Case studies in derm pattern recognition 1

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Case studies in derm pattern recognition 1

  1. 1. CASE STUDIES IN DERMATOLOGIC PATTERN RECOGNITION Part 1
  2. 2. PATTERN RECOGNITION IS THE CAPACITY TO DESCRIBE A RASH OR LESION USING A VARIETY OF PHYSICAL CHACTERISTICS IN ORDER TO LIMIT THE DIFFERENTIAL DIAGNOSIS
  3. 3. PHYSICAL CHARACTERISTICS OF ALL RASHES AND LESIONS • 1.BASIC MORPHOLOGY • 2.SIZE • 3.SHAPE • 4.COLOR • 5.PATTERN • 6.DISTRIBUTION
  4. 4. EXAMLPES OF BASIC MORPHOLOGY • 1.MACULE AND PATCH • 2.PAPULE AND NODULE • 3.PUSTULE • 4.WHEAL • 5.VESICLE AND BULLA • 6.PLAQUE
  5. 5. MACULES AND PATCHES MACULES ARE FLAT AND THEREFORE NOT RECOGNIZED BY TOUCH BUT RATHER A CHANGE IN COLOR FROM YHE SURROUNDING SKIN. PATCHES ARE LARGER MACULES
  6. 6. MONGOLIAN SPOTS
  7. 7. PAPULES AND NODULES PAPULES ARE ELEVATED SOLID LESIONS UP TO.5 CM IN DIAMETER. NODULES ARE LARGER THAN PAPULES
  8. 8. NEUROFIBROMA
  9. 9. PUSTULES PUSTULES ARE EPIDERMAL OR UPPER DERMAL COLLECTIONS OF PUS. ABSCESSES ARE DEEPER PUSTULES
  10. 10. BULLOUS IMPETGO
  11. 11. ABSCESSES
  12. 12. WHEALS WHEALS ARE ROUNDED PALE RED PAPULES OR PLAQUES CAUSED BY THE EXTRAVASATION OF FLUID
  13. 13. URTICARIA
  14. 14. VESICLES AND BULLAE VESICLES ARE LESIONS FORMED BY FLUID CREATING A CLEAVAGE PLANE BENEATH THE STRATUM CORNEUM. BULLAE ARE LARGER VESICLES
  15. 15. IMPETIGO
  16. 16. PLAQUES PLAQUES ARE RAISED LESIONS WITH A FLAT TOP. THE RISE IN ELEVATION IS MUCH LESS THAN YHR WIDTH OF THE LESION
  17. 17. PSORIASIS
  18. 18. EXAMLPLES OF LESION SHAPE • 1.ANNULAR • 2.NUMMULAR • 3.LINEAR • 4.OVAL • 5.TARGET • 6.SERPIGENOUS • 7.RETICULATE • 8.STELLATE
  19. 19. ANNULAR ANNULAR LESIONS ARE CIRCULAR AND HAVE A CENTER WITH AN APPEARANCE DIFFERENT FROM THEIR EDGE OR BORDER
  20. 20. KERATOACANTHOMA
  21. 21. NUMMULAR NUMMULAR LESIONS TAKE ON THE APPEARANCE OF A FILLED CIRCLE OR COIN
  22. 22. NUMMULAR ECZEMA
  23. 23. LINEAR LINEAR LESIONS ARE LONG RELATIVE TO THEIR WIDTH AND GENERALLY STRAIGHT
  24. 24. KELOID
  25. 25. OVAL THE WORD IS SELF EXPLANATORY
  26. 26. FIXED DRUG ERUPTION
  27. 27. TARGET TARGET LESIONS ARE MADE UP OF CONCENTRIC CIRCLES OF WHITE AND RED FORMING A BULLSEYE APPEARANCE
  28. 28. ERYTHEMA MULTIFORME
  29. 29. SERPIGENOUS LESIONS THAT ARE LONG AND WAVEY WITH A SNAKE-LIKE APPEARANCE
  30. 30. LARVA MIGRANS
  31. 31. RETICULATE LESIONS WITH AN INTERCONNECTED OR LACE- LIKE APPEARANCE
  32. 32. STRETCH MARKS
  33. 33. STELLATE LESIONS WITH A STAR-LIKE APPEARANCE USUALLY FROM A RADIAL SPREAD FROM A CENTRAL FOCUS
  34. 34. SUPERFICIAL VARICOSITIES
  35. 35. EXAMPLES OF LESION PATTERN • 1.GROUPED • 2.DISSEMINATED • 3.DERMATOMAL • 4.SYMMETRIC • 5.PHOTOSENSITIVE • 6. CONFLUENT • 7.INTERTRIGENOUS
  36. 36. GROUPED MULTIPLE SIMILAR LESIONS ORGANIZED IN CLOSE PROXIMITY
  37. 37. GENITAL WARTS
  38. 38. DISSEMINATED LESIONS WHICH ARE SCATTERED RANDOMLY OVER ALL OR MOST OF THE BODY
  39. 39. GENERALIZED DRUG REACTION
  40. 40. DERMATOMAL LESIONS THAT FOLLOW THE PATH OF A PERIPHERAL SENSORY NERVE
  41. 41. HERPES ZOSTER
  42. 42. SYMMETRIC LESIONS THAT ARE MIRROR IMAGES OF EACHOTHER FROM ONE SIDE OF THE BODY TO THE OTHER
  43. 43. ONYCHOMYCOSIS
  44. 44. PHOTOSENSITIVE LESIONS LIMITED TO THE SUN EXPOSED PARTS OF THE BODY
  45. 45. PHOTOSENSITIVE DRUG ERUPTION
  46. 46. CONFLUENT THE PROCESS OF SMALLER LESIONS COMING TOGETHER UNTIL THEY FORM A LARGE LESION BY MERGING
  47. 47. TINEA CORPORIS
  48. 48. INTERTRIGENOUS LESIONS THAT ARE LOCATED BETWEEN SKIN FOLDS SUCH AS THE AXILLA, GROIN OR BETWEEN FINGERS OR TOES
  49. 49. LESION SIZE • USUALLY DESCRIBED IN MILLIMETERS OR CENTIMETERS
  50. 50. EXAMPLES OF LESION OR RASH COLOR • 1.HYOPIGMENTED • 2.HYPERPIGMENTED • 3.WHITE • 4.BLACK • 5.BLUE • 6.YELLOW • 7.VIOLACEOUS • 8.VARIEGATED
  51. 51. EXAMPLES OF LESION DISTRIBUTION • 1.HEAD • 2.ORAL • 3.AXILLARY • 4.TRUNCAL • 5.ANOGENITAL • 6.INGUINAL • 7.DEPENDENT • 8.PEDAL
  52. 52. PURPOSE OF THIS LEARNING MODULE • THESE CASE STUDIES WILL PRESENT YOU WITH A RASH OR LESION FOLLOWED BY A DESCRIPTION USING AS MANY PHYSICAL CHACTERISTICS AS POSSIBLE. THE GOAL IS TO IDENTIFY THE RASH OR LESION BASED ON YOUR ABILITY TO RECOGNIZE IT’S PHYSICAL CHARACTERISTICS
  53. 53. • WITH EACH CASE YOU WILL FIRST SEE THE RASH OR LESION FOLLOWED BY THE RASH OR LESION WITH IT’S DESCRIPTION AND FINALLY THE DIAGNOSIS. TRY TO DESCRIBE IT USING AS MANY CHARACTERISTICS AS YOU CAN THEN COMPARE IT TO THE DESCRIPTION GIVEN AND FINALLY CHECK THE DIAGNOSIS
  54. 54. CASE #1
  55. 55. • A 3 CM. PINK TO BROWN ANNULAR PLAQUE WITH SCALING CENTER ON THE ARM OF AN EIGHT YEAR OLD BOY
  56. 56. TINEA CORPORIS
  57. 57. CASE #2
  58. 58. • MULTIPLE AREAS OF ALOPECIA WITH BROKEN HAIRS AND SCALES ON THE SCALP OF A TWELVE YEAR OLD BOY
  59. 59. TINEA CAPITIS
  60. 60. CASE #3
  61. 61. • MULTIPLE DISCRETE AND CONFLUENT HYPERPIGMENTED MACULES WITH FINE SCALES ON THE UPPER BACK AND NECK OF A FORTY-FIVE YEAR OLD WOMAN
  62. 62. TINEA VERSICOLOR
  63. 63. CASE #4
  64. 64. • BEGINS AS A BROWN MACULE BECOMES PLAQUE-LIKE DARKER AND HAS A STUCK-ON APPEARANCE OFTEN SEEN IN GREAT NUMBERS ON THE BACKS OF ELDERLY INDIVIDUALS
  65. 65. SEBORRHEIC KERATOSES
  66. 66. CASE #5
  67. 67. • STARTS AS MULTIPLE PAPULES THEN VESICLES FOLLOWED BY PUSTULES AND FINALLY CRUSTS ON AN ERYTHEMATOUS BASE AND DISTRIBUTED ALONG A DERMATOME. INDIVIDUAL LESIONS ARE 2 TO 3 MM. IN DIAMETER
  68. 68. HERPES ZOSTER
  69. 69. CASE #6
  70. 70. • MULTIPLE 1 TO 2MM. WHITE TO YELLOW PAPULES SEEN IN CLUSTERS ON AND AROUND THE NOSE IN INFANTS. MAY BE SEEN AS SINGLE LESIONS IN ADULTS
  71. 71. MILIA
  72. 72. CASE #7 •
  73. 73. • A SINGLE 2 CM. PAINLESS PUSTULE ON THE HAND OF A SIX YEAR OLD GIRL.MORE OFTEN SEEN GROUPED IN CLUSTERS
  74. 74. BULLOUS IMPETIGO
  75. 75. CASE #8
  76. 76. • A RAPIDLY EXPANDING (HORIZANTALY AND VERTICALLY) 2 CM. BY 3 CM. NODULE WITH VARIEGATED COLORATION ON THE BACK OF A FORTY- TWO YEAR OLD MAN
  77. 77. MELANOMA
  78. 78. CASE #9
  79. 79. • MULTIPLE HONEY- COLORED CRUSTS AROUND THE MOUTH AND CHIN OF A SIX YEAR- OLD CHILD
  80. 80. IMPETIGO
  81. 81. CASE #10
  82. 82. • A STREAK OF EXTREMELY PRURITIC VESICLES ON THE ARM OF AN ADULT RECENTLY BACK FROM A CAMPING TRIP
  83. 83. POISON IVY CONTACT DERMATITIS
  84. 84. CASE #11
  85. 85. • A CLUSTER OF 1 CM. VERRUCOUS PLAQUES WITH TINY BKACK DOTS ON THE PLANTAR SURFACE
  86. 86. PLANTAR WARTS
  87. 87. CASE #12
  88. 88. • MULTIPLE SYMMETRIC FACIAL PAPULES AND NODULES ON AN ERYTHEMAT- OUS BASE IN A SIXTY YEAR OLD WOMAN
  89. 89. ROSACEA
  90. 90. CASE # 13
  91. 91. • SHARPLEY MARGINATED ERTHEMATOUS PLAQUES WITH SILVER SCALES ON AN ERYTHEMATOUS BASE AND A PREDOMINANTLY EXTENSOR DISTRIBUTION
  92. 92. Case #14
  93. 93. • A LARGE WARM TO HOT ERYTHEMATOUS MACULE WITH ASSOCIATED EDEMA ON THE LEG OF A FIFTY- FIVE YEAR OLD MAN
  94. 94. CELLULITIS
  95. 95. Case #15
  96. 96. MOLLUSCUM CONTAGIOSUM
  97. 97. • MULTIPLE GROUPED OR DISSEMINATED PEARLY 1 TO 2 MM. ROUND OR OVAL PAPULES WHICH MAY SHOW AN UMBILICATED CENTER
  98. 98. MOLLUSCUM CONTAGIOSUM
  99. 99. CASE #16
  100. 100. • RED YELLOW AND WHITE GREASY OR SCALING MACULES AND PAPULES PRIMARILY SEEN ON THE CENTRAL FACE. MAY BE SEEN ON SCALP AND ANTERIOR CHEST COMMON IN ELDERLY AS ABOVE
  101. 101. SEBORRHEIC DERMATITIS
  102. 102. CASE #17
  103. 103. • PAINFUL BURNING 3 TO 5 MM. VESICLES ON AN ERYTHEMATOUS BASE AND IN A DERMATOMAL DISTRIBUTION
  104. 104. HERPES ZOSTER
  105. 105. CASE #18
  106. 106. • A GROUP OR CLUSTER OF 2 TO 3 MM. VESICLES ON AN ERYTHEMATOUS BASE PRECEEDED BY A SENSATION OF BURNING OR STINGING
  107. 107. HERPES SIMPLEX
  108. 108. CASE #19
  109. 109. • MULTIPLE OVAL 5 MM. TO 5CM. BROWN TO VIOLACEOUS MACULES AND PAPULES IN A35 YEAR OLD HIV POSITIVE MAN
  110. 110. KAPOSI”S SARCOMA
  111. 111. KAPOSI”S SARCOMA
  112. 112. CASE #20
  113. 113. • A SINGLE 3 CM. VIOLACEOUS MACULE COMMONLY SEEN IN THE GENITAL AREA
  114. 114. FIXED DRUG ERUPTION
  115. 115. CASE #21
  116. 116. • TRANSIENT PINK WHEALS WHICH ARE PRURITIC AND MAY ASSUME OVAL, ANNULAR POLYCYCLIC OR SERGIGENOUS FORMS
  117. 117. URTICARIA
  118. 118. CASE #22
  119. 119. • VELVETY FEELING AREA OF HYPERPIMENTATION ALSO COMMONLY SEEN IN THE AXILLAE
  120. 120. ACANTHOSIS NIGRICANS
  121. 121. CASE #23
  122. 122. • A 2 TO 5 CM. SCALING PINK OVAL PAPULE USUALLY FOUND ON THE TRUNK FOLLOWED BY MULTIPLE SMALLER SIMILAR OVA L LESIONS
  123. 123. PITYRIASIS ROSEA
  124. 124. Case #24
  125. 125. • CONFLUENT RED PLAQUES ON THE CHEEKS OF A TWELVE YEAR OLD GIRL. SIMILAR LESIONS IN A LACEY PATTERN SCATTERED OVER THE BODY
  126. 126. FIFTH DISEASE
  127. 127. CASE #25
  128. 128. • TRANSIENT PRURITIC PINK WHEALS SHOWING A PREDOMINANTLY ANNULAR SHAPE
  129. 129. URTICARIA
  130. 130. Case #26
  131. 131. • STREAKING PRURITIC CONFLUENT VESICLES ON AN ERYTHEMATOUS BASE IN A GARDENER
  132. 132. CONTACT DERMATITIS TO WILD PARSNIP
  133. 133. Case #27
  134. 134. • ERYTHEMATOUS PLAQUES WITH OVERLYING SILVER SCALES IN A PREDOMINTLY EXTENSOR DISTRIBUTION
  135. 135. PSORIASIS
  136. 136. Case #28
  137. 137. • A FIRM LINEAR FLESH COLORED PAPULE FOLLOWING THE SITE OF A SURGICAL INCISION
  138. 138. HYPERTROPHIC SCAR
  139. 139. CASE #29
  140. 140. • ENLARGING ERYTHEMATOUS PAINLESS MACULE WITH SLOWLY CLEARING CENTER
  141. 141. ERYTHEMA MIGRANS
  142. 142. CASE #30
  143. 143. • SINGLE AND CONFLUENT PAINLESS VIOLACEOUS PLAQUES DIISSEMINATED THROUGHOUT THE BODY
  144. 144. KAPOSI’S SARCOMA
  145. 145. CASE #31
  146. 146. • A PEARLY APPEARING 2 CM. ANNULAR PAPULE WTH AN ULCERATED CENTER AND ASSOCIATED TELANGECTASIA
  147. 147. BASAL CELL CARCINOMA
  148. 148. CASE #32
  149. 149. • FLAT TOPPED PLAQUES USUALLY 1 MM. TO 1CM. LESIONS ARE VIOLACEOUS ,SHARPLY DEFINED AND SHINY. SOMETIMES SEEN WITH THIN WHITE STREAKS
  150. 150. LICHEN PLANUS
  151. 151. CASE #33
  152. 152. • LARGE LICHENIFIED PLAQUES WHICH ARE PRURITIC AND DULL RED OR BROWN COMMONLY SEEN OVER THE SHINS
  153. 153. LICHEN SIMPLEX CHRONICUS
  154. 154. CASE #34
  155. 155. • 1 MM. DEEP SEATED VESICLES GROUPED IN CLUSTERS VERY PRURITIC AND COMMONLY SEEN BETWEEN THE FINGERS
  156. 156. DYSHYDROTIC ECZEMA
  157. 157. CASE #35
  158. 158. • THE SKIN IS EDEMATOUS AND ERYTHEMATOUS. THERE IS A FIRM PAINFUL FLESHY PAPULE IN THE CENTER OF THE LESION
  159. 159. PARONYCHIA WITH PYOGENIC GRANULOMA
  160. 160. PARONYCHIA WITH PYOGENIC GRANULOMA
  161. 161. CASE #36
  162. 162. • THE DISTAL HANDS ARE COVERED WITH A WELL-DEFINED MACULAR HYPOPIGMENT- ATION.FACE, FEET AND GENITAL AREA MAY BE INVOLVED
  163. 163. VITILIGO
  164. 164. CASE #37
  165. 165. • A LONG SERPIGENOUS 3 MM. WIDE ERYTHEMATOUS TRACK IN A WOMAN RECENTLY RETURNED FROM THE CARRIBEAN
  166. 166. CUTANEOUS LARVA MIGRANS
  167. 167. Case #38
  168. 168. ERYTHEMA MULTIFORME
  169. 169. • 3 CM OVAL LESIONS MADE UP OF CONCENTRIC CIRCLES OF RED AND WHITE
  170. 170. CASE #39
  171. 171. • SYMMETRCALLY PLACED SCALING NUMMULAR PLAQUES ON A BABY WHO LIKES HIS ‘NUK’
  172. 172. CONTACT DERMATITIS (PACIFIER)
  173. 173. CASE #40
  174. 174. • BRIGHT RED MACULAR LESIONS WITH A WELL DEFINED BORDER AND SATELLITES IN AN ITERTRIGENOUS DISTRIBUTION
  175. 175. CANDIDIASIS
  176. 176. CASE #41
  177. 177. WHITE PLAQUES ADHERENT TO THE TONGUE IN AN INFANT
  178. 178. CANDIDIASIS (THRUSH)
  179. 179. CASE #42
  180. 180. • CONFLUENT HYPERPIGMENTED PATCH ON THE SACRUM OF A NEWBORN
  181. 181. MONGOLIAN SPOT
  182. 182. CASE #43
  183. 183. • A ROW OF 1 CM. ERYTHEMATOUS PAPULES ON THE FACE OF AN INFANT
  184. 184. FLEA BITES
  185. 185. CASE #44
  186. 186. • A LINEAR TRACK OF 1MM. FIRM FLESHY WHITE PAPULES AROUND THE CORONA OF THE PENIS
  187. 187. PEARLY PENILE PAPULES
  188. 188. CASE #45
  189. 189. • A LARGE ERYTHEMATOUS INTERTRIGENOUS MACULE WITH A WELL-DEFINED BORDER AND SATELLITE LESIONS
  190. 190. CANDIDIASIS
  191. 191. CASE #46
  192. 192. • DISSEMINATED 5MM. TO 2CM. PINK OVAL TO ROUND MACULES WITH EVENTUAL CONFLUENCE OF LESIONS IN A THREE YEAR OLD GIRL
  193. 193. MEASLES
  194. 194. CASE #47
  195. 195. • A PUSTULE ON AN ERYTHEMATOUS BASE (THE DEW DROP ON A ROSE PETAL)
  196. 196. VARICELLA

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