1st Dermatology Practicals

• May F. Gonzales, MD,

FPDS
 REGIONAL VARIATIONS
• Epidermis- thickest on
palms and soles,
thinnest on eyelids
• Dermis- thickest on
back
• Subcutaneous- thickest
on abdomen and
buttocks
Epidermis
• Horny layer/stratum
corneum
• Granular layer
• Spinous/Malphigian/Pri
ckle
• Basal layer
 EPIDERMIS
• Keratinocytes EPIDERMAL APPENDAGES
• Melanocytes – Eccrine sweat unit
– Apocrine unit
• Langerhans cell – Hair follicle- anagen, catagen,
• Indeterminate dendritic telogen
– Sebaceous glands
cell
• Merkel cell
 PRIMARY LESIONS
• Macule
• Patch
• Papules
• Plaque
• Nodule
• Tumor
• Wheals (Hives)
• Vesicles (Blisters)
• Bullae
• Pustule
PRIMARY LESIONS
• Macule
– <1cm, change in skin color
– No elevation or depression
(nonpalpable)
– can be hypopigmented, as in
actinic lentigines
vitiligo;
– pigmented, as in a freckle (a);
or erythematous as in a
capillary haemangioma (b).

solar lentigo
PRIMARY LESIONS
Patch
– Large macule
– > 1cm in diameter
– Seen in nevus flammeus or
vitiligo

Patch - a
combination typical
of neurofibromatosis.
This patch is a caf้-
au-lait spot.
PRIMARY LESIONS
Papules
– A circumscribed, solid
elevation with no visible
fluid
– From a pinhead to 1cm

lichen planus
PRIMARY LESIONS
Plaque
– Is a broad papule (or
confluences of papules)
– 1cm or more in diameter
– Generally flat, but may
be centrally depressed
PRIMARY LESIONS
 PRIMARY LESIONS
Nodule
– Morphologically similar
to papules but larger
than 1cm in diameter
– Most frequently are
centered in the dermis

neurofibromatosis squamous cell carcinoma

PRIMARY LESIONS
Cyst
– Nodule filled with liquid or
semi solid
PRIMARY LESIONS
Tumor
– Are soft or firm and free
movable or fixed masses of
various size and shapes
(>2cm)
– Elevated or deep seated
PRIMARY LESIONS
Wheals (hives)
– Are evanescent, edematous,
plateau-like elevations of
various sizes
– Usually oval or arcuate
contours, pink to red, and
surrounded by a “flare” of
macular erythema
– Prototypic lesion of urticaria

urticaria
PRIMARY LESIONS
Vesicle (Blister)
– < 1 cm. Elevation filled
with fluid no pus

pemphigus

pompholyx
 PRIMARY LESIONS
Bullae
– > 1 cm. Elevation filled with
fluid no pus (bigger Vesicle)

erythema multiforme
PRIMARY LESIONS
Pustule
– Any size elevation filled
with pus

Pompholyx
•Pustule
•Bullae
•Vesicle
 SECONDARY LESIONS
• Scales (Exfoliations)
• Crusts (scabs)
• Excoriations and
Abrasions (scratch
marks)
• Fissures (cracks, Clefts)
• Erosions
• Ulcers
• Scars
SECONDARY LESIONS
Scales (Exfoliation)
– Dry or greasy laminated
masses of keratin
– Stratum corneum
– Dry skin, dandruff, thin
flake

Bulb patch + Scale ; Tinea capitis

 SECONDARY LESIONS
Crusts (Scabs)
– Mixture = serum + pus +
epithelial + bacterial
debris

Atopic dermatitis

Tinea barbae
 SECONDARY LESIONS
Excoriation and Abrasions
(Scratch Marks)
– Linea or punctate
erosion erosion cause by
scratching
– epidermis

atopic dermatitis
SECONDARY LESIONS
Fissure (Crack)
– A linear split in the
epidermis, often just
extending into the
dermis
Erosion
– Loss of all epidermis
layer
 Ulcer
– Loss of epidermis +
dermis
– Athlete’s foot, bed sore

squamous cell carcinoma

SECONDARY LESIONS
Scar
– New connective tissue
form to repair skin
secondary to injury
Atopic Dermatitis
PSORIASIS
 Fungal infection
Superficial Mycosis

• Tinea capitis – scalp

• Tinea barbae – beard
• Tinea facieil / faciale – face
• Tinea corporis – body
• Tinea manus / manum – hands
• Tinea pedis – feet
• Tinea cruris – folds
• Tinea ungium – nails
Superficial Mycosis
• Tinea vesicolor
– Macule
Superficial Mycosis
• Candida
– Satellite lesion
Superficial Mycosis
• Tinea unguium
– nails
– Candica albicans
– onychomycosis
Superficial Mycosis
• Tinea capitis
– scalp
– Alopecic patch
– scales
Superficial Mycosis
• Tinea facie
– Unilateral

• Tinea barbae
– Spares the lips
Superficial Mycosis
• Tinea corporis
– Ringworm
– Distinct borders
Superficial Mycosis
• Tinea cruris
– Jock itch
– Scaling
– Definite borders
Superficial Mycosis
• Tinea manum
– Hands
– Scaling
– Vesicles
– Fissures
Superficial Mycosis
• Tinea pedis
– Athlete’s foot
– Fissures, scales, odorous,
crusting
• KOH
BACTERIAL SKIN INFECTIONS
Sycosis vulgaris
– Barber’s itch
– Upper lip
– Hairless, atropic scar,
bordered by pustules
and crusts
BACTERIAL SKIN INFECTIONS
• Furuncle
– Boil
– Nodule with central
suppuration
BACTERIAL SKIN INFECTIONS
Carbuncle
– 2 heads

pustule
BACTERIAL SKIN INFECTIONS
• Impetigo contagiosa
– Golden yellow crust
– Staph or Strep or mix
– Vesicle, pustule,
ruptures
BACTERIAL SKIN INFECTIONS
Bullous Impetigo
– Insect bite
– Vesicle  bullae 
pustule  crust 
collarete scale
BACTERIAL SKIN INFECTIONS
Ecthyma
– Saucer shaped ulcer
– Shins or dorsum feet
– Strep
BACTERIAL SKIN INFECTIONS
Scarlet fever
– Pastia lines
• Linear petechial eruption
• Often present antecubital
and axillary folds
– Branny desquamation
• Occurs as eruption fades
• With peeling of palms and
soles
BACTERIAL SKIN INFECTIONS
Erysipelas
– St. Anthony’s fire or Ignis
sacer
– Intense inflammation
with vesicle or bullae
– Begins as erythematous
patch
BACTERIAL SKIN INFECTIONS
Cellulitis
– S.pyogenes or S.aureus
– Subcutaneous
– Mild local erythema and
tenderness
BACTERIAL SKIN INFECTIONS
Erythrasma
– Brown scaly patches
– Intertriginous areas
– Coral red fluorescence
on wood’s light
 PRIMARY INOCULATION
TUBERCULOSIS
• Infection of the non – immuned host

• Tuberculous chancre + regional

Lymph nodes

• Children

• Introduced at site of minor abrasion

• Slow heating papule ulcer

granulation tissue / indurated
 TUBERCULOSIS VERRUCOSA
CUTIS
• Infection of the immuned host

• Anatomist’s / Postmortem wart

• Hands / Lower extremities in children

• Papule / Pustule hyperkeratotic

verrucous plaque clefts and fissures with
pus
 LUPUS VULGARIS

•Moderate immunity and high degree of

tuberculin sensitivity

• Hematogenous, Lymphatic or contigous

spread from TB elsewhere (cervical adenitis or
pulmonary TB)
• Head and neck

• Apple jelly color or diascopy

•Brownish red papule hypertrophy

atrophic scarring
 SCROFULODERMA
• Tuberculosis Colliquativa cutis

• Subcutaneous TB cold abscess and

breakdown of the skin

• Parotid, submandibular, supraclavicular,

lateral neck

• Nodule ulcers and sinuses tracks and

clefts with purulent and caseation material
 ORIFICIAL TUBERCULOSIS

• Rare form

•Autoinoculation from of internal

Organs

•Tongue, soft and palate

•Yellow or reddish punched out ulcer

•Unfavorable prognosis
 NODULAR VASCULITIS

• Erythema Induratum of Bazin

• Women in 90 – 95 %

• Peaks in adolescence and menopause

• Active tuberculosis is rare

•Erythrocyanotic changes of the lower

extremities
HANSEN’S DISEASE

Well-defined hypopigmentation
Erythematous plaque

HANSEN’S DISEASE
 CHANCROID
 Hemophilus duerexi
 Painful ulcer with erthema and edema
 Management – Azithromycin, Ceftriaxone,
Erythromycin
 DONOVANOSIS
 Granuloma inguinate / venereum
 Calymma tobacterium granulomatis
Beefy red granulation tissue
 Management – Chloramphenicol,
Gentamycin, Tetracycline
 LYMPHO GRANULOMA
VENEREUM
 Chlamydia trachomatis
 Striking tender lymphadenopathy at the
femoral and inguinal lymph nodes separated
by Poupart’s groove
Frei skin test
 Management
- Doxycycline
 MUCOSAL WARTS
 Human papillomavirus
 Pinhead to cauliflowerlike
 Condylomata acuminata
 Diagnosis – aceto whitening, serology, Pap
Smear
 Management – Cryosurgery, Podophyllin,
TCA 80 – 90%, ECT, imiguimod
 PRIMARY SYPHILIS
 21 days ( 10 – 90 days )
incubation period
 Painless ulcer
 SECONDARY SYPHILIS
 2 – 10 weeks after chancre Papulosquamous
eruption on the trunk
Condyloma lata
and palms
 Mucous patches
 Syphilids
 TERTIARY SYPHILIS
 3 – 7 years
 Gumma
 Nodular , ulcer