Acanthosis nigricans Can see with DM, new GI or lung malignancies that are aggressive and quickly spreading
4.
Obese pt with: Polyuria Velvety pigmented rash in folds of neck and axilla Fasting glucose >125 2.
Atopic dermatitis (eczema)
5.
Bullous pemphigoid Usually biopsy Increasing in frequency Onset middle ages, pruritic bullae, improves with steroids Ddxdermatitis herpetiformisnot restricted to flexural areas, presents with assc disease like celiac dz
Middle aged male, itchy recurrent skin rash
Pruritic papulosquamous lesions in axilla, progress to vesicles and bulla Vesicles burst, giving erosions Lesions not symmetric, don't always occur in the same place Normal mucosal surfaces Improved with potent topical corticosteroids
Condyloma accuminata Confused with condyloma lata of syphilis (flat, wet, not verrucous)
Adolescent with asthma presents with:
long standing intermittent, pruritic, papulosquamous eruption over antecubital fossa, behind knees; worse after hot showers 3.
Basal cell CA Key: pearly papules. May ulcerate
Sexually active pt with:
multiple painless, cauliflower-like, verrucous lesions on the external genitalia 6.
Middle aged Caucasian woman with:
Skin lesion on forehead HO extensive sun exposure as child with repeated sunburns Flesh colored papular lesion with pearly sheen, multiple telangiectasias
Pt develops: Itchy, papulosquamous rash on abdomen- scaly, well circumscribed lesion at the area of the belt buckle
7.
8.
9.
Erythema multiforme with genital HSV Usually assc with new HSV infection, can also see with mycoplasma infection
Erythema nodosum Bilateral painful nodules over shins= E. nodosum! Assc. with GAS pharyngitis, Coccidiodes, Histoplasmosis, TB, sarcoidosis (with hilar adenopathy), IBD (with abd pain) 75% idiopathic
Fixed drug eruption Same rash every time Frequently in the genital region
10.
Geographic tongue-yellowish or looks like patchs of "missing tongue"; Only tongue condition that is migratory (changes position)
Sexually active adult with:
Pain in the genital region Rash on forearm Multiple small painful blisters on external genitalia with surrounding erythema 11. Several small target shaped lesions on forearm Guttate psoriasis. Get small, without scale or itch droplike 1-10mm No mucosal lesions salmon-pink papules with fine scale. Guttate comes fro latin "gutta" which means drop. History of URI may precede eruption, esp due to strep;
Hairy Leukoplakia Caused by EBV DDx- thrushwhole mouth, can be removed with red undersurface
Pt prescribed Doxycycline for rx of pneumonia,
after 3 days develops: Large erythematous annular plaque in the genital region Had same rash as teen when given Doxy for acne Resolves with DC of Abx
Pt with:Intermittent mild pain and
burning on the tongue Variable, raised, yellow pattern on the tongue that changes position
22 y/o woman presents with hundreds
of 2-5 mm scaly red papules on trunk and extremities that are moderately pruritic. Lesions appeared abruptly about 2 wks prior to exam and quickly spread. Pt had sore throat the prior month. What's dx?
Pt with: Wt. loss x 3 mo Intermittent fevers Bilateral white plaques on the lateral aspect of the tongue that cannot be removed with a tongue depressor + HIV ELISA, Western Blot
13.
Hidradentis suppurativa DDx- boils (furuncles, not symmetric, get central necrosis), acne conglobata (not in axilla)
16.
Multiple actinic keratosis with squamous cell CA in situ AKs turn into SCC
Middle aged Caucasian woman with:
Skin lesion on forehead HO extensive sun exposure as child with ,multiple sunburns Multiple rough scaly patches on forehead, dorsum of hands One patch on the forehead has a firm hyperkeratotic macule
Female presents with:
Pain under both axilla x 2 mo- began as small bumps but getting larger Significant pain and erythema around the bumps x 24 hrs Deep, nodular lesions in both axilla without any cental area of necrosis Few comedones in the axilla 14.
17.
Melanoma Remember the ABCDEs
Middle aged Caucasian woman with
Skin lesion on her thigh HO extensive sun exposure as a child with repeated sunburns Flat, asymmetric, pigmented lesion, lacks uniform color, is 8mm in size Enlargement over the last few months 15.
Molluscum contagiosum Key- central umbilication Have depressed center to the lesions Can be large, numerous with HIV
Pt with: Multiple, painless clustered papules with central umbilication on the arm (or anywhere else)
Necrobiosis lipoidica diabeticorum Painful nodules would be E. Nodosa. These are yellow plaques
Diabetic pt with: Yellowish irregular plaques with purplish pigment at the edges over both shins 18.
Pediculosis capitus= head lice Might see nits, louse picture
Adolescent from a group home with:
Scalp itching Erythema at the base of the scalp Mild bilateral posterior auricular lymphadenopathy Woods lamp- small area of pale blue fluorescence at the base of multiple hair shafts
19.
20.
Pediculosis pubis = pubic lice Blue macules not always present Can be visible Ddx scabies- see itching in other parts of the body as well
22.
20's y/o with:
Bilateral itchy, erythematous plaques in knees, elbows that develop an adherant silvery scale that bleeds when removed Similar plaques on the scalp multiple tiny pits in some of the nail beds
Young sexually active adult with:
Itching in pubic region Multiple small bluish macules along the upper abdomen and inner thighs Palpable small inguinal lymph node
Pityriasis rosea
23.
Young patient with:
Asymtomatic rash on back 1 wk after circular salmon-colored scaly patch on chest Multiple plaques on back with long axis oriented in direction of skin lines in "christmas tree" distribution; No tx necessary and usually clears within 6-8 wks. 21.
Porphyria cutanea tarda Always think of with Hep C, isolated rash on hands Urine uroporprin levels just confirm it Can be scaly, blistering, vesicles
Psoriasis Assc with spondyloarthropathies
Pt with active ulcerative colitis presents with:
Pretibial sore, began as erythematous pustule>nodular->ulcer, ragged with purple raised border Skin bx- tissue necrosis with neutrophilic infiltrate cx- Staph, but no AFB or fungi 24.
Pt with Hep C, cirrhosis with:
Blistering lesions on dorsum of hands, began as erythematous macules with adherent scale Intermittent sun exposure in past month Elevated urine uroporphyrin levels
Pyoderma gangrenosum Keys: UC, neutrophilic infiltrate; Assoc with IBD (crohn's and UC); May also be assoc with RA. Usually has a violaceous hue.
Rosacea Keys: lack of comedones, worse with alcohol, telangiectasias
Middle-aged female develops:
"Acne" on the cheeks Repeated eruptions of facial flushing and erythematous papular lesions, made worse with alcohol intake Multiple small papules on the cheeks without comedones Scattered telangiectasias
25.
Scabies May describe mite burrow Intense itching, ESP axillary and interdigital webs
28.
Nursing home pt with:
Itching, worse at night, x1 month Multiple excoriations in both axilla and groin, on the wrists, between fingers 26.
27.
Seborrheic dermatitis Can also present on eyebrows, lashes, facial hair HIV can have a much worse presentation; Due to a lipophilic yeast in skin called Pityrosporum ovale and can be tx with ketoconazole cream, ciclopirox gel or low potency topical steroid.
29.
Adult pt with: "dandruff" and scaly rash around the nose with underlying redness when the scales are removed
This is seborrheic keratoses and it may be a marker for a non-skin malignancy but is completely benign and not a precancerous lesion. Usually has "stuck on" appearance (like you stuck on a piece of clay) with warty surface.
What's this and is it a marker for malignancy.
Tinea capitis Keys: elderly, African American, barber, black dots. Usually an unclean razor
African American male, complains of hair loss after
getting his hair cut by an electric razor Annular scaly patch of hair loss Small black dots over the hair follicles Palpable small posterior cervical lymph nodes
Stevens-Johnson syndrome Triggers: sulfas, abxs, allopurinol, antiepileptics (esp phenytoin, carbamazapine), NSAIDs Skin sloughing of >30%= toxic epidermal necrolysis Pt with HIV: prescribed Bactrim for presumed pneumocystis infection 2 days later, gets fever, painful erythematous blistering rash on <10% of body surface, including mucous membranes, mouth, and conjunctiva
30.
31.
Tinea corporis Clues: cat. Could be wrestler. Often confused with herald patch of pityriasis, but that doesn't itch. Granuloma annulare doesn't scale. Nummular eczema looks different on micro
33.
Pt with: annular scaly rash on arm, present since week after getting a new cat Clear towards center of rash with raised advancing erythematous margin and scale
Tinea pedis Can also see vesicles, nail thickening
Pt wears heavy shoes and goes to then
gym with: Itchy rash between toes Multiple intensely pruritic pinpoint vesicles between the toes 32.
Tinea versicolor Patches tend to be worse in the summer Disseminated skin rashes can be syphilis, micro gives diagnosis From malassezia furfur; very difficult to tx.
Dark skinned individual presents with:
Scaly rash on chest Numerous hypo and hyper pigmented areas No large isolated patch No itching KOH stain- spaghetti and meatball fungal hyphae
Verrucus vulgaris (plantar warts) Keys: wt bearing parts of feet, verrucous appearance, disruption of nl skin lines
Pt with: Pain with walking Multiple raised verrucous growths on the heels and balls of the feet that obscure the nl skin markings and are painful when palpated
