Dermatology Final

Description

CHA/PA 2017
Emma Richardson6484
Flashcards by Emma Richardson6484, updated more than 1 year ago
Emma Richardson6484
Created by Emma Richardson6484 almost 9 years ago
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Resource summary

Question Answer
Psoriasis
Psoriasis (nail pitting)
Koebner's Phenomenon (psoriasis post-trauma)
Psoriasis Vulgaris (trunk)
Psoriasis Vulgaris (extensor surfaces)
Psoriasis Vulgaris (knees & extensor surfaces)
Guttate Psoriasis - discrete - all over
Guttate Psoriasis (dark skin) - discrete - all over
Psoriasis - pitting - onycholysis (nail lifting)
Psoriasis (scalp)
Pityriasis Rosea - multiple red mac/pap progress to to oval, pink/red with fine scale in center - parallel skin tension lines (xmas tree distribution)
Pityriasis Rosea - black skin --> hyper pigmented & @ folds (neck), proximal extremities, axillae, & groin
Pityriasis Rosea
Herald Patch - Pityriasis Rosea - preceded by prodrome (URI) - HHV-7
Herald Patch - Pityriasis Rosea DDX: - Secondary syphilis (palm/sole [≠ PR], LAD) - Tinea corporis - Guttate psoriasis - Parapsoriasis
Acute Parapsoriasis (PLEVA) - recurrent crops 2-4 mm red papules - progress --> central crusts - can leave depressed scars "Chicken Pox that won't heal"
PLEVA - can be very itchy
Chicken Pox vs. PLEVA Mucosal involvement = ? Chicken Pox (Varicella)
Chicken Pox vs. PLEVA NO mucosal involvement = ? PLEVA
Chicken Pox vs. PLEVA Lasts 2 weeks = ? Varicella
Chicken Pox vs. PLEVA Lasts 9-12 months = ? PLEVA
Chronic Parapsoriasis (PLC: pityriasis lichenoides chronica)
Chronic Parapsoriasis (PLC: pityriasis lichenoides chronica - salmon colored - oval plaques - central thin scale (≠ crust) - boxer shorts distribution - mimics PR
PLEVA ~ Chicken pox
Lichen Planus - polygonal - purple-red - papules
Lichen Planus - polygonal - purple-red - papules
Lichen Planus Nail dystrophy
Lichen Planus Hypertrophic version: thick & scaly
Lichen Planus Lower legs = scaly plaques
Wickham's Striae (Lichen Planus)
Lichen Striatus - along lines of blascho (migration route) - extremity - resolve on own over 3-6 months - skin colored / pink / brown
Lichen Striatus
SLE - Malar Rash Red scaly mac-pap eruption over nose & cheeks
SLE - Discoid lesion Persistent focal plaques @ face, are & scalp. Nummular w/ atrophy & follicular accentuation. Disfiguring (Seal).
SLE Erythematous scaly plaques on dorsal hand BETWEEN knuckles
SLE Periungal erythema (dilated blood vessels)
SLE Subacute cutaneous lupus erythematous
Neonatal Lupus
Dermatomyositis Gottron's papules: flat-topped, red/purple, scaly nodules OVER knuckles
Dermatomyositis Heliotrope Rash (periorbital edema)
Dermatomyositis (rash may precede muscle weakness by months WITHOUT pain) Heliotrope Rash
Epithelial Cyst (Epidermoid / Sebaceous) Dilated
Dermoid Cyst Newborn: lateral border of eyebrow OR in scalp More fixed to bone than epidermoid.
Branchial Cyst Lateral aspect of neck (defect of embryological closure)
Milia
Milia
Pilomatricoma - Adnexal tumor - cells of HAIR MATRIX - NOT fixed - blue (?) - stretched skin - Teeter totter sign (seesaw)
Pilomatricoma Multi lobar papules NOT fixed Hard (calcify)
Syringoma - Adnexal Tumor Cells of eccrine sweat glands. Eyelids, cheeks, etc. Most common in DOWN Syndrome
Trichoepithelioma Cells of HAIR FOLLICLE Firm, Benign. Cheeks, nose. Confused with acne.
Trichoepithelioma
Dermatofibroma well-defined. round. often pigmented. @ leg/trunk. SCAR BALL
Dermatofibroma PINCH SIGN: lateral pressure produces DIMPLING on its surface Area of PREVIOUS TRAUMA (e.g. shaving) -- reactive proliferation of FIBROBLASTS
Hypertrophic Scar Overgrowth of scar tissue. Remains at site of injury
Keloid esp. @ earlobe, presternal area, neck, face No definition of border (noncompliant of previous scar) - shiny & hairless - progressively enlarging
Neurofibroma BUTTON-HOLE sign (dx): involutes into skin Benign tumor of nerve sheath cells Elephantiasis = whole limb
Plexiform Neurofibroma Large clustering of neurofibromas (often gathering of hair in that area). Often associated with neurofibromatosis.
Lipoma - soft & squishy - SubQ nodules - Mobile (UNattached to overlying skin) - Solitary - Begin in adolescence (≠ children) - @ neck, chest, arms (forehead: elderly)
Granuloma Annulare small, firm pap/nod Circle / semicircle Misdx: ringworm Usually solitary (can have multiple) @ ankles, WRISTS (aural areas, digits) Dusky violaceous or skin-colored hue
Granuloma Annulare small, firm pap/nod Circle / semicircle Misdx: ringworm Usually solitary (can have multiple) @ ankles, wrists (aural areas, digits) Dusky violaceous or skin-colored hue
Juvenile Xanthogranuloma (JXG) Orange/pink to yellow-brown. Soft nodules. Often MULTIPLE. Large accum. of MACROPHAGES @ dermis Also found on trunk, etc.
Juvenile Xanthogranuloma (JXG) @ IRIS --> glaucoma (hyphema)
Juvenile Xanthogranuloma (JXG) Orange/pink to yellow-brown. Soft nodules. Type of Non-Langerhan's Cell Histiocytosis.
Pyogenic Granuloma (PG) @ Acral areas: hands, fingers, face Solitary Dull red. Firm (perhaps pedunculated) BLEEDS easily: increased expression of vascular endothelial growth factor.
Pyogenic Granuloma (PG) @ Acral areas Solitary. Dull red. Firm nodules. May be smooth/glistening...but often ulcerated & crusted if open.
Langerhan Cell Histiocytosis (LCH) Discrete. Papules or nodules. Hemorrhage/petechia do NOT blanch Red, orange, and/or yellow-brown. Seborrheic Distribution. Crusted scaling of SCALP, post auricular, perianal, & axillary areas.
Langerhan Cell Histiocytosis (LCH) Organs & lymph nodes may be affected. Diagnosis via Biopsy. Tx = chemotherapy
Congenital Self-Healing Reticulohistiocytosis looks like LCH or PG (type of LCH) Solitary CRATERIFORM central erosion. No tx, but monitor over time.
Benign Cephalic Histiocytosis JXG on the head (non-LCH). @ Face & neck. Resolve during childhood (≠ tx)
Benign Cephalic Histiocytosis JXG on head (non-LCH) 2-5mm (small) Yellow-red to tan papules.
Kawasaki Disease Mucocutaneous & lymph node 1. Abrupt high fever ≥ 5 days 2. Eyes: bilateral injection of conjunctiva (NO purulence or crusting) 3. Mouth: strawberry tongue; erythema 4. Cervical LAD. 5. Rash: nonspecific 6. Extremities: red palms/soles, Beau's lines (transverse lines on nail plates)
Kawasaki Disease Beau's lines
Kawasaki Disease Nonspecific exanthem (no vesicles/crusts) Treatment (acute: w/in 10 days of onset) 1. IVIG 2. ASA 80-100mg/kg/day (after fever controlled for 4-5 days) 3. Low dose aspirin 3-5mg/kg/day (continue forever if coronary artery abnormalities)
Erythema Multiforme TARGET or IRIS lesion (concentric zone of color ∆) - preceded by herpes labialis (?): HSV-specific host response - NO prodrome. - ABRUPT & symmetric
Erythema Multiforme TARGET or IRIS lesion (concentric zone of color ∆: central duskiness, crust, or blister) DDX: Urticaria Sx relief: oral antihistamines Recurrent dz: oral acyclovir -NOT steroids
Left = ? Right = ? Left = Erythema Multiform - fixed (7 days) - NO relief with Epi Right = Urticaria - transient (< 24 hrs) - relief w/ Epi SQ - clear center w/ red border
Stevens Johnson Syndrome Prodrome 1-4 days ≥ 2 mucosal sites (oral / eyes) HEMORRHAGIC crusts Rapid progression to BULLAE & EROSIONS
Stevens Johnson Syndrome Etiology - Drugs: NSAIDs, Sulfonamids, Anti-convul. - Infection: Mycoplasma pneumonia, HSV Tx: supportive care
Stevens Johnson Syndrome Tender red skin w/ dusky discoloration (lesions are targetoid)
Urticaria Acute. Itchy/burning. Clear in center. Transient. Tx: Oral Antihistamine, Epi, Anti-Leukotriene
Urticaria
Urticaria
Angioedema SubQ edema; Deep hives. Large deep swelling with indistinct borders. Eyelids, Lips, Hands.
Dermatographism Physical Urticaria
Heat- and Exercise-Induced Urticaria (Physical Urticaria) Sombrero Lesion: large flare with small central tiny wheal Persistent
Delayed Pressure Urticaria
Salmon Patch (Nevus simplex) "Stork Bite" / "Angel Kisses" CAPILLARY Malformation Most common Face: fade over time...EXCEPT @ NECK
Port Wine Stain CAPILLARY Malformation Lacy. Reticulated. Purple. BLANCH. Darker over time.
Port Wine Stain Capillary Malformation Face: hypertrophy, verrucous (warty) after puberty Tx: pulsed-dye laser (PDL)
Sturge-Weber Syndrome Facial Port Wine Stain in V1 Distribution (unilateral OR bilateral PWS) Assoc. with CNS & EYES abnormalities
Sturge-Weber Syndrome Capillary Malformation V1 distribution (PWS)
Klippel-Trenaunay Syndrome Overgrowth of extremity associated with PWS, venous malformation, or mixed malformation. Soft Tissue Hypertrophy. Swelling.
Klippel-Trenaunay Syndrome PWS/Venous/Mixed
Klippel-Trenaunay Syndrome Sometimes assoc. with varicose veins. PWS/Venous/Mixed
Parkes-Weber Syndrome Overgrowth of extremity assoc. with arteriovenous malformation (AVM) Similar to Kippel-Trenaunay, but - higher flow (seen on imaging) - pulsatile (AVM)
Venous Malformation STATIC (grows only with child, since birth) Never regresses
Venous Malformation Can sometimes look like hemangiomas
Arteriovenous Malformations PALPABLE THRILL. Rare. Frequently over-diagnosed.
Microcystic Lymphatic Malformation (lymphangioma circumscriptum) If localized, they look like FROG EGGS. More infiltrative. Difficult to completely excise.
Macrocystic Lymphatic Malformation (cavernous lymphangioma - cystic hygroma) Less infiltrative. More easily excised
Cutis Marmorata Telangiectasia Congenita More common in DOWN Syndrome. Present at birth. Stays fixed (fades over time). UNILATERAL. Atrophy of skin/limb. Mottled
Hemangioma (pictured: white/blue macule) Tumor of CAPILLARY endothelium. MOST COMMON tumor of infancy Rapid growth phase out of proportion to growth of child. Long period of regression.
Hemangioma
Hemangioma (pictured: telangiectasia) More common if: FEMALE, PREMATURE, CVS, AMNIO
Hemangioma (pictured: red papules)
Hemangioma Pictured: superficial "strawberry"
Hemangioma Pictured: deep Soft compressible RUBBERY bluish nodule under skin.
Hemangioma Pictured: mixed RAPID growth phase: 4-8 wks thru 6-9 m.o. Proliferation (6-12 mo): grows slowly & APPROXIMATES GROWTH of infant Slow INVOLUTION begins: > 12 mo (softer, less warm, flattens out)
Hemangioma BEARD distribution = AIRWAY involvement
Hemangiomas (top left = deep
Hemangiomas Worry about cartilage destruction
Ulceration of Hemangioma (complication - others include, bleeding, infection [STAPH AUREUS], obstruction of vital fxn, HIGH OUTPUT CARDIAC FAILURE)
Involution of Hemangioma
Residua of Hemangiomas - Hypopigmentation - Telangiectasia - Fibrofatty deposits - Excess skin
Diffuse Neonatal Hemangiomatosis May have HUNDREDS of lesions < 2 cm May have INTERNAL INVOLVEMENT (e.g. central hypothyroidism
Spider Telangiectasia Red/pink ill-defined macule @ cheeks, nose, posterior hands BLANCH completely w/ pressure (put glass slide over it to make sure)
Spider Telangiectasia Sun-exposed area 2-6 yo kids Fair-skinned individuals Dilation of CENTRAL feeding ARTERIOLE w/ multiple radiating capillaries.
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