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STEP 2 > STEP 2: DERM: Identifying Skin Lesions > Flashcards

STEP 2: DERM: Identifying Skin Lesions Flashcards

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1
Q

________ is the most common malignancy of the lip w/95% of cases occuring in the lower lip vermilion border

A

SCC, likely due to sunlight exposure

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2
Q

This is concerning for

A

SCC

SCC typically presents as firm scaly papules, plaques, or nodules

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3
Q

painful, shallow, round ulcertations w/ white/yellow bases. They are recurrent and self-limiting and affect only the oral mucosa, not the keratinuzed epithelium of the lips

A

Aphthous ulcers aka kanker sores

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4
Q

This is most concerning for…

A

BCC

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5
Q

Most likley dx:

A

Herpes labialis

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6
Q

Most likely Dx:

A

Verruca vulgaris

aka Common wart

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7
Q

Well differentiated SCC vs poorly differentiated SCC

A

Well diff: firm scaly papules/plaque/nodule w or w/out ulceration

Poor diff: beefy red papules or nodules that may bleed or ulcerate

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8
Q
A

Acute allergic contact dermatitis

note that these lesions have a hx of exposure to external allergens and the lesions are pruritic

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9
Q

The most common skin lesion in general population

A

BCC

Head or neck 70%
trunk 15%

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10
Q

(BCC or SCC) is more likely in immunosuppressed pts and is more likely to cause neural invasion

A

SCC

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11
Q

Small vascular tumors composed of abnormal capillaries and granulation tissue. Occur in young adults and particuarly pregnant women.

A

Pyogenic granuloma

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12
Q

Lipoma vs epidermal inclusion cyst

A

Lipomas are benign, painless and irregular compared to epidermal inclusion cyst

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13
Q

A high suspicion of ______________ secondary infection should be maintained in pts w/atopic dermatitis who develop sudden onset of vesicles.

A

Eczema Herpeticum

Overlying HSV infection on top of atopic dermatitis. People w/this have hx of atopy or active atopic dermatitis and then can have an HSV outbreak. Note that pts w/atopic derm have a faulty skin barrer making them particuarly susceptiple to secondary infections in a way that contact dermatitis does not present.

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14
Q

Vesiculobullous disorder characterised by small, tense vesicles on extensor sites (elbow, knees, buttocks) that are extremely pruritic.

A

Dermtitis herpetiformis, closely associated w/celiac and tx is to avoid gluten.

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15
Q
A

Tinea corporis, fungal infection normally by Trichophyton rubrum, normally treated w/topical antifungal w/ clotrimazole, terbinafine, or ketoconazole.

Note that there are specific dermatophyte infections:
groin: tinea cruris
foot: tinea pedis
Scalp: tinea capitis
Nail: tinea unguium

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16
Q

Chronic erethematous rash most prominent on convex areas of the face, symptoms include flushing, skin sensitivity, and sometimes telangiectasias or small papules and pustules

A

Rosacea, there are 4 major kinds. See table.

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17
Q

23 yo female w/recent hx of miscarriage comes in concerned for diffuse hairloss. There is no erythema or scaling of the scalp and over 20% of fibers are pulled out. Most likely cause?

A

Telogen effluvium. Acute, diffuse, noninflammatory hair loss

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18
Q

34 yo w/ following lesion on neck and groin areas. They occasionally feel itchy:

A

Acanthosis nigrans

This 34 yo w likely has PCOS and the AN is due to insulin resistance

Hyperkeratotic, hyperpigmented plaques w/velvety texture. Often seen in flexural areas. There are two type of AN: benign or malignant.

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19
Q
A

dome-shaped papules with central umbilication: likely Molluscum contagiosum.

In kids, its viral and spreads via skin contact, outbreaks on trunk, face, and genitalia.

In adults, its considered an STI.

NOTE THAT DISSEMINATED MC CAN BE SEEN IN IMMUNOCOMPROMISED INDIVIDUALS ie HIV+

In healthy patients, molluscum contagiosum is generally self-limiting and heals spontaneously after several months. However, in immunosuppressed individuals, lesions can be very large, widespread, and persistent. If treatment is indicated (e.g., for sexually transmitted molluscum contagiosum), cryotherapy with liquid nitrogen is usually the first treatment option.

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20
Q

What other disease is this pt likely to have if they are displaying this skin lesion?

A

1: this skin lesion is pyoderma gangrenosum
2: inflammatory bowel disease like crohns

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21
Q

A neutrophilic dermatosis that manifests with painful, rapidly progressive, erythematous papules and/or pustules that can develop into deep, ulcerated lesions with central necrosis. Associated with inflammatory bowel diseases and autoimmune and hematologic disorders.

A

Pyoderma Gangrenosum

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22
Q

Characterized by symmetrical, hyperpigmented, velvety plaques in the axilla, groin, and neck. It is associated w/ insulin resistance states (in younger patients) and GI malignancy in older individuals.

A

Acanthosis Nigrans.

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23
Q
A

Tinea Corporis

Presents w/ round pruritic plaques that typically form an annual pattern.

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24
Q
A

Ecthyma

Strep skin infection related to impetigo. It can form eruthematous plaques but presents acute and it often associated w/pusutles and small ulcers.

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25
Nummular eczema Seen sometimes in the setting of chronically dry skin. Characteristic pruritic, round, scaly, fissured plaque that would fit under a large coin.
26
1 week old neonate w/rash on back and bilateral groin areas. No fever or new exposures. Swaddled in fleece blanket. No medications.
Milia Rubra Benign neonatal rash. Erythematous papular rash on occluded and intertriginous areas.
27
Rash that may appear at brith to age of 3 days. Presents w/ pustules w/erythematous base on trunk and proximal extremities. Resolves w/in a week
Erythema toxisum neonatorum
28
Typically presents age 40-60 and mucosal surfaces are almost always affected, oral mucosa being the most common inital site of involvment. These lesions rupture to form erosions.
Pemphigus vulgaris
29
How can you tell the difference between pemphigus vulgaris and bullous pemphigoid?
Pemp Vulg: erosions, mucosal involvment is common Bullous: tense bullae, less likely to erode, mucosal involvment is RARE
30
Net like intercellular igG against desmosomes on immunoflurourescence
Pemphigus vulgaris
31
Linear IgG against hemidesmosomes along basement membrane
Bullous pemphigoid
32
Which is more likely, pemphigus vulgaris or bullous pemphigoid: age over 60
bullous pemphigoid
33
Which is more likely, pemphigus vulgaris or bullous pemphigoid: erosions
pemphiguus vulgaris
34
Which is more likely, pemphigus vulgaris or bullous pemphigoid: mucosal involvement
Pemphigus vulgaris
35
Pruritic, purple, polygonal, papules and plaques
Lichen planus
36
Onychomycosis likely caused by trichophyton rubrum infection
37
What is the clinical approach to IDing features of melanoma?
38
39
Mild pruritis, no fever, chills or pain.
papules w/indented centers
40
41
Condylomata acuminata caused by HPV. Lesions are verrucous, papilliform, and are ususally asymtpomatic but can hace mild itching or burning.
42
Recurrent prritic rash caracterized by deep vesicles that affect palms, soles, and sides of digits.
43
Chronic, scaly, irregular or annular patches on hands.
Tinea Manuum
44
Presents with papules, vesicles, and burrows often on hands/web speces/flexural surfaces
scabies
45
Lichenification fur to chronic allergic contact dermatitis
46
What is the difference in mechanism between Atopic Dermatitis and Allergic contact dermatitis?
Atopic= type I hypersensitivity Allergic Contact: type IV hypersensistivity
47
Pt w/hx of eczema
Bullous impetigo
48
Yellow greasy scales of the face/scalp, seen in infants
Seborrheic dermatitis
49
Chronic, scaly, irregular erythematous plaques w/ulceration and central hypopigmentation surrounded by hyperpigmentation.
Discoid Lupus Erethematosus
50
Pretibial skin in a pt w/diabetes
Necrobiosis lipoidica
51
Fragile blisters and erosions on dorsum of hands and face
Porphyria cutanea tarda
52
Systemic Sclerosis
53
Two likely etiologies of diaper dermatitis
54
Cutaneous T-cell lymphoma sometims referred to as mycosis fungoides
55
Irritant Contact Dermatitis
56
Candidia dermatitis
57
How can you ID Telogen effluvium from alopecia areata?
Telogen eff is characterized by DIFFUSE not patchy hair loss and is triggered by stressors.
58
Patchy hairloss not brought on by stress
59
defined as the abrupt appearance of multiple seborrheic keratoses caused by an associated cancer and the rapid increase in their size and number.
Leser-Trelat, concerning for melanoma
60
Ecthyma gangrenosum skin infection often due to Pseudomonas aerginosa Not to be confused w/pyoderma gangrenosum (ulcers, purulent, associated w/crohns)
61
Erethema nodosum
62
What comorbidities are associated with these skin findings:
Inflammatory bowel disease Erythema nodosum (EN) is an inflammation of subcutaneous fat caused by a delayed hypersensitivity reaction. Women in early adulthood are commonly affected. Most cases are idiopathic, but an association with a variety of diseases, including infections and autoimmune disorders (e.g., ulcerative colitis), is possible. The characteristic lesions are painful nodules on the lower legs (particularly shins). EN is a clinical diagnosis. The condition typically heals spontaneously within a few weeks and, therefore, generally requires no more treatment than supportive care (e.g., analgesia).
63
Hidradentitis supprativa Hidradenitis suppurativa is a chronic inflammatory skin condition characterized by recurrent follicular inflammation, typically in the intertriginous areas. Manifestations include painful skin lesions (nodules and abscesses), draining sinus tracts, and scarring; the severity of symptoms varies. The disease typically affects young adults. The exact etiology is unknown but likely multifactorial and thought to involve blockage of hair follicles. Diagnosis is clinical and treatment includes wound care, pain management, and pharmacotherapy. Psychological support may be required for mental health conditions that can be associated with hidradenitis suppurativa. Surgical interventions may be needed for severe and/or recurrent disease. Complications include disfigurement resulting from excessive scarring, bacterial superinfection, and, in affected areas, cutaneous squamous cell carcinoma.
64
Keratoacanthoma
65
Diffuse cutaneous scaling, rough dry
66
Note that LP is usually idiopathic but it is often seen in pts w/hep C and can be drug induced by ACE inhibitors, thiazide diuretics, beta blockers, and hydroxycloroquine.
67
68
Plantar warts likely caused by HPV
69
Presents in children and young adults with friction induced blisters at the palms and soles. Hx might have issues w/ oral blisters as an infant.
Epidermolysis Bullosa Simplex. There are 4 subtypes (simplex, junctional, dystrophic, and kindler syndrome)
70
NONSCARRING patchy hair loss with NORMAL underlying scalp
Alopecia areata
71
Angiofibromas in the malar region, acne not responsive to normal therapy, and hypopigmented macules (ash leaf spots) are characteristic of
tuberous sclerosis
72
What other disorders should you test for if you have this kind of skin finding?
Vitiligo raises concern for autoimmune thyroid disease
73
Senile purpura in older pts w/ no concerns for abuse or bleeding disorder (normal blood bounts and normal coagulations studies)
74
Inflamed papules and pustules w/ erethema is consistent with what kind of acne?
Inflammatory
75
Closed or open comedomes on forehead, nose and chin are cinsistent with what kind of acne?
Comedonal
76
Large nodules that don't respond to normal acne treatments raises concern for what kind of acne?
Nodular (cystic)
77
itty bitty at 3 weeks
78
How can you tell erysipelas from cellulitis?
Erysipelas: RASIED sharp edges, fever early in course Cellulitis: flat esges, fever later in course
79
Erysipelas
80
Pseudofolliculitis barbae ## Footnote First line Advise patients to stop shaving for at least 8 weeks. [3] Educate patients on shaving techniques to minimize the risk of recurrence. Advise photoprotective measures to reduce the risk of postinflammatory hyperpigmentation. Persistent lesions or definitive treatment:: Permanent hair-removal techniques (e.g., laser hair removal with or without eflornithine) Chemical peels
81
What is the greatest risk factor for this condition?
Tobacco use Hiradentitis supprativa ## Footnote Patient education on disease process and management Recommend smoking cessation if relevant. [2][4] Wound care Warm compresses Cover open wounds. Discuss ways to improve physical comfort, e.g., wearing loose-fitting clothes. Pain management
82
Erythrasma, superficial bacterial infection (corynebacterium minutussumum) ## Footnote General: improved skin hygiene, maintaining dry skin (e.g., with cotton or linen cloth) Medical therapy Localized disease: topical antibiotic treatment (e.g., clindamycin, erythromycin) Extensive disease: systemic antibiotic treatment (e.g., erythromycin) Prognosis: Recurrence is common.
83
Pityriasis rosea
84
Lentigo, from intraepidermal melanocyte hyperplasia
85
lower leg. Most concerning for...
SCC. This would not be BCC even though BCC is most common. BCC presents w/pearly papule, raised borders, not a flat lesion like the one here. Remember that Actinic Keratosis is precursor to SCC and this looks closer to those kinds of lesions.
86
Herald patch (mother patch) in pityriasis rosea The primary plaque (located on the trunk) in this image is the initial and largest lesion in pityriasis rosea. The surface shows irregular scaling.
87
How do we treat the following:
This is pityriasis rosea Advise patients that spontaneous resolution typically occurs within 6–12 weeks. [1][4] Consider symptomatic treatment for pruritus as necessary. [3][7] Topical emollient (e.g., calamine lotion) Topical corticosteroid Acyclovir Oral antihistamine Oral macrolide, e.g., erythromycin UVB phototherapy
88
A chronic inflammatory disease of unknown cause that is characterized by white, atrophic plaques with intense pruritus affecting the skin, nails, hair, and/or mucous membranes. It most commonly affects the anogenital area and women. Well-demarcated, white papules and plaques potentially with a surrounding red inflammatory halo
Lichen Sclerosis | Other presentation: ## Footnote First-line: Initiate a high-potency or ultra-high potency topical steroid ointment. [3][4][6] Clobetasol Betamethasone Mometasone Second-line options [6] Intralesional corticosteroid injections Topical calcineurin inhibitors (with caution): tacrolimus, pimecrolimus
89
First line treatment:
First-line: Initiate a high-potency or ultra-high potency topical steroid ointment. [3][4][6] Clobetasol Betamethasone Mometasone ## Footnote Second-line options [6] Intralesional corticosteroid injections Topical calcineurin inhibitors (with caution): tacrolimus, pimecrolimus
90
Purple (violaceous) Polygonal, irregular borders Planar (flat-topped) Pruritic, often severe Papules Plaques
Lichen Planus ## Footnote chronic inflammatory disease characterized by lesions involving the skin (i.e., cutaneous), mucosa (i.e., mucosal), and hair or nails (i.e., appendageal). It most commonly affects adults aged 30–60 years. The exact etiology is unknown. Cutaneous lichen planus typically manifests as pruritic purple papules and plaques with well-demarcated irregular borders and Wickham striae on the extremities (e.g., wrists and ankles). First-line treatment consists of high-potency topical steroids; intralesional preparations are indicated for hypertrophic cutaneous disease and appendageal involvement.
91
The sloughing of epidermis when lateral pressure is applied to the skin. Suggests detachment of the epidermis from the dermis.
Nikolsky sign ## Footnote Characteristic of pemphigus vulgaris, staphylococcal scalded skin syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis, and certain forms of epidermolysis bullosa.
92
Nikolsky sign is positive in what dermatological conditions?
Characteristic of pemphigus vulgaris, staphylococcal scalded skin syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis, and certain forms of epidermolysis bullosa.
93
Stevens-Johnson syndrome Back, buttocks, thighs, and legs of an 8-month-old infant 2 weeks after primary vaccination Irregularly shaped, partially confluent, erythematous macules with bullae are visible. Patient history suggests Stevens-Johnson syndrome triggered by vaccination. ## Footnote Toxic epidermal necrolysis (severe Stevens-Johnson syndrome) Right arm of an infant in whom toxic epidermal necrolysis was likely triggered by smallpox vaccination
94
What differentiates SSSS from SJS?
Mucosal involvement differentiates SJS from staphylococcal scalded skin syndrome. ## Footnote Make a clinical diagnosis of SJS based on history and mucocutaneous lesions
95
Tx for SJS
Discontinue the offending drug. Consult dermatology, ophthalmology, and/or gynecology. Supportive management is similar to that of extensive burns, including: Goal-directed IV fluid therapy Pain management Wound care See also “Supportive care for burn injury.” ## Footnote Monitor for acute complications, including: Infection, septic shock Hypovolemic shock
96
What is your differential:
SJS/TEN SSSS Erythema Multiforme
97
A rare, acute type IV hypersensitivity reaction triggered by certain infections (e.g., Mycoplasma pneumoniae, herpes simplex virus, SARS-CoV-2), medications (e.g., sulfonamides), or vaccines (e.g., influenza vaccine). Manifests as a polymorphic rash that develops into target lesions. Disease severity ranges from minimal mucosal involvement and localized lesions to severe mucosal involvement and extensive lesions with or without systemic symptoms
Erythema multiforme
98
How do you differentiate SJS from erythema multiforme?
EMF minor does not typically involve mucous membranes. Lesions of EMF (both major and minor) are more acrally distributed and have limited skin detachment.
99
What are the pediatric exanthems?
Measles (paramyxoviru) Scarlet Fever ( Streptococcus pyogenes) Rubella (rubella virus) Erythema Infectiosum (Fifths) (parvovirus B19) Roseola (sixth) (human herpesvirus 6) Chicken Pox (varicella)

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