diagnostic groupings · it resembles acne, with papules and pustules on an erythematous and...
TRANSCRIPT
![Page 1: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/1.jpg)
Diagnostic Groupings
![Page 2: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/2.jpg)
Review of Primary LesionsFLAT LESIONS
SMALL LARGE
MACULE PATCH
RAISED LESIONS
SMALLLARGE
WITHOUTSUBSTANCE
LARGEWITH
SUBSTANCE
PAPULE PLAQUE NODULE
CYST
TUMOR
DERMAL
WHEALFLUID-FILLEDLESIONS
SMALL LARGE PUS-FILLED
VESICLE BULLA PUSTULE
![Page 3: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/3.jpg)
Your description Location/Distribution Size/Configuration Border (Well‐marginated/Poorly marginated) ColorMorphological term Secondary Characteristics
Example On her right flank, there is a 1.5 cm well‐marginated erythematous plaque with silvery scale.
![Page 4: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/4.jpg)
Steroid potencies VERY POTENT (up to 600 times as potent as
hydrocortisone) Clobetasol propionate
(Temovate) Betamethasone dipropionate
(Diprolene) Halobetasol propionate (Ultravate)
POTENT (over 100 times more potent than
hydrocortisone) Fluocinonide (Lidex) Betamethasone valerate (Valisone) Mometasone furoate (Elocon)
MODERATE (2‐25 times as potent as
hydrocortisone) Aclometasone dipropionate
(Aclovate) Fluocinolone acetonide (Synalar) Triamcinolone acetonide
(Kenalog‐inj and generic‐top) Fluticasone propionate (Cutivate)
MILD Hydrocortisone 0.5‐2.5%
![Page 5: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/5.jpg)
Vehicles The vehicle is also an important factor in the strength of your topical steroid
OINTMENT > CREAM > LOTION
*Any of the above under occlusion (ex. wet dressing) will make them stronger as well.
![Page 6: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/6.jpg)
Using the Algorithm
![Page 7: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/7.jpg)
To categorize a skin lesion you need to ask FOUR questions…
![Page 8: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/8.jpg)
![Page 9: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/9.jpg)
Question #1:ARE THERE BLISTERS?
If YES…What type of fluid is within the blister?
Clear fluid? Pus?
FLUID-FILLEDLESIONS
SMALL LARGE PUS-FILLED
VESICLE BULLA PUSTULE
CLEAR FLUID PUS
![Page 10: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/10.jpg)
I. VESICULOBULLOUS DISEASES
Blisters with clear fluid
Small = VesicleLarge = Bulla
![Page 11: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/11.jpg)
II. PUSTULAR DISEASESII. Blisters with PUS
![Page 12: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/12.jpg)
![Page 13: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/13.jpg)
NO, the lesions are solid.
Question #2a:ARE THE LESIONS RED?
If YES, continue with the algorithm If NO…
• Question #2b:• WHAT IS THE COLOR OF THE LESIONS?
![Page 14: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/14.jpg)
![Page 15: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/15.jpg)
SKIN COLOREDIII. SKIN COLORED PAPULES AND NODULES
![Page 16: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/16.jpg)
WHITEIV. WHITE LESIONS
![Page 17: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/17.jpg)
BROWN, BLUE, or BLACKV. BROWN, BLUE OR BLACK LESIONS
![Page 18: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/18.jpg)
YELLOWVI. YELLOW LESIONS
![Page 19: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/19.jpg)
![Page 20: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/20.jpg)
YES, the lesions are SOLID and RED.
Question #3aIS THERE SCALE?
If YES, continue with the algorithm If NO…
Question #3bARE THE LESIONS DOME‐SHAPED OR FLAT‐TOPPED?
![Page 21: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/21.jpg)
The lesions are: SOLID RED DOME‐SHAPED(No scale)
VII. RED PAPULES AND NODULES
![Page 22: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/22.jpg)
The lesions are: SOLID RED FLAT‐TOPPED(No scale)
VIII. VASCULAR REACTIONS
![Page 23: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/23.jpg)
![Page 24: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/24.jpg)
![Page 25: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/25.jpg)
YES, there is scale. The lesions are…
SOLID RED and SCALY
Question 4:IS THERE EPITHELIAL DISRUPTION?
orARE THEY WELL‐MARGINATED or POORLY‐MARGINATED?
![Page 26: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/26.jpg)
Well‐marginated! Red Solid ScalyWell‐marginated
IX. PAPULOSQUAMOUS DISEASES
![Page 27: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/27.jpg)
Poorly‐marginated… Red Solid Scaly Poorly‐marginated
X. ECZEMATOUS DISEASES
![Page 28: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/28.jpg)
![Page 29: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/29.jpg)
Now its time to cover some of the diseases…
![Page 30: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/30.jpg)
The diseases
![Page 31: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/31.jpg)
![Page 32: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/32.jpg)
Case 1
15 year old woman Lesions on cheek which started 1 week ago with a burning / itching sensation
Never had this before Some tender nodes on head and neck exam
![Page 33: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/33.jpg)
![Page 34: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/34.jpg)
Herpes SimplexDescription:
On the right cheek, there are grouped vesicles on an erythematous plaque.
Epidemiology: Any age Transmitted by skin‐skin contact
Mucous membranes or keratinized skin
How does the clinical presentation differ between a primary and a recurrent infection?
What are precipitating factors for recurrence?
![Page 35: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/35.jpg)
Case 2
65 year old man Severe pain and allodynia for 2 days and then subsequently developed a rash
![Page 36: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/36.jpg)
![Page 37: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/37.jpg)
Herpes ZosterDescription:
On the right V1 branch of the trigeminal nerve dermatome, there are grouped vesicles on an erythematous plaque.
Epidemiology: Who is at risk?
What is the significance of the lesion on the tip of the nose?
What is the disease called with involvement of the geniculate ganglion?
![Page 38: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/38.jpg)
Case 3
35 year old man Noticed “bumps” in between his fingers for the last 5 days. Had similar lesions a year ago which went away by themselves. They are very itchy.
![Page 39: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/39.jpg)
![Page 40: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/40.jpg)
Dyshidrotic Eczema Multiple 2 mm skin‐colored, pruritic, deep‐seated clear vesicles which may later develop into scaling and fissures.
What would you want to know about his past medical history?
What is a complication of the disease? Treatment?
![Page 41: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/41.jpg)
Case 3 55 year old woman from Lebanon A couple months ago, had a couple of erosive lesions in her mouth which were tender. They spontaneously resolved. Now has noted lesions on her back and abdomen which are painful and blister. The blisters rupture easily and spread with lateral pressure.
![Page 42: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/42.jpg)
![Page 43: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/43.jpg)
Pemphigus VulgarisDiagnosis:
5 mm punch biopsy x 2! H and E (edge of the lesion) Immunofluroescence (Michel’s
media) (perilesional normal skin)
Description:• Multiple polymorphic 1‐3 cm
bullae on the lower back that are easily ruptured (also involving the mouth)
• Spread of the blister following application of lateral pressure to an active lesion: NIKOLSKY’s SIGN
Epidemiology:• Age 40‐60 • Middle Eastern descent
![Page 44: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/44.jpg)
Punch biopsy with H and E stain shows acantholysis:separation of the epidermis occurs above the basal layer revealing a “row of tombstones”.
Pemphigus Vulgaris
![Page 45: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/45.jpg)
Pemphigus Vulgaris
Direct immunofluorescence reveals IgG and C3 stain at the cellular junctions between the stratified squamous epithelial cells in the epidermis.
![Page 46: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/46.jpg)
Treatment Dermatology referral
High‐dose steroids Prednisone 40‐120 mg/day to start
Up to 200 mg/day Complicated to manage
Steroid sparing agent Azathioprine or Cyclophosphamide
![Page 47: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/47.jpg)
Case 4
45 year old man Rash started on his face and then involved the back. Looks flaky and crusted. There is no mucosal involvement on exam.
![Page 48: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/48.jpg)
![Page 49: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/49.jpg)
Pemphigus FoliaceusDescription:
On the back, there are multiple approximately 1 cm circular plaques with superficial erosion coalescing together. (with no mucous membrane involvement).
Epidemiology: Ages 50‐60 Brazil and Columbia
Diagnosis: You tell me!
![Page 50: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/50.jpg)
![Page 51: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/51.jpg)
IgG Antibodies Antibodies against
DESMOGLEIN 1 in DESMOSOMES
Confirmatory test Indirect Immunofluoresecence finds IgG antibodies in the serum
![Page 52: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/52.jpg)
Case 5
70 year old woman 2 months ago had “hive‐like” lesions which continued until the current lesions appeared
![Page 53: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/53.jpg)
![Page 54: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/54.jpg)
Bullous PemphigoidDescription:
On the legs, there are many 1‐5 cm bullous lesions with firm,
unruptured roofs on erythematous skin (often start as urticarial type
lesion)Epidemiology:
> Age 60 or childhoodDiagnosis:
You tell me! Treatment:
Prednisone to induce remision Steroid‐sparing agents
Dapsone
![Page 55: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/55.jpg)
![Page 56: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/56.jpg)
Direct Immunofluorescence
![Page 57: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/57.jpg)
IgG Antibodies Antibodies against
Bullous pemphigoid antigen in HEMIDESMOSOMES
Confirmatory test Indirect Immunofluoresecence – serum IgG *Level of Antibody NOT CORRELATED with level of disease and as the disease subsides, C3 deposits disappear.
![Page 58: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/58.jpg)
Treatment Goals: Arrest blistering and limit secondary infection Itching: Hydroxyzine 10‐50mg q4hr
Caution in elderly (sedation) Disease: Prednisone 1‐1.5 mg/kg/day Dapsone to produce remission Sparing agents: tetra/minocycline IVIG if unresponsive
![Page 59: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/59.jpg)
Comparison
![Page 60: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/60.jpg)
Case 6
25 year old woman Intensely pruritic and “burning” rash on knees, elbows, and buttocks for the past several weeks. She has a past medical history of Hashimoto’s thyroiditis for which she takes thyroid supplement.
![Page 61: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/61.jpg)
![Page 62: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/62.jpg)
Dermatitis HerpetiformisDescription:
On the extensor sides of both knees, there are small grouped vesicles on an erythematous base. (strikingly symmetrical, annular pattern)
Epidemiology: Age 30‐40
Diagnosis: You tell me!
What autoantibody is involved and seen on biopsy?
What treatment is helpful to control the disease?
![Page 63: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/63.jpg)
Case 7
2 year‐old child Day care Lesion duration: days Some regional lymphadenopathy on exam
![Page 64: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/64.jpg)
![Page 65: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/65.jpg)
Impetigo
Multiple well‐marginated honey‐crusted erythematous erosions on the face
Very contagious! (Daycare, close living quarters) Very superficial infectionOne of two organisms is usually to blame: what are they?
Give a possible treatment…What is a feared complication?
![Page 66: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/66.jpg)
Case 7 28 year old woman History of a lesion on her lip approximately 2 weeks ago, which was painful and crusted and went away spontaneously. Now, complains of diffuse rash involving her palms and soles and arthralgias.
![Page 67: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/67.jpg)
![Page 68: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/68.jpg)
Erythema Multiforme Minor Description:
On the palms of both hands there are multiple 5 mm‐1 cm targetoid lesions with central vesicles that appear necrotic.
Pathology: Immune complex deposition in
cutaneous microvasculature with mononuclear cells predominating (type 3 hypersensitivity)
What 3 infections are often linked to EM Minor? Herpes simplex virus Coccidiodomycosis Mycoplasma
What is the spectrum of disease? Erythema multiforme minor Erythema multiforme major
(SJS) Toxic epidermal necrolysis
(TEN)
![Page 69: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/69.jpg)
![Page 70: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/70.jpg)
Case 8
50 year old man Painful blisters in sun‐exposed areas; heal with scarring, several months duration
History of IVDU and chronic renal insufficiency
![Page 71: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/71.jpg)
![Page 72: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/72.jpg)
![Page 73: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/73.jpg)
Porphyria Cutanea Tarda (PCT)Description:
On the dorsum of the hand, there are two 1 cm unrupturedbullae, on the second MCP joint, there are three white papules, and on the second PIP joint there is a pink well‐circumscribed scar.
Pathophysiology: Enzyme in heme synthesis
“UROD” functioning at 25% capacity with build up of uroporphyrin in urine and plasma
Associations: HEPATITIS C (50%) (IVDU) Liver disease
Iron overload or etoh abuse Renal failure
Porphorins are renallyexcreted
![Page 74: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/74.jpg)
Vesiculobullous Diseases Herpes Simplex Herpes Zoster Pemphigus Vulgaris Pemphigus Folaceous Bullous Pemphigoid Dermatitis Herpetiformis Erythema Multiforme Porphyria Cutanea Tarda
![Page 75: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/75.jpg)
![Page 76: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/76.jpg)
Case 1
25 year old man Rash on face, worsened by shaving Lesion duration: days Lesions are minimally tender, slightly pruritic
![Page 77: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/77.jpg)
![Page 78: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/78.jpg)
Superficial Folliculitis
Multiple pustules that confined to ostium of hair follicle in the distribution of the beard
What is the usual organism?
Hot‐tub folliculitis due to what organism?
![Page 79: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/79.jpg)
Case 2 A 42 year old woman Complains of a deep ulcer on the anterior shin which began 3 weeks ago. The patient thinks that she might have injured her leg on the edge of a coffee table, but isn’t sure. She developed a nodule which broke down into a deep ulcer. On ROS, she has intermittent diarrhea and crampy abdominal pain.
![Page 80: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/80.jpg)
![Page 81: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/81.jpg)
Pyoderma Gangrenosum Irregular, boggy, blue‐red ulcer with undermined “heaped up” borders surrounding a purulent, necrotic base
What systemic disease is it most commonly associated with?
What should you NOT do to the lesion? Why?
![Page 82: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/82.jpg)
Case 3 30 year old woman She complains of rash surrounding her mouth for the last several months. She never had a problem with acne in her adolescence, but is distressed with her appearance and uses make up to try to hide the rash.
![Page 83: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/83.jpg)
![Page 84: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/84.jpg)
Perioral Dermatitis It resembles acne, with papules and pustules on an erythematous and sometimes scaling base
Almost exclusively in females
What do you want to ask about in medication history that could potentially cause this?
![Page 85: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/85.jpg)
Case 4
50 year old woman Red rash on face for several months. Worsened with drinking hot tea and coffee.
No systemic symptoms
![Page 86: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/86.jpg)
![Page 87: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/87.jpg)
Rosacea Chronic acneform inflammation
of the pilosebaceous units of the face, coupled with a peculiar increased reactivity of capillaries to heat, leading to flushing and telangiectasias
NO comedones
What organ of the face (besides the skin) is often involved?
![Page 88: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/88.jpg)
Case 5
23 year old woman Complaints of pain in her axillary regions, right worse than left, and a history of abscesses that she had to have drained in her right axilla in the past.
![Page 89: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/89.jpg)
![Page 90: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/90.jpg)
Hidradenitis Suppurativa Chronic, suppurative, scarring
disease of apocrine glands, mostly involving the axillary and anogenital region
What is the mainstay of treatment?
![Page 91: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/91.jpg)
Case 6 20 year old woman Skin colored to white “bumps” for years on backs of upper arms and upper thighs
Bothered by appearance PMH: asthma
Exam: “pseudo‐pustules”
![Page 92: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/92.jpg)
Keratosis Pilaris (KP) Distribution: Back of arms or thighs
Follicular plugging 25% of population
Association: Atopy Treatment: Lac‐Hydrin lotion
![Page 93: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/93.jpg)
Pustular and Pseudopustular Diseases Superficial Folliculitis Pyoderma Gangrenosum Perioral dermatitis Rosacea Hidradenitis Suppuritiva Keratosis Pilaris
![Page 94: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/94.jpg)
![Page 95: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/95.jpg)
Case 1
10 year old girl Lesion duration: months Seen on hands and knees Occasionally bleed painlessly when she picks at them Painful lesion on the bottom of her foot
![Page 96: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/96.jpg)
![Page 97: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/97.jpg)
Verruca Vulgaris
A one‐cm flesh‐colored nodule with frond‐like protrusions on the surface
What virus is causative? School children; incidence decreases after age 25 Hyperkeratotic, “reddish‐brown dots” seen with hand lens. What are these dots?
![Page 98: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/98.jpg)
![Page 99: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/99.jpg)
Verruca PlantarisOne‐cm flesh‐colored flat‐topped plaque with loss of skin markings and firm‐pressed scale on the surface
Lesions appear often on sites of pressure, may be multiple
Tenderness may be markedWhat is in the differential? How do you tell the plantar wart from the other differential diagnoses?
![Page 100: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/100.jpg)
Case 2
23 year old woman Noticed the lesions on her hands a couple months ago. First started as a couple of lesions, now many.
Not painful or pruritic
![Page 101: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/101.jpg)
![Page 102: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/102.jpg)
Verruca Plana (“Flat Wart”)
Skin colored or light brown flat papules 1‐5 mm Young children and adults Seen on face, dorsa of hands, shins What causes the linear lesions?
![Page 103: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/103.jpg)
Case 3
19 year old sexually active male Lesions noted on face for the past 2‐3 months Not pruritic or painful No systemic symptoms
![Page 104: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/104.jpg)
Case 3
![Page 105: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/105.jpg)
Molluscum Contagiosum Pearly‐white or skin colored papules or nodules with central umbilication
Children, Young Adults (sexually transmitted) What is the causative virus? Multiple facial lesions suggest what disease?
![Page 106: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/106.jpg)
Case 4
![Page 107: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/107.jpg)
Cutaneous HornDifferential:KeratoacanthomaActinic KeratosisSquamous Cell Carcinoma
![Page 108: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/108.jpg)
Keratoacanthoma Benign but mimics SCC
Rapid growth Cental keratoticplug
Heals with scarring
Surgical removal
![Page 109: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/109.jpg)
Actinic Keratosis (AK)
Sun exposure
Rough red scaly hyperkeratotic papules
Rx: Cryotherapy if few; Efudex (topical 5‐FU)if generalized
SCC from AK: 1:1000
![Page 110: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/110.jpg)
Squamous Cell Ca. (SCC) SCC In Situ = Bowen’s Well marginated, hyperkeratotic plaque usually in sun‐exposed area
Invasive SCC Ulcerated Metastatic (3‐4%) Risks:
Immunosuppression Areas of chronic
inflammation Burn scars
![Page 111: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/111.jpg)
Case 5 40 year old man Native to Arizona, likes to golf and play tennis Lesion present for a couple months, occasionally bleeds
![Page 112: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/112.jpg)
![Page 113: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/113.jpg)
Basal Cell Carcinoma Most common NMSC ~1,000,000 new BCC/year Classic: Skin‐colored pearly papule with telangiectasia and rolled borders
Categories: Superficial, Nodular, Pigmented, Sclerosing
Rarely metastatic – local invasion “Rodent ulcer”
![Page 114: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/114.jpg)
Case 6
![Page 115: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/115.jpg)
Synonyms: Wen, sebaceous cyst, epidermal cyst
Follicular with CENTRAL PORE Keratinaceous debris “CHEESY”, smell rancid
Ruptured cyst invokes inflammation; it does not mean it is infected!
Important to remove sack or will recur!
Epidermoid Cyst
![Page 116: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/116.jpg)
Case 7
![Page 117: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/117.jpg)
Dermatofibroma (DF) Very common! Adult females Lower leg Common post trauma/bite
DERMAL “Dimple sign”
![Page 118: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/118.jpg)
Skin‐colored papules and nodules
Keratoacanthoma Actinic keratosis Squamous cell CA Basal cell CA Epidermoid cyst Dermatofibroma
Verruca Vulgaris Verruca Plana Molluscumcontagiosum
Cutaneous Horn
![Page 119: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/119.jpg)
![Page 120: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/120.jpg)
Case 1
![Page 121: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/121.jpg)
Vitiligo Autoimmune destruction of melanocytes
Poliosis: Vitiligo macule
Association: Thyroid Disease (30%) Also: Pernicious anemia, Addison’s, Diabetes type 1
Very difficult to treat in hairless areas! Recruits melanocytes from follicles Glucocorticoids and phototherapy
![Page 122: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/122.jpg)
Case 2
![Page 123: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/123.jpg)
Tinea Versicolor Clinical: Hyper or hypopigmented KOH: Spaghetti and meatballs
![Page 124: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/124.jpg)
White lesions
Vitiligo Tinea versicolor
![Page 125: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/125.jpg)
![Page 126: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/126.jpg)
Case 1
![Page 127: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/127.jpg)
![Page 128: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/128.jpg)
Acanthosis Nigricans1. Internal Malignancy
Adenocarcinoma More mucosal involvement
2. Insulin Resistance Presumed mechanism: ↑↑ IGF Skin tags (acrochordon) Tripe palms
![Page 129: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/129.jpg)
Case 2
![Page 130: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/130.jpg)
Melasma (Chloasma)“Mask of Pregnancy”
90% Female
? Due to progesterone
Risk factors: Pregnancy, OCPs Always in addition to sun
Tx: Bleaching + Sunscreen
![Page 131: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/131.jpg)
Case 3:Ephelides versus Lentigines(Freckles) (Liver spots)
PEUTZ-JEGHERS(poyts-yay-gurz)
![Page 132: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/132.jpg)
Case 3: Types of Nevi
JUNCTIONAL
DERMAL
COMPOUND
![Page 133: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/133.jpg)
Case 4: Melanoma Asymmetry Border Irregularities Color Variation Diameter < 6mm Elevation
Dermatologists like to refer to the “flag sign”.
![Page 134: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/134.jpg)
Types of melanomas
Superficial spreading Nodular
Lentigo maligna melanoma Acral melanoma
![Page 135: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/135.jpg)
Blue, Black and Brown Lesions
Acanthosis Nigricans Melasma Nevus Melanoma
![Page 136: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/136.jpg)
![Page 137: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/137.jpg)
Case 1
![Page 138: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/138.jpg)
Xanthomata TYPES
Tendinous xanthoma Tuberous xanthoma Eruptive xanthoma Palmar xanthoma Xanthalasma
Lipid abnormalities
![Page 139: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/139.jpg)
Case 2
![Page 140: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/140.jpg)
Previously called: NLD
1/3 Patients DM 1/3 Abnormal GTT 1/3 Normal Glucose Tolerance
Control of DM does not affect course of skin lesion
Glucocorticoids (Topical/Intralesional)
Necrobiosis Lipoidica
![Page 141: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/141.jpg)
Sebaceous Hyperplasia
![Page 142: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/142.jpg)
Case 3
MI at age 37
Angioid streaks on retinal exam
“Chicken-skin” appearance to neck
![Page 143: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/143.jpg)
Connective tissue disorder (Elastin) Skin: Peau d’orange Blood vessels: Premature MI, Renovascular HTN, Claudication
Eye: Angioid streaks of retina GI: Gastric artery hemorrhage (hematemesis)
“Chicken skin” Genetic Counseling
Pseudoxanthoma elasticum
![Page 144: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/144.jpg)
Yellow lesions Xanthomata Necrobiosis Lipoidica Pseudoxanthoma Elasticum
![Page 145: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/145.jpg)
![Page 146: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/146.jpg)
Case 1: Cherry Angiomata
![Page 147: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/147.jpg)
Case 2
![Page 148: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/148.jpg)
Erythema Nodosum (EN) NECK:
Post‐streptococcal infxn CHEST
Cocci/Sarcoidosis ABDOMEN
Inflammatory bowel dz PELVIS
OCPs
TENDER deep inflammation of CT around fat
![Page 149: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/149.jpg)
Case 3: Lyme disease
ERYTHEMA CHRONICUM MIGRANS
LYMPHOCYTOMA CUTIS
ACRODERMATITIS CHRONICA ATROPHICANSBorrelia Burgdorferi
What is the organism?
![Page 150: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/150.jpg)
Case 4
![Page 151: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/151.jpg)
SWEET’S SYNDROME(Acute Neutrophilic Dermatosis)
Red tender plaques Sweet's is a reaction to an internal condition.
It may follow: Upper respiratory tract infection (strep throat)
Vaccination Inflammatory bowel disease (UC or Crohn's)
Rheumatoid arthritis
Blood disorders including leukemia(AML).
Internal cancer(bowel, GU or breast)
Pregnancy Drugs (G‐CSF, NSAIDs, cotrimoxasole)
Sometimes difficult to distinguish from PG
![Page 152: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/152.jpg)
Red papules and nodules: (solid, red, non‐scaling)
Cherry angiomata Erythema nodosum Erythema chronicum migrans Sweet’s syndrome
![Page 153: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/153.jpg)
![Page 154: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/154.jpg)
Case 1
![Page 155: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/155.jpg)
Palpable Purpura Non‐blanching on diascopy
Association? URI (75%) GI: Bowel angina or bloody diarrhea Arthritis
UA…HEMATURIA (RBC casts) What is HSP localized to the kidney?
Henoch‐Schonlein Purpura
IgA Nephropathy (Berger’s Disease)
![Page 156: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/156.jpg)
Case 2
![Page 157: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/157.jpg)
Palpable Purpura Histologic diagnosis (no etiology)
Small vessel necrotizing vasculitis MOST COMMON
Immune complexes in walls of post‐capillary venules Major cause: Drugs
Leukocytoclastic Vasculitis
![Page 158: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/158.jpg)
Case 3: Fixed Drug Eruption
MOST COMMON SITE? GLANS PENIS
![Page 159: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/159.jpg)
Case 3: Morbilliform Drug Eruption
![Page 160: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/160.jpg)
Case 4
![Page 161: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/161.jpg)
Wheals (Hives) Blanching on diascopy
Classification: Acute or ChronicMany physical and immunologic causes
Changes in size and shape and can disappear ‐DYNAMIC
Urticaria
![Page 162: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/162.jpg)
Case 5: Angioedema
• Hereditary or Acquired
First test to check is C4!
![Page 163: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/163.jpg)
Dermatographism
![Page 164: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/164.jpg)
Vascular Reactions
Henoch‐Schonlein Purpura Leukocytoclastic vasculitis Morbilliform drug eruption Urticaria Angioedema
![Page 165: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/165.jpg)
The 3 Ps, 3Ls, and Fungus!
![Page 166: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/166.jpg)
Case 1
![Page 167: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/167.jpg)
![Page 168: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/168.jpg)
PSORIASISMany types
Plaque Scalp Pustular Guttate
POST‐STREP Nail pittingOnycholysisOil spots
![Page 169: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/169.jpg)
Case 2:
Parapsoriasis – Cutaneous T‐cell Lymphoma(Mycosis Fungoides and Sezary Syndrome)
![Page 170: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/170.jpg)
Case 3
![Page 171: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/171.jpg)
Pityriasis Rosea
HERALD PATCH
DISTRIBUTION? PROBABLEVIRUS?
HHV-7
![Page 172: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/172.jpg)
3Ps: PapulosquamousPsoriasisParapsoriasisPityriasis Rosea
Now to the Ls…
![Page 173: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/173.jpg)
Case 4
![Page 174: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/174.jpg)
LICHEN PLANUSClassic description
5Ps PURPLE POLYGONAL PLANAR PRURITIC PAPULES
What are the little white lines atop the LP?
Major Association?WICKHAM’S STRIAE
HEPATITIS C
![Page 175: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/175.jpg)
![Page 176: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/176.jpg)
PRIMARY
Case 5
![Page 177: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/177.jpg)
Palms and soles involved Primary lesion: Chancre Secondary (in addition to rash)?
Tertiary: Neurosyphilis/Aortitis/Gummas
Lues (Secondary Syphilis)
CONDYLOMA LATA
![Page 178: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/178.jpg)
Case 6: LUPUS
KNUCKLESPARING
![Page 179: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/179.jpg)
Papulosquamous= 3P’s, 3L’s Psoriasis Parapsoriasis Pityriasis Rosea Lichen Planus Lues (Secondary Syphilis) Lupus AND
![Page 180: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/180.jpg)
Fungal Infections
![Page 181: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/181.jpg)
COMMON GROIN DERMATOSES Psoriasis (inverse) Tinea Cruris Erythasma Irritant Contact Allergic Contact Candidiasis Intertrigo
![Page 182: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/182.jpg)
![Page 183: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/183.jpg)
Atopic Dermatitis
![Page 184: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/184.jpg)
Asteatotic Dermatitis(Eczema Craquele)
![Page 185: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/185.jpg)
Nummular Eczema
![Page 186: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/186.jpg)
Seborrheic Dermatitis (Dandruff)
![Page 187: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/187.jpg)
Contact Dermatitis
What kind of testing is this??PATCH TESTING
![Page 188: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/188.jpg)
Contact Dermatitis Allergic Contact
Nickel Neomycin Tape
Irritant Contact Lip‐lickers Dribble Chemicals
![Page 189: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/189.jpg)
Last one! Scabies
![Page 190: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/190.jpg)
Eczematous Diseases
Atopic dermatitis Eczema craquelatum (asteatotic) Seborrheic dermaitis Contact dermatitis Scabies
![Page 191: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/191.jpg)
![Page 192: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/192.jpg)
Case 1
10 year old girl Lesion duration: months Seen on hands and knees Occasionally bleed painlessly when she picks at them Painful lesion on the bottom of her foot
![Page 193: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/193.jpg)
![Page 194: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/194.jpg)
Verruca Vulgaris
A one‐cm flesh‐colored nodule with frond‐like protrusions on the surface
What virus is causative? School children; incidence decreases after age 25 Hyperkeratotic, “reddish‐brown dots” seen with hand lens. What are these dots?
![Page 195: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/195.jpg)
![Page 196: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/196.jpg)
Verruca PlantarisOne‐cm flesh‐colored flat‐topped plaque with loss of skin markings and firm‐pressed scale on the surface
Lesions appear often on sites of pressure, may be multiple
Tenderness may be markedWhat is in the differential? How do you tell the plantar wart from the other differential diagnoses?
![Page 197: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/197.jpg)
Case 2
23 year old woman Noticed the lesions on her hands a couple months ago. First started as a couple of lesions, now many.
Not painful or pruritic
![Page 198: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/198.jpg)
![Page 199: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/199.jpg)
Verruca Plana (“Flat Wart”)
Skin colored or light brown flat papules 1‐5 mm Young children and adults Seen on face, dorsa of hands, shins What causes the linear lesions?
![Page 200: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/200.jpg)
Case 3
19 year old sexually active male Lesions noted on face for the past 2‐3 months Not pruritic or painful No systemic symptoms
![Page 201: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/201.jpg)
Case 3
![Page 202: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/202.jpg)
Molluscum Contagiosum Pearly‐white or skin colored papules or nodules with central umbilication
Children, Young Adults (sexually transmitted) What is the causative virus? Multiple facial lesions suggest what disease?
![Page 203: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/203.jpg)
Case 4
![Page 204: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/204.jpg)
Cutaneous HornDifferential:KeratoacanthomaActinic KeratosisSquamous Cell Carcinoma
![Page 205: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/205.jpg)
Keratoacanthoma Benign but mimics SCC
Rapid growth Cental keratoticplug
Heals with scarring
Surgical removal
![Page 206: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/206.jpg)
Actinic Keratosis (AK)
Sun exposure
Rough red scaly hyperkeratotic papules
Rx: Cryotherapy if few; Efudex (topical 5‐FU)if generalized
SCC from AK: 1:1000
![Page 207: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/207.jpg)
Squamous Cell Ca. (SCC) SCC In Situ = Bowen’s Well marginated, hyperkeratotic plaque usually in sun‐exposed area
Invasive SCC Ulcerated Metastatic (3‐4%) Risks:
Immunosuppression Areas of chronic
inflammation Burn scars
![Page 208: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/208.jpg)
Case 5 40 year old man Native to Arizona, likes to golf and play tennis Lesion present for a couple months, occasionally bleeds
![Page 209: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/209.jpg)
![Page 210: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/210.jpg)
Basal Cell Carcinoma Most common NMSC ~1,000,000 new BCC/year Classic: Skin‐colored pearly papule with telangiectasia and rolled borders
Categories: Superficial, Nodular, Pigmented, Sclerosing
Rarely metastatic – local invasion “Rodent ulcer”
![Page 211: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/211.jpg)
Case 6
![Page 212: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/212.jpg)
Epidermoid Cyst Synonyms: Wen, sebaceous cyst, epidermal cyst
Follicular with CENTRAL PORE Keratinaceous debris “CHEESY”, smell rancid
Ruptured cyst invokes inflammation; it does not mean it is infected!
Important to remove sack or will recur!
![Page 213: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/213.jpg)
Case 7
![Page 214: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/214.jpg)
Dermatofibroma (DF) Very common! Adult females Lower leg Common post trauma/bite
DERMAL “Dimple sign”
![Page 215: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/215.jpg)
Skin‐colored papules and nodules
Keratoacanthoma Actinic keratosis Squamous cell CA Basal cell CA Epidermoid cyst Dermatofibroma
Verruca Vulgaris Verruca Plantaris Verruca Plana Molluscumcontagiosum
Cutaneous Horn
![Page 216: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/216.jpg)
![Page 217: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/217.jpg)
Case 1
![Page 218: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/218.jpg)
Vitiligo Autoimmune destruction of melanocytes
Poliosis: Vitiligo macule
Association: Thyroid Disease (30%) Also: Pernicious anemia, Addison’s, Diabetes
Very difficult to treat in hairless areas! Recruits melanocytes from follicles Glucocorticoids and phototherapy
![Page 219: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/219.jpg)
Case 2
![Page 220: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/220.jpg)
Tinea Versicolor Clinical: Hyper or hypopigmented KOH: Spaghetti and meatballs
![Page 221: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/221.jpg)
White lesions
Vitiligo Tinea versicolor
![Page 222: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/222.jpg)
![Page 223: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/223.jpg)
Case 1
![Page 224: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/224.jpg)
![Page 225: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/225.jpg)
Acanthosis Nigricans1. Internal Malignancy
Adenocarcinoma More mucosal involvement
2. Insulin Resistance Presumed mechanism: ↑↑ IGF Skin tags (acrochordon) Tripe palms
![Page 226: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/226.jpg)
Case 2
![Page 227: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/227.jpg)
Melasma (Chloasma)“Mask of Pregnancy”
90% Female
? Due to progesterone
Risk factors: Pregnancy, OCPs Always in addition to sun
Tx: Bleaching + Sunscreen
![Page 228: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/228.jpg)
Case 3:Ephelides versus Lentigines(Freckles) (Liver spots)
PEUTZ-JEGHERS(poyts-yay-gurz)
![Page 229: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/229.jpg)
Case 4: Types of Nevi
JUNCTIONAL
DERMAL
COMPOUND
![Page 230: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/230.jpg)
Case 5: Melanoma Asymmetry Border Irregularities Color Variation Diameter < 6mm Elevation
Dermatologists like to refer to the “flag sign”.
![Page 231: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/231.jpg)
Types of melanomas
Superficial spreading Nodular
Lentigo maligna melanoma Acral melanoma
![Page 232: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/232.jpg)
Blue, Black and Brown Lesions Acanthosis Nigricans Melasma Ephelides Lentigines Nevus Melanoma
![Page 233: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/233.jpg)
![Page 234: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/234.jpg)
Case 1
![Page 235: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/235.jpg)
Xanthomata TYPES
Tendinous xanthoma Tuberous xanthoma Eruptive xanthoma Palmar xanthoma Xanthalasma
Lipid abnormalities
![Page 236: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/236.jpg)
Case 2
![Page 237: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/237.jpg)
Necrobiosis Lipoidica Previously called: NLD
1/3 Patients DM 1/3 Abnormal GTT 1/3 Normal Glucose Tolerance
Control of DM does not affect course of skin lesion
Glucocorticoids (Topical/Intralesional)
![Page 238: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/238.jpg)
Sebaceous Hyperplasia
![Page 239: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/239.jpg)
Case 3
MI at age 37
Angioid streaks on retinal exam
“Chicken-skin” appearance to neck
![Page 240: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/240.jpg)
Pseudoxanthoma elasticum Connective tissue disorder (Elastin) Skin: Peau d’orange Blood vessels: Premature MI, Renovascular HTN, Claudication
Eye: Angioid streaks of retina GI: Gastric artery hemorrhage (hematemesis)
“Chicken skin” Genetic Counseling
![Page 241: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/241.jpg)
Yellow lesions Xanthomata Necrobiosis Lipoidica Pseudoxanthoma Elasticum
![Page 242: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/242.jpg)
![Page 243: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/243.jpg)
Case 1: Cherry Angiomata
![Page 244: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/244.jpg)
Case 2
![Page 245: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/245.jpg)
Erythema Nodosum (EN) Poststreptococcal Cocci OCPs IBD Sarcoidosis
TENDER
PANNICULITIS Very deep
![Page 246: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/246.jpg)
Case 3: Lyme disease
ERYTHEMA CHRONICUM MIGRANS
LYMPHOCYTOMA CUTIS
ACRODERMATITIS CHRONICA ATROPHICANSBorrelia Burgdorferi
What is the organism?
![Page 247: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/247.jpg)
Case 4
![Page 248: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/248.jpg)
SWEET’S SYNDROME(Acute Neutrophilic Dermatosis) Red tender plaques
Sweet's is a reaction to an internal condition. It may follow:
Upper respiratory tract infection (strep throat) Vaccination Inflammatory bowel disease (UC or Crohn's) Rheumatoid arthritis Blood disorders including leukemia (AML). Internal cancer (bowel, GU or breast) Pregnancy Drugs (G‐CSF, NSAIDs, cotrimoxasole)
Sometimes difficult to distinguish from PG
![Page 249: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/249.jpg)
Red papules and nodules: (solid, red, nonscaling)
Cherry angiomata Erythema nodosum Erythema chronicum migrans Sweet’s syndrome
![Page 250: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/250.jpg)
![Page 251: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/251.jpg)
Case 1
![Page 252: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/252.jpg)
Henoch‐Schonlein Purpura Palpable Purpura Non‐blanching on diascopy
Association? URI (75%) GI: Bowel angina or bloody diarrhea Arthritis
UA…HEMATURIA (RBC casts) What is HSP localized to the kidney?
IgA Nephropathy (Berger’s Disease)
![Page 253: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/253.jpg)
Case 2
![Page 254: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/254.jpg)
Leukocytoclastic Vasculitis Palpable Purpura Histologic diagnosis (no etiology)
Small vessel necrotizing vasculitis MOST COMMON
Immune complexes in walls of post‐capillary venules Major cause: Drugs
![Page 255: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/255.jpg)
Case 3: Fixed Drug Eruption
MOST COMMON SITE? GLANS PENIS
![Page 256: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/256.jpg)
Case 4: Morbilliform Drug Eruption
![Page 257: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/257.jpg)
Case 5
![Page 258: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/258.jpg)
UrticariaWheals (Hives) Blanching on diascopy
Classification: Acute or ChronicMany physical and immunologic causes
Changes in size and shape and can disappear ‐DYNAMIC
![Page 259: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/259.jpg)
Case 6: Angioedema
Hereditary Defect?
C1INH
![Page 260: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/260.jpg)
Dermatographism
![Page 261: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/261.jpg)
Vascular Reactions Henoch‐Schonlein Purpura Leukocytoclastic vasculitis Fixed drug eruption Morbilliform drug eruption Urticaria Angioedema
![Page 262: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/262.jpg)
The 3 Ps, 3Ls, and Fungus!
![Page 263: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/263.jpg)
Case 1
![Page 264: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/264.jpg)
![Page 265: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/265.jpg)
PSORIASISMany types
Plaque Scalp Pustular Guttate
POST‐STREP Nail pittingOnycholysisOil spots
![Page 266: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/266.jpg)
Case 2:
Parapsoriasis – Cutaneous T‐cell Lymphoma(Mycosis Fungoides and Sezary Syndrome)
![Page 267: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/267.jpg)
Case 3
![Page 268: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/268.jpg)
Pityriasis Rosea
HERALD PATCH
DISTRIBUTION? PROBABLEVIRUS?
HHV-7
![Page 269: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/269.jpg)
3Ps: Papulosquamous Psoriasis Parapsoriasis Pityriasis Rosea
Now to the Ls…
![Page 270: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/270.jpg)
Case 4
![Page 271: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/271.jpg)
LICHEN PLANUSClassic description 5Ps
PURPLE POLYGONAL PLANAR PRURITIC PAPULES
What are the little white lines atop the LP?
Major Association?WICKHAM’S STRIAE
HEPATITIS C
![Page 272: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/272.jpg)
![Page 273: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/273.jpg)
PRIMARY
Case 5
![Page 274: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/274.jpg)
Lues (Secondary Syphilis)
Palms and soles involved Primary lesion: Chancre Secondary (in addition to rash)?
Tertiary: NeurosyphilisCONDYLOMA LATA
![Page 275: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/275.jpg)
Case 6: LUPUS
KNUCKLESPARING
![Page 276: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/276.jpg)
Papulosquamous= 3P’s, 3L’s Psoriasis Parapsoriasis Pityriasis Rosea Lichen Planus Lues (Secondary Syphilis) Lupus AND
![Page 277: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/277.jpg)
Fungal Infections
![Page 278: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/278.jpg)
COMMON GROIN DERMATOSES Psoriasis (inverse) Tinea Cruris Erythasma Irritant Contact Allergic Contact Candidiasis Intertrigo
![Page 279: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/279.jpg)
![Page 280: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/280.jpg)
Atopic Dermatitis
![Page 281: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/281.jpg)
Asteatotic Dermatitis(Eczema Craquele)
![Page 282: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/282.jpg)
Nummular Eczema
![Page 283: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/283.jpg)
Seborrheic Dermatitis (Dandruff)
![Page 284: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/284.jpg)
Contact Dermatitis
What kind of testing is this??PATCH TESTING
![Page 285: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/285.jpg)
Contact Dermatitis Allergic Contact
Nickel Neomycin Tape
Irritant Contact Lip‐lickers Dribble Chemicals
![Page 286: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/286.jpg)
Last one! Scabies
![Page 287: Diagnostic Groupings · It resembles acne, with papules and pustules on an erythematous and sometimes scaling base Almost exclusively in females What do you want to ask about in medication](https://reader031.vdocuments.us/reader031/viewer/2022011910/5f7ad92f5ce00b5f3c524ed3/html5/thumbnails/287.jpg)
Eczematous Diseases Atopic dermatitis Eczema craquelatum (asteatotic) Nummular eczema Seborrheic dermaitis Contact dermatitis Scabies