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12/12 dermatologic diagnostics
Derm
36
Medical
Graduate
12/13/2011

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Cards

Term
steps involved in dermatologic diagnosis
Definition
visual examination

history

diagnostic tests
Term
what to look for during visual examination
Definition
lesion type, sequential lesions/secondary changes, shape, arrangement, distribution
Term
macule
Definition
circumscribed flat area of color change

any size or shape

only difference from surrounding skin is color
Term
things that can result in macules
Definition
hyperpigmentation
hypopigmentation
vascular abnormalities
dilated capillaries
extravasated RBCs (bruise)
Term
papule
Definition
small <1cm circumscribed, solid elevation

projects above the level of the skin
Term
plaque
Definition
circumscribed, solid elevation >1cm

surface area>>height above skin

ex: psoriasis
Term
nodule
Definition
spherically enlarged papule with significant palpability

has length, width, depth to it

descriptors of nodules: firm soft, fixed, mobile, painfull/less
Term
fluid filled lesions
Definition
vesicle
bulla
pustule

separation in the skin, wall often thin allowing visualization of underlying fluid-type
Term
vesicle
Definition
small <0.5cm fluid filled lesion

fluid = serum, lymph, blood
Term
bulla
Definition
larger >0.5cm fluid filled lesion

fluid = serum, lymph, blood
Term
pustule
Definition
circumscribed, elevated lesion containing a purulent fluid (white,yellowish)

contains neutrophils +/- bacteria

PUS FILLED LESION
Term
sequential lesions and secondary changes
Definition
erosion
crust
Term
erosion
Definition
circumscribed, moist, depressed lesion

loss of epidermis

following rupture of vesicle or bulla, or after epidermal necrosis
Term
crust
Definition
dried serum, blood, or purulent exudate

thin/delicate or thick/adherent

commonly from injury, erosion, or infection
Term
lesion shape

vs.

lesion arrangement
Definition
shape: the morphology of the individual lesion

arrangement: how lesions are placed together

both use the same descriptors
Term
linear
Definition
suggests an outside/exogenous cause

i.e. scrape of poison ivy
Term
annular
Definition
ring-like
Term
targetoid
Definition
bulls eye

concentric rings
Term
arciform
Definition
partial ring shape
Term
serpiginous
Definition
snake-like appearance
Term
grouped
Definition
clusters of vesicles ("herpetiform")

lesions following along a dermatome ("dermatomal" or "zosteriform")
Term
reticular
Definition
lacy

net-like
Term
types of diagnostic tests
Definition
blood tests
cultures
KOH examination
Tzanck preparation
patch testing
skin biopsy
Term
types of skin biopsy
Definition
punch biopsy

shave biopsy
Term
impetigo
Definition
most common bacterial skin infection in kids

non-bullous and bullous types

usually staph aureus (some strep pyogenes)
Term
non-bullous impetigo
Definition
70% of all cases

red macule -> vesicle/pustule -> crust

*honey colored crust

affects nose, mouth, extremities, occurs at sites of trauma
Term
bullous impetigo
Definition
all staph aureus

small vesicle -> bulla -> dry erosion (upon rupture)

face, truck, extremities
bullous lesions caused by toxin
Term
pseudomonal folliculitis
Definition
"hot tub" folliculitis

follicular, erythematous papules and p ustules occur at site of exposure
Term
lyme disease/erythema migrans
Definition
annular erythema as bite site

red macule -> papule -> expanding annular plaque

may be edematous, vesicular, or crusted
Term
herpes simplex
Definition
primary and recurrent grouped vesicular eruptions

most are asymptomatic

vesicles -> pustules or ulcerations -> crusts
Term
varicella
Definition
"chicken pox"

transmission via airborne droplets or direct contact with vesicle fluid

infectious until all lesions are crusted

random pustules and crusts

red macules/papules -> vesicles -> pustules -> crusts

lesions present in all stages of development
Term
herpes zoster
Definition
"shingles"

coalescing grouped vesicles in a dermatomal pattern -> crusts
Term
erythema infectiosum
Definition
intial bright red macular erythema on cheeks -> lacy, reticular rash on extremities 1-4 days later

parovirus B19 infection
Term
cercarial dermatitis
Definition
"swimmer's itch"

local inflammatory reaction of cercariae worms penetration of human skin causes erythematous papular eruption
Term
scabies
Definition
linear/serpinginous lesion
papular/pustular eruption

interdigital webs, flexural wrists, axillae, behind ears, waist, ankles, feet, buttocks
Term
brown recluse spider bite
Definition
dermonecrotic reaction through a toxic venom

dusky erythema -> erosion/ulceration
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