dermatology

ID

Atrophie blanche

[...] allergy–cross sensitivities to griseofulvin 

Penicillin

[What demographic?] 

• seldom have tinea pedis or onychomycosis but are prone to eczema 

Children 

Weeping vesicles on erythematous plaques of acute [...] 

neurodermatitis 

Atrophie Blanche

• Common skin disorder
  

  • 1-5% normal population

  • 38-87% patients with [...]

  • 75% patients with recurrent venous leg ulcers 

• More frequent in women (4:1 Ratio)

• Extremely painful ulcers in acute stage

• mostly lower legs and perimalleolar regions. 
  

• Skin changes permanent
  

  • White atrophic scars-not painful 

chronic venous insufficiency

Atrophie Blanche

• Common skin disorder
  

  • 1-5% normal population

  • 38-87% patients with chronic venous insufficiency

  • 75% patients with recurrent venous leg ulcers 

• More frequent in [what gender?] (4:1 Ratio)

• Extremely painful ulcers in acute stage

• mostly lower legs and perimalleolar regions. 
  

• Skin changes permanent
  

  • White atrophic scars-not painful 

women

Classical Kaposi’s sarcoma is seen more often in [what ethnicity?]

Mediterranean people

Cutaneous Disease Distribution  

• Arms 
  

  • Flexor: [...] 

  • Extensor: [...]

• Legs 
  

  • Flexor: [...] 

  • Extensor knee: [...] 

• atopic dermatitis 

• psoriasis

• atopic dermatitis 

• psoriasis 

Cutaneous Disease Distribution  

• [Where are these usually found?]

  • Tinea pedis

  • onychomycosis

  • pressure keratoses

  • warts 

• Feet

Cutaneous Disease Distribution  

• [Where are these usually found?]
  

  • Tinea cruris

  • discharge

  • ulceration 

• Groin

Cutaneous Disease Distribution  

• [Where are these usually found?]
  

  • Warts

  • paronychia

  • tinea manum

  • punctate keratoderma 

• Hands

Cutaneous larvae migrans from stepping in [...]

cat feces 

Dermatophytid Reaction

• Called [...] when associated with a corresponding infectious process due to bacteria 

Bacterid

• Duration in days suggests [...] process and cool soaks, sprays or lotion are indicated.

• Present for weeks means it is [...] and creams often work best. 

• Present for months is definitely a [...] condition and may respond better with ointment vehicle 

• acute

• subacute

• chronic

• Duration in days suggests acute process and cool soaks, sprays or lotion are indicated.

• Present for weeks means it is subacute and [...] often work best. 

• Present for months is definitely a chronic condition and may respond better with [...] vehicle 

• creams

• ointment

Heel pain and paronychia may be [...]

Reiter’s disease 

Paronychia is a nail infection that is an often tender bacterial or fungal infection of the hand or foot

Reactive arthritis, formerly known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity).

Lacy white network on buccal mucosa in [...]

lichen planus 

Palmar plantar plaques may suggest [...] 

syphilis 

Pruritus or generalized itching is worsened by [...] in eczemas and anemias 

hot

read the bottom of this slide 

Purple plaques or nodules may be [...] 

Kaposi’s sarcoma 

associated with AIDS 

Suspect [...] in any bizarre, extensive or surprisingly recurrent skin disease even psoriasis, tinea and onychomycosis 

AIDs

Volleyball and basketball can cause [...] or [...]

talon noir or black heel 

Xerosis (dry skin) & skin cancer is more common in [What ethnicity?] 

Celtic people 

[What ethnicity?] have higher incidence of palmar plantar punctate keratodermas (KPPP)

African American people

[...]

• Genetic predisposition to allergic rhinitis, hay fever, asthma, sensitive skin or urticaria

• Predisposed to itch or scratch 

• Frequent history of milk allergies as a newborn 

Atopy of atopic dermatitis

Atopy of atopic dermatitis

• Genetic predisposition to allergic rhinitis, hay fever, asthma, sensitive skin or urticaria

• Predisposed to itch or scratch 

• Frequent history of [...] as a newborn 

milk allergies

[...]

• Secondary skin eruption that is an expression of immune hypersensitivity to a dermatophyte fungal antigen
  

  • extremely pruritic, erythematous, maculopapular, or papulovesicular eruption occurs 1-2 weeks after primary infection

  • 4-5% of patients with dermatophyte infections

  • 37% of patients with stasis dermatitis 

Dermatophytid Reaction

Dermatophytid Reaction

• Secondary skin eruption that is an expression of immune hypersensitivity to a dermatophyte fungal antigen
  

  • extremely pruritic, erythematous, maculopapular, or papulovesicular eruption occurs 1-2 weeks [before or after] primary infection

  • 4-5% of patients with dermatophyte infections

  • 37% of patients with stasis dermatitis 

after

[What demographic often have the following conditions?]: 

• Solar damage

• actinic keratoses

• skin cancer

• xerosis (dry skin)

• nail dystrophies

• infection

• pressure keratoses

• ulcers 

Elderly often have:

actinic keratosis  is a rough, scaly patch on your skin that develops from years of exposure to the sun

Pressure-related hyperkeratosis occurs as a result of excessive pressure, inflammation or irritation to the skin. When this happens, the skin responds by producing extra layers of keratin to protect the damaged areas of skin

[where would you find the following?]:

• Actinic Keratoses

• melasma

• xanthelasma

• spider angiomas

• rosacea

• acne

• peleche

• psoriasis

• seborrheic dermatitis 

Face:

[...] useful to distinguish warts from corns 

[...] useful to distinguish warts from corns 

[...] 

• any of several generalized skin disorders due to a genetically caused molecular defect in keratinization process resulting in retention of keratinocytes rather than normal desquamation 

Ichthyosis 

[...] grouping: 

• Lymphangiitis

• contact dermatitis due to poison ivy

• shin excoriations from itching xerotic skin 

Linear

[What demographic] exhibit more

• Contact dermatitis

• mechanical keratoses

• tinea 

• eczemas 

Middle age

[where would you find the following?]: 

• leukoplakia - precancer

• Wickham’s striae-lichen planus

• scrotal tongue - congenital central furrow and lateral transverse grooves

• Hairy tongue - black hairs of Aspergillus fungus 

Oral Cavity

[...] can be triggered by

• Chlorpromazine

• griseofulvin

• tetracycline 

Solar urticaria hypersenstivity

Solar urticaria, also known as sun allergy, is a rare allergy to sunlight that causes hives to form on skin that's exposed to the sun

[...] is abnormal dryness of the skin 

Xerosis

[What demographic] often have

• Verrucae (painful wart) 

• IGTNs (ingrown toenail)

Young adults

[...] grouping: Lesions in broad bands following dermatome. 

Zosteriform

Silver scaly large plaque of [...] 

psoriais 

Hyperkeratotic annular plaques of [...]; chronic and pruritic 

Tinea pedis

A (max of 5 points) = total area of involvement

• 1 point – [...] to [...] of nail

• 2 point – [...] to [...] of nail

• 3 point – [...] to [...] of nail

• 4 point – [...] to [...] of nail

• 5 point – [...] of nail 

• 1 to 10%

• 11 to 25%

• 26 to 50%

• 51 to 75%

• more than 75%

Additional 10 points if nail dystrophies are present

• [...] – longitudinal streaking or patches

• [...] – Thick nails (> 2 mm) 

• Dermatophytoma

• Subungual Hyperkeratosis

Additional 10 points if nail dystrophies are present

• Dermatophytoma – [...]

• Subungual Hyperkeratosis – [...] 

• longitudinal streaking or patches

• Thick nails (> 2 mm) 

Benign nevus or malignant melanoma? Use acronym ABCDE

• A = [...]

• B = [...]

• C = [...]

• D = [...]

• E = [...] 

• A = Asymmetry

• B = Border irregularity with blurred, notched or ragged edges

• C = Color (variation indicates melanoma)

• D = Diameter (greater than 6 mm (pencil top eraser) is suspicious)

• E = Elevation and Evolution

Dermoscopy

• Survey [...] to the tip of the toes 

tibial tubercle

Dermoscopy

• [...] has a pigment network (honey combed grid network)

• Dried blood is easily cut away

Melanin

Dermoscopy

• Melanin has a pigment network (honey combed grid network)

• [...] is easily cut away

Dried blood

Erosions: usually seen [where?]

in between toes

Following occurs more in [what gender?]:

• Vasospastic disorders

• atrophy blanche

• stasis dermatitis 

• diabetic dermopathies 

females

Following occurs more in [what gender?]:

• Keratoderma blenorrhagicum of Reiter’s

• tinea

• onychomycosis 

males

Keratoderma blenorrhagicum is the most common skin lesion of reactive arthritis or Reiter's sydnrome. Typically these scaly lesions occur on the palms and soles and are thought to be indistinguishable clinically and histologically from pustular psoriasis.

If melanin, what are the 3-point checklist?

• [...] 

• [...] 

• [...] 

• Asymmetry 

• Atypical network 

• Blue-white structures 

Interpreting KOH

• Mold appear as [...]

• Candida albicans is characterized by pseduohyphae
  

  • Terminally segmented, shorter rectangular buds 

very large flat ribbons (aerial hyphae)

Interpreting KOH

• Mold appear as very large flat ribbons (aerial hyphae)

• Candida albicans is characterized by [...]
  

  • Terminally segmented, shorter rectangular buds 

pseduohyphae

KOH wet mount Artifacts

• [...] – mosaic pattern

• Air bubbles – dark outline & central clear space 

• KOH crystals are long and thin

• Cotton fibers are large, long rough tipped stalks

• Synthetic fibers are smooth long and curving

Lipids

KOH wet mount Artifacts

• Lipids – mosaic pattern

• [...] – dark outline & central clear space 

• KOH crystals are long and thin

• Cotton fibers are large, long rough tipped stalks

• Synthetic fibers are smooth long and curving

Air bubbles

KOH wet mount Diagnostic Techniques

• Procedure
  

  • Apply 2 drops of either [...] or [...]

  • Let stand for 5 to 10 mins

  • Cover slip and observe with reduced light on low power

  • Scan for thick scales of keratin

    • Diagnostic narrow segmented branching hyphae of dermatophyte

    • Resembles pearls on a string 

Chlorozol black E fungal stain or 20% KOH and DMSO

KOH wet mount Diagnostic Techniques

• Procedure
  

  • Apply 2 drops of either Chlorozol black E fungal stain or 20% KOH and DMSO

  • Let stand for 5 to 10 mins

  • Cover slip and observe with reduced light on low power

  • Scan for thick scales of keratin

    • Diagnostic [...] branching hyphae of dermatophyte

    • Resembles [...] 

• narrow segmented

• pearls on a string 

Onychomycosis Severity Index (OSI)

• Index to quantify progression of nail fungal treatment

• Maximum of [...] points

• OSI = [...]*[...] ([...]) 

• 35

• OSI = (A)*(P) (+10?) 

OSI related to onychomycosis

• Mild: [...] to [...] points

• Moderate: [...] to [...] points

• Severe: [...] to [...] points 

• Mild: 1 to 5 points

• Moderate: 6 to 15 points

• Severe: 16 to 35 points 

P (max of 5 points) = proximity to nail matrix

• 1 point – [...]

• 2 point – [...]

• 3 point – [...]

• 4 point – [...]

• 5 points – [...] 

• 1 point – Distal rectangle

• 2 point – Rectangle #2

• 3 point – Rectangle #3

• 4 point – Rectangle #4

• 5 points – Lunula 

Past medical history of hyperuricemia, gout or allopurinol or cholchicine suggest: 

• [...]

• Tophaceous nodules tumors and ulcers 

Hyperuricemia is an excess of uric acid in the blood

Allopurinol is used to treat gout or kidney stones, and to decrease levels of uric acid in certain cancer patients

Colchicine is an oral drug used to treat or prevent gout symptoms

Past medical history of [what might cause the following?]

• Cutaneous somatization disorder

• neurodermatitis

• lichen simplex chronicus 

Anxiety and obsessive compulsive behavior

unexplained cutaneous sensory syndromes especially the cutaneous dysesthesias associated with pain, numbness and pruritus; traumatic memories in post-traumatic stress disorder (PTSD) which are experienced on a sensory level as 'body memories' and may present as local or generalized pruritic states

Neurodermatitis is a skin condition characterized by chronic itching or scaling (can be triggered by anxiety)

Lichen simplex chronicus (LSC) is a localized, well-circumscribed area of thickened skin (lichenification) resulting from repeated rubbing, itching, and scratching of the skin.

Past medical history of [of what might suggest the following?] 

• pyoderma gangrenosum ulcers 

Crohn’s ileitis 

Crohn ileitis: Inflammation of the ileum due to Crohn's disease

Pyoderma gangrenosum (pie-o-DUR-muh gang-ruh-NO-sum) is a rare condition that causes large, painful sores (ulcers) to develop on your skin, most often on your legs

Past medical history of [what might indicate the following?] 

• dermopathy

• necrobiosis lipoidica

• paronychia 

Diabetes Mellitus 

Dermopathy is a skin condition that develops as a result of changes to the blood vessels that supply the skin. Dermopathy appears as a shiny round or oval lesion of thin skin over the front lower parts of the lower legs

Necrobiosis lipoidica is a rare granulomatous skin disorder which can affect the shin of insulin-dependent diabetics

If you have diabetes, there's a risk that paronychia could spread to deeper tissues and bones, or into the bloodstream and other parts of the body

Past medical history of [what?]:

• tinea pedis

• atopic eczema

• disordered plantar dermatoglyphic 

down syndrome

Past medical history of [what might cause the following?]:

• hyper sensitivity to pain or clothing

• chronic fatigue

• disordered sleep 

Fibromyalgia

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues

Past Medical History of [what?]

• hemorrhagic pressure keratoses

• vasculitic ulcers 

Rheumatoid arthritis

Vasculitic ulcers are known to be more resistant to treatment and also more painful than ulcers of other aetiologies [10, 11, 14-17]. It has also been shown that patients with RA

Pedal Skin Temperature

• Diabetic neuropathy
  

  • In early stages, [...]

  • In late stages, [...] 

• temperature increases with loss of sympathetic tone

• temperature decreases 

Pedal Skin Temperature

• Normal day temperature: [...] deg C or [...] deg F

• Normal night temperature: [...] deg C or [...] deg F

• 30 deg C or 86 deg F

• 34 deg C or 93.2 deg F

Pedal Skin Temperature

• Normal: [...] deg F

• Active psoriasis: [...] deg F

• Parkinson’s disease: [...] deg F 

• 86 deg F

• 95 deg F

• 71.5 deg F 

Pedal Skin Temperature

• Peripheral Arterial Disease – compare extremities
  

  • Normal side – [...] deg F

  • Affected side – [...] deg F 

• 84 deg F

• 72 deg F 

Scales: implies [...] 

shedding

Scars: changes in skin texture due to injury

• [...] often occur in acne

• [...] hoped for after a success verrucae curettage

• [...] elevated 

• Soft scars

• Flat scares

• Hypertrophic scars

A curettage procedure involves an incision into the epidermal and dermal layers surrounding the verrucae (wart) lesion followed by the use of a curette

Shape and arrangement clues

• Linear like scratches in [...]

• Target or iris lesions in erythema multiforme

poison ivy lesions

Shape and arrangement clues

• Linear like scratches in poison ivy lesions

• Target or iris lesions in [...]

• erythema multiforme

Shape and arrangement clues

• [...] lesions in: 

  • tinea

  • psoriasis

  • drug eruptions

• Zoster form vesicles and bullae in dermatomal pattern unilaterally point to Herpes Zoster or shingles 

Annular or ring shaped

Shape and arrangement clues

• Annular or ring shaped lesions in: 

  • tinea

  • psoriasis

  • drug eruptions

• Zoster form vesicles and bullae in dermatomal pattern unilaterally point to [...] 

• Herpes Zoster or shingles 

Types of Pedal Melanoma

1. [...]

2. [...]

3. [...] (most common)

4. [...] 

1. Superficial spreading

2. Nodular

3. Acral lentiginous (most common)

4. Subungual Melanoma 

What does NLDOCAT stand for?

• N = [...] 

• L = [...] 

• D = [...] 

• O = [...] 

• C = [...]

• A = [...] 

• T = [...] 

• N = Nature 

• L = Location 

• D = Duration 

• O = Onset 

• C = Course

• A = Attributes 

• T = Treatment 

What does the MEASURE acronym stand for? 

• M = [...] 

• E = [...] 

• A = [...] 

• S = [...]

• U = [...] 

• R = [...]

• E = [...] 

• M = Measure 

• E = Exudate 

• A = Appearence 

• S = Suffering

• U = Undermining 

• R = Re-evaluation 

• E = Edge 

Wood’s light examination

• Examples
  

  • Detects [...] florescence of Corynebacteria minuitissium in erythrasma

  • Pseudomonas glows white to yellow

  • Urine glows orange to pink

  • Microsporum in tinea capititis glows yellow to green

  • Trichophytons do not glow

  • Tinea verisicolor and patches of tuberous sclerosis do not glow

coral-red

Wood’s light examination

• Examples
  

  • Detects coral-red florescence of Corynebacteria minuitissium in erythrasma

  • Pseudomonas glows [...]

  • Urine glows orange to pink

  • Microsporum in tinea capititis glows yellow to green

  • Trichophytons do not glow

  • Tinea verisicolor and patches of tuberous sclerosis do not glow

white to yellow

Wood’s light examination

• Examples
  

  • Detects coral-red florescence of Corynebacteria minuitissium in erythrasma

  • Pseudomonas glows white to yellow

  • Urine glows [...]

  • Microsporum in tinea capititis glows yellow to green

  • Trichophytons do not glow

  • Tinea verisicolor and patches of tuberous sclerosis do not glow

orange to pink

Wood’s light examination

• Examples
  

  • Detects coral-red florescence of Corynebacteria minuitissium in erythrasma

  • Pseudomonas glows white to yellow

  • Urine glows orange to pink

  • Microsporum in tinea capititis glows [...]

  • Trichophytons do not glow

  • Tinea verisicolor and patches of tuberous sclerosis do not glow

yellow to green

Wood’s light examination

• Examples
  

  • Detects coral-red florescence of Corynebacteria minuitissium in erythrasma

  • Pseudomonas glows white to yellow

  • Urine glows orange to pink

  • Microsporum in tinea capititis glows yellow to green

  • Trichophytons [glows..?]

  • Tinea verisicolor and patches of tuberous sclerosis [glows..?]

• do not glow

• do not glow

[...]

• Autoimmune mediated hair loss that progressively attacks hair follicles

• May progress to alopecia universalis

Alopecia Areata

Alopecia Areata

• Autoimmune mediated hair loss that progressively attacks hair follicles

• May progress to [...]

alopecia universalis

[...] 

• autosomal dominant

• Male pattern baldness

• In women, diffuse thinning on the crown  

Androgen alopecia 

[...]: arranged in a circle or ring shape 

Annular

[...]: arranged in arcs or portions of a circle 

Arciform

[...]: depression in contour of skin

• Corticosteroid injections within the subcutaneous fat layer can cause atrophy 

• Is a secondary lesion

Atrophy

Atrophy: depression in contour of skin

• [...] within the subcutaneous fat layer can cause atrophy 

• Is a secondary lesion

Corticosteroid injections

[...] of Psoriasis

• Pinpoint bleeding upon forcible removal of a scale of psoriasis

• Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal

Auspitz’s Sign

[Benign or melanoma?]

• Homogenous

• Parallel pattern

• Pigmented network

• Cobblestone pattern

• Pigmented globules

• Starburst pattern 

Benign criteria

[...] can occasionally stain apocrine sweat (bible) 

Blood pigments

[...] stains the skin yellow if there is dietary excess

Carotene

[...]: dried blood or pus

Crusts

[...] – checking for blanching of a skin lesion

• Blanching (turning pale) suggest vascular lesion like telangectasia or erythema

• No blanching if pigmented or purpuric (rash of purple spots) because that’s due to extravascular changes 

Diascop

Diascopy – checking for blanching of a skin lesion

• Blanching (turning pale) suggest [...] lesion like telangectasia or erythema

• No blanching if pigmented or purpuric (rash of purple spots) because that’s due to extravascular changes 

vascular