acne vulgaris = zits, comedones, papules, pustules, inflamed nodules, superficial pus-filled cysts and deep purulent sacs, sometimes secondary infx of plugged ducts w/ priopionibacterium (consider rosacea
actinic keratosis = pre-malignant change dt UV exposure, rough scaling macule or plaque, red/pink, ill-marginated, risk: light skin (rule out: seborrheic keratoses, squamous cell carcinoma, psoriasis)
angioedema = painless, well-circumscribed swelling of lips?
annular = ring with central clearing (seen in granuloma annulare, dermatophyte infection, secondary syphillis)
apthous stomatitis = in mouth (ddx: erythema multiforme)
atopic dermatitis = rash on person who reacts to "everything", aka eczema, often genetic influence, IgE mediated in 70-80%, 5% of kids in US have it, usu resolves by age 30 but can occur in adults, kids gt it on face/neck, adults have it on flexor surfaces of arms/legs, buttocks, neck, hands. (rule out: seoborrheic derm, contact derm, nummular derm, candidiasis, impetigo)
Auspitz' sign = pinpoint bleeding after removal of plaques (psoriasis)
black-green distal tongue and chronic sore throat = ?
bulla = a vesicle over 10mm in diameter
bullous pemphigoid = chronic usu pruritic bullous eruptions, autoimmune, mostly in elderly who have Ab's vs basement membrane of epidermis, no Nikolsky's sign (doesn't shed), oral lesions in 1/3, (rule out: pemphigus, dermatitis herpetiformis, erythema multiforme, drug eruption) (different: pemphigus vulgaris)
candida = thrush (white plaque) on tongue, red scaling painful between toes, in groin area, forms satellite lesions, usu candida albicans (70-80%), likes damp heat, intertriginous, perianal, vulvovaginal (itchy, w/ discharge), oropharyngeal, look for budding yeast and pseudohyphae on KOH prep, risks: corticosteroids, hot moist climate, restrictive clothing, diapers, antibiotic therapy, depressed fx of adrenal, thyroid or immune sys, does not flouresce
carbuncle = furuncles gone wild, multiple draining orifices, usu on neck, face, breast, butt, painful, may have fever etc, culture if depressed immune sys
canker sore = painful oral lesion, yellow-gray ulcer, oft dt food intolerance/GI upset
cellulitis = bacterial infx of skin esp dermis, usu strep or staph aureus, also animal bites, hot tubs, injury if immune compromised. Can recur in same area. Calor, rubor, dolor, tumor, lymphangitis and regional LAD, peau d'orange skin texture, systemic sx, CBC shows leukocytes, culture if immune compromised or if not respond to tx (rule out: DVT, stasis dermatitis)
cheilosis = from B12 or iron deficiency anemia, inflam lesion on labial commisures
condyloma accuminata = genital or anal warts usu caused by HPV types 6 & 11, may progress to cervical cancer, "condyl" from Greek for "knob"
contact dermatitis = rash on person who has contacted something irritating/noxious/allergic, ICD = irritant contact (80% of cases, more painful), or ACD = allergen contact derm = type IV hypersensitivity (20%, more itchy). http://allergies.about.com/OD/contactdermatitis/IG/patch-test/
corn = epidermal thickening dt pressure/friction, usu on feet/toes, yellowish core when pared, interrupts skin lines
cutaneous abscess = pus bubble under skin, usu endogenous bacteria, (rule out: hydradenitis suppurativa)
cutaneous larva migrans = hookworm -->serpiginous lesion, contracted from dog/cat poop, usu on foot/leg, more in tropics, intensely itchy, ddx: scabies
Darier's sign = blistering of lesion after stroking (urticaria pigmentosa, mastocytosis)
dermatitis herpetiformis = autoimmune, chronic, recurring, intensely itchy, symmetrical groups of inflamed vesicles, papules and hives (looks like herpes), most sufferers (75-90%) have severe gluten intolerance, scratching changes appearance and misdx common (rule out: pemphigus, bullous pemphigoid, eczematous dermatitis, herpes), IgA deposition in papillary tips
dermatographism = urticaria after stroking skin (sign of high histamine)
dermatophytosis = fungal infx of keratin in skin/nails, epidermophyton/microsporum/trichophyton, rarely invasive, more w/ obesity in skin folds, mildly pruritic, scaling, dx: appearance, scraping and KOH prep, all the TINEAs incl: barbae (trichophyton in beard), capitis (scalp), corporis (torso, neck, pink-red annular lesions, raised scaly borders), cruris (jock itch), pedis (athlete's foot), versicolor (Malassezia furfur changes skin color)
drug eruption = can be any kind of rash so dx via hx, can be: exanthem (ampicillin), urticaria (NSAIDS, PCN, watch for worse rxn to follow), fixed (tetracycline), acneiform (B2, B6, B12, prednisone)
DVT = deep vein thrombosis-->erythematous lesions on lower leg
erysipelas = superficial cellulitis with dermal lymphatic involvement, usudt beta strep, not same as erysipeloid, SHINY, raised, indurated and plaque-like lesions w/ distinct margins, may have high fever/chills/malaise or not. red hot fast spreading. complications: scarlet fever, fat necrosis, gangrene. (rule out: herpes zoster if on face, contact derm)
erysipeloid = like erysipelas except more purple, bacteria is erysipelothrix, more on hands/forearms and not hot. RARE.
erythasma = skinfold (intertriginous) infx w/ corynebacterium, more in middle aged women, tropics, diabetics, find it in toe webs, genitcals, patchy on trunk, flouresces red with wood's lamp, no hyphae in skin scraping (to rule out tinea)
eryhthema multiforme = target lesions, uncommon, usudt drugs/radiation/virus (HSV), 2-4 weeks self resolving, sudden onset of erythema, edema, bullae on face/extremities, symmetrical annular lesions, bull's eye, target, or iris. May itch, may have systemic sx. (rule out: urticaria, bullous pemphigoid, pemphigus, dermatitis herpetiformis, aphthous stomatitis, herpes stomatitis)
erythema nodosum = tender red nodules on shins, sometimes arms, axilla, panniculitis, women 20-30's, kids w/ URIs (strep), adults w/ sarcoidosis or TB, mbdt drugs, other dz, 1/3 ideopathic. (look for underlying disorder, biopsy, ESR, ANA, CBC, chest x-ra, ASO-titer, pharyngeal culture)
exanthem = common drug eruption, mbdt ampicillin, mild itch, measles-like (morbilliform) rash
excoriation = linear erosion, usudt scratching, aka: a scrape.
folliculitis = usudt staph aureus, sometimes pseudomonas (hot tub), pustule or nodule at hair follicle (rule out: acne, fungal folliculitis)
furuncle = boil under 1 cm (abscess over 1cm), usudt staph, more in obese, oily skin, dirty, DM, acne, dandruff, sugar, clothing friction, cortisone use, usu on neck, face, breasts, buttocks. many-->carbuncle.
hair loss = mbdt endocrine malfx, local infx, general health
hand, foot and mouth dz = fever and vesicular rash on parts named, sometimes buttocks/genitals, dt coxsackie virus, usu in small children, self limiting (1 week), ddx: varicella, herpes
herpes simplex lesions = single or clustered vesicles, painful, on face, genitals, fingertips, later dark and crusty, prodromal tingling, usu heals in ~3wks, types 1 & 2, more recurrence w/ type 2, sx w/ 1st outbreak: fever, malaise, h/a, LAD. dx: culture, Twanck smear. ddx: impetigo, eczema, zoster.
herpetic whitlow = HSV lesions on fingertips, usu in healthcare workers but can be fatal to newborns
herpes zoster = shingles = painful erythematous vesicular herpetic rash in a dermatome, usu resolves after ~5 days, begins with radicular pain and itch, occurs many years after initial infection with chickenpox (varicella-zoster v), usu in elderly or w/ cancer, lymphoma, tramua, after rash is gone there may be post-herpetic neuralgia and scarring, ddx: HSV, herpetiformis, contact dermatitis. If near eye, refer immediately to specialist, can cause blindness.
hydradenitis suppurativa = chronic abscesses or boils in apocrine sweat glands and hair follicles, find in axilla, under breasts, groin, buttocks, more common in women, painful, I&D to tx, risks: stress, perspiration, hormones, humid heat, clothing friction. Complic: cellulitis.
I&D = incision & drainage
ichthyosis = scaling and flaking of skin, incl: xeroderma (mild & annoying dt dry skin, see lower legs of older folks) and a heritable form.
id rxn = dermatophytic rxn = spots on body concurrent with fungal infection but spots don't contain fungus
impetigo = yellow crusting vesicles & bullae, superficial, acute, contagious (stay home) infx of strep or staph, most in infants & preschool, occ in young adults, common on FACE (Amy Winehouse), risks: crowding, dirty, minor trauma untreated. complication: glomerulonephritis in young. may have LAD.
induration = hardening or thickening of tissue
intertriginous = in skin fold
keloid = hypertrophic scar extending past wound margin
keratosis pilaris = horny keratin plugs fill follicles, COMMON, usu on lateral aspect of upper arms, thighs, butt, autosomal dominant, annoyed by cold weather, also dt food allergies and ERA metabolis probs
Koebner's phenomenon = lesions form after trauma to tissue (psoriasis, lichen planus, herpes)
labial commissures = where the labia minora and major meet, anterior and posterior
LAD = lymphadenopathy
leukoplakia = white, yellow-brown or gray patch inside cheek or on tongue (rule out candiasis and lichen planus) 2:1 more in males, age 40-70, mbdt chronic irritation of mouth, smoking, bloodroot, betel chewing, drinking, "hairy" leukoplakia w/ HIV & other immune deficiency, tx incl: beta carotene supplementation
lice = pediculosis = crabs. ITCHY!, see excoriations & nits on head/body/pubic area. Head: usu girls, 5-11 years, classroom spread, rare in blacks, pediculus humanus, post cervical LAD. Pubic: usu STD, Phthirus pubis.
lichen planus = recurrent itching inflam w/ small, discrete angular papules that can coalesce, PURPLE ("violaceous") Polygonal Pruritis Papules or Plaques, mbdt autoimmune or drugs (beta blockers, NSAIDS, ACE inhibitors, sulfonylureas, gold, anti-malarials, penicillamine, thiazides). Mouth lesions white with blue lines and mb ulcers, dx: band of lymphocytes btw dermis & epidermis (rule out: leukoplakia, candidiasis, herpes stomatitis, carcinoma, aphthous ulcers, erythema multiformae)
lichen simplex chronicus = neurodematitis = chronic pruritis w/ itch-scratch cycle, dt anxiety/stress/psych, ie chronic neurotic scrating causes skin to toughen up, common on neck, hands, rule out tinea, lichen planus, psoriasis
lipoma = what Dave has lots of and says is hereditary, benign tumor composed of fatty tissue, most common soft tissue tumor, usu moveable & painless, commonest in middle age (any relation to cellulite?)
lupus => butterfly rash
maceration = big patch of skin comes off
maculopapular rash = bad term, generalized, may be due to allergies, drug sensititivies, whatever
measles = rubeola = morbilli --> very contagious infx of paramyxovirus, red-brown maculopapular rash (morbilliform), lasts 5-6 days, scales eventually. Rash appears after 2-3 days of fever, coryza, conjunctivitis, photophobia, Koplik's spots on buccal mucosa. CBC may show leucopenia with relative lymphocytosis. Ddx: scarlet fever, rubella, drug rxn, roeola, erythema infeciosum
miliaria = occluded sweat duct inflamed, children, small red papules & mild itching, "prickly heat rash", head, eyelids, sometimes not raised
molluscum contagiosum = viral, smooth flesh-colored umbilicated domes with hard cheesy core, up to 15mmD, usu spontaneously resolves in 6-9mo or up to 3 years, can be single or in crops, usu on abdomen but can be anywhere, DDX: folliculitis, verrucae, milia
mucocele = mucus filled bulla
Nikolsky's sign = epidermal shearing w/ gentle pressure
nodule = firm papule that extends into dermis or subQ, cyst, lipoma or fibroma (called tumor when over 10mm)
nummular dermatitis = vesicular rash w/ crusting/scaling, coin shaped, idiopathic, middle aged adults, rule out ringworm, scabies, sebor.derm, fungus, paget's.
Paget's dz = lesion on breast dt cancer inside
pemphigus vulgaris = flaccid bullae that shear off (Nikolsky's sign) in mouth first, potentially fatal (via resp infx) blistering disease, autoimmune and occurs in Jews & Mediterraneans btw 40-60 years, may present as bullae in mouth, they erode, skin eruptions later
petechiae = small non-blanchable puntuate foci of hemorrhage
pityriasis rosea = red rash with mild itch plus scaling, minimally elevated papules and plaques on the torso with fine scaling, flouresces red under black light, xmas tree pattern on trunk, acute, self limiting, mild, more in young, women, cool, viral, sometimes mild systemic sx, (rule out: tinea corporis, tinea versicolor, drug erupt, psoriasis, 2ndard syphillis)
pruritis = itching (mediators incl: histamine, kallekrein, peptidases)(things that itch: dermatitis (all kinds), erytehma multiforme, pityriasis rosea, insect bites, juvenile RA, herpes, psoriasis, urticaria, burns, ichthyosis, lichen planus, drug eruptions, infection, allergens)
psoriasis = chronic recurring inflam of epidermis/dermis w/ proliferation -> scaling, thick scaling lesions esp on elbows, knees, anywhere incl scalp, also can present with sterile pustules, pitted nails, arthritis. Gradual onset age 10-40, oft familial, more in light skinned, Koebner phenomenon (lesions may appear after tissue trauma), 5-30% experience arthritis, Auspitz sign (pinpoint bleed when scales removed) (rule out: seborr derm, SCC, dermatophytoses, cutaneous lupus, dermatitis, lichen simplex chronicus)
purpura = large than petechiae same thing, hermorrhage in skin, aka bruise or ecchymosis
rosacea = chronic inflam, shows telangeictasia, erythema, sterile (?) papules, pustules, can disfigure nose/cheeks w/ collagen deposition (rhinophyma), sensitive to alcohol, heat,
roseola infantum = macular rash on face, 30% have it on abdomen, infx w/ HHV 6 or 7, HIGH FEVER possible convulsions, DDX: measles, DX: sx, culture, PCR, serology
scabies = sacroptes mite loves to dig burrows in skin, have babies, raise a family. Asymptomatic for about a month. Likes soft, moist areas, ITCHY AS HELL, may have erythematous papules, (ddx: insect bites, fungus, exzema). Risks: crowding, poor hygiene. Burrows are pathgonomic: fine wavy lines in skin, 2-10mm long, covered in lichenified skin (dt ITCH).
seborrheic dermatitis = rash on oily places
seborrheic keratosis = hyperkeratinization of areas with fatty glands
secondary syphillis = generalized rash, reddish brown macules and papules esp on hands/feet, white plaques in mouth, flulike sx
stasis dermatitis = leg skin starts to fall apart on people with chronic venous insufficience, hx of heart surgery-leg vein removal, CHF, etc
strawberry hemangioma = red birthmark that usu goes away ?
tinea general = a red, scaling sometimes itchy dermatophytic (fungal) infection, not much inflam. Dx: biopsy + KOH to test for tinea, does not bud or grow in genital area like candida does, 3 types of fungi: epidermophyton, microsporum, trichophyton (most common). DDX: psoriasis, seborrheic derm, erythasma.
tinea barbae = trichophyton in beard
tinea capitis = on scalp, round patches of dry scaling skin, alopecia, flouresce blue-green
tinea corporis = ringworm, torso, neck, pink-red annular lesions, raised scaly borders
tinea cruris = jock itch, redness, scaling in groin area
tinea pedis = athlete's foot, often secondary bacterial infx, has vesiculobulbous form
tinea versicolor = Malassezia furfur changes skin color, no itch, flouresces gold-white
tonsilitis & pharyngitis = bacterial or viral, viral shows cobblestoning
Twanck smear = old test for macrocytic cells, used for HSV
urticaria = itchy rash, aka wheals or hives, transient elevated lesion due to localized edema, usu allergic, many causes, seek systemic cause of any case that lasts over 2 weeks or recurs
varicella = chicken pox = HHV3 causing vesicular rash on whole body, usu in kids, worse in adults, 2-3 day prodrome = fever, low appetitie, dry mouth, sore throat, rash starts at top and moves down, severe itch, very contagious, crusts after vesicles pop, complications: pneumonia, encephalitis, erysipelas, acute hemorrhagic nephritis.
viral exanthem = any skin eruption caused by a virus
vitiligo = like tinea but doesn't flouresce, +KOH
warts = verrucae vulgaris = dt HPV 1, 2, 4, 27, 29, usu in kids or immune compromise, common wart is dome shaped, round or irregular, rough, gray/yellow/brown/black/nude, 2-10 cm. filiform wart is long, narrow, soft, small, on eyelid, face, neck. Flat wart is HPV 3, 10, 28, 49, smooth, on hands/face. Plantar wart on feet soles, pinpoint bleed when pared, black puncta, mosaic = many plantar. Condyloma accuminata is genital wars, soft moist papules or plaques.
xanthoma = yellow