Clin Med 2 - derm - Benign Skin Lesions

seborrheic keratosis

Typically appear as sharply marginated pigmented lesions

Can arise on all body surfaces except palms and soles

Usually papules or plaques but may be macular

Seborrheic Keratosis

What is shown in the following image?

Seborrheic Keratosis (verrucous, tan presentation)

What is shown in the following image?

Seborrheic Keratosis (light tan or almost skin color presentation)

What is shown in the following image?

Seborrheic Keratosis (velvety, dark brown presentation)

What is shown in the following image?

Seborrheic keratosis

What is shown in the following image?

After the 4th decade of life and continue to arise after this time

Contrast with nevi which typically appear in the first 3 decades of life

When do seborrheic keratoses appear?

gently pick the lesion, it may crumble, flake, or lift off revealing a superficial waxy character

What is a trick to tell if a lesion is a seborrheic keratosis if there is doubt?

Keratin pseudocysts (small white circular spots)

What are SK findings under dermoscopy?

none required (curettage, cryotherapy, electrodessication, or shave removal if symptomatic)

What is the treatment for seborrheic keratoses?

dermatosis papulosa nigra

Variant of SK seen in darker skin types

Multiple small, hyperpigmented, sessile to filiform, smooth-surfaced papules

Harmless, but can be a cosmetic issue

Dermatosis papulosa nigra

What is shown in the following?

Very light electrodessication

(freezing is not recommended as it can cause pigment changes)

What is the treatment for dermatosis papulosa nigra?

stucco keratoses

small white-gray SKs on dorsal feet/ankles of older light-skinned individuals.

none required (can be treated with cryotherapy, curettage, electrodessication, or OTC ammonium lactate lotion/cream)

What is the treatment for stucco keratoses?

Stucco keratosis

What is shown in the following?

acrochordons

Skin tags

Skin-colored or brown often pedunculated fleshy papules

Arise on the eyelids, neck, axillae, and groin

Usually asymptomatic but can become painful

Genetics, obesity, and friction

mc during pregnancy

can be a marker of insulin resistance

What are causes of skin tags?

Snipping, Liquid nitrogen, electrodessication

What are the methods of removal of skin tags?

cherry angioma

Common acquired vascular proliferation

Usually develop in the 4th decade and increase in number over time

Cherry Angioma

What is shown in the following?

dermatofibroma

Benign tumor of the skin

firm, hyperpigmented dome-shaped papule

If you pinch the sides it will dimple- "dimple sign"

Dermatofibroma

What is shown in the following?

Bleaching creams, liquid nitrogen, chemical peels, lasers

(important to promote sun protection)

What are the cosmetic treatments available for solar lentigines?

solar lentigines

What is shown in the following?

sebaceous hyperplasia

yellow colored lesion with umbilication due to gland growth around central hair follicle

Sebaceous hyperplasia: yellow, umbilication, multiple similar papules, seldom bleed or form a crust

BCC: pearly, waxy, often with telangiectasia, fragile, can bleed or scab easily with minimal trauma

How can you tell the difference between sebaceous hyperplasia and BCC?

intralesional corticosteroid injection (Triamcinolone acetonide 10-40mg/ml 4-6 week intervals)

What is the treatment for keloids?

Epidermal inclusion cyst

What is the most common cutaneous cyst?

hair follicles (NOT the oil glands)

What do epidermal inclusion cysts arise from?

Degenerating keratinocytes- rancid smell when opened (can be mistaken for infection)

What is contained within epidermal inclusion cysts?

inflamed EIC tend to be sterile and do not require oral antibiotics

How is inflamed EIC differentiated from an abscess?

incision and drainage

intralesional triamcinolone injections (maybe for inflammation)

What is the treatment for an inflamed EIC?

lipoma

Texture is the clue, feels like what it is, collection of fat under the skin

often solitary

can occasionally be tender

milium

What is shown in the following?