302 terms

Dermatology Pathology Slides from Lecture

Based on lectures given to the TTUHSC MSII class in 2013. Intended solely for educational use; the creators of the sets do not own any associated images.
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B. Papule
palpable lesion, <10 mm
What is the type of lesion?
A. Macule
B. Papule
C. Patch
D. Plaque
E. Ulcer
C. Patch
What is the type of lesion?
A. Macule
B. Papule
C. Patch
D. Plaque
E. Ulcer
D. Plaque
What is the type of lesion?
A. Macule
B. Papule
C. Patch
D. Plaque
E. Ulcer
E. Ulcer
What is the type of lesion?
A. Macule
B. Papule
C. Patch
D. Plaque
E. Ulcer
Scabies
axilla distribution, burrows
Scabies
burrows
Scabies
burrows; finger web involvement
Scabies
RIGHT mite itself
MIDDLE poop
LEFT cyst
Nodular Scabies
Nodular Scabies
hundred to thousands of mites
Fire Ant Sting
pustules
papulovesicles
Head lice
nits
Pubic Louse
Body/Head Louse
Tick
Flea
Flea Bites
leg involvement
not displaying "breakfast, lunch, and dinner" pattern
Brown Recluse Bite
(Note that Black Widow bites do not cause cutaneous lesions.)
necrotic ulceration
Brown Recluse Bite
(Note that Black Widow bites do not cause cutaneous lesions.)
necrotic ulceration
Lichen Planus
(Can progress to squamous cell carcinoma.)
purple, polygonal, pruritic papules and plaques
commonly seen on the wrists, genitalia, and buccal mucosa
Lichen Planus
(Can progress to squamous cell carcinoma.)
purple, polygonal, pruritic papules and plaques
Wickham's striae (reticulated scaling) on the buccal mucosa
also seen on the wrists and genitalia
Miliaria Crystalina
(Caused by occlusion of eccrine sweat ducts and seen in "hot, humid" weather. Note that miliaria rubra [monomorphic red papules] and profunda [with pustules] are progressively deeper with more inflammation.)
"dew drops" without inflammation
Keratosis Pilaris
keratotic firm flesh-colored to red follicularly based papules
seen on lateral arms, thighs, +/- cheeks
Lichen Nitidus
(Histology demonstrates a characteristic ball and claw pattern.)
flat-topped, asymptomatic, shiny papules
seen on arms, dorsal hands, genitalia, and trunk
D. Mouth
Lichen planus "likes" the buccal mucosa, specifically.
What other body parts does this "like?"
A. Eye
B. Feet
C. Finger
D. Mouth
E. Scalp
Open comedonal (non-inflammatory)
(Acne is caused by the gram positive anaerobe *Proprionibacterium acnes*.)
Name the acne.
Severe Nodulocystic Acne
Name the acne.
("Are you impressed by it?")
Acne Rosacea
(Findings include facial erythema, telangiectasias, papules, and pustules. Does not present with comedomes. Rosacea is exacerbated by sun exposure, ethanol, and "flushing" agents.)
central facial erythema
Rhinophyma
(This is a complication of rosacea. Ocular symptoms include blepharitis, conjunctivitis, keratitis.)
usually in males with long history of sun exposure and ethanol consumption
Gram Negative Folliculitis
(Treat with ampicillin or augmentin.)
pustules on acne patient
Impetigo
(Caused by S. aureus or Streptococcus pyogenes.)
honey crusts
can have vesicles or bullae
Satellite Candida
(Associated with obesity and DM.)
beefy red eroded plaque, intertriginous areas
satellite pustules and papules
Satellite Candida
(Associated with obesity and DM.)
beefy red plaque, intertriginous areas
satellite pustules and papules
Pustular Psoriasis
(Most commonly limited to palms and soles. Treat with MTX or Soriatane.)
lake of pus with skin sloughing
A. Comedonal
Type of acne?
A. Comedonal
B. Inflammatory
C. Mixed
D. Nodulocystic
E. Rosacea
Morphea
(Biopsy shows markedly thickened collagen bundles, with entrapment or compression of sweat glands, adnexal structures, and blood vessels. Labs results are negative for ANA, anti-centromere, and Scl-70.)
white, well demarcated plaque of induration with rim of hyperpigmentation
perhaps some violaceous change
Morphea
(Biopsy shows markedly thickened collagen bundles, with entrapment or compression of sweat glands, adnexal structures, and blood vessels. Labs results are negative for ANA, anti-centromere, and Scl-70.)
coup de sabre
Progressive Systemic Sclerosis
(Positive for ANA, Scl-70. Treat with physical therapy. Complications include severe HTN, conduction defects, pericarditis, CHF, renal failure, pulmonary fibrosis; esophageal dysmotility and strictures.)
shiny, swollen fingers
difficulty opening mouth (beaked facies)
CREST Syndrome: Telangiectasias
(Calcinosis of skin, Raynaud's, Esophageal dysmotility, Sclerodactaly, Telangiectasias; positive for ANA, anti-centromere, negative for Scl-70.)
superficial dilated blood vessels
CREST Syndrome: Raynaud's
(Calcinosis of skin, Raynaud's, Esophageal dysmotility, Sclerodactaly, Telangiectasias; positive for ANA, anti-centromere, negative for Scl-70.)
sausage digits, swollen, shiny
Lichen Sclerosus (et atrophicus)
(Commonly misdiagnosed as child abuse. Treat with high potency topical steroids with or without minocyclin/doxycycline.)
porcelain white; sharply demarcated with purpura; cigarette paper skin
usually seen in genital area, but may be generalized
Granuloma Annulare
(Commonly diagnosed as ringworm, which displays annular papules/plaques with scaling.)
annular papules/plaques with central clearing
seen on the dorsal hands and feet
Necrobiosis Lipoidica
(Called "diabeticorum," as 2/3 of patients also have abnormal glucose metabolism.)
red-brown to yellow plaques with prominent telangiectasias
commonly seen on the shins
B. Morphea
("coup de sabre*)
What is the diagnosis?
A. Granuloma annulare
B. Morphea
C. Necrobiosis lipoidica
D. Lichen sclerosus
E. Systemic sclerosis
Petechiae
(Most prominent in legs; if patient is bedridden, in back and sacrum.)
pinpoint to 3mm in size
Actinic ("Solar") Purpura
(Chronic sun induces blood vessel fragility; loss of "shock absorbers" of the dermis. Skin atrophy and solar elastosis is usually severe.)
ecchymoses; skin atrophy and bleeding
usually seen on dorsolateral arms and dorsal hands
Systemic Amyloidosis
(Also shows pinch purpura and macroglossia.)
eyelid purpura
DIC
(Uncontrolled clotting causes diffuse thrombus formation, which leads to consumption of platelets and thrombocytopenia. Other findings include prolonged prothrombin time, hypofibrinogenemia, and fibrinogen degradation products.)
petechiae, purpuric stellate (irregular) ecchymosis; central necrosis most characteristic
Leukocytoclastic Cutaneous Vasculitis
(Check for fever and arthritis in order to rule out sepsis. Causes include SLE and RA. Order ANA, viral hepatitis panel [especially for Hepatitis C] and rheumatoid factor to determine cause.)
palpable purpura of the legs
Gonococcemia caused by N. gonorrhoeae
(Culture cervical/penile urethra, oropharynx, and rectum; treat with IV ceftriaxone.)
necrotic, hemorrhagic pustule on extremity
may also present with swollen knee
Tinea (Pityriasis) Versicolor
(Worse in hot/humid environments.)
fairly well demarcated, hypopigmented atrophic plaques with fine scale
usually seen on chest, back, and shoulders
Tinea (Pityriasis) Versicolor
(Worse in hot/humid environments.)
fairly well demarcated, hyperpigmented atrophic plaques with fine scale
usually seen on chest, back, and shoulders
Tinea (Pityriasis) Versicolor
(Worse in hot/humid environments.)
fairly well demarcated, erythematous atrophic plaques with fine scale
usually seen on chest, back, and shoulders
Tinea (Pityriasis) Versicolor
(Hyphae and spores can be seen.)
chopped spaghetti and meatballs
KOH stain
Vitiligo
(Associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)
periorificial, sharply marginated white (depigmented) non-scaly patches
Vitiligo
(Associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)
periorificial, sharply marginated white (depigmented) non-scaly patches
Repigmentation in Vitiligo
(Vitiligo is associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)
process from hair follicle outward
Pityriasis Alba
(Usually first noticed in spring or summer. Repigmentation takes >1 year.)
hypopigmented poorly demarcated atrophic plaques with fine white scale.
usually affects the cheeks; also commonly involves upper outer arms
Postinflammatory Hypopigmentation
(Can be caused by contact dermatitis, autoimmune effects, local trauma; Xrays and frostbite; phenols and sulfhydryl compounds, discoid lupus erythematosus, atopic dermatitis, psoriasis.)
rim of hyperpigmentation at edge
scarring in center
Postinflammatory Hypopigmentation
(Can be caused by contact dermatitis, autoimmune effects, local trauma; Xrays and frostbite; phenols and sulfhydryl compounds, discoid lupus erythematosus, atopic dermatitis, psoriasis.)
subtle, somewhat well-demarcated scaly white patches/macules
Tuberous Sclerosis
(Cutaneous findings include ash leaf macules/patches: 80-90%, adenoma sebacum/facial angiofibromas): 80-90%; periungual fibromas/Koenen's tumors: 50% shagreen patches: 21-80%; flesh to yellowish-orange plaques (orange peel/pigskin) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)
)
"ash-leaf" macule/patch
Tuberous Sclerosis
(Cutaneous findings include ash leaf macules/patches: 80-90%, adenoma sebacum/facial angiofibromas): 80-90%; periungual fibromas/Koenen's tumors: 50% shagreen patches: 21-80%; flesh to yellowish-orange plaques (orange peel/pigskin) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)
4+ ash-leaf patches
Tuberous Sclerosis
(Cutaneous findings include ash leaf macules/patches: 80-90%, adenoma sebacum/facial angiofibromas): 80-90%; periungual fibromas/Koenen's tumors: 50% shagreen patches: 21-80%; flesh to yellowish-orange plaques (orange peel/pigskin) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)
Shagreen patch
"ash-leaf" patch
Tuberous Sclerosis
(Cutaneous findings include ash leaf macules/patches: 80-90%, adenoma sebacum/facial angiofibromas): 80-90%; periungual fibromas/Koenen's tumors: 50% shagreen patches: 21-80%; flesh to yellowish-orange plaques (orange peel/pigskin) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)
adenoma sebaceum
angiofibromas
dental enamel pits
Tuberous Sclerosis
(Cutaneous findings include ash leaf macules/patches: 80-90%, adenoma sebacum/facial angiofibromas): 80-90%; periungual fibromas/Koenen's tumors: 50% shagreen patches: 21-80%; flesh to yellowish-orange plaques (orange peel/pigskin) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.)
Koenen's tumors
C. Neisseria infection
Gonococcemia is the diagnosis; culture cervical/penile urethra, oropharynx, and rectum; treat with IV ceftriaxone.
What is the best diagnosis?
A. ITP
B. Leukocytoclastic vasculitis
C. Neisseria infection
D. Solar purpura
E. TTP
Idiopathic Guttate Hypomelanosis
(No good therapy.)
macules, "sprinkled confetti"
seen on shins of females
Leprosy
(Tissue biopsy for Fite stain. Caused by Mycobacterium leprae and spread by armadillos.)
hypopigmented, hypestetic macule/patch/plaque
Hypopigmented Mycosis Fungoides
(Cutaneous T-Cell Lymphoma.)
hypopigmented areas, bathing trunk distribution
D. Shagreen patch
Cutaneous findings in Tuberous Sclerosis include ash leaf macules/patches: 80-90%, adenoma sebacum/facial angiofibromas): 80-90%; periungual fibromas/Koenen's tumors: 50% shagreen patches: 21-80%; flesh to yellowish-orange plaques (orange peel/pigskin) usually in the lumbosacral area.
Which of the following may be found in this patient?
A. Cafe au lait macules
B. Coup de sabre
C. Neurofibromas
D. Shagreen patch
Telogen Effluvium
(Pull test: many telogen hairs (small bulb at end of hair), club-shaped hairs. Order CBC, ANA, RPR, thyroid to rule out anemia, hypothyroidism, nutritional, toxic drugs, lupus, syphilis.)
significant thinning of the parietal region
no inflammation or scarring
Telogen Effluvium
(Pull test: many telogen hairs (small bulb at end of hair), club-shaped hairs. Order CBC, ANA, RPR, thyroid to rule out anemia, hypothyroidism, nutritional, toxic drugs, lupus, syphilis.)
thinning of the vertex scalp
Androgenic Alopecia
(Caused by a testosterone-induced reversion of mature hair to vellus hairs in a specific pattern; physical exam shows nonscarring, frontal, vertex affected terminal hairs replaced by vellus, smooth shiny scalp; will see diffuse thinning of vertex in women.)
no scarring or inflammation
Androgenic Alopecia
(Caused by a testosterone-induced reversion of mature hair to vellus hairs in a specific pattern; physical exam shows nonscarring, frontal, vertex affected terminal hairs replaced by vellus, smooth shiny scalp; will see diffuse thinning of vertex in women.)
no scarring or inflammation
Androgenic Alopecia
(Caused by a testosterone-induced reversion of mature hair to vellus hairs in a specific pattern; physical exam shows nonscarring, frontal, vertex affected terminal hairs replaced by vellus, smooth shiny scalp; will see diffuse thinning of vertex in women.)
vertex loss
Trichotillomania
(Caused by self-induced traumatic hair loss by plucking, twisting or rubbing; physical exam shows empty hair follicles in strange geometric patterns, traumatized follicles, perifollicular hemorrhage, pigmentary casts, increased number of catagen hairs.)
irregularly-shaped with variable hair length
no scaling or erythema
Trichotillomania
(Caused by self-induced traumatic hair loss by plucking, twisting or rubbing; physical exam shows empty hair follicles in strange geometric patterns, traumatized follicles, perifollicular hemorrhage, pigmentary casts, increased number of catagen hairs.)
diffuse thinning
"difficult to tell here"
Trichotillomania
(Caused by self-induced traumatic hair loss by plucking, twisting or rubbing; physical exam shows empty hair follicles in strange geometric patterns, traumatized follicles, perifollicular hemorrhage, pigmentary casts, increased number of catagen hairs.)
bizarre geometric shape
Alopecia Areata
(Caused by autoimmune hair loss; physical exam shows round or oval patches, exclamation point hairs, no inflammation or scarring and skin biopsy shows "Swarm of Bees"- lymphocytes surrounding base of hair follicles.)
oval/round patch, exclamation point hairs
Alopecia Areata, Ophiasis type (most common)
(Caused by autoimmune hair loss; physical exam shows round or oval patches, exclamation point hairs, no inflammation or scarring and skin biopsy shows "Swarm of Bees"- lymphocytes surrounding base of hair follicles.)
sharply demarcated, oval and smooth patch
Alopecia Areata
(Caused by autoimmune hair loss; physical exam shows round or oval patches, exclamation point hairs, no inflammation or scarring and skin biopsy shows "Swarm of Bees"- lymphocytes surrounding base of hair follicles.)
totalis
Nonspecific nail pitting, here associated with Alopecia Areata
Lupus Erythematosus
(Causes chronic/discoid patchy scarring or non-scarring alopecia; broken hairs at frontal hairline, carpet tack scale, dyspigmentation, inflammation. Biopsy shows interface dermatitis- lymphocytic infiltrate and DE junction, liquifactive degeneration of basal cells, follicular plugging.)
erythema
scaling
some scarring, possibly
Lupus Erythematosus
(Causes chronic/discoid patchy scarring or non-scarring alopecia; broken hairs at frontal hairline, carpet tack scale, dyspigmentation, inflammation. Biopsy shows interface dermatitis- lymphocytic infiltrate and DE junction, liquifactive degeneration of basal cells, follicular plugging.)
lots of erythema
scaling
Tinea Capitis
(Demonstrates scarring alopecia [if you see scarring on the scalp of a child, think tinea]; useful labs include Wood's light, KOH exam, culture; griseofulvin is the gold standard of treatment; topicals do not work.)
young children
Tinea Capitis
(Demonstrates scarring alopecia [if you see scarring on the scalp of a child, think tinea]; useful labs include Wood's light, KOH exam, culture; griseofulvin is the gold standard of treatment; topicals do not work.)
exclamation point
young child
E. Tinea capitis
(Demonstrates scarring alopecia [if you see scarring on the scalp of a child, think tinea]; useful labs include Wood's light, KOH exam, culture; griseofulvin is the gold standard of treatment; topicals do not work.)
Diagnosis in this 8 year old?
A. Exzema
B. Discoid Lupus erythematous
C. Psoriasis
D. Seborrheic Dermatitis
E. Tinea capitis
Onychomycosis
(Most commonly caused by T. rubrum, T. mentagrophytes; physical exam shows yellow, thickening and dystrophy, subungual debris, superficial white changes.)
"crumbly nails"
debris, yellow change

DIFFERENTIAL psoriasis, trauma, lichen planus
Onychomycosis
(Most commonly caused by T. rubrum, T. mentagrophytes; physical exam shows yellow, thickening and dystrophy, subungual debris, superficial white changes.)
hallux involvement
Psoriasis
(Caused by increased rate of proliferation of keratinocytes; physical exam shows nail pitting, dystrophy, onycholysis, "oil drop sign" [yellow color under nail], fingernails affected more than toenails.)
onycholysis
oil drop
Psoriasis
(Caused by increased rate of proliferation of keratinocytes; physical exam shows nail pitting, dystrophy, onycholysis, "oil drop sign" [yellow color under nail], fingernails affected more than toenails.)
pitting
Pustular Psoriasis
(Most commonly limited to palms and soles. Treat with MTX or Soriatane.)
nail and skin involvement
pustules, "lakes of pus"
Psoriasis
(Caused by increased rate of proliferation of keratinocytes; physical exam shows nail pitting, dystrophy, onycholysis, "oil drop sign" [yellow color under nail], fingernails affected more than toenails.)
Acute Paronychia
(ACUTE S. aureus infection leading to inflammation and infection of proximal and lateral nail folds; red, swollen, painful; CHRONIC Candida infection leading to inflammation and infection of proximal and lateral nail folds; loss of cuticle, creases in nail plate, scaling)
red, swollen
Acute Paronychia
(ACUTE S. aureus infection leading to inflammation and infection of proximal and lateral nail folds; red, swollen, painful; CHRONIC Candida infection leading to inflammation and infection of proximal and lateral nail folds; loss of cuticle, creases in nail plate, scaling)
swollen
Clubbing
(Bulbous thickening of distal digit, proximal nail fold soft and thickened; hypertrophic osteoarthropathy; Lovibond's angle > 180 degrees)
Koilonychia
(Caused by iron deficiency anemia, Plummer-Vinson syndrome, Hemachromatosis, CAD, syphilis, polycythemia, acanthosis nigricans, familial forms; physical exam shows spoon nails, thin and concave)
spoon-shaped
Beau's Lines
(Temporary arrest of growth of nail plate leading to ransverse furrows that grow out; Triggered by traumatic/stressful events: childbirth, febrile illness, drug reaction. Note that the nails grow out at a rate of 1mm/month.)
transverse furrows affecting all nails
A. Beau's Lines
(Temporary arrest of growth of nail plate leading to ransverse furrows that grow out; Triggered by traumatic/stressful events: childbirth, febrile illness, drug reaction. Note that the nails grow out at a rate of 1mm/month.)
What is the diagnosis?
A. Beau's lines
B. Clubbing
C. Fungus
D. Koilonychia
E. Paronychia
F. Psoriasis
Stasis (Venous Insufficiency) Ulcers
(Common in CHF and incompetent leg vein vales; physical exam shows significant, bilateral swelling of medial lower legs, brownish dyspigmentation and petechiae, commonly
Most common etiology of leg ulcers, check DP/PT pulses to rule out associated arterial disease.)
medial aspect of lower leg
full thickness epidermal loss with petechiae (pinpoint - 3 mm)
Arterial Ulcers
(History commonly shows intermittent claudication, rest pain; physical exam demonstrates punched out ulcers on the lateral aspects of the legs (classically); DP/PT pulses absent, cool extremities, local hair loss.)
sharply demarcated, "punched out" ulcer
Pyoderma Grangrenosum
(Physical exam shows distinctive ulceration: acute onset of a painful ulcer with an undermined border [Dr. Stetson likes to say "you could stick a probe into it"], which heals with cribriform scarring; associated with ulcerative colitis, rheumatoid arthritis, and acute myeloblastic leukemia; biopsy reveals neutrophils throughout the dermis, but cultures are negative.)
cribriform scarring
Chancre in Primary Syphilis
(Note that the chancre caused by Treponema pallidum is painless, whereas the chancroid caused by Haemophilus ducreyi is painful.)
Spirochetes
(You can test for the syphilitic Treponema pallidum by dark field microscopy.)
dark field microscopy
Secondary Syphilis

HIGHLY STRESSED)
"nickles and dimes" on palm
Secondary Syphilis
"moth-eaten" alopecia
Chancroid
(This is caused by Haemophilus ducreyi, and should be differentiated from the chancre of primary syphilis, as caused by Treponema pallidum.)
"punched out, painful" ulcers
Chancroid
(This is caused by Haemophilus ducreyi, and should be differentiated from the chancre of primary syphilis, as caused by Treponema pallidum.)
painful, ragged ulcer
"undetermined"

NOTE difficult to culture
Haemophilis ducreyi
(Causative agent of chancroid.)
"school of fish"
gram negative coccobacilli
HSV
grouped ulcerations on erythematous base
HSV
grouped vesicles on erythematous base
HSV
Tzanck smear showing multinucleated keratinocytes, ballooning degeneration
steel-gray nuclei
chromatin margination
Factitial Ulcer
(Causes include a variety of insults: deep excoriations, injections of foreign material, heat/cold. Note that the patient will often deny causing the ulceration and the history will be unreliable. These ulcers appear as bizarre, geometric shaped angulated ulcers. Must be suspected clinically; especially if location is unusual for ulcerations, and there are no other explanation for the ulcer.)
angulated linear heme-crusted ulcer
C. Pyoderma gangrenosum
Note underlying edge, where "one could stick a probe."
What is the best diagnosis?
A. Arterial ulcer
B. Factitial ulcer
C. Pyoderma gangrenosum
D. Stasis ulcer
E. Syphilis
Eczema, Atopic Dermatitis
(Most common form is atopic dermatitis; appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; infantile form favors face, scalp and extensors; 80% develop allergic rhinitis)
cheek, arms
Eczema, Atopic Dermatitis
(Appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; childhood form favors flexors; often lichenified; 40% have persistent disease as adults)
plaque, erythematous papules
seborrheic appearance
Eczema
(Appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; childhood form favors flexors; often lichenified; 40% have persistent disease as adults)
possible lichenification in the cubital fossa
Eczema
(Associated with keratosis pilaris, xerosis, icthyosis vulgaris, Dennie-morgan lines, hyperlinear palms, pityriasis alba; can become erythrodermic. Often impetiginized [S. aureus, honey crusted] or considered eczema herpeticum [painful super-infection by HSV]).
hyperlinear palms
Hand Dermatitis
(Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)
thickening

NOTE the papulovesicles on the lateral finger
Hand Dermatitis
(Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)
Hand Dermatitis
(Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)
Asteatotic Eczema
(Appearance is termed "eczema craquele" and "dried river bed;" favors shins, flanks, post axillary line. Associated with aging, xerosis, low humidity, frequent bathing)
"plate-like or fish-like" changes
dry river bed
Nummular Dermatitis
(Appears as pruritic coin-shaped eczematous lesions with a chronic, recurrent course. Associated with contact sensitization and stasis, but not atopy. More common in older patients.)
coin-shaped, scaly
Nummular Dermatitis
(Appears as pruritic coin-shaped eczematous lesions with a chronic, recurrent course. Associated with contact sensitization and stasis, but not atopy. More common in older patients.)
Phyto Contact Dermatitis (Poison Ivy here)
(Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of Neosporin/Polysporin/Triple antibiotics or topical benadryl])
eye involvement
linear pattern
Acute Contact Dermatitis
(Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of Neosporin/Polysporin/Triple antibiotics or topical benadryl])
eczematous changes with vesicles
Contact Dermatitis, caused by leather
(Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of Neosporin/Polysporin/Triple antibiotics or topical benadryl])
Seborrheic Dermatitis
(Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale];
can be severe and refractory in HIV)
scalp involvement
Seborrheic Dermatitis, here as cradle cap in infant
(Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale];
can be severe and refractory in HIV)
intertrigious area
Seborrheic Dermatitis
(Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale];
can be severe and refractory in HIV)
eyebrow scaling
Seborrheic Dermatitis
(Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale];
can be severe and refractory in HIV)
scalp and forehead involvement
Seborrheic Dermatitis
(Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale];
can be severe and refractory in HIV)
brown, angular, ring shaped
could be fungal
Seborrheic Dermatitis
(Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale];
can be severe and refractory in HIV)
impressive scaling and redness over the face
guttate (drop-like)
Seborrheic Dermatitis
(Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale];
can be severe and refractory in HIV)
Stasis Dermatitis
(Appears as eczematous dermatitis due to venous insufficiency and dependent edema; often associated with allergic contact dermatitis. Stasis dermatitis is often seen in combination with venous hypertension, varicosities, edema, venous ulceration, hemosiderin deposits, and lipodermatosclerosis, and confers a risk for stasis ulcer and contact sensitization/ dermatitis)
varicosities, venous ulceration
pigmentary changes
Stasis Dermatitis
(Appears as eczematous dermatitis due to venous insufficiency and dependent edema; often associated with allergic contact dermatitis. Stasis dermatitis is often seen in combination with venous hypertension, varicosities, edema, venous ulceration, hemosiderin deposits, and lipodermatosclerosis, and confers a risk for stasis ulcer and contact sensitization/ dermatitis)
petechiae, ulceration, hyperpigmentation
Stasis Dermatitis
(Appears as eczematous dermatitis due to venous insufficiency and dependent edema; often associated with allergic contact dermatitis. Stasis dermatitis is often seen in combination with venous hypertension, varicosities, edema, venous ulceration, hemosiderin deposits, and lipodermatosclerosis, and confers a risk for stasis ulcer and contact sensitization/ dermatitis)
pigmentary changes only, longstanding
Lichen Simplex Chronicus
(Secondary finding due to chronic rubbing and scratching; continued by Itch-scratch-itch cycle)
Lichen Simplex Chronicus
(Secondary finding due to chronic rubbing and scratching; continued by Itch-scratch-itch cycle)
spikiness; not all at same level
vertical streaking of collagen
irregular epithelial hyperplasia

NOTE compare to psoriasis histology
Neurodermatitis
(Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])
irregular presentation
linear heme crusts
post inflammatory changes
Neurodermatitis
(Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])
old scarring from past flares
angulated
upper back only
Neurodermatitis
(Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])
linear scratches
DIFFERENTIAL contact dermatitis
Neurodermatitis
(Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])
bizarre ulceration pattern
Pityraisis Rosea
(Appears as classically well circumscribed papules and plaques in a "Christmas" or "fir" tree appearance on back, upside down on chest; primarily involves trunk. The primary plaque is referred to as a herald patch.)
sharply demarcated, erythematous papules, plaques, some annular (central clearing)
not very much scaling
truncal predominance
Pityriasis Rosea
(Appears as classically well circumscribed papules and plaques in a "Christmas" or "fir" tree appearance on back, upside down on chest; primarily involves trunk. The primary plaque is referred to as a herald patch.)
sharply demarcated annular and erythematous papules and plaques
truncal distribution
Psoriasis
(Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, usually sparing the face. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)
papulosquamous eruption at scalp
thick scaling
Psoriasis
(Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, usually sparing the face. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)
papulosquamous eruption
sharply demarcated
scaly
Psoriasis
(Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, usually sparing the face. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)
very erythematous
swollen joints with potential arthritic changes
Psoriasis
(Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, usually sparing the face. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)
nail pitting
plaque on right
Psoriasis
(Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, usually sparing the face. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)
onycholysis
oil drop
Psoriasis
(Dermatologic appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, usually sparing the face. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)
club shaped
equal level

NOTE compare to histology of lichen simplex chronicus
Psoriasis
(Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, usually sparing the face. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)
Monroe's microabscess

NOTE compare to histology of lichen simplex chronicus
Mycosis Fungoides, a cutaneous T cell lymphoma
(Erythrodermic patch progresses to intensely pruritic, well-developed plaques in a bathing trunk distribution [clinically diagnostic]. These then progress to low grade, insidious tumors. Less developed lesions are typically not pruritic. Median duration from onset to definitive diagnosis is 4-6 years. Dermatopathic lymphadenopathy usually present.)
plaques, slightly scaly
buttocks and lower trunk most affected
Mycosis Fungoides, a cutaneous T cell lymphoma
(Erythrodermic patch progresses to intensely pruritic, well-developed plaques in a bathing trunk distribution [clinically diagnostic]. These then progress to low grade, insidious tumors. Less developed lesions are typically not pruritic. Median duration from onset to definitive diagnosis is 4-6 years. Dermatopathic lymphadenopathy usually present.)
orange/salmon color
some scaling
Tinea
(Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)
Tinea
(Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)
annulare with scaling
Tinea
(Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)
Tinea
(Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)
Tinea
(Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)
Tinea
(Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)
segmented; hyphae in fungus
C. Eczema
Note that this is on the cheek in a child approximately <2 months. Psoriasis does not "like" the face.
(Most common form of eczema is atopic dermatitis; appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; infantile form favors face, scalp and extensors; 80% develop allergic rhinitis)
What is the most likely diagnosis?
A. Allergic contact dermatitis
B. Candidiasis
C. Eczema
D. Psoriasis
E. Tinea
Aphthous Stomatitis
(Affects 20-60% of the population and manifests as recurrent, idiopathic oral ulcers commonly called "canker sores"
with a whitish, yellow necrotic surface/base and surrounding erythema;
variants include herpetiform and major aphthae [1-3 cm; may be an initial manifestation of Behcet's, but this is rare in Lubbock].)
round, "punched out" ulcers
yellow/white necrotic base with surrounding erythema
Histoplasmosis
uncommon oral ulcer
Pemphigus Vulgaris
(90% will develop oral ulcers, and 50% present with oral ulcers, may involve buccal mucosa or tongue.)
uncommon oral ulcer
Mucosal/Cicatricial Pemphigoid
uncommon ulcerative scarring of mucosa
Herpes Labialis
blister on erythematous base
Hand, Foot, Mouth Disease
(Diagnosis especially likely if dermatologic findings are in a child.)
blisters, erythema around it on hand
Squamous Cell Carcinoma of the Lip
Squamous Cell Carcinoma of the Tongue
Leukoplakia
(Appearance is a "white-plaque" that does not scrape off, commonly seen in the middle aged and elderly with history of gradual onset, smoking, snuff, dentures. Biopsy shows hyperkeratosis, acanthosis, dysplasia and atypia, lymphocytic infiltrate, carcinoma in-situ.)
plaque
Leukoplakia
(Appearance is a "white-plaque" that does not scrape off, commonly seen in the middle aged and elderly with history of gradual onset, smoking, snuff, dentures. Biopsy shows hyperkeratosis, acanthosis, dysplasia and atypia, lymphocytic infiltrate, carcinoma in-situ.)
plaque
Geographic tongue
(Occurs after eating hot foods or drinking hot beverages; benign finding that will heal.)
histologically appears like psoriasis
C. Herpes virus infection
What is the best diagnosis?
A. Candidiasis
B. Cicatricial pemphigoid
C. Herpes virus infection
D. Pemphigus vulgaris
E. Syphilis
A. True
Note the pearly color and presence of telangiectasias. This is a basal cell carcinoma.
Is this lesion malignant?
A. True
B. False
Verruca Vulgaris, the Common Wart
(Caused by multiple types of human papilloma virus infecting epidermal cells. Appears as flesh-colored firm papule or nodule with hyperkeratotic (corrugated) surface with black dots, interrupting normal skin lines. Commonly found on hands, fingers. Treat with non-specific destruction.)
flesh-colores firm papules/nodules
interrupts normal skin lines
usually on hands, fingers
Verruca Vulgaris, the Common Wart
(Caused by multiple types of human papilloma virus infecting epidermal cells. Appears as flesh-colored firm papule or nodule with hyperkeratotic (corrugated) surface with black dots, interrupting normal skin lines. Commonly found on hands, fingers. Treat with non-specific destruction.)
flesh-colores firm papules/nodules
interrupts normal skin lines
usually on hands, fingers
Flat Warts
Slightly raised, flat surfaced papule
Plantar Warts
often covered by callus
can be painful
Condyloma Acuminatum, the Venereal Wart
(Appears as a soft, moist papule or plaque, can be sessile or pedunculated and is often cauliflower-like.)
soft, moist papule
cauliflower-like
Corn (Clavus or Heloma)
(Localized thickening of epidermis caused by pressure or friction, appears as white-gray or yellow-brown, well circumscribed, scaly papules or nodules that do not interrupt skin lines; most commonly involving toes. )
yellow-brown, well circumscribed, scaly papules
not interrupting skin lines
usually on feet and toes
Seborrheic Keratosis
(Arises as benign neoplasm of epidermal cells; appearance varies in size and color: flesh, tan, brown, occasionally black; oval to round, waxy, well-demarcated, "stuck on" appearance; may have verrucous or crumbly surface, occasionally with keratin-filled pits. Spares palms and soles.)
tan to dark brown; round and waxy
"stuck on", like you could peel it off
Seborrheic Keratosis
(Arises as benign neoplasm of epidermal cells; appearance varies in size and color: flesh, tan, brown, occasionally black; oval to round, waxy, well-demarcated, "stuck on" appearance; may have verrucous or crumbly surface, occasionally with keratin-filled pits. Spares palms and soles.)
tan to dark brown; round and waxy-appearing
"stuck on", like you could peel it off
Skin Tag
(An extremely common benign fleshy tumor; appears as a tan- to flesh-colored, soft pedunculated papule with smooth, folded surface. Commonly found on the eyelids, neck, and skin folds (inframammary, axilla, inguinal). No therapy is necessary.)
soft, pedunculated papule
Skin Tag
(An extremely common benign fleshy tumor; appears as a tan- to flesh-colored, soft pedunculated papule with smooth, folded surface. Commonly found on the eyelids, neck, and skin folds (inframammary, axilla, inguinal). No therapy is necessary.)
flesh-colored papules with smooth, folded surface in the axilla
Molluscum Contagiosum
(Caused by poxvirus infection of epidermal cells, common in childhood; also venereal transmission as an adult; suspect HIV if 100s of persistent lesions; will commonly see pontaneous remission over several months. Appears as 2-5mm hard, smooth, dome-shaped flesh colored or translucent papules demonstrating central umbilication with 'cheesy' core content.)
hard, smooth, dome-shaped flesh-colored
central umbilication with "cheesy" core
Molluscum Contagiosum
(Caused by poxvirus infection of epidermal cells, common in childhood; also venereal transmission as an adult; suspect HIV if 100s of persistent lesions; will commonly see pontaneous remission over several months. Appears as 2-5mm hard, smooth, dome-shaped flesh colored or translucent papules demonstrating central umbilication with 'cheesy' core content.)...
hard, smooth, dome-shaped flesh-colored
central umbilication with "cheesy" core
Actinic Keratoses ("Sun Spots")
(Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)
rough, yellowish adherent scale
Actinic Keratoses ("Sun Spots")
(Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)...
rough, yellowish adherent scale
Squamous Cell Carcinoma
(Malignancy of keratinocytes caused by UV light with potential to metastasize [2% overall], appearing as a scaling, indurated plaque or nodule that sometimes bleeds or ulcerates. Persistent ulceration or bleeding warrants a biopsy. Treat by surgical excision)
scaling, indurated nodule
Squamous Cell Carcinoma
(Malignancy of keratinocytes caused by UV light with potential to metastasize [2% overall], appearing as a scaling, indurated plaque or nodule that sometimes bleeds or ulcerates. Persistent ulceration or bleeding warrants a biopsy. Treat by surgical excision)
scaling plaque
Bowen's Disease (Squamous Cell Carcinoma in Situ)
red, scaly, crusted and well-defined plaque
Keratoacanthoma
(May involute, but difficult to differentiate from SCC, so treat regardless.)
rapidly growing, crater-like nodule
Basal Cell Carcinoma
(Malignancy of the epidermal basal cell that rarely metastasizes, but can be locally destructive; caused most commonly by UV radiation, nodular subtype most common. Appears as a pearly, semitranslucent papule or nodule, often with central depression and telangiectasias. Borders are rolled and waxy or cratered. Treat with surgery.(
pearly, semitranslucent nodules
central depression
Basal Cell Carcinoma with Rodent Ulcer
(Malignancy of the epidermal basal cell that rarely metastasizes, but can be locally destructive; caused most commonly by UV radiation. Appears as a pearly, semitranslucent papule or nodule, often with central depression and telangiectasias. Borders are rolled and waxy or cratered. Treat with surgery.)
ulceration and crusting
pearly appearance with telangiectasias
Pigmented Basal Cell Carcinoma
pearly with rolled margin
shiny blue-black color, speckled
Pigmented Basal Cell Carcinoma
pearly with telangiectasias
blue-black color, speckled
Superficial Basal Cell Carcinoma
red, slightly scaling, well-demarcated plaque

DIFFERENTIAL eczema
Superficial Basal Cell Carcinoma
red, slightly scaling, well-demarcated plaque

DIFFERENTIAL eczema
Sclerosing (Scarring) Basal Cell Carcinoma
(Least common and most aggressive.)
atrophic white plaque that looks like scar
Sclerosing (Scarring) Basal Cell Carcinoma
(Least common and most aggressive.)
atrophic white plaque that looks like scar
Epidermal Inclusion Cyst / Epidermoid Cyst
(Derived from the upper portion of the hair follicle lining and commonly located in the mid and lower dermis. Discharges cheesy, foul-smelling macerated keratin. Appears as a flesh-colored, firm, but often malleable, solitary nodule with central punctum or pore. Multiple epidermal inclusion cysts are a feature of Gardner's syndrome.)
flesh-colored solitary nodule with central pore
Epidermal Inclusion Cyst / Epidermoid Cyst
(Derived from the upper portion of the hair follicle lining and commonly located in the mid and lower dermis. Discharges cheesy, foul-smelling macerated keratin. Appears as a flesh-colored, firm, but often malleable, solitary nodule with central punctum or pore. Multiple epidermal inclusion cysts are a feature of Gardner's syndrome.)
flesh-colored solitary nodule with central pore
Hemangioma, Superficial
(Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)
bright red lesion
Hemangioma, Subcutaneous
(Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)
bluish lesion
Hemangioma, Mixed
(Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)
bright red, dome-shaped lesion
Dermatofibroma
(Dermal fibrotic papule or small nodule of unknown origin, possibly trauma; appears as a slightly elevated area ~5mm, often with overlying hyperpigmentation and epidermal thickening. When palpated, these are firm and indurated; demonstrate "dimple sign.")
Pinching shows central dimpling
Light tan to dark brown
Dermatofibroma
(Dermal fibrotic papule or small nodule of unknown origin, possibly trauma; appears as a slightly elevated area ~5mm, often with overlying hyperpigmentation and epidermal thickening. When palpated, these are firm and indurated; demonstrate "dimple sign.")
dark brown, overlying hyperpigmentation and thickening
Keloids
(Exuberant scar tissue due to excessive proliferation of collagen, most common in young black people. Appear as overgrown scars; pink to dark brown, elevated, firm, protuberant nodules/plaque; more extensive than the original wound; irregular claw-like borders. New and active lesions often itch. Treat these cautiously due to their high recurrence rate.)
dark brown elevated, firm, protuberant nodules/plaque
usually appearing on earlobes, shoulders, upper chest, and back
Keloids
(Exuberant scar tissue due to excessive proliferation of collagen, most common in young black people. Appear as overgrown scars; pink to dark brown, elevated, firm, protuberant nodules/plaque; more extensive than the original wound; irregular claw-like borders. New and active lesions often itch. Treat these cautiously due to their high recurrence rate.)
pink elevated, firm, protuberant nodules/plaque
usually appearing on earlobes, shoulders, upper chest, and back
Lipoma
(Benign subcutaneous fat tumor, most common in midlife. Appears as freely mobile, rubbery, flesh-colored nodules, only slightly elevated above the skin's surface, but easily palpable deep in skin.
Biopsy if rapidly growing; therapy is usually not required, but if desired can be excised.)
rubbery, flesh-colored nodule
usually seen on trunk, neck, and upper extremities
Lipoma
(Benign subcutaneous fat tumor, most common in midlife. Appears as freely mobile, rubbery, flesh-colored nodules, only slightly elevated above the skin's surface, but easily palpable deep in skin.
Biopsy if rapidly growing; therapy is usually not required, but if desired can be excised.)
rubbery, flesh-colored nodule
usually seen on trunk, neck, and upper extremities
Neurofibroma
(Focal proliferation of neural tissue in the dermis; multiple lesions are seen in Neurofibromatosis Type 1 [von Recklinghausen's disease]; appear as soft, flesh colored protruding papule or nodule which demonstrate characteristic "buttonhole sign" [when compressed, the papule feels like it can be pushed through a defect in the skin]; less often, these can be deep, firm nodule [plexiform neurofibroma] and be tender; "feels like bag of worms.")
soft, flesh-colored, protruding papule or nodule

DIFFERENTIAL skin tags
Plexiform Neurofibroma
(Focal proliferation of neural tissue in the dermis; multiple lesions are seen in Neurofibromatosis Type 1 [von Recklinghausen's disease]; most commonly appear as soft, flesh colored protruding papule or nodule which demonstrate characteristic "buttonhole sign" [when compressed, the papule feels like it can be pushed through a defect in the skin]; less often, these can be deep, firm nodule [plexiform neurofibroma] and be tender; "feels like bag of worms.")
large, deep, firm nodule
"feels like a bag of worms"
Xanthelasma
(Focal collection of lipid-laden histiocytes in dermis or tendons with yellow appearance due to fat composition; usually a skin sign of hyperlipidemia [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)
yellowish plaques on eyelids
Eruptive Xanthomas (due to very high triglycerides
(Focal collection of lipid-laden histiocytes in dermis or tendons with yellow appearance due to fat composition; usually a skin sign of hyperlipidemia [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)
reddish-yellow papules and plaques
Tuberous Xanthoma
(Focal collection of lipid-laden histiocytes in dermis or tendons with yellow appearance due to fat composition; usually a skin sign of hyperlipidemia [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)
potato-like nodules
commonly seen on elbows, buttocks
Tendon Xanthomas (*due to very high cholesterol)
(Focal collection of lipid-laden histiocytes in dermis or tendons with yellow appearance due to fat composition; usually a skin sign of hyperlipidemia [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)
deep, flesh-colored, hard nodules located within peripheral tendons
most commonly involving Achilles tendon and extensor fingers
Kaposi's Sarcoma
(Malignant vascular tumor caused by HHV8; appears as purple macules, papules, plaques and nodules. In classic Kaposi's Sarcoma (elderly men of Mediterranean descent), it appears as lower leg lesions. If AIDS-associated, the lesions may appear anywhere.)
purple macules, papules, plaques, and nodules
Kaposi's Sarcoma
(Malignant vascular tumor caused by HHV8; appears as purple macules, papules, plaques and nodules. In classic Kaposi's Sarcoma (elderly men of Mediterranean descent), it appears as lower leg lesions. If AIDS-associated, the lesions may appear anywhere.)
purple macules, papules, plaques, and nodules
Freckle/Ephelis
(Sun-induced hyperpigmented macules that only occur in sun-exposed areas; very common. Amount of melanin is increased, but number of melanocytes stays the same.)
hyperpigmented macules
Lentigo
(Hyperpigmented macule caused by increased number of melanocytes
Two main types: (1) Lentigo simplex: childhood, idiopathic, few in number, (2) Actinic lentigo: adults, sun induced, often numerous, more common.)
hyperpigmented macules
Lentigo
(Hyperpigmented macule caused by increased number of melanocytes
Two main types: (1) Lentigo simplex: childhood, idiopathic, few in number, (2) Actinic lentigo: adults, sun induced, often numerous, more common.)
hyperpigmented macules
Junctional Nevus
(Benign common neoplasm of pigment-forming cells [the nevus cell], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)
light to dark brown macule
Compound or Intradermal Nevus
(Benign common neoplasm of pigment-forming cells [the nevus cell], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)
brown, rough-surfaced papule
Compound or Intradermal Nevus
(Benign common neoplasm of pigment-forming cells [the nevus cell], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)
flesh-colored smooth-surfaced papule
Dysplastic Nevus
(Benign common neoplasm of pigment-forming cells [the nevus cell], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)
variegated in color; irregular, indistinct border
erythematous background
Dysplastic Nevus
(Benign common neoplasm of pigment-forming cells [the nevus cell], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)
variegated in color; irregular, indistinct border
Congenital Nevus
(Benign common neoplasm of pigment-forming cells [the nevus cell], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)
elevated, dark brown papule or plaque with discrete borders
Cognenital Nevus
(Benign common neoplasm of pigment-forming cells [the nevus cell], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)
elevated, dark brown papule or plaque with discrete borders

NOTE large congenital nevi (> 20cm) have increased chance of developing into melanoma
Superficial Spreading Melanoma
(Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. Note that superficial spreading melanoma is the most common type.)
irregular in color, surface, border
may occur anywhere on body but show predilection for upper back in males and lower legs in females
Superficial Spreading Melanoma
(Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. Note that superficial spreading melanoma is the most common type.)
irregular in color, surface, border
may occur anywhere on body but show predilection for upper back in males and lower legs in females
Nodular Melanoma
(Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)
rapidly growing, blue-black, eroded nodule
occur anywhere on the body
Nodular Melanoma
(Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)
rapidly growing, blue-black, smooth nodule
occur anywhere on the body
Lentigo Maligna Melanoma
(Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)
multicolored patch with some elevated areas; changes in size, growing slowly; darkening is insidious (years)
occurs on sun-exposed skin
Lentigo Maligna Melanoma
(Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)
multicolored patch with some elevated areas; changes in size, growing slowly; darkening is insidious (years)
occurs on sun-exposed skin
Acral Lentiginous Melanoma
(Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. Note that acral lentiginous melanoma is most frequent in blacks and Asians.)
irregular, enlarging, black growth
occurs on palms, soles, toes or fingers

DIFFERENTIAL lentigo maligna melanoma
Acral Lentiginous Melanoma
(Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. Note that acral lentiginous melanoma is most frequent in blacks and Asians.)
irregular, enlarging, black growth
occurs on palms, soles, toes or fingers

DIFFERENTIAL lentigo maligna melanoma
Survival Statistics Based on Melanoma Depth
Main treatment is surgical excision, with increasing margins for increasing thickness.
Pigmented Basal Cell Carcinoma
shiny, blue-black color, speckled
rolled borders; waxy and cratered
Superficial Spreading Melanoma
irregular in color, surface, border
Combined Melanocytic Nevus
variegated in color; irregular, indistinct border
C. Poison Ivy
Linear and geometric patterns usually have their source outside the body.
This vesicular eruption is caused by:
A. HSV
B. VZV
C. Poison Ivy
D. Streptococcus
HSV
(Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)
grouped vesicles on erythematous base
Herpetic Whitlow
(Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)
grouped vesicles on erythematous base
fingers
Eczema Herpeticum
(Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)
generalized skin infection with predisposing skin disease
HSV
Tzanck smear
multinucleated giant cells
Chronic HSV
grouped vesicles in plaque
Varicella
(Caused by primary VZV infection. Crops of macules develop into papules --> vesicles --> pustules --> crust. Typically all types of lesions seen at the same time
'Dewdrop on a rose petal' is classic.)
generalized, pruritic vesicular eruption
various lesions (macules, papules, vesicles)
"dewdrop on a rose petal"
Zoster
(Caused by reactivation of VZV in sensory nerve; can involve adjacent [but not bilateral] dermatomes. Post-herpetic neuralgia is more common in elderly and can be severe.)
unilateral eruption of groups of vesicles along dermatome
Zoster
(Caused by reactivation of VZV in sensory nerve; can involve adjacent [but not bilateral] dermatomes. Post-herpetic neuralgia is more common in elderly and can be severe.)
unilateral eruption of groups of vesicles along dermatome
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Superficial desquamation beginning.
Superficial desquamation after toxic erythema.
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erythematous plaques, violaceous hue; sun exposure
DIFFERENTIAL drug reaction
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sparing of the nasolabial folds; "butterfly rash"
Cellulitis (displaying the four cardinal signs)
redness, warmth, swelling, pain
intact epidermis
blisters occur only rarely
Fungal Cellulitis (cannot determine cause by observation)
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sharply demarcated red plaque with orange peel appearance (follicles accentuated)
Furuncle
associated hair follicle
Abscess
no associated hair follicle
fluctuates when pressed
Erythema Nodosa
(Causes: Strep, OCPs, Pregnancy, or idiopathic)
red, ill-defined nodules with bruise-like appearance on shins
will be painful when touched
Fixed Drug Eruption
(Causes: NSAIDs, sulfonamides, tetracyclines, carbamazepine)
sharply demarcated red plaques, later dusky
same lesion can reappear
prefers the distal extremities, face, lips, and genitalia
Carcinoid Syndrome
persistent flushing of the face due to high levels of 5HT
Carcinoma Erysipeloides
cutaneous metastases mimicking cellulitis
painful, hot
Urticaria
(Individual lesions last <24 hours)
slightly raised, some blanching at border
edematous plaques
Uritcaria
localized, acute dermal edema
Urticaria, cold induced
localized, acute dermal edema
geographic patterns
Urticardia, cold induced
localized, acute dermal edema
Urticaria, pressure induced
localized, acute dermal edema
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(Most often caused by HSV)
target lesions with rim of pallor and outermost zone of red
(Most often caused by HSV)
target lesions with rim of pallor and outermost zone of red
Erythema migrans
(Caused by Borrelia burgdorferi transmitted by Ixodes, treat with doxycycline, amoxicillin, or ceftriaxone)
slowly expanding, >5 cm red expanding plaque
Erythema migrans
(Caused by Borrelia burgdorferi transmitted by Ixodes, treat with doxycycline, amoxicillin, or ceftriaxone)
slowly expanding, >5 cm red expanding plaque
Ixodes tick
Erythema migrans
(Caused by Borrelia burgdorferi transmitted by Ixodes, treat with doxycycline, amoxicillin, or ceftriaxone)
slowly expanding, >5 cm red expanding plaque
Erythema gyratum repens
reaction to internal malignancy
Erythema annular centrifugum
reaction to distal infection?
scaling trailing behind red border
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