Clinical DM Integument

Dermatofibroma

Benign fibrous skin nodule w/ lupus, bite, trauma; dimples when squish, .5-1cm; biopsy or excision

Cafe au lait macule

small, large, round, oval, coffee-colored patch

What is neurofibromatosis

when there are more than 6 cafe au lait macules on adults and more than 5 on children; inherited benign tumors grow on nerves; freckles in folds; lisch bodies on iris; optic gliomas, bone abnormalities, learning disorders

What are other names for neurofibromatosis?

Von reckinghausen’s disease, albright’s syndrome

What is neurofibroma?

benign tumor of schwann cells; nodule(s) of various sizes on trunk, extemities; excision

What are epidermal inclusion cysts?

sebaceous cysts with central hole

hypomelanosis is known as?

leukoderma

hypermelanosis is known as?

melanoderma

Blue hypermelanosis is?

caused by meds

how are skin pigmentation disorders diagnosed?

Wood’s lamp, which emphasized white of hypopigmented and darker color of hypermelanosis

What is vitiligo?

Hypomelanosis due to autoimmunity of melanocytes; sharply bordered malcules unite ino larger patches with irregular white borders; unilateral or symmetrical; early hair graying; everywhere except neck, scalp, breasts, belly, back, butt, legs, arms

Associated disorders and diagnosis for vitiligo?

vitiligo associated with thyroid diseases, type 1 DM, adrenal insufficiency (addison’s), pernicious anemia, seen with chemo for melanocytes; biopsy for melanocyte count, wood’s lamp

Treatment for vitiiligo?

oral steroids, topical steroids for stable lesions (clobetasole), PUVA (UV light), grafting, immunosuppressants (elidel, protopic, tacrolimus), bleaching creams, sunscreen

What is lentigo/solar simple?

brown-black equally pigmented macules; benign proliferation of melanocytes along basement membrane with sun; common on face, arms, hands, chest, back

What are liver spots?

lentigo - seen after 40 on hands, .5-3cm, round or oval; different shades of gray-brown-black

What are rhytids?

Wrinkles

How are rhytids treated?

retinoids (avage ex.) for life, botox for deep frown lines; alpha-hydroxy acids-glycolic, lactic, citric acid also for dark spots; vitamin A, C

what are melanocytic nevi?

moles; most dissapear after 40s; flat or raised

What are nevi?

Lesions classified by layer which cells in

What is junctional nevus?

Cells between dermis and epidermis; tan or brown macule and flat; smooth and regular borders; benign

intradermal nevus

cells in upper dermis; no pigment; raised and domed; before 30, maybe hair, benign

What is compound nevus?

combination of intradermal and junctional - elevated and pigmented; maybe hairs

what is dysplastic nevus?

cancerous appearance, inflammation and fibrosis, mixed colors in one, macules or papules, <15mm, indistinct margins, precancerous; EXCISE

what is congenital melanocytic pigmented nevus?

resembles intradermal or compound, >1.5cm, hair coat common, potential for melanoma

What is halo nevus

white area circling pigmented macule; if formed when adult, sign of cancer; due to inflammatory response to lesion

What is cherry angioma?

benign dilated venules, can be pinpoint macule or dome papule, common in fair skin, hereditary, mostly on trunk

What is venous lake?

benign vascular lesion, >60 y.o., macule or papule dark blue/purple; sun; blanches; face,e ars, lips, eyelids

What is angiokeratoma?

vulva or scrotum, young adulthood, red-purple benign papules

How to treat spider angioma?

light cautery or laser

What is capillary hemangioma?

benign vascular proliferation; at birth; bright red/deep purple; goes away by 5

what is nevus flammeus?

port-wine stain, congenital dilated capillaries; irregular, pink/red/purple patch/macule; face and neck; sturge-weber syndrome; blood vessels on brain same body side where stain; epilepsy, eyesight issues; laser removal

cavernous hemangioma

deep vascular and lymphatic issues in childhood → swelling and area of multiple colors with no real borders; surgery; x-ray

erythroderma

red skin; exfolliative dermatitis (scaling, peeling) full-body; pruritus (burning); loss of hair and nails; due to underlying condition → hospital

cutaneous metastases

hard nodule, associated with breast, colon, lung, melanoma, sister mary joseph’s nodule

What is sister mary joseph’s nodule?

large nodule on umbilicus due to GI cancer

Paget’s disease

breast cancer, sometimes extramamary (around anus or genitalia); bordered, slightly raised, red, scaling, maybe fissure or weep; biopsy; appears as eczema

Oral hairy leukoplakia

w/ HIV/AIDS; white plaques on side of tongue; non-scrapable; caused by epstein-barr; antiretroviral therapy

thrush

most common associated disease w/ HIV; angular cheilitis; yeast; if scraped off will bleed; topical therapy (clomitrazole) or oral fluconazole for severe

herpes zoster

shingles blistering rash; caused by varicella zoster virus; treated with anti-virals; shingrix vaccine prevents

condyloma acuminata

anogenital warts with HPV; topical cream, cryotherapy, excision

seborrheic dermatitis in babies is?

Cradle cap

What is molloscum contagiosum?

HIV related; poxvirus causes prolliferation of epidermis → firm flesh-colored papule with central umbilication, cryotherapy, curettage (scrape), topical blistering agent, resolution on own

Kaposi’s sarcoma

HIV correlated; herpes causes cancerous angioproliferation → elliptical (football) lesions on lower extremities, face/nose, inside mouth, genitals, LYMPH NODES, LIVER, PANCREAS, HEART; (ART therapy), chemo if rapid growth

psoriasis

HIV-associted with arthritis, nail abnormalities; white flaky blemishes; ART therapy

Acanthosis nigricans

bilateral velvety, papillomatous, brown/black keratotic plaques; in skin folds and neck; obesity, ovarian, pituitary tumors, PCOS, DMll,nicotinic acid, glucocorticoids, tumor

Granuloma annulare

systemic associated; benign inflammatory lesions; red, annular (raised ring), maybe scales; distal regions, head, butt; reappears; biopsy and observation; topical steroids

pyoderma gangrenosum

systemic disease; inflammatory papules/pustule/vesicle/nodule enlarges and breaks down into erosion/juicy ulcer in center with blue/dark edge; severe pain, fever; associated with IBD, RA, multiple myeloma, leukemia, lymphoma; pretibial areas (not well-vascularized), head, neck, trunk mucosa; wound care and corticosteroids, prednisolone,cyclosporine immunotherapy

panniculitis

systemic disease; inflammatory fat lobules; potential involvement of vasculitis; associated with infection, lymphoma, leukemia, erythema nodosum, polyarteritis nodosa

erythema nodosum

large erythematous tender subcutaneous nodule on extensor part of lower legs (pre-tibial); pain and edema; onset w/ fever, malaise, joint pain; associated w/ strep/infections, cancer, sarcoidosis, pregnancy, IBS; goes away 3-6 weeks; treat underlying conditions, NSAIDS, leg elevation, wet dressing, special socks; more in women

Polyarteritis Nodosa