case studies in derm pattern recognition 1
TRANSCRIPT
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