Derm terms

Question 1

Answer 1

Macula - primary lesion

flat, circumscribed, <1cm

Question 2

Answer 2

Patch - primary

Flat, circumscribed, >1 cm

Question 3

Answer 3

Papule - primary

Elevated, circumscribed, <1 cm

Question 4

Answer 4

Pseudofolliculitis

• Consists of papules, but not pustules.
• Is often seen in the beard area.
• Can be distinguished from acne because the inflammation is adjacent to hair follicles.
• The hair grows out of the follicle and, when shaved closely, often grows back in to the surrounding skin, causing irritation and inflammation

Question 5

Answer 5

Plaque- primary

Elevated, broad (or confluence of papules); > 1 cm

Question 6

Answer 6

Vesicles - primary

Fluid filled, circumscribed, < 1 cm

Question 7

Answer 7

Bullae- primary

Fluid filled, circumscribed, > 1 cm

Question 8

Answer 8

Pustule- primary

Exudate filled, circumscribed

Question 9

Answer 9

Nodule- primary

Elevated dermis +/- subQ, circumscribed (majority underskin)

Question 10

Answer 10

Urticaria- primary

“wheals” Blanching edematous, thin erythematous papule/plaque +/- hypopigmented rim. Maybe white-pale red often disappear after a couple hrs

Question 11

Answer 11

Telangiectasia- primary

Dilated superficial bv/caps, visible on skin

Question 12

Answer 12

Petechiae- primary

Tiny red/purple macules via cap hemorrhage, no blanching

Question 13

Answer 13

Purpura- primary

Lg purple macules/papule via bleeding under skin, no blanching

Question 14

Answer 14

Scale- 2ndary

flakes of keratin coarse/fine, loose/adherent

Question 15

Answer 15

Crust- 2ndary

dried serum/ blood/ pus on top of skin

Question 16

Answer 16

Fissure- 2ndary

linear cleavage on skin

Question 17

Answer 17

Depression through dermis/sub q +/- scar

Question 18

Answer 18

Depression through epidermis, no scar

Question 19

Answer 19

Excoriation - superficial skin loss, often linear, via scratching/rubbing

Question 20

Infant rashes x 4

Answer 20

1. Seborrheic dermatitis (cradle cap)
2. Eczema or Atopic Dermititis
3. Candidal rash
4. Psoriasis

Question 21

Answer 21

Seborrheic dermatitis

• Consists of erythematous plaques with fine to thick, greasy yellow scale.
• Typically seen on the scalp, but may spread to the ears, neck, and diaper area of infants.

Treatment

For infants, treatment can include:

• Baby oil and a small brush to remove the scales
• Frequent (i.e., daily) shampoong with a gentle baby shampoo, or-for more persistent cases-use of a prescription shampoo containing ketoconazole, an anti-fungal agent, or pyrithione zinc. Care must be taken not to get the shampoo in the infant’s eyes.

In older patients it is often caused by a fungus (Malassezia).

• A low-potency topical steroid cream (e.g., hydrocortisone). In older children and adults, ketoconazole cream may be used.

Question 22

Answer 22

Eczema or atopic dermatitis

• May involve the posterior scalp.
• A positive history of atopic diathesis would support this diagnosis.
• Look for pruritic, erythematous, scaling plaques on extensor surfaces as evidence of atopic dermatitis on other areas of the body.

Question 23

Answer 23

Candidal rash

• Commonly manifests as a diaper dermatitis peaking between 7-10 months of age.
• Characterized by an area of erythema in the inguinal region, as well as erythematous papules and plaques with satellite lesions.

Question 24

Answer 24

Psoriasis

• More erythematous, with a thicker, non-waxy scale and more defined borders than seborrheic dermatitis.
• May or may not be pruritic.
• A family history of psoriasis is present in 40% of patients.

Question 25

Answer 25

Open comedones (black heads) Acne

Question 26

Answer 26

Closed comedones (white heads) Acne

Question 27

Differential Diagnosis for Pustular Conditions

Answer 27

1. Staphylococcal folliculitis, Furunculosis 2. Acne vulgaris 3. Hidradenitis suppurativa 4. Rosacea 5. Perioral dermatitis

Question 28

Answer 28

Acne Vulgaris Due to several processes: 1. Keratinous material and excess sebum (due to androgenic influence) plug the pilosebaceous gland. 2. Increased sebum provides a growth medium for superinfection with Propioniobacterium acnes. Areas of the body with the greatest number of sebaceous glands usually affected, including: * Neck * Face * Chest * Upper back * Upper arms

Question 29

Answer 29

Staph folliculitis * Can be very similar to nodular or cystic acne. * Often below waist or in groin area.

Question 30

Answer 30

Hidradenitis suppurativa * Pustular lesions caused by occlusion of the apocrine follicular units (instead of the pilosebaceous units). * Often superinfected with Staphylococcus aureus or Streptococcus pyogenes. Distribution markedly different from acne. * Areas most likely affected in women: Axillae, Groin, Inframammary regions * In men: * Perineal and perianal areas more commonly affected.

Question 31

Answer 31

Rosacea * More often seen in adults. * "Early" form seen in adolescents is characterized by inflammatory papules and micropustules, and redness. * No comedones. * Worsens with alcohol, spicy food, temperature extremes, and stress. * Can be treated with topical metronidazole and various other medications. * Distribution - malar & nasal surfaces

Question 32

Answer 32

Periorbital dermatitis * A variant of rosacea also commonly seen in adolescents, and treated the same way. * See erythema, scaling, and papules or pustules, but no comedones. * Distribution = "Perioral" almost a misnomer, as this may be seen around the mouth, nose, or eyes.

Question 33

Answer 33

Erythema nodosum * Hypersensitivity reaction presenting as red, tender, nodular lesions on pretibial surface of the legs. * Many possible etiologies, a few of which include infections, drugs, and inflammatory bowel disease. * Primary lesions are nodules, not pustules.