LALALA-LALA

PRIMARY LESIONS: original skin lesions; unaltered by any factors

FLAT LESIONS
1. MACULE - Flat discoloration
- < 1 cm
2. PATCH - Larger (> 1cm) macule
- Ex. vitiligo, nevus flammeus

ELEVATED SUPERFICIAL
3. PAPULE - Elevated, circumscribed, solid
- No visible fluid
- < 1cm in size
- May appear white (milia), red (eczema), yellowish
(xanthoma), black (melanoma)
- Usually found in the dermis
o Opening of sweat ducts
o Root of hair follicles
- If associated w/ scales: papulosquamous
- May last for a year
- Papules that are equidistant: follicular papules (ma y also see
hair sticking out)
4. PLAQUE - Broad papule or confluence of papules
- >1cm
- Center may be depressed or may have normal skin
- May also be centrally depressed
ELEVATED DEEP -
5. NODULE - Large papule (>1cm)
- Deep on palpation (centered in dermis and subcutaneous fat)
6. TUMOR - Soft/firm, fixed/movable, elevated/deep/pedunculated
(fibromas)
- Usually >2cm
- Usually round
7. WHEALS (HIVES) - Plateau like, edematous elevations
- Evanescent (do not last > 1 day)
- Associated with angioedema
- May be pink to red, surrounded by a flare of macular
erythema
- May be discrete/coalesce
- Prototype lesion of urticaria
- Dermatographism or pressure induced whealing may be
seen
 LALALA-LALA

FLUID CONTAINING
8. VESICLES (BLISTERS) superficial - Circumscribed, fluid containing
- Epidermal
- May contain serous fluid or blood mixed with serum
- Apex may be rounded, acuminate, or umbilicated
- < 1cm size (usually 1 10mm)
- May arise directly from macule/papule and may develop into
bullae or pustules
- When vesicles rupture, it may form an erosion.
- Findings
o Umbilicated: eczema herpeticum
o Grouped: herpes zoster
o Linear: allergic contact dermatitis from uroshiol
(poison ivy)
- If with seropurulent contents -> vesicopustules
- May consist of a single cavity (unilocular) or multiple
compartments (multilocular) containing fluid
9. BULLAE superficial/deep - >1cm
- Round/irregularly shaped blisters containing
serous/seropurulent fluid
- Usually unilocular
- If superficial (epidermal), it may have thin walls = prone to
rupture
o Remnants of the thin wall may form a crust
- If subepidermal, usually tense; ulceration & scarring may
result
- Nikolskys sign: diagnostic maneuver of putting lateral
pressure on unblistered skin in a bullous eruption & having
the epithelium sheared off
- Asboe Hansens sign: extension of a blister to adjacent
unblisteredskin when pressure is put on top of the blister
- Hemorrhagic bullae may be seen in : pemphigus, herpes
zoster, severe bullous drug reactions, lichen sclerosus et
atrophicus
10. PUSTULES - Small elevations of the skin which contain pus (necrotic Ex. acne
inflammatory cells)
- May see neutrophils
- With inflammatory areola
- Usually white or yellow centrally (may be red if with blood)
- May originate as pustules or papules or vesicles (may
represent a transitory early stage papulopustules or
vesicopustules)
 LALALA-LALA
SECONDARY LESIONS: altered by external factors (ex. scratching); modified by evolution, regression, trauma or other external factors

1. SCALES (exfoliation) - Implies a pathologic process in epidermis Fine & branny or powdery: Tinea versicolor
- Parakeratosis (persistence of nuclei in keratinocytes in Coarser: eczema, ichthyosis
stratum corneum of skin) often present Stratified: scalded skin syndrome & infection
- Dry, greasy, laminated masses of keratin associated desquamations (scarlet fever)
- We normally shed little amounts of stratum corneum Silvery squames (due to trapping of air between
- Occurs due to: layers): psoriasis described as plaque with thick
o Rapid epidermal cell formation scales
o Interruption in the normal process of keratinization
-
2. CRUSTS/SCABS - Dried serum, pus, ,or blood with epithelial/bacterial debris Dry, superficial, golden yellow: impetigo
- When removed, there is erosion/ulcer/wound underneath Hard and tough: third degree burns
Elevated brown/black/green masses: late
syphilis (oyster shell crusts: rupia)
3. EXCORIATIONS & ABRASIONS Excoriations
- Punctate/linear abrasions
- Superficial (usually only involves epidermis but may reach
papillary dermis)
- Due to scratching with fingernails in an effort to reduce
itchiness
- Inflammatory areola
- May allow entry of microorganisms -> may cause crusting,
pustules, cellulitis & enlargement of neighboring lymph
glands
- Elevated, long & deep excoriations = severe pruritus
(except lichen planus where there is severe pruritus but rare
excorations)

Abrasions
- If due to mechanical trauma or constant friction
4. FISSURES (CRACKS/CLEFTS) - Linear cleft in epidermis or dermis following skin lines
- Common in skin that is thickened & inelastic from frequent
inflammation & dryness (especially in areas of frequent
movement)
o Ex. tips & flexural creases of thumb, fingers, palms;
edges of heels; clefts between fingers & toes, angles
of mouth, lips, nares, auricles, anus
- May be single or multiple
- Exposure to cold, wind, water, or cleaning products may
produce a stinging burning sensation = indicates microscopic
fissuring
o Referred to as chapping (chapped lips)
- Pain often produced by movement of the parts involved ->
may open, deepen or form new fissures
- Painful but NOT bacterial! No need for oral antibiotics. May
apply topical antibiotics or wait it out
 LALALA-LALA
5. EROSIONS - Produced by a loss of all or portions of the epidermis alone
- Heals without a scar
6. ULCERS - Rounded or irregularly shaped excavations due to complete
loss of epidermis + some part of the dermis
- Heal with scarring
7. SCARS - Composed of new connective tissue that replaced the lost
substance in the dermis or deeper parts as a result of
injury/disease, as part of the normal reparative process
- Shape & size determined by form of previous destruction
- May be diagnostic
o Lichen planus & discoid lupus erythematosus: same
inflammation anatomically but DLE produces
scarring as it resolves while LP rarely does
- May be atrophic or fibrotic (keloid)
- May also present as discoloration
o True discolorations disappear with time or tx
o Discolorations due to a scar: do not disappear; they
only improve
- Scars will have no skin lines & follicular openings making
them appear shiny

**Anything that involves the dermis will leave a scar. Bleeding also indicates that you have reached the dermis.

**Laser: used as a treatment for some skin lesions because it can penetrate up to the dermis without damaging the epidermis

**Things to discuss when describing skin lesions: count, color, size, characteristic configuration, location, surface, elevation, discrete/coalescing
 LALALA-LALA
1A & 1B: NAIL LESIONS

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Predilection
Factors
Dermatophyte Yellow discoloration Fungal infection by a Scrape on top of nail: Oral: Onychomycosis is fungal
onychomycosis Nail becomes thick & dermatophyte do KOH test & look Itraconazole infection of the nail
brittle due to for long, septate Ketoconazole
keratin T. rubrum most hyphae only give for 10 Onycholysis is separation
Nail may separate cases days for tinea of the nail from the nail bed
from nail bed If subungual: get versicolor due to
May involve skin of keratin under brittle hepatotoxicity 3 types:
the toe & soles nail Terbinafine 1. Distal subungual
(scaling, Fluconazole most common
erythematous, well REMEMBER: KOH is - usually caused
defined patches may not highly reliable 2 4mos: time by T rubrum
appear) because it has poor needed to grow
Usually starts distally yield since keratin fingernails 2. White superficial
going proximally has to be dissolved to 4 6 mos: grow - leukonychia
actually see the toenails trichophytica
Superficial without T. mentagrophyte hyphae - usually due to T
paronychial mentagrophytes
inflammation - invasion of
Chalky white spots on Duration of anti toenail plate on
or in the nail plate that fungal treatment nail surface
is easily shaved off 3. Proximal
subungual
Asymptomatic in the - involves nail
nails (reservoir for plate from
infection); Px will proximal nailfold
usually complain of - usually due to T
the alipunga than the rubrum & T
changes in the nail megninii
- may be an
indication of HIV
infection

Candida Pain or swelling in Candida albicans Fingernails See Anticandidal Check proximal part first
onychomycosis proximal fold commonly pseudohyphae/yeasts agents + topical when treating candida
Pink & tender Common in affected corticosteroid
Described as a yucky homemakers, and Avoidance of wet With paronychia (swelling
nail frequent/prolonged work & other of nail fold; pressing on it
Gradual thickening & exposure of hands irritants makes fluid come out)
brownish to water If topical tx fail,
discoloration of nail give oral
plates Usually seen in DM fluconazole 1x/wk
px or itraconazole
 LALALA-LALA
Produces destruction
of the nail & massive
nailbed
hyperkeratosis
**Remember, it is very important to differentiate a dermatophyte type of onychomycosis from a candidal one.

Dermatophyte Candida onychomycosis

Why is it important to differentiate?
onychomycosis Drug of Choice
Brittle Not brittle Dermatophyte: Terbinafine
No paronychia With paronychia Fluconazole & Itraconazole can be used for
Long septate hyphae Pseudohyphae both dermatophytes and candida

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Predilection
Factors
Psoriatic Pits on the nails 86.5% of patients Characterized by Intralesional Features of psoriasis:
onychomycosis Furrows/transverse have psoriatic pitting of nails + injection of 1. Distal
depressions (Beaus arthritis symptoms of Triamcinolone onycholysis
lines) dermatophyte acetonide 2. Brittle
Nail bed splinter onychomycosis suspension, 3 5 3. Nail pits
hemorrhages mg/ml 4. Oil spots
Yellowish green The px usually comes
discoloration may with psoriatic plaques Topical 1% 5 F U
occur in area of in other parts of the solution, MTX,
onycholysis body (ex. scalp) PUVA,
Oil spots (start in the cyclosporine or
middle) acitretin

Pathology is in the
nail plate
 LALALA-LALA
2A: ERYTHEMATOUS LESIONS: Non Scaly Papules

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Factors Predilection
Miliaria Rubra Discrete, extremely Retention of sweat as Infants due to Control temperature to Non follicular Problem in kids
(prickly heat, pruritic, a result of occlusion immature eccrine decrease sweating distribution due to itching
heat rash) erythematous of eccrine sweat ducts gland Good aeration - No hair is (may present
papulovesicles and pores Anhydrous lanolin coming out, with bacterial
May also become Antecubital & popliteal resolves occlusion of therefore does infection
confluent S. epidermidis fossae, trunk, pores not involve hair already)
inframmary areas, Calamine lotion follicles
Accompanied by abdomen (waistline), Antihistamines
prickling, burning, or inguinal region -> Topical corticosteroids
tingling sensation areas usually
macerated due to
impedance in the
evaporation of
moisture
Scabies Pruritic papular Sarcoptes scabei (itch Young children See mite under Permethrin 5% cream Features of scabies: May be
lesions, excoriations mite, causative M=F microscope (usually - safest, most effective 1. Circle of Hebra mistaken for
& burrows w/c house organism) burrows in stratum (C/I: pregnancy) 2. Nocturnal itch Langerhans cell
the female mite & her Circle of Hebra: corneum & deposits - apply neck down 3. Contact w/ histiocytosis
young (burrows appear Close personal axillae, elbow, eggs here) because most lesions are person at home
as slightly elevated, contact, fomites flexures, wrists, hands, here Suspect scabies
grayish, tortuous lines (clothing, bedsheet) crotch Majority of mites - treat all household Reinfections may occur if more than 1
in the skin) Finger webs found on hands & contacts earlier and in more famly member
Immunocompromised, wrists - repeat after 1 week severe forms has pruritus
institutionalized, Scalp & face spared Less frequently in (wait for eggs to hatch
Vesicle or pustule malnourished patients (adults) (decreasing order): again) In animal or
containing mite may Entire cutaneous elbows, genitalia, zoonotic
be seen at end of surface involved buttocks, axillae 6 10% precipitated scabies,
burrow (infants) sulphur in petrolatum burrows are
India ink or gentian - safe in pregnancy usually absent &
Presentation: violet applied to - doesnt smell good is self limited
F itching of nipples infested area =
M itchy papules on allows identification Ivermectin not used
scrotum & penis of burrows easily
2 4 wks after
infection:
sensitization period

Nodular scabies: Nodular scabies:

Dull red nodules (3 Scrotum, penis, or For nodular scabies:
5mm diameter) vulva Intralesional steroids, tar,
appearing during excision
active scabies,
may/may not itch
 LALALA-LALA
Crusted scabies Crusted scabies:
(Norwegian or Face & scalp,
hyperkeratotic): seen genitalia, buttocks,
in pressure bearing
immunocompromised areas
or debilitated px
Acne Vulgaris Chronic inflammatory Propionibacterium Begins at puberty (sign TOPICAL (long term Remember that acne is
disease of the acnes of increased sex usage is the rule, and apply one of the follicular
pilosebaceous - metabolize sebum to hormone production) to entire acne affected diseases
follicles free fatty acid -> usually 8 12 y/o area, not just the lesions; 6
8 wks)
cause inflammation of - Lesions are
Benzoyl peroxide (most
Comedo (primary cyst wall -> rupture comedonal in
effective for inflammatory
lesion of acne) non character
inflammatory lesion Androgenic acne)
Topical retinoids
(ex. blackhead or stimulation of Adolescents (15 - 18
Clindamycin
open comedo; sebaceous gland y/o) majority of cases
Erythromycin + benzoyl
whitehead or closed - Lesions
comedones) External factors: become peroxide
Sulfur, resorcin, salicylic
mechanical trauma, inflammatory
acid
May also present as cosmetics, topical pustules
Azeleic acid Keep px disease free for
papules, pustules, corticosteroids - Involution of
cysts, nodules, scars disease 1 2 mos first, before
SYSTEMIC (inhibits
Hereditary (keratinous before 25 y/o decreasing dosage to
formation of new lesion; for
Remember that all plug in lower moderate to severe acne;
prevent flaring
lesions of acne will infundibulum of hair Acne may also begin usually 3 6 months
ALWAYS have a follicle primary at 20 35 y/o in duration)
plug defect) people who did not Tetracycline (safest &
have teenage acne cheapest; may cause
No pruritus in acne! staining of teeth if taken
Face (most common in by kids < 9 or 10 y/o)
cheeks), neck, upper Minocycline (most
trunk, upper arms and effective oral antibiotic in
other oily seborrheic treating acne vulgaris)
areas Doxycycline
Erythromycin
Clindamycin
Sulfonamides
OCPs
Spironolactone
Major advantage: ONLY
Dexamethasone
acne therapy that is not
Isotretinoin (do not give
open ended (leads to
in childbearing age due
remission of months or
to teratogenicity)
years)
- Indicated for
severe acne that
improves by less
than 50% after 6
mos of therapy
w/ combined
 LALALA-LALA
oral & topical
antibiotics

Give keratolytics to
slough off corneum w/
hopes of removing
comedones

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Factors Predilection
PEDICULOSIS
(Phthiriasis)
Pediculosis Intense pruritus of Pediculus humanus Children (but may also GOAL: eliminate both lice
Capitis the scalp w/ posterior var. capitis (head occur in adults) & ova
cervical louse) Problem: Knockdown
lymphadenopathy Permethrin (most widely Resistance (common
Affected hair used pediculicide) mechanism of resistance
becomes lustreless & - Some that manifests as lack of
dry association with immobilization of lice
Visible nits whitish congenital
concretions on the leukemia in
hair shaft but most permethrin Secondary complications
common in the abuse with impetigo &
retroauricular area furunculosis common
Pyrethrins + piperonyl during itching
butoxide

Enzymatic egg remover

(Clear)
Pediculosis Generalized itching + Pediculus humans Indigent, homeless Established by Bathe thoroughly with Body louse infestation is
corporis erythematous & var. corporis (body individuals generalized itching soap & water different from scabies, in
(pediculosis copper colored louse) + parallel linear that there is no
vestimenti, macules or urticarial Upper back; no scratch marks + Destruction of lice involvement of hands &
vagabonds wheals and Due to body lice that involvement of hands hyperpigmentation + - Wash bedding & feet
disease) lichenification lay their eggs in the & feet erythematous clothing
seams of clothing macules - Disinfection Body lice vectors for
(placing clothes relapsing fever, trench
See nits on clothing 2 6wks: in dryer for 30 fever, epidemic typhus
or beddings sensitization period mins at 65oC or
for first time ironing them) Secondary impetigo &
Pediculid reaction infections furunculosis are common

Supported by finding
lice in the seams of
clothing or in
beddings
 LALALA-LALA
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Factors Predilection
Pediculosis Nits are attached to Phthirus pubis Adults If diagnosed with Permethrin
pubis (crabs) hairs at an acute crabs, search for
angle Transmission through Genital region & other STDs Pyrethrins combined w/
sexual intercourse & hypogastrium piperonyl butoxide
See sky blue close physical hairy areas of the legs,
macules (maculae contact; not abdomen, chest, arms, Enzymatic egg remover
ceruleae) in side of infrequently from axillae (rare) (Clear)
trunk and inner bedding
aspects of thighs Retreatment in 1 week
(due to altered blood recommended
pigments)

INSECT BITES Immediate reaction: CLASS INSECTA a) Pruritus: camphor, Recurrent bacterial
inflammatory reaction Order Lepidoptera menthol lotions, gel infection may be due to
at the site of the (caterpillar, moth) formulations, topical insect bites
punctured skin, to Order Hemiptera anesthetic preparations
the insects venom or (bedbug, reduviid b) Persistent bite
saliva containing bugs) reactions: topical
histamine, enzymes, Order Anoplura corticosteroid
agglutinins, (louse) preparations
serotonin, formic Order Diptera c) If topical agents fail,
acid, or kinins. (mosquito, flies) give intralesional injection
Accompanied by Order Coleoptera of corticosteroids or
pruritic local (beetles) excision of pruritic nodule
erythema & edema Order Hymenoptera
(bees, wasps, ants) Prevention: Protective
Delayed reaction: Order Siphonaptera clothing & inset repellant
hosts immune (fleas)
response to
proteinaceous
allergens

Present as pruritic
red papules typically
with a surrounding
swelling & a central
punctum (minute
round spot indicating
an opening)
Bedbug Several Cimex lectularius: Arms, legs, ace Diascopic exam Topical antipruritics or
bites/Cimicosis erythematous most common in shows hemorrhagic corticosteroids
(Order papules or urticarial temperate dot (site of bite) in Zinc lotion with 2 4%
Hemiptera) lesions grouped C hempiterus: tropical the middle of most polidocanol or 1%
together or in rows climates lesions methanol
(breakfast, lunch, Severe cases: systemic
dinner) Suspected vectors for antihistamines
Chagas disease &
 LALALA-LALA
Hepa B Eliminate bird nests & bat
roosts, cracks & crevices
Often infest bats & Treat area with
birds & usually reside insecticide (dichlorvos &
in cracks & crevices permethrin)
and descend to feed
while victim sleeps Permethrin
impregnated bednets:
effective in tropical
climates
Reduviid bites Typically painless Poor housing Exposed areas of skin
(Order Romanas sign: conditions
Hemiptera) unilateral eye
swelling after a
nighttime encounter
with Trypanosoma
cruzi (transmitted by
feces & rubbed into
bite)
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this Other info
Factors/Risk Factors Predilection
Mosquito bites Multiple pruritic often Moisture, warmth, Exposed areas of the Antipruritics/corticosteroid Secondary infection
(Order Diptera) excoriated papules CO2, estrogens, lactic body; arms & legs creams common in children
acid in sweat, drinking Oral antihistamines
Bullous reaction alcohol attract Insect repellatns (diethyl Mosquito bites are a
(culicosis bullosa) mosquitos toluamide) common cause of papular
urticaria & may also play
Large blisters Protective clothing & a role in reactivation of
(pemphigus mosquito netting latent EBV infection
hystericus) Attack mosquito habitats
(sprays/disposing Severe local reactions
stagnant water) seen in young children,
immunodeficient
individuals

Flea Multiple, irregularly 4 species that most Legs & covered body Diascopic exam: Topical & systemic
bites/Pulicosis distributed wheals & commonly attack regions (waist) central hemorrhagic antipruritic treatment;
(Order papules that are humans: bite site (purpura corticosteroids
Siphonaptera) grouped and may be 1. Cat flea pulicosa) Pet grooming :D
arranged in zigzag (Ctenocepha Insect repellent
lines lides felis)
2. Human flea
Hypersensitive (pulex
reactions appear as irritans)
nodules or bullae 3. Dog flea (C
canis)
4. Oriental rat
flea
 LALALA-LALA
(Xenopsylla
cheopis)

Usually present in
houses with cats or
dogs
Ant bites (Order Painful stings within Any body part Ice packs
Hymenoptera) seconds of bite Oral antihistamines
accompanied by Topical antipruritics or
whealing corticosteroids

Later: intense pruritic If w/ secondary infection:

sterile pustule antibiotics
develops at the site
with an erythematous
hemorrhagic halo

Severe cases may

cause anaphylaxis,
seizures,
mononeuropathy
Bee (Order Reaction to venom = Bee venom contains Usually exposed areas For local reactions:
Hymenoptera) ranges from pain & histamine, mellitin, Immediate application of
mild local edema to hyaluronidase, HMW ice packs or topical
exaggerated substance with acid anesthetics
reactions that may phosphatase, &
last for days phospholipase A For chronic reactions:
Injection with
Serum sickness Triamcinolone
(fever, urticaria, joint suspension diluted to
pain) occur 7 10 5mg/mL with 2%
days after sting lidocaine

Severe anaphylactic For severe reactions:

shock and death may Oral prednisone
occur w/in minutes of
sting For severe systemic
reactions:
0.3mL of epinephrine IM
Corticosteroids
 LALALA-LALA
2B: ERYTHEMATOUS LESIONS: Non Scaly Nodules

SKIN LESION Description Cause/Precipitatin Age & Area of Diagnosis Treatment Also know this
g Factors/Risk Predilection
Factors
Furuncle (boil)/ Furuncle S aureus Nape, axillae, Warm compress may arrest Vs. acne: furuncle is extremely
Caruncle Acute, round, tender, buttocks (but may early furuncles painful
circumscribed Predisposing occur anywhere)
perifollicular factors: Penicillinase resistant Furuncle is deep so topical meds
staphylococcal abscess; Disruption of skin penicillin or 1st gen will not work
nodular & with central surface integrity cephalosporin (1 2g/day)
suppuration (pressure, irritation, oral! Similarities between erysipelas &
friction, dermatitis, furuncle:
Carbuncle shaving, etc) Bactobran applied to 1. + signs of inflammation
2 or more confluent anterior nares to prevent 2. Painful
furuncles, w/ separate Systemic disorders recurrence (apply daily for 5 3. Acute
heads (alcoholism, days)
malnutrition, blood
Lesions begin in hair dyscrasias, If localized with definite
follicles, continue by immunosuppression) fluctuation: incision &
autoinoculation (carriers drainage DO NOT do I & D if
in nose/groin) Atopic dermatitis acutely inflamed, give
(predisposes If lesion is in EAC, upper lip moist heat instead.
Most will undergo central individual to carrier or nose, I & D will only be
necrosis & rupture thru state) done if antibiotics fail
skin
Nasal carriers are at To eradicate carrier state:
risk for chronic 1. Daily use of
furunculosis chlorhexidine wash
2. Rifampin +
Dicloxacillin (10
days)
3. Sulfa TMP for
MRSA (10 days)
4. Low dose
clindamycin (3 mos)
 LALALA-LALA
2C: ERYTHEMATOUS LESIONS: Non Scaly Plaques

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Fixed Drug Begins as a red patch that Medications taken Young boys Stop taking Features:
Eruption (FDE) soon evolves to an intermittently offending drug. 1. Normal stratum corneum
iris/target lesion (~1cm), Oral & genital 2. Chronic changes in
identical to erythema HLA B22 mucosa (50%) dermis:
multiforme & may - NSAIDS: a. Papillary fibrosis
eventually blister & erode usually lips b. Pigment
- Sulfa incontinence
Known as fixed because TMP: 3. Eosinophils & neutrophils
it occurs at the same site usually 4. No anesthesia or
w/ every exposure to genital hyposthesia
medication
With first intake of drug:
Usually causes 1. Redness
prolonged/permanent 2. Hyperpigmentation
postinflammatory 3. Redness + increasing size
hyperpigmentation + pruritus

A non pigmenting FDE FDEs may progress to Steven

is usually caused by
Pseudoephedrine HCl
(Baboon syndrome
buttocks, groin, axilla)
Erythema Begin as sharply
Multiforme marginated, erythematous
(EM) macules, which become
raised, edematous
papules over 24 48 hrs In the Phils: usually
Target or iris lesions with
3 zones:
1. Central dusky
purpura
2. Elevated,
edematous, pale
ring
3. Surrounding
macular
erythema
Px may present with
conjunctivitis
Johnsons syndrome
- Usually associated with
anticonvulsant intake
Herpes simplex Young adults Prevention: Features:
infection (usually cornerstone of 1. Target/iris lesions
orolabial HSV) Dorsal hands (initial treatment (if due to 2. Cellular necrosis
involvement), dorsal HSV) 3. Basketweave stratum
feet, extensor limbs, corneum
drug induced elbows & knees, Sunblock creams 4. Mononuclear infiltration
palms & soles (site (may prevent UVB
HLA DQ3 of typical iris/target induced outbreaks) FDE vs. EM
lesions) FDE: < 6 lesions
Antiherpetic EM: many generalized lesions
antibiotic (in oral,
1 chronic, suppressive
2
doses)
- Acyclovir
3 may prevent
lesions
For severe erythema multiforme,
Prednisone (may give oral steroids.
reactivate HSV and
increase frequency
of attacks)
 LALALA-LALA
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Erysipelas (St. Fiery red swelling with Any inflammation of Newborn, postpartum Systemic penicillin Acute tuberculoid leprosy may look
Anthonys fire or characteristic raised, the skin (esp if women (vigorous tx for 10 like erysipelas BUT acute
ignis sacer) indurated border; onset fissured/ulcerative) days; improvement tuberculoid leprosy has no fever,
usually w/ prodromal sx may provide entrance Face (lesion starts in seen in 24 48h) pain, or leukocytosis.
for beta hemolytic cheek near nose & in
Distinctive feature: streptococcus front of ear lobe) Erythromycin
advancing edge of patch Legs (more likely to Locally: ice bags &
need hospitalization) cold compresses
PAINFUL! Perineum &
abdomen (in
Spreads peripherally; postpartum women)
more superficial than
cellulitis
Cellulitis Suppurative inflammation S pyogenes/ S aureus Leg: Tinea pedis as IV penicillinase Erysipelas & cellulitisare both deep
involving the mode of entry resistant penicillins see neutrophils reaching the
subcutaneous tissue Usually follows some or 1st gen dermis w/c is why topical meds
discernible wound cephalosporin (oral!) wont work :(
No central suppuration
(Sinong may central Possible complications:
suppuration? - Gangrene
Furuncle/carbuncle ) - Metastatic abscess
- Sepsis
Ill defined border
indicates deepness May present with chills & fever
Urticaria Wheals, white/red Drugs (most frequent Covered areas: If individual wheal persists Antihistamines Features:
evanescent plaques, cause: Penicillins) trunk, buttocks, chest for > 24 hrs = do skin 1. Mild dermal edema
surrounded by a red halo - Aspirin may biopsy Avoidance of the 2. Margination of neutrophils
or flare; pruritic! exacerbate trigger w/in postcapillary venules
chronic 3. No karyorrhexis & fibrin
May be accompanied by urticaria For chronic: deposition (compared to
angioedema Food, food additives, antihistamine daily vasculitis)
emotional stress,
Rarely lasts >12 hrs menthol, neoplasms Acute: < 6wks
(carcinomas, Chronic: >6wks
Mast cell degranulation = Hodgkins, CLL),
increased histamine inhalants, infections
(acute urticaria: strep,
TB; chronic urticaria:
hep B & C)
Exfoliative Extensive erythema & Possible causes: Face & extremities Topical steroids, Features:
Dermatitis scaling; may ooze a straw 1. Generalizatio soaks, compresses No vesicles or pustules
(erythroderma, colored exudates n of a pre Course of disease may be
pityriasis rubra) existing Systemic protracted, last years, or may
Itching appears w/ chronic corticosteroids persist & resist therapy
systemic toxicity (fever) dermatoses Immunosuppresants
2. Drug
 LALALA-LALA
eruptions
3. Idiopathic
Predisposing Factors:
Psoriasis, eczema,
drug allergy, other
dermatoses
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Before starting tx, do a CBC
Hansens Important feature: Mycobacterium leprae 2 peaks of Early diagnosis is Dapsone
because Dapsone may
Disease Neurotropism - Weakly acid presentation: essential! (cornerstone of tx)
cause hemolytic anemia
(Leprosy) fast 1. Children 10
- Grows best 20 yrs Lepromin skin test (to Dapsone + Rifampin
(30oC) 2. Adults 30 determine type of leprosy) Do liver function tests &
- Intracellular 60 yrs - Multibacillary (if chest xray (check for TB)
+ organisms on Clofazimine (side
Areas of predilection: skin smear) effect: skin
Cooler areas of the - Paucibacillary (if discoloration) Leper reaction:
body (spares scalp & skin smear is (-) Upon starting tx, px may experience
midline) or px has < 5 Compared to TB tx the ff:
lesions) regimens, meds are - Fever
given once a month - Joint pains
PGL 1 (for pure neural for leprosy. - Nerve damage due to
leprosy) inflammation of nerve
- Skin becomes swollen &
erythematous
- New lesions appear
Management of leper reaction:
Prednisone

Early & First lesion: solitary, ill Cheeks, upper arms, Usually no/few bacilli Peripheral nerves not enlarged
Indeterminate defined hypopigmented thigh, buttocks No plaques/nodules
Leprosy patch w/ slight anesthesia
(indeterminate Few cases stay in this state; most
because course of 90% initially present with will become lepromatous,
disease cannot be numbness (cutaneous borderline, or tuberculoid. Some
predicted yet)
findings may appear years may spontaneously resolve.
later)

Loss of cold & light touch

earliest sensory
changes (usually
feet/hands)

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
 LALALA-LALA
Tuberculoid Typical lesion: large, Face, limbs, trunk High chance for Features:
Leprosy (TT) erythematous plaque w/ a spontaneous cure 1. Presence of palpable
sharply defined & elevated over the years induration & neurologic
border that slopes down to findings differentiates
a flattened atrophic center indeterminate from
(saucer right side up) tuberculoid lesions
2. Lesions are
Lesions are solitary or few anesthetic/hypesthetic,
in number (< 5) because anhidrotic.
cell mediated immunity 3. Superficial peripheral
is high nerves serving/proximal to
lesion = enlarged/tender
Paucibacillary (visible in greater auricular
nerve & superficial
Nerve involvement is early peroneal nerve)
& permanent (may cause
muscle atrophy)
Borderline Lesions similar to
Tuberculoid tuberculoid lesions except
Leprosy (BT) they are smaller & more
numerous

Satellite lesions around

large macules/plaques
Borderline Lesions numerous but Moderate anesthesia in lesions
Leprosy (BB) countable, red irregularly
shaped plaques Nerves may be enlarged or
thickened
Generalized lesions but
asymmetrical

Borders not so well

defined compared to
tuberculoid
Borderline Lesions symmetrical, too Small lepromatous lesions more
Lepromatous numerous to count, may than borderline type lesions
Leprosy (BL) include macules, papules,
plaques, nodules Nerve involvement later
Sensation & sweating over lesions
is normal
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Lepromatous Lesions: may appear as May become Clues to leprosy:
Leprosy 1)pale lepromatous progressively worse 1. Permanent anesthesia
macules or 2) infiltrations w/o treatment doesnt disappear with
with numerous bacilli in treatment
lesions 2. Nerve involvement &
clawing appear late in the
 LALALA-LALA
Lepromatous macules disease
Symmetrical & diffusely Present with loss of hair in 3. Anesthesia on a lesion
distributed over the body eyebrows (madarosis) -> leprosy is the only
Small & numerous eyelashes -> body (scalp dermatologic disease that
Ill defined, blend into hair spared) will cause this
surrounding skin 4. Hypopigmented patches in
Little or no loss of kids early sign!
sensation, no nerve
thickening, no sweating
Misdiagnosed as diabetic
Lepromatous neuropathy
infiltrations
3 types: diffuse, plaque,
nodular
**Diffuse diffuse
infiltration of face,
madarosis, waxy/shiny
appearance of skin

May manifest as lepromas

(ill defined nodules
occurring in acral parts:
ears, brows, nose, chin,
elbows, hands, buttocks,
knees)

Nerve disease is bilateral

& symmetrical (stocking
glove pattern)
 LALALA-LALA
2D: ERYTHEMATOUS LESIONS: Non Scaly Patch

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Phototoxic Exaggerated sunburn Phototoxic agents: Sun exposed areas: Topical agent: clinical Symptomatic tx: Onset: minutes to hours after
Dermatitis reaction: erythema, edema, - Coal tar - Face Systemic agent: corticosteroids exposure; usually occurs after
vesicles, bullae, burning, (cosmetics, drugs, - V of neck clinical + phototests 1st exposure
stinging dyes, insecticides, - Extensors of Avoid sun exposure
Frequently resolves with disinfectants) upper Protective clothing is
hyperpigmentation - Furocoumarins in extremities essential
plants - Dorsum of Sunscreen with broadest
Mechanism: Direct tissue - Bergapten (lotion, hands UVA coverage
injury aftershave) - Often lower
- Yellow cadmium legs & feet
sulfide (tattoos)
- Drugs:
doxycycline,
naproxen,
ibuprofen,
amiodarone,
phenothiazine

Photoallergic Rash Photoallergic agents: Sun exposed areas: Topical agent: Same Onset: 24 48hrs after
Dermatitis - Drugs: - Face photopatch tests exposure
Usually eczematous phenothiazines, - V of neck Systemic agent:
lesions & pruritic chlorpromazine, - Extensors of clinical + phototests; No occurrence after 1st
quinidine, upper photopatch tests exposure
Mechanism: Type IV sulfonylureas, extremities
delayed hypersensitivity NSAIDs - Dorsum of
reaction - Topical hands
antimicrobials/ Often lower legs & feet
antibacterial
soaps(hexachloro
phene, bithionol)
- Sunscreens
(PABA,
benzophenones)
- Fragrances (must
ambrette, 6
methylcoumarin)
- Aftershave (oil of
sandalwood)
 LALALA-LALA
2E: ERYTHEMATOUS LESIONS with Eczema

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Atopic Hallmark of AD: pruritus Risk factors: Adults: flexural Topical therapy Associated features &
Dermatitis (itching usually precedes 1. Polygenic lichenification 1. Corticosteroids complications:
lesions) inheritance/person Infants: facial & dominant method of 1. Dennie Morgan folds
al or family hx of extensors tx for AD - Linear transverse fold
Diagnostic criteria of atopic disease - Potent steroid below edge of lower
Hanifin & Rajka: 2. Environmental during eyelids
Major criteria: factors weekend, milder 2. Hertoghes sign
Pruritus 3. High level of IgE steroid during - Thinning of lateral
Typical morphology & antibodies to the week eyebrows
distribution (adults: flexural, housemites 2. Calcineurin inhibitors 3. Headlight sign
infants: facial & extensors) (Tacrolimus) - Perioral, perinasal &
Chronically relapsing alternative to periorbital pallor
dermatitis steroids 4. Pityriasis alba
Personal or family hx of - Subclinical dermatitis
atopic disease Systemic therapy - Poorly marginated,
1. Antihistamines for hypopig mented
Minor criteria (at least 3): sedative effect slightly scaly patches
Xerosis 2. Antistaph antibiotics 5. Keratosis pilaris
Ichthyosis during flares - Horny follicular
Elevated serum IgE (cephalosporins & lesions
Early age of onset semisynthetic - Refractory to tx
Nipple eczema penicillins)
Cheilitis 3. Systemic steroids
Recurrent conjunctivitis only for controlling
Dennie Morgan folds acute exacerbations
Keratoconus 4. Azathioprine,
Anterior subcapsular mycophenolate
cataract mofetil,
Periorbital darkening methotrexate for
Pityriasis alba debilitating disease
Itch when sweating unresponsive to
Blanching phenomenon other tx
White dermographism 5. Phototherapy
Food hypersensitivity hospital based; good
Susceptibility to infection (S for control of severe
aureus, eczema AD
herpeticum HSV 1, HIV)

SKIN LESION Description
Infantile AD 60% present in 1st yr of life
(usually >2 mos of age)
Usually begins as erythema
& scaling of cheek
Lesions may be papular or
exudative
Childhood AD Less exudative
Often lichenified, indurated
plaques
Itch scratch cycle:
Pruritus leads to scratching
& scratching causes
secondary changes that
causes itching
Adult AD Localized, erythematous,
scaly, papular, exudative,
or lichenified plaques
Staphylococcal colonization
is universal
Hand dermatitis: most
common problem for adults
w/ hx of AD
LALALA-LALA
Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Worsened after 2 mos 2 yrs of age Blinded food Partial remission during
immunizations & viral challenges summer & relapse during
infections Assays for food winter (due to therapeutic
Cheek, scalp, neck, specific IgE effects of UVB and humidity
forehead, wrists, Prick testing & aggravation by wool & dry
extensor extremities air)
(areas involved
Evaporation barrier
correlates with immediately after bathing
capacity of child to White petrolatum
scratch/rub site & with Aquaphor & vegetable
babys activities like shortening
crawling) Protection of affected part
from scratching & rubbing
- Antecubital & popliteal Scratching impulse is usually
fossa, flexor wrists, beyond control of px (itching is
eyelids, face, neck same as lichen simplex
chronicus -> compelling,
paroxysmal) inability to feel
pain during paroxysms
Severe AD (>50% body
surface area involved)
associated with growth
retardation
- Topical calcineurin
inhibitors
(macrolactams)/photo
therapy may allow for
rebound growth
1. Wet work Adolescents: Dermatitis is uncommon Itching usually occurs in
- Especially Antecubital & popliteal after middle life response to heat/stress, during
implicated in hand fossa, front & sides of the evening when trying to
eczema neck, forehead, area Topical corticosteroid: relax, or at night
st
2. After birth of 1 child around eyes mainstay of tx
3. Soaps Avoid extremes of cold & Flares may be due to acute
Adults: chronic hand heat emotional stress (decreases
eczema is common Avoid overbathing itch threshold)
Tepid showers, not hot
Mild stigmata of dry skin &
irritation remain even after
recovery

SKIN LESION Description
Seborrheic Moist plaques w/ chronic,
Dermatitis superficial, inflammatory
disease of the skin
Scaling on an
erythematous base +
severe itching
Nummular Discrete, coin - shaped,
Eczema well circumscribed
erythematous, edematous,
vesicular & crusted plaques
+ Koebners phenomenon:
formation of lesions after
trauma
Severe, paroxysmal &
nocturnal pruritus
Infectious Widespread dermatitis or
Eczematous/ dermatitis distant from a
Autosensitiza- local inflammatory focus
tion
Dermatitis Generalized acute
vesicular eruptions
associated with chronic
eczema of the legs w/ or
w/o ulceration
Often in linear configuration
Cause/Precipitating
Factors/Risk Factors
Pityrosporum ovale
Emotional stress
Alcohol age
Atopy
Trauma (Koebners Lower legs, dorsa of
phenomenon)
surfaces of arms
Cause of the distant
dermatitis is not the same
as the cause of the local
one
Autosensitization to the
discharge
Precipitating factors:
- Diabetics w/ non
healing wounds
- Chronic otitis
media, eye, nose,
vaginal discharge
LALALA-LALA
Age & Area of Diagnosis Treatment Also know this
Predilection
Scalp, eyebrows, Differentiate from Antifungal agents Dandruff (pityriasis sicca)
eyelids, nasolabial psoriasis (more (Ketoconazole) & topical mild form of SD
creases, lips, ears, severe scaling, + calcinearia inhibitors -
sterna area, axillae, Auspitz sign: removal mainstay Lesions may become
submammary folds, of scales discloses generalized -> generalized
umbilicus, groin, bleeding points, nail Corticosteroid creams, exfoliative erythroderma/
gluteal crease pitting) gels, sprays, foam erythroderma desquamativum
(esp in infants)
Cradle cap seen in Be careful with use of
infants as steroids due to side Atopic D has more severe
yellow/brown scaling effect of steroid rosacea itching than seborrheic
lesions of the scalp
with adherent epithelial
debris
Young adulthood & old Initial tx: simple soaking Recurrent staph infection may
& greasing w/ occlusive be present
ointment OR application
of potent steroid As new lesions appear, old
hands, extensor Antihistamine lesions expand by tiny
Antibiotics if w/ staph papulovesicular satellite
infection lesions at the periphery fusing
Lower legs (older men) Intralesional or systemic with the main plaque
Trunk, hands, fingers steroids (if refractory to
(younger females) topical meds) May be very similar to AD but
different in site of predilection
& presentation (coin shaped).
Although AD may be
nummular in adolescents, AD
is more chronic & lichenified.
Antibiotics Usually develops about a:
Oral glucocorticoids - Discharging abscess
- Ulcer
- Sinus
- Fistula
 LALALA-LALA
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Contact
Dermatitis
Irritant CD Inflammatory reaction to a Acids Hands Topical steroids This is a non allergic
substance that causes Alkaline materials (betamethasone, inflammatory response. No
eruptions in most people (soaps/detergents) Lesions sharply clobetasol propionate) previous exposure necessary.
Solvents circumscribed to
Hallmark: Pain & burning! Diaper contact area; no Effect is evident w/in mins/hrs
distant lesions
Lesions: necrosis & Acute: direct cytotoxic
ulceration damage to keratinocytes

Chronic: slow damage to

cell membranes by CHON
denaturation & cellular
toxicity
Allergic CD Inflammatory reaction only Poison ivy, poison oak, More intense in Topical steroids Lesions appear 24 72 hrs
among people who have poison sumac contact areas but may after exposure, but may
been previously sensitized Nickel/other metals have distant lesions develop as early as 5 hrs or as
(delayed reaction) Medications (antibiotics, late as 7 days after exposure
anesthetics, topical meds)
Delayed contact Rubber/latex
hypersensitivity Cosmetics
Fabric & clothing
Acquired sensitivity to Detergents
various substances Adhesives
Erythematous papules, Perfumes
vesicles, linear & Jewelry
symmetrical lesions w/in Shoes
scratch marks

Hallmark: Itch!

Lesions: edema, vesicles,

Diaper/Napkin Alkaline irritative effects of Highest incidence :6 Use diaper w/
Dermatitis ammonia formed in wet 12 mos of age superabsorbent gel
diaper
Lower abdomen, Frequent change of
Risk factor: frequent genitals, thighs, diaper
maceration convex surfaces of
buttocks Topical hydrocortisone
Zinc oxide paste
Irritant Hand Dryness/redness of fingers Under rings when not Betamethasone
Dermatitis/ removed during dipropionate
Housewifes Chapping at back of hands, washing Clobetasol proprionate
Eczema erythematous hardening of
palms, fissuring Triamcinolone
 LALALA-LALA
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Intertrigo Superficial inflammatory Hot & humid weather Children & elderly Eliminate maceration
dermatitis occurring where Obesity Local
2 skin surfaces are in DM & hyperhidrosis Retroauricular areas, antibiotics/fungicides
apposition folds of upper eyelids, Separate apposing skin
creases of neck, surfaces w/ gauze or
Result of friction, heat, axillae, antecubital other dressings
moisture -> affected fold areas, finger webs,
becomes erythematous, inframammary areas, Castellani paint,
macerated, secondarily umbilicus, popliteal polysporin ointment, low
infected spaces, toe webs, potency topical steroid
gluteal folds

Inframammary area in
obese women: most
frequent site of
intertriginous
candidiasis
Groin: fungal infection
Stasis Erythema/yellowish/ light Venous insufficiency Elderly (rarely occurs Symptom relief Swelling may be noted late in
Eczema brown pigmentation of before 5th decade of Tx of underlying venous the afternoon with
lower 1/3 of legs esp Persons with heart failure, life) insufficiency spontaneous resolution in the
superior to medial varicose veins, recent Emollients for pruritus morning
malleolus trauma of legs greater Lower 1/3 of lower leg & eczema
risk (superior to medial Topical corticosteroids
Hyperpigmentation due to malleolus) Support stockings
melanin & hemosiderin

Cutaneous marker for

venous insufficiency

2E: ERYTHEMATOUS LESIONS: Dry, Chronic Eczema
SKIN LESION Description
Lichen Paroxysmal pruritus
Simplex
Chronicus Criss cross pattern:
(Neuroderma- between is a mosaic
titis composed of flat topped,
Circumscripta) shiny, smooth, quadrilateral
facets (lichenification)
Circumscribed, lichenified,
pruritic patches
Excoriated papules
(sometimes w/ bleeding),
slightly scaly & moist, rarely
nodular
Prurigo Multiple severe itching
Nodularis nodules (pea sized or
larger; 3 20mm)
Chronic disease, lesions
evolve slowly
Symmetrical & usually
linear arrangement
Prurigo Mitis Mild form of chronic
dermatitis characterized by
recurrent, intensely itching
papules & nodules
Severe itching ->
excoriation, eczematisation
Cause/Precipitating
Factors/Risk Factors
Chronic rubbing &
scratching
Associated with topic or
allergic contact dermatitis,
anxiety, nervousness,
depression
Unknown
Atopic dermatitis, anemia,
Hep C, pregnancy, stress,
etc.
Chronic renal failure:
most common internal
cause of pruritus
Worsened after
immunizations & viral
infections
LALALA-LALA
Age & Area of Diagnosis Treatment Also know this
Predilection
Nuchal area (female), Goal: cessation of With habitual itch scratch
scalp, ankle, lower pruritus cycle
legs, upper thighs,
exterior forearms, Stop scratching!
vulva, pubis, anal area, Cover affected areas at
scrotum, groin night to prevent
scratching while asleep
Topical steroids:
Clobetasol propionate,
betamethasone
dipropionate
cream/ointment used
initially
Triamcinolone
suspension
Any age but mainly in Visual examination Initial tx: intralesional or
adults (20 60 y/o) Biopsy topical administration of
M=F Blood tests, liver, steroids
kidney, thyroid fxn
Anterior surfaces of tests Other measures:
thighs & legs Keep in cool areas,
Forearms, trunk, neck avoid hot baths or
showers and wool
clothing
Use soap only in axilla
& inguinal area
Antihistamines
Antipruritic
lotions/emollients
PUVA
Vit D3, tacrolimus
Cryotherapy
Early childhood Blinded food Same
challenges
Assays for food
specific IgE
Prick testing

2F: ERYTHEMATOUS LESIONS: Papulosquamous Disease
SKIN LESION Description
Tinea Capitis Scalp ringworm
Incubation period: 2 4
days
T tonsurans Black dot ringworm
Subtle seborrheic like
scaling
Inflammatory lesion
Large spore endothrix
M canis Scaly, erythematous,
papular eruptions with
loose & broken off hairs -
> inflammatory
Small spore ectothrix
Tinea 1 or more circular, sharply
Corporis circumscribed, slightly
(Tinea erythematous, dry, scaly,
Circinata) hypopigmented patches
With progressive central
clearing
Depth of infection usually
limited to epidermis & its
appendages
See annular outlines
(ringworm)
Cause/Precipitating
Factors/Risk Factors
Pathogenic dermatophytes
(Except: Epidermophyton
floccosum &Trichophyton
concentricum)
Most common: T tonsurans
& M canis
T rubrum most common Preadolescents
M canis causes moist F>M
type
T mentagrophytes
Mode of transmission:
Contact w/ infected human
(most common)
Contact w/ contaminated
household pets, farm
animals, fomites
Widespread tinea corporis
may be a presenting sign of
AIDS or related to the use
of a topical steroid or
calcineurin inhibitor
LALALA-LALA
Age & Area of Diagnosis Treatment Also know this
Predilection
Children Woods light Griseofulvin (2 4 mos) Kerion celsii: deep tender
Boys > Girls Fungal fluorescence Terbinafine (for boggy plaques exuding pus;
Fluorescent tricophyton infections; 1 cause scarring & permanent
Scalp, glabrous skin, substance: pteridine 4 wks) alopecia
eyelids, lashes (+) if bright green or Itraconazole/fluconazole
yellow green (2 3 wks) Favus: concave, sulfur
Selenium sulfide yellow crusts around loose,
10 2% KOH solution shampoo or wiry hairs; atrophic scarring
Findings: pattern of ketoconazole shampoo results to smooth, glossy,
endothrix/ ectothrix (adjunct) paper white patch
Culture (growth in 1 Kerion celsii: systemic Scutulae: cupshaped crust on
2 wks) steroids + antifungal glabrous skin, < 2cm, mousy
odor
(-) fluorescence in
Woods light
Culture:
granular/powdery,
yellow to red, brown
colony
(+) fluorescence in
Woods light
Culture: profuse,
cottony, aerial mycelia;
buff to light brown
KOH exam of skin TOPICAL: localized Variants:
scrapings (get from disease w/o fungal 1. Fungal folliculitis
active border of lesion folliculitis (Majocchi granuloma)
Neck, extremities, -highest yield of fungal - Sulconazole, - Infection of hair
trunk elements) miconazole, follicles w/ granuloma
itraconazole formation
Fungal culture (give 2 4 - Usually in F who
PCR wks) shave legs
Skin biopsy (see - Terbinafine, - T rubrum/
septate branching Ketoconazole mentagrophyte
hyphae in stratum give for 1 wk 2. Tinea imbricate
corneum) - Concentric ring of
Combination with a scales, extensive
potent corticosteroid patches w/ polycyclic
may cause widespread borders
tinea & fungal - T concentricum
folliculities so avoid 3. Tinea incognito

Tinea Cruris Begins as small,
(jock itch, erythematous scaling or
crotch itch) vesicular & crusted patch
that spreads peripherally
and partly clears in center
Patch: curved, well
defined border, particularly
on lower edge
SKIN LESION Description
TINEA PEDIS Dermatophytosis of the feet
(athletes foot)
Characterized by erythema,
scaling, vesicular & crusted
patch spreading
peripherally with partial
central clearing
Most common fungal
disease
Chronic w/ exacerbations in
hot weather
T rubrum Moccasin type lesions:
non inflammatory type w/
dull erythema &
pronounced scaling that
may involve entire sole and
LALALA-LALA
using CS! - Atypical presentation
due to corticosteroid
SYSTEMIC: for tx
extensive 4. Tinea gladiatorum
disease/fungal folliculitis - Skin to skin contact in
Griseofulvin, terbinafine, wrestlers
itraconazole,
fluconazole
T rubrum common Adult men KOH wet mount Treat all areas of active Candidal infection may mimic
Epidermophyton floccosum Growth on infection this (difference is the presence
T mentagrophytes Upper & inner surface Mycosel/Saboraud Keep groin area clean & of satellite pustules in candida)
of thighs agar plates dry
They produce keratinases Perineum & perianal Loose fitting clothing
that allow invasion of areas Lose weight
cornified cell layer of Use plain talcum
epidermis powder
Antifungal creams
Risk factors:
Warm & moist areas
Tight fitting clothes
Autoinoculation (athletes
foot & ringworm)
Direct skin-to-skin
contact/fomites
Obesity, DM,
immunocompromised
Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
T rubrum cause Late childhood to young Dry toes thoroughly May become a portal of entry
majority of infection; adulthood after bathing for lymphangitis when
usually non Younger indvls: Good antiseptic powder pyogenic cocci infect fissures
inflammatory type inflammatory Fungicides between toes & in the vesicles
Older: non - inflammatory
T mentagrophytes M>F
cause inflammatory
lesions Site: usually 3rd toe web
Distribution: usually
Risk factors: bilateral; may involve one
Hyperhidrosis (sweat hand, both feet
between toes and soles)
Hot, humid weather
Occlusive footear
This type of lesion may also be
caused by E floccosum
 LALALA-LALA
sides of foot =
moccasin/sandal
appearance
T mentagro - A. Inflammatory/ bullous C. White superficial
phytes type onychomycosis
- Plantar arch &
along sides of feet
- Burning/itching
sensation
- Least common
- Involves sole,
instep, webspaces
B. Interdigital type
- Erythema, scaling,
maceration extend
up to dermis
- Complicated by
secondary
bacterial infection
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
TINEA Dermatophytosis of the T rubrum more Direct microscopic Oral antifungal agents
MANUM hands common; produces dry, exam of scrapings (topical dont usually
scaly erythematous type (instep, heel, sides work because of the
Dry, scaly, erythematous Unilateral if associated with of foot, palms) thick palmar stratum
type OR moist, vesicular, T mentagrophytes tinea pedis & cruris corneum)
eczematous type dermatophytosis of hand Often associated with tinea 10 20% KOH Griseofulvin, terbinafine,
secondary to tinea of feet; unguium of fingernails (if solution itraconazole,
produces vesicular type; chronic) Fungal culture fluconazole
both hands involved
Prevention:
Dry toes thoroughly
after bathing
Good antiseptic powder
between toes (tolnaftate
or zeasorb powder)
Plain talc, cornstarch
dusted into socks
PITYRIASIS Usually begins with single 2 Unknown 15 40 y/o KOH wet mount Supportive Usually asymptomatic but may
ROSEA 4cm thin oval plaque w/ Some evidence points to a F>M Growth on Topical CS or be pruritic & have
fine collarette of scale viral cause reactivation Mycosel/Saboraud antihistamines for constitutional symptoms
inside the periphery of HHV7 & HHV6 agar plates associated pruritus
(herald patch/mother UV treatment may
patch) Spring & autumn months expedite involution of
lesions
Salmon colored papules
& macules., oval/circinate
patches, covered with finely

crinkled, dry epidermis that
often desquamate
TINEA Hypopigmented,
VERSICOLOR coalescing, scaly macules
(due to abnormally small &
poorly melanised
melanosomes) in dark skin
Hyperpigmented on pale
skin
SKIN LESION Description
PSORIASIS Common, chronic,
recurrent, inflammatory
disease of the skin
Round, circumscribed,
erythematous, dry scaling
plaques of various sizes,
covered by gray or silvery
white imbricated lamellar
scales
Symmetrical, solitary
macule to > 100 macules
May be accompanied by
itching/burning
Nail pitting & oil spots
Types
Seborrheic W/ prominent features of
like psoriasis seborrheic dermatitis
W/ minimal amount of soft
& greasy micaceous scales
Inverse flexural psoriasis palms
psoriasis & toes
volar psoriasis
Malassezia furfur (skin Sterna region, sides of
lesions area produced chest, abdomen, back,
when in hyphal phase) pubis, neck, intertriginous
areas, oily areas of skin
Risk factors:
Genetic predisposition Face & scalp (usually in
Warm, humid envt infants &
Immunosuppression immunocompromised px)
Malnutrition
Cushing disease
Cause/Precipitating Age & Area of
Factors/Risk Factors Predilection
Unknown Mean: 27 y/o
Scalp, nails, extensor
surfaces of limbs
(shins), elbows, knees,
umbilical & sacral
region
Flexure areas
(antecubital areas,
axillae, under breast)
Folds, recesses, flexor
surfaces: ears, axillae,
groin, inframammary
fold, palms, soles, nails
LALALA-LALA
Woods light exam Anti fungal agents Hypopigmentation may persist
Culture (rarely used (selenium sulfide, for wks/mos after fungal
for dx) imidazoles, triazoles, disease is cured
sulfur preparations,
salicylic acid, benzoyl Most cost effective tx:
peroxide, etc) selenium sulfide & zinc
pyrithione soap
Ketoconazole:
400mg/1x a month
Itraconazole: 200mg for
7 days
Terbinafine: topical
Diagnosis Treatment Also know this
Depends on site, Koebners phenomenon:
severity, duration, age appearance of lesions at areas
of injuries
Topical:
- Corticosteroids Auspitzs sign: bleeding points
- Tars secondary to thinning of
- Vit D epidermis over dermal
- Salicylic acid papillae; bleeding upon
- UV removal of scales
- Tazarotene
Woronoff ring: concentric
Systemic blanching of erythematous skin
- CS near periphery of healing
- Methotrexate psoriatic plaque
 LALALA-LALA
Napkin Increases risk for adult Infants between 2 8
psoriasis psoriasis infection mos of age
Psoriatic 5 clinical patterns: Distal & proximal Aspirin, NSAIDs, oral
arthritis 1. asymmetrical distal interphalangeal joints retinoids, PUVA
interphalangeal joint (relative sparing of
involvement w/ nail metacarpal &
damage metatarsal phalangeal
2. arthritis mutilans w/ joints)
osteolysis of phalanges &
metacarpals
3. symmetrical polyarthritis
like RA, with claw hands
4. oligoarthritis w/
swelling & tenosynovitis
of 1 or few hand joints
most common
5. ankylosing spondylitis
alone or with peripheral
arthritis
Guttate Typical lesions: size of Usually px <30 y/o Topical steroids
psoriasis water drops (2 5mm) UVB

Abrupt erosion following an

infection (ex. strep
pharyngitis)
Generalized Sudden onset, with Px usually have hx of Acitretin
pustular formation of lakes of pus psoriatic arthritis
psoriasis periungually, on palms &
edges of psoriatic plaques Linked with pneumonia,
CHF, ARDS
Erythema in flexures before
eruptions appear

w/ pruritus & burning

sensation
 LALALA-LALA
3: SKIN COLORED PAPULES

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Verruca Benign epidermal HPV type 1, 2, 4, 27, 57, 5 20 y/o Generally self limited Usually asymptomatic:
vulgaris proliferations 63 painless & no itching
(common wart) Hands, peri ungal In the Phils:
Elevated round papules w/ Transmission: simple (esp in nail biters), Electrocautery (complete Larger than verruca plana
a rough grayish surface direct contact; elbows, knees, plantar removal)
(verrucous) autoinoculation surfaces, anogenital - Give xylocaine No dermatoglyphics
- If in palms & areas before doing (fingerprint folds) in calluses,
soles, not very Predisposing factors: this because these lines are accentuated
verrucous Frequent immersion of warts in palms
hands in water are painful
Linear configuration of (makes skin soft, easier (many pain
verruca for virus to enter) receptors
Meat handlers Meissner &
See black dots Pacini)
(thrombosed dilated Topical keratolytics
capillaries) on surface (salicylic acid/lactic acid
preparations)
Verruca Plana Flat topped papules that HPV type 3, 10, 28, 41 Children & young adults Light cryotherapy (may W/ Koebnerization (also
(flat warts) are slightly erythematous produce loss of color) found in psoriasis) tend to
Transmission: direct Forehead, cheeks, because nitrogen can form linear, slightly raised
Brown on light skin & contact & autoinoculation nose, neck, dorsa of cause death of papular lesions
hyperpigmented on dark (in men who shave hands, wrists, elbows or melanocytes in colored
skin beards, women who knees skin Lesions are small and
shave their legs) numerous & spread fast
Multiple & grouped Topical salicylic acid
(may cause burning of Of all HPV infections, flat warts
No rough surface, no black normal skin = apply have the highest rate of
dots petroleum jelly) spontaneous remission

Topical tretinoin
Molluscum Painless, itching not Poxvirus (MCV 1 4) Usually in kids, sexually If px is healthy: usually DO NOT DO CAUTERY. Do
contagiosum prominent MCV 1: children active individuals, self limited curettage! Scrape off infected
MCV 2: HIV immunosuppressed px area with curette w/c will
Smooth surface, firm, (HIV infected) Kids: no tx OR topical remove abnormal tissue. Try to
dome shaped pearly tretinoin/cantharidin (4 6 also remove the molluscum
papules (3 5mm) with Kids: face, trunk, hrs) body
Adults: cryotherapy or
central umbilication extremities
curettage; sexual partners
Adults: lower abdomen, should be examined
upper thighs, penile Immunosuppressed:
shaft in men aggressive tx with HAART;
Immunosuppressed: curettage or core removal w/
face (cheeks, neck, blade; cantharone or 100%
eyelids), genitalia trichloroacetic acid;
cryotherapy
4: PUSTULAR DISEASE
LALALA-LALA
SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Acne Vulgaris Comedo as basic lesion Propionibacterium acnes Adolescents (15 18 See acne vulgaris (p. 8)
(review nalang y/o)
:D) Follicular disease w/ a
keratinous plug Involution of disease
before 25 y/o
Miliaria Distinct, superficial Preceded by another No particular age Usually self limited Recurrent episodes may be a
Pustulosa pustules that are dermatitis that has Place px in cool envt sign of type I
independent of the hair produced injury, Intertriginous areas, Circulating air fans pseudohypoaldosteronism
follicle destruction, or blocking flexure surfaces of Anhydrous lanolin help (salt losing crises may
of the sweat duct extremities, scrotum, resolve occlusion of precipitate miliaria pustulosa or
Pruritic back of bedridden px pores & helps restore rubra)
Commonly associated normal sweat secretions
diseases: Hydrophilic ointment Difference from acne: no
Contact dermatitis Soothing, cooling baths keratinous plug
Lichen simplex chronicus Dusting powders
Intertrigo
No need for antibiotics
(because pustules are
sterile; contain non-
pathogenic cocci)
Gram (-) Superficial pustules (3 Enterobacter, Klebsiella, Anterior nares, face Isotretinoin
Folliculitis 6mm) Proteus, Serratia Sulfa TMP
Fluctuant, deep seated
nodules Predisposing factors:
Long term antibiotic
therapy
Continuous scratching
Occurs in areas of
irritation (shaving,
friction, clothes rubbing)
P Aeruginosa Pruritic, follicular, Usually occurs 1 4 Sides of trunk, axilla, Involutes w/in 7 14 Some may present with fever
Folliculitis maculopapular, vesicular, days after bathing in hot buttocks, proximal days & prolonged disease (hot foot
or pustular lesions tub extremities, apocrine syndrome)
areas of breast & axilla 3rd gen cephalosporins
(oral), fluoroquinolones if
w/ fever
Staphyloco- Atypical plaque S aureus Eyelashes, axilla, pubis, Thorough cleansing of
ccal Pustular erythematous thighs affected area with
Folliculitis follicular lesion antibacterial soap and
water (3x/day)
Deep lesions should be
drained
Mupirocin ointment
topically
st
1 generation
cephalosporin (if
 LALALA-LALA
drainage or topical
therapy fail)
Anhydrous formulation of
aluminum chloride (for
chronic folliculitis)

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Superficial Superficial folliculitis w/ thin S aureus Extremities, scalp, face
Pustular walled pustules at follicle
Folliculitis orifice May secondarily arise in
(impetigo of scratches, insect bites,
Bockhart) Fragile, yellowish white, other skin injuries
domed pustules
Ecthyma Begins with vesicle or Beta hemolytic Children Lesions may heal but
vesicopustule w/ streptococcus may leave a scar
erythematous base & S aureus Lower extremities,
surrounding halo that shins, dorsal feet Good hygiene
enlarges over days & Predisposing factors: Muciprocin or bacitracin
crusts Uncleanliness ointment
Malnutrition 1st generation
Becomes superficial saucer Trauma cephalosporin or oral
shaped ulcer with raw IV drug users dicloxacillin
base HIV infection
DM
Indurated ulcer margin;
granulating base may
extend deeply into dermis
Pyogenic Inflammatory reaction of Primary predisposing No particular age Smears of purulent Protection against
Paronychia the nail folds factor: separation of material will confirm trauma & keeping hands
eponychium from nail Folds of skin impression dry
Purulent, painful swelling of plate (due to surrounding nail
tissues around the nail trauma/frequent wetting Acutely inflamed
of hands) pyogenic abscess:
May be acute/chronic Manicure/pedicure incision & drainage (do
this first before giving
Secondary bacterial penicillin or
infection due to: S cephalosporin)
aureus, Strep pyogenes,
Candida albicans Candida (usually
implicated in chronic
paronychia) topical/oral
antifungal (miconazole) +
topical steroids
Intertriginous Pruritic pink to red Candida albicans No particular age 10% KOH microscopic Goal: reduce
Candidiasis intertriginous moist patches (seen in exam (see inflammation!
surrounded by a thin immunocompromised Inframammary area (for pseudohyphae)
collarrette scale & pustules px,& conditions that favor obese women) Topical terbinafine will

closely adjacent to the
patches
Hallmark: Satellite lesions
on surrounding healthy skin
(satellite pustules)
LALALA-LALA
growth: warm, moist, Axilla, groin, not work; only AZOLES
high skin pH, reduced overhanging abdominal will work
microbial flora due to folds, intergluteal folds,
antibiotic therapy), interdigital spaces,
obesity, poor hygiene, umbilicus
restrictive clothing
 LALALA-LALA
5: VESICULAR
5: VESICULAR DISEASE
DISEASE

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Miliaria Small, clear, very Increased perspiration Neonates ( < 2 wks) Self limited Impt features to remember:
Crystallina superficial vesicles w/ no Clothing that prevents No medical treatment 1. Rupture spontaneously
inflammatory reaction dissipation of heat & Infants: head, neck, required 2. Normal skin w/
moisture upper trunk Symptom relief (keep px desquamation
Asymptomatic, short Bedridden px & bundled Adults: trunk in cool envt) 3. No mucosal involvement
lived, self limited children 4. Acute
5. No target lesions
6. No erythema! most
important
Impetigo Discrete, thin walled S aureus (most common) Children Histopathology: Clean area before Impetigo on the scalp:
Contagiosa vesicles that become Streptococci 1. Superficial applying meds complication of pediculosis
pustular & rupture (group B strep newborn Exposed body parts: inflammation in capitis
impetigo) face, hands, neck, upper part of Systemic antibiotics
Very weepy lesions (fresh extremities (palms & pilosebaceous (semisynthetic penicillins Acute glomerulonephritis
exudates) covered by Predisposing factors: soles spared) follicles or 1st gen complication following beta
yellow/orange crusts Temperate zones 2. Subcorneal cephalosporins) w/ hemolytic strep skin infection
vesicopustule topical therapy - Usually in kids <
Gyrate pattern/gyrate Sources of infection: 3. Mild inflammation (Bacitracin & muciprocin 6y/o
erythema (round, ring Kids: pets, dirty in dermis (PMNs, ointment) - Absent in staph
like polycyclic or arcuate) fingernails, other kids edema) impetigo
Adults: barber shops, Recurrent: 10 days
beauty parlors, swimming Rifampin (600mg/d)
pools, etc

Steven Flat, erythematous, Drug allergy (1day 3 Oral mucosa & Skin biopsy: Similar to px with Cause of mortality in
Johnsons purpuric macules that form wks latent period): conjunctiva Lymphocytic infiltrate extensive burn dermatology
Syndrome incomplete atypical antibiotics, NSAIDs, at dermoepidermal 1. IV immunoglobulin
targets that may blister allopurinol, junction w/ necrosis of 2. Systemic Px usually go to the hospital
centrally anticonvulsants keratinocytes corticosteroids because of pain
(Erythema multiforme minor (dexamethasone,
may also appear as target methylprednisolone) + Nikolsky sign: application
lesions, may be drug induced, - Stops spread & of very slight pressure causes
and may have the same areas
skin loss the skin to slough off; usually
of predilection. Difference is in
Nikolsky sign) 3. ICU seen in vesicular lesions (due
4. Increase caloric to weakening of intercellular
Evolution of lesions: enteral intake attachments)
Macules -> vesicles & - This is absent in
bullae erythema multiforme
minor because
Fever & influenza like lesions here are
symptoms precede more papular

eruption/skin lesions
(rapidly spread w/in 4 days)
Mucosal involvement (>2
mucosal surfaces eroded
oral or conjunctiva)
Not pruritic
Herpes Intraepidermal vesicles
Simplex
Acantholysis (ballooning
degeneration of epidermal
cells)
Types of infection:
Primary infection: virus
replicates in site of
infection; usually resides in
trigeminal ganglion
Nonprimary initial
episode: initial clinical
lesion in a person
previously infected w/ the
virus
Recurrent infection
HSV 1: orolabial herpes;
more common
HSV 2: genital herpes
Risk factors:
Immunocompromised
Prior infection
Occupation (esp in
herpetic whitlow)
Minor trauma & sun
exposure
Transmission: intimate
skin to skin contact, bodily
fluids
LALALA-LALA
2 causes of mortality in SJS:
1. Sepsis
2. Electrolyte
imbalance
SJS involves less than 10%
body surface. (Toxic
epidermal necrolysis involves
>30% body surface & its a
more severe SJS)
Tzanck smear most Drug of choice: Features:
common procedure Acyclovir (oral) 1. Acute
- Not specific (HSV, 2. Clustered lesions (In
VZV) Indications for oral meds: SJS, not clustered)
- Multinucleated - Recurrence 3. Can have mucosal
epidermal giant cells - Dissemination involvement
(in
Direct fluorescent immunocompro Other manifestations:
antibody test more mised) Herpetic whitlow
accurate - Infection of digits
- Tenderness &
Viral culture very erythema of lateral
accurate & rapid nail fold
(results ini 48 72 hrs) Herpetic
keratoconjunctivitis
PCR - Punctate/marginal
Skin biopsy keratitis
Serology - May impair vision
Herpes gladiatorum
- HSV 1
- Seen in wrestlers,
rugby players
- Face, sides of neck,
inner arms
Herpes Sycosis
- Affect primarily the
hair follicle
- Close razor shaving
Recurrent Ecthyma
Multiforme
- Presents with
papules later
become target
lesions in palms,
elbows, knees and
oral mucosa
Neonatal Herpes
- Passage through
birth canal
 LALALA-LALA
- Skin lesions,
microphthalmos,
encephalitis,
chorioretinitis,
intracerebral
calcifications
HSV
Encephalitis/Meningitis
- Headache, fever,
mild photophobia,
autonomic
dysfunction

Orolabial Lesions in mouth: broken 95%: recurrent HSV1 Lips near vermillion If untreated, may last 1 Upon onset: high fever,
Herpes vesicles that appear as infection border 2 wks lymphadenopathy, malaise
erosions or ulcers covered
w/ white membrane Frequent trigger: UVB
exposure
Frequent manifestation:
cold sore or fever blister

Erosions may spread to

oral mucosa, tongue,
tonsils = herpetic
gingivostomatitis
Genital Vesicles in erythematous HSV2 Labia, vulva, Usually resolves in 21 Asymptomatic shedding may
Herpes base that ulcerate & crust perineum, perianal days occur between outbreaks
Spread by skin-to-skin areas, shaft, glans
Grouped blisters & contact during sexual penis Can present as severe
erosions w/ continued intercourse systemic illness
development of new - Fever & flulike
blisters over 7 14 days illness
- Vaginal pain &
Course: dysuria (herpetic
vulvovaginitis)
 LALALA-LALA

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Herpes Zoster Shingles Reactivation of varicella F>M Tzanck smear Acyclovir Features:
zoster virus Indications: 1. More painful than
Cutaneous eruptions Sensory dorsal root - Immunocompro simplex
frequently preceded by one Risk factors: ganglion cells mised px 2. Dermatomal
to several days of pain in Age - To prevent 3. Not recurrent
affected area Immunosuppression Usual sites: complications in 4. Unilateral w/in
Thoracic (55%) elderly (give 1st distribution of
Papule & plaques of Cranial trigeminal 3 days) cranial/spinal nerve
erythema -> blisters (20%) - Ophthalmic 5. Neuralgic
Lumbar 15% involvement
Sacral 5% Postherpetic Neuralgia
Major complication; occurs 1
Ophthalmic zoster: month after onset of zoster
involvement of infection
ophthalmic division of
5th CN

Ramsay hunt
syndrome:
involvement of facial &
auditory nerves
Scabies See page 7 for complete
details

Features:
1. Pruritic
2. No target lesions
3. No mucosal
involvement
4. Px usually comes
to you the lesion
has been there for
several weeks
duration
 LALALA-LALA
6: BULLOUS DERMATOSIS

SKIN LESION Description Cause/Precipitating Age & Area of Diagnosis Treatment Also know this
Factors/Risk Factors Predilection
Fixed Drug See p 13/14
Eruption (FDE)
Contact See p. 22
Dermatitis
Bullous Strikingly large, fragile S aureus Any age but usually in Systemic antibiotics
Impetigo bullae newborn infants IV fluid resuscitation
Predisposing factor: - Neonatal type is if w/ large areas of
Ruptures & leaves Insect bites highly contagious involvement w/
circinate, weepy or Cuts - Begins in 4th denuded skin from
crusted lesions (impetigo Nursery w/ infected 10th days of life ruptured bullae
circinate) children w/ appearance of
bullae
Other manifestations:
Constitutional symptoms Early: face & hands
appear later Adults: axillae, groin,
Diarrhea w/ green stools hands
Bacteremia, pneumonia, (spares scalp)
or meningitis

Sources:
Andrews Clinical Dermatology
Dra. Ismaels lec
The original megatable from MH :D Thank you <3