Physican assistant dermatology

rough, thickened epidermis

• thick fibrous tissue
• Initially, they are pink or red in color, and later may become hypo- or hyperpigmented.

•coin-shaped plaques of small papules and vesicles on erythematous base (almost looks like ring worms)
•Excoriations from scratching
•Distribution - common on lower legs of older males, trunk, hands, & fingers for younger females.

sudden onset of many deep-seated pruritic, clear, ‘tapioca-like’ vesicles that progress into scaling fissures and lichenification occurs
Distribution - fingers, palms, soles

•intense dry pruritic skin;
•erythematous scaly patches, small vesicles, excoriations, crusting
•itch-scratch cycle leads to lichenification.
• Infants - face, scalp, extensor, flexural skin creases
• adults - hands

oily scaly skin in regions where sebaceous glands are active (face, scalp - cradle cap, hairline, body folds, chest, back, diaper area)• Orange-red or gray-white skin, often "greasy" or dry scaling macules, papules of varying size, or patches

•dryness, chapping, erythema, blistering and scaling, fissures and crusts.• In some individuals, subjective symptoms (burning, stinging) may be only manifestation• may occur in minutes or delayed to > 24 hrs

•Findings may be erythema; lichenification; round, firm or flat-topped papules and/or vessicles, excoriations and pigmentation. • Sensitization of skin occurs 1-2 weeks after 1st exposure • Subsequent eruption hrs or days after contact

Symmetric, erythematous plaques of silvery-white scale of scalp, elbows, lumbosacral region, knees, hands & feet. • Mildly itchy. • Often Nail pitting is present. • (FYI: 80% of patients with psoriatic nail pitting also have psoriatic arthritis)

• prodrome: malaise•Initially presents with a large salmon colored herald patch on trunk • In few days/ week followed by multiple pruritic plaques with collarettes of scale arranged in a “christmas tree” distribution

•flat-topped, pink to violaceous, shiny, pruritic polygonal papules w/white lines (Wickham striae).•5 P's = pruritic, planar (flat-topped), polyangular, purple papules• sites: wrists, lumbar, shins, scalp, glans penis, mouth

similarity to "fish scales"• mild generalized xerosis (dry skin)w/powdery scaling• sites: shins, arms, legs, cheeks, & forehead

Big rings, not itching, grows• consists of papules in symmetrically annular arrangement • firm, smooth, shiny, beaded, 1-5 cm erythematous dermal papules & plaques• distribution: dorsa of hands, feet, elbows

• General symptoms such as fatigue, fever, arthralgia, mostly of the hands. • butterfly rash & discoid lupus & photosensitivity, 1/3 pts have oral ulcerations•50% of the patients have nephropathy

•starts in the oral mucosa, and months may elapse before skin lesions occur•No itch, but burning + pain•PV: flaccid blisters on skin & erosions on mucous membranes, rupturing•PF: scaly & crusted skin lesions

•lesions are erythematous macules & edematous papules w/ vesicular centers. "target lesions" or "iris lesion"• may be pruritic & painful•may include hemorrhagic crusting of the lips, ulceration of the ocular mucosa, and genital involvement

Gradual onset•fragility of sun-exposed skin, leading to bullae and erosions which are worse on the dorsal hands, face, and forearms. •The healing of crusted erosions and blisters leave scars and hyper/hypo-pigmented atrophic patches

•vesicular superficial infection of the skin•Honey-colored crusts and erosions of nose, lips & chin • pruritus

•Papule or pustule, w/ erythametous halo, discrete lesions (not a bunch of them), small 2mm•Distribution - face, beard area, scalp, neck, legs, trunk, buttocks

Acute, deep-seated, red, hot, tender nodule (1-2 cm), pus collects within•Throbbing Pain & tenderness•The abscess is either round or conical.

•may be accompanied by low-grade fever and malaise.•multiple, adjacent, coalescing furuncles. Dermal and subcutaneous abscesses, superficial pustules, necrotic plugs, and sieve-like openings draining pus

•Red, hot, tender area of the skin; commonly affects one lower leg in adults •The lesion expands over hrs•lesions are not raised, and demarcation from uninvolved skin is indistinct. The tissue feels hard on palpation & is extremely painful.

•pain well out of proportion to the physical findings•High fever, Tachycardia ,Hypotension. •skin appears erythematous and possibly edematous• Dusky blue, with weeping blisters, and border of surrounding cellulitis.

•A tense, painful, sharply demarcated, glissyning, smooth bright red, hot edematous, indurated plaque w/advancing raised borders . • overlying skin streaking and regional lymphadenopathy•Often in the cheeks and lower extremities

•early - pink, 2- to 10-mm macules/papules distributed on trunk/lower extremities, face, arms•Petechiae may coalesce into hemorrhagic bullae or undergo necrosis and ulcerate•Later lesions become purpuric/hemorrhagic

•Red linear streaks and palpable lymphatic cords, usually enlarged and tender, •extend from the local lesion toward the regional lymph node

Fever, sore throat, weight loss, malaise, anorexia•Macules & papules 0.5 to 1 cm, round to oval; pink brownish-red.•1st exanthem always macular and faint.•nontender lymphadenopathy

Erythema & grouped vesicles•Erosions may enlarge to ulcerations•Gingivostomatitis in in children younger than 5 yo characterized by fever, sore throat, pharyngeal edema, and erythema + vesicular or ulcerative lesions

•Verruca vulgaris- firm papules 1-10mm, hyperkeratotic, characteristic "red or brown dots" •Verruca Plantaris - small, shiny, sharply marginated papule -> plaque w/rough hyperkeratotic surface, studded w/brown-black dots

Begins w/ Low grade fever, URI symptoms, mild malaise & myalgia before rash•successive crops of pruritic vesicles that evolve to pustules, crusts, & scars •Lesions begin on the face and scalp, then spread but sparing palms & soles

Predrome 4 days before rashBegins as pain, itch or burning •Characterized by unilateral pain & group umbilicated vesicles on erythematous base in dermatomal distribution• commonly on trunk but face or extremities may be involve

• dimpled or umbilicated Papules (1 to 2mm), or nodules ( 5 to 10 mm) . Pearly white or skin-colored. • lesions asymptomatic unless irritated•Any site may be infected, especially axillae, antecubital, Popliteal fossae, crural folds.

•erythema, scaling, maceration, and/or bulla formation• itching, burning, or stinging• Types: interdigital type, moccasin type, inflammatory bullous type, ulcerative type

Scaly, feels rough, has a clearing in the center, itching, pinkish annular lesions • Distribution - trunks, legs, arms, and/or neck• Size - small to large

•Crusty white area on scalp, very contagious • varying presentations: noninflammatory scaling, scaling & broken-off hair, severe painful inflammation w/painful, boggy nodules that drain pus

• well-demarcated scaling patches, • variable pigmentation: hypo & hyperpigmentation• Distribution: most commonly trunk

Satalite lesions, redness & confluent lesion, • Intertrigo - sharply demarcated, erythematous, eroded patches w/small pustular lesions• Diaper dermatitis - erythema, edema w/papular & pustular lesions

persistent pruritis & minimal cutaneous findings, sparing head & neck. • linear burrows of finger web spaces, wrists, axilla, & scrotum, with minute vesicle or papule at end of burrow

•Pruritic infestation •Myriads of nits (oval, gray-white egg capsules) attached to hair shaft of scalp, neck, & eyelashes. • distribution: pubic & axillary, perineum, thighs, lower legs, trunk, periumbilical, eyelash

•Pruritic infestation •Myriads of nits (oval, gray-white egg capsules) attached to hair shaft of scalp, neck, & eyelashes. • distribution: pubic & axillary, perineum, thighs, lower legs, trunk, periumbilical, eyelash

• open (blackhead) - early• closed (whitehead) comedones - precursors of inflammatory acne lesions • papules & pustules, nodules & cysts over face, chest and back.

•Stage I: persistent erythema w/telangiectases•Stage II: persistent erythema, telangiectases, papules, tiny pustule•Stage III: persistent deep erythema, dense telangiectases, papules, pustules, nodules

• 1-2 mm Discrete erythematous micropapules & microvesicles• Distribution: irregularly grouped, symmetric, often confluent in perioral & periorbital skin

• 1-2 mm Discrete erythematous micropapules & microvesicles• Distribution: irregularly grouped, symmetric, often confluent in perioral & periorbital skin

•wheals are annular, superficial, & well defined•small (<1 cm) to large (>8 cm), erythematous or white with an erythematous rim

•Early: Necrotic epidermis appears as macular areas w/crinkled surface that enlarge & coalesce. •Raised flaccid blisters on erythematous areas,•With trauma, full thickness epidermal detachment resembling 2nd degree burn

•Single or multiple, discrete, dry, rough, scaly lesions•Adherent scale is removed w/difficulty & pain• Skin colored, yellow brown, or brown• Commonly < 1cm oval or round• Site: typically on face

5 clinical types: nodular, ulcerating, sclerosing, superficial, and pigmented•3 P's = “Pearly” pink papule with telangiectasias, rolled borders & central erosionsites: face, scalp, ears, neck

Sharply demarcated, scaling, or hyperkeratotic macule, papule or plaque •Lesions may bleed•distribution: sun exposed areas e.g scalp, dorsum of hands, lower lip, ear

•Dysplastic Nevi can change to melanoma•irregular notched border•irregular topography ie, partly raised & partly flat•color variant: pink, blue, gray, white, and black•Bleeding and ulceration are ominous signs

Violaceous papules -> become purple brown•macule -> evolve to patches, papules, plaques & nodules•lesions may ulcerate and bleed easily•Site: feet, legs, hands & slowly spread centripetally

•Enlarges rapidly during 1st yr & regresses gradually over 2-6 yrs, completed by age 10• Soft, bright red to deep purple nodule or plaque 1-8 cm, rubbery, compressible.• May ulcerate

•irregularly shaped pink to purple, macular capillary malformation that is present @ birth & doesn’t disappear spontaneously• w/ ↑age papules or rubbery nodules develop•site: typically unilateral, involving face

asymptomatic, bright red to violaceous to black lesions• site: usually on trunk, 1st appears at ~30 yrs old

•One or more lobulated tumors which are soft, smooth, well circumscribed, & freely mobile• many are small but may enlarge to >6 cm•site: neck, trunk, extremities.

•button-like dermal nodule•firm, asymptomatic papule or nodule, 3 to 10 mm in diameter, may be pink, brown, or tan.•Texture: dull, shiny, or scaling•site: extremities, legs > arms > trunk

•usually solitary •dermal-to-subcutaneous nodule, 0.5–5 cm, which often connects with the surface by keratin-filled pores•content of the cyst is cream-colored w/pasty consistency & the odor of rancid cheese.

•appears as a dermal nodule •soft to firm, usually elevated, and are filled with an odorous cheesy material. •site: palms, soles, fingers, scalp, face, ears, neck, and back.

soft, skin-colored or tan or brown, round or oval, papilloma. • 1 mm to 10 mm• asymptomatic but may be tender after trauma• sites: axillae, inframmary, goin, neck, eyelids

Maculopapular rash beginning on face, rapidly spreading to the entire body (in 1 day), and disappearing by third day.• Arthralgia, particularly in young women. • No prodrome in children, mild prodrome in adults

Prodrome: fever, malaise, coryza, cough, conjunctivitis•Koplik spots (small, irregular, and red with whitish center)•Clusters of blanching erythematous maculo-papular rash (on day 4) on face/neck & spread in 3 days• includes hands & soles

painful ulcerative oral lesoins•vesicular exanthem on distal extremities• vesicles have clear fluid or yellow hue•predrome 12-24 h of low grade fever, malaise• site: palms/fingers, sole/toes, oral

•Sudden onset of fever, malaise, headache, anorexia, dysphagia, sore throat.•1-2 mm gray-white papules /vesicles -> evolve to ulcers w/ red halos, &red pharynx•Distributed on the anterior tonsillar pillars, soft palate, uvula, and tonsils.

Pruritus, arthalgia common in adult women, NO FEVER•Edematous erythematous plaques on the cheeks ("slapped cheeks") will clear-up & replaced by ->•Erythematous lacy eruption on the trunk and extremities.

High fever in a healthy infant x4 days, after resolves sudden appearance of exanthem•Small blanchable pink macules and papules, 1–5 mm in diameter on trunk & neck• lacy rash•Complication: febrile seizure

Lesions range from small, barely elevated papules to plaques w/warty surface and "stuck on" appearance• beige to brown or even black, 3–20 mm in diameter• occurs in multiples

Café-au-lait macules are not usually present at birth but appear during the first 3 years•dome-shaped or pedunculated invaginations•headaches, fractures, mental retardation, brain tumor, short stature, precocious puberty

rash begins on the 1st or 2nd day of illness over the upper trunk and spreads•Symptoms of pharyngitis•sunburn look w/goosebumps•Exanthem: perioral pallor, erythema on trunk, linear petechiae in body folds, minute papules

Triad: fever, rash, tick bite•Sudden onset fever, severe headache, myalgia•Initially few small pink macules -> deep red papules -> hemorrhagic. Local edema.•Site: rash begins on wrists, forearms, & ankles & spreads centripetally within 6-18hrs

Phase I:Abrupt onset of fever, approx 12 days •Lesions 1-3 days after fever. Confluent macules to plaque-type erythema, Edema of hands/feet•Phase II: until day 30 of illness; fever, Desquamation, arthritis, arthralgia, carditis

•acquired light- or dark-brown hyperpigmentation that occurs in the exposed areas • commonly on the face

•early: mild erythema and scaling associated with pruritus•may become acutely inflamed, w/ crusting and exudate•site: medial aspect of ankle

Asymmetric velvety thickening and hyperpigmentation of the skin, •skin appears dirty•site: chiefly on the neck, axilla, groins, and other body folds

gray-blue macular lesions are characteristically located on the lumbosacral area•usually a single lesion

dome-shaped nodule, reddish, w/central keratotic plug•Rapid growth, achieving a size of 2.5 cm within a few weeks•site: exposed skin: cheeks, nose, ears, hands

•1- to 2-mm, superficial, white to yellow, keratin-containing epidermal cyst, occurring multiply, •Site: eyelids, cheeks, and forehead in pilosebaceous follicles

smooth, firm, dome-shaped, 0.5- to 5-cm nodules or tumors•cyst contains keratin—very dense, homogeneous; often calcified,•frequently as multiple lesions, 90% on the scalp

Throbbing pain, erythema, swelling, pain, ± abscess formation of nail fold•cuticle absent

Thick, opacified nails

reticulated mottling of the skin that symmetrically involves the trunk and extremities

multiple pinpoint- to 1-mm white papules representing benign, superficial keratin cysts•commonly on the nose of infants• if present in the oral cavity, they are called Epstein's pearls

Tiny (< 1-mm) yellow macules or papules are seen at the opening of each pilosebaceous follicle over the nose and cheeks of term newborns

erythematous macules 1 to 3 cm in diameter with a 1- to 4-mm central vesicle or pustule•begin at 24-48 hours of age•lesions can be located anywhere but tend to spare the palms and soles