Skin, Hair, Nails

Question 1

What is a macule?

Answer 1

Lesion is flat, nonraised, and <1 cm.

Question 2

What is a patch?

Answer 2

Lesion is flat and >1 cm.

Question 3

What is a papule?

Answer 3

Papule: Lesion is raised, <1 cm, and not fluid filled.

Question 4

What is a plaque?

Answer 4

Plaque: Lesion is raised, >1 cm, but not fluid filled.

Question 5

What is a vesicle?

Answer 5

Vesicle: Lesion is raised, <1 cm, and filled with fluid.

Question 6

What is a bulla?

Answer 6

Bulla: Lesion is raised, >1 cm, and fluid filled.

Question 7

What does an annular shape entail?

Answer 7

ring-like, with central clearing

Question 8

Describe a nummular lesion

Answer 8

coin-like, no central clearing

Question 9

What are the important characteristics to include with skin lesions?

Answer 9

1. number
2. size
3. color
4. shape
5. texture
6. primary lesion
7. location
8. configuration.

Question 10

What does confluent mean?

Answer 10

Lesions that tend to run together

Question 11

Describe a morbilliform drug eruption

Answer 11

Multiple 3–8-mm erythematous confluent round macules on chest, back, and arms

Question 12

Describe benign melanocytic nevi

Answer 12

Multiple scattered 2–4-mm round and oval brown macules, symmetrically pigmented, on back and chest with reticular pattern on dermoscopy

Question 13

Describe benign melanocytic nevus

Answer 13

Solitary 6-mm dark brown round symmetric macule on upper back

Question 14

What is the ABCDE rule for detecting melanoma?

Answer 14

• Asymmetry - Of one side of mole compared to the
  other
• Border irregularity - Especially if ragged, notched, or blurred
• Color variations - More than two colors, especially blue-black, white (loss of pigment due to regression), or
  red (inflammatory reaction to abnormal cells)
• Diameter >6 mm - Approximately the size of a pencil eraser
• Evolving - Changing rapidly in size, symptoms, or morphology

Question 15

Describe plaque psoriasis

Answer 15

Scattered erythematous to bright pink well-circumscribed flat-topped plaques on extensor knees and elbows, with overlying silvery scale

Question 16

Describe atopic dermatitis

Answer 16

• Bilateral erythematous, lichenified (thickened from rubbing) poorly circumscribed plaques on flexor wrists, antecubital fossae, and popliteal fossae
• Usually beginning in infancy, this red, itchy rash most commonly occurs where the skin flexes — inside the elbows, behind the knees and the front of the neck. When scratched, the rash can leak fluid and crust over. People with atopic dermatitis may experience improvement and then flare-ups.

Question 17

Describe herpes simplex virus vessicles

Answer 17

Multiple 2–4-mm vesicles and pustules on erythematous base

Question 18

Describe a herpes zoster (shingles) lesion distribution

Answer 18

Grouped 2–5-mm vesicles on erythematous base in a dermatomal distribution that does not cross the midline

Question 19

Describe how contact dermatitis presents

Answer 19

Scattered 2–5-mm erythematous papules and vesicles with transudate crust, some with linear arrays

Question 20

Describe a pustule

Answer 20

Small palpable collection of neutrophils or keratin that appears white

Question 21

What is a Furuncle?

Answer 21

Inflamed hair follicle; multiple furuncles together form a carbuncle

Question 22

What is a wheal?

Answer 22

Area of localized dermal edema that evanesces (comes and goes) within a period of 1–2 days; this is the essential primary lesion of urticaria

Question 23

What are cherry angiomas?

Answer 23

A cherry angioma is often bright red, circular or oval in shape, and small — usually ranging in size from a pinpoint to about one-fourth of an inch in diameter. Some cherry angiomas appear smooth and even with your skin, while others appear slightly raised. They most often grow on the torso, arms, legs, and shoulders.

Question 24

What are epidermal cysts?

Answer 24

• Epidermoid cysts are noncancerous small bumps beneath the skin. They can appear anywhere on the skin, but are most common on the face, neck and trunk.
• Epidermoid cysts are slow growing and often painless, so they rarely cause problems or need treatment

Question 25

What is seborrheic keratosis?

Answer 25

* A seborrheic keratosis usually appears as a brown, black or light tan growth on the face, chest, shoulders or back. * The growth has a waxy, scaly, slightly elevated appearance. Seborrheic keratoses don't become cancerous and aren't thought to be related to sun exposure, but they can look like skin cancer. * Seborrheic keratoses are normally painless and require no treatment. You may decide to have them removed if they become irritated by clothing or for cosmetic reasons.

Question 26

What does lichenified mean?

Answer 26

* Lichenified means the skin has become thickened and leathery. This often results from continuously rubbing or scratching the skin. * Chronic irritation due to conditions such as eczema can cause lichenified skin

Question 27

What are some characteristics of squamous cell carcinoma?

Answer 27

* Keratoacanthomas are SCCs that arise rapidly and have a crateriform center * Often have a smooth but firm border * SCCs can become quite large if left untreated (Note: highest Sites of metastasis are the scalp, lips, and ears)

Question 28

Describe petechia/purpura

Answer 28

* Deep red or reddish purple round, sometimes irregular, flat lesions that fade away over time; * petechia, 1–3 mm; purpura are larger

Question 29

Describe Ecchymosis

Answer 29

* **COLOR & SIZE:** Purple or purplish blue, fading to green, yellow, and brown with time; ariable size, larger than petechiae, \>3 m * **SHAPE:** Rounded, oval, or irregular; may have a central subcutaneous flat nodule (a hematoma

Question 30

What is Onycholysis?

Answer 30

A painless separation of the whitened opaque nail plate from the pinker translucent nail bed. Fingernails that extend past the fingertip are more likely to result in the traumatic shearing forces that produce onycholysis. **Starts distally and progresses proximally, enlarging the free edge of the nail.**

Question 31

What causes Onycholysis?

Answer 31

* **Local causes:** Trauma from excess manicuring, * psoriasis, fungal infection, and allergic reactions to nail cosmetics. * **Systemic causes:** Diabetes, anemia, photosensitive drug reactions, hyperthyroidism, peripheral ischemia, bronchiectasis, and syphilis.

Question 32

What is anonchia?

Answer 32

The absence of the fingernails and toenails.

Question 33

Describe Koilonychia

Answer 33

It is a nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia. It refers to abnormally thin nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape

Question 34

Describe the hairloss seen in male pattern hairloss

Answer 34

* In men, look for frontal hairline regression and thinning on the posterior vertex * The hair pull test is normal or only pulls a few hairs.

Question 35

Describe the hairloss seen in female pattern hairloss

Answer 35

* In women, look for thinning that spreads from the crown down without hairline regression * The hair pull test is normal or only pulls a few hairs.

Question 36

Describe Alopecia Areata

Answer 36

There is sudden onset of clearly demarcated, usually localized, round or oval patches of hair loss leaving smooth skin without hairs, in children and young adults. There is no visible scaling or erythema.

Question 37

Describe Tinea Capitis (“Ringworm”)

Answer 37

* There are round scaling patches of alopecia, mostly seen in children. There may be “black dots” of broken hairs and comma or corkscrew hairs on dermoscopy. * Usually caused by Trichophyton tonsurans from humans, and less commonly, Microsporum canis from dogs or cats. Boggy Paques are called kerions.