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Atopic Dermatitis (Eczema)

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Itchy rash on cheeks, arms, back, knees Family history of asthma Erythematous, patches of eczematous change with excoriation to the malar cheeks, bilateral antecubital and popliteal fossa

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Rhus Contact Dermatitis (Poison Ivy)

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Itchy rash with blisters on arms, neck, ankles, Recent time outdoors; Linear, erythematous streaking with vesicles to the anterior neck, upper and lower extremities

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Dyshidrotic Dermatitis (Pompholyx)

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Itchy hands, worse when wet, small water blisters Excoriated erythema with multiple 1-3 mm vesicles, worse on the lateral aspect of the fingers

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Nummular Dermatitis

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Itchy red patches back & hands, worse in winter; Multiple round, dry erythematous patches to the back and dorsal hands. There is no white scale and no central clearing.

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Seborrheic dermatitis (Buildup of YEAST on the skin)

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Redness and flaking to face and ears, Oily skin and Dandruff; Erythema with mild scale to the central face, eyebrows and nasolabial folds. There is also diffuse flaking to the scalp and ears.

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Stasis Dermatitis

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Elderly, HTN and CHF history with swelling, redness, itching lower legs with standing; Multiple varicosities to the lower extremities. 2+ pretibial edema. Lichenified eczematous changes with excoriation to the pretibial region

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Lichen Simplex Chronicus (Secondary to uncontrolled Atopic Dermatitis)

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Dry itchy skin, history of eczema; Excoriated eczematous changes to the trunk and extremities with large areas of lichenification

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Lichen Simplex Chronicus (Secondary to uncontrolled Atopic Dermatitis)

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Dry itchy skin, history of eczema; Excoriated eczematous changes to the trunk and extremities with large areas of lichenification

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Tinea Pedis (Athlete's Foot)

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College athlete rash between toes; Excoriated scaling erythema to the web spaces of foot with involvement of the plantar surface. Toenails are normal with no discoloration or subungal debris. KOH +

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Tinea Corporis

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Red circular rash, hydrocortisone worsened; Two 2-3 cm well demarcated, circular areas of erythema with central clearing and follicular involvement on the arm

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Tinea Corporis

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Red circular rash, hydrocortisone worsened; Two 2-3 cm well demarcated, circular areas of erythema with central clearing and follicular involvement on the arm

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Onychomycosis

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Thick, ugly toenails Yellow, hypertrophic toenails with subungal debris and spiking to the left foot. Nail biopsy PAS +

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Tinea Versicolor

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Rash on chest spread to back, no itching; Outdoors; Multiple pink macules on the chest, back and shoulders. Woods light exam is + for a yellow/green fluorescence

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Tinea Versicolor

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Rash on chest spread to back, no itching; Outdoors; Multiple pink macules on the chest, back and shoulders. Woods light exam is + for a yellow/green fluorescence

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Lichen Planus

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Itchy bumps on wrists; Planar, polygonal, purple papules on the volar surface of the wrist. Oral exam reveals a white lacy plaque to the buccal mucosa and tongue (Wickam's striae)

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Lichen Planus

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Itchy bumps on wrists; Planar, polygonal, purple papules on the volar surface of the wrist. Oral exam reveals a white lacy plaque to the buccal mucosa and tongue (Wickam's striae)

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Lichen Planus

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Itchy bumps on wrists; Planar, polygonal, purple papules on the volar surface of the wrist. Oral exam reveals a white lacy plaque to the buccal mucosa and tongue (Wickam's striae)

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Pityriasis Rosea

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Itchy rash on chest and back starting with a single spot; Multiple salmon colored broad-based papules with thin collarette scale (in a Christmas tree pattern). There is a single larger lesion to the right posterior shoulder (Herald patch). Woods light exam is negative

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Cutaneous Drug Eruption

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Itchy, red rash spread from abdomen to extremities, cut hand a few days ago - on Kefelx;Maculopapular erythematous eruption to the trunk and extremities. Wound on hand is sutured and skin is well approximated, there is no drainage, warmth or induration. Punch biopsy obtained from abdomen. (May present with: urticaria, vasculitis, photosensitivity, lupus like reaction (joint pain))

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Fixed Drug Eruption

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Pink spot that comes and goes; Takes tetracycline for flares; Single well demarcated erythematous macular lesion to the left lower abdomen. There are no blisters, pustules, scaling or tenderness.

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Acute Urticaria

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Red, itchy welts abdomen and legs, Sore throat week ago; Multiple erythematous, edematous plaques to the trunk and extremities. + dermatographism

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Vasculitis

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Itchy red spots on legs, mild fever; Patches of palpable purpura to the bilateral calves and pretibial region.

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Steven-Johnson Syndrome

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Blisters to mouth, trunk, and hands came on rapidly (12 hours), fever/cough, prescribed Dilantin for seizures; Dusky vesicles with desquamation to the trunk and extremitites. There are some bullae and erosions to the oral and genital mucosa.

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Toxic Epidermal Necrolysis

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Spreading blisters and peeling skin, mouth sores, fever, taking allopurinol for gout flare; Painful erosions to mucus membranes. Skin is diffusely erythematous with multiple bullae and desquamation - gentle pressure easily produces epidermal detachment (Nikolsky's sign)

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Bullous Pemphigoid

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Severely itchy blisters to trunk, worse in groin and underarms; Multiple erythematous fluid filled bulla to the trunk and upper extremities, worse in the axilla and groin.

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Perioral Dermatitis

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Red bumps around mouth and nose; Multiple erythematous papules to the perioral and perinasal areas. There are no pustules or honey colored crusting.

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Acne Vulgaris

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Facial pimples; Multiple inflammatory papules and multiple open comedones with moderate oil to the central face.

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Rosacea

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Oily, red pimples and flushing to face, sun exposure and spicy food; Background erythema to the central face with scattered inflammatory papules. There are no comedones.; Rhinophyma

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Rosacea

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Oily, red pimples and flushing to face, sun exposure and spicy food; Background erythema to the central face with scattered inflammatory papules. There are no comedones.; Rhinophyma

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Folliculitis (Pseudomonas)

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Itchy rash of small pimples to back and legs, Keflex with no improvement, hot tub user; Muliple areas of follicular erythema and inflammation. There are no obvious pustules.

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Folliculitis (Pseudomonas)

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Itchy rash of small pimples to back and legs, Keflex with no improvement, hot tub user; Muliple areas of follicular erythema and inflammation. There are no obvious pustules.

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Seborrheic Keratosis

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Multiple brown waxy stuck-on lesions with sharply demarcated borders to the trunk.

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Seborrheic Keratosis

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Multiple brown waxy stuck-on lesions with sharply demarcated borders to the trunk.

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Pediculosis Capitus (Lice)

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Severely itchy scalp; Multiple white flakes attached firmly to the hair shaft - more prominent at the base of the scalp. There is excoriation to the occipital scalp and upper neck. No obvious lice.

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Scabies

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Itchy rash that is worse at night, waking the patient up; Multiple punctate areas of excoriation to the trunk and extremities that involves the palms, soles and web spaces. Skin scraping + for microscopic ova.

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Scabies

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Itchy rash that is worse at night, waking the patient up; Multiple punctate areas of excoriation to the trunk and extremities that involves the palms, soles and web spaces. Skin scraping + for microscopic ova.

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Actinic Keratosis

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Dry, crusty spots on face, scalp, and ears (sun-exposed areas); Multiple areas of dry erythema, some lesions have a yellow or transparent adherent scale. Some areas are easier to palpate than observe

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Actinic Keratosis

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Dry, crusty spots on face, scalp, and ears (sun-exposed areas); Multiple areas of dry erythema, some lesions have a yellow or transparent adherent scale. Some areas are easier to palpate than observe

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Squamous Cell Carcinoma

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Rapidly growing, crusty, tender bump on hand; 8 x 8 mm hypertrophic scaling lesion to the left dorsal hand.

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Basal Cell Carcinoma

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Growing mole on forehead; 8 x 7 mm erythematous pearly papule to the frontal scalp. Often friable with central ulceration.

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Malignant Melanoma

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A few superficial, uninflamed stuck-on lesions to the chest and midback. There is a 6 x 7 mm grossly irregular lesion with jet black border to the scapula. ABCDE

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Psoriasis Vulgaris

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Thick scaling rash, joint pain in knees and ankles; Well demarcated erythematous plaques with thick white scale to the scalp, trunk, elbows, knees and hands. Joint exam reveals no obvious deformity. There is pitting to the nails.

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Alopecia Areata

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Losing hair on one side of the head, no other symptoms; 4 x 5 cm well demarcated area of hair loss to the right scalp. There is no evidence of excoriation, pustules, scaring, flaking or hair breakage.

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Vitiligo

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White spots on hands; Large macular, hypopigmented patches to the bilateral hands.

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Acute Paronychia

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Redness and pain around the fingernail after pulling off hangnail; Flourid erythema with accumulated exudate to the lateral nail fold.

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Erythema Multiforme

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Itchy red circles on hands and feet, under stress; Multiple erythematous target lesions to the dorsal hands, palms and soles. There is a fever blister to the right upper lip

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Erythema Multiforme

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Itchy red circles on hands and feet, under stress; Multiple erythematous target lesions to the dorsal hands, palms and soles. There is a fever blister to the right upper lip

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Herpes Simplex Virus

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Painful blisters to penis with burning sensation prior to outbreak, stress; Small, erythematous vesicles to the distal shaft of the penis

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Herpes Zoster (Shingles)

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Red blistering rash to the right side, had chicken pox as child; Erythematous macular rash with small vesicles to the right flank in a dermatomal pattern. Lesions do not pass the midline

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Condyloma Acuminata

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Multiple "hemorrhoids" and unprotect sex recently; Multiple filliform lesions to the anus.

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Molluscum Contagiosum (Pox Virus)

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Bumps behind the knees; Multiple flesh colored umbilicated papules to the popliteal fossae

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Verrucae Vulgaris (HPV)

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Warts on the hands; Multiple hypertrophic verrucous lesions to the fingers.

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Cellulitis

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Trauma to the hand, redness swelling, pain few days after; Confluent erythema with significant edema to the entire hand that extends to the wrist. Affected area is very warm on palpation. Patient has limited range of motion - he cannot make a fist or bend his fingers 90*. There is no red streaking to the forearm.

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Acanthosis Nigricans

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Obese patient with "dirty neck;" Velvety brown hyperpigment to the neck and axilla.

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Hidradenitis Suppurativa

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Painful draining boils under arms and between the legs; Multiple areas of post inflammatory pigment, scaring, dilated pores with communicating cysts. Double comedones, Painful abscesses, Cord-like bands of scar tissue

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Melasma (Chloasma - mask of pregnancy, hormonally induced)

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Discoloration of face since pregnancy; Macular hyperpigmented patches to the forehead and cheeks.

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Candidiasis (Intertrigo - Diaper Dermatitis)

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Red tender rash under arms and skin folds, hydrocortisone made it worse; Confluent, bright erythema with multiple satellite lesions

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Candidiasis (Intertrigo - Diaper Dermatitis)

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Red tender rash under arms and skin folds, hydrocortisone made it worse; Confluent, bright erythema with multiple satellite lesions

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Erythrasma (Corynebacterium infection)

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Rash to the groin; Confluent, mild erythema to groin. Woods light exam reveals a coral red fluorescence

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Fifth Disease (Erythema Infectiosum "Slapped Cheek")

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Red cheeks, fever; Bright erythema to the malar cheeks - the forehead and perioral area are clear. There is macular, lacy erythema to the trunk and extremities. The palms and soles are clear

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Roseola (Herpes Virus 6 & 7)

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Very high temperature; Small, pink macules diffusely spread over the trunk and extremities. Posterior cervical and occipital lymphadenopathy. Patient is alert and in no distress

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Impetigo

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Red crusty rash around mouth and nose; Denuded erythema to the perioral area with honey colored crusting

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Hand, Foot, and Mouth Disease (Coxasackie A16 Virus)

answer

Tongue hurting and clear blisters on hands and feet; Total of 5, 3-4 mm ulcerations to the tongue and buccal mucosa. Scattered 4mm, square vesicles on the palms and soles. No lymphadenopathy

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Herpes Varicella (Chicken Pox)

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Headache, low grade fever, small itchy blisters on abdomen spread to extremities; Multiple 2-4 mm clear vesicles, crusts and pustules on an erythmatous base (dew drop on rose petal / teardrop) to the trunk and extremities. Several ulcers to oral cavity. Patient is scratching. Patient was not immunized for varicella.

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Measles - Rubeola

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Spread by respiratory droplets. Prodrome: Cough, fever, conjunctivitis, rhinitis (1-7 days).Erythematous maculopapular rash that becomes confluent. Starts in hairline, spreads to face and neck, then to trunk and extremities (6-7 days). Koplik spots on buccal mucosa.

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Measles - Rubeola Koplik spots on buccal mucosa.

answer

Spread by respiratory droplets. Prodrome: Cough, fever, conjunctivitis, rhinitis (1-7 days).Erythematous maculopapular rash that becomes confluent. Starts in hairline, spreads to face and neck, then to trunk and extremities (6-7 days). Koplik spots on buccal mucosa.

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Rubella - German Measles

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Prodrome: Mild fever, malaise, headache, URI symptoms (1-5 days); Maculopapular rash becomes pinpoint. Begins on face and spreads to trunk and extremities in 24 hours and resolves in 3 days. Posterior cervical, suboccipital and postauricular lymphadenopathy.

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Rocky Mountain Spotted Fever (Rickettsia reckettsii)

answer

South central and south eastern US and Brazil; 6-8 days after tick bite Acute fever, severe headache, myalgia, vomiting and petechial rash; Rash typically starts on the wrists and ankles, then spreads to palms and soles

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Lyme Disease (Borrellia burgdorferi)

answer

Tick borne, affects many organ systems Onset 3-28 days after tick bite. Stage 1: erythema migrans - "bull's eye" lesion at site of tick bite, flu symptoms. Stage 2: cardiac and neurological problems Stage 3: arthritis and chronic neurological problems

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Classic Kaposi's Sarcoma (Human Herpes Virus 8 HHV-8)

answer

Men of Eastern European or Mediterranean descent, ages 50-70 Violaceous patches and plaques involving the lower extremities; Progresses slowly, rarely fatal from lymph node or GI/lung involvement

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Endemic Kaposi's Sarcoma (Human Herpes Virus 8 HHV-8)

answer

In regions of Africa seen in men ages 20-50 and in children under the age of 10 Men: Locally aggressive, nodular infiltrating lesions on extremities Children: Aggressive lymph node involvement with or without skin lesions Course: Aggressive with poor prognosis

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Immunosuppressed Kaposi's Sarcoma (Human Herpes Virus 8 HHV-8)

answer

(1) AIDS, CD4 count often < 200. Violaceous macules, plaques and nodules commonly involving the head, neck and upper trunk, lymphadenopathy common. Course: Rarely fatal as patient usually dies of other infection OR (2) Immunosuppressed secondary to medication (i.e. organ transplant patients)

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Black Widow Spider Bite

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Systemic disease due to neurotoxin causes abdominal pain, muscle cramping, hypertension, nausea/vomiting, weakness, tremors and potential paralysis. Mild erythema or swelling at site of bite

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Brown Recluse Spider Bite

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Yellow, tan or brown spider with violin shaped marking on back. Localized pain, burning and stinging and possible local tissue ischemia. Uncommon systemic symptoms: fever, chills, nausea/vomiting, weakness, joint pain.

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Androgenetic Alopecia

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Male Baldness

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Androgenetic Alopecia - Female

answer

Female Baldness

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