Dermatology Review

Dermatology Review
By:Jennifer Best, MD

Acanthosis Nigricans
* Velvety discoloration of skin in flexural creases
* Most commonly seen in insulin resistant states (e.g. DM, PCOS, niacin use), endocrinopathy, malignancy

Xanthelasma
* Soft, polygonal papules and plaques consisting of cholesterol, usually located on upper lids
* When seen in children and young adults, associated with familial hypercholesterolemia
Necrobiosis lipoidica
* Well-demarcated plaque, yellow-orange to tan-pink with thinning and telangiectasia
* Non-painful
* Usually located on shins/feet
* Associated with long-standing, juvenile-onset DM
Molluscum contagiosum
* Centrally umbilicated papules seen in children and sexually active adults
* Viral cause
* More aggressive and common on face in HIV
Angular cheilitis
* Fissuring of corners of mouth
* Associated with thrush, atopic dermatitis, nutritional deficiencies and denture use
Prurigo nodularis
* Pickers’ nodules
* Nodular lesions due to chronic excoriation of the skin
Keratosis pilaris
* Benign sandpaper like bumps (“goosebumps”) on extensor surfaces
* Associated with atopy or a normal variant
Morphea
* Plaques are initially purplish and become ivory in color
* Localized scleroderma
Nikolsky’s sign
* POSITIVE when epidermis is dislodged from the dermis by lateral shearing pressure and blister extends
* Seen in toxic epidermal necrolysis, scalded skin syndrome and pemphigus vulgaris
Seborrheic keratosis
* What is it?
* Does it have malignant potential?
* Warty brown growths seen on aging skin – looks “stuck on”
* No malignant potential, purely cosmetic
Seborrheic dermatitis
* Always think of HIV in seborrheic dermatitis that is extensive or refractory to treatment
Rhinophyma
* Bulbous erythematous enlargement of the nose
* Seen in advanced rosacea
Hidradenitis suppurativa
* Sebaceous cysts seen in follicular areas (e.g. groin, axillae, scalp)
* More common in African Americans
Hereditary Hemorrhagic Telangiectasia
* Other names?
* Dermatologic manifestations?
* Clinical associations?
* Otherwise known as Osler-Weber-Rendu Syndrome
* Autosomal dominant
* Red macular/papular telangiectasias and AVMs on or around mucous membranes/GI tract
* Associated with bleeding tendency
Acrochordon
* Common name?
* Skin tag
Rosacea
* 1. Papules
* 2. Pustules
* 3. Telangiectasias
* Located over cheeks
* May involve nasolabial folds
* Exacerbated by alcohol, hot beverages, spicy foods, sun exposure
Nail pitting
* Associated with?
* Psoriasis
Condyloma lata
* What is it?
* What organism is responsible?
* Flat flesh-colored warts seen in anogenital region
* Representative of secondary syphilis
Condyloma acuminata
* What is it?
* What organism is responsible?
* Human papilloma virus (HPV)
* Genital warts
Whitlow
* Herpes simplex virus infection on finger
* Often seen in health care workers
Tinea versicolor
* Macules with fine scaling on trunk, upper arms, neck, abdomen, axillae with varying pigmentation
* Asymptomatic
* Caused by Malassezia furfur (looks like “spaghetti and meatballs” on KOH prep)
Ascending skin lesions
* Differential diagnosis?
* Mycobacterium marinum
* Sporothrix schenkii
* Nocardia
* Francisella tularensis
Hypopigmented anesthetic macules
* Leading diagnosis?
* Leprosy (Hansen’s Disease)
Yellow-orange skin discoloration
* What should you think of?
* Jaundice
* Increased beta carotene ingestion
* Hypothyroidism (without thyroid hormone, problems metabolizing beta carotene)
* Usually seen best on palms
Argyria
* What is it?
* Silver-gray discoloration of the skin due to intradermal deposition of silver
* Permanent!
Hot tub folliculitis
* What causes it?
* Pseudomonas aeruginosa
Heliotrope lids
* Purplish discoloration around eyes seen in dermatomyositis
* Also associated with…
* Purplish discoloration around eyes seen in dermatomyositis
* Also associated with…Gottron papules
* Recall association of dermatomyositis with malignancy in older patients
Common drug causes of slate-gray discoloration
Common cause of bullous cellulitis in liver disease
Erysipelas
* Responsible organism?
* Group A beta-hemolytic strep
* Raised erythematous plaques, may involve face or extremities
Bullous pemphigoid
* Most common blistering disorder
* Most common in elderly
* Nikolsky negative
* Commonly related to medications (sulfa, furosemide, penicillin
Erythema marginatum
* Pink rings on the trunk and inner surfaces of the arms and legs which come and go for as long as several months - barely raised and non-pruritic. Face is generally spared.
* Associated with rheumatic fever (but only less than 5% of patients)
* Considered a major Jones criterion when it does occur (4 others?)
Erythema nodosum
* Painful, erythematous round plaques, commonly pretibial
* Associated with infection (including strep, fungal, TB), IBD, sarcoidosis, drugs (OCPs, sulfa)
Drug cause of skin necrosis
* Warfarin (1:10,000)
* High doses
* Overweight women
* Breasts, buttocks, thighs, abdomen
Bacillary angiomatosis
* Associated with Bartonella infections (quintana, henselae)
* Cutaneous vascular tumors seen almost exclusively in HIV
Lupus pernio
* Dermatologic manifestation of sarcoidosis
* Indurated violaceous lesions, usually on face
Erythema multiforme
* Strong association with HSV, mycoplasma
* Drug causes (sulfa, phenytoin, PCN, allopurinol)
* Target lesions – can be localized to hands/face or generalized
* On a continuum with Stevens-Johnson
Dermatitis herpetiformis
* Grouped erythematous papules and plaques – seen on extensor areas (elbows, knees, trunk, buttocks, sacrum) as well as scalp, face and hairline
* Associated with celiac sprue
Herpes zoster
* Reactivation of VZV along dermatomal distribution
* Increasing incidence with age and immunosuppression
* Pain precedes rash
Erythema migrans
* “Bulls-eye” lesions seen in 50-70% of patients with Lyme disease (Borrelia burgdorferi).
Serology?
Infectious disease most associated with cryoglobulinemia?
Infectious disease most strongly associated with cryoglobulinemia?
* Hepatitis C virus
* Can cause vasculitic lesions (palpable purpura) commonly on lower extremities
Kaposi’s Sarcoma
* Associated with?
* HIV
* HHV-8
Keratoderma Blenorrhagicum
* Red-brown papules/pustules/vesicles with erosion and crusting on dorsilateral and plantar foot and palms
* Associated with reactive arthritis
Livedo reticularis
* Associated with?
* Vasculitis
* Vascular spasm
* Atheroemboli
* Normal variant (finer pattern)
* Most common on extremities/abdomen
Pyoderma gangrenosum
* Painful, hemorrhagic pustule or macule that breaks down into an ulcer with irregular raised borders and purulent base
* Usually on lower extremities
* Most strongly associated with IBD, but also associated with inflammatory arthritis, hematologic disorders and other GI conditions
Increased skin elasticity
* Ehlers-Danlos
Lichen planus
* Associated with?
* Hepatitis C virus
* Purple, planar, pruritic, polygonal papules on volar wrists, ankles, genitals, mucous membranes and nails
* Wickham’s striae are white lines inside lesions
Peutz-Jeghers
* Cutaneous hyperpigmented macules of lips, perioral and perinasal areas
* Associated with polyps and hamartomas of the GI tract (small bowel, colon and stomach)
* Associated with increased cancer risk
Koebner phenomenon
* What is it?
* With what dermatologic condition is it associated?
* Development of lesions at the site of skin trauma
* Seen in psoriasis (1/3 of patients), but also eczema, vitiligo, lichen planus or sclerosus
Pathergy
* What is it?
* With which disease is it associated?
* Development of pustule at the site of skin breach (i.e. blood draws, injections)
* Seen in Behcet’s Disease
Dermatographism
* With which condition is it associated?
* Development of wheal and flare at site of minor friction
* Seen in urticaria
Eruptive xanthomas
* Yellowish papules located on extensor surfaces (knees, buttocks, elbows)
* Seen in familial hypertriglyceridemia
Urticaria pigmentosa
* Name the disease…
* Flat top papules and brown plaques that for wheal and flare when scratched
* Seen in mastocytosis
Osler’s nodes
* Painful, purplish lesion usually on hands - immune complex deposition
* Seen in endocarditis
Janeway lesions
* Flat , bluish-red, non-painful lesions on palms and soles
* Seen in endocarditis
Cat-scratch disease
* Causative organism?
* Bartonella
* Following cat scratch, development of acute, tender regional lymphadenopathy
“Slapped-cheek” rash
Eosinophilic folliculitis
Koilonychia
Corkscrew hairs and perifollicular hemorrhage
Tophus
Peau d’orange
Actinic keratosis
Porphyria cutanea tarda
Nailfold telangiectasia
Beau’s lines
Clubbing
Oral Hairy Leukoplakia
Pityriasis rosea
Spider angioma
Café au lait spots
Caput medusae
Migratory necrolytic erythema
Acrodermatitis enteropathica
Ecthyma gangrenosum
Sweet’s syndrome

Dermatology Review.ppt