fate Preface | / L } Tel ary Lesions | \ |Z “Pemphigoid |—_ \\ py _-— Secondary lesions Ki (Pemphigus Bullous Diseases | \\ I oe —_ —{Red Rash | Scabies | \ | | Infestations _——| Reactive Erythemas | | Alopecia | — {Eczema | {Rosacea |——— {Types of eczema | {Acne Presentation |——~ Acne Hypopigmentation fections | K\ ~—{ Staphylococcal infections |\\\ 1\Varicelta zoster | ~— Bact {Hyperpigmeniation | Pityriasis rosea — Lichen planus | | Psoriasis Treatment and DDx a {Psoriasis Presentation |“ —{ Psoriasis IMaen K. Abu Househ | Reviewed by Reem Al-qudah( Poiktioderma is a combination of) atrophy, retieuiato hyperpamentation and telangiectasia, , ( Hors 8 kein psjscion hats) | (taller than itis broad. j Telangiectasia isthe visble diataton of sma cutaneous blood \\ \\ h \ \\\ \\ \ | ‘Rcomedo isa plug of groasy ‘oratin wedged na diated plosebaceaus orice. Open ‘comedones are blackheads’. The {olicie opening ofa closed comodo ‘seat coveted aver by skin 30 {half ooks Bke a pinheodt-sized, \_ weny-coloured papule. J ( Aburrow ia inear or cuniinear —) papule, with some scaing, caused bya scabies mie. (Seatics } \\\ \ i \ ‘A haematoma is a swoling trom (toss biaeding. Gash (Ga) An ecchymosis (bruise) isa larger ‘extravasation of blood into the skin and deeper structures. J “The term purpura describes a Gagp)__| lager madule or pape of bioog in (HSP}| the skin Such Blood filed lesions Hf so pt bane 9 ss oss // I (A papilioma is a nippie-tke on rom the skin. | { Atumour is harder to define as. ee ceee scarey cmos pathy anon ceicimontoby weteopt | | peg ato piling descibe an engemet of he Sesues by nomalor rrtsrol cae tel om 0 oes usually more than 1 ém in coher ecnte we med Seeratoe se tarowt uy couse boca ‘large nodules’, especialy i they mera nanan ) (9/25/2011 - Maen Kk. Abu Househ | Reviewed by Reem Al-qudah Erthyroderma is a generalized redness of skin that may be vaseuiar diatation. ‘A papule is 3 smal solid elevation ‘of Skin, less than 0.5 em ia siameter “A plaque is an elevated area of ‘skin gteater than 2 cm in diameter \_but without substantial depth, ‘A macule isa srmal fiat area, loss ‘than § mm in ameter, of altered _ colour of texture ( Avesicie isa cecumserbed ‘elevation of skin, loss than 0.5 em __In diameter, and containing fhid. ‘A bulla i 8 orcumscribed ‘elevation of skin over 0.5 om in ameter and containing thid. collection of pus ina cavity, more than 1 cm in diarneter. Abscesses _are usually nodules, and the term ‘purulent buts is sometimes used to describe a pus-fled bister that 's stvatod on top ofthe skin rather than within ‘compressible evanescent area produced by dermal oedema, It's ‘ltan surrounded by a red axon-meciated flare, Although ‘usualy less than 2 cm in diameter, heals are ‘Angioedema is a difuse swelling ‘caused by ondema extending to ‘the subeutangous ssua, skin, usualy greater than 0.5 cm in sdameter, in both wieth and depth, which can be seen to be slovated (exophytc) or can be palpated {endoptiyte. Primary lesions, A nodule. is a sold mass inthe en ‘A wheal i an elevated white“Pigmentation, either more or less than surrounding skin, can develop \_after lesions heal. { Asstria (stretch mark) is a streak-like linear atrophic pink, purple or white lesion of the skin caused by changes in the \ connective tissue, ) Lichenification isan area of | \ thickened skin with increased ~ markings. (Eczema }._| (Atrophy is a thinning of skin ‘caused by diminution of the epidermis, dermis or subcutaneous {Topical fat. When the epidermis is atrophic _ steroids || | it may crinkle like cigarette paper, [Uchen |) | appear thin and translucent, and (sores lose normal surface markings. Blood vessels may be easy to see in both epidermal and dermal Xatrophy. A scar isa result of healing, where) / normal structures are permanently \_ replaced by fibrous tissue. / | A sinus is a cavity or channel that |/ permits the escape of pus or fluid. [9/28/2011 - Maen Kk. Abu Househ | Reviewed by Reem Al-qudah - Secondary lesions, ‘ A scale is a flake arising from the horny layer. Scales may be seen on the surface of many primary lesions | A keratosis is a horn-like thickening of the stratum comeum. | { A crust may look like a scale, but - is composed of dried blood or \ tissue fluid. / An ulcer is an area of skin from which the whole of the epidermis and at least the upper partofthe dermis has been lost. Ulcers may extend into subcutaneous fat, and heal with scarring. (Rak EN { An erosion is an area of skin —— ‘| denuded by a complete or partial = {Eczema | loss of only the epidermis. Pemphigus | \_ Erosions heal without scarring. \\{ An excoriation is anuceror | ea } _erosion produced by scratching. | (Eczema | A fissure isa slitin the skin, }~“Ee6m@ )Green on shatt of hair Tinea capitis, ea 1 P.versicolor _ Golden yellow {Biopsy }\ \ Prick Test | N\A (Paces h, | a | rf : L magnifying lans_ | | [aero ‘Chakky white | Depigmentation _,2Ppearance Poor enhancement Peat prganasis rs ~{ Deep tesion \ | Hyperpigmentaton | Good _ Good prognosis _ entancemen SS yporfiial lesion (air J {Teanck smear |! | { Pemphigus |! ((_ fame given to the technique in which a) ‘lass side or clear piastic spoon is pressed on vascular lesions io blanch -Acantholysis. them and verify that their redness is >—{ Diascopy } | ‘caused by vasodilatation and to unmask ——s \_ieitunderyingentour ‘We 08 hyphae and spores [3/25/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Dermatology InvestigationsUrticaria _-<24h. 1-2 Weeks | Shomer Muttiforme —_{ Acrofacial \ Target lesions mo Blanchable _4-6 Weeks r_Non-scaly | (Shines. Painful \Nodules _ Bruises on resolvins \ \ Erythema nodosum | Vasculitis ‘| Non-Bianchable | Bleeding disorder Commonest ill Defined Eczema _ Skindisease _ itateral___Fungal infections | | | Psoriasis _-Commonest_ \ f { Sealy | arains }- | “puis \ Pruritic \ Well Defined | ‘Ease \ Bilateral_|_Lichen Planus 5° Papule Plane \Polygonal_ 2-10 weeks [9/28/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Red Rash“feaction pink, pattem eae resus o) (Lesions last lass than 24h} oe fi boos pomy {pink tery whens | ee {most appear wih Tew hours) resohve contrally to take-up an shape. eee came cee | ay {depression } aco onaphyocie (Eh eee ions } _aspnyiaion eee) wets between skin te yr) (siantas : -orbital, per-oral | ‘Giger ‘ceonerosevenie wiera (3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Urticariaareas exposed to cold SYE!N. reproduced by holding an ice cube, in a thin plastic bag to avoid wetting, against | forearm skin for 10 mins. t {toatment_[Proieciv coting_ [Antisamines. {Cold} Exclude connective tissue diseases se ‘mast cels releasing extra histamine ater rubbing oF '(Dermographism || Scratching Due to Sustained pressure Develop 3-6h later May last up to 48h ————___| Cased wnt. (Delayed Pressure || ©2922! prostaglandins feat ater waking ‘Stes _/ hands afer clapping _ Dutiocks alter sting (rarely justified) \ pe _ [106 antibodies to 19 or Folge | ‘Avoid {Autoimmune }~ receptors on mast cols aspitn containing | drugs [2/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Types of Urticaria_Merpes Simpien AY —(pepawtis A B ard C_ cently an eins te cause reat ndioge {3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Reactive Eiyihemas{9/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - EozemaPastor present atpi dora ‘bios ho rake tar Rane weze ‘aborts wth eyo ae sis re enpocialy eanenbe, hn wt enc ame allergen ‘Senstzaten persis ndty “Dezeneaton assem posable ‘cornont sey al ove tre Boy, sparing ap oe (3/18/2011 - Maen Ik. Abu Househ | Reviewed by Reem Al-qudah - Types of Eczema,tes ha ea, a ies (Presaraion|-{ most eermen n seu mates fet infants ‘Rescton to baceri Ag (Chvei sese ‘atreaiy known Limbs emia a0 mites {g/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Types af EczemaH untested can be fatal pid to systemic penicin (Causative organisms enter i hie spit _ Episodes can allt the same area ‘epsatedy and so ead o persistent ymphoedems (9/24/2011 - Maen Ik. Abu Househ | Reviewed by Reem Al-qudah - Bacterial infectionsFolow omgronh og siph f Assoc wh sing tamgors_] [vzs/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Staphylococcal infectionsvvaticela- zoster. {resto a ection | ( a as cera aman & \gensny reat gangtion i ‘ios }-{Oceurin levloeria (birt wi zoster can tanemit he vnato chen som paints " vain nn daa ot on ste. {9/25/2011 - Maen K. Abu Househ | Reviewed by Reem A-qudah - Varicella zosteracute gingivostomat n turing into ulcers \ Vesicles scattered over the lips malaise fe a with enlarged cervical nodes. lasts about 2 weeks _pusiiled bsters ona fingertip)“ ‘genital or perianal which rapidly ulcerate—_/ strike in roughly the same place each time fespiratory tract infections Ltraviolet radiation | menstruation } ] recipitated | lips genitals Tingling sites h ema cumanst once vies |_ Toon ing occurs within 24-48 h_/ | whole episod ass about 12 dys | [9/28/2011 - Maen Kk. Abu Househ | Reviewed by Reem Al-qudah - Herpes simplex Rasa | _usually extragenital ainly on the gen Cause |- | ear) titaugh mucous membranes Netto skin. { } (Herpes encephailtis or meningitis | |{ Disseminated herpes simplex > | Complications | eae hrerpeticum | ‘ecutrent dendritic ulcers leading 10 comeal scarring } J {erythema multiforme} | Presentation | {sunblock } cout down the length of attacks {or those with widespread or systemic invoh \{orataciciovir } ~~{Teatment}| Seat (siigey Couendcaed } (Rickscan corigeaun {Presentation | (Poros {Ques commer) Samnenis | {Some plantar wars are very painful {witin2 years inas%e. Mosaic warts are ncteviousy slow to) resove and often resist al treatments _| [23/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Viral wartslems sexing patel olen and tan sscoated wiht pects naa changes occur at hw bea ee ct a __. —— Inecton by mestetret wee so "(Causing paranen scing tits [3/23/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Dermatophyte infections (Tinea)Presentation [2/25/2011 - Maen KK. Abu Househ | Reviewed by Reem Al-qudah - Fungal infections ‘Altec mba and face moto | eepigmentation is \ mr complote | woods taht {Treatment} —[epeinpame |{3/18/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Psoriasisithcrawal of potent topic or “Systemic steroids ‘skin becemes universally and unilormiy red \ iil and addlesconts \ [Triggered by streptococcal tonsitis Guatate cara {pattern {smal round red macules ‘Generalized redness of skin that may be scaling (extlative _Atwas of seaing ara interspersed with normat skin ‘vortiows just boyord the Auspitz sign [3/12/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Psoriasis PresentationDifferential _ diagnosis [9/42/2011 - Maen Kk. Abu Househ | Reviewed by Reem Al-qudah - Psoriasis Treatment and DDx planation and reassurance cab ‘Tacaleitol | mild to moderate Vitamin D ‘ete Photervcty SE. ‘Skin cancer Whon SovoreNal and halos can bo paranent jinous collcarénona_—_. }-{ Gomrpcatons | Seton te erator (8/12/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Lichen planus{systemic symptoms such as aching and tiredness - Course |) [eruption lasts 2-10 weeks {resolves spontaneously H {leaving hyperpigmented patches |/ {No Cure } topical steroid \ calamine jotion | i=} Sunlight. )~{ For itching Hf LTeeatrhent 5" ) uve / ointment reduces scaling |! | H ¢ Differential diagnosis / | secondary syphilis Hy ‘en, /12/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah ~ Pityriasis rosea {Presentation | f herpes virus 7 ~ Cause —~reactivation of | herpes virus 6. {Common during winter | \{ affects children and young jadults } |{ second attacks are rare } larger than later lesions “Atfirst herald or | j Rounder rst herald or || ‘mother’ plaque | | Redder jore scaly smaller plaques appear (Alter several days || On trunk mainly _ \ also on neck and extremities | iviovel | | salmon pink | | delicate | | | \plaques Ay | Chi | axes run down and \ configuration _| out from the spine | along the lines \ of the ribsbv1siz011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Hyper pigmentation{3/18/2071 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Hypo pigmentation ——__ a eseineurinntiters CVU cntrent_sneered {g/13/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Acne esd aieecaers_ \eeomery serraaepangia | 1 ‘breast atrophy _/ vhs ‘rcogensoceivg | va) (StI tumours {dominated by papulopustules h {suddenty }) Corticosteroids androgens | anabotec steroids | H{Congenita'adtenaltyperpiasa |~ | \ hirsutism ‘Acne | {Cutaneous h rmate-pattern balding) \vitlzaton _J\\ Boyce {oligomenorhoea |} {Common in white ppl traveling to the tropics} {mainly in women }, ido He chin } | cee Anna ‘{Excorated }-( [3/43/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Acne Presentation [abscesses or cysts wih | intercommunicatng sinuses | (eee treme) {Inportophe sears J /{congiobate acne } fever 1_{ joint pains. ~~ bigh SR) ‘common in young gitls } {With ebsessionalpeking or bing]_papulogusiiar (zie + erythematctelanpiectatic \( attests me |_-sumtywomen_ ater etone peak incidence is in the thirties } {Intros (rece | ents eet } (eee {3/16/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Rosacea(Gees 10% ote win Down aynaIOTe ae; Ec aa ‘chro cages (Soimponunbe ol har are iostegenet (2-3 mnie sere proving ness > onus ines on nails Beau's nes: ‘Transverse grove uote |—(Assouited wih} sow grows tauren err iwilbetempormy | [emer 3 {9/15/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - AlopeciaCushing syndrome [ androgen producing tumors congenital adrenal hyperplasia androgen producing tumors serum testosterone 25:1 (decrease weight and exercise | \ ‘underlying disorder must be treated } {waxing or shaving |)\ | Adrenal | Treatment | (Plucking should probably be avoided _| {Laser || {Oral antiandrogens |) | | LHFSH {electrolysis }/ —E | Poly cystic | Sex hormone-binding globulin ovarian dehydroepiandrosterone sulphate (DHEA-S) androstenedione ‘occurs in childhood: sudden or recent onset 4 done | menstrual ireguiarity | if ‘or cessation —_ | Serum testosterone 2: | |{ Drugs } | Racial / Familial | \ } 1 —— ~—{LHFSH }}| beard chest Investigations {'sex hormone-binding globul { dehydroepiandrosterone sulphate [androstenedione {Excess hair |{" shoulder-tips \ around the nipples _ ‘| Presentation \{maie pattern of pubic hair } {Pelvic U/S | {Transvaginal ovarian ultrasound || 15/2011 - Maen Kk. Abu Househ | Reviewed by Reem Al-qudah ~ Hirsutismdeditnatin fist eS gree fits) Bvekt0 the nae hats osc then contact {9/18/2011 - Maen K. Abu Househ | Reviewed by Reem A-qudah - Infestationstea al members lite fay ard sonal eoraeis | too, whether they are itching or not h permet i f ineubaion for tmanih_} ‘socond application a wack ater ho first) calamine otor _{ Residual aching may last for several days, | — or even a tow weeks: [ Ordinary urderng desis satstciony wih coting | and'heots, ites den doing unworn fr 1 weeks For 4-Gwooks _noiteting [Only scabies shows characteristic burrows _|._/ pee eee (et esitin } Waters with pustuiation Jlomerulonephritis_}-{ Secondary infection crusted eruption. is wastnumbers of mites | ‘mental retardation |, | {Crusted (Norwegian) scabies } \ IN immunosuppression_} = ‘(second attack |~{ victims already have immunty I Sites of burtows }-{ (persis indetinteyaness weaed }_{Gomse 1 preymtiio_ {Onis rors restos wih) sity scay | [Sotominentbayrosse \unanocerelnearpapues _}-[ Burrows are ) ‘Patogeamenic fr Seabies_ [2/49/2011 - Maen Kx. Abu Househ | Reviewed by Reem Al-qudah - Scabies{cold and friction injury ~ tend to be tense { Suberidermal )_{ tac. (bute } \ may contain blood |Penicilamine > _{ grugs |—_ \ | —— JS \ within the prickle cell layer \ [thin roof | @ Pemphigus.) i semana) | in roofs ————— | _______\ \ {Location of bullae }+| !nteenidenmal |_| rupture easily | @ Pemphigoid || Autoimmune | [L_ Soeener eT Ti JV ge avauns jenuded surface | @ Dermatitis herpetiformis | nT beneath the ‘stratum corneum ee Subcorneal | inner roofs | Blisters in diabetes and renal disease |— \ bulla _ \ upture more easily _ | Porphyria cutanea tarda — impetigo | ~— Infections + { herpes simplex } herpes zoster | “(vesicular tinea pedis} | bullous lupus erythematosus | Acute dermatitis ‘i 16/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - Bullous Diseasesi tpl trois (cabal prednisolone of prednisane ited with eosinophils )~[Biopsy } linear band of IgG and C8 along _the basement membrane ( Direct (ee cscs N | |immunotluorescence antibodies that bind to ‘normal skin at the basement membrane _ But UV play a part “re does not coreiate with clinical a} disease activity ‘SIE of Systemic steroids and immunosuppressives 3/16/2011 - Maen K. Abu Househ | Reviewed by Reem Al-qudah - PemphigoidEanes ee, [seasonal cen mate casey pail _}+-{Compicatore } Cowes. [9/16/2011 - Maen Kk. Abu Househ | Reviewed by Reem Al-qudah - Pemphigus:dapsone {sulfapyridine | {gluten-free diet |- Resolves later than enteropathy with — Gluten free diet Mt pt in groups subepidermal vesicies |~( herpetitormis wuisimmune } epidermal ‘subepidermal blister ia fe L transglutaminase Can be asymptomatic. ) en pst Towaps casos —) | 28 \| {cause sie js 1 \I J) wih luten-senstive | Involves only the i imunatluorescer \ oxi smal Besta po tae |i nce | \) | enteropathy \ieare anti-endamysial antibodies | {issue transglutaminase {anaemia } [rdbscrion /) -ComBlcations | Decreased risk with Giuten tree diet — ‘often broken by {Small bowel Foes ES [ shows only grouped _excoriations. { Resoives later Gluten free di Site |{ buttocks shoulders ‘secondary eczematous dermatitis develops | [9/16/2011 - Maen Kx. Abu Househ | Reviewed by Reem Al-qudah - Dermatitis herpetiformis