Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Signs in dermatology.pptx

7,992 views

Published on

dermatology signs

Published in: Education
  • Login to see the comments

Signs in dermatology.pptx

  1. 1. Dr.Rula jafari ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
  2. 2. What is a Sign…? Objective physical finding found by the examiner. Two types: 1- De novo 2- Physician induced
  3. 3. ● If the superficial silvery white scales are removed via curettage a characteristic coherence is observed, as if one has scratched on a wax candle (“signe de la tache de bougie” Candle sign). ● Subsequently, a surface membrane is seen, The lesion remains dry until this last level is reached (sign of the last Häutchen) which will also come off as a whole. ● If the latter is removed, then a wet surface is seen with characteristic pinpoint bleeding. This finding,is called Auspitz sign.
  4. 4. Auspitz sign, is the clinical reflection of elongated vessels in the dermal papillae together with thinning of the suprapapillary epidermis
  5. 5. ‫ك‬
  6. 6. - Knuckle dimple sign. - Due to short 4th and 5th metacarpals. - Enhanced by making a fist. - Described by Fuller Albright . - Found in Albright hereditary osteodysrtrophy.
  7. 7. - Short stature. - Obesity. - Round face. - Mental retardation. - Brachydactaly - Soft tissue ossification. - Short 4th and 5th metacarpals. - Pseudohypoparathyroidism (PHP): low calcium high phosphate high PTH non responding kidneys •Some Share them the habitus of AHO but are not resistant to PTH. The latter group are said to have pseudo-PHP.
  8. 8. McCune Albright Syndrome Albright Hereditary Osteodystrophy AD XLD Inheritance Polyostotic fibrous dysplasia osteodystrophy Bony lesions Large café –au-lait macule (cost of Maine) with ipsilateral bony changes. Precocious puberty. Short stature. Obesity. Round face. Mental retardation. Brachydactaly Soft tissue calcification. Short 4th and 5th metacarpals. Pseudohypoparathyroidism Other symptoms
  9. 9. McCune Albright Syndrome
  10. 10. - -Named after an English surgeon William Henry Battle. -Indicates fracture base of skull at the posterior fossa. - Blood dissects through fascia and collects at mastoid process.
  11. 11. - The ability to invaginate the tumor/lesion into the dermal defect with digital pressure. - Found in neurofibromas in NF1. - others: - Anetoderma - Old pigmented nevi - syphilitic chancre
  12. 12.
  13. 13. ● AKA Fitzpatrick’s sign, seen in dermatofibromas. ● Lateral compression with the thumb and index finger leads to depression of the lesion. ● This dimpling effect is secondary to the lesion being attached to the subcutaneous fat
  14. 14. Crowe’s sign
  15. 15. ● Named after Frank W. Crowe, an American physician.He noticed that axillary freckles are present in about 20-30% of patients with neurofibromatosis, but he did not see any in patients who did not have neurofibromatosis. - Axillary freckling in NF-1 -Occurs at a later stage compared to the Café au lait lesions. - Can also be found in the perenium.
  16. 16. skeletal defects
  17. 17. - wheeling, circumscribed erythema and localzed pruritis caused by scratching or rubbing the lesions. - Named after the French dermatologist : Ferninand Jean Darier (1856-1938). -Classically in mastocytosis. (which types ?) --explanation ? - Also seen in : insect bite, NF , JXG, acute neonatal lymphoblastic leukemia.
  18. 18. - Transient piloerection and elevation or increased induration of a lesion induced by rubbing. - observed in congenital smooth muscle hamartomas.
  19. 19. What translocation is most likely present within this lesion? What are the histopathologic findings? Identify the immunohistochemical pattern classic to this diagnosis. What is the recommended standard treatment option with the highest cure rate without recurrence? What treatment is recommended for patients with recurrent or metastatic lesions? Complete surgical excision, including Mohs micrographic surgery, is the standard treatment for DFSP Imatinib mesylate is currently FDA-approved for adults with unresectable, recurrent and/or metastatic DFSP (800 mg daily).
  20. 20. Darier-Roussy subcutaneous sarcoidosis
  21. 21. - Central depression surrounded by an elevated skin rim. - Seen in scleromyxedema. - On the extended proximal intelphalenges.
  22. 22. What stains would you use for a skin biopsy of a scleromyxedema case?
  23. 23. ● Symmetric confluent violacous erythema over the knuckles, wrists, knees is called Gottron’s sign ●Violaceous papules over MP joints (Gottron’s papules)
  24. 24. What are the other features of dermatomyositis?
  25. 25. Photodistributed poikiloderma involving the “V” of the chest and the upper back is often referred to as the “shawl sign” (Samitz sign) cuticular dystrophy and nail fold telangiectasias. The cuticles are “ragged” and within the proximal nail fold, dilated capillary loops alternate with vessel dropout Heliotrope sign (most characteristic)
  26. 26. Holster sign
  27. 27. CALCINOSIS CUTIS
  28. 28. • BLEOMYCIN treatment •Adult -onset Still's disease • Shiitake mushroom dermatitis.
  29. 29. .Juvenille DM vs adult DM – list 5 clinical differences Juvenile Adult Calcinosis cutis No calcinosis No malignancy Malignancy (ovarian) No sex predominance F:M = 2-7:1 10% overlap with other CTD 20% overlap with other CTD More vasculitis Less vasculitis what is in adults but not children ? malignancy (12% vs 0%) serology in adults not in children ? anti-synthetase ab (Jo-1)
  30. 30. Two medications can induce DM Statin – type lipid lowering agents. Hydroxyurea Two important clinical features differ lesion of DM from LE Violaceouse hue Pruritus
  31. 31. - After the English surgeon George Grey Turner ( 1877 – 1951 ). - Induration and brusing of skin over the costovertebral angel secondary to the spread of blood from the anterior pararenal space. - Commonly with acute hemorrhagic pancereatitis. - Can be with any other causes of retroperitoneal hemorrhage.
  32. 32. What other signs are seen in acute hemorrhagic pancereatitis ?
  33. 33. - Cullen's sign : hemorrhagic discoloration of the umbilicus.
  34. 34. - Around 20% of lymphogranuloma venereum. - Caused by a mass of femoral and inguinal nodes separated by the femoral ligament.
  35. 35. LYMPHOGRANULOMA VENEREUM Incubation Period ?? 3-21 days Chlamydia trachomatis L1, L2, or L3 Ccc histology?? Gamna-Favre bodies - Basophilic inclusion bodies located in the cytoplasm of endothelial cells Doxycycline 100 mg PO bid for 21 d Erythromycin base 500 mg PO qid for 21 d
  36. 36. - A cutaneous sign of neural tube defect on the scalp. - Coarse dark hair surrounding the underlying defect. - Can be seen in : aplasia cutus congenita, encephalocele, meningocele, ectopic brain tissue.
  37. 37. Aplasia Cutis Congenita (ACC ) • Onset before birth; localized defect in epidermis, dermis and/or fat; variable appearance, typically along midline • Presents with erosion, ulceration, scar, or membranous defect (ovoid lesion covered by an epithelial membrane) • Hair collar sign
  38. 38. IV
  39. 39. Group Main criterion Associations 1 Scalp: ACC without or with only isolated anomalies CLP, CMTC, PDA, tracheoesophageal fistula 2 Scalp ACC with limb reduction defect Adams-Oliver syndrome 3 Scalp ACC with associated epidermal nevi Sebaceous nevus , nevus verrucosus 4 ACC with underlying embryonic malformations Encephalocele, meningocele, spina bifida, omphalocele 5 ACC associated with fetus papyraceus Scalp, chest, flanks, axillae and/ or extremities Multiple, symmetric Stellate/angulated configuration 6 ACC with epidermolysis bullosa Lower extremities (“Bart syndrome”) or large areas of the trunk and extremities 7 ACC in the extremities Pretibial areas, extensor forearms, dorsal hands and feet Radial dysplasia (associated with ACC on the extensor forearm) 8 ACC in conjunction with specific teratogens Methimazole, Misoprostol, Low-molecular- weight heparin ,Valproic acid Maternal antiphospholipid syndrome intrauterine HSV or VZV infection 9 ACC in conjunction with Malformations
  40. 40. - Loss of lateral third of eye brow. -Seen in a list of diseses: -AA, trichotelemania, leprosy, ectodermal dysplasia, syphilis, KP, alopecia mucinosa, systemic sclerosis and hypothyroidism.
  41. 41. ● Symmetric, prominent horizontal fold(s) (single or double) just beneath the margin of the lower lid, originating at or near the inner canthus and extending one-half to two-thirds the width of the lid
  42. 42. ● Peri oral pallor due to cheilitis ( inflammation of the skin around the lips) Periorbital darkening (“allergic shiners”) • Skin around the eyes appears gray to violet–brown, while the rest of the facial skin is rather pale • Periorbital edema and lichenification may also be seen
  43. 43. ● Refers to reticulate pigmentation of the neck seen in patients with chronic atopic dermatitis. ● The condition was described in 1987 by two different groups, Manabe and colleagues and Colver and colleagues. ● The label ‘‘dirty neck’’ was given because of the resemblance to the appearance of unwashed skin, with the anterolateral aspects of the neck typically affected. ● The pigmentary changes are secondary to melanin incontinence
  44. 44. Can you remember the criteria to dx atopic dermatitis ???
  45. 45. MAJOR FEATURES (3 OF 4 PRESENT) • Pruritus • Typical morphology and distribution of skin lesions • Chronic or chronically relapsing dermatitis • Personal or family history of atopy MINOR FEATURES (3 OF 23 PRESENT) • Xerosis • Ichthyosis/palmar hyperlinearity/keratosis pilaris • Immediate (type I) skin test reactivity • Elevated serum IgE • Early age of onset • Tendency toward cutaneous infections/impaired cell- mediated immunity • Tendency toward nonspecific hand or foot dermatitis • Nipple eczema • Cheilitis • Recurrent conjunctivitis • Dennie–Morgan infraorbital fold • Keratoconus • Anterior subcapsular cataract • Orbital darkening • Facial pallor/erythema • Pityriasis alba • Anterior neck folds • Pruritus when sweating • Intolerance to wool and lipid solvents • Perifollicular accentuation • Food intolerance • Course influenced by environmental/emotional factors • White dermographism/delayed blanch
  46. 46. ● It is seen in keratosis pilaris in which individual follicles show a long strand of keratin glinting when examined in tangentially incident light
  47. 47. -Almost a certain sign of subungual malignant melanoma. The possibility of melanoma should be considered for all pigmented nail bands in fair-skinned individuals, especially if they are ● darkly pigmented, ● have irregular pigmentation and/or ● have a width ≥3 mm.
  48. 48. What other “ hutchinsosns” do you know ?
  49. 49. - In congenital syphilis: Hutchinsons teeth Eighth nerve palsy Keratistis
  50. 50. ● (V1; ~10–15% of zoster patients) ● Hutchinson’s sign refers to increased risk of ocular involvement if skin lesions are in the distribution of the nasociliary branch, which supplies the nasal tip, dorsum and root of the nose and the medial canthus as well as the cornea ● ~50% of patients have ocular involvement, which can include conjunctivitis, (epi)scleritis, keratitis, uveitis, acute retinal necrosis and optic neuritis ● May lead to ocular scarring and visual loss Herpes zoster Ophthalmic division of the trigeminal nerve
  51. 51. Other “Hutchinsons
  52. 52. Hutchinson’s summer
  53. 53. ● Severe form common in Native Americans , often with cheilitis and conjunctivitis ● Can occur in all races, including Caucasians ● Childhood onset; often resolution by adolescence, but can persist indefinitely ● Intensely pruritic, crusted papules or nodules in sun-exposed sites ● Strong association with HLA-DR4 (DRB1*0401) and subtype DRB1*0407 ● Management: photoprotection, NB-UVB, PUVA, thalidomide, topical calcineurin inhibitors
  54. 54. ●Deck-chair sign ● Classically described in Papulo-erythroderma of Ofuji, wherein there is flat-topped red papules that become generalized erythrodermic plaques without the involvement of abdominal skin folds
  55. 55. - After the European surgeon Edmund Leser ( 1853 – 1916 ). ● Rapid appearance or growth of multiple seborrheic keratoses; ● Often these patients have acanthosis nigricans and generalized pruritus. ● Adenocarcinomas are typically reported, particularly of the stomach and colon but also of the breast, uterus, esophagus, and pancreas ● Eruptive seborrheic keratoses can also develop in erythrodermic patients who do not have an underlying malignancy
  56. 56. ● Pseudo sign of Leser Trelat (Patton et al J. Drugs dermatology 3:565, 2OO4): ● Increase in size of seborrheic keratosis which can be seen after the use of cytarabene for the the treatment of acute myelogenous leukemia. ● Cytarabene causes inflammation of existing seborrheic keratosises
  57. 57. 1)Both conditions began simultaneously (neoplasia and paraneoplasia) 2) Development of a parallel course * 3) The skin lesion is not associated with a genetic syndrome 4) There is a specific type of neoplasia that occurs with paraneoplasia 5) The dermatosis is rare in the general population 6) There is a high frequency of association between both conditions * Treatment of the neoplasia results in regression of the skin lesion; recurrence of the neoplasia implies recurrence of the skin lesion.
  58. 58. Association with adenocarcinoma of the stomach or other sites within the GI or GU tracts How do you know its MALIGNANT acanthosis nigricans ? •If it is : • Sudden onset • With constitutional symptoms and weight loss • Extensive and involves sites such as the palms and soles and mucous membaranes . • With other paraneoplastic features
  59. 59. ● Tripe palms : ● Ridged velvety lesions on the palms with prominence of dermatoglyphics ● adenocarcinoma of the gastrointestinal tract. ● squamous cell carcinoma of the lung Florid cutaneous papillomatosis (gastric adenocarcinoma) Dermatoglyphics are absent/hypoplastic in what genodermatoses ? • Dermatopathia pigmentosa reticularis •Naegeli–Franceschetti–Jadassohn syndrome •Profuse congenital familial milia with absent dermatoglyphics (Basan's Syndrome)
  60. 60. Paraneoplastic Pemphigus (PNP) • Associated with •Non-Hodgkin’s lymphoma (most common), •Chronic lymphocytic leukemia, •Castleman’s disease, •Thymoma , •Waldenström macroglobulinemia , •Sarcoma Benign Autoantigen : various desmosomal proteins including •desmoglein 3, •periplakin, •envoplakin, • desmoplakin 1/2, •BPAG1, •plectin, •170 kDa Ag, •rarely desmoglein 1
  61. 61. Bazex syndrome (acrokeratosis paraneoplastica) •Acral psoriasiform plaques, typically with involvement of the nose and helices; often the lesions are violaceous . • Longitudinal and horizontal ridging of the nails occurs in 75% of patients •By definition, this condition is linked to malignancy, generally occurring in the upper aerodigestive tract (pharynx, larynx or esophagus)
  62. 62. Erythema gyratum repens Variable sites and types of malignancy
  63. 63. Glucagonoma syndrome (Necrolytic migratory erythema), •With angular cheilitis, glossitis •Due to a glucagon-secreting tumor of the pancreas. •Patients are often treated for intertrigo before the syndrome is diagnosed. •Weight loss and diabetes mellitus accompany the dermatosis
  64. 64. Don’t mix between Necrolytic MIGRATORY erythema ( paraneoplastic ) with Necrolytic ACRAL erythema ( associated with HCV and zinc def )
  65. 65. Acquired hypertrichosis lanuginosa (malignant down) •Growth of fine lanugo hairs in a generalized distribution or •localized to the face. With time, these hairs may become coarser •Associated with a variety of internal malignancies, most often carcinoma of the lung, colon or breast
  66. 66. Acquired ichthyosis Resembles ichthyosis vulgaris; most often located on the legs Lymphoma typically predates the diagnosis of the ichthyosis
  67. 67. Sister Mary Joseph sign, refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen. Gastrointestinal malignancies account for about half of underlying sources (most commonly gastric cancer, colonic cancer or pancreatic cancer,
  68. 68. Pitryasis rotunda associated with HCC (in type 1)
  69. 69. Sweet’s syndrome ● Associated with hematologic malignancies (10–20% of cases), in particular acute myelogenous leukemia; solid tumors, e.g. carcinoma of the genitourinary tract, breast and colon.
  70. 70. Trousseau syndrome Migratory superficial thrombophlebitis’ with Pancreatic cancer
  71. 71. - Hyperpigmentation of the neck occurring in pellagra patients. What is deficient in pellagra ???????????? Niacin
  72. 72. - Blue sclera. -Seen in multiple cases: ● Osteogenesis imperfecta, ● Ehler danlos syndrome, ● nevus of Ota, ● argyria and ● Alkaptinuria.
  73. 73. What are the other features of Alkaptinuria ??
  74. 74. It is a rare condition in which a person's urine turns a dark brownish-black color when exposed to air defect : Homogenestic acid oxidase deficiency. - AKA : endogenous Ochranosis. - AR. ● Osler sign, ● blue pigment in the skin, ● cartilage destruction ( ears), ● brown sweat, ● dark urine, ● arthropathy, intervertebral disc calcification.
  75. 75. Features that may present early in life include : brownish discoloration of diapers (due to the dark urine) and cerumen that is more brown to black in color than normal
  76. 76. Slight rubbing of the skin results in exfoliation of the outermost layer. - Seen in : ●Autoimmune condition (pemphigus vulgaris). ●Bacterial infection ( scalded skin syndrome). - Negative in BP.
  77. 77. ● Seen in Steven Johnson syndrome, toxic epidermal necrolysis and in some cases of burns and bullous icthyosiform erythroderma. ● The underlying mechanism here is the necrosis of epidermal cells and not acantholysis, as seen in true Nikolskiy's sign. ● It is elicited the same way as the true sign. However, unlike Nikolskiy's sign, pseudo-Nikolskiy's sign is elicited only on clinically involved or erythematous areas.
  78. 78. What is the name of the sign positive in BP?
  79. 79. - Named for Gustav Asboe-Hansen (1917–1989), Danish physician. - AKA "indirect Nikolsky sign" or "Nikolsky II sign“. - Extension of a blister to adjacent unblistered skin when pressure is put on the top of the bulla.
  80. 80. - The new blisters arises around the old leasions forming linear sequential lesions. - Seen in CBDC. •Target antigen: •9 7 kDa Ag ( LAD-1 or LABD97 ): cleaved ectodomain of BPAG2 Treatment of choice ???
  81. 81. IgG staining IgA staining linear deposition of IgA along the BMZ
  82. 82. Direct IF (DIF) : Detects in vivo antibodies bound to tissue antigens in perilesional skin
  83. 83. Indirect IF (IIF) Detects circulating serum antibodies (substrate sections react with serially diluted serum from patient → incubated with anti-IgG or other specific fluorescent dye- tagged antibody) Best substrate : monkey esophagus (PV), guinea pig esophagus (PF), transitional rat bladder
  84. 84. Salt-split-skin (SSS) Technique ● Variant of IIF allowing distinction between different subepidermal blistering conditions with similar DIF findings; ● Normal human skin incubated in 1 M NaCl for 48–72 h resulting in split at lamina lucida level; location of antibody binding to split ( epidermal or dermal side ) distinguishes different diseases
  85. 85. B- Bullous pemphigoid
  86. 86. - A diagonal ear lobe crease extending diagonally from the tragus across the lobule to the rear edge of the auricle. - It has been hypothesized that Frank's sign is indicative of cardiovascular disease and/or diabetes. - have no predictive value in Native American Indian and Asian patients.
  87. 87. ● Sometimes used for scale crust of pemphigus foliaceous. ● Cornflake sign seen in Flegel's disease is characterized by 2-3 mm keratotic scaly papules with discrete irregular margins. ● The scale separates from many lesions, leaving a non- exudative red base.
  88. 88. What other types of scale do you know?
  89. 89. .
  90. 90. Ichthyosiform scale Describes large, polygonal scales - as in fish scales. Example: Ichthyosis vulgaris.
  91. 91. Thin adherent mica-like scale attached at the center of a lichenoid firm reddish brown papule and free at the periphery. Example: Pityriasis lichenoides chronica.
  92. 92. In clear cell acanthoma, wafer-like scale is seen adherent at the periphery, which leaves a moist or bleeding surface when removed.
  93. 93. Double-edged scale Describes erythematous, exfoliating or scaly, annular or polycyclic, flat patch with an incomplete advancing double edge of peeling scale. Example: Ichthyosis linearis circumflexa
  94. 94. ICHTHYOSIS HYSTRIX descriptive term for massive hyperkeratosis that has a verrucous surface or forms protruding, porcupine-like spines; Observed : • In patients with EI (most common ) •Verrucous epidermolytic nevi •Ichthyosis hystrix Curth-Macklin • Hystri -like ichthyosis with deafness (HID) syndrome (mutations in the GJB2 gene)
  95. 95. Mauserung desquamation Mutations: keratin 2 (KRT2),
  96. 96. Plate-like scale (Armor plate) LAMELLAR ICHTHYOSIS Transglutaminase-1 deficiency due to deleterious mutations in both copies of the TGM1 gene LAMELLAR ICHTHYOSIS
  97. 97. ● This sign is diagnostic of Discoid Lupus Erythematosus [DLE]. ● Removal of an adherent scale from a lesion of DLE reveals the undersurface to be covered with horny plugs [resembling carpet tacks] overlying dilated hair follicular openings
  98. 98. ● This is pathognomic of Congenital Syphilis. ● An irregular thickening or enlargement of the sternal end of clavicle, usually unilateral
  99. 99. V
  100. 100. ● This is seen in Kwashiorkor and other diseases leading to severe protein malnutrition like extensive bowel resection, severe ulcerative colitis etc. ● Presence of alternating white and dark bands along individual hair shafts SEEN BY NAKED EYES ● The bands are formed due to intermittent severe protein malnutrition.
  101. 101. What else can cause this sign ???????
  102. 102. ? Tiger tail appearance : alternating light and dark bands under polarizing light Seen in Trichothiodystrophy (autosomal recessive disorder characterized by sulfur-deficient hair)
  103. 103. Actinic keratosis ●alternating areas of orthokeratosis and parakeratosis.
  104. 104. ●It is the ability of patients of Ehlers- Danlos syndrome to touch the tip of the nose with the tip of their tongue.
  105. 105. ● This sign is seen in Rubella and was originally described by Forschheimer. ● The name is given to an enanthem [mucosal rash] that is confined to the soft palate during the prodromal period in Rubella
  106. 106. Friar-Tuck signFriar-Tuck sign
  107. 107. ● This is seen in Trichotillomania. ● In severe forms of the disease, when the whole scalp is involved the hair at the margins is characteristically spared.
  108. 108. ● The bites of bed bugs (Cimex lectularius) usually follow a linear pathway in a group of three to five blood meals and are often referred to as “Breakfast, lunch, and dinner” or “Breakfast, lunch, and supper” sign
  109. 109. 31+ 32
  110. 110. sign
  111. 111. Chagas–Mazza–Romaña's sign ● Chagas’ disease (American trypanosomiasis), conjunctiva is the portal of entry for Trypanosoma Cruzi. ● Unilateral swelling of eyelids and orbit after conjunctival inoculation is called as eye-sign or Chagas–Mazza– Romaña's sign or Romaña's sign ● It is seen in early stages of African trypanosomiasis caused by Trypanosoma brucei rhodensiense and Trypanosoma brucei gambiense known Sleeping sickness. ● Winterbottom's sign is enlargement of lymph nodes in the posterior cervical chain Winterbottom's sign
  112. 112. ● In 1877, Heinrich Koebner described the appearance of psoriatic lesions in the uninvolved skin of psoriatic patients as a consequence of trauma. ● In general, the interval to koebnerization is between 10 and 20 days, but may be as short as 3 days or as long as 2 years. ● The original classification of Koebner phenomenon is : Koebner/Isomorphic phenomenon
  113. 113. ● Reverse Koebner phenomenon This phenomenon is explained, in which an area of psoriasis clears after injury
  114. 114. ● Remote reverse Koebner phenomenon It is defined in vitiligo patients, in which spontaneous repigmentation is seen in distant patches after autologous skin graft surgery. Punch grafting on right leg (shown with blue arrow). Spontaneous repigmentation over left leg (shown with yellow arrow)
  115. 115. ● Pseudokoebner phenomenon : ● Seen skin infections like MC and warts ● Due to auto inoculation
  116. 116. Ugly duckling sign ● Refers to the observation that a nevus that does not resemble a patient’s other nevi is more likely to represent a melanoma
  117. 117. A few other signs …..
  118. 118. Drip sign ● Found in dermatitis artefacta produced by corrosive liquids. ● Patterned burned areas correspond to the areas of dripping of the liquid when applied by the patient.
  119. 119. Enamel paint sign ● Seen in patients with kwashiorkor ● Sharply demarcated hyperpigmented desquamating patches and plaques resembling enamel paint occur on the skin, predominantly in areas of pressure and irritation. ● The underlying skin is inflamed and raw.
  120. 120. Hoagland’s sign ● is early and transient bilateral upper lid edema occurring in patients with infectious mononucleosis. ● The sign is usually present only for the first few days of the clinical presentation of the illness.
  121. 121. Foot prints in snow' appearance in Pseudopelade of Brocq
  122. 122. Asbestos-like appearance Pityriasis amiantacea
  123. 123. Cauliflower appearance Relapsing polychondritis Cauliflower appearance condylomata acuminata
  124. 124. Cayenne pepper appearance Schamberg disease
  125. 125. Cigarette paper like scars The skin in patients with Ehler-Danlos syndrome is hyperextensible which gives rise to gaping "fish-mouth wounds" over bony prominences like the shins, knees, and elbows following minor trauma. Such wide, thin, papyraceous scars over the knees and elbows are also called "cigarette paper scars."
  126. 126. cigarette paper"-like wrinkled appearance in parapsoriasis
  127. 127. Cliff drop appearance Atrophoderma of Pasini and Pierini
  128. 128. Cobblestone appearance In Darier's disease
  129. 129. In crohn's disease
  130. 130. Cowden’s disease (AD)
  131. 131. In Heck's disease What is Hecks disease ? Focal epithelial hyperplasia: papules on buccal, gingival, labial mucosa resembling flat warts What is the causative agent ? HPV 13, 32
  132. 132. Following punch grafting for vitiligo
  133. 133. Confetti-like appearance Amyloidosis cutis dyschromica (Primary cutaneous amyliodosis), ‫الورق‬ ‫قصاصات‬ ‫الملونة‬
  134. 134. Dyschromatosis symmetrica hereditaria (Acropigmentation of Dohi) The skin findings are characterized by hypo- and hyperpigmented macules on the dorsal and ventral aspects of the hands and feet, which may extend to the proximal portions of the limbs (knees and elbows). Macules appear in the first to second decade and are typically non- progressive. Similar lesions (freckle-like macules) can be found on the face.
  135. 135. Dyschromatosis universalis hereditaria The disease begins in early childhood and is characterized by mottled pigmentation which originates from the hands and can progress to involve the trunk, extremities and face. The lesions are characterized by hyperpigmented macules admixed with hypopigmented lesions and can also involve the palms, soles and oral mucosa.
  136. 136. Tuberous Sclerosis Complex
  137. 137. Vitiligo ponctué, an unusual clinical presentation of vitiligo, is characterized by multiple small (confetti- like), discrete amelanotic macules, sometimes superimposed upon a hyperpigmented macule
  138. 138. Purse string appearance of oral aperture in a case of systemic sclerosis
  139. 139. Figure of 8/hour glass appearance of vulva in lichen sclerosus
  140. 140. Glazed appearance Juvenile plantar dermatosis ‫مصقول‬
  141. 141. Inverted wine bottle appearance in lipodermatosclerosis
  142. 142. A child with diffuse cutaneous mastocytosis giving a leather grain appearance to the skin
  143. 143. Nutmeg grater appearance Pityriasis rubra pilaris (PRP)
  144. 144. Pebbly appearance Hunter syndrome mucopolysaccharidosis II (MPS II), is a lysosomal storage disease caused by a deficient (or absent) enzyme, iduronate-2-sulfatase (I2S). The accumulated substrates in Hunter syndrome are heparan sulfate and dermatan sulfate. The syndrome has X-linked recessive inheritance.
  145. 145. Pseudoxanthom a elasticum showing the characteristic 'plucked chicken' appearance
  146. 146. Rippled appearance Macular amyloidosis
  147. 147. Salt and pepper' appearance on upper back in a female with systemic sclerosis
  148. 148. Sandpaper appearanc trachyonychia
  149. 149. Speckled appearance Speckled lentiginous nevus
  150. 150. Tapir nose appearance Mucocutaneous leishmaniasis caused by Leishmania braziliensis and L. mexicana is termed as "espundia," which is characterized by mutilation of the nasal apparatus. It spares the nasal bones. When the septum is destroyed, the nasal bridge and tip of the nose collapse, giving the appearance of a parrot beak, camel nose, or tapir nose appearance
  151. 151. Vermiculate atrophoderma in a young patient with 'worm-eaten' picture
  152. 152. Zebra-like appearance Linear and whorled nevoid hypermelanosis
  153. 153. Thank you

×