Skin Object is for you to learn and identify skin lesions Describe his skin Normal skin Color: Brown Normal hair No lesions Should feel for texture, turgor, moisture and warmth Describe the lesion Normal Mole • Tan to brown • Uniformly pigmented • Small (usually less than 6 mm across) • Solid regions of relatively flat (macules) to elevated skin (papules) • Well-defined, rounded borders Describe skin over legs Chronic ITP Hyperpigmentation Describe the lesion Campbell’d morgan spots Cherry angiomas are • Bright red • Small (usually 1-4 mm) • Papules • Commonly seen on the trunk of adults. • Medically insignificant Describe the skin Hodgkin’s disease • Dry • Scaly What do you see Senile purpura • Red • Patch • Does not blanch on pressure • Thin skin Describe the lesions Steroid induced purpura • Red • Patch • Does not blanch on pressure Describe the lesions Schonlein-Henoch purpura • • • • Ankle locaton Multiple Red Not blanching on pressure • Less than 5 mm • Vasculitis What type of skin lesions do you see? Henoch Schonlein purpura • Multiple • Red • Not blanching on pressure • Less than 5 mm • Vasculitis Describe the lesion Echymosis • Red • Large patch • Irregular edge • Changing colors Coagulation defect Describe the skin lesions Vasculitis • Multiple • Red • Not blanching on pressure • Less than 5 mm • Coalesing Vasculitis drug induced Describe each lesion Leukemia cutis • Ulcerating lesions Black base Sharp edges Surrounding echymoses • Blister 1 cm Fluid filled Patient with HIV. Describe the legs Kaposi Sarcoma • Nonblanching red macule • Surrounding ecchymoses and acquire more of a violet hue • The lesions may become nodular Describe the lesions Malignant Melanoma A: asymmetry- one side or half does not look like the other B: border irregularity C: color-black, or much darker than patient's other moles, often with red, white or blue areas. D: diameter > 6 Describe the lesions Sarcoidosis • Patch • O.5-1 cm in size • Different color than skin • Slightly elevated Maculo-papular lesions Descrbe the skin lesions Sarcoidosis • • • • Multiple Less than 1 cm Raised spot Dome shaped Papular lesions What do you see? Sickle cell anemia • • • • • Over ankle Patch larger than 1 cm Thin skin Loss of substance of skin Old scar Interpret his Nails Normal Transluscent Shiny Appears firm Describe the nails Doxorubicin • Transeverse band • White in color Describe the Nails Iron deficiency anemia • Spooning • concave Koilonychia Describe the scar Ehler’s danlos syndrome • • • • Patch larger than 1 cm Thin skin Loss of substance of skin Old widened scar Describe the skin Gardner Diamond syndrome • Multiple • Leniar wide • Thin skin Striae Describe the lesion Suqmous cell carcinoma • • • • • Ulcer Ear lobe Crusted lesion Sharp margin Indurated What is the lesion behind Ear? Keloid (after piercing) • Very firm • Rubbery lesions • Reddish or darkly colored • Occur after trauma sometimes very minor trauma • May itch. Describe the skin Eczema dyshydrotic Chest wall. Warm. Diagnosis? Empyema • • • • • Posterior chest wall Red patch Raised area Warm Tender Describe his scar in chest Empyema • Posterior chest wall • Wide scar • Loss of rib Previous open drainage Describe her face Sezary syndrome • Red face Erythroderma Diagnosis Erythroderma Differential diagnosis includes: psoriasis, eczema, drug reaction, pityriasis rubra pilaris (PRP), seborrheic dermatitis, lymphoma, mycosis fungoides, and other dermatoses. Painful lesions. Diagnosis? Erythema nodosum • Well-localized, multiple tender, red, deep nodules, 1 to 5 cm in size • bilaterally over the pre-tibial areas Painful. Diagnosis? Herpes Zoster • • • • Rash Along a dermatome Blisters not seen Crosses mid-line Describe the lesion Strawberry hemangioma • Red • Patch • 5 cms • Elevated • Blanch with pressure Capillary angiomas composed of small, superficial vessels Diagnosis? Plantar Warts • • • • • • • . Sole of foot Multiple Raised Rough Varying size Verrucous Skin-colored papules Describe the skin lesions Psoriasis Larger than 1 cm Elevated patches Plaques Silvery scale Describe the lesion Superficial Epidermal cyst • • • • 5 cm Fluid filled Fluctuant Orifice or "pore" near the center What do you see? Stasis ulcer • • • • Location in leg Denuded skin Hyper-pigmentation Firm skin