Bates Ch. 6 Skin, Hair And Nails

Front 1

Back 1

Cafe-Au-Lait-Spot
A slightly but uniformly pigmented macule or patch with a somewhat irregular border, benign; six or more of these suggest neurofibromatosis

Front 2

Back 2

Vitiligo

Depigmented macules appear on the face, hands, feet, extensor surfaces, and other regions and may coalesce into extensive areas that lack melanin

Front 3

Back 3

Cyanosis

Somewhat bluish color that is visible in these toenails and toes; may be hard to distinguish

Front 4

Back 4

Jaundice

Skin diffusely yellow; seen most easily in the sclera

Front 5

Back 5

Carotenemia

Yellow palm; does not effect the sclera; cause is a diet high in carrots and other yellow vegetables or fruits

Front 6

Back 6

Erythema

Red hue, increased blood flow ("Fifth disease")

Front 7

Back 7

Heliotrope

Violaceous patches over the eyelids in the collagen vascular disease dermatomyositis

Front 8

Back 8

Psoriasis

Silvery scaly papules or plagues, mainly on the extensor surfaces

Front 9

Back 9

Tinea Versicolor

Tan, flat, scaly plagues

Front 10

Back 10

Atopic Eczema

Mainly appeard on flexor surfaces (adult form)

Front 11

Back 11

Linear Lesion Pattern

Linear epidermal nevus

Front 12

Back 12

Geographic Lesion Pattern

Mycosis fungoides

Front 13

Back 13

Serpiginous Lesion Pattern

Tinea corporis

Front 14

Back 14

Annular, arciform Lesion Pattern

Annular plaque of tinea faciale

Front 15

Back 15

Hemangioma Primary Skin Lesion (Flat, Nonpalpable)

Macule

Front 16

Back 16

Hemangioma Primary Skin Lesion (Flat, Nonpalpable)

Patch (Cafe Au Lait Spot)

Front 17

Back 17

Vitiligo Primary Skin Lesion (Flat, Nonpalpable)

Front 18

Back 18

Psoriasis (Palpable)

Plaque, coalescence of papules

Front 19

Back 19

Psoriasis (Palpable)

Plaque, coalescence of papules

Front 20

Back 20

Psoriasis (Palpable)

Plaque, coalescence of papules

Front 21

Back 21

Dermatofibroma (Palpable)

Nodule; knot-like lesion

Front 22

Back 22

Epidermal Inclusion Cyst (Palpable)

Nodule filled with expressible material, either liquid or semisolid

Front 23

Back 23

Uriticaria (Palpable)

Wheal; Somewhat irregular, relatively transient, superficial area pf localized skin edema

Front 24

Back 24

Herpes Simplex (Palpable Fluid-Filled)

Front 25

Back 25

Herpes Zoster (Palpable Fluid-Filled)

Front 26

Back 26

Insect Bite (Palpable Fluid-Filled)

Bulla

Front 27

Back 27

Insect Bite (Palpable Fluid-Filled)

Bulla

Front 28

Back 28

Acne (Palpable Fluid-Filled)

Pustule; filled with pus

Front 29

Back 29

Small Pox (Palpable Fluid-Filled)

Pustule; filled with pus

Front 30

Back 30

Scabies (Palpable Fluid-Filled)

Burrow; a minute, slightly raised tunnel in the epidermis, commonly found on finger webs and on the side of fingers. Looks like a short, linear or curved line and may end in a tiny vesicle; with a magnifying lens, you can be the burrow of the mite that causes scabies

Front 31

Back 31

Ichthyosis Vulgaris (Secondary Skin Lesion)

Scale; thin flake of dead exfoliated epidermis

Front 32

Back 32

Dry Skin (Secondary Skin Lesion)

Scale; thin flake of dead exfoliated epidermis

Front 33

Back 33

Impetigo (Secondary Skin Lesion)

Crust; dried residue of skin exudates such as serum, pus or blood

Front 34

Back 34

Neurodermatitis (Secondary Skin Lesion)

Visible and palpable thickening of the epidermis and roughening of the skin with increased visibility of the normal skin furrows (often from chronic rubbing)

Front 35

Back 35

Hyperthrophic Scar From Steroid Injections (Secondary Skin Lesion)

Increased connective tissue that arises from injury or disease

Front 36

Back 36

Keloid - ear lobe (Secondary Skin Lesion)

Hypertrophic scarring that extends beyond the borders of the intiating injury

Front 37

Back 37

Erosion (Secondary Skin Lesions - Depressed)

Nonscarring loss of the superficial epidermis; surface is moist but does not bleed

Ex: Aphthous stomatitis - moist area after the rupture of a vesicle; chickenpox

Front 38

Excoriation

Back 38

Linear or punctate erosions caused by scratching

Front 39

Back 39

Fissure (Secondary Skin Lesions - Depressed)

A liner crack in the skin, often resulting from excessive dryness

Ex: Athlete's foot

Front 40

Back 40

Ulcer (Secondary Skin Lesions - Depressed)

A deeper loss of epidermis and dermis; may bleed and scar

Ex: Stasis ulcer of venous insufficiency, Syphilitic chancre

Front 41

Back 41

Acne Vulagris Primary Lesion

Mild Acne

Open and closed comedones (blackheads), occasional papules

Front 42

Back 42

Acne Vulagris Primary Lesion

Moderate Acne

Comedones, papules, pustules

Front 43

Back 43

Acne Vulagris Primary Lesion

Severe Cystic Acne

Front 44

Back 44

Acne Vulagris Secondary Lesion

Acne with pitting and scars

Front 45

Back 45

Vascular Lesion

Spider Vein

Bluish, variable size

Spider shape or linear, irregular, cascading

Most often on legs and near veins

Often accompanies increased pressure in the superficial veins, as in varicose veins

Front 46

Back 46

Vascular Lesion

Cherry Angioma

Bright or ruby red; may become purplish with age

Round, flat; maybe surrounded by pale halo

Partial blanching (temporary whitening of skin), especially with pressure applied at edge

Trunk and extremities

Increases in size and numbers with age

Front 47

Back 47

Vascular Lesion

Spider Agioma

Fiery red

Central body, sometimes raised, surrounded by erythema and radiating legs

Pressure on the body causes blaching of the spider

Face, neck, arms, upper trunk; almost never below the waist

Liver disease, pregnancy, vitamin B deficiency; also normal in some people

Front 48

Back 48

Purpuric Lesion

Petechia/Purpura

Deep red or reddish purple, fading away over time

Rounded, sometimes irregular; flat

No effect from pressure

Variable distribution

Blood outside the vessels; may suggest a bleeding disorder, or, if petechia, emboli to skin; palpable pupura in vasculitis

Front 49

Back 49

Purpuric Lesion

Ecchymosis

Puprle or purplish blue, fading to green, yellow, brown with time; variable size

Rounded, oval, or irregular; may have a subcutaneous flat nodule

No effect from pressure

Variable distribution

Blood outside the vessels; often secondary to bruising or trauma, also seen in bleeding disorders

Front 50

Back 50

Skin Tumor

Actinic Keratosis

Typical on face and hands

Round or irregular; pink, tan or grayish

Sun exposed skin of older, fair-skinned people

Precancerous

Front 51

Back 51

Skin Tumor

Seborrheic Keratosis

Trunk of older people, may also be on face and elsewhere

Raised papules of plaques; whitish-yellow to brown; feel slightly greasy and velvety

Have a "stuck on" appearance

Front 52

Back 52

Skin Tumor

Basal Cell Carcinoma

Malignant, but almost never metastasizes

Common in fair-skinned over 40

Appears on face

Initiely red macule or papule; may have depressed center and firm elevated border

Front 53

Back 53

Skin Tumor

Squamous Cell Carcinoma

Face and dorsum of hand

On sun-exposed fair-skinned older than 60

Can start in an acitinic keratosis

Firmer and redder than Basal Cell Carcinoma

Front 54

Back 54

Typical Benign Nevi

Round or oval shaped

Sharply defined borders

Uniform color, especially skin-coloraed, tan or brown

Diamete <6 mm but >10 mm if congenital

Flat or raised surface

Front 55

Malignant Melanoma

Back 55

ABCDEs

Nevi that changes or atypical

May have new swelling or redness beyond the border, scaling, oozing, or bleeding, or sensations such as itching, burning, or pain

On darker skin, look for under the nails, on hands, or on soles of feet

Front 56

Back 56

Solar lentigines

Macules on the dorsum of hand, wrist, and forearm

Front 57

Back 57

Pseudomonas

Papules and pustules (in hot tub folliculitis)

Front 58

Back 58

Pustular psoriasis

Pustules on the palm

Front 59

Back 59

Chickenpox

Front 60

Back 60

Erythema multiforme

Front 61

Back 61

Squamous cell carcinoma

Front 62

Back 62

Infected atopic dermatitis

Front 63

Back 63

Lichenification and Excoriation on the leg

Atopic dermatitis

Front 64

Back 64

Urticaria

Drug eruption in an infant

Front 65

Back 65

Combination typical of neurofibromatosis

Cafe-au-lait spots and Nodules

Front 66

Back 66

Kaposi's sarcoma in AIDS

Malignant tumor; often multiple and may involve internal structures

Left: ovoid, pinkish red plaques that lengthen along skin

Right: purplish red nodule on the foot

Front 67

Back 67

Stage 1 Pressure Ulcer

Reddened area that fails to blanch with pressure

Changes in temperature, firmness or boggy, pain or itching, or red, blue, purple; red on lighter skin

Front 68

Back 68

Stage 2 Pressure Ulcer

Forms a blister or sore

Partial thickness skin loss or ulceration involving the epidermis or dermis or both

Front 69

Back 69

Stage 3 Pressure Ulcer

Deepens, full thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to, but not through, underlying muscle

Front 70

Back 70

Stage 4 Pressure Ulcer

Full thickness skin loss, with destruction, tissue necrosis, or damage to underlying msucle, bone, and sometimes tendons and joints

Front 71

Back 71

Paronychia

Superficial infection of the proximal and lateral nail folds adjacent to the nail plate

Red, swollen and tender

Infection from Staphylococcus aureus or Streptococcus

Front 72

Back 72

Clubbing of the Fingers

Vasodilation with increased blood flow to the distal portion of the digits and changes in connective tissue, possibly from hypoxia, changes in innervation, genetics, or platelet-derived growth factor from fragments of platelet clumps.

Seen in congenital heart disease, interstitial lung disease and lung cancer, inflammatory bowel disease, and malignancies

Front 73

Back 73

Onycholysis

Painless separation of the whitened opaque nail plate from the pinker translucent nail bed

Local cause: trauma from excess manicuring, psoriasis, fungal infection, allergic reaction to nail cosmetics

Systemic cause: diabetes, anemia, photosensitive drug reactions, hyperthyroidism, peripheral ischemia, bronchiectasis, syphilis

Front 74

Back 74

Terry's Nails

Nail plate turns white, a distal band of reddish brown

Liver disease, usually cirrhosis, heart failure, diabetes, decreased vascularity and increased connective tissue in nail bed

Front 75

Back 75

White Spots (Leukonychia)

Trauma to nail beds

Pattern is typical in overly vigorous and repeated manicuring

Front 76

Back 76

Transverse White Bands (Mees' Lines)

Curving transverse lines

Arsenic poisoning, heart failure, Hodgkin's disease, chemotherapy, carbon monoxide poisoning, and leprosy

Front 77

Back 77

Transverse Linear Depressions (Beau's Lines)

Temporary disruption of proximal nail growth from systemic illness

Timing of illness may be estimated by measuring the distance of the line from the nail bed

Severe illness, trauma, cold exposure if Raynaud's disease is present

Front 78

Back 78

Pitting

Punctuate depressions

Caused by defective layering of the superficial nail plate

Psoriasis, Reiter's syndrome, sarcoidosis, alopecia areata, localized atopic or chemical dermatitis

Front 79

Back 79

Tinea Versicolor

Fungal infection of the skin

Hypo or hyperpigmentation, scaly macules on the trunk, neck and upper arms

Front 80

Pityriasis Rosea

Back 80

Reddish oval ringworn-like papules or plagues

Front 81

Trichotillomania

Back 81

hair loss from pulling, plucking, or twisting hair. Hair shafts are broken and of varying lengths. More common in children, often in settings of family or psychosocial stress

Front 82

Tinea Capitis ("Ringworm")

Back 82

Round scaling patches of alopecia. Hairs are broken off close to the surface of the scalp. Usually caused by fungal infection from Trichophyton tonsurans from humans, less commonly from microsporum canis from dogs or cats