Term
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Definition
Macule
An area of increased or decreased pigmentation without elevation or depression
Approximately 1 cm in diameter
It is not palpable
It is flat and can only be seen and not felt.
Superficial layers |
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Definition
Patch
nMacular type lesion that is greater than 1 cm in diameter |
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Definition
Papule
n small, solid and usually conical elevation of the skin. Do not contain pus, which distinguishes them from pustules. Often occur in clusters and can accompany rashes.
nCaused by:
Inflammation (from infection/abrasion of the skin)
Accumulated secretion of skin tissue (hyperplasia) or glandular fluids
Presence of an infection (disseminated histoplasmosis)
Hypertrophy of skin cells
Acne |
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Definition
Nodule
A solid lesion between 1 and 2 cm in diameter
It is elevated and palpable
It usually invades the epidermis and lower dermis |
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Definition
Tumor
nA solid lesion that has both elevation and depth
nUsually involves epidermis and dermis, and may invade subcutaneous tissue
nMay or may not be clearly demarcated
nGreater than 2 cm in diameter
May or may not be pigmented |
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Lichenification
Often associated with pruritic disorders.
nis the thickening of skin (or epidermis) with accentuation of the normal lines of the skin, giving rise to an appearance resembling a tree bark.
nCommonly seen in chronic eczema (or atopic dermatitis), where there is constant scratching and rubbing of the skin and in lichen simplex chronicus.
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Definition
nA plateau-like elevation that has a surface area greater than its height
nFrequently formed by a confluence of papules
nIf the surface is rough and the skin is thickened, it is called a lichenification |
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Term
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Definition
Wheal
From infiltration of edema into the papillary body of the dermis. Borders are sharp, but not stable. As the papillary edema shifts, each wheal transiently moves from involved areas to adjacent uninvolved areas over a period of hours.
Also called an urticarial exanthem, or urticaria, an allergic response to agents such as drugs or insect bites
Wheals can be reproduced by Darier's sign, and by stroking the skin of certain normal persons who demonstrate the phenomenon called dermatographism |
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Definition
Pustule
A superficial skin cavity that contains a purulent exudate
The exudate may be white, yellow, greenish yellow, or hemorrhagic |
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Definition
Vesicle
nA small superficial skin cavity that contains a non-purulent exudate (serum, lymph, blood or extracellular fluid)
nDiameter < than 0.5 cm
nThe cavity arises from various levels of skin.
if within the epidermis- intraepidermal
if at the epidermal-dermal interface – subepidermal |
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Definition
Bulla
nA vesicle that is > 0.5 cm in diameter
nBoth vesicles and bulla are called blisters
A blister or bulla is a defense mechanism of the human body. When the outer (epidermis) layer of the skin separates from the fiber layer (dermis), a pool of lymph and other bodily fluids collect between these layers while the skin re-grows from underneath.
Blisters can be caused by chemical (allergic rxn) or physical injury (heat, frostbite or friction) . |
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Term
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Definition
Ganglion Cyst
Cyst=
An encapsulated lesion filled with fluid or semisolid material
Elevated, circumscribed, and palpable
A cyst is a closed sac and has a distinct membrane lining.
A collection of pus is called an abscess, not a cyst. Once formed, the cyst will remain in the tissue permanently and can be removed by surgery and by taking medication that will dissolve the "sac".
Antibiotics with bacterial cysts (acne) or steroid injections |
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Crusts (cradle cap)
nDried exudates on skin surface
nBlood gives a brown crust, serum a honey-colored crust, and pus a combination of yellow and green
nEcthyma – thick, adherent crust. Involves the entire epidermis along with necrosis of deeper tissues. |
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Definition
SCALES (DESQUAMATION)
Abnormal areas of stratum corneum
Caused by an increased rate of epidermal cell proliferation (normal life cycle is 27 days)
The stratum corneum normally has no cell nuclei. If the life cycle shortens, the cells may retain their nuclei (parakeratosis)
May be (adherent or loose) and (large sheet like areas or tiny particles like dust) |
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Definition
Ichthyosis vulgaris
Fish scale pattern. Worsen drg cold,dry winter mos. Heritary |
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Definition
Comedone
A plug of dried sebum & dead skin caught in a hair follice opening
The follice may be:
open AKA blackhead, or
closed AKA whitehead |
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Definition
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Definition
Milium
A cyst of a hair follicle or its associated sebaceous gland
A small, white or yellowish cystlike mass just below the surface of the skin, caused by retention of the secretion of a sebaceous gland.
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Definition
Erosion
nA skin defect in which there has been loss of epidermis only
nUsually heals without scar tissue |
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Definition
Ulcer
nA skin defect with a loss of epidermis and upper papillary layer of the dermis
nMay extend into the subcutis and always occurs within pathologically altered tissue
nAlways heals with scar tissue |
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Term
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Definition
Venous Leg Ulcer
(Caused by venous stasis) |
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Definition
Aphthous Ulcer (canker sore)
(Caused by friction and
the Human Papillomavirus) |
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Definition
Laceration
nA tearing of the skin usually caused by an external force |
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Definition
Excoriation
nUsually a self induced laceration of the skin
nAlso called a scratch |
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Definition
Telangiectasia
nTelangiectasias, or spider veins, are small enlarged blood vessels near the surface of the skin; usually measure only a few millimeters.
nCan develop anywhere on the body but commonly on the face around the nose, cheeks, and chin. They can also develop on the legs, specifically on the upper thigh, below the knee joint, and around the ankles. |
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Term
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Definition
Telangiectasia
(Spider Veins) |
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Definition
Petechia and Purpura
nA petechia, (plural petechiae), a small red or purple spot on the body, caused by a minor hemorrhage (broken capillary blood vessels). Pin-dot sized
nPetechiae may be a sign of thrombocytopenia (low platelet count)
nAlso occur in circumstances when platelet function is inhibited (e.g., as a side effect of medications or during certain infections) or when excessive pressure is applied to tissue (e.g., when a tourniquet is applied to an extremity or with excessive coughing). |
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Term
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Definition
Petechiae
nPetechiae in adults should always be quickly investigated.(within a day)
n Can be interpreted as vasculitis, an inflammation of the blood vessels, which requires immediate treatment to prevent permanent damage. Some malignancies can also cause petechiae to appear.
n Consider a Derm referral if labs are ok
nPetechiae in children are particularly common with viral infections. In this setting, they do not necessarily signify serious illness. They are the hallmark of some possibly serious illnesses, however, such as meningococcemia or various causes of thrombocytopenia. |
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Term
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Definition
Ecchymosis
nAKA bruise,contusion, is an injury in which the capillaries are damaged, allowing blood to seep into the surrounding tissue. It is usually caused by blunt impact. Bruises often induce pain but are not normally dangerous.
nSometimes bruises can be serious, leading to other more life threatening forms of hematoma, or can be associated with serious injuries, including fractures and internal bleeding. Minor bruises are easily recognized by their characteristic blue or purple color in the days following the injury. |
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Definition
Purpura
nPurpura is the appearance of red or purple discolorations on the skin, caused by bleeding underneath the skin. Small spots are called petechiae, while large spots are called ecchymosis.
nCommon with: typhus
meningitis due to meningococcal meningitis or septicemia. |
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Term
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Definition
Contusion
A crushing type injury, usually from impact, that does not have accompanying laceration
Is usually caused by blunt impact |
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Term
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Definition
Spider Angioma
nIt has a central body and radiating spider-like legs
nThe central body (punctum) blanches with pressure |
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Definition
Venus Star
nA spider shape that is more blue than red
It does not blanch with pressure |
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Term
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Definition
Cherry Angiomas
nA red vascular lesion that can have macular, papular, nodular, or tumor characteristics
nDue to numerous moderately dilated capillaries
nAppear at age 30 & increase with age
nBenign |
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Term
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Definition
Scar
nFibrous tissue that replaces injured dermis
nRemains confined to the injury site
nCan be atrophic or hypertrophic
nMay be pink, red, or white in color |
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Term
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Definition
Atrophy
nThinning of the skin surface and loss of skin markings
nTranslucent and paper-like appearance
n Complication of prolonged topical steroid use |
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Definition
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Term
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Definition
§The formation of comedones, papules, pustules, nodules &/or cysts
§Pilosebacous units become obstructed with plugs of sebum & despuamated keratinocytesà colonozed, infected with Propionibacterium acnes (P. acne)
nMost common trigger is puberty (surges in androgen stimulate sebum production and hyperproliferation of keratinocytes)
nOther triggers: hormonal changes (pregnancy, menses)
occlusive cosmetics
cleansing agents
clothing
humidity and sweating.
nNo association exists between acne exacerbation and diet (eg, chocolate), inadequate face washing, masturbation
nAcne may improve in summer months because of sunlight's anti-inflammatory effects. Proposed associations between acne and hyperinsulinism require further investigation.
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Term
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Definition
nRosacea (acne rosacea): chronic acneform inflammatory disorder with á capillary reactivity
nCharacterized by: facial flushing
telangiectasia
erythema
papules, pustules
rhinophyma (severe cases)
§Exacerbated by: heat
hot/spicy foods
alcohol
sun exposure
Can precede acne or coexist with acne but is not related. Causes significant cosmetic disfigurement |
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Term
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Definition
Rosacea
nLong standing disease can lead to edema & hyperplasia of tissues of the nose(rhinophyma), cheeks & forehead |
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Definition
nThe etiology of is unknown, although associations with impaired facial venous drainage, an increase in hair mites (Demodex folliculorum), and Helicobacter pylori infection have been proposed.
nThe basic disturbance seems to be one of vasomotor control. Rosacea most commonly affects patients aged 30 to 50 with fair complexions (Irish and Northern European descent) but it is probably under-recognized in darker-skinned patients.
nThe age of onset helps distinguish rosacea from acne |
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Definition
Cellulitis
nAn acute bacterial infection of the skin and sc tissue
nMost often caused by streptococci or staphylococci.
n S&S: pain
rapidly spreading erythema &edema
fever may occur
lymphadenopathy
nCellulitis is most often caused by group A β-hemolytic streptococci (eg, S. pyogenes) and Staphylococcus aureus.
nStreptococci: diffuse, rapidly spreading infection because enzymes produced by the organism (streptokinase, DNAase, hyaluronidase) break down cellular components that would otherwise contain and localize the inflammation.
nStaphylococcal cellulitis: typically more localized
occurs with an open wound or
cutaneous abscess
nRisk factors include skin abnormalities (eg, trauma, ulceration, fungal infection, other skin barrier compromise due to preexisting skin disease), which are common in patients with chronic venous insufficiency or lymphedema.
nScars from saphenous vein removal for cardiac or vascular surgery are common sites for recurrent cellulitis, especially if tinea pedis is present. Frequently no predisposing condition or site of entry is evident. |
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Term
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Definition
Impetigo
nA superficial skin infection with crusting or bullae
nCaused by streptococci, staphylococci, or both.
nNo predisposing lesion is identified in most patients, but impetigo may follow any type of break in the skin. Risk factors seem to be moist environment, poor hygiene, and chronic nasal carriage of staphylococci.
nMay be bullous or nonbullous. Bullae are caused by exfoliative toxin produced by staphylococci.
nNonbullous impetigo typically presents as clusters of vesicles or pustules that rupture and develop a honey-colored crust (exudate from the lesion base) over the lesions.
nBullous impetigo is similar except that vesicles typically enlarge rapidly to form bullae.
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Term
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Definition
Basal Cell Carcinoma
nmost common type of skin cancer
n> 400,000 new cases yearly in the US.
nMore common in fair-skinned, sun-exposed persons
nVery rare in African Americans.
nBegins as a shiny (pearly) papule, enlarges slowly, and, after a few months or years, shows a shiny, pearly border with prominent engorged vessels (telangiectases) on the surface and a central umbilication or ulcer.
nRecurrent crusting or bleeding is not unusual, and the lesion continues to enlarge slowly
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Term
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Definition
Melanoma
nArises from melanocytes in a pigmented area: skin, mucous membranes, eyes, and CNS
nMetastasis is correlated with depth of dermal invasion. Is highly unpredictable.
Prognosis is poor with metastasis
nThose with one or more 1st-degree relatives with a history of melanoma have an increased risk (up to 6 or 8 times) over those without a family history.
nAbout 40 to 50% of melanomas develop from pigmented moles; almost all the rest arise from melanocytes in normal skin. Precancerous lesions include atypical moles (dysplastic nevi)
nMelanomas also occur on the mucosa of the oral and genital regions and conjunctiva.
nMucosal melanomas (especially anorectal melanomas), which are more common in nonwhites, have an unfavorable prognosis. |
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Term
Evaluation of skin lesions:
A
B
C
D
E |
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Definition
A:Asymmetry - the two sides of the pigmented area do not match
B: Border - irregular, blurry or jagged (exhibits indentations). Can also stand for bleeding.
C: Color - more than one pigmented area: black, brown, tan, and sometimes red or blue. Can also stand for changing.
D: Diameter - larger than 6 mm (size of a pencil eraser)
E: Elevation - the mole is raised above the surface and has an uneven surface |
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Term
| image of ABCDs of melanomas |
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Definition
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Term
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Definition
nSCC is a malignant tumor of epithelial keratinocytes (skin & mucous membrane)
nUsually seen >55 yrs old
ná with sunlight exposure in whites & in geographical areas with á sunshine
BCC: has rolled, well defined margins |
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Term
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Definition
Atopic Dermatitis
nAn immune-mediated inflammation of the skin, often with a significant genetic component
nPruritus is the primary symptom
nSkin lesions range from mild erythema to severe lichenification
Typically appears in:
antecubital and popliteal fossae
eyelids, neck, and wrists
nMay be linked to pro-allergic/pro-inflammatory T-cell immune responses
nEnvironmental exposures trigger immunologic, usually allergic (ie, IgE-mediated), reactions in genetically susceptible people
nTriggers: food(eggs, soy, wheat, peanuts,
fish, milk)
airborne allergens (dust mites,
mold, dander)
S.aureus on skin
Primarily affects children in urban areas or developed countries; at least 5% of children in the US are affected |
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Term
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Definition
Contact Dermatitis
nAcute inflammation of the skin caused by irritants or allergens
nPrimary symptom is pruritus (itching)
nSkin changes range from erythema to blistering and ulceration, often on or near the hands but occurring on any exposed skin surface |
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Term
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Definition
Vitiligo
nAKA leukoderma
nLoss of pigment from an area of skin
nCan occur suddenly
nAssociate vwith pernicious anemia, hyperthyroidism & diabetes
nWell demarcated
nDe[igmented areas can burn in sunlight
nCan occur at any age
nEqual in men & women
nCause: unknown
nInheritance & autoimmune factors have been implicated
nAffected areas spread over time
nOf great cosmetic distress to darkly pigmented people of all races
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Term
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Definition
PITYRIASIS ROSEA
nAcute exanthum (rash) disruption
nCharacteristic course:
“herald” lesions develops – single,
usually on the trunk
generalized eruption develops 1-2
wks later in a “Christmas tree”
pattern
§Remits spontaneously in 6 wks w/o Rx
nCause: unknown
nMay be viral or a rxn to a previous virus
nPatches are usually salmon colored & are located on the trunk primarily
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Term
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Definition
Drug Eruptions
nAccount for <1% of all AE effects of drug administration
nUsually begin within a week although rxns to PCN can occur later
ná rxns in women
nCommon drugs: ampicillin/PCN
cephalosporins
barbiturates
thiazides
sulfanomides
nHypersensitive immune reaction
nThe drug may act as a hapten & bind to proteins to form structures not recognized by the immune system
nPE: erythematous, maculopapular exanthem(rash)
widely dispersed pruritic lesions
clear over several wks
§Uncommon: urticaria
erythema multiforme
(including Stevens-Johnson syn)
exfoliative dermatitis
photosensitivity
vasculitis
fixed drug eruption |
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Term
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Definition
Folliculitis (this case is from hot tub)
nUsually an infection of upper portion of a hair follcile. Can extend to the entire length of the follicle (sycosis).
nPE: folliular papule
pustule
erosion/crust at follicular infundibulum
nCause: S. aureus (impetigo, furuncle or
carbuncle formation)
P. aeruginosa (“hot tob”)
Gram neg bacteria
Dermatophytes (tinea capitis,
tinea barbae)
Candida |
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Term
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Definition
Verruca (Warts)
§An exaggeration of normal skin composition
§S. corneum is irregularly thickened
§Vary in appearance, depending on their location
§Caused by HPV viruses
§Transmission: skin-to-skin contact
immunocompromise
in the plume from warts treated
with laser or electrosurgery
§Minor trauma with breaks in S. corneum facilitate infection
á risk in meat handlers, butchers
nTypes: V. vulgaris - common warts
V. plantaris - Plantar warts
V. plana – flat warts
§Contagion occurs in groups – small(home) or large (school gyms)
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Term
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Definition
PSORIASIS
nInflammation of epidermis & dermis with hyperproliferation of keratinocytes
nCommon, chronic skin disease
nManifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales
nEtiology: unknown
multifactorial, inherited condition of the immune system
§Disease is unpredictable and can wax & wane
nTriggers: trauma, infection, and certain drugs
nSx: usually minimal
occasional mild itching
cosmetic implications may be major
can develop severe disease with painful arthritis
(Psoriatic arthritis)
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Term
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Definition
Psoriasis
nAffects about 1 to 5% of the population worldwide; light-skinned people are at greater risk
nPeak onset: 16 to 22 and at ages
57 to 60
can occur at any age.
nFHx is common, suggesting a genetic component
nLesions: widespread – can extend out
asx or mildly pruritic
sites: scalp
**extensor surfaces of elbows, knees**
sacrum/buttocks/penis
nails
eyebrows
axillae
nSeveral types: P.vulgaris(chronic plaques) – most common
guttate pustular
arthritic numular
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Term
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Definition
SEBORRHEIC DERMATITIS
n(SD) - inflammation of skin with a high density of sebaceous glands (face, scalp, upper trunk)
nSx develop gradually
nEtiology is unknown
Pityrosporum ovale, a normal skin organism, plays some role
nIncreased frequency in pts with HIV, certain neurologic diseases
•Dx: PE
occasional pruritus
dandruff
yellow, greasy scaling along the hairline & face
• á with emotional/physical stress
cold weather
• may be associated with psoriasis
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Term
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Definition
nSuperficial, skin infection with Candida sp (C.albicans)
nOccurs most commonly in: intertriginous areas (skin folds) such as the axillae, groin, and gluteal folds (eg, diaper rash)
digital web spaces
the glans penis
beneath the breasts.
nCandidal nail infections and paronychia may develop after improperly performed manicures and in kitchen workers and others whose hands are continually exposed to water.
n**Oropharyngeal candidiasis is a common sign of local or systemic immunosuppression**
•S&S: PE - pruritic, well demarcated, erythematous
patches
can have satellite lesions & pustules
perianal candida can produce pruritus ani &
maceration
vulvovaginal candida causes pruritus &
discharge in women
nRisk factors include:
hot weather
restrictive clothing
poor hygiene (infrequent diaper /undergarment changes in children and elderly patients)
altered flora from antibiotic therapy
immunosuppression from corticosteroids & immunosuppressants
pregnancy
diabetes, other endocrinopathies (eg, Cushing's disease, hypoadrenalism, hypothyroidism), blood dyscrasias, or T-cell defects)
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Term
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Definition
Paronychia
Inflammation of the folds of tissue surrounding the nail due to infection. The infection may be bacterial (most commonly, staph or strep) or to fungal. |
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Term
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Definition
nDermatophytes are molds that require keratin for nutrition and must live on stratum corneum, hair, or nails to survive. May exist indefinitely.
nCaused by Epidermophyton, Microsporum, and Trichophyton spp.
nRarely if ever invasive
nTransmission: person-to-person a
animal-to-person
soil-to-person
nOrganism virulence and host susceptibility and hypersensitivity determine severity.
nSx: asymptomatic
mild pruritus a scaling, slightly raised border
wax & wane (come and go)
nWith severe inflammation, sudden vesicular or bullous disease (usually of the foot) or as an inflamed boggy lesion of the scalp (kerion) can occur
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Term
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Definition
Tinea Capitis
Tinea Pedis (Athlete’s foot)
Tinea Cruris (Jock itch)
Tinea Versicolor
Tinea Corporis |
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Term
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Definition
Tinea versicolor
(Dermatophyte Infection) |
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Term
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Definition
Tineas Pedis
(Athlete's Foot)
Dermatophyte infection |
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Term
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Definition
Tinea Cruris (Jock itch)
dermatophyte infection
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Term
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Definition
ONYCHOMYCOSIS = fungal infection of the nail
Tinea unguium =Dermatophyte infection of the nails
nFungal infection of the nail plate, nail bed, or both
nRisk factors include tinea pedis, preexisting nail dystrophy, older age, male sex, and circulatory disease
nToenails are 10x more commonly infected than fingernails
nMajority are caused by dermatophytes (Trichophyton rubrum)
nOther causes: nondermatophyte molds (eg, Aspergillus, Scopulariopsis, Fusarium) |
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Term
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Definition
KELOIDS
nSmooth overgrowths of fibroblastic tissue. Arise in an area of injury (eg, surgical scars, truncal acne) or spontaneously
nMore frequent in people with pigmented skin. They tend to appear on the upper trunk/back, mid chest, and deltoid areas.
n**Unlike hyperplastic scars, keloidal scar tissue always extends beyond the area of original injury.**
nKeloids are shiny, firm, smooth, often dome-shaped, and slightly pink.
nDx: PE
nTx: corticosteroid injections
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Term
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Definition
SEBORRHEIC KERATOSIS
nSeborrheic keratoses are pigmented superficial epithelial lesions that are usually warty but may occur as smooth papules.
nEtiology is unknown
nCommonly occur in middle or old age
nMost often appear on the trunk or temples
nIn blacks, especially women, small keratoses often occur on the malar part of the face (dermatosis papulosa nigra).
nVary in size and grow slowly.
nMay be round or oval; flesh-colored, brown, or black.
nUsually appear “stuck on” and may have a verrucous, velvety, waxy, scaling, or crusted surface.
nDx: PE
nAre not premalignant
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Term
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Definition
ACTINIC KERATOSIS
nAKA Solar keratosis
ná overgrowth of atypical keratinocytes
nAre confined to the epidermis
nPrecancerous skin growth, caused by UV exposure
nPE: rough & dry papules/patches
scaling may be present
erythematous, poor margins
§Small percent can progress to SCC
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Term
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Definition
ACANTHOSIS NIGRICANS
nA diffuse, velvety thickening. Hyperkeratosis & hyperpigmentation of the skin
nUsually noted in the axillae & other body folds, neck
nMay be inherited
nAssociated with: endocrine disorders
obesity
drugs (nicotinic acid, DES,
glucocorticoids, growth
hormone)
nEndocrine disorders (with insulin resistance)
diabetes mellitus
hyperandrogenic states(PCOS)
Cushing’s disease
Acromegaly/gigantism
hypogonal syndromes
Addison’s disease
hypothyroidism
obesity
§Onset: childhood, puberty |
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Term
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Definition
nStratum basale – deepest layer, attached to underlying dermis
nStratum spinosum(prickly layer) – several layers thick
nStratum granulosum(granular layer) – keratinization begins here
nStratum lucidum(clear layer) –
nStratum corneum(horny layer) – outermost, accounts for ¾ of epidermal thickness. Protects against penetration & abrasion, waterproof |
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Term
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Definition
nFlexible connective tissue
nSemi-fluid, binds the body together
nNerve fibers, blood & lymph vessels, hair follicles,oil & sweat glands are here
n2 layers: Papillary layer
Reticular layer |
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