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Dermatology: Conditions and Vocabulary

acantholysis = loss of intercellular connections resulting in loss of cohesion between keratinocytes

acanthosis = diffuse epidermal hyperplasia

acanthosis nigricans = “dirty neck” = hyperpigmented areas with velvety texture, esp in skin folds (neck, axillae, groin, anogenital), 80% is bening, occurs in children through the onset of adolescence and tends to indicate insulin resistance in this population, 20% malignant in middle aged population, associated with GI adenocarcinoma, also in all ages with DM, obesity, pituitary and pineal tumors

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, perioral dematitis, drug eruptions)

actinic keratosis = pre-malignant change dt UV exposure, rough or horny growth, scaling macule or plaque, brown/red/pink, ill-marginated, risk: light skin, arsenic exposure (rule out: seborrheic keratoses, squamous cell carcinoma, psoriasis) Tx: cryotherapy. May be a marker for internal cancer (Bowen’s Dz).

allergic triad = asthma, eczema, hayfever

alopecia = hair loss, may be non-scarring and focal, or scarring and focal (rare). Nonscarring: pattern baldness (both genders), toxic (after fver or stress by 3-4 mo, usu temp, also from endocrine disorders & drugs, no broken hair) also alopecia areata (see below), trichotillomania (kids nutty), tinea capitis. Scarring usu dt infx, injuries, burns, trauma, ulcers, granulomas, syphilis, tinea. Dx: examine ratio or anagen and telogen hairs to assess ratio of resting hairs, biopsy if needed.

alopecia areata = sudden hair loss in circumscribed areas, no systemic sx, thought to be autoimmune, or dt hypothyroid, chemotherapy

anagen hair = active growth phase, cells in the root of the hair are dividing, hair grows about 1 cm every 28 days, scalp hair stays in this phase for 2-7 years

angioedema = painless, well-circumscribed swelling of lips, trachea, etc, when extreme → anaphylaxis

annular = ring with central clearing (seen in granuloma annulare, dermatophyte infection, secondary syphillis)

apthous stomatitis = canker sore on lips or gums, shallow pale sore with red (hyperemic) border, covered by thin exudates, usu painful, some say runs in family, mbdt hypersensitivity, stress, hormones (b4 menses), more with celiac dz, some sensitive to lauryl sulfate in toothpaste, DDX: erythema multiformae, Behcet’s syndrome, TX: non-deglycerrhizonated licorice, and silver nitrate to kill pain.

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)

basal cell carcinoma = BCC = highly variable appearance, from small/shiny/firm/translucent nodule to crust/flat lesions like dermatitis, shiny pearly border around “rodent ulcer”, superficial slow growing papule or nodule, from epidermal basal cells, most common skin cancer, 146/100,000 in Minnesota, good prognosis dt slow growth & almost never metastasizes, only on skin with hair, risks: light skin, xeroderma, sun, basal cell nevus syndrome (Gorlin syndrome = genetic loss of oncogene deletion gene, autosomal dominant). Morphology: telangiectatic papule or nodule, may have pigment or be “rodent ulcer” (excavated lesion with rolled pearly border). Dx: alcohol on cotton ball on it to bring telangiectasia into view, biopsy. Histology: nests of basal like cells arising from follicles, palisading (flowing look) to cells, Tx: cryotherapy, antioxidants, black salve, homeopathy for those with nevi: carcinosum.

Behcet’s syndrome = ? uncommon condition w/ painful ulcers like aphthous ulcers initially, genital ulcers, iridocyclitis (iris & ciliary body inflam →pain, photophobia, hazy vision), may occur with arthritis and GI probs, more in 20-30 males, more in Mediterranean, Asia, Japan.

black-green distal tongue and chronic sore throat = ?

Bowen’s dz = actinic keratosis indicating internal cancer??

bulla = a vesicle over 10mm in diameter

bullous pemphigoid = very rare w/ good prognosis, chronic usu pruritic bullous eruptions, autoimmune (eos destroy basal cells), mostly in elderly, (-) Nikolsky's sign (doesn't shed), may begin with uritcaria, oral lesions in 1/3, mild and transient. DX: test for Ab’s. DDX: pemphigus, dermatitis herpetiformis, erythema multiforme, drug eruption) (different: pemphigus vulgaris. Tx: systemic prednisone, topical glucocorticoids, anti-inflam diet, nicotinamide and zinc. Often permanent remission.

cancer indicators = acanothisis nigricans, dermatomyositis, eczema on breast, erythema multiformae, sign of Leser-Trelat (seborr. ker), actinic keratosis (Bowen’s dz),

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 = rare (10-39/100,000), autoimmune, neurogenic, chronic, recurring, intensely itchy, symmetrical groups of inflamed vesicles, papules and hives (looks like herpes). Most sufferers (75-90%) have severe gluten intolerance, mostly caucasian, M:F 2:1. Scratching changes appearance and misdx common (rule out: pemphigus, bullous pemphigoid, eczematous dermatitis, herpes), IgA deposition in papillary tips. Tx: gluten free diet, consider dapson and sulfapyridine. Prog: mb prolonged x years, 1/3 have remission.

dermatofibroma = small red to brown papule with dimple sign, does not grow, small area of local fibrosis, common on lower extremities in adults, more in women in 20’s, idiopathic. If it grows, consider dermatofibroma protuberans (malignant)

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)

dermatosis papulosa nigra = spots on malar aspect of dark skinned face (type VI skin), Condaleeza Rice has it, cosmetic only, same morphology as seborrheic keratosis meaning lesions are dark, verrucous and look “stuck on”

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

dyskeratosis = abnormal keratinization, premature within individual cells or groups of cells below stratum granulosum

dysplastic nevi = premalignant moles → melanoma. Over 6mm in diameter, also happens where sun doesn’t shine. Flat to slightly raised, variegated color, irreg border, distorts skin lines, dysplastic nevi SYNDROME is genetic mutation xsome 1 in 2-6% of pop and skin types I-IV only, these individuals have 6% lifetime risk of melanoma.

eczema = red, oozing, crusting, papules, vesicles, pruritic, acute inflam of epidermis & dermis, chronic→elevated lesions, scaley plaque, scratch it a lot→lichen simplex chronicus, histopathology: spongiosis, epidermal microvesicles, parakeratosis, acanthosis, dermal edema, dermal infiltrate.

epidermal cyst = COMMON, firm flesh-colored moveable nodule, 1-3 cm, nontender unless ruptured, contains keratinous or sebaceous material, DDX: lipoma

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, 80% is minor, 20% is major (Stevens-Johnson syndrome = toxic epidermal necrolysis), lesions occur on lips, everywhere, aplsm and soles too, (usudt drugs, radiation, virus (HSV), fungal infx, paraneoplasms, lupus, polyateritis, dermatomysitis, polyarteritis nodosum) 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: syphilis, hand, food and mouth dz, 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.

exocytosis = infiltration of epidermis by inflam or circulating blood cells

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, HSV types 1 & 2, more recurrence w/ type 2, sx w/ 1st outbreak: fever, malaise, h/a, LAD. Triggers: UV, menses, trauma, stress, fever, arginine rich food. Dx: culture, Twanck smear. ddx: impetigo, eczema, zoster.

herpetic stomatitis = HSV outbreak around or on the mouth (stoma), use Tzank test for multinucleated giant cells from fused eosinophilic intranuclear viral inclusions.

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.

hirsutism = increased facial/body hair on female usu dt elevated androgens, Dx: serum free and total testosterone, DHEA sulfate, FSH, LJ, prolactin, TSH.

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.

hydropic swelling = ballooning = interacellular edema of keratinocytes, often seen in viral infx

hypergranulosis = hyperplasia of stratum granulosum, oft dt intense rubbing

hyperkeratosis = thickening of stratum corneum

hyperpigmentation = melasma/chloasma or lentigo

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

infantile hemangioma = superficial lesions, bright red, raised, may have some blue, starts soon after birth and enlarges, disappears at 2-5 years, benign proliferation of BV’s in dermis, called deep, cavernous, superficial, strawberry, most common tumor of infancy (10-12% by age 1), DX by appearance.

intertriginous = in skin fold

keloid = hypertrophic scar extending past original wound margin, firm, protuberant, shiny, may have clawlike extensions, may be dark colored, ETIO: fibroblastic proliferation following trama, hereditary tendency more in blacks, more in ages 10-30

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

lentiginous = a linear pattern of melanocyte proliferation within the epidermal basal cell layer. Hyperplasia can occur as reactive change or neoplasm.

lentigo = flat, brown or tan spots on sun-exposed areas, usu face or back of hands, dt chronic sun exposure, nevus or macule, may be “solar” which turns darker with sun, or “benign” which doesn’t change with sun, plural = lentigines

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 with network of white lines (Wickham striae) and mb ulcers, dx: band of lymphocytes btw dermis & epidermis, death of basal deratinocytes, sawtoothing of rete pegs. (rule out: leukoplakia, candidiasis, herpes stomatitis, carcinoma, aphthous ulcers, erythema multiformae), slow cell turnover rate.

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 = subcu fatty rubbery nodules, more in women, more on trunk, forearms, neck, ETIO: excess fibroblastic proliferation, 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

malignant melanoma = less common but more dangerous skin cancer, 5 year survival rate 80%, fast growing radial phase in situ then vertical into dermis, asymmetrical with irregular/scalloped borders, mottled colors, diameter over 6mm, macular early and later raised, bleeds, itches, sloughs. Approx ½ from previously “normal” moles. Risks: light skin, hx of blistering sunburns, chemical exposures incl StJW, dysplastic nevus (7x risk), many nevi over 2mm. Occurs in mouth, anogenital, mucosa, back (men), legs (women), meninges, uvea/retina. Types: lentigo-maligna (15%), superficial spreading (2/3), nodular (fast growing), acrolentiginous (in blacks where less pigment). High lymphocyte count better prognosis. Tx: fractionated pectin, wide excision, alpha interferon, IL-2, astragalus, quercitin, curcurmin, betulinic acid, green tea, cimetadine

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

melanoma = malignant cancer, four types: lentigo malgina, superficial spreading (most common, 70%), acral lentigenous (around nails, palms, soles on type V-VI skinned person), nodular (2nd most common and dangerous dt no radial phase).

melasma/chloasma = macular hyperpigmented sharply delineated patches, usu on face of pregnant women or women on oral contraceptives (OCP), ETIO: increase in melanin dt estrogen stimulation/UV light. DDX: past inflam hyperpig.

meltump = skin changes with “uncertain malignant potential” or “undetermined significance”

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

nevocellular nevi = pigmented or melanocytic nevi = MOLES. More in men, skin types I-III, hot vacations, kids after chemo, three locations: junctional (at epidermal/dermal junction), intradermal & compound (in both epid/dermis).

nevus = mole, circumscribed usu pigmented macule, papule or nodule, or nodule comprised of melanocytes

nevus eraneus = spider angioma = spider nevis = spider veins usu on legs faintly pulsatile, no internal pathology except possibly liver, associated with venous insufficiency, runs in families, blanches when press on center

nevus flammeus = flat pink mark near eye, capillary malformation present at birth, disappears in a few mo.

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.

onchomycosis = fungal infx of nails, usu trichophyton, risks: tinea, age, male, circ dz. DX: psoriasis, lichen planus

Paget's dz = lesion on breast dt cancer inside

PAN = polyarteritis nodosum, possible cause of erythema multiformae

papillomatosis = surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae

parakeratosis = keratinization characterized by retention of nuclei in stratum corneum, normal on mucous membranes

paronychial infx, periungal infx = acute or chronic infx with staph of strep at corner of finger or toe nail

pemphigus vulgaris = very rare and potentially fatal blistering disease, flaccid bullae that shear off or travel with pressure (Nikolsky's sign) appearing first on oral mucosa, hoarseness, skin eruptions later, autoimmune, occurs in Jews & Mediterraneans btw 40-60 years. Tx: glucocorticoids and immunosuppressive therapies (allo), anti-inflam diet, high chance of gluten sensitivity. DDX: bullous pemphigoid.

peripheral ossifying fibroma = common growth on gingival, etio unknown, may arise from pyogenic granuloma, most in young & teen females

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)

port wine stain = capillary malformation present at birth, becomes darker with time, reddish-purple and may appear anywhere (different from nevus flammeus which is near eye and goes away). Dx by exam.

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 silvery scaling lesions over salmon-colored inflamed base, 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 (spicules on bottom surface of scale, pinpoint bleed when scales removed) (rule out: seborr derm, SCC, dermatophytoses, cutaneous lupus, dermatitis, lichen simplex chronicus) (etiology: drugs incl beta-blockers, ca channel-blockers, antimalarias, alcohol, HLA-C and other genetic markers, chronic fungal infx, diet, mom didn’t breast feed and child didn’t get probiotics) (CD4 cells react w/ APC’s producing IL-12, IFNgamma, TNF, lowered camp->increased histamine, increased cGMP->keratinocyte proliferation = acanthosis) (normal camp usually keeps platelets from being overactive, keeps histamine down, increases heart force, relaxes arteries and smooth muscle) (often occurs with arthritis, myopathy, enteropathy, AIDS, nail changes, ankylosing spondylitis, HLA-B27)

purpura = large than petechiae same thing, hermorrhage in skin, aka bruise or ecchymosis

pyogenic granuloma = highly vascular peduncular lesion, usu in gingival, nodule dt overproliferation of capillaries, friable under thin epidermis, occurs after trauma, usu in preg, shown in class: tip of finger, on gum, DX: biopsy. May regress after preg or become peripheral ossifying fibroma.

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

rubella = pinpoint erythema w/ LAD, rash starts on face and moves down, may have petechiae on palate, ETIO: RNA virus, TRANS: resp droplets, mild incubation of 2-3 weeks, if pregnant and suspect this infx get blood test, Less contagious than measles but more likely to cause genetic deformations if the mother is infected during the first trimester of preg. DDX: drug rash, scarlet fever, measles, erythema infectiosum.

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 = COMMON benign neoplasm, hyperplasia of basal cells with age, (I have one), usu pigmented (mine’s black), usu verrucous sometimes smooth, can be scraped off but will grow back, looks “pasted on”. Made of nests/sheets of basiloid cells & plugs of keratin. If many of these occur at the same time (rare) it is the sign of Leser-Trelat (heralds visceral adenocarcinoma)

secondary syphillis = generalized rash, reddish brown macules and papules esp on hands/feet, white plaques in mouth, flulike sx

sign of Leser-Trelat = multiple new seborrheic keratoses (rare to occur all at once), heralds visceral adenocarcinoma

skin tag = pedunculated fiborma, fleshy skin tumor, usu on neck, axilla, groin, under breast, eyelid. DDX: warts, nevi.

spongiosis = intercellular edema of the epidermis

squamous cell carcinoma = SCC = 2nd most common skin cancer, 107/100,000 in US, risks: ligh skin, sun, arsenic, coal tar, chornic draining osteomyelitis, old burn scars, low immune, xeroderma. morphology: appearance highly variable but usu starts as red papule or plaque, may form nodule, scale, ulcerate, bleed, exophytic (sticks out), on sun exposed area. histopathology: malignant tumor of epithelial keratinocytes that invades dermis, hyperchromatic nuclei at all levels of epidermis, cells mb polygonal or anaplastic & round, most common in males over 60 in sun exposed areas. DX: biopsy. DDX: actinic keratosis, seborrheic keratosis, BCC.

stasis dermatitis = leg skin starts to fall apart on people with chronic venous insufficience, hx of heart surgery-leg vein removal, CHF, etc

Stevens-Johnson syndrome = large areas of epidemis slough off from blistering dz = toxic epidermal necrolysis (severe form of erythema multiformae)

strawberry hemangioma = red birthmark that usu goes away ?

telogen hair = resting phase, follicle is at rest and the club hair is formed. Pulling out a hair in this phase will reveal a solid, hard, dry, white material at the root. Usu ~10–15% of hairs in telogen phase. Opposite is anagen, active growth phase.

tinea = 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

trichotillomania = hair pulling neurosis usu in children

Twanck smear = old test for macrocytic cells, used for HSV

urticaria = pruritic edematous plaques, aka itchy rash, wheals or hives, dt mast cell degranulation in dermis, transient elevated lesion due to localized edema, usu allergic, many causes, seek systemic cause of any case that lasts over 2 weeks or recurs

vacuolization = formation of vacuoles within or adjacent to cells, often refers to basal cell-basement membrane zone area

varicella = chicken pox = HHV3 causing vesicular pruritic crusting rash on whole body, usu in kids, worse in adults, 2-3 week incubation then 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. Complic: pneumo, encephalitis, erysipelas, acute hemorrhagic nephritis.

vermillion border = where epidermis meets lip mucosa (no hair)

viral exanthem = any skin eruption caused by a virus

vitiligo = common (1%) acquired loss of pigmentation (melanocytes quit or die), sharply demarkated patches. M=F. Patchy but usu symmetrical, usu progressive, idiopathic/autoimmune/hereditary, like tinea but doesn't flouresce, neg KOH no flaking, assoc w/ Graves and Hashimoto’s, beware of sunburn. Onset age 10-30yrs (50%). DDX: tinea versicolor (tinea has light scale, fluoresces gold/white)

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

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