differential diagnosis in derm - constant...
TRANSCRIPT
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Differential Diagnosis in Derm
Andrei Metelitsa, MD, FRCPC, FAAD
Co-Director, Institute for Skin Advancement
Clinical Associate Professor, Dermatology
University of Calgary, Canada
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Faculty/Presenter Disclosure
Faculty: Andrei Metelitsa
Relationships with commercial interests:
▪ Speakers Bureau/Honoraria: none
▪ Consulting Fees: none
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Disclosure of Commercial Support
Potential for conflict(s) of interest:
▪ Dr. Andrei Metelitsa has no conflicts for this lecture
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Learning Objectives
Recognize common primary skin lesions
Recognize cutaneous patterns
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Primary Lesions
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Macule
Flat (non-palpable), differs in color from surrounding skin
<1 cm in diameter
Often hypo- or hyperpigmented, but also other colors (e.g. pink, red, violet)
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Patch – a large macule
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Papule
a solid raised lesion that has distinct borders and is less than 1 cm in diameter
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Plaque
a solid, raised lesion greater than 1 cm
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Nodule
a raised solid lesion more than 1 cm
Involves dermis and/or subcutaneous tissue
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Vesicle
raised lesions less than 1 cm. in diameter that are filled with clear fluid
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Bullae
circumscribed fluid-filled lesions that are greater than 1 cm
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Pustule
circumscribed elevated lesions that contain pus
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Wheal
Transient elevation of the skin due to dermal edema
Often erythematous rim
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Tumor
a solid mass of the skin or subcutaneous tissue; it is larger than a nodule.
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Burrow
linear lesions produced by infestation of the skin and formation of tunnels
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Telangiectasia
permanent dilatation of superficial blood vessels in the skin
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Petechiae/Purpura
Red purple lesions that result from extravasation of blood into skin
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Secondary Lesions
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Scale
Hyperkeratosis Accumulation of
stratum corneum due to delayed desquamation
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Crust
Dried serum, pus, or blood
May include bacteria
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Atrophy
Epidermal – thinning of epidermis with wrinkling or shiny appearance
Dermal - presents as depression
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Lichenification
Accentuation of normal skin lines (epidermis thickening)
Usually due to chronic rubbing or scratching
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Erosion
Epidermal partial loss
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Ulceration
Full thickness loss of epidermis
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Excoriation
traumatized or abraded skin caused by scratching or rubbing
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Fissure
linear cleavage of skin which extends into the dermis
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Patterns and distribution
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Papulosquamous
‘Scaling papule’
DDx: Psoriasis, pityriasis Rosea, PLEVA/PLC, lichen planus, pityriasis rubra, tinea, syphilis, mycosis fungoides
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Photodistributed
Exposed to the sun
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Erythrodermic
Red, head to toe Fine desquamation
DDx: psoriasis, atopic dermatitis, drug eruption, mycosis fungoides
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Annular
Ring shape
DDx: granuloma annulare, sarcoid, tinea, urticaria, nummular dermaittis, erythema multiforme, EAC, linear IgA
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Morbilliform
a rash that looks like measles
macular lesions that are red and are usually 2-10 mm in diameter but may be confluent in places
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Reticular
Erythema ab igne Livedo reticularis
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Folliculocentric
involve the hair follicle
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Clustered
grouped
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Zosteriform
dermatomal
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Discrete
lesions tend to remain separate
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Eczematous
inflamed with a tendency toward clustering, oozing, or crusting
‘boiling over’
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Targetoid
Target like
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Linear
in a line or band-like configuration
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Serpiginous
as though following the track of a snake
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Universalis
affects the entire skin
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Koebnerized
the appearance of lesions along a site of injury
lichen planus, warts, molluscum contagiosum, psoriasis, vitiligo
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Satellite
surrounded by numerous, smaller red macules located adjacent to the body of the main lesions
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verrucous
warty
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ichthyosiform
Fish-scales
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PEARLs
Primary lesions – macule, patch, papule, plaque, nodule, vesicle, bullae, pustule, wheal
Secondary lesions – crust, scale, fissure, excoriation, erosion, ulcer, atrophy
Patterns of eruptions: photodistributed, linear, discrete, annular, papulosquamous, erythrodermic, morbilliform, reticular, follicular, targetoid