- Tinea versicolor is a common superficial fungal infection of the skin, causing hypo or hyperpigmented (“versicolor”), slightly scaly macules on the trunk, neck, and upper arms (short-sleeved shirt distribution). They are easier to see in darker skin and may be more obvious after tanning. In lighter skin, macules may look reddish or tan instead of pale.
- Tinea corporis has annular lesions with central clearing and papules on the borders. This is usually seen in children.
- Vitiligo may exhibit depigmented macules appear on the face, hands, feet, extensor surfaces, and other regions; and may coalesce into extensive areas that lack melanin.
- Hereditary
- Ichthyosis vulgaris is a skin disorder that causes thin flakes of dead exfoliated epidermis.
- Melanoma– dark, raised, asymmetric lesion with irregular borders may be a melanoma.
- A squamous cell carcinoma has a raised, crusted border with central ulceration on the lesion. Biopsy confirms the diagnosis.
- Squamous cell carcinoma appear on sun exposed skin of fair skinned adults over sixty and look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed.
- Basal call carcinoma can present as a red raised nodule with a lustrous surface and telangiectatic vessels with or without ulceration. It occurs more frequently in fair -skinned people who have been exposed to large amounts of sun.
- basal call carcinoma of the eyelid is uncommon, it does occur most often on the lower lid and medial canthus. It looks like a papule with an ulcerated Metastasis is rare but should be referred for removal.
- Basal cell carcinoma typically presents with an initial translucent nodule that spreads, leaving a depressed center, a firm elevated border, and visible telangiectatic vessels. They usually appear in adults over forty and seldom metastasize.
- Kaposi’s sarcoma is seen in patients with AIDS and appears in many forms and on any part of the body. The abnormal cells form purple, red, or brown blotches or tumors on the skin and can become life threatening when the lesions are in the lungs, liver, or digestive tract.
- A cutaneous cyst is a benign, closed sac that lies in the dermis, forming a dome shaped lump.
- Tophi are identified as deposits of uric acid crystals secondary to gout and appear as hard nodules in the helix or antihelix.
- Chondrodermatitis Nodularis Helicus is a condition with painful nodules that develop on the rim of the helix (where there is no subcutaneous tissue). This develops a result of repetitive mechanical pressure or environmental trauma (sunlight). They are small, indurated, dull red, poorly defined, and painful.
- Impetigo usually appears as red crusty lesions on the face, especially around a child’s nose and mouth. The lesions burst and develop honey-colored crusts.
- Varicella is characteristic of papules, vesicles, and crusted lesions occurring simultaneously.
- Herpes simplex on the lips and mouth appear as small vesicles or blisters and are termed “fever blisters” or “cold sores”.
- Shingles appear as vesicles or blisters in clusters along the entire path of the nerve or in certain areas supplied by the nerve.
- Verruca plana are small, flat warts located on superficial surfaces of the skin.
- Verruca vulgaris are dry, rough warts located on the hands. Small tender warts located on the superficial surfaces of the feet are plantar warts.
- Molluscum contagiosum are dome-shaped, flashy lesions and are located anywhere on the skin.
- Seborrheic keratoses are common, benign, yellowish to brown, raised lesions that feel slightly greasy and appear velvety and warty. They usually appear on trunk and face of the elderly.
- Actinic keratoses are superficial, flattened papules covered by a dry scale and can appear pink, gray, or tan in color. They appear on sun exposed skin of older fair-skinned persons.
- Actinic purpura– Well-demarcated vividly purple macules or patches; Skin on the backs of the hands and forearms appears thin, fragile, loose, and transparent. There may be purple patches or macules, termed actinic purpura, that fade over time. These spots and patches come from blood that has leaked through poorly supported capillaries and spread within the dermis.
- Lichenification is thickening and roughening of the skin with increased visibility of normal skin furrows. It can be seen in patients with atopic dermatitis.
- Annular lesions are described as circular lesions that begin in the center and spreads to the periphery as with tinea and ringworm lesions.
- Confluent lesions appear as if the lesions run together and are characteristic of hives.
- Discrete lesions appear as distinct, individual lesions that remain separate as in acne.
- Target lesions resemble the iris of the eye and appear with concentric rings of color in the lesions. These are seen in erythema multiforme.
- Koplik spots are seen with measles. They are small, white spots (often on a reddened background) that occur on the inside of the cheeks early in the course of red measles, rubeola.
- Pastia’s spots are pink or red lines that are formed of confluent petechiae found in skin creases and are seen in patients who have scarlet fever.
- Aphthous ulcers are recurrent small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or gray floors occurring in the mouth.
- Skin that appears very dry, rough and cool to touch can be associated with
- hyperthyroidism, the skin has a velvety appearance and is usually warm to touch.
- Psoriasis can present as silvery, scaly papules or plaques, mainly on the extensor surfaces of the skin.
- Scleroderma appears as skin that is thickened, taut, and shiny in appearance.
- Addison’s Disease-Hyperpigmentation of skin and mucous membranes
- AIDS–Hairy leukoplakia
- Cushing’s disease skin conditions: striae, skin atrophy, purpura, ecchymosis, telangiectasias, acne, moon facies, buffalo hump, or hypertrichosis.
- Pallor, xerosis, pruritus, hyperpigmentation, uremic frost, calciphylaxis (calciphylaxis occurs when calcium accumulates in the skin and small vessels of the skin and fat tissue), “half and half” nails, are skin conditions which may be found in patients with chronic renal disease.
- Diabetes may produce any of these skin conditions: necrobiosis lipoidica diabeticorum, diabetic bullae, diabetic dermopathy, granuloma annulare, acanthosis nigricans, candidiasis, neuropathic ulcers, eruptive xanthomas, and peripheral vascular disease.
- Whiteheads are closed comedones
- Blackheads are open comedones
- Pustules are skin lesions with pus
- Cysts are fluid-filled skin lesions
- Boils {furuncles}- are painful infections that develop within hair follicles. They usually begin as papules on the skin, then develop a white or soft center.
- Blisters {vesicles}– small lesions filled with clear fluid.
- Mole (nevus/nevi) is a pigmented area on the epidermis.
- Ulcer: occurs on the skin or a mucous membrane accompanied by the disintegration of tissue.
- Psoriasis is scaly, commonly erythematous, and presents with silvery scales, An alternative presentation of psoriasis is plagues.
- An allergic reaction to something usually presents with a generalized rash that resembles hives; erythematous and symmetric rash.
- Contact dermatitis is associated with a reaction in the area that the object touched. Erythema becomes evident initially, followed by swelling, wheals (or urticaria), or maculopapular vesicles, scales. This is often accompanied by intense pruritus.
- Atopic dermatitis presents with erythematous papules and vesicles, with weeping, oozing, and crusts. Lesions usually appear in characteristic areas: the scalp, forehead, cheeks, forearms and wrists, elbows, and backs of knees. Paroxysmal and severe pruritus can be present. There is usually a family and/or personal history of allergies.
- – Pritority intervention for child with atropic dermatitis is relive itching. By relieving pruritus, itching is eased and this helps decrease scratching behaviors which can increase risk of infection. This is the major intervention. The others are helpful but not priority. The key is to keep the lesions moist as dryness will lead to itching and scratching and the potential for infection, especially in the case of impetigo.
- Beau’s linesare deep grooved lines that run from side to side on the fingernail. They appear as transverse depressions of the nail plates, usually bilateral, resulting from temporary disruption of proximal nail growth from systemic illness, such as severe illness, cold stress in the presence of Reynaud’s disease, and trauma.
- Terry’s nails, the nail plate turns white with a ground-glass appearance, a distal band of reddish brown, and obliteration of the lunula.
- Mees’ lines present as curving transverse white bands that cross the nail parallel to the lunula. They arise from the disrupted matrix of the proximal nail, vary in width, and move distally as the nail grows out. These lines are seen in arsenic poisoning, heart failure, Hodgkin’s disease, chemotherapy, carbon monoxide poisoning, and leprosy.
- Pitting nails present as punctate depressions of the nail plate caused by defective layering of the superficial nail plate by the proximal nail matrix. They may be associated with psoriasis, but also seen in Reiter’s syndrome, sarcoidosis, alopecia areata, and localized atopic or chemical dermatitis.
- Paronychia is red, swollen, tender inflammation of the nail folds. Acute paronychia is usually secondary to a bacterial infection. Chronic paronychia is often secondary to a fungal infection from a break in the cuticle in those who perform “wet” work.
- Onychomycosis is a slow, persistent fungal infection of fingernails and toenails causing change in color, texture, and thickness. Onycholysis- separation of the nail plate from the nail bed & the nail may crumble or break with loosening of the nail plate, usually beginning at the distal edge and progressing proximally.
- Leukonychia is a white discoloration appearing on nails. The most common cause is injury to the base of the nail (the matrix) where the nail is formed. Psoriasis of the nails may appear as small pits in the nails.
- PRESSURE ULCERS:
- Stage I: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue.
- Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.
- Stage III: Full thickness tissue loss and subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss and the depth varies by anatomical location.
- Stage IV: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. The depth varies by anatomical location.
- Dacryocystitis is an infection and blockage of the lacrimal sac and duct.
- Hordeolum is often secondary to localized staphylococcal infection of the hair follicles at the lid margin.
- Chalazion is a beady nodule protruding on the lid.
- Physiologic changes of aging include loss of elastic turgor, and wrinkling.
- Skin that appears dry, flaky, rough, and itchy is termed Sun exposure can cause damage to the skin resembling an appearance as weather beaten, thickened, yellowed, and deeply furrowed.
- Seborrheic keratoses appear as raised, yellowish lesions that feel greasy, velvety, or warty.
- Painful vesicular lesions in a dermatomal distribution may suggest herpes zoster.
- The National Melanoma/Skin Cancer Screening Program of the American Academy of Dermatology validates the HARMM model for designating risk factors for melanoma. H – history, A – age, R – regular dermatologist absent, M-mole changing, and M- male gender.
- ABCDE nomenclature is the method used in recognizing characteristics of possible melanomas. A – asymmetry, B – borders, C – color, D – diameter, and E – evolution.
- BCRAT is the Breast Cancer Risk Assessment Tool.
- The National Health and Nutrition Examination Survey (NHANES) is used to predict diabetes prevalence.
- A chancre is defined as a painless ulceration formed during the primary stages of syphilis.
- A group of scattered small vesicles is associated with genital herpes.
- Papules appearing in many shapes that can be raised, flat, or cauliflower-like are characteristic of genital warts (condylomata acuminata).
- Non-tender indurated nodules are associated with carcinoma of the penis.
- Ecchymoses in the elderly is not a sign of aging and should be evaluated for injury or abuse.
- Brown macular spots, age spots, on the hands are related to sun exposure.
- Seborrheic keratoses are thickened lesions on the skin that range from tan to brown to black with a clear border and develop on the trunk but can also occur on the hands, feet, face, and scalp and are not considered harmful.
- Cherry angiomas are a common type of skin lesion that first occurs in early adulthood and continues with age. These round lesions typically develop on the trunk, hands, and feet. They range from bright to dark red and are asymptomatic with no reported clinical consequences.
- BURNS:
- Types of burn injuries are chemical, electric, radiation, or thermal and are classified by the depth of damaged skin.
- Superficial thickness burns appear erythematous without blisters and usually have local pain. A superficial thickness burn involves the epidermis only.
- Superficial partial thickness burns include: moist areas that are red to ivory white in color, blisters forming almost immediately, and painful to touch. Since the pain receptors are intact, pain is perceived. A superficial partial thickness burn involves the epidermis and the dermis.
- Deep partial thickness burns have a dry waxy, whitish appearance and resemble full thickness burns. Sometimes grafts are needed. A deep thickness burn involves the entire layer of dermis, and is more severe than a superficial partial thickness burn.
- Full thickness burns involve the destruction of all skin elements with coagulation of subdermal plexus, muscle, and or tendons. A full-thickness burn involves all skin layers, including the epidermis, dermis, and the subcutaneous tissue and fat. Muscles and tendons may be involved.
- The “Rule of Nines-small Child” assigns percentage of body surface area burned based on the location of the burn. The percentages are as follows: head and neck = 18%, anterior and posterior chest = 18% each, arms (anterior and posterior) = 4.5% each, legs (anterior and posterior) = 6.7% each, and perineum = 1%. For this example, 18% for posterior trunk plus 9% for arms = 27%.
- Dark-colored adherent crust of dead tissue found on some ulcers is referred to as
- Erythroderma occurs when a skin condition affects the whole body or nearly the whole body, resulting in a red appearance all over.
- An excoriation is a scratch mark or surface injury penetrating the dermis.
- Exfoliation refers to peeling skin.
- Skin that is edematous, erythematous, tender, and warm to touch is consistent with cellulitis.
- Erythema multiform may appear as a nodule, papule, or macule or may look like hives. They may have blisters or vesicles and have a central sore surrounded by pale red rings, also called a “target”, “iris”, or “bulls-eye”.
- Impetigo is the dried residue of serum, pus, or blood and can lead to cellulitis if left untreated.
- A stage II pressure ulcer presents with a partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.
- Jaundice appears as a yellow color in the sclera, the palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane, and skin. It is usually seen in patients with liver disease or excessive hemolysis of red blood cells. Carotenemia results in a yellow color of the skin, particularly on the face, palms, and soles from intake of large quantities of carotene (found yellow vegetables). Scleroderma is characterized by sclerosis of the skin or a hardening of the skin with a taunt, shiny appearance. Café-au-lait spots appear as uniform pigmented macules or patches on the skin and never appear in the eyes.
- A macule is defined as a small flat spot measuring no larger than 1 cm. Examples are a freckle and petechiae. An elevated nevus is an example of a papule. Papules are raised above the level of the skin. Impetigo is an example of a crust which is dried residue of pus, serum, or blood. And psoriasis is an example of a scale, a thin flake of exfoliated epidermis. Dandruff and dry skin also fall under this category.
- A cavernous hemangioma appears as a reddish blue, irregularly shaped, solid and spongy mass of blood vessels. It may be present at birth, may enlarge during the first 10 to 15 months, and will not involute spontaneously. A port-wine stain is a large, flat, macular dark red or purplish patch covering the scalp or face, frequently along the distribution of cranial nerve V and intensifies with crying, exertion, or exposure to heat or cold. A strawberry mark is a type of hemangioma that has a raised bright red area with well-defined borders about 2 to 3 cm in diameter. It does not blanch with pressure. Telangiectasia are caused by vascular dilation and are permanently dilated blood vessels that are visible on the skin surface.
- Ecchymosis is purple or bluish purple area that fades to green, yellow, and brown with time. It is generally larger than petechia and can be round, oval or take on an irregular shape. It does not blanch with pressure and does not pulsate. These lesions are termed bruises and occur secondary to trauma. Petechia and purpura are deep red or reddish purple and fade with time. A spider vein is bluish in color and is mostly seen on the legs near veins.
- A spider angioma is fiery red, slightly raised and surrounded by erythema and radiating legs that blanch with pressure. These are usually seen in patients with liver disease, pregnancy, vitamin B deficiency, and sometimes patients with no disease. The spider vein is blue. Cherry angiomas are bright or ruby red and increase in size and number as one ages. Petechiae are deep red or reddish purple and are seen when blood is outside the vessels. This suggests a bleeding disorder or injury to the skin.
- Rubor is a term used to describe the response of the skin to inflammation. Skin that appears dusky red is rubor.
- A dysplastic nevus is a type of mole that looks different from a common mole. It may be bigger than a common mole, and its color, surface, and border may be different. It is usually more than 5 millimeters wide and can have a mixture of several colors, from pink to dark brown. Usually, it is flat with a smooth, slightly scaly, or pebbly surface, and it has an irregular edge that may fade into the surrounding skin.
- Basal cell carcinoma usually arises in sun-exposed areas and classically appears as pearly, erythematous, translucent papules, but may also be subtle red macules or exhibit other morphologies.
- Squamous cell carcinoma are crusted hyperkeratotic lesions with a rough surface or flat, reddish patches with an inflamed or ulcerated appearance.
- Melanomas arise from the pigment-producing melanocytes in the epidermis. These melanocytes give skin its color and appear as dark, raised, asymmetric lesions with irregular borders.
- Onychomycosis is a slow, persistent fungal infection of fingernails and toenails causing change in color, texture, and thickness. The nail may crumble or break with loosening of the nail plate, usually beginning at the distal edge and progressing proximally. Leukonychia is a white discoloration appearing on nails. The most common cause is injury to the base of the nail (the matrix) where the nail is formed. Psoriasis of the nails may appear as small pits in the nail. Paronychia is red, swollen, tender inflammation of the nail folds.
- pediculosis pubis (lice or “crabs”)– Excoriations or itchy, small, red maculopapular.
- A circumscribed superficial elevation of the skin formed by free fluid in a cavity within the skin layers are classified as three different lesions: a vesicle, filled with serous fluid and up to 1 cm.; a bulla, filled with serous fluid and measures greater than 1 cm.; and a pustule, filled with pus. Varicella and herpes simplex are examples of vesicles. Second degree burns are examples of a bulla. Acne and impetigo are examples of pustules. Psoriasis and athlete’s foot are examples of a scale type lesion.
- Lichenification is defined as the thickening and roughening of the skin with increased visibility of the normal skin furrows (numerous grooves of variable depth on the surface of the epidermis). Atrophy is thinning of the skin with loss of normal skin furrows. Excoriation of the skin is an abrasion or scratch mark. The burrow of a scabies lesion includes small papules, pustules, lichenified areas and excoriations.
Keyword – Some derm review
