| flat lesions | § Macule – flat circumscribed area of skin <0.5cm
Patch – flat circumscribed areas of skin >0.5cm |
| Lumpy lesions small | Papule raised but less than .5 |
| Lumpy lesions big | Nodule greater than .5 |
| Plaque on skin | Larger superficial topped lesions |
| Fluid filled lesion | Vesicle – fluid filled lesion <0.5cm
Bulla – fluid filled lesion >0.5cm |
| what is a pus filled lesion called | Pustule |
| A weal is a | raised erythematous lesion with surrounding flare/oedema |
| Lithication is | a thick topped thickening of the skin secondary to scratching |
| Scale is a | – visible and palpable flakes due to aggregation/abnormal shedding of epidermal cells |
| Ulcer – | a loss of epidermis (often with loss of underlying dermis and subcutis) |
| Inflammatory dermatoses | Eczema
Atopic
Contact dermatitis
Urticaria and angioedema
Psoriasis
Lichen planus |
| Eczema is | dermatitis |
| Endogenous eczema is | atopic or sebbhoreic |
| Atopic eczema | erythema
Scaling
Lichenification
Pruritus
Secondary infection (Staph. Aureus) |
| Tx of eczema | Emollients
Topical corticosteroids
Antibiotics (anti-staph. Aureus)
Phototherapy
Immunosuppression
Ciclosporin (Gum hypertrophy)
Methotrexate
Azathioprine |
| Seborrheic eczema | Facial rash
Erythema
Scaling
‘cradle cap’
Pityriasis capitis (bad dandruff) |
| Contact dermatitis | Allergic contact dermatitis
Immune mediated
Type IV hypersensitivity
Allergens
Latex (+ type I reactions)
Acrylates
Metals
Cinnamates (toothpaste)
Balsam of peru (toothpaste) |
| Urticaria and angiodema | Type I (type II) hypersensitivity
Mast cell mediated erythema
Erythema
Oedema
Pruritus (urge to itch)
Drugs
Aspirin/NSAID
Opiates |
| Psoriasis | Common (1-2% population)
Family history ++
Erythema
Silver scale
Extensors
Hard to distinguish on the face between psoriasis and eczema |
| Lichen planus: skin | Very itchy
Usually wrists
Symmetrical
Purple/violaceous, shiny
Polygonal and flat topped
Wickham striae (white lines)
Cause unknown
Self-limiting
Rx: topical steroids |
| Lichen planus in mouth | tx soluble prednisolone try toothpaste without sodium lauryl sulphate |
| Folliculitis | Staphylococcal
Outer part of follicle
Painful pustules
Hair in centre
(ingrown hair) |
| Erysipelas/cellulitis | Streptococcal
Dermal infection
Systemic upset
Well demarcated
Tender
Unilateral
Urgent treatment with antibiotics |
| Herpes simplex | HHV-1 and 2
Grouped vesicles
Painful
Prodrome |
| Herpes zoster | Varicella-zoster
Painful
Dermatomal
Prodrome |
| Blistering diseases | Erythema multiforme (SIS -TEN)
Pemphigus
Bullous pemphigoid |
| Erythema multiforme | Asymptomatic rash
Acral distribution
Symmetrical target lesions
Usually found in the oral cavity
Self-limiting
HSV
Drugs
Idiopathic (50%)
Good to take a viral swab from to confirm whether is it HSV related or not |
| Pemphigus (superficial) | Widespread, flaccid, superficial blisters
Painful erosions
Caused by circulating auto-antibodies that disrupt the desmosomal attachment between the skin and the keratinocytes
Usually trunk
Extensive de-nucleation
No scarring
Autoimmune process Px = immunosuppression
Long term steroids can lead to: |
| Pemphigoid (deep) | Very itchy
Tense deep blisters
Initially thighs
Clear à haemorrhagic
Crusting
No scarring
Autoimmune process
Rx = immunosuppression |
| Cicatricial pemphigoid: oral | Rare form of bullous pemphigoid
Characterised by painful subepithelial blistering and scarring |
| non urgentcancer of the skin | Basal cell not too urgent |
| squamous cell carcinoma | more serious ulceration urgent referral |
| Malignant melanoma | History of change
Irregular colour
irregular border
Urgent referral |
| Lentigo maligna | In situ melanoma
Sun exposed skin
Flat pigmented lesion
Irregular colour
Irregular border
Urgent referral |
| Benign pigmented lesions | Labial melanotic macule
Provoked by sun exposure
More common in fair skinned people
May also occur in dark skinned individuals
Melanotic macules are harmless |
| Multiple lesions may be a sign of a widespread skin condition, such as: | Addison disease
Peutz-Jegers syndrome
Rare inherited disease characterised by gastrointestinal polyps in association with pigmentation affecting skin and mucous membranes
Laugier-Hunziker syndrome
Harmless rare sporadic disorder characterised by flat brown marks on the lips and inside the mouth, and frequently brown stipes on the nails |
| Mucocele of the lip | Form when mucous or saliva escapes into surrounding tissues |
| Botox contra indic. | Aminoglycoside antibiotics (may increase effect of botulinum toxin)
Chloroquine and hydroxychloroquine (may reduce effect)
Blood thinning agents e.g. warfarin or aspirin (may result in bruising)
pregnant etc... |
