Widespread increase in melanin may be caused by Addison's (hypofunction of adrenal cortex) or pituitary tumors

More common = local areas of increased or decreased pigment

Slightly but uniformly pigmented macule or patch with somewhat irregular border, usually 0.5-1.5cm diameter

Benign

>6 spots, each with diameter >1.5cm suggestive of neurofibromatosis

Common superficial fungal infection of skin, causing hypo- or hyperpigmented

Slightly scaly macules on trunk, neck, and upper arms (short-sleeved shirt distribution)

Easier to see in darker skin and may be more obvious after tanning.

Can appear as tan, flat, scaly plaques

Lighter skin-->may look reddish or tan instead of white

Depigmented macules appear on face, hands, feet, extensor surfaces, and other regions

May combine into extensive areas that lack melanin

Brown skin = normal; abnormality = pale areas

May be hereditary

Makes skin diffusely yellow

Seen most easily and reliably in sclera; also in mucous membranes

Causes: liver disease, hemolysis of RBCs

Yellowish palm; sometimes subtle

Does not affect sclera

Cause: diet high in carrots and other yellow vegetables or fruits

Not harmful, but indicates need for assessing dietary intake

Red hue, increased blood flow

"slapped cheeks"

Erythema Infectiosum ("fifth disease")

Violaceous (violet) patches over eyelids 

Seen in dermatomyositis (a collagen vascular disease)

Reddish oval ringworm-like papules or plagues

Associated with "Herald lesions"

Silvery scaly papules or plagues

Mainly on extensor surfaces

Initial presentation of a lesion

Can be flat, nonpalpable lesions with changes in skin color; solid palpable elevations; or fluid-filled palpable cavities

Macule

Patch

Hemangioma

Vitiligo

Cafe-au-lait spot

Small spot- up to 1cm

Flat, nonpalpable lesion with change in skin color

Larger spot - > 1cm

Flat, nonpalpable lesion with change in skin color

Plaque

Psoriasis

Papule

Nodule

Cyst

Wheal

Elevated lesion > 1cm

Often formed by coalescence of papules

Palpable elevation - solid bump

< 1cm

Palpable elevation - solid bump

Knot-like lesion

>0.5cm

Deeper and firmer than papule

Palpable elevation - solid bump

Nodule filled with expressible material, either liquid or semisolid

Palpable elevation - solid bump

Irregular, relatively transient, superficial area of localized skin edema

Ex- urticaria

Palpable elevation - solid bump

Vesicle

Bulla

Pustule

Burrow (scabies)

< 1cm

Filled with serous fluid

Ex- Herpes simplex; Herpes zoster

Palpable elevation with fluid-filled cavity

> 1cm

Filled with serous fluid

Ex- insect bites

Palpable elevations with fluid-filled cavities

Filled with pus

Ex- acne, small pox

Palpable elevations with fluid-filled cavities

Tiny slightly raised tunnel in epidermis, commonly found on finger webs and on sides of fingers

Looks like a short (5-15mm), linear or curved gray line and may end in a tiny vesicle

Lesions include small papules, pustules, lichenified areas, and excoriations

With a magnifying lens, look for burrow of the mite that causes scabies

Palpable elevation with fluid filled-cavities

Seen in overtreatment, excess scratching, and infection of primary lesions. Can also be depressed lesions

Can be scales, crust, lichenification, scars, or keloids

Depressed secondary lesions: erosion, excoriation, fissure, ulcer

A thin flake of dead exfoliated epidermis

Ex- Ichthyosis vulgaris, dry skin

Dried residue of skin exudates, such as serum, pus, or blood

Ex- Impetigo

Visible and palpable thickening of the epidermis and roughening of the skin with increased visibilityo f the normal skin furrows

Often from chronic rubbing

Ex- Neurodermatitis

Nonscarring loss of the superficial epidermis

Surface is moist, but does not bleed

Ex- aphthous stomatitis (canker sore); moist area after rupture of a vesicle, as in chickenpox

Linear or punctate erosions caused by scratching

Ex- cat scratches

Linear crack in the skin

Often from excessive dryness

Ex- Athlete's foot

Deeper loss of epidermis and dermis

May bleed and scar

Ex- stasis ulcer of venous insufficiency, syphilitic chancre

Spider Angioma

Spider Vein

Cherry Angioma

Fiery red, <2 cm

Central body, sometimes raised, surrounded by erythema and radiating legs

Pressure on spider body causes blanching of spider center

Found on face, neck, arms, and upper trunk. Almost never below the waist

Often seen in liver disease, pregnancy, and vitamin B deficiency

Can be a normal finding

Bluish color. Varying sizes from very small to several inches

May resemble a spider, or be linear, irregular, and cascading

Pressure over center does not cause blanching, but diffuse pressure blanches the veins

Most often seen on legs, near veins; can also be found on anterior chest

Often accompanies increased pressure in superficial veins (like varicose veins)

Bright or ruby red; may become purple with age. 1-3mm

Round, flat or sometimes raised, may be surrounded by pale halo

May show partial blanching, especially if pressure applied with edge of a pinpoint

Found on trunk and on extremities

No significance; increases in size and numbers with aging

Petechia/Purpura

Ecchymosis

Deep red or reddish purple, fading away over time

Petechia = 1-3mm, Purpura = >3mm

Round, sometimes irregular; flat

No blanching from pressure

Found all over

Significance: blood outside the vessls; may suggest a bleeding disorder, emboli to skin (petechiae), or vasculitis (purpura)

Purple/purplish blue, fading to green, yellow, and brown with time. >3mm

Rounded, oval, or irregular; may have a central subcutaneous flat nodule (hematoma)

No blanching from pressure

Found all over body

Significance: blood outside vessels; often secondary to bruising or trauma; seen in bleeding disorders

Actinic Keratosis

Seborrheic Keratosis

Basal Cell Carcinoma

Squamous Cell Carcinoma

Superficial, hyperkeratotic papules

Often multiple; can be round or irregular; pink, tan, or gray

Found on sun-exposed skin of older, fair-skinned people; most comon on face and hands

Considered to be dysplastic or precancerous

Common, benign, whitish-yellowish to brown raised papules or plaques

Feel slightly greasy and velvety or warty; have a "stuck on" appearance

Typically multiple and symmetrically distributed on the trunk of older people, but can also appear on face and elsewhere

In younger black women, may appear as small, deeply pigmented papules on cheeks and temples (dermatosis papulosa nigra)

Malignant, but grows slowly and almost never metastasizes

Most common in fair-skinned adults >40, and on face

Initial red macule or papule may develop a depressed center and a firm, elevated border

Telangiectatic vessels are often visible

Usually appears on sun-exposed skin of fair-skinned adults >60

May develop in an actinic keratosis

Grows quicker than basal cell and is firmer and redder

Face and dorsum of hand most often affected

Asymmetry

Irregular Borders (especially notching)

Color variation (esp mixes of black, blue, white, and red)

Diameter > 6mm

Evolution or change in size, symptoms, morphology

On darker skin, look for melanomas under nails, on hands, or on soles of feet

Intense year-round sun exposure

Blistering sunburns in childhood

Fair skin that freckles or burns easily (esp if blonde or red)

Family history of melanoma

Changing or atypical nevi (esp if >50 years old)

Malignant tumore may appear in many forms: macules, papules, plaques, or nodules almost anywhere on the body

Lesions are often multiple and may involve internal structures

Clearly demarcated round or oval patches of hair loss

Usually affecting young adults and children

No visible scaling or inflammation

Hair loss from pulling, plucking, or twisting hair

Hair shafts are broken and of varying lengths

More common in children, often in settings of family or psychosocial stress

AKA Ringworm

Round scaling patches of alopecia

Hairs are broke off close to surface of scalp

Usually caused by fungal infection from Trichophyton tonsurans from humans, less commonly from microsporum canis from dogs or cats

Mimics seborrheic dermatitis

Superficial infection of the proximal and lateral nail folds adjacent to the nail plate

Nail plates often swollen, red, and tender; may spread to surround the entire nail plate

Most common infection of the hand, usually from S. aureus or strep species

Comes from local trauma d/t nail biting, manicuring, or frequent hand immersion in water. Chronic infections may be r/t candida

Bulbous swelling of soft tissue at nail base, with loss of normal angle between nail and proximal nail fold

Angle >180*; nail feels spongy or floating

Seen in congenital heart disease, interstitial lung disease, lung CA, inflammatory bowel diseases, and malignancies

Painless separation of whitened opaque nail plate form pinker translucent nail bed. Starts distally, and progresses proximally, enlarging the free edge of the nail

Local causes: trauma from excess manicuring, psoriasis, fungal infection, allergic rxns to nail cosmetics

Systemic causes: DM, anemia, photosensitive drug rxns, hyperthyroidism, peripheral ischemia, bronchiectasis, syphillis

Nail plate turns white with a ground-glass appearance, a distal band of reddish brown, and obliteration of the lunula

Commonly in all fingers, but may only affect one

Seen in liver disease (usually cirrhosis), heart failure, DM. May arise from decreased vascularity and increased connective tissue in nail bed

AKA Leukonychia

Trauma to nails is commonly followed by nonuniform white spots that grow out slowly with nail

Common in over manicuring

AKA Mees' Lines

Cross the nail parallel to the lunula

Comes from disrupted matrix of proximal nail

Vary in width and move distally as nail grow out

Timing of illness may be estimated by measuring distance from the line to the nail bed (nail grows ~1mm/6-10 days)

Seen in arsenic poisoning, heart failure, Hodgkin's, chemo, carbon monoxide poisoning, leprosy

AKA Beau's Lines

Comes from temporary disruption of proximal nail growth with systemic illness

Timing of illness may be estimated by measuring distance from the line to the nail bed (nail grows ~1mm/6-10 days)

Seen in severe illness, trauma, and cold exposure if Raynaud's present

Punctate depressions of nail plate caused by defective layering of superficial nail plate by the proximal nail matrix

Usuall associated with psoriasis, but also seen in Reiter's syndrome, sarcoidosis, alopecia areata, and localized atopic or chemical dermatitis