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Skin
Disorders II
Jason Ryan, MD, MPH
Erythema Nodosum
• Type IV hypersensitivity reaction
• Panniculitis
• Inflammation of subcutaneous fat
• Often idiopathic
• Many triggers: AfraTafreeh.com

• Infection (most commonly Strep)

• Crohn’s disease (may precede flare)
• Sarcoidosis
• Coccidioidomycosis
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Erythema Nodosum
• Painful, red nodules
• Most commonly on shins

James Heilman, MD
Erythema Nodosum
Pathology Findings

• “Septal panniculitis”
• Inflammation of septa of fat between dermis and fascia
• Contrast with “lobular”: inflammation of fat lobules

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Specialclass/Sideshare
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Lichen Planus
• Rare, chronic inflammatory skin disorder
• “Lichen” = tree moss
• “Planus” = flat Lichen on tree

• Occurs in adults
• Unknown pathogenesis
• Resolves spontaneously over years
• Associated with hepatitis C
Lichen Planus
• 6Ps
• “Pruritic, Purple, Polygonal, Planar, Papules and Plaques”
• Itchy (often intense)
• Purple flat lesions
• Multiple, symmetric usually on arms/legs/wrists
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• Wrists, ankles are common sites

James Heilman, MD
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Lichen Planus
• Mucosal involvement
• Mouth, tongue
• Glans penis
• Wickham striae: white dots/lines
• Caused by hypergranulosis (classic feature of LP)
• Best seen on oral lesions

James, Candice, Mai/Wikipedia

Lichen Planus
• Lymphocytes at dermal-epidermal junction
• Hyperkeratosis
• Hypergranulosis
• “Sawtooth” pattern of rete ridges
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G Salunkhe/Slideshare
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Pityriasis Rosea
• Acute, self-limited skin rash
• Eruption of skin lesions
• Self-limited
• Resolves 2-3 months
• Usually no treatment required
• Cause unknown (possibly viral)
Pityriasis Rosea
• Begins with “herald patch”
• Single red/salmon-colored lesion
• Round or oval
• Well demarcated
• Chest, neck, or back AfraTafreeh.com
• Days later: Multiple lesions on trunk James Heilman,MD /Wikipedia

• Multiple similar, smaller lesions

• Groups of lesions
• Follow skin lines on back
• “Christmas tree distribution”
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Pityriasis Rosea

James Heilman,MD /Wikipedia

Burns
Depth Classification

Depth Degree Skin layers

Superficial 1st Epidermis
Superficial partial thickness 2nd Epidermis, some dermis
Deep partial thickness AfraTafreeh.com
2nd Epidermis, most dermis
Full thickness 3rd Epidermis and dermis
4th degree 4th Underlying tissue
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Superficial Burn
1st Degree Burn

• Epidermis only
• Painful, red, blanch with pressure
• Looks like sunburn
• No blisters
• Heal within 7 days
• Minimal treatment required

Bejinhan/Wikipedia
Superficial Partial Thickness
• 2nd degree
• Epidermis and some dermis
• Often form blisters
• Painful, red
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• Blanch with pressure
• Heal within 7 to 21 days

Snickerdo/Wikipedia
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Deep Partial Thickness

• 2nd degree
• Epidermis, most dermis
• Erythematous, yellow or white
• Almost always blister
• Easily unroofed (tissue moves)
• Painful to pressure only
• Do not blanch
• Usually > 21 days to heal
• Heal with scarring
Wikipedia/Public Domain
Full Thickness 3rd Degree Burn

• 3rd or 4th degree

• Entire epidermis and dermis
• Can involve underlying tissue (4th degree)
• Fat, fascia or muscle
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• Painless
• Scarring with wound contracture

4th Degree Burn

Wikipedia/Public Domain
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Sunburn
• Delayed inflammatory response of skin
• Caused by ultraviolet radiation (UVR)
• Two forms UV radiation
• UVB radiation: wavelength 280 to 320 nm
• UVA radiation: wavelength 320 to 400 nm
• Both may cause sunburn
• UVB range most effective at causing sunburn
Sunburn
• Damage to epidermis and dermis
• UV radiation → DNA damage → apoptosis
• “Sunburn cells”: keratinocytes undergoing apoptosis
• Vasodilation
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• Release inflammatory mediators
• Self-limited

Wikipedia/Public Domain