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D

Darier Disease

Etiology: 

Inheritance: AD

Appearance: greasy plaque (SD-like); alternating red + white nail beds with V-shaped nicking

Location: chest + back

Dermatitis Herpetiformis

Etiology: cross-reactivity between anti-gliadin IgA antibodies + transglutaminase at the dermal basement membrane

Appearance: erythematous vesicules that coalesce 

Location: elbows, dorsal forearms, knees, scalp, buttocks

At risk: pts with Celiac Disease

Dermatofibroma

Etiology: trauma (mosquito bite, shaving nick)

Appearance: tan to pink, firm, hyperpigmented dome-shaped papules with peripheral rim of darkening pigment

Location: extremities

Prog: once you get one, you're at risk of getting more

Dermoscopy: peripheral fine network, central white or pink scar-like area, ring-like globules, dotted vessels
 

Dermatofibrosarcoma protuberans

Etiology: rare type of skin cancer characterized by its slow-growing, locally aggressive nature

Appearance: skin colored, pink or brown irregular border multi nodular fungating mass

Location: trunk

Tx: wide excise, MOHs​

Dermatographia

Etiology: skin trauma may release an antigen that reacts with the membrane bound IgE on mast cells triggering histamine release

Appearance: linear wheals + a surrounding erythematous flare which appears 1-3 minutes after stroking + resolves in 30-60 minutes

Dermatomyositis

Etiology: unknown; classic model considers DM to be the result of a humoral attack against the endothelium of muscle capillaries + small arterioles

Sx: rash appears weeks to months before proximal muscle weakness

Locations:

  • extensor surfaces of MCP + IP = Gottron papules

  • upper eyelids = Heliotrope 

  • malar-like rash

  • chest = V neck sign = Poikiloderma

  • upper back = Shawl sign

  • lateral thigh = Holster sign

Dermatophytosis / Tinea / Ringworm

Etiology: 

Dermatosis Papulosa Nigra

Etiology: activating mutation in FGFR3
Appearance: hyperpigmented brown-black sessile to filiform, smooth surfaced papules
Location: cheeks, temples
At risk: darker skin tones
Tx: EDC

Diffuse Palmoplantar Keratoderma (DPK)

Etiology: 

Appearance: hyperkeratosis with white/yellow hue

Location: symmetric palmar + plantar surfaces

Drug Eruption Acne

Etiology: 

Appearance: all acne is in the same stage (ex: all open comedones or all pustules)

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

Etiology: delayed type IV HS reaction to certain medication (anti epileptics, allopurinol, sulfonamides, minocycline, HIV meds)

Appearance: facial edema, diffuse erythematous macules + plaques that typically occur in 3rd week after starting a med or increasing dose

Location: first involves face, upper trunk, UE, and then spreads to LE

Dyshidrotic Eczema

Etiology: 

Tx: clobetasol + tacrolimus; severe = Dupixent

Dyskeratosis Congenita (DC)

Etiology: 14 different genes (DKC1 gene mutations on X chromosome)

Appearance: lacy reticular hyperpigmentation

Location: upper chest, neck, nail atrophy, oral leukoplakia

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