Classification of Skin Presenting Disorders

 Inflammatory Diseases Based on Abnormal Humoral Reactivity and Other Inflammatory Diseases
1. Urticaria and Angioedema
- Urticaria : skin lesion consisting of a wheal-and-flare reaction in which localized
intracutaneous edema (wheal) is surrounded by an area of redness (erythema) that is
typically pruritic.
- Circumscribed, raised, erythematous, highly pruritic, evanescent areas of edema that
involve the superficial portion of the dermis
- Arise suddenly, can last 24 to 48 hours
- They can be as small as millimeter or 6 to 8 inches in diameter (giant urticaria).
- Angioedema : can be caused by the same pathogenic mechanisms as urticaria, but the
pathology is in the deep dermis and subcutaneous tissue and swelling is the major
manifestation.
- The overlying skin may be erythematous or normal
- Commonly affects the face or a portion of an extremity, lips, cheeks, and periorbital areas,
but also may affect tongue, pharynx, or larynx.
- Last several days
- Less pruritus, but pain or burning may be present
2. Erythema Multiforme
- Acute self-limited, usually mild, frequent reccurent
- Related to an acute infection : Herpes Simplex Virus (HSV)
- Face & extrimities
3. Epidermal Necrolysis ( Steven-Johnson Syndrome and Toxic Epidermal Necrolysis)
- Rare, life-threatening, mainly drug induced
- Widespread and extensive necrosis of keratinocytes
- Confluent pupuric, erythematous macules ,flaccid blisters, detachment of the epidermis,
associated with mucous membrane
- the trunk and upper limbs
4. Cutaneous Reaction to Drugs
- Drug-induced
- They range from common nuisance rashes to rare life-threatening diseases
- Exanthematous, urticarial, pustular, bullous, erythema multiforme-like eruptions
5. Pityriasis Rosea
- Pityriasis : scale, rosea : pink
- Most often begins as a single 2 to 4 cm thin oval plaque with a fine collarette of scale
located inside the periphery of the plaque (“herald patch”). Similar-appearing, but smaller,
lesions then appear several days to weeks later and are typically distributed along the lines
of cleavage on the trunk (in a “Christmas tree” pattern)
- Usually asymptomatic, but sometimes with pruritus and mild flu-like symptoms
- Occurs most commonly in teenagers and young adults

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 6. Erythema Annulare Centrifugum and Other Figure Erythemas
- No single cause, uncommon disorder
- Annular expanding erythematous rings, which enlarge rapidly, fade, and then disappear, as
new lesions appear
- Can be superficial or deep lesion
7. Granuloma Annulare
- Relatively common disorder, children and young adults
- A localized ring of beaded papules on the extrimities is typical; generalized, subcutaneous,
perforating

 Disorders of Epidermal Differentiation and Keratinization

1. Irritant Contact Dermatitis
2. The Ichthyoses
- A heterogenous group of skin diseases, generalized scaling, and often, areas of thickened
skin
- Most types are inherited, usually present at birth, however, some forms are acquired
- Scale may vary in size, color, and body site
- May be accompanied by erythema, abnormalities in other parts of skin, and adnexal
structures
- May be associated with systemic findings, such as failure to thrive, increased susceptibility
to infection, atopic dermatitis, neurosensory deafness, neurologic and other disease
3. Inherited Keratodermas of Palms and Soles
- Chronic thickening of palms and soles may be found alone (simple), in combination with skin
lesions elsewhere (complex), or in association with complex syndrome (syndromic),
including ectodermal dysplasia where hair, teeth, and nails may be affected
4. Acantholytic Disorders of the Skin
- Darier-White Disease : genetic disorder; warty papules and plaques in seborrheic areas,
specific nail changes, palmo-plantar pits, and papules on the dorsum of the hands and feet
- Acrokeratosis Verruciforms : rare, multiple small flat papules on the dorsum of the hands
and feet
- Grover Disease : pruritic, polymorphic, cutaneous papulovesicular eruption on the trunk,
occurs in adults after long-term sun damage
- Hailey-Hailey Disease : also called familial benign chronic pemphigus, late-onset blistering
dermatosis, painful erosions and fissures (rhagades) in the flexures
5. Porokeratosis
- Chronic progressive disorder of keratinization
- Hyperkeratotic papules or plaques surrounded by a thread-like elevated border that
expands centrifugally

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