MED: Common Skin Disorders & Manifestations of Systemic Disorders

papulosquamous, proliferative, inflamatory skin disease
(common skin disorder)

salmon pink plaque topped by silvery white scale on extensor surfaces (scalp, elbows, knees);
can be round/gultate/
geographical/ circinate;
(+) Auspitz
(common skin disorder, be specific)

pinkish, glazed, clearly demarcated, non-scaly; (groin, perianal, genital, inframammary folds);
usually mistaken as dermatophytic or candida
(type of psoriasis)

well-demarcated, scaling, erythematous, pustules are white/yellow/green/brown; common in palms and soles
(type of psoriasis)

more complicated; life-threatening; can lead to death
(type of psoriasis)

Psoriasis Management?

Acute: vesicular, can rupture to leave a raw, weeping surface;
Subacute: diffuse, irritating, pruritic, sometimes painful;
Chronic: lichenification
(common skin disorder)

presents at infancy, resolves by 12y/o;
area of predilection: cheek;
(+) Prick test to common allergens;
itch rash cycle
(type of eczema/dermatitis)

age 2 and above; at flexural, antecubital, popliteal areas
(type of eczema/dermatitis)

Atopic Eczema Management?

erythema, vesiculation, fissuring;
commonly affects hands;
can manifest even in 1st exposure
(type of eczema/dermatitis)

sharp cut-off where contact ends;
previous sensitization, autosenzitation;
most vulnerable: thin, moist skin;
(+) Patch Test: marked prolonged response
(type of eczema/dermatitis)

scaly, rusty, red, pruritic eruption on oily areas of skin (T-zone, flexures, scalp, nasolabial, eyebrows)
(type of eczema/dermatitis)

papulopustular inflammatory condition affecting face and trunk;
mild: comedo, open/closed;
severe: pustular, scarring, cystic
(common skin disorder)

Acne Vulgaris Management?

chronic inflammatory eruption on cheeks, nose, chin;
erythema, papules, pustules, cyst, telangectasia;
complication: nose deformity
(common skin disorder)

Acne Rosacea Management?

small, polygonal, flat-topped, violaceous papules; very pruritic;
areas: wrist, lower extremities;
Wickham striae;
post-inflammatory hyperpigmentation
(common skin disorder)

Lichen Planus Management?

self-limiting, non-recurrent, scaling reddish-brown discrete maculopaular eruption;
Herald patch: shoulder or back;
Christmas-tree like: trunk, upper thighs, arms;
Colarette scaling
(common skin disorder)

Pityriasis rosea Management?

very pruritic, transient/evanescent, sharply defined, erythematous or white weals w/ erythematous rim
(common skin disorder)

"burrows", excoriations;
nocturnal pruritis or discomfort;
Circle of Hebra;
areas: fingerwebs, wrists, antecubital fossae, axilla, areola, abdomen, gentialia, areas w/ thin skin
(common skin disorder)

Scabies Management?

chronic, granulomatous;
leonine facies, saddle nose
(common skin disorder)

few, well-defined, hypopigmented, hypoesthetic macules/patches w/ raised erythematous/purple border enlarging peripherally
(type of Hansen's)

symmetric, skin-colored/slightly erythematous papules/nodules on nose, earlobes, face, arms, buttocks, trunk, and lower extremities; Leonine facies
(type of Hansen's)

painful to touch, nodular lesions usually on anterior shins
(systemic manifestations)

Possible causes of Erythema Nodosum?

Erythema Nodosum Management?

target lesions or circular w/ central blistering; usually on limbs, symmetric
(systemic manifestations)

Possible causes of Erythema Multiforme?

enlarging, coalescing macules w/ crinkled surface; sheet-like loss of epidermis; extensive necrosis;
(+) Nikolsky
(systemic manifestations)

SJS Management?

evanescent pink rash/rings on trunk or proximal extremities
(systemic manifestations)

starts as a papule, become vesicular and pustular; painful ulcers on back, thigh, buttocks w/ bluish edge
(specific disease w/ skin manifestation)

hardened, raised, shiny area on shins, center has yellowish tint, surrounding: pink; telangectasia (lips, nose, eyes, fingers, oral cavities); gradual formation, slow healing
(specific disease w/ skin manifestation)

smooth, discolored, annular, pustular patches w/ intact skin surface; no ulceration, no damage to epidermis;
usually on hands
(specific disease w/ skin manifestation)

pruritic, symmetrical clusters of urticarial lesions, evolve to vesicles & bullae; very itchy; found at gluteal area, extensor aspect of elbows, knees, and upper back
(specific disease w/ skin manifestation)

infiltrative dermopathy: erythematous, edematous swellings above lateral malleoli = thickened edema of legs & feet
(specific disease w/ skin manifestation)

pigmented, rough, thickened skin in axilla or groin w/ warty lesions; velvety plaques on back in obese
(specific disease w/ skin manifestation)

heliotrope inflamm changes, edema of eyelids & periorbital area;
erythema of face, neck, upper trunk, usually sun-exposed areas;
hands: Gottron's papule = flat-topped violacrous papules over knuckles
(specific disease w/ skin manifestation)

dry, scaly skin;
sparing of flexural areas e.g. popliteal
(specific disease w/ skin manifestation)

successive crops of tender nodules affecting blood vessels throughout the body
(specific disease w/ skin manifestation)

painful groups of vesicles on an inflamed base, unilateral w/ dermatomal distribution
(specific disease w/ skin manifestation)

reddening of skin on palmar aspect of hands, usually over hypothenar eminence
(specific disease w/ skin manifestation)

telangectasis found slightly beneath skin surface, often containing central red spot and reddish extension which radiate
(specific disease w/ skin manifestation)

diffuse bluish plaque w/ small papules w/in the swelling affecting the nose;
sometimes spreads to cheek
(specific disease w/ skin manifestation)

Café-au-lait macules, axillary freckling, violaceous dermal neurofibroma, subcutaneous nodules
(specific disease w/ skin manifestation)

tense bullae & erosions on normal appearing skin; slowly heals to form pink atrophic scars, milia on dorsa of hands, feet, nose, forehead, scalp;
hypertrichosis on face
(specific disease w/ skin manifestation)

small, red papule; gradually enlarges to form ring w/ raised border
(specific disease w/ skin manifestation)

Lyme Disease Treatment?

yellow plaque, commonly found on eyelids
(specific disease w/ skin manifestation)

periorificial, acral eczematous and erosive dermatitis; may be some alopecia and diarrhea
(specific disease w/ skin manifestation)

painful oral and genital ulcerations and eye and joint conditions;
iritis, keratitis, hyopyon, retinal vein occlusion, arthritis, CNS, complications
(specific disease w/ skin manifestation)

Bechet's Disease Management?

initial: flesh-colored papule/plaque w/ superficial dilated blood vessels over surface;
classic lesion: ulceration & central necrosis, pearly rolled border;
"rodent ulcer": dirty-looking ulcerations

Basal Cell Carcinoma Management?

hyperkeratotic, crusted, indurated, may ulcerate; may look like psoriatic lesion;
from damaged/chronically irritated skin, sun exposure, HPV

Squamous Cell Carcinoma Management?

pigmented lesion with: rapid enlargement, bleeding, variegated pigmentation, ulceration, indistinct border, persistent itching, small satellite lesions around principal lesion

Melanoma Management?

Casal necklace: symmetric photosensitive eruption on face, neck and upper chest;
Gauntlet: extensor arms, back of hands

starts as erythema and swelling after sun exposure, accompanied by itching and burning or pain; skin becomes thickened, scaly, hyperpigmented w/ copper or mahogany hue

dull erythema of bridge of nose w/ fine yellow, powdery scales over follicular orifices (sulfur scales)

vesicular or bulous erruptions
(type of pellagra)

pustular and bullous dermatitis w/ acral and periorificial distribution; patchy, red, dry, scaling w/ exudation and crusting on face, groin, flexor areas

periungual areas are erythematous and scaling, sometimes have superficial, flaccid pustules; angular chellitis, stomatitis; nail dystrophy, generalized alopecia; diarrhea, lethargy, irritibalitiy, whining, crying, Candidiasis, Staph

hypopigmented on dark skin, erythematous/ purple on fair; first appear on friction areas (flexures, groin, buttocks, elbows); hyperpigmented patches w/ slightly raised edges, peeling, desquamation

"crazy pavement", "crackled skin", "mosaic skin", "enamel paint", "flaky patient"

hair: hypopigmented, reddish-yellow to gray or even white, dry, lusterless, crackled;
(+) Flag Sign: alternating bands of pale and dark hair;
nails are soft and thin;

failure to thrive, edema, lethargy, irritability, apathy, abdominal distention, hypoglycemia, anemia, hypoprotenemia

multiple, intensely pruritic, small papules and vesicles on thenar and hypothenar eminences of hands, soles, sides of fingers and toes

round or oblong, yellow fibrinous base ulcers; lower medial aspect of leg

early eruptions: symmetrical, more or less generalized, superficial, non-destructive, exanthematic, transient, macular
later: maculopapular or papular, polymorphous

exanthemic erythema; round indistinct nonconfluent macules; appear first on sides of trunk, about the navel, and on inner surface of extremities

raw ham or coppery shade and round; slightly raised; deep, firm, palpable;
Ollendorf's sign: papule tender to touch of blunt probe;
healing lesions leave hyperpigmented spots

adherent scales covering lesions more or less dominate
(syphilid)

minute scale-capped papules; at the ostia of hair follicles; conical, elsewhere domed
(syhpilid)

mimics sarcoidosis; usually in cheeks or angles of mouth; "nickels and dimes"

large central papule, group of minute satellite papules
(syphilid)

widely scattered over trunk and extremities, involve face; arise from red infiltrated base
(syphilid)

papular lesions, relatively broad and flat; located on fold of moist skin, esp genitalia and anus
(syphilid)

mucus patches; macerated, flat, grayish, roudned erosions covered by delicate, soggy membrane; occur on tonsils, tongue, pharynx, gums, lips, buccal areas, genitalia

butterfly rash over cheeks and bridge of nose; skin sores or flaky red spots on arms, hands, neck, head area; scaly red/purple raised rash; Raynaud's; temporary hair loss