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Salmon patch / Nevus simplex

Etiology: vasomotor immaturity

Appearance: pink to red blanchable patches

Location: nape of neck, eyelids, glabella

Tx: none

Prog: fades within first 2 yrs of life

Scabies

Etiology: Sarcoptes scabiei

Appearance: scattered pink papules, burrows, vesicles, and excoriations

At risk: living in close quarters (dorms, nursing homes, homeless)

Location: web spaces of fingers, umbilicus, belt line, groin, axillae

Tx: 2 doses of permethrin given 10 days apart or with oral ivermectin

Scalded Skin Syndrome

Etiology: 
 

Cause: S. Aureus (exfoliative toxin)

 

Description: red rash with wrinkled tissue or paper-like consistency that typically starts on the face and flexural regions, then spreads rapidly to other parts of the body; bullae can form post-rash and easily rupture causing sloughing of the skin in large sheets 

At risk: <5 yo, RF immunosuppressed, DM

Location: skin folds and then disseminates in 48 hrs 

Tx: burn unit/ICU, IV abx

Scarlet fever / Second Disease

Etiology: 
 

Cause: S. pyogenes (exotoxins A, B, C)

 

Description: fine blanching rash post sore throat; “goose skin or sandpaper like”

Sebaceous Hyperplasia

Etiology: 
 

  • Appearance: skin-colored or yellowish umbilicated papules

  • Vs. BCC – pearly, waxy with telangiectasia that will bleed or scab easily 

  • Prog: expect more in coming years

  • Dermoscopy: “crown vessel” pattern with vessels that are blurry and restricted to the periphery

Seborrheic Dermatitis

Etiology: 
 

  • Appearance: erythematous patches with overlying scale; greasy yellow plaque with scale 

  • Location: scalp, eyebrows, eyelids, nasolabial folds, external auditory canal, central chest

  • Tx: ketoconazole twice daily, desonide cream twice daily for 1-2 weeks, antidandruff shampoo

  • Cause: increased activity of sebaceous glands due to presence of Malassezia

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  • Description: erythematous, well-demarcated plaques with greasy yellow scales in areas rich in sebaceous glands; worsens in winter and early spring; in darker skin, the plaques and scales can make the skin appear lighter

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  • Location: scalp, face, periocular

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  • Associated with: Parkinson’s Disease

Seborrheic Keratosis (SK)

Etiology: mutations in FGFR3 genes

At risk: > 30 yo

Appearance: "stuck on" appearing warty plaque or patches

Dermoscopy: moth eaten borders, keratin pseudocysts

Tx: cryo (light skin), EDC (darker skin)

Senile Purpura

Etiology: steroids, blood thinners, poor nutritional status, fair skin, age

Location: dorsal hands, forearms

Tx: none

Sézary Syndrome

Etiology: 
 

Cause: unknown

 

Description: 

Lighter skin = diffuse red rash with pruritis and edema covering >80% of body. 

Darker skin = gray, purple or brown. 

Early symptoms of rash appears like eczema or psoriasis

 

At risk: elderly

Sjögren-Larsson syndrome

Etiology: 
 

  • Define: rare genetic disorder characterized by ichthyosis (scaly skin), intellectual disability, and spasticity

  • Etiology: deficiency in fatty aldehyde dehydrogenase (FALDH), which is encoded by the ALDH3A2 gene

  • Inheritance: AR

  • Tx: leukotriene B4

Skin Tags / Acrochordons / Fibroepithelial Polyp

Etiology: 
 

Cause: excess friction 

 

Description: smooth or slightly wrinkled, flesh-colored, or darker, and hanging off the skin by a small stalk

 

Locations: areas of high friction: armpits, under breasts, groin, neck

 

Associated with: obesity, diabetes, pregnancy, acromegaly

Smallpox

Etiology: 
 

Cause: smallpox virus

 

Description: 

1. after 2-4 days of fever, body aches and headache, a rash develops

2. rash becomes raised bumps that then become fluid-filled with a depression in the center (umbilicated)

3. bumps turn into pustules that are raised, round and firm to touch

4. after about 5 days pustules begin to form a crust and then scab

5. scabs fall off leaving marks on the skin that eventually become pitted scars

 

Location: Rash spreads to face, arms, legs, hands and feet and to all parts of the body within 24 hours

Solar Elastosis / Actinic Elastosis

Etiology: 
 

Cause: chronic sun damage + smoking

 

Description: dry, thick, and yellow skin, with bumps, wrinkles, or furrowing

Solar Lentigo / Sun spot

Etiology: 
 

  • Appearance: hyperpigmented macules and patches

  • Tx: bleaching creams, LN, chemical peels, lasers

Solitary (Juvenile) Xanthogranuloma (JXG)

Etiology: 
 

  • Appearance: 

  • Histo: touton giant cells, lots of eos

Spider angioma / Spider naevus / Spider telangiectasia

Etiology: 
 

Cause: increased estrogen

 

Description: spider webs or tree branches (arteriole)

 

Associated with: liver cirrhosis + pregnancy

Spitz nevus

Etiology: 
 

  • Appearance: raised, dome-shaped mole, typically reddish or pinkish

  • At risk: children + young adults

  • Vs. melanoma due to appearance

Splinter hemorrhages

Etiology: 
 

Cause: S. aureus (mostly), S. viridans (anything that can increase IC deposition)

 

Description: linear hemorrhage lesions 

 

Location: nail bed

Squamous Cell Carcinoma (SCC)

Etiology: UV exposure over a lifetime

Location: lower legs (women), chest/back (men)

At risk: Fitzpatrick types I + II, smoking, arsenic exposure, immunosuppression, scars, tanning bed use, HPV infection

Appearance: firm, skin to pink colored, infiltrative papule or plaque that is sometimes ulcerated or covered in crust

Dermoscopy: focal scale, glomerular vessels, pinpoint hemorrhages, central keratin mass, hairpin vessels 

Tx: excision, Mohs, radiation or cryo in select cases

Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN)

Etiology: 
 

  • Sx: fever, HA, rhinitis, and myalgias precede mucocutaneous lesions by 1-3 days; eruption initially symmetric and pain is a prominent symptom

  • Location: face, upper trunk, proximal extemities

  • Appearance: erythematous irregularly shaped, dusky red to purpuric macules with dark center which progressively coalesce; + Nikolsky sign

  • SJS <10% TEN >30%

  • Tx: stop drug, go to a burn unit, IVIG, IV CS

  • Cause: type IV HS drug reaction

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  • Description: circular non-pruritic rash that is darker in the middle and lighter on the border; progresses to blisters and sores which are painful and easily peel

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  • Location: usually starts on the upper body before quickly spreading to the face, arms, legs, genitals + mucosal surfaces

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  • Associated with: TEN (SJS that covers >30% of body surface)

Strawberry / Infantile Hemangioma

Etiology: expresses higher levels of vasculogenic factors than normal tissue (VEGF)

Appearance: well-defined bordered erythematous papules or nodules

At risk: before 4 weeks of age

Location: head + neck

Tx: most are self resolving; if it is high risk (airway, liver, GI involvement, periorbital, PHACE syndrome, rapidly growing) then oral propranolol

Prog: involution typically begins between 6-12 mo of age

Stucco keratoses

Etiology: 
 

  • Appearance: small white-gray SKs

  • Location: dorsal feet/ankles 

  • At risk: older light-skin

  • Tx: cryo, curettage, ED, Amlactin

Sturge-Weber syndrome

Etiology: 
 

Cause: somatic mosaicism of activating mutation in 1 copy of GNAQ gene

 

Description: port-wine stain in trigeminal nerve territory 

Sweet Syndrome / Acute febrile neutrophilic dermatosis

Etiology: 
 

  • Appearance: sudden onset of painful, red or purple, “juicy”, raised lesions (plaques, papules, or nodules) 

  • Sx: fever

  • Ass. conditions: infections, IBD, + hematologic malignancies

  • Tx: pred

  • Cause: 

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  • Description: erythematous, edematous, well-demarcated, tender plaques that are asymmetrically distributed

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  • Location: face, neck, + upper extremities

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  • Associated with: IBD

Swimmer’s Itch / Cercarial Dermatitis

Etiology: 
 

Cause: Schistosoma mansoni

 

Description: 

1. occurs within hours of exposure after the film of water has dried on the skin

2. itch or a tingling sensation which settles quickly, leaving tiny red spots where skin penetration by the cercariae/larvae

3. Intense itch develops over hours and the red spots can enlarge to form papules and hives

4. Blisters may develop over the next 24 to 48 hours

 

At risk: anyone swimming in waters with infested snails

Syphilis

Etiology: Treponema pallidum pallidum

Appearance:

  • primary = chancre (firm, painless, oozes fluid)

  • secondary = maculopapular rash including palms + soles; condylomata lata (smooth, painless, warlike white lesions on genitals)

  • tertiary = gumma

Tx: penicillin

Systemic Lupus Erythematosus (SLE)

Etiology: systemic autoimmune condition

Types/Appearance:

  • Acute cutaneous LE: butterfly/malar rash that spares nasolabial folds

  • Subacute cutaneous LE: annular scaly erythematous macules + plaques on head + extremities

  • DLE: pink infiltrative scaly patches + plaques that heal with atrophy, depigmentation, scarring

Tx: antimalarials, CS, immunosuppressants, dapsone

Systemic Scleroderma (SSc)

Etiology: 
 

Cause: autoimmune condition with noninflammatory vasculopathy and collagen deposition with fibrosis (anti-Scl-70 Ab, anti-RNA polymerase III Ab, anti-centromere Ab)

 

Description: 

Limited SSc = only involving fingers and face = calcinosis cutis, Raynaud phenomenon, sclerodactyly, telangiectasia 

 

Diffuse SSc = widespread skin thickening, shiny appearance, feeling of tightness + visceral involvement; sometimes have a “salt and pepper” appearance on darker skin

Syringoma

Etiology: 
 

  • Define: benign skin growths that originate from sweat ducts

  • Appearance: small, skin-colored or yellowish bumps

  • Location: clustered around the eyes, but can also occur on neck, chest, abdomen, and genitals

  • Cause: overgrowth of eccrine sweat glands

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  • Description: firm bump that resembles a pimple (papule) on your skin that usually forms in small clusters or groups on your skin

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  • Location: face (lower eyelid + upper cheeks)

  • Ass: Down syndrome

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