Download MBBS Skin Diseases Handbook Lecture PPT

Table of Contents

7. Gyrate Erythema

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Erythema Chronicum Migrans (Lyme

1. Acne

Disease)

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Rosacea

8. Pre-malignant and Malignant Les

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2. Bacterial Infections

ions

Folliculitis

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Actinic Keratoses
Impetigo

Basal Cell Carcinoma

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Squamous Cell Carcinoma
3. Benign Neoplasms

Malignant Melanoma

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Seborrheic Keratoses

Atypical Mole (Dysplastic)
Granuloma Pyogenicum

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Atypical Mole
Lentigo Simplex

Atypical Mole

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Atypical Mole
4. Childhood Infectious Disea

ses/skin Lesions

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9. Psoriasis

Varicella (Chicken Pox)
Psoriasis of the Nails

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Hand, Foot and Mouth Disease
Intertriginous Psoriasis

Verruca Plana
Psoriasis of the Scalp

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Pustular Psoriasis

5. Eczematous Dermatitis

Guttate Psoriasis

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Pityriasis Rosea
Vesicular Hand Dermatitis

10. Sexually Transmitted Diseases

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Seborrheic Dermatitis

Herpes Simplex, Penis

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Nummular Dermatitis

Herpes Simplex, Vulva
Herpes Simplex, Perineum

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6. Fungal Infections

Herpes Simplex in AIDS

Tinea Capitis

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Condyloma Acuminatum (Genital

Tinea Versicolor

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Warts)

Candidiasis

Secondary Syphilis

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11. Stings and Insect Bites

Scabies
Pediculosis (Lice)

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12. Urticaria

Papular Urticaria
Urticaria

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13. Viral Infections

Molluscum Contagiosum
Herpes Simplex
Herpes Zoster

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Rosacea

Rosacea is a congestive blushing and

flushing reaction of the central areas of

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the face. It is usually associated with an

acneiform component (papules,

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pustules, and oily skin). It usually

occurs in middle-aged and older people.

The cheeks, nose, and chin, on the

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entire face, may have a rosy hue.

Burning or stinging often accompanies

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episodes of flushing. It is much more

common than lupus erythematosus, with which it is often confused. Rosacea

is distinguished from acne by age, the presence of the vascular component, and

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the absence of comedones.

Folliculitis

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Folliculitis is characterized by red-ringed
papules and pustules at hair follicles. Gram
negative folliculitis may be spread by
contaminated hot tubs. Gram stain and culture
will help to differentiate bacterial from non

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bacterial folliculitis. History is important for
pinpointing the cause of non-bacterial
folliculitis.
Impetigo

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Superficial honey-colored serous crusts are
characteristic of this disorder. It is usually
caused by a staphylococcus infection. Culture is
rarely reliable.
Seborrheic Keratoses

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These lesions are benign overgrowths of
epithelium, largely appearing on the torso,
face, and neck. They are seen on almost every
one over the age of 50. The borders are

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typically irregular, and they range in color
from beige or gray-white to very dark brown.
These "barnacles" of older skin can number
only a few to as many as hundreds. Although
often raised and dry, they can be flatter and

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greasier (seborrheic) in texture.
Granuloma Pyogenicum

This is a vascular reactive nodule that develops as
a response to a minor injury. The overgrowth of

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capillaries leads to a raised red lump which bleeds
profusely when torn.
Lentigo Simplex
These lesions occur on sun-exposed skin, especially
face, arms, and hands. Lesions are flat, and

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pigmented in shades of brown, with characteristically
sharp borders. They tend to fade with sun avoidance.
Varicella

Chicken Pox

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The rash is pruritic and most prominent on the face,

scalp and trunk. It appears as multitudes of red

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ringed papules and vesicles in varying stages of

development. Crusts eventually form and slough off

in 7 to 14 days. Nondermatomal distribution and

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lesions of varying stages distinguish primary

varicella from herpes zoster. Fever and malaise may be mild in children and

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much more severe in adults.

Hand, Foot, and Mouth Disease

The disorder is characterized by stomatitis and

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vesicular rash on palms of hands and soles of feet. It

is caused by Coxsackieviruses A5, 10, 16. The

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development of mouth sores is most troublesome to

adults. The skin lesions are vesicopustules, 0.5 to 5

mm, red-ringed, more oval than round, on palms,

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sides of fingers and soles.

Verruca Plana

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The numerous discrete lesions, closely set, usually
occur on face, dorsa of hands and shins. Lesions are
flat-topped, slightly elevated, well demarcated,
generally flesh-colored, with a matte-smooth surface.
Lesions tend to spontaneously disappear.

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Pityriasis Rosea

This disorder is a common, but unexplainable,
reaction. The initial lesion, "herald patch", is red and
scaly, followed in 1 to 2 weeks by widespread, oval,

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scaling, fawn-colored macules 4 to 5 mm in
diameter over the trunk and proximal extremities.
Pityriasis rosea is usually an acute self-limiting
illness that lasts 4 to 8 weeks. It is not highly infectious.
Vesicular Hand Dermatitis

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This disorder is a severely pruritic reaction in
individuals with a personal or family history of
allergic manifestations. It is characterized by flares
of congestion resulting in deep and superficial

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blisters, followed by peeling, scaling, and a dry,
reddened surface. Flares generally result from
contact with irritants, but stress is also a significant
factor.
Seborrheic Dermatitis

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Seborrheic dermatitis is generally limited to the scalp;

however, dry scales and underlying erythema can

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occur on the face, ears, chest, back, and body folds.

Skin may be dry or oily. In infants, a widespread

reaction is associated with minimal discomfort. The

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yeast organism, Pityrosporum, may be a factor. Mild

scaling without any erythema is often termed simple

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dandruff. Tinea capitis may simulate dandruff or seborrheic dermatitis, and

scrapings should be taken for KOH examination and fungal culture, especially

in children, if hair loss is present.

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Nummular Dermatitis

A pruritic dermatosis, characterized by round to oval
(coin-shaped) areas of vesiculation, superficial

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crusting, and redness. Number of lesions varies from
few to many. More often this is a symmetrical
pattern in young adults. Not related to atopic
dermatitis.
Tinea Capitis

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Along with hair loss, the scalp surface shows
seborrheic dermatitis-like scaling, impetigo-like
crusting, pustules, inflammatory nodules or kerion.
Identify tinea with KOH culture onto a fungal media.
No longer a disease confined to children. If infection

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suspected, all family members should be examined.
Tinea Versicolor

Asymptomatic to mildly itchy macules that scale

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readily on scraping. Lesions, usually occur on the

trunk, but may appear on upper arms, neck, face,

and groin. Caused by a yeast organism,

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Pityrosporum orbiculare. Altered pigmentation can

be very subtle to obvious, both hypo and

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hyperpigmented. KOH shows characteristic spores and hyphae. Fungal culture

is not useful.

Candidiasis

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Common normal flora, but it may become an

opportunistic pathogen widespread in patients with

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AIDS and other immunosuppressed patients.

Mucocutaneous candidiasis occurs on the vulva, anus,

breast or groin folds. Superficial denuded beefy red

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areas with or without scattered satellite

vesicopustules with marginal scaling. Microscopic examination with 10%

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KOH reveals budding spores and short hyphae.

Erythema Chronicum Migrans

Lyme Disease

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Caused by the spirochete Borrelia burgdorferi, which

is transmitted to humans by a deer tick bite, infection,

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is characterized by erythema migrans. A flat or

slightly raised red lesion appears at the site. The

reaction can become quite large, is generally circular

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in shape, and can show several concentric rings

(target pattern). Erythema migrans is often accompanied by flu-like illness

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with fever, chills, and myalgias. At this stage, laboratory tests are not reliable.

Actinic Keratoses

Actinic keratoses are single or multiple, flesh

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colored or slightly hyperpigmented, dry, rough,
scaly lesions which occur on skin exposed to the
sun. Cells are atypical, and they are considered to
be pre-malignant because some may eventually
become squamous cell cancers.

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Basal Cell Carcinoma

This lesion represents 90% of skin cancers. Basal

cell carcinoma is the most common cancer. On the

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face, it usually starts as a reddened papule or nodule

with a smooth surface and a translucent, pearly

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quality. Because of a poorly formed stroma, it is

fragile and often bleeds. On the torso, the lesion has

an irregular surface, bright red color, sometimes scaly, with a distinct edge.

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Histologic examination is required.

Squamous Cell Carcinoma

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This lesion usually appears on skin that shows other

significant changes of chronic sun exposure.

Especially prevalent in fair-skinned people who

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sunburn easily and tan poorly. It may arise out of

actinic keratoses. Characteristically, the lesion

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appears fairly rapidly as a small red, conical, hard

nodule. Should it appear on the mucus membrane or lip area, it behaves much

more aggressively and can be fatal. Histologic examination is required.

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Malignant Melanoma

Recognized through the mnemonic, "A-B-C-D:"
Asymmetry of contour, irregularity of Border and

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Color, and Diameter larger than 6 mm. Melanomas
vary from macules to nodules. Color ranges from
flesh tints to pitch black and mixtures of white, blue,
purple, and red. Any pigmented skin lesion with
recent change in appearance should be suspected.

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Malignant melanoma can exist in a superficial spreading mode for years and

still be curable by excision with 1 to 2 cm margins. Once a vertical growth
phase develops, rapid spread through blood and lymph vessels occurs.

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Histologic examination is required.
Atypical Moles

Dysplastic change implies abnormal cell
development, which does not necessarily imply

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precancerous change. These atypical moles, show
irregular outlines, and different shades and patterns
of brown color. If they appear in a person with a
family history of melanoma and are multiple in
number, the incidence of cancer developing reaches

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100%. If they are sporadic in pattern and number,
they should be photographed and reexamined
regularly. Histopathologic examination is required.
Psoriasis of the Nails

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Pitting of nail surface with spots of white to yellow
brown (oil droplets) reflects psoriatic changes in the
nail matrix and nail bed respectively. Distally, there
are irregular onycholysis, splitting, and dystrophic
changes. Onycholysis may simulate onychomycosis;

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therefore, fungal culture will be valuable in
diagnosis.
Intertriginous Psoriasis

Sebopsoriasis

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The skin fold areas are shades of red and orange,

with mild to severe itching. The characteristic sign

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is the uniform appearance (unlike tinea) and distinct

border (unlike candida). Generally, a complete skin

exam will reveal other signs of psoriasis.

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Psoriasis of the Scalp

The lesions are red, sharply defined plaques covered
with thick silvery scales. This distinguishes psoriasis

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from the diffuse or patchy redness and scaling of
seborrheic dermatitis.
Pustular Psoriasis

Generally, a chronic, disabling condition of the

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palms and soles, it can also be a part of a very
severe generalized reaction.
Guttate Psoriasis

A form of psoriasis characterized by the rapid

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development of myriad small lesions, 3 to 10 mm in
diameter, on all areas of the body, especially the
extremities. More often seen in young people.
Herpes Simplex, Penis

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Red, sharply marginated, grouped vesicles usually
become crusted sores within 48 hours. Typical
distribution includes prepuce, coronal sulcus, glans,
shaft. Deep aching pain of the perineum may occur
2 to 3 days before appearance of the skin lesions.

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Itchy and painful, lesions generally recur in the
same location.
Herpes Simplex, Vulva

Painful, recurrent, grouped vesicles. Viral

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shedding occurs even when no lesions are present.
This sexually transmitted disease can complicate
pregnancy.
Herpes Simplex, Perineum

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Recurrence of painful sores is a diagnostic sign.
Herpes Simplex in AIDS

Lesion in the perianal area becomes a deeply
ulcerated, very painful, disabling infection.

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Condyloma Acuminatum

Genital Warts

Highly contagious and sexually transmitted, soft,

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skin-colored, fleshy warts can be pin-head papules

or cauliflower-like masses that are caused by the

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human papilloma virus. On the vulva, perianal area,

vaginal walls, cervix, or on the shaft of the penis,

warts can be raised clusters and obviously wart-like, or so small they only

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become recognizable after application of 5% acetic acid (vinegar) for ten

minutes. Lesions must be distinguished from condylomata lata caused by

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syphilis. Diagnosis of syphilis is based on a positive serologic test or discovery

of Treponema pallidum on darkfield examination.

Secondary Syphilis

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Generalized maculopapular eruptions are most

common, although lesions may be pustular or

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follicular as well (or combinations of any of these

types). Condylomata lata are raised, weeping

papules on the moist areas of the skin and mucous

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membranes. The patient generally feels sick, can

have regional lymphadenopathy, but complains only of minimal itching.

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Diagnosis of syphilis is based on a positive serologic test or discovery of

Treponema pallidum on darkfield microscopy.

Scabies

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Scabies is a common dermatitis caused by

infestation with Sarcoptes scabiei. The entire

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family may be affected. Skin lesions are scattered

groups of pruritic vesicles and pustules in "runs" or

"burrows" on the sides of the fingers, palms, wrists,

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elbows, axillae, as well as around the waist and

groin. Itching occurs almost exclusively at night.

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Microscopic examination of a scraping will reveal scabies mites, ova, and

feces.

Pediculosis

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Lice

Pediculosis is a parasitic infestation of the skin of the

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scalp, trunk, or pubic areas. Itching may be very

intense and scratching may result in deep

excoriations over the affected area. Head lice are

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easiest to see above the ears and at the nape of the neck. The nits (egg sacs) are

attached to hairs, close to the skin. Body lice deposit visible nits on vellus hair.

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Head and body lice are similar in appearance and are 3 to 4 mm long.

Papular Urticaria

Almost exclusively in children, this is a widespread

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reaction to insect bites such as fleas, bedbugs,
chiggers, or gnats, and may persist for long periods.
The tendency will fade with onset of adolescence.
Urticaria

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Usually intensely itching intradermal vascular
reaction (wheals or hives). No epidermal changes
such as scaling, papules, or blisters. More often has
an unknown, nonspecific etiology, but can be
related to medications, foods, and similar vascular

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stimulating agents. Laboratory studies are not likely
to be helpful in evaluation unless there are sugges
tive findings in the history and physical examination.
Molluscum Contagiosum

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Caused by a large pox virus, these smooth-walled,
dome-shaped, pearly papules, 2 to
5 mm in size, have an umbilicated center.
Occasionally a significant inflammatory reaction
will occur. Principal sites are face, hands, lower

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abdomen, and genitals. A common viral infection
seen in AIDS. It is more difficult to eradicate in
these patients.
Herpes Simplex

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Small red-ringed blisters can occur anywhere,
especially around oral and genital areas. Associated
and often preceded by burning and stinging.
Regional lymph nodes may be swollen and tender.
Blisters rupture early, leaving serous crusts which

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can then become secondarily infected. Viral cultures
and ELISA are positive.
Herpes Zoster

Red-ringed blisters occur in a dermatomal

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distribution of a nerve root. Papules change to

vesicles which become pustules before crusting.

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New lesions appear for up to one week. Regional

lymph glands may be tender and swollen. Since this

is primarily a nerve infection with secondary skin

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manifestations, it is preceded, accompanied, and

followed by pain. In elderly patients, it is often severe and prolonged. In

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immunosuppressed patients, herpes zoster may disseminate, producing lesions

beyond the dermatome, visceral lesions, and encephalitis. Disseminated Zoster

is a serious, sometimes life-threatening complication.

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