HOMO
SAPIENS DISEASES - CUTANEOUS APPARATUS AND SUBCUTANEOUS TISSUE
Table of contents :
Diseases of skin (see also physiology
of skin
)
Pathogenetic processes
:
-
with regard to the stratum corneum and stratum granulosum
-
parakeratosis : process of keratinization
in which the keratinocytes in stratum corneum retain their nuclei; abnormal
in skin, normal in mucous membranes. It occurs in ...
-
hyperkeratosis / lichenification / lichenoid
dermatosis : hypertrophy of the stratum corneum layer of the skin,
whether by normal or abnormal keratinocytes. It occurs in ...
-
lichen planus
-
Kyrle's disease
/ hyperkeratosis penetrans : a rare chronic disorder of keratinization
characterized by a papular eruption with hyperkeratotic cone-shaped plugs
in the hair follicles and eccrine ducts, which project through the epidermis
into the dermis, producing a foreign body giant cell reaction and pain.
The usually discrete lesions leave a depression on removal; they may coalesce
to form patches, and coalescing plaques are often seen
-
keratosis pilaris : a condition
in which hyperkeratosis is limited to the hair follicles, usually on the
extensor surfaces of the thighs and arms, but occurring anywhere, with
discrete follicular papules which re-form after removal
-
keratosis punctata : a form of
hyperkeratosis in which the lesions are localized in multiple points on
the palms and soles; it is transmitted as an autosomal dominant trait.
-
hypergranulosis : increase in thickness
of the granular layer. It occurs in ...
-
keratolysis : softening and dissolution
or peeling of the horny layer of the epidermis.
-
pitted keratolysis / keratolysis plantare
sulcatum / cracked heels : a superficial bacterial infection of the
skin of worldwide distribution usually involving the weight-bearing portions
of the soles of the feet, and characterized by the formation of shallow
asymptomatic discrete round pits, some of which become confluent and form
fissures; the specific etiologic agent is unknown
-
ulcus interdigitale : keratolysis
of the horny layer of the skin between the toes, a disease similar to cracked
heel.
-
with regard to the stratum spinosum and stratum basale
-
acanthosis : keratinocyte (acanthocyte
/ spur cell) hyperplasia in stratum spinosum with thickening of the
epidermis
-
papillomatosis : increase in keratinocytes
with formation of projections from the surface of the skin, i.e. papillae.
It occurs in ...
-
wart
-
acanthosis nigricans
-
confluent and
reticulate papillomatosis / Gougerot-Carteaud syndrome : a progressive,
pruritic papillomatosis, probably a genodermatosis, seen chiefly in girls,
especially those at or near puberty, beginning in the intramammary and
midback areas as slightly keratotic pigmented papules that increase in
size and spread over the trunk and other body areas; centrally located
lesions tend to become confluent and peripherally located ones to become
reticulate
-
psoriasiform epidermal
hyperplasia : increase in keratinocytes with elongation of rete ridges
and elongation of dermal papillae. It occurs in ...
-
acanthosis nigricans (AN) : a
skin disease characterized by diffuse velvety acanthosis
with gray-black warty patches usually situated in back of the neck, the
axillae or groin or on elbows or knees
Aetiology :
-
endocrinopathy
-
paraneoplastic (more rarely) in patients with carcinoma of abdominal viscera
(malignant acanthosis nigricans)
-
benign, nevoid form, more or less generalized
-
benign juvenile form associated with obesity
(pseudoacanthosis nigricans) (post-receptorial insulin-resistance)
-
dyskeratosis : cell death associated
with premature keratinization below the level of the stratum granulosum
-
spongiosis : widening of the interspaces
between keratinocytes due to edema fluid without detachment of cells from
each other. It occurs in ...
-
acantholysis : detachment of keratinocytes
from each other due to loss of intercellular contacts. This often is associated
with the cell assuming a spherical shape, i.e., a round profile in sections
-
vacuolization : the formation of vacuoles
within cells. This term is used often in reference to changes in the basal
keratinocytes
-
ballooning degeneration :
intracellular edema with cellular swelling. This is often secondary to
viral injury or nutritional deficiency
-
with regard to dermis
-
necrobiosis : swelling, basophilia, and
distortion of collagen bundles in the dermis, sometimes with obliteration
of normal structure, but without actual necrosis, seen especially in granuloma
annulare and necrobiosis lipoidica
Symptoms :
-
pruritis / pruritis / itching : an
unpleasant cutaneous sensation that provokes the desire to rub or scratch
the skin to obtain relief.
Aetiology (prurigos) :
-
cutaneous diseases
-
systemic diseases
-
chronic renal
failure
(uremic pruritus). Therapy : k
opioid receptor agonists
-
diabetes mellitus
-
cholalemia
-
hepatitis
-
cirrhosis
-
third trimester of pregnancy
(prurigo gestationis of
Besnier) : development of tiny crust-covered excoriated papules mainly
on the extensor surfaces of the limbs but also found on the upper trunk
and other areas of the body, and leaving postinflammatory residua on resolution
of the lesions. It tends to clear after delivery, and occasionally recurs
with subsequent pregnancies
-
cutaneous amyloidosis
-
paraneoplastic pruritus
-
polycythemia vera
-
ectoparasitoses
-
Crohn's disease (CD)
-
hypothyroidism
-
hyperthyroidism
-
hyperparathyroidism
-
psychogenous pruritus
-
drugs
-
sweating
-
temperature
-
humidity
-
prurigo agria / prurigo ferox : a severe, chronic pruriginous dermatosis
characterized chiefly by hard excoriated prurigo papules and lichenification
-
prurigo chronica multiformis : a pruriginous dermatosis characterized
by the presence of prurigo papules, patches of lichenification and eczematization,
enlarged regional lymph nodes, and eosinophilia
-
senile pruritus / pruritus senilis : an itching in the aged, possibly
due to dryness of the skin occurring as a result of decreased sweat and
sebum secretion, or bathing too frequently, or both
-
prurigo mitis / pruritus of Hebra : an extremely pruritic, chronic
pruriginous dermatosis beginning in early childhood, characterized by excoriations,
lichenification, and eczematization that become progressively more pronounced,
and accompanied by enlarged glands and associated constitutional symptoms.
The condition may be the same as papular urticaria
-
nodular prurigo : a chronic, intensely pruritic form of neurodermatitis,
usually occurring in women, located chiefly on the extremities, especially
on the anterior thighs and legs, and characterized by the presence of single
or multiple, pea-sized or larger, firm, and erythematous or brownish nodules
that become verrucous or fissured
-
prurigo simplex : a form in which the prurigo papules are present
in various stages of development, especially on the trunk and extensor
surfaces of the extremities in middle-aged persons, and usually occur in
crops
-
prurigo estivalis / summer prurigo of Hutchinson : a papular dermatosis
regarded as a form of polymorphous light eruption, usually occurring in
childhood during the summer months, and sometimes improving or resolving
after puberty
Pathogenesis : stimulation of receptors linked
to Ad (mild and localized pruritus) and C (intense
and poorly defined pruritus) nerve fibers. Itch can be classified into
4 types:
-
pruritoceptive itch develops in the skin because of dryness, inflammation,
or other skin damage
-
psychogenic itch can arise in patients with psychiatric disorders,
such as delusional parasitosis
-
neurogenic itch originates in the CNS without evidence of neural
pathology: one example is the itch of cholestasis, caused by the action
of neuropeptides on opioid receptors
-
neuropathic itch derives from lesions located at any point along
the sensory pathway, and has been linked to conditions including post-herpetic
neuralgia, multiple sclerosis, and spinal tumours; the compression of spinal
nerve roots can cause brachioradial itch, notalgia paraesthetica, and anogenital
itch.
It is increased by :
... and decreased by :
Signs :
-
dermatorrhagia : discharge of blood into or from the skin
-
skin trophism
-
skin pigmentation
-
hypopigmentation
-
localized hypopigmentation
Aetiology :
-
primitive cutaneous diseases
-
systemic diseases
-
diffuse hypopigmentation
Aetiology :
-
primitive cutaneous diseases
-
systemic diseases
-
oculocutaneous
albinism (OCA)
-
cutaneous ischemia due to hemometakinesis
-
anemia
-
chlorosis : a disorder that was common during
the nineteenth century but has now disappeared, characterized by greenish
yellow skin discoloration and hypochromic erythrocytes; it was usually
seen in adolescent females and may have been associated with iron
deficiency anemia.
-
hyperpigmentation
-
localized hyperpigmentation
-
primitive cutaneous diseases
-
epidermal alterations
-
permanent hyperpigmentation can occur as a complication post-sclerotherapy
-
melanoderma : an abnormally increased
amount of melanin in the skin, with production of hyperpigmented patches.
-
melanocytosis : a condition characterized
by an excessive number of melanocytes in the tissues
-
increase in the production of melanin by the melanocytes normally present
-
parasitic melanoderma
/ vagabonds' disease
-
senile melanoderma : pigmentation of the skin in the aged.
-
érythrose
péribuccale pigmentaire of Brocq : a patchy facial melanoderma
seen chiefly in women that may involve an inflammatory photosensitivity,
perhaps phototoxic, reaction, and characterized by the presence of a combination
of erythema and a diffuse brownish red pigmentation of the perioral region.
-
systemic diseases
-
epidermal alteration
-
seborrheic keratosis (Leser-Trélat
sign) : eruptive appearance of numerous seborrheic keratoses or the
sudden increase in the number and size of previous seborrheic keratoses,
in association with an internal malignancy. In 50% it concers an adenocarcinoma
(gastrointestinal tract, breast and others), in 20% a lymphoproliferative
disorder (Leser Edmund. Ueber ein die Krebskrankheit beim Menschen haufig
begleitendes, noch wenig bekanntes Symptom. Munch. Wochenschr. 48:2035-2036
(1901). Trélat Ulysse)
-
acanthosis nigricans (endocrinopathy,
paraneoplastic)
-
melanocyte proliferations
-
lentigo
-
Peutz-Jeghers syndrome (PJS)
-
lentigines (multiple), electrocardiographic conduction
abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities
of genitalia, retardation of growth, deafness (LEOPARD) syndrome :
a hereditary syndrome transmitted as an autosomal dominant trait, consisting
of multiple lentigines, asymptomatic cardiac defects, and typical coarse
facies; it may also be associated with pulmonary stenosis, sensorineural
deafness, skeletal changes, ocular hypertelorism, and abnormalities of
the genitalia
-
xeroderma pigmentosum
-
nevi (Carney
complex)
-
increased pigment production
-
dermal pigmentation
-
diffuse hyperpigmentation
-
primitive cutaneous diseases
-
systemic diseases
-
endocrinopathies
-
metabolic disorders
-
melanosis secondary to metastatic melanosis
-
autoimmune hyperpigmentations
-
drugs
-
metals
-
metallic
melanism / argyria
-
chrysoderma / aurochromoderma / chrysiasis
: a manifestation of chrysiasis
presenting as a permanent gray- to lilac-colored permanent pigmentation
on the face, eyelids, and other sun-exposed areas of the body due to long-lasting
parenteral chrysotherapy
-
red hyperpigmentation
-
cherry red => CO.
intoxication
-
blue : cyanosis
(first at extremities, where skin is thin
and cold) if oxy-HGB < 5 g /dL
-
yellow : jaundice
(also in sclerae) or carotenism
-
brown / bronze
-
burn wounds
-
melanosis a disorder caused by a disturbance
in melanin pigmentation; melanism (hyper-ACTH
or hyper-MSHs)
-
Riehl's melanosis : a patchy melanoderma manifested as a light to
dark brown pigmentation, which is most intense on the forehead, on the
malar regions, behind the ears, on the sides of the neck, and on other
sun-exposed areas. It is seen most often in women and may involve an inflammatory
photosensitivity, perhaps phototoxic, reaction.
-
tar melanosis / melanodermatitis toxica lichenoides : a dermatosis
representing photosensitivity or phototoxicity induced by exposure to tar
or other hydrocarbons, usually occupationally, most often involving the
face or back of the hands, and characterized by pruritus associated with
the development of reticular pigmentation, telangiectases, and small, dark,
lichenoid, follicular papules
-
transient neonatal pustular melanosis : a congenital skin condition
usually seen in babies of African descent, characterized by pigmented macules
and vesicopustules that may rupture and leave a scaly collar. It usually
resolves completely within a few weeks to 2 years
-
melanism : excessive
pigmentation or blackening of the integuments or tissues, usually of genetic
origin; melanosis.
-
erythrodermia
-
primary cutaneous diseases
-
drug eruptions
-
systemic diseases
-
idiopathic
-
dyschromia : any disorder of pigmentation of the skin or hair
-
dyschromatoses are a group of disorders
characterized by the presence of both hyperpigmented and hypopigmented
macules, many of which are small in size and irregular in shape. There
are 2 major forms, both of which are seen most commonly in Japan
-
dyschromatosis
symmetrica hereditaria (DSH) was first described by Toyama in 1929
and is characterized by a symmetrical distribution of hyperpigmented and
hypopigmented macules on the extremities, especially over the dorsa of
the hands and feet
-
dyschromatosis
universalis hereditaria (DUH) was first described in 1933 by Ichikawa
and Hiraga as well-demarcated brown macules admixed with various-sized
hypopigmented macules in a generalized as opposed to acral distribution.
DUH was noted to appear within the first month of life. Some clinicians
have suggested that DSH might be a subtype of DUH
The differential diagnosis of dyschromatosis includes xeroderma
pigmentosum,
dyschromic amyloidosis,
and exposure to chemicals such as diphenylcyclopropenone and monobenzyl
ether of hydroquinone.
-
figurated skin lesions
-
primitive cutaneous diseases
-
systemic diseases
-
migrating cutaneous lesions
-
nonmigrating cutaneous lesions
-
primary lesions (if
new onset : skin eruptions / exanthema (as opposed to mucosal eruption
/ enanthema): a disease in which skin eruptions (visible efflorescent
lesions of the skin due to disease, especially an exanthematous disease,
and marked by redness and prominence; a rash) or rashes (a temporary
eruption on the skin, as in urticaria; a drug eruption or viral exanthem)
are a prominent manifestation. Classically, 6 exanthems (or exanthematous
diseases) were described that had similar rashes; they were numbered in
the order in which they were reported:
Only the latter 3 ordinal designations are still used)
-
liquid- or semisolid, raised lesions
-
superficial
-
serum and cell remnants-containing : they arise from necrosis => vacuolization
=> acantholysis and vacuole confluence
-
hydroa : a vesicular or bullous eruption.
-
vesicle / blister : Ø
< 0.5 cm
-
intraepidemal vesicles occur
in ...
-
dermal-epidermal vesicles
(containing also blood cells) occur in ...
-
bulla : Ø >
0.5 cm
-
intraepidermal bullae occur in :
-
dermal-epidermal bullae (containing
also blood cells) occur in
-
pus-containing
-
pustule / pimple : Ø
< 0.5 or 1 cm (evolution of a vesicle) occur in
-
deep : cyst : a deep lesion that is filled
with pus or other contents.
-
subcutaneous abscess : one occurring beneath the skin
-
solid lesions
-
flat
-
differing in color from the surrounding skin
-
macule : Ø <
2 cm. They occur in ...
-
pigmented macula,
not disappearing at vitreopressure
-
achromic macula (see also localized
hypopigmentation)
-
lack of melanocytes. It occurs in vitiligo
-
hypoproliferation of melanocytes. It occurs in tuberous
sclerosis
(ash-leaf macule / lance-ovate macule / ash-leaf spot or patch :
usually 1 to 3 cm in size and having the general shape of an ash leaf,
round at one end and pointed at the other)
-
cyanematous macula : bluish macula
due to passive hyperemia
-
erythema / erythematous macula : abnormal
redness of the skin due to active hyperemia
Grading :
-
E0 : no erythema
-
E+/- : minimal perceptible erythema with sharp borders.
-
E+ : pink erythema
-
E++ : fiery red erythema with oedema
-
E+++ : fiery red erythema with oedema and blistering
-
E+++ : violaceous erythema, marked oedema, strong pain, partial blistering
Varieties :
-
erythema infectiosum / fifth disease
/ Sticker's disease : a moderately contagious, often benign epidemic
disease seen mainly in children and caused by parvovirus
B19,
characterized by a rash of abrupt onset with 3 stages:
-
livid erythema of the cheeks, which appear to have been slapped
-
erythematous maculopapular rash on the trunk and extremities
-
fading of the rash with central clearing, leaving a lacelike pattern.
More severe cases may be seen in immunocompromised patients.
-
erythema
multiforme
-
erythema
nodosum
-
erythema necroticum / Lucio's phenomenon
-
necrolytic migratory
erythema (NME) / necrolytic erythema migrans / glucagonoma syndrome
: a generalized symmetrical scaling eczematous dermatitis, followed
by migratory necrolysis of the upper epidermis, liquefaction of the granular
layer, and subcorneal clefting, flaccid bulla formation, erosions, crusts,
and postinflammatory hyperpigmentation It is usually seen on the central
third of the face, lower abdomen, perineum, groin, buttocks, thighs, and
distal extremities in association with a glucagon-secreting
tumor of the a cells of the pancreas
-
erythema solare / sunburn
-
erythema arthriticum
epidemicum / Haverhill fever
-
erythema caloricum : that caused by exposure to heat or cold
Aetiology :
-
cold erythema : a congenital hypersensitivity
to cold seen in children, characterized by localized pain, widespread erythema,
occasional muscle spasms, and vascular collapse on exposure to cold, and
vomiting after drinking cold liquids
-
chilblain / chilblains / erythema pernio / pernio
: a recurrent localized erythema and doughy subcutaneous swelling caused
by exposure to cold associated with dampness, and accompanied by pruritus
and a burning sensation, usually involving the hands, feet, ears, and face
in children, the legs and toes in women, and the hands and fingers in men
-
erythema ab igne : permanent erythema
or a brown to red reticulated residual pigmentation produced by prolonged
exposure to excessive nonburning heat. It is seen most often on the legs
of women, but under appropriate environmental circumstances, it can occur
anywhere on the body in either sex
-
palmar erythema / erythema palmare :
persistent redness of the palms
Aetiology :
-
butterfly
(rash) : a pattern formed by a skin eruption across the nose
and adjacent areas of the cheeks,
Aetiology :
-
facial flushing
Aetiology :
-
toxic erythema / erythema toxicum :
a generalized, diffuse erythematous eruption or a widespread erythematomacular
eruption occurring as a result of hypersensitivity to certain foods or
drugs, or caused by bacterial or other toxins, or associated with various
systemic diseases.
-
erythema toxicum neonatorum
: a benign, idiopathic, very common, generalized, transient eruption occurring
in infants during the first week of life, usually consisting of small papules
or pustules that become sterile, yellow-white,
firm vesicles surrounded by an erythematous
halo and some edema. It is due to microchimerism
-
subepidermal
hemorrhages / dermatorrhexis
-
patch : Ø > 2 cm
-
scale / squama : dead skin cells that look
like flakes or dry skin produced because of dyskeratosis
or parakeratosis => epidermis exfoliation.
-
collarette : a narrow rim of loosened keratin
overhanging the periphery of a circumscribed skin lesion, attached to the
normal surrounding skin, especially in syphilid,
moniliasis and Gilbert's pityriasis rosea.
It occurs in ...
-
psoriasis
-
pityriasis : any of various skin diseases
characterized by the formation of fine, branny scales.
-
pityriasis alba, maculata or simplex / erythroderma streptogenes / pityriasis
: a common skin disorder most often seen in young children and adolescents,
usually involving the face, especially the cheeks and the area around the
mouth, and characterized by the presence of round or oval, slightly scaling,
hypopigmented patches; it usually involutes spontaneously
-
parapsoriasis : any of a group of slowly
evolving erythrodermas having common characteristics of scaling, resistance
to treatment, and chronicity
-
plaque parapsoriasis
-
small plaque parapsoriasis / parapsoriasis guttata / guttate parapsoriasis
/ xanthoerythrodermia perstans : a benign, asymptomatic, chronic eruption
consisting of small to moderate sized, red-blue to yellow plaques, occurring
chiefly on the trunk and proximal extremities, which have distinct, thin
borders and fine, adherent scales, giving the surface a cigarette paper–like
appearance
-
large plaque parapsoriasis / atrophic parapsoriasis : a chronic,
asymptomatic or mildly symptomatic eruption consisting of red-blue, oval,
poorly defined, flat, sometimes indurated large plaques with superficial
scaling, which preferentially involves the trunk, especially the hips and
buttocks, proximal extremities, and breasts in women. It may progress to
cutaneous
T cells lymphomas (CTCL),
particularly if atrophy and poikiloderma are prominent features
-
retiform parapsoriasis / parapsoriasis lichenoides / parapsoriasis
variegata / parakeratosis variegata / poikilodermatous parapsoriasis /
poikilodermic parapsoriasis : a chronic eruption consisting of red
to brown, scaly lesions with a netlike distribution, intermixed with which
are deep red plaques, some exhibiting lichenoid papules, which is histologically
similar to large plaque parapsoriasis (considered by some authorities to
be a variant) except that atrophy and poikiloderma are prominent features.
It is the form of parapsoriasis from which cutaneous
T cells lymphomas (CTCL)
is most likely to arise
-
lichenoid pityriasis
-
acute lichenoid pityriasis
/ pityriasis lichenoides acuta / acute parapsoriasis / Habermann's, Mucha-Habermann,
or Mucha's disease / parapsoriasis varioliformis acuta / pityriasis lichenoides
et varioliformis acuta : an acute or subacute, sometimes relapsing,
widespread macular, papular, or vesicular eruption that tends to crusting,
necrosis, and hemorrhage, which heals, leaving pigmented depressed scars,
followed by the development of a new crop of lesions. Occasionally, progression
to the chronic lichenoid form may occur
-
chronic lichenoid pityriasis / pityriasis lichenoides chronica / chronic
or guttate parapsoriasis, parapsoriasis guttata / parapsoriasis varioliformis
chronica : a chronic brown to red-brown scaly macular eruption, distributed
chiefly over the trunk, characterized histologically by epidermal alterations
and a perivascular lymphocytic infiltrate. It may represent progression
of the acute lichenoid form or arise de novo
-
pityriasis rotunda : a form of acquired ichthyosis manifested by
circular or oval, brown, scaly, sharply demarcated patches on the trunk
and extremities, which become worse during the winter and improve in the
summer.
-
Leiner's disease / erythroderma desquamativum : a disorder of infancy
characterized principally by generalized seborrheic-like dermatitis and
erythroderma, intractable, severe diarrhea, recurrent infections, and failure
to thrive. The cause is unclear, but familial cases associated with a dysfunction
of the C5 component of complement, which results in decreased phagocytosis
of the patient's serum (opsonic activity), have been reported
-
exfoliative
dermatitis / erythroderma / dermatitis exfoliativa / scalded skin syndrome
/ pytiriasis rubra (Hebra) (a.k.a. Ritter's
disease in babies below age 4) : systemic exanthema => intraepidermal
bullae => skin detachment.
-
primary or idiopathic
-
secondary or reactive process to an underlying cutaneous disorder
Symptoms & signs : scaly erythematous
dermatitis often associated with loss of hair and nails, hyperkeratosis
of the palms and soles, pruritus, and sometimes severe and debilitating
secondary physiological effects
Therapy : IVIG,
GR
agonists,
aseptical environments
-
pityriasis rubra pilaris
: a chronic inflammatory cutaneous disease characterized by tiny acuminate,
reddish brown follicular papules topped by central horny plugs in which
are embedded hairs, partial or complete; disseminated yellowish pink scaling
patches; and often solid confluent hyperkeratosis of the palms and soles
with a tendency to fissuring.
-
pityriasis sicca / dandruff : seborrheic
dermatitis of the scalp. Dandruff is made up of small flakes of dead
scalp skin. It occurs under circumstances in which the surface skin cells
of the scalp grow unusually fast
Aetiology : Malassezia
furfur
-
pityriasis versicolor / tinea versicolor
-
pityriasis nigra / tinea nigra
-
Gilbert's pityriasis rosea
-
raised bump (any color)
-
papule : oedema and cell infiltration => circumscribed
hard relief Ø < 0.5 or 1 cm (color
from pink to brown)
-
intraepidermal papule
-
dermal-epidermal papule
-
dermal papule
It occurs in :
-
Gottron's papules / Gottron's sign : a cutaneous manifestation pathognomonic
of dermatomyositis
-
moist papule / mucous papule / condyloma latum
-
pearly penile papules / hirsutoid papillomas of penis : numerous
tiny white, dome-shaped asymptomatic angiofibromas occurring circumferentially
around the penile coronal sulcus
-
piezogenic papules / painful fat herniation / painful piezogenic pedal
papules : transitory, noninflammatory, soft, sometimes painful, large
papules appearing above the heel on the side of one or both feet, elicited
by weight bearing associated with prolonged standing or running, and presumed
to result from temporary herniation of fat tissue together with its blood
vessels and nerves through connective tissue defects. They disappear when
the pressure is removed
-
split papules : fissured papular syphilides sometimes seen at the
corners of the mouth.
-
papulosis : a state marked by the presence
of multiple papules.
-
bowenoid
papulosis
-
lymphomatoid papulosis : a
usually benign, self-healing, recurrent eruption of hemorrhagic papules,
similar to acute lichenoid pityriasis
(of which it may be a variant); lesions occur asynchronously primarily
on the trunk and extremities and, after healing, either leave macular scars
or form crusted scales or a central necrotic mass. Histologic features
may suggest malignancy and include clusters of large mononuclear cells
with dark-staining nuclei and large pale-staining histoid cells.
-
granulomatous eccrinotropic lymphomatoid papulosisref
-
malignant atrophic papulosis / Degos' disease : an often fatal disease
occurring most often in men, characterized by endovasculitis of the skin,
gastrointestinal tract, and sometimes other organs, resulting in ischemic
infarction of involved tissues. Cutaneous lesions occur in crops of erythematous
papules that become umbilicated with characteristic porcelain-white centers
with telangiectatic borders, many of which atrophy and leave white scars
-
Degos clear cell acanthoma : a slightly elevated, erythematous,
dome-shaped plaque or papule, with some crusting or scaling, usually occurring
on the lower leg in older adults; it is characterized by acanthotic epithelium
containing large, pale, glycogen-rich squamous cells.
-
nodule / nodulus : 0.5 or 1 < Ø
< 5 cm.
-
dermal nodule (tubercle)
It occurs in ...
-
cutaneous tuberculosis
-
dermal melanocytic naevus
-
basal cell carcinoma
-
foruncle
-
erythema
nodosum
-
subcutaneous sarcoids
-
Fraenkel's nodules : typhus nodules of the cutaneous blood vessels
-
Sister Mary Joseph's nodule
:
a nodule deep in the subcutis in the umbilical area associated with metastasizing
intra-abdominal cancer, usually of gastric, ovarian, colorectal, or pancreatic
origin. Sister Mary Joseph, a nurse assistant of Dr.William Mayo, was the
first person to observe that a firm umbilical nodule was associated with
intra-abdominal cancer. The late Hamilon Bailey subsequently described
the lesion and named it Sister Joseph's nodule in her memory. Several observations
of it were in fact already published before (Bailey Hamilton. Demonstration
of physical signs in clinical surgery. Wiliams & Wilkins 13th edition
p.356)
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surfers' nodules, knobs or knots / Malibu disease : hyperplastic,
fibrosing, rarely ulcerated granulomas 1 to 3 cm in diameter, occurring
over bony prominences of the feet and legs of surfers, occurring as a result
of repeated trauma from kneeling on surfboards
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Wohlbach's or typhus nodules
: minute nodules, originally described in typhus, produced by perivascular
infiltration of polymorphonuclear leukocytes and mononuclear cells in rickettsial
disease.
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hypodermal nodule (gumma, pl. gummata)
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tumor : Ø >
5 cm
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crust / scab : a formation of coagulated
exudate over a break in the skin
-
serous exudate = yellow scab
-
haemorrhagic exudate = red scab
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purulent exudate = brown scab
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evolutive polymorphic
dermatoses
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plaque : Ø > 1
cm, formed by the coalescence of more elementary lesions. Elementary lesions
are still distinguishable in periphery of the plaque. It occurs in ...
-
maculopapular exanthemas : contemporaneous
macules
+ papules. It occurs in ...
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morbilliform exanthemas
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scarlatiniform exanthemas
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papulonodular lesions : contemporaneous
papules
+ nodules. It occurs in ...
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whitish lesions
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calcinosis cutis : a condition marked
by deposits of calcium salts in the skin in the form of nodules or plaques.
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meaty skin
-
pinky / transparent lesions (darker in individuals with very pigmented
skin)
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cutaneous amyloidosis : amyloidosis
localized to the skin and usually associated with pruritus,
which may be a characteristic of primary disease or occur in secondary
amyloidosis.
-
lichen amyloidosis
/ lichen amyloidosus : the most common form of cutaneous amyloidosis,
characterized by the symmetrical distribution over the extensor surfaces
of the lower extremities, thighs, dorsal feet, and lower back of translucent,
yellow to brown, dome-shaped, discrete pruritic papules; the chest, shoulders,
and skin of the abdominal walls may be involved later
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macular amyloidosis : cutaneous
amyloidosis manifested by ill-defined, sometimes pruritic grayish brown
macules distributed on the upper back, breasts, buttocks, arms, ankles,
and thighs
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nodular amyloidosis : a form of
localized amyloidosis in which single or multiple, amyloid-containing nodular
or tumefactive masses are found most often in the lung, urinary bladder,
larynx, tongue, conjunctiva, and skin, especially that of the extremities,
trunk, genitals, and face.
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papular mucinosis
-
yellowish lesions
-
xanthoma : a fatty irregular yellow patch
or nodule on the skin composed of lipid-laden foam cells, which are histiocytes
containing cytoplasmic lipid material
-
disseminated
xanthoma / xanthoma disseminatum / xanthoma multiplex
-
fibrous
xanthoma / benign fibrous histiocytoma
-
xanthoma palpebrarum /
xanthelasma
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planar xanthoma / plane xanthoma / xanthoma
planum : a form manifested as soft yellowish, tannish, or dark red
flat macules or slightly raised plaques, sometimes having a white central
area, which may be localized or generalized, often occurring in association
with other types of xanthomas
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xanthochromia striata palmaris
:
planar xanthoma involving the volar creases of the palms and finger joints,
manifested by yellowish brown discoloration of the creases of the palmar
aspect of the hands, which is assumed by some to gradually progress to
...
-
xanthoma striatum palmare :
planar xanthoma involving the creases of the palms and volar finger joints,
manifested by linear, slightly elevated papules in the palmar creases,
especially of the fingers
Aetiology :
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xanthoma tendinosum / tendinous
xanthoma : a form manifested by the presence of freely movable papules
or nodules in the tendons, ligaments, fascia, and periosteum, especially
on the dorsum of the hands, fingers, elbows, knees, and heels (Achilles
tendon), which occurs in association with tuberous
xanthoma, xanthelasma,
and cerebrotendinous
xanthomatosis
Aetiology :
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xanthoma tuberosum / xanthoma tuberosum
multiplex / tuberous xanthoma : development of groups of large, flat
or elevated, yellow to orange indurated nodules on the extensor surfaces
and areas subjected to trauma, particularly on the elbows and knees; lesions
tend to coalesce
Aetiology :
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diabetic or eruptive xanthoma / xanthoma
diabeticorum or eruptivum : crops of small yellowish orange or yellow
papules surrounded by an erythematous halo, occurring suddenly, usually
on the buttocks, posterior thighs, knees, and elbows; the papules may be
intensely pruritic and may ulcerate
Aetiology : hypertriglyceridemia
Prognosis : usually disappears when the
underlying condition is corrected
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tuberoeruptive xanthoma :
a form in which lesions of eruptive xanthoma develop in association with
already existing tuberous xanthoma and have a tendency to coalesce
Aetiology : type
III hyperlipoproteinemia
-
verruciform xanthoma : an uncommon
solitary xanthoma of the oral mucosa; it is covered with a rough parakeratinized
layer and usually occurs on the lower alveolar ridge.
-
xanthomatosis / xanthelasmatosis : a
condition characterized by the presence of xanthomas
Laboratory examinations : Touton giant
cell (a large vacuolated cell with numerous nuclei surrounding a peripheral
rim of foamy cytoplasm)
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gouty tophi
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necrobiosis lipoidica diabeticorum / Urbach-Oppenheim
disease
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pseudoxanthoma
elasticum
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Muir-Torre
syndrome : multiple carcinomas, primarily of the gastrointestinal tract,
in association with a large number of sebaceous
gland adenomas
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red-colored lesions
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papulae
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papule / plaques
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subacute
cutaneous lupus erythematosus (SCLE)
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leukemia cutis : a cutaneous manifestation
of leukemia resulting from infiltration of the skin by malignant leukocytes
and occurring as specific or nonspecific lesions (leukemid), or both coexisting
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nodules
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primitive cutaneous diseases
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cherry hemangioma
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infections
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polymorphic photodermatitis
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cutaneous lymphoid hyperplasia
: a term for several benign cutaneous disorders with lesions clinically
and histologically resembling those of malignant lymphoma. The lesions
may be lymphoreticular, granulomatous, and follicular and include lymphocytes,
histiocytes, eosinophils, plasma cells, and lymphoid follicles. The disorders
may be of unknown etiology or be reactions to insect bites, allergy hyposensitization
injections, light, trauma, and tattoo pigment. The term embraces :
-
lymphocytic infiltration of the skin
-
arthropod bites and stings
reactions
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lymphocytoma cutis (LC) / Bäfverstedt's
syndrome / cutaneous lymphoplasia / Spiegler-Fendt pseudolymphoma or sarcoid
: a manifestation of cutaneous lymphoid hyperplasia, seen especially in
women, characterized by red-brown-colored skin lesions ranging from a solitary
plaque or nodule to several in a group or more widespread lesions; they
are usually found on the face, ears, extremities, or areolae of the breasts.
When multiple, they may resemble malignant lymphoma, although some may
regress, sometimes with recurrences
Aetiology :
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blue-colored lesions
-
vein malformations / blue
rubber bleb nevus syndrome : a syndrome of multiple blue rubber bleb
nevi associated with hemangiomas of the gastrointestinal tract, which bleed
readily and cause chronic iron-deficiency anemia; most cases are sporadic
and present in infancy or childhood.
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primitive cutaneous diseases
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purple-colored lesions
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purpureal lesions
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angiosarcoma
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Peruvian
wart / verruga peruana / verruca peruana or peruviana / hemorrhagic pian:the
second or chronic stage of bartonellosis (Bartonella
bacilliformis),
characterized by a benign skin eruption of hemangioma-like macules
on whole body skin and sometimes mucosae (nodules
and often ulcers)
surrounded by hyperpigmented borders
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angiolymphoid
hyperplasia with eosinophilia (epithelioid hemangioma) (ALHE/EH) / Kimura's
disease (KD) : a type of erythematous dermal or subcutaneous tumor-like
nodule occurring singly or multiply, primarily on the head and neck of
young adults, sometimes associated with lymphadenopathy, serum eosinophilia,
and markedly elevated serum IgE levelsref1,
ref2.
However, it is also known to present in many other sites including the
limbs,
groin, trunk and scalp, and is often associated with regional lymphadenopathyref1,
ref2,
ref3.
Histologically, the lesions are characterised by lymphoid hyperplasia,
proliferating blood vessels and eosinophilic infiltrationref1,
ref2,
ref3.
The optimal treatment for KD remains controversial. However, early diagnosis
of KD could spare the patient unnecessary and potential harmful diagnostic
procedures. The more superficial, usually larger, lesions have been called
pseudopyogenic
granuloma. First described in China by Kim and Szeto in 1937, this
disease was given its name and became more widely known after a systematic
description by Kimura in 1948 in Japan. KD occurs endemically in the Far
East, and only a small number of cases have been reported in the West.
The disease is also reported to be associated with systemic connective
tissue disease and the nephrotic syndrome, occurring in up to 60% of patients
with the latter conditionref1,
ref2,
ref3,
ref4.
The lesions of KD may precede or coincide with the development of renal
disease. Several mechanisms have been postulated but none have gained widespread
acceptance to date. These include atopy to persistent fungal or parasitic
antigenic stimulationref1,
ref2
and alterations of immune regulationref1,
ref2,
ref3.
The onset of KD is insidious and the lesions are benign, following an indolent
course, gradually increasing in size over months or years. The overall
prognosis is good. Although spontaneous involution is rare, malignant transformation
has not been documented. Diagnosis of KD is frequently difficult. A biopsy
and/or excision of the involved lymph node or the lesion itself is frequently
required for definitive histopathological diagnosis, and is often therapeutic
as well. The histopathological findings in KD are the same, regardless
of the site of involvement, and are characterised by lymphoid follicles
formation with prominent germinal centres, infiltration of eosinophils,
sometimes forming microabscesses, fibrosis, increased postcapillary venules
and vascular proliferationref1,
ref2,
ref3.
Vessels remain thin-wall with cuboidal endothelial cellsref1,
ref2.
Polykaryocytic giant cells of the Warthin-Finkeldey type are a common feature.
These features are also present in affected lymph nodes, in which their
nodal architecture is preserved. The paracortex and sinuses showed striking
eosinophilic infiltration with eosinophilic microabscesses and increased
postcapillary venules. Although FNAC can be performed for the diagnosis
of KD, its role is largely in the diagnosis of recurrent lesions and it
may obviate the need for repeated open biopsiesref1,
ref2.
Clinical differential diagnoses for KD include reactive lymphadenopathy,
lymphoma, salivary gland tumour, nodal metastasis (breast, colorectal and
nasopharyngeal cancer), and Mikulicz’s diseaseref1,
ref2.
Lesions of KD are also frequently diagnosed as angioma, lymphangioma or
haemangioma, and other tumours. The differential diagnosis frequently highlighted
in the literature is angiolymphoid hyperplasia with eosinophilia (ALHE).
Although there has been controversy in the past, it is now widely accepted
that ALHE and Kimura’s disease are separate entities with different clinical
and histopathological featuresref1,
ref2,
ref3.
Although not diagnostic, imaging studies can play a major role in aiding
the diagnosis of KD and distinguishing the disease from other conditions.
It is also useful in delineating the extent and progression of the disease.
Radiological features, particularly on CT and MR imaging, have been reported
to be useful in the diagnosis of KD. Tissues involved in KD, for example
the parotid gland and lymph nodes, show intense enhancement on CT, reflecting
the vascular nature of the lesionsref1,
ref2,
ref3.
The borders areusually ill-defined and there is usually adjacent enhancing
cervical lymphadenopathy. The CT findings in our patients were compatible
with KD. On MR imaging, these lesions demonstrate intermediate to high
signal intensities on T1-weighted images and hyperintense signals on T2-weighted
imagesref1,
ref2.
The optimal treatment for KD is not well established. However, treatment
should aim to preserve cosmesis and function while preventing recurrences
and long-term sequelae. The range of treatment options include conservative
treatment, steroid therapy, radiotherapy, cryotherapy, laser fulguration,
and surgical excision. Other therapeutic options, including cytotoxic agents,
cyclosporin and pentoxifyline, have been used with variable resultsref1,
ref2.
At initial presentation, surgical excision is the choice for both diagnosis
and therapyref1,ref2,
ref3.
The value of achieving negative surgical margins for local control in excision
has not been studied. Nevertheless, the treatment outcome after excision
is variable and recurrence is common. In cases treated with surgical excision
alone, the recurrence can be as high as 25%ref.
Localised recurrences can often be managed by surgical excision. However,
if recurrence is frequent or there is symptomatic nephrotic syndrome, systemic
steroids should be started. Steroid dosages should be initiated at high
doses and then tapered to effectref1,
ref2,
ref3.
Unfortunately, there is a tendency for lesions to recur when steroid therapy
is stoppedref.
For recalcitrant cases or lesions not amenable to surgery due to size or
unacceptable resultant morbidity, radiotherapy can be consideredref.
Low-dose local irradiation (about 25 to 30 Gy) has been reported to yield
good control and obviates the need for long-term corticosteroidsref1,
ref2.
However, in addition to the side effects of radiotherapy, there is also
concern regarding secondary malignancies in the irradiated field, although
none has been reported yet.
-
Kimura's disease : a disease of the
skin considered by some authorities to be synonymous with angiolymphoid
hyperplasia with eosinophilia but differentiat