SELF-ASSESSMENT 1
Psoriasis presents with erythematous plaques with silver scale. Favors knees, elbows, scalp.
May develop psoriatic arthritis.
A. Psoriasis affects 2% population.
B. Oral involvement is uncommon.
C. Ultraviolet exposure (phototherapy) is therapeutic.
Skin/mucosal signs of Lupus.
1. Malar rash.
2. Oral ulcers.
3. Discoid lesions.
4. Photosensitivity.
Heliotrope rash is seen in dermatomyositis.
Impetigo: honey colored crusts.
Etiology: Staph (#1) or Strep (#2).
Psoriasis: Erythematous plaques w/ silver scale.
Eczema is pink, scaly, excoriated. Honey colored crust/oozing is a sign of bacterial infection.
Shingles: vesicles in a dermatomal distribution.
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Moist skin, pretibial myxedema, exopthalmos.
Granuloma Annulare.
Pink infiltrated annular plaques.
Diabetes Mellitus.
Acanthosis nigricans, diabetic dermopathy, necrobiosis lipoidica diabeticorum.
Hypothyroidism
itchy skin, brittle slow growing nails, and loss of the lateral third of her eyebrows
BCCs: Pearly papules with raised borders and telangectasias.
SCCs: Erythematous (pink/red) scaly plaques or nodules.
IDN: Are skin colored papulesno raised borders, not pearly.
Keratinous cyst: Subcutaneous cystic nodule with punctum.
Inflammed cysts: Subcutaneous cysts with surrounding erythema. Often tender.
Wart (verruca vulgaris): Hyperkeratotic verrucous papules.
Bullous Pemphigoid presents with tense bullae, typically in elderly patients. Oral involvement is uncommon.
No acantholysis
Path: Subepidermal bullae with eosinophils.
B & C are seen in Pemphigus Vulgaris.- acantholysis, oral ulcers
Keratinocyte necrosis is not seen in bullous pemphigoid.
Melanoma ABCDEs= Asymmetry, irregular Borders, multiple Colors, Diameter > 6mm, Evolving.
All suspicious pigmented lesions should be completely excised to allow for a complete, histopathological
evaluation.
Melanoma may only be present in a single portion of a pigmented lesion, so a biopsy of just the edge is
incorrect.
Seborrheic keratoses are one of the most common benign skin neoplasms.
They are generally pigmented verrucous stuck on appearing papules.
Sign of Leser-Trelat is the acute development of hundreds of eruptive SKs. This is very rare.
o Classically associated with an underlying gastric adenocarcinoma.
Vasculitis results in palpable purpura.
Common etiologies: infection, connective tissue disease, drugs.
A. Metastatic cancer generally presents as a nodule that may bleed or ulcerate.
B. Erythema Nodosumpink, tender nodules on shins.
C. Sarcoidosispink, infiltrative papules.
Pathogenesis of Pemphigus Vulgaris is autoantibodies to desmoglein 3 (a cadherin). Flaccid bullae of
the skin and oral erosions are common.
Pts have + Nikolsky sign = development of bullae with lateral pressure applied to the skin.
Antibodies to hemidesmosomes are seen in Bullous Pemphigoid.
Psoriatic arthritis affects ~25 % patients with psoriasis which is not AD or AR inherited.
Favors DIP, PIP, wrists, ankles.
Methotrexate is a treatment option.
Dermatomyositis: Photodistributed erythema, heliotrope rash, Gottrons papules = pink papules over mcp,
pip, dip without arthritis.
Shingles (Herpes Zoster): Vesicles on erythematous base in a dermatomal distribution.
Tzank prep would be positive.
KOH is positive in fungal infections.
Annular arrangement is seen in tinea corporis.
Keratinous Cyst: Subcutaneous nodule, with a punctum.
o Patients may complain of a white, cheesy, malodorous drainage.
Lipoma: Soft, mobile, subcutaneous cysts, but never have a punctum, no drainage.
Intradermal melanocytic nevi: Skin colored dome shaped papules.
Basal cell ca: Pearly papules with telangiectasias.
Psoriasis commonly involves the scalp, elbows, and knees.
May have psoriatic arthritis and nail involvement.
Psoriasis is not photosensitivePhototherapy is therapeutic!
There is no association between psoriasis and thyroid disease.
Infantile hemangiomas are benign vascular neoplasms. Periorbital hemangiomas can result in amblyopia.
An ophthalmology consult is required.
Observation without intervention in this case might result in permanent visual impairment.
Biopsy is incorrectThis is a clinical diagnosis.
Radiation is not a standard treatment.
A papule is a bump which is smaller than a nodule. The typical size cutoff between the two is 1 cm.
A macule is small flat spot which is not palpable.
A plaque is a raised or depressed textural abnormality that is more diffuse than a papule or nodule.
Main point: Try to use standard medical language when communicating dermatological descriptions in a
professional setting. E.g., use "papule" and "macule" instead of "bump" and "spot."
Tinea corporis ("ringworm"): scaly erythematous plaques w/ annular borders. Note the scale is right at the
edge of the lesion. Koh prep is positive.
Psoriasis is a pink plaque with silver scale.
This is tinea pedis (fungal infection of the foot). In general, extensive erosion and maceration indicate
bacterial superinfection. This is an important consideration when treating diabetics and treatment
includes both anti-bacterial and anti-fungal medications.
Zosteriform refers to a dermatomal arrangement.
