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CASE STUDIES IN DERMATOLOGIC PATTERN RECOGNITION Part 1

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Page 1: Case studies in derm pattern recognition  1

CASE STUDIES IN DERMATOLOGIC PATTERN

RECOGNITIONPart 1

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PATTERN RECOGNITION IS THE CAPACITY TO

DESCRIBE A RASH OR LESION USING A VARIETY

OF PHYSICAL CHACTERISTICS IN ORDER

TO LIMIT THE DIFFERENTIAL DIAGNOSIS

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PHYSICAL CHARACTERISTICS OF ALL

RASHES AND LESIONS

• 1.BASIC MORPHOLOGY

• 2.SIZE

• 3.SHAPE

• 4.COLOR

• 5.PATTERN

• 6.DISTRIBUTION

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EXAMLPES OF BASIC MORPHOLOGY

• 1.MACULE AND PATCH

• 2.PAPULE AND NODULE

• 3.PUSTULE

• 4.WHEAL

• 5.VESICLE AND BULLA

• 6.PLAQUE

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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

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MONGOLIAN SPOTS

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PAPULES AND NODULES

PAPULES ARE ELEVATED SOLID LESIONS UP TO.5 CM IN

DIAMETER. NODULES ARE LARGER THAN PAPULES

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NEUROFIBROMA

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PUSTULES

PUSTULES ARE EPIDERMAL OR UPPER DERMAL COLLECTIONS

OF PUS. ABSCESSES ARE DEEPER PUSTULES

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BULLOUS IMPETGO

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ABSCESSES

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WHEALS

WHEALS ARE ROUNDED PALE RED PAPULES OR PLAQUES

CAUSED BY THE EXTRAVASATION OF FLUID

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URTICARIA

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VESICLES AND BULLAE

VESICLES ARE LESIONS FORMED BY FLUID CREATING A

CLEAVAGE PLANE BENEATH THE STRATUM CORNEUM.

BULLAE ARE LARGER VESICLES

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IMPETIGO

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PLAQUES

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

ELEVATION IS MUCH LESS THAN YHR WIDTH OF THE

LESION

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PSORIASIS

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EXAMLPLES OF LESION SHAPE

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

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ANNULAR

ANNULAR LESIONS ARE CIRCULAR AND HAVE A

CENTER WITH AN APPEARANCE DIFFERENT FROM THEIR

EDGE OR BORDER

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KERATOACANTHOMA

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NUMMULAR

NUMMULAR LESIONS TAKE ON THE APPEARANCE OF A FILLED

CIRCLE OR COIN

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NUMMULAR ECZEMA

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LINEAR

LINEAR LESIONS ARE LONG RELATIVE TO THEIR WIDTH AND GENERALLY STRAIGHT

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KELOID

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OVAL

THE WORD IS SELF EXPLANATORY

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FIXED DRUG ERUPTION

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TARGET

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

BULLSEYE APPEARANCE

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ERYTHEMA MULTIFORME

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SERPIGENOUS

LESIONS THAT ARE LONG AND WAVEY WITH A SNAKE-LIKE

APPEARANCE

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LARVA MIGRANS

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RETICULATE

LESIONS WITH AN INTERCONNECTED OR LACE-

LIKE APPEARANCE

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STRETCH MARKS

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STELLATE

LESIONS WITH A STAR-LIKE APPEARANCE USUALLY FROM

A RADIAL SPREAD FROM A CENTRAL FOCUS

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SUPERFICIAL VARICOSITIES

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EXAMPLES OF LESION PATTERN

• 1.GROUPED

• 2.DISSEMINATED

• 3.DERMATOMAL

• 4.SYMMETRIC

• 5.PHOTOSENSITIVE

• 6. CONFLUENT

• 7.INTERTRIGENOUS

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GROUPED

MULTIPLE SIMILAR LESIONS ORGANIZED IN CLOSE

PROXIMITY

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GENITAL WARTS

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DISSEMINATED

LESIONS WHICH ARE SCATTERED RANDOMLY OVER

ALL OR MOST OF THE BODY

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GENERALIZED DRUG

REACTION

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DERMATOMAL

LESIONS THAT FOLLOW THE PATH OF A PERIPHERAL

SENSORY NERVE

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HERPES ZOSTER

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SYMMETRIC

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

OTHER

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ONYCHOMYCOSIS

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PHOTOSENSITIVE

LESIONS LIMITED TO THE SUN EXPOSED PARTS OF THE BODY

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PHOTOSENSITIVE DRUG ERUPTION

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CONFLUENT

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

LESION BY MERGING

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TINEA CORPORIS

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INTERTRIGENOUS

LESIONS THAT ARE LOCATED BETWEEN SKIN FOLDS SUCH AS

THE AXILLA, GROIN OR BETWEEN FINGERS OR TOES

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LESION SIZE

• USUALLY DESCRIBED IN MILLIMETERS OR CENTIMETERS

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EXAMPLES OF LESION OR RASH COLOR

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

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EXAMPLES OF LESION DISTRIBUTION

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

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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

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• 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

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CASE #1

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

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TINEA CORPORIS

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CASE #2

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

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TINEA CAPITIS

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CASE #3

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

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TINEA VERSICOLOR

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CASE #4

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• 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

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SEBORRHEIC KERATOSES

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CASE #5

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• 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

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HERPES ZOSTER

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CASE #6

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• 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

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MILIA

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CASE #7•

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

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BULLOUS IMPETIGO

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CASE #8

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• 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

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MELANOMA

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CASE #9

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

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IMPETIGO

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CASE #10

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

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POISON IVY CONTACT DERMATITIS

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CASE #11

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

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PLANTAR WARTS

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CASE #12

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

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ROSACEA

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CASE # 13

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

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Case #14

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

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CELLULITIS

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Case #15

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MOLLUSCUM CONTAGIOSUM

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

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MOLLUSCUM CONTAGIOSUM

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CASE #16

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• 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

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SEBORRHEIC DERMATITIS

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CASE #17

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

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HERPES ZOSTER

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CASE #18

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

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HERPES SIMPLEX

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CASE #19

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

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KAPOSI”S SARCOMA

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KAPOSI”S SARCOMA

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CASE #20

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

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FIXED DRUG ERUPTION

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CASE #21

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

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URTICARIA

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CASE #22

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

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ACANTHOSIS NIGRICANS

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CASE #23

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

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PITYRIASIS ROSEA

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Case #24

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

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FIFTH DISEASE

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CASE #25

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• TRANSIENT PRURITIC PINK WHEALS SHOWING A PREDOMINANTLY ANNULAR SHAPE

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URTICARIA

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Case #26

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

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CONTACT DERMATITIS TO WILD PARSNIP

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Case #27

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

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PSORIASIS

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Case #28

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

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HYPERTROPHIC SCAR

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CASE #29

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• ENLARGING ERYTHEMATOUS PAINLESS MACULE WITH SLOWLY CLEARING CENTER

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ERYTHEMA MIGRANS

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CASE #30

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• SINGLE AND CONFLUENT PAINLESS VIOLACEOUS PLAQUES DIISSEMINATED THROUGHOUT THE BODY

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KAPOSI’S SARCOMA

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CASE #31

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

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BASAL CELL CARCINOMA

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CASE #32

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

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LICHEN PLANUS

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CASE #33

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

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LICHEN SIMPLEX CHRONICUS

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CASE #34

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

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DYSHYDROTIC ECZEMA

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CASE #35

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

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PARONYCHIA WITH PYOGENIC GRANULOMA

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PARONYCHIA WITH PYOGENIC GRANULOMA

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CASE #36

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

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VITILIGO

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CASE #37

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

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CUTANEOUS LARVA MIGRANS

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Case #38

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ERYTHEMA MULTIFORME

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

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CASE #39

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

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CONTACT DERMATITIS (PACIFIER)

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CASE #40

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

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CANDIDIASIS

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CASE #41

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WHITE PLAQUES ADHERENT TO THE TONGUE IN AN INFANT

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CANDIDIASIS (THRUSH)

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CASE #42

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• CONFLUENT HYPERPIGMENTED PATCH ON THE SACRUM OF A NEWBORN

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MONGOLIAN SPOT

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CASE #43

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

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FLEA BITES

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CASE #44

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

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PEARLY PENILE PAPULES

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CASE #45

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

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CANDIDIASIS

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CASE #46

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

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MEASLES

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CASE #47

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

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VARICELLA