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W Waardenburg Syndrome Etiology: mutations in genes involving the development of melanocytes + neural crest cells Inheritance : AD Appearance : patchy depigmentation of skin, hair Ass. conditions : deafness, heterochromia iridis Tx : no cure, sun protection, audiology exam Warfarin-induced skin necrosis Etiology: warfarin decreases protein C = poor inactivation of factor Va and VIIIa = hyper coagulable state Timing : first 2-5 days of starting warfarin Appearance : purport that becomes bluish-black with a red rim over a few days; blood blisters and full thickness skin necrosis follows Locations : extremities, breasts, trunk, penis Ass. conditions : protein C deficiency At risk: 50-70 yo, obese pts, perimenopausal women Tx : stop warfarin, Vitamin K reverses warfarin quicker, may require surgery or skin grafting Waterhouse-Friderichsen Syndrome (meningococcal disease) Etiology: Meningococcus which leads to adrenal hemorrhage, fulminant sepsis, and DIC Appearance : petechial or purpura that do not blanch Ass. sx : neck stiffness, HA, N/V, fevers, chills, irritability, seizure Location : begins on trunk or legs At risk : less than 4 yo, complement deficiencies, asplenic patients Tx : Penicillin, 3rd gen cephalosporin, IVF, NE, platelets Prog : if not treated quickly, pt may rapidly die A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

X Xanthoma Etiology: disorders of lipid metabolism (dyslipidemia) or occur in histiocytosis; accumulation of fat in macrophages Appearance : soft, yellow or skin colored papules or plaques Location/Types: medial canthus of upper eyelid = xanthelasma over pressure areas (knees, elbows, heels) = tuberous xanthoma extensor surfaces (buttock, shoulders) = eruptive xanthoma Tx: treat underlying dyslipidemia +/- chemical peels, electrodessication, cryo, excision Xeroderma Pigmentosum (XP) Etiology: mutation in nucleotide excision repair (NER) + UV rays Inheritance: AR Appearance : born with normal skin, but with increased sun exposure, patients develop hyperpigmented and hypo pigmented macules Location : sun exposed skin Tx : no cure, prevent UV exposure Prog : premature aging; die earlier from skin cancers Xerosis Cutis/Dry Skin Etiology: skin is lacking moisture in stratum corneum Appearance : rough, scaly plaque At risk : everyone 60+ yo, AD, hypothyroidism, CKD, weight loss Tx : moisturizers + emollients Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link 1/2 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

T Telangiectasia Etiology : UV light exposure, irradiation, trauma, topical glucocorticoids (atrophic skin) Description : spider veins (capillaries + venules) Associated with : Scleroderma (CREST) Telogen effluvium Etiology : illness, hospitalizations, preg, meds, surgeries Prog : resolves within 6-12 mo Thrombotic Thrombocytopenic purpura Etiology : excessive platelet activation and aggregation potentially due to (AR) genetic or acquired deficiency of ADAMTS13 (cleaves vWf) Description : Petechiae (small, flat, red spots) Purpura (red, purple larger spots) Tinea Etiology : dermatophytes Location/Appearance/Tx: Tinea corporis = body annular, scaly, erythematous plaques with slightly raised borders and partial central clearing topical antifungals (terbinafine) Tinea manuum = hand fine palmar scaling + dryness with redness topical antifungals (terbinafine) Tinea cruris = groin well demarcated scaly borders topical antifungals (terbinafine) + absorbant powders + loose undergarments Tinea capitis = scalp broken hairs resembling dots, a moth eaten appearance due to patchy hair loss oral griseofulvin Tinea pedis = foot silvery white scaling along soles or plantar surface topical antifungals (terbinafine) + powders Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link 1/2 Tinea Nigra Etiology : Hortaea werneckii Description : pigmented (gray to black) macules, irregular patches Location : palms + soles At risk : laborers in Africa, Asia, Central America, South America Toxic Shock Syndrome Etiology: S. aureus enterotoxin Type B or toxic shock syndrome toxin 1 (TSST-1) from tampons or other foreign objects located in the body for a long period of time Sx : fever, diffuse macular erythematous rash, low BP shedding of the skin in large sheets, especially from palms + soles, 1-2 weeks after the onset of illness Location : palms + soles Tx : supportive care + systemic abx Traction Alopecia Location : frontal hairline, sides Etiology : regularly wearing tight chignon, cornrows, dreadlocks, weaves, braids, hair extensions, and chemical relaxers and rollers Description : itching, redness, scaling, folliculitis, multiple short broken hairs, hair loss At risk : African American women Transient Neonatal Pusular Melanosis Etiology: Appearance: pustules that rupture leaving scale and PIH At risk : skin of color 1/4 Trichostasis Spinulosa Etiology: To play, press and hold the enter key. To stop, release the enter key. Trichotillosis/Trichotillomania Appearance : different lengths of hair in patch; have black dots from short hairs Trousseau’s Syndrome Etiology : people with occult or recently diagnosed visceral malignant disease (pancreatic cancer) Description : Lesions appear as inflamed, reddened lines or lumps in the fat under the skin Location : trunk or extremities Tuberous Sclerosis Etiology : mutation in TSC1 (hamartin), TSC2 (tuberin) Inheritance : AD Description : hypomelanotic macules / ash-leaf spots + angiofibroma (small bumps especially around nose + cheeks) shagreen patch Ash leaf marks Ash leaf marks Ash leaf marks Periungual fibroma Periungual fibroma Periungual fibroma Periungual fibroma Periungual fibroma Periungual fibroma Angiofibromas Angiofibromas Angiofibromas Angiofibromas Angiofibromas Angiofibromas Angiofibromas Angiofibromas Angiofibromas Angiofibromas Angiofibromas A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

R Raynaud’s Phenomenon Description : vasospastic event where digits change from blue to white to red Associated with : Scleroderma (CREST), SLE, Cold AIHA Reticulohistiocytoma (Solitary Epithelioid Histiocytoma) Appearance : solitary red to brown to yellow papule or nodule in adults Richner Hanhart Syndrome Appearance : dendritis keratosis, painful hands Inheritance : AR Rocky mountain spotted fever (RMSF) Etiology : Dermacentor variabilis, Dermacentor andersoni, Rhipicephalus sanguineus Description : 1. nonblanching rash initially appearing as red macules 1-5 mm in size and pruritic 2. within days the macules become papules, petechiae, and ecchymoses 3. in 50% of cases, rash becomes hemorrhagic Location : begins on the ankles and wrists, then spreads to the palms and soles To play, press and hold the enter key. To stop, release the enter key. Rosai Dorfman Disease Histo : S100+ Rosacea Etiology: increased amount of Demodex in sebaceous follicles, UV radiation, triggers (spicy food, alcohol, stress, extreme temperatures) At risk : females, Northern European Location : central face Appearance : flushing, papules, pustules, telangiectasias Ass. conditions: hyper/hypothyroid Tx : topical metronidazole, lasers, azelaic acid, doxy Rhinophyma Papulopustular Rosacea Erythematotelangiectatic Rosacea Erythematotelangiectatic Rosacea Rhinophyma Papulopustular Rosacea Papulopustular Rosacea Erythematotelangiectatic and papulopustular rosacea on the cheeks Papular rosacea on the cheeks Rhinophyma and papular rosacea on the chin Papulopustular and ocular rosacea Rhinophyma Steroid induced papulopustular rosacea Swelling and papulopustules in steroid induced rosacea Rhinophyma showing swelling and sebeceous gland openings Steroid induced rosacea on the forehead Papulopustular rosacea on the cheeks Rose Gardener’s Disease / Sporotrichosis Etiology : Sporothrix schenkii Description : multiple inflammatory subcutaneous nodules in a linear fashion along the course of the lymphatic channels Roseola / Exanthema Subitum / Sixth Disease Etiology : HHV-6 / HHV-7 Description : red lacy appearance (spares face), rose-colored macule (post high fever) Rubella / German measles / 3 day measles Etiology : Rubella Description : fine, erythematous, blanchable rash Location : begin on the face and spreads down Rubeola / Measles Etiology : measles virus (paramyxovirus) Description : diffuse, blanchable, erythematous, maculopapular rash + blue-white Koplik spots on buccal mucosa Location : rash begins at head and moving down A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

S 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 To play, press and hold the enter key. To stop, release the enter key. 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 1/9 Scalded Skin Syndrome Etiology : 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 : S. pyogenes (exotoxins A, B, C) Description : fine blanching rash post sore throat; “goose skin or sandpaper like” Sebaceous Hyperplasia 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 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 Etiology : increased activity of sebaceous glands due to presence of Malassezia 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 Location : scalp, face, periocular Associated with : Parkinson’s Disease, HIV Hypopigmentation due to widespread SD Faint redness and scaling along creases of nose Slight scale Fine scaliness and redness along nose and cheeks Beard is common location for SD SD affecting eyelid The fold behind the ear is a common location for seborrheic dermatitis. SD common in ear canal Scale and erythema due to seborrhoeic dermattis on the glabella and brows Confluent erythema and scale due to scalp seborrhoeic dermatitis Flexural seborrhoeic dermatitis in the axilla Pigmented paranasal seborrhoeic dermatitis in skin of colour Seborrhoeic blepharitis and dermatitis on the cheeks Seborrhoeic dermatitis around the hair line and forehead in skin of colour Inflammatory infantile seborrhoeic dermatitis – note lesions in the body folds Thick yellow scale in crade cap 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 1/10 Sézary Syndrome Etiology : 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 1/3 Sjögren-Larsson syndrome 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 Smallpox Etiology : smallpox virus Description : after 2-4 days of fever, body aches and headache, a rash develops rash becomes raised bumps that then become fluid-filled with a depression in the center (umbilicated) bumps turn into pustules that are raised, round and firm to touch after about 5 days pustules begin to form a crust and then scab 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 : chronic sun damage + smoking Description : dry, thick, and yellow skin, with bumps, wrinkles, or furrowing Solar Lentigo / Sun spot Appearance : hyperpigmented macules and patches Tx : bleaching creams, LN, chemical peels, lasers Solitary (Juvenile) Xanthogranuloma (JXG) Histo : touton giant cells, lots of eos Spider angioma / Spider naevus / Spider telangiectasia Etiology : increased estrogen Description : spider webs or tree branches (arteriole) Associated with : liver cirrhosis + pregnancy Spitz nevus Appearance : raised, dome-shaped mole, typically reddish or pinkish At risk : children + young adults Vs . melanoma due to appearance Splinter hemorrhages Etiology : S. aureus (mostly), S. viridans (anything that can increase IC deposition) Description : linear hemorrhage lesions Location : nail bed 1/6 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 Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link 1/2 Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN) Sx : fever, HA, rhinitis, and myalgias precede mucocutaneous lesions by 1-3 days; eruption initially symmetric and pain is a prominent symptom 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 Etiology : type IV HS drug reaction 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 Location : usually starts on the upper body before quickly spreading to the face, arms, legs, genitals + mucosal surfaces 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 Appearance : small white-gray SKs Location : dorsal feet/ankles At risk : older light-skin Tx : cryo, curettage, ED, Amlactin Sturge-Weber syndrome Etiology : 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 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 Description : erythematous, edematous, well-demarcated, tender plaques that are asymmetrically distributed Location : face, neck, + upper extremities Associated with : IBD and AML (20-50%) Histo : lots of neutrophils 1/8 Swimmer’s Itch / Cercarial Dermatitis Etiology : Schistosoma mansoni Description : occurs within hours of exposure after the film of water has dried on the skin itch or a tingling sensation which settles quickly, leaving tiny red spots where skin penetration by the cercariae/larvae Intense itch develops over hours and the red spots can enlarge to form papules and hives Blisters may develop over the next 24 to 48 hours At risk : anyone swimming in waters with infested snails To play, press and hold the enter key. To stop, release the enter key. 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 tertiary syphilis tertiary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis secondary syphilis primary syphilis primary syphilis primary syphilis primary syphilis primary syphilis primary syphilis primary syphilis 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 discoid lupus discoid lupus discoid lupus discoid lupus discoid lupus discoid lupus discoid lupus discoid lupus acute SLE acute SLE acute SLE acute SLE acute SLE acute SLE subacute SLE subacute SLE subacute SLE subacute SLE subacute SLE chronic SLE chronic SLE chronic SLE Systemic Scleroderma (SSc) Etiology : 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 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 Etiology : overgrowth of eccrine sweat glands Description : firm bump that resembles a pimple (papule) on your skin that usually forms in small clusters or groups on your skin Location : face (lower eyelid + upper cheeks) Ass. with : Down syndrome A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

H Hailey Hailey Etiology: Halo nevus Etiology : unknown, but suspected to related to autoimmune in origin and triggered by sunburn or local trauma Description : white halo that surrounds a mole/nevus and is usually symmetrical and about 0.5–1.0 cm wide Location : most often trunk Hand Foot & Mouth Disease Etiology : Coxsackie A Description : vesicular rash Location : around the lips, mouth, and back of the throat Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link 1/2 Hand-Foot Syndrome Etiology : chemotherapy agents (5-FU, capecitabine) Description : sunburnt-like hands that appears 2-3 months after starting chemotherapy where the whole sole or palm turns completely red 1/6 Hand-Schüller-Christian Disease Etiology : unknown cause, but the number of Langerhans cells in the skin and other organs are triggered to increase (type of Langerhans cell histiocytosis); BRAF V600E mutation associated Description : Pinkish crusted papules with lytic bone lesions in skull, diabetes insipidus, and exophthalmos At risk : 2-6 yo 1/2 Harlequin Ichthyosis Define : severe genetic skin disorder characterized by thick, diamond-shaped plates of skin separated by deep cracks Tx : oral retinoids Hereditary Hemorrhagic Telangiectasia / Osler-Weber-Rendu Etiology : AD mutation (loss of function of ENG gene) causing thin-walled blood vessels, especially in the mouth and GI tract Description : blanching lesions (telangiectasias) on skin and mucous membranes, recurrent epistaxis, skin discolorations, arteriovenous malformations, GI bleeding, hematuria Herpes Labialis (cold sores) Etiology : HSV1 Description : shallow oral ulcers that rupture and dry after a few days forming a thin, yellowish crust and will completely heal At risk : children (transmitted through contact with oral secretions) Herpes Zoster / Shingles Etiology : recurrent VZV Description : eruption of a “belt” of maculopapular lesions with erythematous base along a single dermatome on the trunk To play, press and hold the enter key. To stop, release the enter key. Hidradenitis Suppurativa (HS) / Acne Inversa Etiology: occlusion + rupture of follicles in folliculopilosebaceous units Locations : axillae, groin, perineum, perianal, inframammary At risk : puberty, women, obesity, cigarette smoking, IBD Appearance : erythematous nodules, pustules, bridging comedones Sx : recurrent tender nodules + abscesses that drain + scar Tx : mild = Hibiclens (1 min soak + then wash), Doxy, Clinda lotion, spironolactone severe/scarring = biologic (Bimzelx, Humira) Hirsutism Etiology: late-onset CAH, prolactinoma, drugs (androgens, minoxidil, cyclosporine, carbamazepine) Location : mustache or beard-liike distribution Tx : correcting underlying hormonal imbalance (spironolactone, OCPs) + hair removing tx Hypertrichosis Description : excessive hair growth Associated with : Porphyria cutanea tarda, anorexia nervosa, malignancy, drugs Hypertrophic Scar Etiology : dysregulation of the normal healing process resulting in excessive production of collagen, elastin, proteoglycans, and extracellular matrix proteins Description : Pink to red, slightly raised, or flat, limited to confines of wound, and usually occurs within weeks of injury Hypohidrotic Ectodermal Dysplasia Define : genetic disorder characterized by the abnormal development of ectodermal tissues, specifically the skin, hair, nails, teeth, and sweat glands Appearance : thin, wrinkled, and dark-colored skin around the eyes A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Z Zoon’s Balanitis Etiology: unknown, potentially from reactive response to an infection, injury, or irritation Histo : plasma cells Appearance: red to orang, shiny plaque Location: glans penis Tx : topical CS, A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

G Genital Herpes Etiology: HSV2 Appearance : vesicles sitting on erythematous base; "dew drops on a rose petal appearance" Treatment : acyclovir 1/9 Giant cell fibroblastoma Etiology: pediatric variant of DFSP History: pseudo vascular spaces, hypocellular spindle cells with myxoid background At risk: < 5 yo Location: thigh, groin, trunk Tx: wide excision, MOHs 1/2 Giant cell tumor of tendon sheath Location: hands, digits Histo : multi nodule oval shaped, darker in color, giant cells ("chocolate chip cookies with extra chips and a ring of pink around it"); hyper cellular; pools of free floating mononuclear histiocytoid tumor cells that can form a halo of hemosiderin around it Giant condyloma acuminatum (GCA) / Buschke-Löwenstein tumor Etiology: HPV 6,11 Appearance: slow-growing, cauliflower-like warty tumor with cobblestone surface Giant Congenital Melanocytic Nevus / Bathing Trunk Nevus Etiology : a proliferation of benign melanocytes that are present at birth or develop shortly after birth Appearance : >20 cm Prog : lifetime 5-10% risk of melanoma Giant Molluscum Contagiosum At risk : HIV, immunocompromised Appearance : dome-shaped, flesh-colored papules with a central indentation; >10-15 mm Location : trunk, armpits, and genital area Tx : cryotherapy, curettage, laser therapy, topical cantharidin, tretinoin, or podophyllotoxin Prog : Most cases resolve on their own within months to a couple of years Gianotti-Crosti Syndrome / Infantile Papular Acrodermatitis Etiology : reaction to a systemic viral infection (URI or GI); #1 virus = EBV Description : papules 5–10 mm in diameter and are a deep red color Location : develops first on the thighs and buttocks, then on the outer aspects of the arms, and finally on the face At risk: children between the ages of 6 months and 12 years Glomus tumor / glomangioma Etiology: Gorlin Syndrome / Nevoid Basal Cell Carcinoma (NBCCS) Define : prone to developing multiple BCCs, often starting in adolescence or early adulthood Inheritance : AD Appearance : flesh-colored or reddish-brown spots to pearly or shiny bumps Etiology : AD mutation to patched (PTCH) gene C9q Description : skin tags + skin cysts (blue nevi) on face + body with multiple basal cell carcinomas multiple BCCs multiple BCCs pits over soles palmar pits palmar pits multiple BCCs and scars palmar pits Graft vs Host Disease Etiology : transplant rejection where immunocompetent T cells reject host cells with "foreign" proteins Description : mild rash may be slightly sore or itchy and look like a minor sunburn Granuloma Annularae Appearance : violasceous annular plaque with scale Sx : itchy Histo : surrounded by lots of mucin Vs . tinea (no scale) Tx : Rinvoq, UVB, Niacinamide, Zoryve Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link 1/3 Granuloma Inguinale / Donovanosis Etiology : Klebsiella granulomatis Description : nodules that appear on genitalia or inguinal area that are painless, raised, beefy red, moist, smooth, and foul-smelling 1/3 Granulomatosis Infantiseptica Etiology : Listeria monocytogenes in neonates Description : pyogenic granulomas distributed over the whole body 1/2 Grey-Turner sign Etiology : retroperitoneal bleeding (kidney laceration) Description : ecchymosis on flanks 1/3 Grover Disease At risk: females Triggers: UV, sweat, heat Appearance: discrete vesicles with crust A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

V Venous Ulcer / Stasis Ulcer Etiology: chronic venous insufficiency Appearance: irregular border, shallow, exudative ulcer At risk : elderly, hx of DVT, obese, immobility Location : Gaiter area (malleoli region) Ass. condition : venous dermatitis Tx : wound care and compression Verrucae planae Etiology: HPV 3 and 10 Appearance: skin colored or pink smooth surfaced slightly elevated flat topped papules Location : dorsal hands, arms, face Verruca vulgaris / cutaneous warts Etiology: HPV 1-4 Appearance: cauliflower-like papules with a rough papillomatous and hyperkeratotic surface ranging in size from 1 mm to 1 cm+ Location : fingers, dorsal hands, knees, elbows Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link 1/1 Vibrosis Etiology: Vibrio vulnificus, ingestion of contaminated seafood or exposure of open wounds to seawater Appearance : widespread hemorrhagic bullae Sx : fevers, chills, hypotension Tx : doxy, 3rd gen cephalosporin 1/4 Vitiligo Etiology : autoimmune attack on melanocytes Associated conditions : DM, Graves disease, Addison disease, adrenal insufficiency , SLE, RA Appearance : sharply demarcated depigmented patches and macules Location : periorificial, acral Tx : topical steroids, topical calcineurin inhibitors, phototherapy, laser tx Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link 1/2 Vohwinkel Syndrome / PPK Mutilans Etiology: Appearance: star shaped hyperkeratotic plaque Location : on knuckles, palms, soles Ass. condition s: autoamputation of fingers, deafness 1/8 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

U Urticaria / Hives Etiology: mast cell degranulation from allergic reaction (T1HS) or AutoAb to FcER1 (T2HS) Appearance: wheals that disappear within 24 hours; surrounding erythema will blanch Ass. conditions : angioedema Sx : pruritus Tx : avoid trigger, antihistamines (cetirizine, loratadine ), omalizumab, cyclosporin Urticarial vasculitis Etiology: rare inflammatory condition affecting small blood vessels in the skin Ass. with : SLE, Sjogrens, leukemia, viral conditions, drug induced Sx : painful or burning sensation Appearance : wheals that will last longer than 24 hours Prog : will go away in 1-3 years of onset Tx : antihistamines, NSAIDs, CCS, immunosuppressant, omalizumab, dapsone A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

O Onchocerciasis Etiology : Onchocerca volvulus (worm transmitted through bite of female blackfly) Description : initially painless skin nodules that progressively become very itchy due to dead larvae; chronic itching leads to permanent skin color changes (leopard skin) At risk : sub-Saharan Africa Ass. sx : irreversible blindness (photophobia, eye itching, pain), epilepsy Tx : oral ivermectin (1 does q3 mo to kill adult and larvae) +/- doxy Onycholysis Etiology : idiopathic or secondary to trauma, skin disease, nail infections, tumors, or systemic event Description : well-defined area of white opaque nail Associated with : Psoriasis, Lichen Planus, Onychomycosis, Eczema At risk : adult women Tx : clip affected portion, keep nail short, minimize trauma, avoid irritants, antimicrobial soaks to prevent secondary infection Onychomycosis Etiology : dermatophytes (75+% of cases), non-dermatophytes (aspergillum, candida, etc.) At risk : 65+ yo, diabetic, immunocompromised, athletes Location : MC at 1st toe Tx : Mild = 50/50 soak in vinegar/water 3x/wk; topical nail polish thing Severe = oral terbinafine/griseofulvin Go to link Go to link Go to link Go to link Go to link Go to link Go to link Go to link 1/2 Osler nodes Etiology : S. aureus (mostly), S. viridans (anything that can increase IC deposition) Description : raised, violaceous lesions Sx : "Osler nodes are Ouchy" = painful Location : finger + toe pads Tx : abx if underlying bacterial endocarditis, cutaneous lesions will resolve on own 1/4 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

N Necrobiosis lipoidica Histo : degenerated collagen, plasma cells, no mucin, “lasagna” Ass. conditions : DM (not as strong as initially thought) Description : reddish brown areas of the skin Location : lower legs Associated with : T1DM Necrobiotic Xanthogranuloma Histo : X shaped red zones of necrosis within granuloma nodules; “peppered bacon”; cholesterol clefts Necrolytic migratory erythema Etiology : glucagonoma Description : red, blistering rash that is itchy and painful Location : genitals, buttock, + groin Necrotizing Fasciitis Etiology : Type I: Klebsiella, E. coli, S. aureus, Pseudomonas Type II: Strep. pyogenes Type III: Clostridium Description : necrosis of muscle and subcutaneous tissue presenting as red, warm, or swollen area of skin that spreads quickly; eventually can lead to dark purple coloration with crepitus; has pain out of proportion Location : lower extremities, abdomen, perineum At risk : diabetes, PVD, trauma, surgery, alcohol abuse, cirrhosis Neonatal acne Etiology: Neonatal purpura fulminans (NPF) Etiology : homozygous protein C or S deficiency Description : Within 1st 72 hours after birth, purpuric lesions develop over perineal region, flexor surfaces and abdominal skin Enlarge and become hemorrhagic bullae with full thickness necrosis of skin and black eschar formation Secondary infection leads to gangrene Neuropathic Ulcer Etiology : peripheral neuropathy (diabetic foot) Description : hyperkeratotic edge with undermined borders and without pain Location : bony prominences (metatarsal heads, heel) Netherton Syndrome Define : rare, inherited disorder primarily affecting the skin, hair, and immune system; characterized by a triad of features: congenital ichthyosiform erythroderma (red, scaly skin from birth), hair shaft abnormalities (bamboo hair), and atopic diathesis Location : lateral eyebrows Histo : trichorrhexis invaginata/bamboo hair (MC) Nevus Comedonicus Etiology: Tx: tretinoin Nevus of Ito Appearance : blue, gray, or brown patch Location : shoulder, upper arm, and side of the neck, typically in the distribution of the posterior supraclavicular and lateral cutaneous brachial nerves Nevus of Ota Appearance : bluish-gray or brown-black pigmentation Location : face, esp. around the eye Nevus Sebaceous Location: scalp Appearance : skin colored to yellow/orange plaque with cobblestone appearance Nodular Fasciitis Define : no inflammation, benign tumor Histo : loose, whispy appearance of myofibroblasts, red cell extravasation; overtime become more myxoid and whispy Notalgia Paresthetica Define : sensory neuropathy that causes chronic, localized itching and sometimes pain, burning, or tingling Location : between shoulder blades (MC) Tx : chiropractor work, capsaicin, gabapentin, CCS Nummular Eczema Etiology: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z