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Atypical Mole
flushingreactionofthecentralareasof
theface.Itisusuallyassociatedwithan
occursinmiddle-agedandolderpeople.
Burningorstingingoftenaccompanies
commonthanlupuserythematosus,withwhichitisoftenconfused.Rosacea
isdistinguishedfromacnebyage,thepresenceofthevascularcomponent,and
theabsenceofcomedones.
Folliculitis
This isavascularreactivenodulethatdevelopsas
a response to a minor injury. The overgrowth of
capillariesleadstoaraisedredlumpwhichbleeds
profuselywhentorn.
Lentigo Simplex
Theselesionsoccuronsun-exposedskin,especially
face, arms, and hands. Lesions are flat, and
pigmentedinshadesofbrown,withcharacteristically
sharpborders.Theytendtofadewithsunavoidance.
Varicella
ChickenPox
Therashis pruriticandmostprominentontheface,
development.Crustseventuallyformandsloughoff
varicellafromherpeszoster.Feverandmalaisemaybemildinchildrenand
muchmoresevereinadults.
vesicularrashonpalmsofhandsandsolesoffeet.It
developmentofmouthsoresismosttroublesometo
adults.Theskin lesionsarevesicopustules,0.5to5
sidesoffingersandsoles.
Verruca Plana
Seborrheicdermatitisisgenerallylimitedtothescalp;
yeastorganism,Pityrosporum,maybe afactor.Mild
scalingwithoutanyerythemaisoftentermedsimple
scrapingsshouldbetakenforKOHexaminationandfungalculture,especially
inchildren,ifhairlossispresent.
Nummular Dermatitis
Apruriticdermatosis,characterizedbyroundtooval
(coin-shaped) areas of vesiculation, superficial
crusting,andredness.Numberoflesionsvariesfrom
few to many. More often this is a symmetrical
pattern in young adults. Not related to atopic
dermatitis.
Tinea Capitis
Along with hair loss, the scalp surface shows
seborrheic dermatitis-like scaling, impetigo-like
crusting, pustules, inflammatory nodules or kerion.
IdentifytineawithKOHcultureontoafungalmedia.
Nolongeradiseaseconfinedtochildren.Ifinfection
suspected,allfamilymembersshouldbeexamined.
Tinea Versicolor
Pityrosporumorbiculare.Alteredpigmentationcan
hyperpigmented.KOHshowscharacteristicsporesandhyphae.Fungalculture
isnotuseful.
Candidiasis
Mucocutaneouscandidiasisoccursonthevulva,anus,
KOHrevealsbuddingsporesandshorthyphae.
LymeDisease
CausedbythespirocheteBorreliaburgdorferi,which
istransmittedtohumansbyadeertickbite,infection,
reactioncanbecomequitelarge,isgenerallycircular
withfever,chills,andmyalgias.Atthisstage,laboratorytestsarenotreliable.
Actinic Keratoses
face,itusuallystartsasareddenedpapuleornodule
fragileandoftenbleeds.Onthetorso,thelesionhas
an irregular surface, bright red color, sometimes scaly, with a distinct edge.
Histologicexaminationisrequired.
Thislesionusuallyappearsonskinthatshowsother
nodule.Shoulditappearonthemucusmembraneorliparea,itbehavesmuch
moreaggressivelyandcanbefatal.Histologicexaminationisrequired.
Malignant Melanoma
Pittingofnailsurfacewithspotsofwhitetoyellow
brown(oildroplets)reflectspsoriaticchangesinthe
nailmatrixandnailbedrespectively.Distally,there
are irregular onycholysis, splitting, and dystrophic
changes.Onycholysismaysimulateonychomycosis;
therefore, fungal culture will be valuable in
diagnosis.
Intertriginous Psoriasis
Sebopsoriasis
withmildtosevereitching.Thecharacteristicsign
istheuniformappearance(unliketinea)anddistinct
border(unlikecandida).Generally,acompleteskin
examwillrevealothersignsofpsoriasis.
Thelesionsarered,sharplydefinedplaquescovered
withthicksilveryscales.Thisdistinguishespsoriasis
from the diffuse or patchy redness and scaling of
seborrheicdermatitis.
Pustular Psoriasis
Red,sharplymarginated,grouped vesiclesusually
become crusted sores within 48 hours. Typical
distributionincludesprepuce,coronalsulcus,glans,
shaft.Deepachingpainoftheperineummayoccur
2 to 3 days before appearance of the skin lesions.
Itchy and painful, lesions generally recur in the
samelocation.
Herpes Simplex, Vulva
Recurrenceofpainfulsoresisadiagnosticsign.
Herpes Simplex in AIDS
GenitalWarts
skin-colored,fleshywartscanbe pin-headpapules
humanpapillomavirus.Onthevulva,perianalarea,
warts can be raised clusters and obviously wart-like, or so small they only
syphilis.Diagnosisofsyphilisisbasedonapositiveserologictestordiscovery
ofTreponemapallidumondarkfieldexamination.
Secondary Syphilis
papulesonthemoistareasoftheskinandmucous
Treponemapallidumondarkfieldmicroscopy.
Scabies
groupsofpruriticvesiclesandpustulesin"runs"or
"burrows"onthesidesofthefingers,palms,wrists,
feces.
Pediculosis
Lice
Pediculosisisaparasiticinfestationoftheskinofthe
easiesttoseeabovetheearsandatthenapeoftheneck.Thenits(eggsacs)are
attachedtohairs,closetotheskin.Bodylicedepositvisiblenitsonvellushair.
Headandbodylicearesimilarinappearanceandare3to4mmlong.
Papular Urticaria
Almostexclusivelyinchildren,thisisawidespread
reaction to insect bites such as fleas, bedbugs,
chiggers,orgnats,andmaypersistforlongperiods.
Thetendencywillfadewithonsetofadolescence.
Urticaria
Causedbyalargepoxvirus,thesesmooth-walled,
dome-shaped,pearlypapules,2to
5 mm in size, have an umbilicated center.
Occasionally a significant inflammatory reaction
will occur. Principal sites are face, hands, lower
abdomen, and genitals. A common viral infection
seen in AIDS. It is more difficult to eradicate in
thesepatients.
Herpes Simplex
lymphglandsmaybetenderandswollen.Sincethis
immunosuppressedpatients,herpeszostermaydisseminate,producinglesions
beyondthedermatome,viscerallesions,andencephalitis.DisseminatedZoster
isaserious,sometimeslife-threateningcomplication.