Skin Semiology

Front 1

Actinic Keratosis Description

Back 1

Pre-malignant lesion typically seen on sun-exposed areas. If untreated can progress to squamous cell carcinoma

Front 2

Back 2

Actinic Keratosis (pre-cancerous)

Front 3

Angular cheilosis description

Back 3

inflammation of corners of lips - seen in malnutrition, anemia (Fe-def anemia if also pica!)

Front 4

Back 4

Angular Cheilosis (malnutrition, anemia)

Front 5

Basal Cell Carcinoma description

Back 5

low-grade
fleshy-colored/pearly papule with translucent/sometimes "umbilicated" border, sometimes central ulceration and telangiectasia.

Front 6

Back 6

Basal Cell Carcinoma

Front 7

Gottron's Papules/Sign Description

Back 7

Red, scaly papules over MCPs, PIPs and DIPs.
Dermatomyositis

Front 8

Back 8

Gottron's Papules (Dermatomyositis)

Front 9

Heliotrope rash Description

Back 9

red/violet discoloration of upper eyelids
Dermatomyositis

Front 10

Back 10

Heliotropic Rash (Dermatomyositis)

Front 11

Shawl Sign Description

Back 11

widespread, flat, reddened area over upper back, shoulders, and back of neck
Dermatomyositis

Front 12

Back 12

Shawl Sign (dermatomyositis)

Front 13

V sign Description

Back 13

similar to shawl sign, except reddened skin isinV-neck pattern of chest
Dermatomyositis

Front 14

Back 14

V Sign (Dermatomyositis)

Front 15

Dermatomyositis findings

Back 15

Gottron's Papules, Heliotropic rash, Shawl/V Sign

Front 16

Hyperextensibility description

Back 16

ability to stretch skin >4 cm at forearm or neck before feeling resistance - Ehlers-Danlos

Front 17

Hyperpigmentation description

Back 17

*address patient's background/race/ethnicity/sun exposure*
Diffuse hyperpigmentation- primary adrenal failure (Addison's), hemochromatosis, hyperthyroidism

Front 18

Back 18

Hyperpigmentation (tricky, I know, but these are the pictures I got when I googled Hyperpigmentation in Addison's Disease)

Front 19

Back 19

Hyperpigmentation (hematochromatosis)

Front 20

Back 20

Hyperpigmentation (Also subtle, but this is what hyperpigmentation in hyperthyroidism seems to look like)

Front 21

Livedo reticularis description

Back 21

red-blue lacy skin discoloration with central pallor, assoc w/ small vessel changes, small vessel vasculitis, anti-phospholipid antibody syndrome ( in lecture he also mentions Raynaud's syndrome, cholesterol embolism, DIC)

more diffuse it is, more serious it is.

Front 22

Back 22

Livedo Reticularis (vasculitis)

Front 23

Malar Rash Associated w/

Back 23

SLE

Front 24

Back 24

Malar Rash - SLE

Front 25

Melanoma Description

Back 25

Tumor of melanocytes. Dark. Can be nodular/lentiginous. Can occur on skin that isn't exposed to sun. Even ocular site.

Front 26

Back 26

Melanoma

Front 27

Back 27

Ocular Melanoma

Front 28

Neurofibroma Description

Back 28

Non-tender, soft, fleshy, sessile, or pedunculated skin tumor. Assoc w/ Von Recklinghausen's Disease

Front 29

Von Recklinghausen's Disease Findings

Back 29

Neurofibromas
cafe-au-lait
axillary freckles
Lisch Nodules (dark spots in iris.... if have these then 100% have VR Disease)

Front 30

Von Recklinghausen's Genetics

Back 30

Autosomal Dominant. Also spontaneous mutations are pretty common too!

Front 31

Back 31

Axillary Freckles, AKA Crowe's Sign, (Von Recklinhausen's disease)

Front 32

Back 32

Neurofibromas (Von Recklinhausen's)

Front 33

Back 33

Lisch Nodules (100% has Von Recklinhausen's)

Front 34

Psoriasis (typical description)

Back 34

Usually red plaques with silvery scales on extensor surfaces of arms and legs, trunk and scalp.

Front 35

Psoriasis (different presentations)

Back 35

Guttate- drop-like
Pustular - less common, painful, itchy, not infectious
Inverse/Flex - Looks raw, on flexor surfaces (or axillary)
Erythrodermic - 80% body, really red, really sick

Front 36

Back 36

Erythrodermic psoriasis

Front 37

Back 37

Guttate (drop-like) psoriasis

Front 38

Back 38

Inverse psoriasis

Front 39

Back 39

Psoriasis (again, an untraditional spot, but you know how Morehead is)

Front 40

Back 40

Pustular Psoriasis

Front 41

Squamous Cell Carcinoma Description

Back 41

Begins as nodule, grows into fungating lesion, sometimes ulcerates. Usually on sun-exposed skin, assoc w/ chronic scarring and inflammation.

Front 42

Back 42

Squamous Cell Carcinoma

Front 43

Thin Skin w/ visible small cells =

Back 43

Ehler Danlos (type 4), assoc w/ arterial rupture (think aortic dissection!!!)

Front 44

Back 44

Thin Skin (Ehlers-Danlos)

Front 45

Shagreen Patch

Back 45

flesh-colored, orange-peel like CT plaque usually on lower back.
Finding of Tuberous Sclerosis

Front 46

Back 46

Shagreen Patch (Tuberous Sclerosis)

Front 47

Ash-leaf spots (ellipticalmacules)

Back 47

hypopigmented spots. Tuberous Sclerosis

Front 48

Back 48

Ash Leaf Spots (Tuberous Sclerosis)

Front 49

Tuberous Sclerosis Findings

Back 49

Angiofibromas
Periungual Fibroma
Ash Leaf
Shagreen Patch

Front 50

Angiofibroma description

Back 50

Looks like acne, but firm, not pustular. Sign of Tuberous Sclerosis

Front 51

Back 51

Angiofibromas (Tuberous Sclerosis)

Front 52

Why important to identify a Tuberous sclerosis patient?

Back 52

These patients could have epilepsy, a nueropsychiatric disorder, huge increased risk of cancer, angiomyolipomas, and risk of developing cystic lung disease.

Front 53

Vitiligo description

Back 53

Autoimmune reaction against melanocytes. Diffuse or focal. Think autoimmune, hypothyroidism, Hashimoto's thyroiditis

Front 54

Back 54

Vitiligo (Autoimmune, hypothyroid, Hashimotos)

Front 55

Xanthomas general description

Back 55

Nodular, papular, tumerous lesions (may be confused with rash/infection). Hyperlipidemia, esp familial variants.

Front 56

Back 56

Xanthoma

Front 57

Variations of Xanthomas

Back 57

Xanthelasma - around eyes
Palmar
Tendon (usually familial)
Eruptive - all over body, usually really bad cholesterolemia

Front 58

Back 58

Eruptive Xanthoma

Front 59

Back 59

Palmar Xanthoma (he got us on this in a practice question a couple sessions ago... xanthomas can be on the palms!)

Front 60

Back 60

Tendon Xanthoma (hyperlipidemia definitely familial)

Front 61

Blastomycosis Skin Presentation

Back 61

Skin is 2nd most common organ involved

lesions appear verrucous and ulcerate - looks a log like squamous cell carcinoma, but blasto will appear faster (usually)

Front 62

Back 62

Blastomycosis (looks like squamous cell!)

Front 63

Ecthyma Gangrenosum Presentation

Back 63

Hemorrhagic vesicles/pustules, cause microinfarcts, evolve into necrotic ulcers. Manifests from infectious vasculitis due to Pseudomonas aeruginosa (gram neg).

Front 64

Back 64

Ecthyma Gangrenosum (Pseudomonas infection)

Front 65

Erythema Chronicum Migrans Presentation

Back 65

Painless, Target rash. Lyme Disease

Front 66

Back 66

Erythma Chronicum Migrans (Lyme)

Front 67

Herpes Zoster Presentation

Back 67

burning dysesthesias, burning dermatomal rash that doesn't cross midline. Crusts. Neuropathic pain may persist. Recurrent VZV.

Front 68

Back 68

Herpes Zoster

Front 69

Back 69

Herpes Zoster

Front 70

Lupus Vulgaris Presentation (AKA?)

Back 70

AKA Tuberculous chancre

Nodule, ulcerates with induration on face and hands. due to primary bacillus inoculation.

Front 71

Back 71

Lupus Vulgaris (TB)

Front 72

Secondary Syphilis Presentation

Back 72

Papular, raised, ulcerated lesions on palms and soles.

Front 73

Back 73

Secondary Syphillis

Front 74

Back 74

Secondary Syphillis