ࡱ> surM j+bjbj== .jWWj'lTTTTTTTh,\h:8p:H\09999999$W; w=>9T9\1TT9\1\1\16 TT9\19\1\1P4:9,TT9d Aht *tB9 990:L9R=~/=9\1hhTTTTMacula Flat Erythematous maculae red blushing , disappears on pressure Vascular maculae permanent , also can disappear with pressure eg telengectesia Purpura , bleeding into dermis , change from red to ochre (earth color), do not disappear on pressure Freckles pigmented from ochre to brown Blue melanin extending to dermis White vitiligo Papules Elevated Epidermal eg plane warts Dermal eg urticaria Both eg lichen planus Nodules Deep dermis and subcutis elevations Rheumatoid Tubercles Vegetations Soft filiform lobules eg condylomata  HYPERLINK "C:\\medical\\condy.jpg" C:\medical\condy.jpg Wart A vegetation covered with thick skin Keratosis Epidermal from keratin layer eg horn Vesicles Small with central clear liquid Bullae are large vesicles Pustules have pus in the middle Scales Horny cells formed by keratin layer eg ichythosis Crusts eg impetigo When secretions dry out Excoriations Superficial eg wounds caused by scratching Fissures Linear ulcers eg athletes foot Ulcers Deeper through the dermis Gangrene Tissue necrosis Atrophy Loss of skin thickness and elasticity eg old age Scars Fibrosis of epidermis or dermis Sclerosis Fibrosis of skin ECZEMA Allergic contact Acute Background erythematous congestion , superificial small vesicles which rupture and exude clear fluid Chronic Keratotic red skin , cracked , infected eg cement on back of fingers Vesicular Red vesico-papular , small vesicle eg hand creams Bullous Larger vesicles eg shoe leather Crusted Eg Jean chromium metal, greyish top , unclear margins Scaly dry Red eg eye cream g Eg gloves , distinct margins Chronic Thickened skin , red , itchy eg hand detergents Chronic palmer Greyish thickened cracked red skin Atopic dermatitis Infant , convex areas of face , red oedematous weepy indistinct margins Fissured yellow exudates suggests infection Infant pityriasis alba , may leave white patch Child eyelids and angles of mouth Child thick (lichenified ) itchy plaques , red , scratch marks in knee and elbow folds Child chelitis upper and lower lip , desquamate Child winter shiny skin eczema , bilateral , fissures Adult nipple , red thick , itchy Adult papular , skin dry Adult back of hand , some fingers may be spared Discoid coin shaped red weepy crusted, also ring shaped with scales , Adult gravitational eczema along areas of varicose veins Seborrheac dermatitis of sternal area greasy exudates Also of scalp area with scalloped margins Also of medifrontal fold , nasolabial fold and free edges of lower lids Pomphylox , like grains of sago , very itchy, vesicles or bullae, maybe red Crazy paving type Conjunctivitis red sclera Di Urticaria Wheals within minutes eg glove provocation test in hospital Dermographic wheals within ten mins in chronic idiopathic urticaria Pressure and cold and solar utricaria Strawberry , medicines geotgraphic wheals , may precede anaphylaxis Hereditary angioedema may affect larynx and need adrenaline and steroids Fixed urticaria lasting days with joint pains and fever (vasculitis) Viruses 36 Herpes Herpes simplex vesicles on red base , last few days then break and dry , tingling beforehand and painful Herpes Genitalis painful vesicles on red base , immune test from lesion , black crusts on old lesion Varicella lesions on larger red base , central umbilicus, later pus in middle Zoster very painful , unilateral nerve tract ; ophthalmic nerves Papilloma virus Wart grey rough Plane flat orange , implanted along scratch lines (Koebners) Condylomata fleshy red ,on genitals Plantar embedded , no dermal lines over it ; can become mosaic , painful confluent Filiform on chin like skin tags , spread with razor shaving 40 Epstein Barr Hairy leukplakia linear hyperplasia on side of tongue  HYPERLINK "C:\\medical\\hairyleu.gif" C:\medical\hairyleu.gif Pox Molluscum contagiosum Small papules with cheesy stuff , may have red base of eczema  HYPERLINK "C:\\medical\\molls.jpg" C:\medical\molls.jpg May become confluent on face and genitals , check immune status Parapox sheep orf Parvovirus Erythema infectiosum cobblestone red , on face-butterfly , and limbs , maculopapular , lasts 10 days  HYPERLINK "einf.jpg" einf.jpg Togavirus rubella , german measles , red rash child is well, may have neck glands  HYPERLINK "C:\\medical\\rubback.jpg" C:\medical\rubback.jpg Measles Red , injected eyes, fever  HYPERLINK "measles.jpg" measles.jpg  HYPERLINK "measles2.jpg" measles2.jpg Coxsacie hand foot and mouth greyinsh vesicles inside lip , painful  HYPERLINK "Hand_Foot_Mouth.jpg" Hand_Foot_Mouth.jpg  HYPERLINK "HFMD.jpg" HFMD.jpg Aids Necrotic herpes zoster 2. Seb dermatitis 3 Excoriated nodules prurigo 4 gingivitis due to spiriform bacilli, molluscum Kaposis painless purple nodules  HYPERLINK "C:\\medical\\kaposi.jpg" C:\medical\kaposi.jpg Rapid condylomata BACTERIAL Bullous and non bullous impetigo , often beta strep; folliculitis , ulcer , Staph aureus furuncle (boil) or carbuncle coalesced furuncles with multiple openings Strep Erysipelas , raised pinkish red on face , fever , Orbital cellulitis around eyes , malaise high fever SEPTIC EMBOLI in heart disease Borrelia central healing with pale pink surrounding spreading patch (Lyme disease) needs doxycycline- due to tick which buries itself in the skin- headache , joint pains , lymph nodes Proteus necorosis of finger gram negative Cat scratch fever , nodules, may ulcerate , lymph glands Intertrigo common bugs in folds , red , like pages of a book  HYPERLINK "intertrigo.jpg" intertrigo.jpg TB lupus vulgaris , reddish yellow ; scofulderma skin ulcer in lymph gland Bcg abscess if injected too deeply Other mycobacterium can cause nodular ulcers eg fishmongers Cornybacterium Erythrasma Brownish macules with rounded margins , symmetrical in groin and axilla , cornybacterium-fluoresce red in Woods light  HYPERLINK "eryth.jpg" eryth.jpg Trichomysis Axillary hair infection , can be yellowish, use clindamycin gel  HYPERLINK "trich-axil1-s.jpg" trich-axil1-s.jpg Pitted keratolysis Punched erosions of soles of feet where there is heavy sweating Wear socks which effectively absorb sweat i.e. cotton and/or wool Wear open-toed sandals whenever possible Wash feet with soap or antibacterial cleanser twice daily Apply  HYPERLINK "http://dermnetnz.org/treatments/antiperspirants.html" antiperspirant to the feet at least twice weekly  HYPERLINK "Pitted Keratolysis.jpg" Pitted Keratolysis.jpg Treponemes Syphilis Prim chancre hard , ulcerated , on glans or vulva, lymph node enlargement Secondary macular rash pink ovules , not itchy , six weeks later Or dull red tiny papules Gonorrhea diffuse redness of glans with purulent discharge MYCOSIS Tinea corporis trichophytum , red round raised margins , may be scaly , may have very tiny vesicles ., may not itch , may have clearing in the center.  HYPERLINK "corp.jpg" corp.jpg cruri s- in scrotal area , raised red margins  HYPERLINK "tineacruris_1_020527.jpg" tineacruris_1_020527.jpg manuun powdery flakes from hand, palms, red diffuseness  HYPERLINK "mann.jpg" mann.jpg pedum athletes foot , cracked skin in between toes , intertigo  HYPERLINK "athletes_foot.jpg" athletes_foot.jpg Capitis floury , broken hair, yellowish , teens  HYPERLINK "capi.jpg" capi.jpg kerion - a form of capitis on face or beard  HYPERLINK "kerion.jpg" kerion.jpg Onychomycosis Toenails , thick brittle Or fingernail white leuco patches  HYPERLINK "ony.jpg" ony.jpg  HYPERLINK "ony2.jpg" ony2.jpg  HYPERLINK "ony3.jpg" ony3.jpg  HYPERLINK "ony4.jpg" ony4.jpg CANDIDA Oral thrush painful , white patches , red erosion when scraped Angular chelitis painful fissures at angle of mouth Axillary red patches with satellite lesions Nappy rash involves flexures , painful , satellite lesions Balanitis painful glazed red rash on glans and shaft of penis Paronychia painful , red base , pus PITYRIASIS VERSICOLOR Brownish patches on neck and trunk , fluoresce yellow in woods , maybe slightly scaly , microscope shows spores  HYPERLINK "pity.jpg" pity.jpg SPOROTRICHOSIS Nodular purple along lines of lymphatics on limbs Mycetoma usually feet , yellowish grains in purulent material Scabies 1 cm lines ending in hill , intensely itchy at night , wrist , inner aspect of fingers; feet in children , ; nodules on groin and in axilla  HYPERLINK "scab1.jpg" scab1.jpg  HYPERLINK "scab4.jpg" scab4.jpg  HYPERLINK "scabies5.jpg" scabies5.jpg Animal scabies no burrows Crabs lice on groin , hands (can be bluish due to toxin) , eggs on hair shaft  HYPERLINK "lice.jpg" lice.jpg;  HYPERLINK "lice2.jpg" lice2.jpg;  HYPERLINK "lice3.jpg" lice3.jpg;  HYPERLINK "lice1.jpg" lice1.jpg Insect bites Itchy papules in children from dogs and cats, flea or mites Leishmaniasis large papule with red rim , Larva migrans hookworm , serpingious track , on beech, itchy Chigger flea , black top 80Psoriasis Vulgaris large confluent scaly red plaques Scales can become very thick and white and adherent , red when scraped off Guttate is very small psoriatic patches Kobeneris if appear in scar Pustular esp palm and feet , recent ones are raised Erythroderma , spreads all over the body Palmar thick scaly red Axillary red shiny non scaly in flexural areas Nail looks like fungus but has central depression Facial Tongue like geographical tongue, glans red  HYPERLINK "psogut.jpg" psogut.jpg  HYPERLINK "pso.jpg" pso.jpg ;;  HYPERLINK "Pitted Keratolysis.jpg" Pitted Keratolysis.jpg ;;  HYPERLINK "psoriasis nails.gif" psoriasis nails.gif 87 Pityriasis Rosea Larger oval pink 3cm thicker margin , followed by smaller lesions Also other types of pityriasis with guttate or papulonecrotic lesions Superficial scaly dermatitis along ribs Plaque eruption on trunk LICHEN PLANUS  !)*NOPde=>?VW,-STUkl+,MNObcde{|}-jUjpUjUj)UjUjUjEUjU0JjU jU>*D  J*M]^fo)fgmj+'(0bcv./8ijpp h q   ' ] ^ h y {     _ 8 h R 6<bb56>?Jn:XY]s$a$0CN,mv+d -l~ & F$a$-.STUjk:;<JK !"3478z{     δδj UjUjMU0JCJOJQJaJjCJOJQJUaJCJOJPJQJ^JaJCJOJQJaJjUjUj]U0JjU jU90iyLM 5I1 & Fd`[$1O Z } &!I!v!!!!$a$ & Fd`[$ Z [ q r s { | &!'!=!>!?!G!H!v!w!!!!!!!!!!!""" 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