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Boils (Furuncle)

Carbuncles
Erysipelas

Acute, tender,
inflammatory
nodules
30mm diameter
Cluster of boils
M>F
Fever
A cellulitis

Infections
Bacterial infections
Staphylococci infection
Breast, butt, neck, face
Staphylocci infection
Neck
Beta haemolytic
streptococcus (group A)

Malaise, fever
Erythrasma

Superficial skin
infection

Limbs, face
Bacteria
(Corynebacterium
minutissimum)

Inflamm. Nodule pustule ooze out


purulent exudate
Recurrent
Slow spread deep area of infection
slow heal and form scars
Defined, red, shiny, oedema, tender
Recurrent: Lymphatic involvement
chronic lymphedema
Looks like chronic fungal infection
Initial: pink, irregular
Later: defined, brow, scales

Common in DM
Folliculitis

Bacterial infection
of hair follicles

Between toes
Staph aureus
Pseudomonas aeruginosa

Lesions: pustules OR inflamm. Nodules


Superficial or deep, acute or chronic

Impetigo

Scaled Skin syndrome

Contagious
superficial
inflammatory
disease
Predisposing:
infected nose/ears;
dirty nails/towels;
scabies; eczema
Widespread skin
infection
Infants, young
children,

Area with many hair


Staphylococcus aureus
Note: staph is most
common skin infection
in nostrils of 50% of ppl;
in body creases of 10%
of ppl
Face and ears
Epidermolytic toxin
(group11 positie
staphylococci)
Skin, eye, nasopharynx

Thin walled vesicles + bullae rupture


form honey coloured crusts
Children more contagious
Itching scratching vaccination to new
site?
Pea coin size
Circular sharp
Will disappear in a month or so
Erythema, peeling of skin
Initial: localize, crusted lesion (e.g. belly
button)
Later: erythematous areas more
generalized blisters desquamation

immunosuppresse
d
Chicken pox

Erythema infectiosum
(slapped cheek disease;
fifth disease)

Herpes simples
infections

Measles (rubeola,
morbilli)

Incubation: 24-21d
Communicability: 1-2d
before rash all lesions
have crusted
Transmission: (direct)
P-P, droplets, airborne.
(indirectly) discharge of
vesicles and mucous
membranes)
Incubation: 4-20d
Communicability: up to
when rash appears
Transmission: contact
(respiratory secretions
like cough + mother to
baby)
Cold sores
Incubation: 2-20d
Communicability:
maximum
communication in the
first few days of onset
Transmission: carrier in
latent form. Contact with
vesicles, saliva
Incubation: 10d till
fever, 14d till rash
appears
Communicability: from
beginning of s+s till 4d
after rash appears

(peeling skin) of large area of skin


Systemic signs
Viral infections
Varicella-zoster virus: a herpes
viru
Covered > exposed skin
Scalp, mucous membrane
(mouth, URT, conjunctiva)

Fever (sudden)
Minimal sign S+S eruptions
maculopapular (few hrs)
vesicular (3-4d) granular
scab
Varicella virus vaccine (live)

Shingles: recur in later years


Parovirus B-19 a DNA virus
Rash on cheeks (appears a
week later)

Herpes virus (type 1 and 2)


1-oral; 2-genital

Asymptomatic
Flu-like, mild fever, headache,
myalgia, chills, rash on cheeks
Infection in utero: severe
anaemia, abortion (<5% of
women infected during
pregnany)
Initial: systemic in distribution
Recurrent: 1 2 3

1. Herpes labialis: Lips


(mucous membrane)
2. Genital herpes: Genitalia
vesicles
3. Herpetic
gingivostomatitis
oropharyngeal cavity
vesicles
Morbillivirus RNA virus
Face red blotchy rash (after
3-7d) desquamation (skin
peeling)

Vesicles:
- Various sizes
- On an erythematous
base
- Later rupture and form a
crust
Fever, conjunctivitis, coryza
(rhinitis), cough
Haemorrhagic measles, mouth
sores, protein losing
enteropathy, dehydration,

Pityriasis rosea

Warts

Dermatophytosi
s

Transmission: droplets,
direct contact (nasal or
throat secretions)

Infant, adult, malnourished severe Kiplik spots on buccal


muscosa (teeth)

Mild inflamm. Disease Macules and


maculopapular lesions
(scaly)

Unknown, may be caused by


virus

Common, contagious,
benign lesions from
epithelial cells often
muliple

Tinea or ringworm
Mycotic diseases of keratinized
areas of body

Tinea pedis (foot)


Man contaminated floors,
showers unknown
adults + males more; hot
weather; young and middle aged
men
SUSC: variable, infections
unapparent; frequent.
CF: scaling/cracking of skin (toes),
blisters
Tinea unguium (nails)

Trunk, upper half of arms and


legs
Lesions: pin-20c size, oval
along creases of skin, pink
Human papilloma virus
Common wart: hands, feet
(pin-pea size) rough,defined,
vary shape and colour, <1cm
Planter wart: pressure point
son foot; pea size or larger,
look like coin
Plane wart: face, forehead,
back of hands, front of knees;
flat, discrete flesh colour
Fungal infections

severe skin reacitons (5-10%)


Complications: otitis media,
pneumonia, encephalitis
6-10wks
Sudden onset Herald patch
solitary muscular lesion 710d other lesions appear

Hyperkeratosis, acanthosis,
papillomatosis
Filiform: neck (middle aged
females), beard (men)
Accuminate wart (condylomata
accuminata): mucocuaneous
areas (esp genital); soft, fleshy,
cauliflower like vegetate +
malodourous

Fungi dermatophytes
Tinea capitis (scalp, beard) - hair
Reservoir: man, animal (dogs, cats, cattle)
Transmission: skin-skin, seats, slippers, toilet, clothes
Occurrence: common
Incubation: 10-14 days
Communicability: as long as lesions are present and viable reinfection
rarely occurs
CF: onset gradual; begins (small papule spread peripherally scaly
patches temporary baldness); infected hairs brittle, occ raised
lesions (kerions); spread to eyelids, neck, trunk

Tinea corporis & Tinea cruris (body & groin and perianal

RE: man, rarely animals or soil


TRANS: skin, nail lesions, floors, showers
OCC: common
INC: unknown
COMM: as long as infected lesion is present
SUSC: nail injury infection; reinfection is frequent
CF: chronic fungal disease 1/+ nails of hands or feet;
nail (thickens, discoloured, brittle, chalky,
disintegrates)

Paronychia
(whitlow)

Pityriasis
versicolour

Any infection of the periungual


region (fingernails and
toenails)

Chronic, symptomless, fungul


infection

Pediculosis

hook worm
A parasite,
pruritic skin
infestation
Lice
Transmission:
direct, clothes,
linen, combs,
sexually

Acute: staph.aureus,
candida albicans, proteus
sp, pseudomonas sp
- Break in the
epitherlium
Chronic: mixed bacteria
and fungi (e.g. candida
albicans (prolonged
periods of contact with
water high risk)
Fungal infection

Acute: acute area of inflamm. with


pain; pus abscess infection
spread to deeper tissues
Chronic: swelling in periungula
region + distortion of nail

Onset (gradual); Looks like vitiligo


Lesions: macular, fawn/caf au late
in colour, defined, size varies
Fine brawny scales

Common: chest, back,


axillae
Other infections
Anclyostoma braziliense (hookworm of
the dog or cat)

Pruritic + winding + line of


inflammation

Lower part of body contact with


contaminated soil by larvae of worm
Parasites
Scalp: pediculosis humanus capitis
Pruritis of scalp; Post-auricular/supraauricular, occipital
Scratching excoriations, bacterial
invasion + post-auricular
lymphadenopathy
Dermatitis

Body: pediculosis Corporis:


pruritis, small red lesions,
scratch marks, urticarial (a
rash of round red wheals),
infection (lice on
clothes>body)
Pubic hair: phthirus Pubis:
lice or nits in pubic or ano-

Change in pigmentation of skin


Creeping eruption

region)
RE: man, animals, soil
TRANS: direct and indirect (ppl, animals, floors, showers, benches)
OCC: worldwide and frequent
INC: 4-10 days
COMM: as long as lesions are present
SUSC: axilla and inguinal regions (friction and sweating), high
temperature and humidity
CF: flat, spreading, ring shaped lesions; periphery is red, vesicular or
pustular, dry, scaly OR moist and crusted; often clears normal skin

Scabies

Parasitic
infestation of
skin severe
pruritis (worse at
night)

Albinism
Rare inherited disorder
melanocytes are present BUT do not
make melanin!
Autosomal recessive inherited
disorder
Pale skin, white hair, pink eyes
sunburn easily prone to skin
cancers
Acne rosacea

Acne vulgaris

Nits (eggs) on hairs close to scalp


blood supply. Lice also close to scalp.
Sarcoptes scabiei
Transmission: direct contact, clothing,
bedding

gential region + underwear


Infestation -> 4-6wks
manifestations (delayed
hypersensitivity reaction)

Lesion: popular eruption, large


Fingers (esp webs), flexor surfaces of
numbers, superficial burrows
wrist and elbow, axilla, areolas of
(<1cm, fine, wavy lines)
breasts, genitalia in males, buttocks
Alteration in skin pigmentation
Melasma (chloasma)
Vitiligo
Areas of pigmentation (usually face)
Common 1/+ areas of well-defined
Pregnancy, pill (increase estrogen)
depigmentation of skin
Pigmentation: dark brown, bilateral
Unknown familial, autoimmune,
Forehead, temples, upper cheeks
immunological pathogenesis
No melanocytes present in
depigmentation areas

Disorders of hair follicles and sebaceous glands


Chronic inflamm.
Unknown but anything giving Onset (gradual) facial flushing
disorder
flushing of face
Lesions: popular and pustular
Central face (acneiform lesions No blackheads (comedones)
Sunlight, winds,
& telangiectasia)
Rhinophyma (condition large
alcoholism, spicy food,
Chin, cheeks, nose, forehead,
bulbous nose) may develop men +
hot drinks, depressed
neck, chest
alcoholics
F>M (perimenopausal
Complications: conjunctivitis, iritis,
period)
keratitis
Common acne
Familial history disease of
Onset (gradual)
Chronic inflamm disorder puberty (androgens
Lesions: few hundreds
comedones, milia
increase sebaceous gland
Skin is greasy
(white heads) papules,
activity)
Dandruff commonly present
pustules, cysts
Face, chest, back, back of neck
(sebaceous follicles and

Alopecia

Hypertrichiosis

glands)
Loss of hair (complete or
partial)

Excessive hair growth

(hirsutism)

Milia (whiteheads)

A type of tiny sebaceous


cyst
Cystic lesion containing
sebaceous, follicular and
keratinous material

Idiopathic, age, drugs, hair


pulling, local diseases,
systemic diseases, genetic
factors
Non-scarring alopecia:
rarely complete hair loss, no
scarring
Scarring: inflamm/injury
hair loss
Familial, endocrine disorders
(excessive androgenic
hormones)
Face, scrotum

Alopecia areata: circumscribed area


of hair loss variable in size
Toxic: temporary, occur months after
febrile illness
Trichotillomania: seen in children
presence of hairs in varying lengths
(hair pulling)

Post-menopausal, drugs

Accumulation of sebaceous
Firm, non-tender (unless 2nd
material under skin
infection), if punctured/ruptured
cyst or wen)
CF: slow growing, globular
(greasy, cream, yellow, malodourous)
cysts
Disorders related to sweat glands
Hyperhidrosis
Miliaria (prickly heat)
Overactivity of sweat glands excessive
Acute, pruritic, inflamm skin disorder retention of sweat
perspiration
Excess environmental temp and humidity swelling of horny layer of
Generalised or local (axilla, groin, palms,
epidermis sweat is unable to reach skin irritation of epidermis
soles, under breasts)
and/or dermis pruritis or prickly feeling
DUE TO: psychogenic, some skin diseases, Irritation or itchy skin
fever, hyperthyroidism, CNS disorder
Lesions: vary in size, minute, superficial, transparent or red BUT may be
(rare)
deeper, larger, and painful
CF: moist skin, skin discolouration,
Areas of high conc of sweat glands most commonly affected
malodorous
Sebaceous
cysts (keratinous

Angiomas

Basal cell
carcinoma

Neoplasia and alterations in cell differentiation


Variety of vascular
Hyperplasia of blood or
2.2 Haemangiomas: CAVERNOUS
disorders skin and/or
lymphatic disorders
HAEMANGIOMA
subcutaneous tissue NOT A 1 Vascular: PORT WINE STAIN
Elevated, red/purplr, large vascular
TUMOUR but a
Flat, pink/red, present at birth, spaces, rarely shrinks
hamartoma (overgrowth of
doesnt fade [face, neck]
2.3 Haemangiomas: SPIDER
blood vessels in a localised
2.1 Haemangiomas:
ANGIOMA
area)
CAPILLARY HAEMANGIOMA
Central arteriole with fine
(strawberry mark) elevated, projections, spider like, bright red,
bright red, common, develop
pregnancy, on pill, liver disease, no
early infancy, fade 5-10yr
underlying disorder
3 Lymphangiomas
Elevated, varied colour (pale>red)
Most common malignancy
Sun exposure
Insidious onset, slow growing
of skin
>40yo, M>F (most common
Modular: pinhead-pea size larger,
From basal cells of
skin cancer)
pearly, shiny, raised, unbroken,
epidermis
ulcerated, oozy, crusted

Dermatofibrom
a
Dysplastic
naevi

Common lesions of fibroblastic tissue

Kaposis
sarcoma

Malignancy from foci in


dermis epidermis

Common pigmented lesions

Herpes virus type B


Keloid

Hypertrophied scar

Keratoacantho
ma

Benign, nodular skin lesion


sloping edges & ulcerated
centre

Lipomas

Common benign tumour


from adipocytes
Common pigmented skin
lesion, benign, but can
become malignant

Melanocytic
naevi (moles)

20% of melanomas arise in


moles

Melanoma

Malignant growth from


melanocytes or other
pigmented cells. From skin
or mucous membranes.

Unknown

Familial tendency

Common: legs

Papule or nodule; red/brown

Single/multiple; larger than other


pigmented, non-dysplastic naevi,
many colours, irregular borders,
macular (flat) and popular (raised),
unlikely melanoma
AIDS: papules, nodules, plaques develop first on upper body
more generalized; oval or round; pink/red/purple/brown; visceral
lesions and lymph node involvement
Non-AIDS: purple/brown papules, nodules, plaques on lower limbs
and feet; deeper tissue invasion; visceral lesion and lymph node
involvement
Excessive number of fibroblasts, blood vessels, collagen at wound
site
Sun exposure
Fast growing, fleshy papule
1-10cm
rapid keratotic core with fleshy
Looks like BCC or SCC
rim
Resolves in 3m atrophic scar
Unknown
Multiple, soft and mobile,
Upper body
subcutaneous, asymptomatic
Inherited tendency for pigment
Average: 50 moles (white), few
cells in epidermis/dermis to
(dark)
develop melanocytic naevi
Flat-elevated, flesh coloured
Giant hairy naevus: congenital
dark brown macules and papules,
Halo naevi: young adulthood,
random over entire skin, occ
depigmentation
presented at birth, appear 1-4yo,
Blue naevi: young adulthood,
increase in adulthood.
dark grey-blue/blue-black
smooth surface
60-80% from normally
Melanoma vs moles
pigmented skin; 20-40% from
Rapid growth, speckles of
moles. Fair skinned. High sun
different colour, diffusion of
exposure.
pigment from papule into
surrounding skin, inflamm or
Acral-lentiginous melanoma
surrounding skin, bleeding,

(rare)

oozing, crusting of surface

Lentigo maligna (30%)


Slow growing, dark macule on
[face] elderly white person.
Irregular border, many shades
of brown, tan and black
hypopigmentation
Macule invasive node
METs
Less aggressive, 100% cure if
treated at the prognosis stage

Superficial spreading melanoma


(50%)
Slightly elevated plaque anywhere
in body. Irregular border, black,
brown, white, pink rim, fragile,
bleed, ooze.
Small plaque (6-24m) nodule
(highly invasive)
>90% cure rate in plaque stage

Nodular melanoma (20%)


Suddenly (papule or nodule) [skin
or in mole]
Blue-black or brown nodule bleeds
easily, rim of inflammation. May be
flesh coloured.
METs: only weeks to dermis and BV.
Occ nodular melanoma develops
after MET spread. Prognosis is poor.

Pagets disease
of the nipple
Pyogenic
granuloma

Ductal carcinoma of breast


+ dermatitis of areola
Vascular nodule of
granulation tissue

Unknown

Seborrheic
warts
(seborrheic
keratosis)

Superficial skin lesion,


pigmented, looks warty

Breast lump, unilateral dermatitis


of areola
Nodular, brown/blue-black, dark
red
Rapid growth, friable, bleed easily
Look like melanoma or skin
malignancies
Light-dark brown patches
Popular, 1-2cm, round/oval, rough
and/or flat; can peel off keratin
cap

NOT BACTERIA! NOT a true


GRANULOMA!
Develop @ site of recent injury

NOT VIRAL, NOT SEBACEOUS


Unknown, familial, sun damage;
middle aged older white
people
[Trunk, scalp, face]
Skin tags
V. common, small, pedunculated lesions. Neck, axilla, groin. Skin coloured or hyperpigmentated.
Rarely cause any sympt.
Squamous cell
Invasive tumour from
Sun exposure, fair people,
Onset gradual, opaque, skin
carcinoma
malpighian layer of
elderly
coloured, fleshy papule, nodule,
(SCC)
epithelium
Skin, mucous membrane, preplaque scaly, keratotic, eroded
existing lesion (more aggressive 1-2cm diameter, ulceration,
20% METs)
fragile, oozing, bleeding.
Metastasis widely.
Other disorders
Callus
Well defined area of
Any site exposed to trauma
Superficial lesions of roughened
hyperkeratosis
hands and feet
skin
- Friction, pressure,
especially over bony
prominence

Corn
Dermatitis
herpetifor
mis
Keratosis
pilaris

Well defined area of


hyperkeratosis
- Friction or pressure
Chronic, pruritic skin disease
- Clusters of papules,
vesicles and urticarial
like lesions
Common disorder plugs of
horny material fill block the
orifices of hair follicles

Metatarsophalangeal and
interphalangeal joints of feet,
between toes
Gluten sensitive enteropathy (IgA)

Hard (over joint), soft (between


toes) painful and/or tender

Unknown

Lesions: multiple, small and


pointed

Gradual onset, intensely pruritic,


lesions on extensor surfaces symmetrical

Lateral aspects of arms, buttocks,


thighs
Autoimmune response:
IgA forms to surface antigens on
cells of epidermis decrease in
cohesiveness of epidermal
keratinocytes + blistering

Pemphigus

Uncommon, autoimmune skin


disorder
- Large bullae, and
erosions on skin and
mucous membranes

Pressure
sores

Ulceration over bony prominences


ulceration
Extrinsic factors: immobilized, paralysed, bedridden
Intrinsic: malnutrition, anaemia, tissue atrophy, infection, poor circulation, loss of sensation
Early: erythema

Followed by: abrasions, shallow craters, blisters, infection


Then: necrosis
deepens, deeper crater, infection

Late: necrosis of deeper tissues (muscles, tendons, bones,


joints). Cellulitis, septic arthritis and osteomyelitis
Rough horny (kertotic) lesions Chronic exposure to sunlight
Pink/red macules OR fleshy
on areas exposed to strong
Fair skinned people
papules covered by scales
sunlight
>40yo
(grey,white,yellow)
Malignant changes occurs in
Tender, vary in size, pin-coin size
Indistinct margins;
small minority Squamous
Scales falls and reforms, painful to
cell carcinoma
remove, bleeding
Dry skin: Severe - scarring and peeling. Environmental conditions, skin disorders, hereditary aetiology
Chronic inflamm disease
Family history, trauma, acute
Onset (gradual)
well defined papules or
infections, psychological upsets
Lesions: popular, dry, scaly, small
plaques of varying sizes, red
Extensor surfaces (knees,
at first, increases to various sizes
lesions, silver scaled (acute
elbows), scalp, sacral region,
Koebmers phenomenon may be
of fatal)
chest, face, abdomen, genitalia
seen

(bedsores =
trophic ulcers
= decubitus
ulcers)

Solar
keratosis
(actinic
keratosis)
Icthyosis
Psoriasis

Middle aged + elderly


Area: any area which stratified
squamous epithelium is found
first appear in mouth
Bullae develop rupture
painful erosions and crusting
Prolonged pressure on tissues ischaemic necrosis

Psoriatic arthropathy (5-10%)


nail pitting (80%)