case studies in derm pattern recognition 1

CASE STUDIES IN DERMATOLOGIC PATTERN

RECOGNITIONPart 1

PATTERN RECOGNITION IS THE CAPACITY TO

DESCRIBE A RASH OR LESION USING A VARIETY

OF PHYSICAL CHACTERISTICS IN ORDER

TO LIMIT THE DIFFERENTIAL DIAGNOSIS

PHYSICAL CHARACTERISTICS OF ALL

RASHES AND LESIONS

• 1.BASIC MORPHOLOGY

• 2.SIZE

• 3.SHAPE

• 4.COLOR

• 5.PATTERN

• 6.DISTRIBUTION

EXAMLPES OF BASIC MORPHOLOGY

• 1.MACULE AND PATCH

• 2.PAPULE AND NODULE

• 3.PUSTULE

• 4.WHEAL

• 5.VESICLE AND BULLA

• 6.PLAQUE

MACULES AND PATCHES

MACULES ARE FLAT AND THEREFORE NOT RECOGNIZED

BY TOUCH BUT RATHER A CHANGE IN COLOR FROM YHE SURROUNDING SKIN. PATCHES

ARE LARGER MACULES

MONGOLIAN SPOTS

PAPULES AND NODULES

PAPULES ARE ELEVATED SOLID LESIONS UP TO.5 CM IN

DIAMETER. NODULES ARE LARGER THAN PAPULES

NEUROFIBROMA

PUSTULES

PUSTULES ARE EPIDERMAL OR UPPER DERMAL COLLECTIONS

OF PUS. ABSCESSES ARE DEEPER PUSTULES

BULLOUS IMPETGO

ABSCESSES

WHEALS

WHEALS ARE ROUNDED PALE RED PAPULES OR PLAQUES

CAUSED BY THE EXTRAVASATION OF FLUID

URTICARIA

VESICLES AND BULLAE

VESICLES ARE LESIONS FORMED BY FLUID CREATING A

CLEAVAGE PLANE BENEATH THE STRATUM CORNEUM.

BULLAE ARE LARGER VESICLES

IMPETIGO

PLAQUES

PLAQUES ARE RAISED LESIONS WITH A FLAT TOP. THE RISE IN

ELEVATION IS MUCH LESS THAN YHR WIDTH OF THE

LESION

PSORIASIS

EXAMLPLES OF LESION SHAPE

• 1.ANNULAR• 2.NUMMULAR• 3.LINEAR• 4.OVAL• 5.TARGET• 6.SERPIGENOUS• 7.RETICULATE• 8.STELLATE

ANNULAR

ANNULAR LESIONS ARE CIRCULAR AND HAVE A

CENTER WITH AN APPEARANCE DIFFERENT FROM THEIR

EDGE OR BORDER

KERATOACANTHOMA

NUMMULAR

NUMMULAR LESIONS TAKE ON THE APPEARANCE OF A FILLED

CIRCLE OR COIN

NUMMULAR ECZEMA

LINEAR

LINEAR LESIONS ARE LONG RELATIVE TO THEIR WIDTH AND GENERALLY STRAIGHT

KELOID

OVAL

THE WORD IS SELF EXPLANATORY

FIXED DRUG ERUPTION

TARGET

TARGET LESIONS ARE MADE UP OF CONCENTRIC CIRCLES OF WHITE AND RED FORMING A

BULLSEYE APPEARANCE

ERYTHEMA MULTIFORME

SERPIGENOUS

LESIONS THAT ARE LONG AND WAVEY WITH A SNAKE-LIKE

APPEARANCE

LARVA MIGRANS

RETICULATE

LESIONS WITH AN INTERCONNECTED OR LACE-

LIKE APPEARANCE

STRETCH MARKS

STELLATE

LESIONS WITH A STAR-LIKE APPEARANCE USUALLY FROM

A RADIAL SPREAD FROM A CENTRAL FOCUS

SUPERFICIAL VARICOSITIES

EXAMPLES OF LESION PATTERN

• 1.GROUPED

• 2.DISSEMINATED

• 3.DERMATOMAL

• 4.SYMMETRIC

• 5.PHOTOSENSITIVE

• 6. CONFLUENT

• 7.INTERTRIGENOUS

GROUPED

MULTIPLE SIMILAR LESIONS ORGANIZED IN CLOSE

PROXIMITY

GENITAL WARTS

DISSEMINATED

LESIONS WHICH ARE SCATTERED RANDOMLY OVER

ALL OR MOST OF THE BODY

GENERALIZED DRUG

REACTION

DERMATOMAL

LESIONS THAT FOLLOW THE PATH OF A PERIPHERAL

SENSORY NERVE

HERPES ZOSTER

SYMMETRIC

LESIONS THAT ARE MIRROR IMAGES OF EACHOTHER FROM ONE SIDE OF THE BODY TO THE

OTHER

ONYCHOMYCOSIS

PHOTOSENSITIVE

LESIONS LIMITED TO THE SUN EXPOSED PARTS OF THE BODY

PHOTOSENSITIVE DRUG ERUPTION

CONFLUENT

THE PROCESS OF SMALLER LESIONS COMING TOGETHER UNTIL THEY FORM A LARGE

LESION BY MERGING

TINEA CORPORIS

INTERTRIGENOUS

LESIONS THAT ARE LOCATED BETWEEN SKIN FOLDS SUCH AS

THE AXILLA, GROIN OR BETWEEN FINGERS OR TOES

LESION SIZE

• USUALLY DESCRIBED IN MILLIMETERS OR CENTIMETERS

EXAMPLES OF LESION OR RASH COLOR

• 1.HYOPIGMENTED• 2.HYPERPIGMENTED• 3.WHITE• 4.BLACK• 5.BLUE• 6.YELLOW• 7.VIOLACEOUS• 8.VARIEGATED

EXAMPLES OF LESION DISTRIBUTION

• 1.HEAD• 2.ORAL• 3.AXILLARY• 4.TRUNCAL• 5.ANOGENITAL• 6.INGUINAL• 7.DEPENDENT• 8.PEDAL

PURPOSE OF THIS LEARNING MODULE

• THESE CASE STUDIES WILL PRESENT YOU WITH A RASH OR LESION FOLLOWED BY A DESCRIPTION USING AS MANY PHYSICAL CHACTERISTICS AS POSSIBLE. THE GOAL IS TO IDENTIFY THE RASH OR LESION BASED ON YOUR ABILITY TO RECOGNIZE IT’S PHYSICAL CHARACTERISTICS

• WITH EACH CASE YOU WILL FIRST SEE THE RASH OR LESION FOLLOWED BY THE RASH OR LESION WITH IT’S DESCRIPTION AND FINALLY THE DIAGNOSIS. TRY TO DESCRIBE IT USING AS MANY CHARACTERISTICS AS YOU CAN THEN COMPARE IT TO THE DESCRIPTION GIVEN AND FINALLY CHECK THE DIAGNOSIS

CASE #1

• A 3 CM. PINK TO BROWN ANNULAR PLAQUE WITH SCALING CENTER ON THE ARM OF AN EIGHT YEAR OLD BOY

TINEA CORPORIS

CASE #2

• MULTIPLE AREAS OF ALOPECIA WITH BROKEN HAIRS AND SCALES ON THE SCALP OF A TWELVE YEAR OLD BOY

TINEA CAPITIS

CASE #3

• MULTIPLE DISCRETE AND CONFLUENT HYPERPIGMENTED MACULES WITH FINE SCALES ON THE UPPER BACK AND NECK OF A FORTY-FIVE YEAR OLD WOMAN

TINEA VERSICOLOR

CASE #4

• BEGINS AS A BROWN MACULE BECOMES PLAQUE-LIKE DARKER AND HAS A STUCK-ON APPEARANCE OFTEN SEEN IN GREAT NUMBERS ON THE BACKS OF ELDERLY INDIVIDUALS

SEBORRHEIC KERATOSES

CASE #5

• STARTS AS MULTIPLE PAPULES THEN VESICLES FOLLOWED BY PUSTULES AND FINALLY CRUSTS ON AN ERYTHEMATOUS BASE AND DISTRIBUTED ALONG A DERMATOME. INDIVIDUAL LESIONS ARE 2 TO 3 MM. IN DIAMETER

HERPES ZOSTER

CASE #6

• MULTIPLE 1 TO 2MM. WHITE TO YELLOW PAPULES SEEN IN CLUSTERS ON AND AROUND THE NOSE IN INFANTS. MAY BE SEEN AS SINGLE LESIONS IN ADULTS

MILIA

CASE #7•

• A SINGLE 2 CM. PAINLESS PUSTULE ON THE HAND OF A SIX YEAR OLD GIRL.MORE OFTEN SEEN GROUPED IN CLUSTERS

BULLOUS IMPETIGO

CASE #8

• A RAPIDLY EXPANDING (HORIZANTALY AND VERTICALLY) 2 CM. BY 3 CM. NODULE WITH VARIEGATED COLORATION ON THE BACK OF A FORTY-TWO YEAR OLD MAN

MELANOMA

CASE #9

• MULTIPLE HONEY-COLORED CRUSTS AROUND THE MOUTH AND CHIN OF A SIX YEAR-OLD CHILD

IMPETIGO

CASE #10

• A STREAK OF EXTREMELY PRURITIC VESICLES ON THE ARM OF AN ADULT RECENTLY BACK FROM A CAMPING TRIP

POISON IVY CONTACT DERMATITIS

CASE #11

• A CLUSTER OF 1 CM. VERRUCOUS PLAQUES WITH TINY BKACK DOTS ON THE PLANTAR SURFACE

PLANTAR WARTS

CASE #12

• MULTIPLE SYMMETRIC FACIAL PAPULES AND NODULES ON AN ERYTHEMAT-OUS BASE IN A SIXTY YEAR OLD WOMAN

ROSACEA

CASE # 13

• SHARPLEY MARGINATED ERTHEMATOUS PLAQUES WITH SILVER SCALES ON AN ERYTHEMATOUS BASE AND A PREDOMINANTLY EXTENSOR DISTRIBUTION

Case #14

• A LARGE WARM TO HOT ERYTHEMATOUS MACULE WITH ASSOCIATED EDEMA ON THE LEG OF A FIFTY-FIVE YEAR OLD MAN

CELLULITIS

Case #15

MOLLUSCUM CONTAGIOSUM

• MULTIPLE GROUPED OR DISSEMINATED PEARLY 1 TO 2 MM. ROUND OR OVAL PAPULES WHICH MAY SHOW AN UMBILICATED CENTER

MOLLUSCUM CONTAGIOSUM

CASE #16

• RED YELLOW AND WHITE GREASY OR SCALING MACULES AND PAPULES PRIMARILY SEEN ON THE CENTRAL FACE. MAY BE SEEN ON SCALP AND ANTERIOR CHEST COMMON IN ELDERLY AS ABOVE

SEBORRHEIC DERMATITIS

CASE #17

• PAINFUL BURNING 3 TO 5 MM. VESICLES ON AN ERYTHEMATOUS BASE AND IN A DERMATOMAL DISTRIBUTION

HERPES ZOSTER

CASE #18

• A GROUP OR CLUSTER OF 2 TO 3 MM. VESICLES ON AN ERYTHEMATOUS BASE PRECEEDED BY A SENSATION OF BURNING OR STINGING

HERPES SIMPLEX

CASE #19

• MULTIPLE OVAL 5 MM. TO 5CM. BROWN TO VIOLACEOUS MACULES AND PAPULES IN A35 YEAR OLD HIV POSITIVE MAN

KAPOSI”S SARCOMA

KAPOSI”S SARCOMA

CASE #20

• A SINGLE 3 CM. VIOLACEOUS MACULE COMMONLY SEEN IN THE GENITAL AREA

FIXED DRUG ERUPTION

CASE #21

• TRANSIENT PINK WHEALS WHICH ARE PRURITIC AND MAY ASSUME OVAL, ANNULAR POLYCYCLIC OR SERGIGENOUS FORMS

URTICARIA

CASE #22

• VELVETY FEELING AREA OF HYPERPIMENTATION ALSO COMMONLY SEEN IN THE AXILLAE

ACANTHOSIS NIGRICANS

CASE #23

• A 2 TO 5 CM. SCALING PINK OVAL PAPULE USUALLY FOUND ON THE TRUNK FOLLOWED BY MULTIPLE SMALLER SIMILAR OVA L LESIONS

PITYRIASIS ROSEA

Case #24

• CONFLUENT RED PLAQUES ON THE CHEEKS OF A TWELVE YEAR OLD GIRL. SIMILAR LESIONS IN A LACEY PATTERN SCATTERED OVER THE BODY

FIFTH DISEASE

CASE #25

• TRANSIENT PRURITIC PINK WHEALS SHOWING A PREDOMINANTLY ANNULAR SHAPE

URTICARIA

Case #26

• STREAKING PRURITIC CONFLUENT VESICLES ON AN ERYTHEMATOUS BASE IN A GARDENER

CONTACT DERMATITIS TO WILD PARSNIP

Case #27

• ERYTHEMATOUS PLAQUES WITH OVERLYING SILVER SCALES IN A PREDOMINTLY EXTENSOR DISTRIBUTION

PSORIASIS

Case #28

• A FIRM LINEAR FLESH COLORED PAPULE FOLLOWING THE SITE OF A SURGICAL INCISION

HYPERTROPHIC SCAR

CASE #29

• ENLARGING ERYTHEMATOUS PAINLESS MACULE WITH SLOWLY CLEARING CENTER

ERYTHEMA MIGRANS

CASE #30

• SINGLE AND CONFLUENT PAINLESS VIOLACEOUS PLAQUES DIISSEMINATED THROUGHOUT THE BODY

KAPOSI’S SARCOMA

CASE #31

• A PEARLY APPEARING 2 CM. ANNULAR PAPULE WTH AN ULCERATED CENTER AND ASSOCIATED TELANGECTASIA

BASAL CELL CARCINOMA

CASE #32

• FLAT TOPPED PLAQUES USUALLY 1 MM. TO 1CM. LESIONS ARE VIOLACEOUS ,SHARPLY DEFINED AND SHINY. SOMETIMES SEEN WITH THIN WHITE STREAKS

LICHEN PLANUS

CASE #33

• LARGE LICHENIFIED PLAQUES WHICH ARE PRURITIC AND DULL RED OR BROWN COMMONLY SEEN OVER THE SHINS

LICHEN SIMPLEX CHRONICUS

CASE #34

• 1 MM. DEEP SEATED VESICLES GROUPED IN CLUSTERS VERY PRURITIC AND COMMONLY SEEN BETWEEN THE FINGERS

DYSHYDROTIC ECZEMA

CASE #35

• THE SKIN IS EDEMATOUS AND ERYTHEMATOUS. THERE IS A FIRM PAINFUL FLESHY PAPULE IN THE CENTER OF THE LESION

PARONYCHIA WITH PYOGENIC GRANULOMA

PARONYCHIA WITH PYOGENIC GRANULOMA

CASE #36

• THE DISTAL HANDS ARE COVERED WITH A WELL-DEFINED MACULAR HYPOPIGMENT-ATION.FACE, FEET AND GENITAL AREA MAY BE INVOLVED

VITILIGO

CASE #37

• A LONG SERPIGENOUS 3 MM. WIDE ERYTHEMATOUS TRACK IN A WOMAN RECENTLY RETURNED FROM THE CARRIBEAN

CUTANEOUS LARVA MIGRANS

Case #38

ERYTHEMA MULTIFORME

• 3 CM OVAL LESIONS MADE UP OF CONCENTRIC CIRCLES OF RED AND WHITE

CASE #39

• SYMMETRCALLY PLACED SCALING NUMMULAR PLAQUES ON A BABY WHO LIKES HIS ‘NUK’

CONTACT DERMATITIS (PACIFIER)

CASE #40

• BRIGHT RED MACULAR LESIONS WITH A WELL DEFINED BORDER AND SATELLITES IN AN ITERTRIGENOUS DISTRIBUTION

CANDIDIASIS

CASE #41

WHITE PLAQUES ADHERENT TO THE TONGUE IN AN INFANT

CANDIDIASIS (THRUSH)

CASE #42

• CONFLUENT HYPERPIGMENTED PATCH ON THE SACRUM OF A NEWBORN

MONGOLIAN SPOT

CASE #43

• A ROW OF 1 CM. ERYTHEMATOUS PAPULES ON THE FACE OF AN INFANT

FLEA BITES

CASE #44

• A LINEAR TRACK OF 1MM. FIRM FLESHY WHITE PAPULES AROUND THE CORONA OF THE PENIS

PEARLY PENILE PAPULES

CASE #45

• A LARGE ERYTHEMATOUS INTERTRIGENOUS MACULE WITH A WELL-DEFINED BORDER AND SATELLITE LESIONS

CANDIDIASIS

CASE #46

• DISSEMINATED 5MM. TO 2CM. PINK OVAL TO ROUND MACULES WITH EVENTUAL CONFLUENCE OF LESIONS IN A THREE YEAR OLD GIRL

MEASLES

CASE #47

• A PUSTULE ON AN ERYTHEMATOUS BASE (THE DEW DROP ON A ROSE PETAL)

VARICELLA