea capitis- see notes above.
• Scarring alopecia:
o Cutaneous lupus, deep bacterial infection, ulcers, granulomas, syphilis,
tinea
141
alopecia (dx)
examine ratio of anagen and telogen hairs to assess if there is normal ratio of resting hairs. Occasional biopsy needed. Look for underlying cause with
appropriate labs.
142
hirsuitism
excess hair in females in areas not normally hairy.
• Diagnosis: Serum free/total testosterone, DHEA sulfate, FSH, LH, prolactin, TSH (to check for presence of thyroid dysfunction). Often related to PCOS
143
Onychomycosis (etio/desc)
Fungal infection of nail plate and/or bed usually caused by dermatophytes but can also be caused by yeast. Risks for
developing are older age, swimming, tinea pedis, psoriasis, diabetes, immunodeficiency, genetic predisposition, and living with family members who have
onychomycosis.
144
Onychomycosis (s/sx)
Nails have asx patches of white, brown, or yellow discoloration;
deformity, and may thicken.
145
Onychomycosis (dx)
by appearance, KOH microscopy, if negative then nail culture or histopathologic examination of nail plate clipping
146
Onychomycosis (ddx)
Nail dystrophies: psoriasis, eczematous conditions, senile ischemia (onychogryphosis), trauma, lichen planus, iron deficiency
147
Paronychial infx
periungual infection (usually from trauma along the cuticles)
* S/Sxs: develops along nail margin, becomes painful, warm, erythematous, and swollen. Pus along the nail margin, or beneath the nail.
* Diagnosis: by examination.
148
dermatofibroma
a benign proliferation of fibroblasts
S/Sxs: epidermal thickening and hyperpigmentation; small red to brown papule. Does not grow. Usually a solitary lesion but can have up to 10 at one time. Can follow an insect bite or trauma. firm lesions, 0.3 to 1.0 cm in diameter, that are nontender and that dimple when pinched together (DEFINING FEATURE)
• Distribution: most often on lower extremity
• Age: adults
• DDX: nevi, basal cell carcinoma. if continues to grow consider dermatofibroma
protuberans (malignant)
149
edpidermal (sebaceous) cyst
epidermally lined cyst containing keratinous material in the dermis
• S/Sxs: contains keratin; firm flesh colored moveable nodule in the skin, 1-3 cm w/ often with a central punctum; insignificant, non tender, unless it ruptures.
• Distribution: face, base of ears, and trunk
• DDX: sebaceous cysts , lipoma, if very firm r/o malignancy or if there are multiples in strange locations r/o Gardner's syndrome which is epidermal cysts associated with colon cancer.
150
keloid
excess fibroblastic proliferation following trauma and scarring;
• S/Sxs: elevated, shiny, firm protuberant nodule on the site of injury. Can have claw like extensions.
• African and Asian descent are most susceptible to the dev of keloids
• Diagnosis: by appearance.
• DDX: Hypertrophic scar- stays confined to original wound margin
151
lipoma
subcutaneous nodules of adipocytes
• More common in women. May have one or more.
• S/Sxs: rubbery nodule below dermis that is moveable. Usu asx. Overlying skin is normal. Varies in size. Grows very slowly
• Distribution: trunk, forearms, and neck
• Dx: Hx & PE. If it is rapidly enlarging, or is firm rather than soft, a biopsy is
indicated.
• DDX: Epidermal cysts.
152
nevi (moles)
circumscribed, often pigmented or flesh colored macules, papules or
nodules composed of melanocytes.
• Lentigo: hyperpigmented macule due to increased melanocytes; darker, sparser, does not darken or multiply with sun. 6 mm) and mostly on covered areas; usually see many on the person. Follow these – pts at greater risk for melanoma. See Table
on pg 1020 for characteristics of atypical vs. typical moles. Use the “ABCDEF” to assess.
• Diagnosis: H&P, always biopsy suspicious lesions (changing or irregular borders, color changes, painful, or bleeding/ulcerating/itching)
• DDX: melanoma, seborrheic keratosis, skin tag, wart
153
seborrheic keratosis
benign neoplasm resulting in pigmented superficial lesions that
usually appear warty, or may be smooth papules. they look plaquish but don't penetrate skin
• S/Sxs: "stuck on,'' warty, well-circumscribed, often scaly yperpigmented lesions located most commonly on the. Close inspection with a hand lens often will demonstrate the presence of horn cysts or dark keratin plugs (keratin plugs are diagnostic). Lesions should almost be able to be picked off with a no. 15 blade. Number of lesions ranges
from 1-100’s.
• Distribution: trunk, face, and upper extremities
• Age: generally in older adults but not a rule
• DDX: warts, nevi, melanoma, pigmented basal cell carcinoma
154
achrochordon
pedunculated fibroma or skin tag (lots of different names)
• S/Sxs: asx, fleshy skin tumor; skin colored or pigmented. Can be pedunculated lesions on narrow stalks. Soft. Can get irritated by friction and bleed
• Perianal skin tags are common in patients with Crohn's disease
• Distribution: neck, axilla, groin, under breasts, eyelids
• Dx: appearance
• DDX: warts, nevi, neurofibromas
155
infantile hemangioma
benign proliferation of blood vessels in dermis; Classified
by appearance – deep, cavernous, superficial, “strawberry”. Most common tumor of infancy – 10-12% by age 1. If they grow near eyes, ears or mouth quickly, they can be dangerous
o Superficial lesions are bright red, raised, deeper may have purple or bluish appearance
o Distribution: head and neck
o Diagnosis is by appearance
o Ddx: vascular growths, vascular malformations
156
Nevus flammeus and Port-Wine stain:
capillary malformations that are present at
birth
o Flat pink marks disappear within a few months if around the eye (nevus flammeus).
Port wine stains are reddish-purple and may appear anywhere, becoming darker with time. They enlarge proportionally to the child's growth and persist in approximately 40-60% of affected patients, darkening
and developing raised nodular or plaque-like components in adults
o Diagnosis is by examination. will not blanch
157
nevus araneus
(spider angioma, spider nevi)
o S/Sxs: pink/red, faintly pulsatile vascular lesion with a central arteriole and projections resembling spider legs. Blanchable, although the central papule often does not blanch. Common (10-15% adults)
o Increase in frequency during pregnancy and chronic liver dz
o Distribution: face, neck upper chest, shoulders, hands (in kids)
o Diagnosis: by appearance. will definitely blanch
158
cherry angioma
Frequently round, smooth, dome-shaped, bright- to dark-red lesions that do
not blanch with applied pressure
o Usually 1-4mm in diameter
159
pyogenic granuloma
vascular nodule of proliferating capillaries
o S/Sxs: yellow to deep red in color. Grow rapidly. Friable nodule under a thin layer of epidermis. Does not blanch. they look terrible but are benign
o Distribution: face, neck, fingers
o Dx: Biopsy
o DDX: melanoma or other malignant tumor
160
basal cell carcinoma
Most superficial of the cancers, slow growing papule or nodule that derives from epidermal basal cells.
• S/Sxs: Highly variable appearance from a small shiny, firm almost translucent nodule to crusty flat lesions to what looks like dermatitis. 3 forms: nodular
(60%), superficial (30%), and morpheaform (10%) Nodular usually starts as a papule that slowly grows and develops into a “rodent ulcer” with a shiny pearly
border, telangiectasia and a central ulcer . Alternately crust and heal. Superficial has a slightly scaly papule or plaque that is light red in color; the lesion may be atrophic in the center and usually is rimmed with fine translucent micropapules.
Morpheaform lesions are smooth, flesh-colored, or very lightly erythematous papules or plaques that are frequently atrophic
• Age: any but more common >40
• Distribution: face, neck and scalp most common, then shoulders and arms (think
sun)
• Diagnosis: Biopsy (punch)
• DDX: nevi, seborrheic keratosis, dermatitis, scars, molluscum, squamous cell carcinoma; also psoriasis early on
161
squamous cell carcinoma
malignant tumor of epithelial keratinocytes that invades
the dermis. causes thickening.
• S/Sxs: Usually on sun exposed areas; appearance is highly variable, but usually starts as a red papule or plaque with a scaly rough surface, or sometimes is
nodular like a wart. Can form cutaneous horns. Eventually ulcerates or bleeds, invades tissue and can metastasize.
• Distribution: sun exposed areas
• Diagnosis: Biopsy
• DDX: actinic keratosis, seborrheic keratosis, basal cell carcinoma.
162
malignant melanoma
Arises in melanocytes in skin & mucus membranes, eye, or CNS.
• S/Sxs: Vary a great deal in appearance but usually pigmented.
• Warning S/Sxs of melanoma development in previously benign-appearing mole:
use the ABCDE rule and/or the revised Glasgow seven-point checklist
• Dx: biopsy
• DDX: basal cell carcinoma, seborrheic keratosis, benign nevi/lentigo, dermatofibroma, warts
163
Glasgow seven-point checklist
```
Major:
• Change in size/new lesion
• Change in shape
• Change in color
Minor:
• Diameter > =7mm
• Inflammation
• Crusting or bleeding
• Sensory change
```
164
Types of melanoma:
o lentigo-maligna melanoma (15% of melanoma): slow onset and
progression, usually on face or sun exposed areas; 2-6 cm flat, tan or brown macule with darker spots, irregular border and surface, or a plaque with raised indurated edges, colored spots, nodules
o Superficial spreading (2/3 of melanoma): arise from a pre-existing lesion. diagnosed when smaller than lentigo melanoma. Mostly on women’s legs and men’s torsos. Plaque with irregular raised, indurated, tan
or brown areas, with white, red black or blue-black spots.
o Nodular: dark protuberant papule or plaque varying in color; grows fast; may not be pigmented
o Acrolentiginous: Arise in areas of non-hair bearing skin; soles, palms, and subungual skin
165
Acquired Cutaneous Paraneoplastic Syndromes:
a group of skin finding
associated with internal malignancy
• Leser-Trelat: sudden eruption of many seborrheic keratosis
• Dermatomyositis: periorbital heliotrope coloration, photosensitive violaceous
eruptions, periungual telangiectasia. Associated in occult breast, ovarian, lung
and GI cancers. Also associated with myositis presenting as proximal muscle weakness.
• Sweets Syndrome: erythematous, pseudovesicular, succulent plaques that are
tender
• Carcinoid: episodic intense flushing of the face, neck and upper body that lasts 30
minutes
166
acanthosis nigricans
• Thickened, velvety hyperpigmentation of flexural surfaces. asx
• Associated with insulin resistance- diabetes, obesity. Can also be seen with
internal malignancy especially gastric cancer, estrogens
