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Introduction to Dermatology

Introduction to Dermatology. Christian Millett, MD. Overview. History Physical Exam Differential Diagnosis. History. When did it start? Duration Rate of onset Where is it at? Location How does it affect you? Itching or burning Pain Bleeding or discharge. Physical Exam.

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Introduction to Dermatology

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  1. Introduction to Dermatology Christian Millett, MD

  2. Overview • History • Physical Exam • Differential Diagnosis

  3. History • When did it start? • Duration • Rate of onset • Where is it at? • Location • How does it affect you? • Itching or burning • Pain • Bleeding or discharge

  4. Physical Exam • Primary lesions • Flat: macule, patch • Palpable: papule, plaque, vesicle, bulla, pustule, nodule, tumor, wheal • Secondary lesions • scale, crust, excoriation, fissure, erosion, ulcer, scar, atrophy

  5. Primary Lesions

  6. Macules and Patches • Nonpalpable changes in skin color (flat spots) • Circular, oval, or irregular • Distinct outline or fade into surrounding skin • Macules are < 1cm and patches are > 1 cm

  7. Macules and Patches

  8. Macules and Patches

  9. Macules and Patches

  10. Macules and Patches • Red spots: • Blanching => erythema (dilated blood vessels) • Non-blanching => purpura (extravasated RBCs) • Diascopy:

  11. Macules and Patches

  12. Macules and Patches

  13. Papules • Circumscribed, solid elevations with no visible fluid (< 1cm) • Usually centered in the dermis • Palpable • White, red, yellow, or black • Soft or firm • Smooth or rough • Discrete or grouped

  14. Papules

  15. Papules

  16. Papules

  17. Papules

  18. Papules

  19. Plaques • Circumscribed, solid elevations > 1cm • Usually flat-topped • Can be formed by confluence of papules

  20. Plaques

  21. Plaques

  22. Plaques

  23. Plaques

  24. Vesicles • Circumscribed, fluid-containing epidermal elevations < 1cm • Fluid is serous or sanguinous (resulting in pale, yellow, or red color) • Apex is round, acuminate, or umbilicated • Discrete, grouped, or linear • Arise directly or from a macule or papule

  25. Vesicles

  26. Vesicles

  27. Vesicles

  28. Vesicles

  29. Bullae • Blisters > 1cm • Rupture => erosions • Epidermal bullae are flaccid • Pemphigus vulgaris • Subepidermal bullae are tense • Bullous pemphigus • Nickolsky’s sign • Lateral pressure applied to unblistered skin in a bullous eruption results in shearing of epithelium

  30. Bullae

  31. Bullae

  32. Pustules • Elevations containing purulent material • Usually have white center with inflammatory areola • Can arise directly or from papules or vesicles

  33. Pustules

  34. Nodules and Tumors • Elevations that are 1-2cm (nodule) or > 2cm (tumor) • Similar to papules but larger and deeper (centered in the deep dermis or subcutaneous fat) • Soft or firm • Fixed or mobile • Cyst: nodule containing fluid

  35. Nodules and Tumors

  36. Nodules and Tumors

  37. Wheals (Hives) • Edematous, plateau-like elevations • Transient (last < 48h) • Circular or oval • Pink to red • Surrounded by “flare” of macular erythema • Discrete or coalesce • Prototypic lesions of urticaria

  38. Secondary Lesions

  39. Scales • Exfoliation • Laminated masses of keratin (detached stratum corneum) • Dry or greasy • Fine, coarse, or stratified • White, silver, yellow, or brown • Usually implies epidermal pathology • Rapid formation of epidermal cells • Interference with normal keratinization process

  40. Scales

  41. Crusts • Scabs • Dried exudates (serum, pus, blood)

  42. Excoriations • Scratch marks • Punctate or linear abrasion caused by mechanical means • Usually involves only the epidermis

  43. Fissures • Cracks • Linear cleft through the epidermis or into the dermis • Straight, curved, irregular, branching • Occur when skin is thickened and inelastic from inflammation and dryness • Mainly in regions subjected to frequent movement (fingers, toes, lips)

  44. Fissures

  45. Erosions • Loss of part or all of the epidermis • Can be seen after rupture of vesicles or bullae • Heal without scarring

  46. Ulcers • Excavations • Complete loss of epidermis plus part or all of dermis • Heal with scarring

  47. Scars • New connective tissue that has replaced lost substance in the dermis as a result of injury or disease • Part of the normal healing process • Smooth or rough • Pliable or firm • At first are pink or violaceous and over time fade to white

  48. Atrophy • Loss of skin tissue • Epidermal atrophy => thin, wrinkled appearance • Dermal atrophy => depression • Can result from solar damage, aging, or steroid overuse

  49. Other Skin Lesions • Comedone • plug of sebaceous and keratinous material lodged in the opening of a hair follicle • the orifice may be open (blackhead) or closed (whitehead)

  50. Other Skin Lesions • Milia • small, superficial keratin cyst with no visible opening

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