1.

NAIL CHANGES
LESION
DERMATOPHYTE
ONYCHOMYCOSIS

AGE OF
PREDILECTION

AREA OF
PREDILECTION

Yellow discoloration, nail

becomes brittle and
separates from the nail
bed resulting in the
piling up of subungal
keratin; breaks off,
leaving an undermined
black-yellow remnant to
dead nail; skin of the
toe & soles may be
involved branny,
scaling, erythematous,
well-defined patches
Superficial without
paronychial
inflammation; Chalky
white spots on or in the
nail plate that is easily
shaved off.

CANDIDAL
ONYCHOMYCOSIS

Pink, swollen & tender

cuticle with neighboring
portion of the nail
becoming dark, ridged
and separates from the
bed.

PSORIASIS

Pits on the nails,

furrows or transverse
depressions ( Beaus
Line), crumbling nail
plate or leukonychia
with a smooth or rough
surface; nail bed
splinter hemorrhages;
hyponychium yellowish
green discoloration may
occur in area of
onycholysis.

fingernails more
affected

HALLMARK

ETIOLOGY

Starts at the distal

corner of the nail
and involves the
junction of the
nail and its bed;
entire maybe
affected

T. rubrum

Scaling of the nail

under the
overhaningcuticle
and remains
localized to a
portion of the nail,
however, in time
entire nail may be
involved
Paronychia
characteristic
feature; Begins on
the lateral or
proximal nail fold
with expression of
small amount of
pus.

PREDISPOSING
FACTORS

TREATMENT
Itraconazole
Dose: 200mg/day,
bid for 1 week/mo
Fingernails: 2 mos
Toenails: 3 mos
Terbinafine
Dose: 250mg/day
Fingernails: 6 wks
Toenails: 12 wks

OTHER INFO
Types:

1. Distal subungal
onychomycosis
2. White superficial
onychomycosis
3. Proximal subungal
onychomycosis

Fluconazole
Dose: 150-300mg
once/wk for 6-12
months

T.
mentagrophytes

Griseofulvin
therapy

Candida Albicans

Common in
homemakers and
canners & others
who have their
hands mostly in
water.

86.5 % of patient
with psoariatic
arthritis
Others:
Reiters disease,
Pityriasis rubra
pilaris, Sezary
syndrome &
acrokeratosis
paraneoplastica

Griseofulvin does
not treat nail
disease caused by
candida.

Intralesional
injection of
triamcinolone
acetonide
suspension, 3-5
mg/ml
Topical 1% 5-FU
solution
MTX, PUVA,
cyclosporine or
acitretin

Involves all the nail

plate; nail does not
become friable ,
yellow, white

E r y t h e m a t o s u s

L e s i o n s

LESION
MILIARIA
RUBRA
(Prickly Heat,
Heat Rash)

AGE OF
PREDILECTION

Dicrete, extremely
pruritic,
erythematous
papulovesicles; may
become confluent
Accompanied by
prickling, burning or
tingling.

SCABIES

2A.NON-SCALY PAPULES
AREA OF
PREDILECTION
Antecubital and
popliteal fossae,
trunk,
inframmary
areas, abdomen
(waistline),
inguinal region

HALLMARK

ETIOLOGY
Miliaria (in
general) retention of
sweat as a result
of occlusion of
eccrine sweat
ducts and pores.

TREATMENT

OTHER INFO
Prickle cell layer
site of injury and
sweat escape;
spongiosis

S. epidermidis

Pruritic popular
lesions and burrows
w/c house the
female mite and her
young

Circle of Hebra
axillae, elbow,
flexures, wrists,
hands and crotch

Active scabies: Dull

Red nodules

Sarcoptes scabei

Fierce itching at
night

Mite burrows in
stratum corneum
ACNE VULGARIS

PREDISPOSING
FACTORS
Impedance of
evaporation of
moisture

-comedo (basic
lesion)

-adolescents
(15-18)

-papules, pustules,
cysts, nodules, scars

-involution of
disease before
25 years old

-face, neck,
upper trunk,
upper arms
-oily seborrheic
areas

Propionibacterium
acnes
(metabolize
sebum to free
fatty acid)
-heredity,
keratinous plug in
lower
infundibulum of
hair follicle
(primary defect),
androgenic
stimulation of
sebaceous gland

Immunocompromised
& institutionalized
(Crusted Scabies),
malnourished
patients, w/
neurologic dsorders

Premethrin 5%
cream

TOPICAL
-benzoyl peroxide
-topical retionoids
-clindamiycin
-erythro
+benzoyl
peroxide
-sulfur, resorcin,
salicylic acid
-azeleic acid
SYSTEMIC (inh.
formation of new
lesion)
-tetracycline
-minocycline
-doxycycline
-erythromycin
-clindamycin
-sulfonamides
-OCP
-spironolactone
-dexamethasone
-prednisone
-vitamin A
-isotretinoin

Transmission:
close personal
contact

1)
2)
3)
4)

atrophic
papular
atrophic
hypertrophic

SURGICAL
-comedo extractor
INTRALESIONAL
CORTICOSTEROID
LESION

AGE OF
PREDILECTION

AREA OF
PREDILECTION

Principally in
children

Scalp

HALLMARK

ETIOLOGY

PREDISPOSING
FACTORS

TREATMENT

OTHER INFO

PEDICULOSIS
(PHTHIRIASIS)
1.

PEDICUL
OSIS
CAPITIS

Intense pruritus of
scalp
Affected hairs
become lusterless
and dry

Pediculus
humanus var.
capitis (head
louse)

May also occur

in adults

Permethrin
Pyrethrins,
combined w/
piperonyl butoxide
Enzymatic egg
remover (CLEAR)

2. PEDICULOSIS
CORPORIS

3. PEDICULOSIS
PUBIS
(pediculosis
vestimenti or
vagabonds
disease)

Generalized itching,
accompanied by
erythematous
macules or urticarial
wheals; or by
excoriated papules,
parallel linear
scratch marks, and a
pigmented
thickening of skin
from continued
rubbing
Maculae cerulae
- occasional, peculiar
bluish or slatecolored macules,
nonpruritic, does not
disappear on
diascopic pressure
-sides of the trunk,
inner aspects of the
thigh

Upper back; no
involvement of
hands and feet

Adults

Genital region
and hypogastrium
Rarely, axillae or
eyelashes
(pediculosis
palpebrarum)

Dx established by
generalized itching,
parallel stretch
marks,
hyperpigtmentation,
and erythematous
macules.

Pediculus
humanus var.
corporis (body
louse)

Px bathe
thoroughly w/
soap and water
Destruction of lice
laundering the
bedding and
clothing.
Disinfection

Permethrin
Pyrethrins
combined w/
piperonyl
butoxide.
Enzymatic egg
remover (CLEAR)
*retreatment in 1
wk recommended

INSECT BITES

*Pls read in Andrews

=)

Secondary
complications w/
impetigo and
furunculosis are
common due to
itching.

Lice live in the

seams of clothing,
esp. wherever there
is pressure (i.e.
warmth) or in
bedding.
Dx supported by
finding lice in the
seams of clothing or
in bedding.

Transmission:
sexual intercourse;
not infrequently
from bedding

E r y t h e m a t o s u s

L e s i o n s

LESION
FURUNCLE
(BOIL) /
CARBUNCLE

Furuncle - Acute, round,

tender, circumscribed
perifollicular
staphylococcal abscess;
generally ends in central
suppuration.
Carbuncle- 2 or more
confluent furuncles, w/
separate heads
*lesions begin in hair
follicles, and often
continue by
autoinoculation
-most undergo central
necrosis and rupture thru
the skin, discharging
purulent, necrotic debris

2B.NON-SCALY NODULES

AGE OF
PREDILECTION

AREA OF
PREDILECTION
Nape, axillae,
buttocks
*but may occur
anywhere

HALLMARK

ETIOLOGY
S. aureus

PREDISPOSING
FACTORS
Impairment of skin
surface integrity
-irritation, pressure,
friction,
hyperhidrosis,
dermatitis,
dermatophytosis,
shaving
Systemic disorders
- alcoholism,
malnutrition, blood
dyscrasias, disorders
of neutrophil fxn,
immunosuppresion
(AIDS)
Atopic dermatitis
-predisposes to
carrier state

TREATMENT
Penicillinaseresistant penicillin
or 1st-gen.
cephalosporin
Bactobran
applied to anterior
nares to help
prevent recurrence

OTHER INFO
Proximate cause is
either contagion or
autoinoculation from
a carrier focus,
usually in the nose
or groin.

Predisposing
ystemic disorders,
renal dialysis
- often nasal
carriers

E r y t h e m a t o s u s

L e s i o n s

LESION
FIXED DRUG
ERUPTION

2C.NON-SCALY PLAQUES

AGE OF
PREDILECTION

Begins as a red patch

that soon evolves to
an iris or target lesion
identical to erythema
multiforme, and may
eventually blister and
erode

AREA OF
PREDILECTION
Oral and genital
mucosa

HALLMARK

dorsal hands,
dorsal feet,
extensor limbs,
elbows and knees,
and palms and
soles

target or
iris lesions

ETIOLOGY

PREDISPOSING
FACTORS

TREATMENT

OTHER INFO

Stop taking the

offending drug.

Nonpigmenting
fixed drug eruption:
large, tender, often
symmetrical
eythematous plaques
ERYTHEMA
MULTIFORME

ERYSIPELAS

CELLULITIS

Begin as sharply
marginated,
erythematous
macules, which
become raised,
edematous papules
over 24 to 48 hours
target or iris
lesion with 3 zones
central dusky purpura;
an elevated,
edematous, pale ring;
and surrounding
macular erythema
Fiery-red swelling with
characteristic raised,
indurated border;
distinctive features is
the advancing edge of
the patch
Suppurative
inflammation

Young adults

Usually has nondrug causes,

most commonly
herpes simplex
infection

Prevention is
cornerstone of
treatment if HSV
can be
demonstrated as
the trigger.
Sunblock creams
Antiherpetic
antibiotic

Newborn,
postpartum
women

Face and legs

Any inflammation of
the skin, especially if
fissured or
ulcerative, may
provide an entrance
for the causative
streptococcus
Usually follows some
discernible wound

Systemic penicillin
Erythromycin
Locally, ice bags and
cold compresses

Intravenous
penicillinaseresistant penicillins
or a first-generation
cephalosporin

Acute tuberculoid
leprosy of the face
may look exactly
like erysipelas, but
the absence of
fever, pain, or
leukocytosis is
distinctive.

LESION
URTICARIA

EXFOLIATIVE
DERMATITIS

wheals, white or red

evanescent plaques,
generally surrounded
by a red halo or flare

Erythematous plaques

2.
TUBERCULOID
LEPROSY (TT)

AREA OF
PREDILECTION
covered areas,
such as the trunk,
buttocks, or chest

HALLMARK

ETIOLOGY

Although it
occurs at all
ages, there are
2 peaks of
presentation: in
children aged 10
to 20 years, and
in adults 30 to
60 years of age.
(true for all
types)

PREDISPOSING
FACTORS

drugs, food, food

additives,
infections,
emotional stress,
menthol,
neoplasms,
inhalants,
viruses,
parasites,
alcohol

Face and
extremities

skin becomes scarlet

and swollen and may
ooze a straw-colored
exudate

HANSENS
DISEASE
(LEPROSY)

1. EARLY AND
INDETERMINATE LEPROSY

AGE OF
PREDILECTION

OTHER INFO
Acute - < 6 weeks

Antihistamines

Chronic - > 6 wks

Avoidance of the
trigger should be
stressed

Psoriasis; excema,
neurodermatitis;
drug allergy;
pityriasis rubra
pilaris; seborrheic
dermatitis, other
dermatoses,
malignant lymphoma
Mycobacterium
leprae

TREATMENT

topical steroid,
soaks, and
compresses
systemic
corticosteroids

The course of the

disease may be
very protracted,
lasting a period of
years, or it may
simply persist and
resist therapy.

immunosuppressives
Dapsone
(cornerstone of
therapy)
Dapsone +
Rifampin
-combination
therapy initially
Clofazimine
Ethionamide

Often, the first lesion is

a solitary, ill-defined
hypopigmented macule
that merges into the
surrounding normal
skin

Cheeks, upper
arms, thigh, and
buttocks

Typical lesion is the

large, erythematous
plaque with a sharply
defined and elevated
border that slopes

Face, limbs

Peripheral nerves
are not enlarged,
plaques and
nodules do not
occur.

The presence of
palpable induration
and neurologic
findings
distinguishes
indeterminated and

down to a flattened
atrophic center

tuberculoid lesions
clinically.

Lesions are solitary or

few in number (usually
3 or less)

3. BORDERLINE
TUBERCULOID
LEPROSY (BT)

Typical lesion is the

large, erythematous
plaque with a sharply
defined and elevated
border that slopes
down to a flattened
atrophic center
Smaller and more
numerous (usually 310) than tuberculoid
leprosy lesions.

Face, limbs

Lesion is anesthetic
or hypesthetic and
anhidrotic, and
superficial
peripheral nerves
serving or proximal
to the lesion are
enlarged, tender, or
both

Satellite lesions around

large macules or
plaques are
characteristic

4. BORDERLINE
LEPROSY (BB)

Numerous (but
countable) red,
irregularly shaped
plaques

Nerves may be
thicker or tender,
but anesthesia is
ony moderate in the
lesions

Small satellite lesions

may surround larger
plaques
Lesions are generalized
but asymmetrical

5. BORDERLINE
LEPROMATOUS
LEPROSY (BL)

Symmetrical, numerous
(too many to count),
and may include
macules, papules,

Nerve involvement
appears later.
The involvement is

plaques, and nodules

symmetrical.
Sensation and
sweating over
individual lesions is
normal.

6.
LEPROMATOUS
LEPROSY (LL)

*HISTOID
LEPROSY

Mainly pale
lepromatous macules
or lepromatous
infiltrations, with
numerous bacilli in the
lesions.

Yellow-red, shiny, large

papules and nodules in
the dermis or
subcutaneous tissue

There is little or no
loss of sensation
over the lesions,
there is no nerve
thickening, and
there are no
changes in
sweating.

buttocks, lower
back, face, and
bony prominences

may appear de
novo or in patients
with dapsone
resistance

E r y t h e m a t o s u s

L e s i o n s

LESION
TINEA
CAPITIS

Two types:
Noninfammatory
-multiple scaly lesions
(gray patch), broken
hair stubs

2F.PAPULOSQUAMOUS DISEASE

AGE OF
PREDILECTION
School children,
city children
(less commonly
in infants and
adults)

AREA OF
PREDILECTION
Scalp
Noninflam
involve glabarous
skin, eyelids and
lashes

Inflammatory
- scaly, erythematous
papupar eruptions w/
loose broken off hairs w/
inflammation

HALLMARK
Black dots
Woods lampinfected hairs
fluoresce green
KOH- long
septated hyphae

ETIOLOGY
-All
dermatophytes,
except E.
floccosum and T.
concentricum

PREDISPOSING
FACTORS
more of boys in
children, more
women in adults

TREATMENT
Griseofulvin for children
-10mg/kg/day for 2-4
mos
steroids may be given
for inflammation

-most caused by
T. tonsurans and
M.canis

selenium sulfide or
ketoconazole shampoo
may be left on the scalp
for 5 mins, 3x/wk
adjuct to oral antifungals

-may be
ectothrix or
endothrix

OTHER INFO
Kerion celsiii
boggy indurated
areas exuding pus
-delayed type
hypersensitivity rxn
Favus scalp,
glabarous skin and
nails
-sulfur-yellow
crusts form around
loose hairs
atrophy glossy
thin, paper white
patch
Scutulae on
glabarous skin,
cupshaped crust
<2cm
-mousy odor

TINEA
CORPORIS
(TINEA
CIRCINATA)

One or more circular,

sharply circumscribed,
slightly erythematous,
dry, scaly,
hypopigmented patches

Children
adults

Neck, upper and

lower extremities
and trunk

-lesions slightly
elevated esp at
the borders,
more inflammed
than central area
-annular outlines
(ringworm)

Any of the
dermatophytes

Exposure to animals
w/ ringworm (kids)

T.rubrum most
common
M.canis cause
moist type

Excessive
perspiration (adults)
Hot, humid areas

Systemic anti-fungals
(griseofulvin, terbinafine,
itraconazole,
fluconazole)
GrisPEG standard
therapy 350-750mg OD,
4-6 wks

nails brittle,
crusted, irred
thickened
Fungal hyphae
stained with
hematoxylin

LESION
TINEA
CRURIS
(JOCK ITCH,
CROTCH
ITCH)

Small erythematous and

scaling or vesicular and
crusted patch that
spreads peripherally and
partly clears the center

TINEA PEDIS

Border may have

vesicles, pustules or
papules
Maceration, slight
scaling and occasional
vesiculation and fissures
between & under toes
Noninflam- dull
erythema pronounced
scaling

TINEA MANUS

PITYRIASIS
ROSEA

TINEA
VERSICALOR
(PYTIRIASIS
VERSICALOR)

Dry, scaly, erythematous

type or
Moist, vesicular,
eczematous type
-salmon colored
papuplar &macular
-oval or circinate
patches
-runs parallel lines of
cleavage
-finely scaling, gluttate
or nummular patches
-yellowish to brownish
on pale skin,
hypopigmented on dark
skin

AGE OF
PREDILECTION
Adult men

AREA OF
PREDILECTION
Upper, inner
surface of thighs

HALLMARK
Curved, welldefined border,

ETIOLOGY
T.rubrum, T.
mentagrophytes,
E.floccosum

Does not involve

the genitals

Younger inflam
type

Third toe web,

most involved

Moccasin, sandal
appearance

Older noninflamm

Mostly bilateral,
may be limited to
one hand, both
feet

Active borders,
central clearing

Inner sole of the

foot involved first
Mostly one hand,
two feet

Tight jockey shorts

w/c prevent
evaporation

Dermatophytes,
T.rubrum most
common

T. rubrum, T.
mentagrophytes

15-40, mostly
women

Trunk, usually
sparing sun
exposed areas

Herald patch
Christmas tree
pattern on the
back

Unknown
-viral infection is
suggested
-may be due to
drug reaction

Young adults

-sternal region
and sides of the
chest, abdomen,
back, pubis, neck
and intertriginous
areas

Woods lampfluoresce as
yellow to brown
lesions

Fungi
Malassezia furfur

Furfuraceous
scales

Sweat
hyperhydrosis

TREATMENT
Keep area as dry as
possible, Reduction of
perspiration,
enhancement of
eveaporation

OTHER INFO
Candidal infection
may mimic it diff
by satellite pustules

Plain takcum powder or

antifungal powders
Dry toes thoroughly
after bathing. Good
antiseptic powder

Most common
fungal disease

Fungicides azoles,
naftifine, terbinafine,
butenafine

Active borders,
central cleraing

KOH spaghetti
and meatball
appearnace

PREDISPOSING
FACTORS
Heat and high
humidity

hyperhydrosis

Those who perspire

freely

-symptomatic
-UV B to expidite the
involution of the lesions
-topical steroids,
antihistamines topical
steroids may be given
Immidazoles, selenium
sulfide shampoos and
lotions, zinc pyrithione
shampoos, sulfur prep,
salicylic acid prep,
propelyn lotions, benzoyl
peroxide, ketokonazole

Most common
during spring and
autumn

LESION
PSORIASIS
(REVIEW
DIFFERENT
TYPES)

round, circumscribed,
erythematous, dry
scaling plaques of
various sizes, covered
by graying white or
silvery white, imbricated
and lamellar scales
symmetrical, solitary
macule to more than
100 macules

AGE OF
PREDILECTION
Mean: 27yrs
Wide range (few
months to
seventies)

AREA OF
PREDILECTION
scalp, nails,
extensor surfaces
of the limbs
(shins), elbows,
knees, umbilical
and sacral region

HALLMARK
silvery white,
imbricated and
lamellar scales
oil spots, nail
pitting nails
patho features:
-abn
differentiation
-keratinocyte
hyperproliferation
-inflammation

ETIOLOGY
Unknown, maybe
hereditary

PREDISPOSING
FACTORS

TREATMENT

OTHER INFO

May disappear
spontaneously, but
almost certain
recurrence

Koebners
Phenomenon:
appearance of
typical lesions at
areas of injuries
(scratches and
burns)

Tx varies accdg to site,

severity, duration, age
Topical
corticosteroids
tars
dihydroxyanthralin
tazarotene
vit D
salicylic acid
UV
Surgery-denervation
Lasers-destruction of
upper dermis
Systemic
corticosteroids
methotrexate
Combination

Auspitzs Sign:
beeding points
secondary to
thinning of the
epidermis over the
dermal papillae
Woronoff Ring:
concentric
blanching of
erythematous skin
near periphery of
healing psoriatic
plaque

3. SKIN COLORED PAPULES

LESION
VERRUCA
VULGARIS
(common wart)

VERRUCA PLANA
(flat wart)

MOLLUSCUM
CONTAGIOSUM

-pinpoint 1cm,
elevated, rounded
papules w/ rough
grayish surface
(verrucous), tiny
black dots
(thrombosed dilated
capillaries) on
surface
-2-4mm flat-topped
papules, slightly
erythematous or
brown on pale skin
& hyperpigmented
on dark skin
-smooth surfaced,
firm, dome-shaped
pearly papules with
central umbilication

AGE OF
PREDILECTION
-5-20

-children
& young adults

-young children,
sexually active
adults,
immunocompromised
patient

AREA OF
PREDILECTION
-hands (fingers &
palms)
-periungal (nail
biters)

-forehead, cheeks,
nose, area around
mouth, back of
hands
-young children:
face, trunk, and
extremities
-adults: lower
abdomen, upper
thighs, penile shaft
in men
-immunocompromised (HIV):
face (esp. cheeks,
neck, eyelids) ,
genitalia

HALLMARK
-Verrucous

-tendency to
koebnerize forming
linear, slightly
raised papular
lesions

ETIOLOGY
-HPV2,
less frequently
1,4,7

-HPV3,
less frequently
10,27,41

PREDISPOSING
FACTORS
-frequent immersion
of hands in water
-meat handlers

TREATMENT
-cryotherapy
-immunotherapy

-light cryotherapy
-topical salicylic acid
- topical tretinoin

-Poxvirus
(MCV 1-4)
-MCV 1 most
common in
children
- MCV 2 in HIV

-young adults: dont

treat or use only
topical tretinoin or
imiquinod cream
daily
-adults: cryotherapy
or curettage
-w/ atopic
dermatitis: EMLA
followed by
curettage or
cryotherapy
-immunocompromised:
combi. therapy w/
protease inh.;
curettage or core
removal if lesions
are few; Catharine
or 100% TCA
applied to individual
lesion; cryotherapy
but used in caution

OTHER INFO
-spontaneously
resolves
-no dermatoglyphics
(fingerprint folds)
-spreads by
autoinoculation

-autoinoculation,
highest rate of
spontaneous
remission
-Dx: Hendersonpaterson, Shellys
method

in persons of
pigment; continous
tretinoin cream

4. PUSTULAR DISEASE
LESION
ACNE VULGARIS

-comedo (basic
lesion)

AGE OF
PREDILECTION
-adolescents (1518)

AREA OF
PREDILECTION
-face, neck, upper
trunk, upper arms

-papules,
pustules, cysts,
nodules, scars

-involution of
disease before 25
years old

-oily seborrheic
areas

HALLMARK

ETIOLOGY

PREDISPOSING
FACTORS

-Propionibacterium
acnes (metabolize
sebum to free fatty
acid)

TREATMENT
TOPICAL
-benzoyl peroxide
-topical retionoids
-clindamiycin
-erythro
+benzoyl peroxide
-sulfur, resorcin,
salicylic acid
-azeleic acid

-heredity,
keratinous plug in
lower infundibulum
of hair follicle
(primary defect),
androgenic
stimulation of
sebaceous gland

OTHER INFO
5)
6)
7)
8)

atrophic
papular
atrophic
hypertrophic

SYSTEMIC (inh.
formation of new
lesion)
-tetracycline
-minocycline
-doxycycline
-erythromycin
-clindamycin
-sulfonamides
-OCP
-spironolactone
-dexamethasone
-prednisone
-vitamin A
-isotretinoin
SURGICAL
-comedo extractor
INTRALESIONAL
CORTICOSTEROID

MILIARIA
PUSTULOSA

-pustules:
distinct,
superficial &
independent of
hair follicle

-no particular age

-intertriginous
area, flexure
surfaces of
extremities,
scrotum & back

-pustules are
sterile & contain
nonpathogenic
cocci

-bedridden patients

-no treatment
-self-limited

-always preceded by
some other
dermatitis that has
produced injury,
destruction or
blocking of the

sweat duct

LESION
GRAM (-)
FOLLICULITIS

-superficial
pustules 3-6mm in
diameter or
fluctuant, deepseated nodules

P.AEROGINOSA
FOLLICULITIS

-pruritic follicular,
maculopapular,
vesicular or
pustular lesions
occurring within 14 days after
bathing in hot tub
-superficial
folliculitis with thinwalled pustules of
the follicle orifice

SUPERFICIAL
PUSTULAR
FOLLICULITIS

AGE OF
PREDILECTION
-no particular age

-no particular age

AREA OF
PREDILECTION
-anterior nares in
patients w/ longterm antibiotic
therapy

-sides of the trunk,

axillae, buttocks
and proximal
extremities,
apocrine areas of
breast & axilla

-no particular age

HALLMARK

ETIOLOGY
-Enterobacter,
Klebsiella, Proteus,
Escherichia,
Serratia

-Pseudomonas
aeruginosa

PREDISPOSING
FACTORS
-long-term broadspectrum antibiotic
therapy
-patients who have
moderate
inflammatory acne
for long period of
time

TREATMENT
-isotretinoin
-amoxicillin or
trimethoprimsulfamethoxazole

-3rd gen. oral

cephalosporins or
fluoroquinolone in
patients with fever,
constitutional
symptoms or
prolonged disease

-Staphylococcus
aureus

-fragile yellowish
white domed
pustules develop in
crops and heals in
few days
STAPHYLOCOCCAL
FOLLICULITIS

-no particular age

-eyelashes, axilla,
pubis & thighs

-Staphylococcus
aureus

-thorough cleansing
of the affected area
with antibacterial
soap & water tid
-mupirocin
ointment topically
-1st gen.
cephalosporin or
penicillinaseresistant penicillin
-anhydrous
formulation of
aluminum chloride
for chloride
folliculitis

OTHER INFO

LESION
ECTHYMA

-vesicles or
vesicopustules w/
an erythematous
base & surrounding
halo that enlarges
over days & then
crusted over

AGE OF
PREDILECTION
-no particular age

AREA OF
PREDILECTION
-shins, dorsal feet

HALLMARK
-saucer-shaped

ETIOLOGY
-Streptococcus
-Staph. aureus

PREDISPOSING
FACTORS
-uncleanliness,
malnutrition,
trauma; ;
intravenous drug
users and HIV pxs

PYOGENIC
PARONYCHIA

-pruritic, pinkish,
intertriginous moist
patches
surrounded by a
collarette scale

-cloxacillin

-antihistamine

-no particular age

-folds of skin
surrounding
fingernail

-Staph. aureus,
Strep. pyogenes,
Pseudomonas,
Proteus, C.
albicans

-separation of the
eponychium from
the nail plate
caused by trauma
as a result of
frequent wetting of
hands
-common among
bartenders, food
servers, nurses, &
others who
frequently wet
their hands

INTERTRIGINOUS
CANDIDIASIS

-mupirocin or
bacitracin

-1st gen.
cephalosporin

-ulcer-punched-out
appearance when
the dirty yello crust
& purulent
materials are
removed
-margin of ulcerindurated, raised &
violaceous & the
granulating base
extends deeply into
the dermis
-acute/chronic with
purulent tender
and painful
swelling of the
tissue

TREATMENT

-no particular age

-between folds of
genitals, groins,
armpits, between
buttocks, under
large pendulous
breasts, under
overhanging
abdominal folds,
umbilicus

-satellite pustule

-Candida albicans

ACUTE
-semisynthetic
penicillin or 1st gen.
cephalosporin
-Augmentin
CHRONIC
-fungicide &
bactericide
(Neosporin),
Castellani paint

-topical candidal
preparations
-amphotericin B

OTHER INFO
Local adenopathy
may be present

5. VESICULAR DISEASE
LESION
MILIARIA
CRYSTALLINE
(SUDAMINA)

IMPETIGO
CONTAGIOSA

Small, clear, and

very superficial
vesicles w/ no
inflammatory
reaction;
asypmtomatic, short
lived, self-limited
Discrete, thin-walled
vesicles that rapidly
become pustular &
then rupture
Superficial, very
weepy lesions
covered by thick,
bright yellow or
orangec crusts with
loose edges

AGE OF
PREDILECTION

AREA OF
PREDILECTION

HALLMARK

ETIOLOGY
Increased perspiration

Exposed body parts:

face, hands, neck &
extremities

Produce gyrate
patterns
Histopathology:
extremely
superficial
inflammation
abot the funnelshaped upper
portion of the
pilosebaceous
follicles
Subcorneal
vesicopustule
containing few
scattered cocci,
PMN leukocytes,
epidermal cells
Dermis: mild
inflammatory
reaction
vascular dilation,
edema &
infiltration or
PMN leukocytes

Stapylococcus aureus
most common
Streptococci spp.
Group B Streptococci
newborn impetigo

PREDISPOSING
FACTORS
Increased
perspiration
Clothind that
prevents dissipation
of heat and moisture
Impetigo on the
scalp: pediculosis
capitis
Early childhood
Temperate zone:
summer in hot,
humid weather
Group A betahemolytic >>>
follows >>> acute
glomerulonephritis
serotypes 49,
55, 57, 60
strains and
strain M-type
2
childhood
under 6 y/o

TREATMENT
Self-limited

Systemic antiobiotics
w/ topical therapy
semisynthetic
penicillin or
firstgeneration
cephalospori
n
bacitracin &
mupirocin
oitment

OTHER INFO
Appears in
bedridden
patients and
bundled
children
Mistaken for
Toxidendron
dermatitis
Common
sources of
infection:
Children pets,
dirty fingernails
and other
children in
school
Adults barber
shops, beuty
parlors, meatpacking plants,
swimming
pools, and
infected children

LESION
STEVENSJOHNSON
SYNDROME

HERPES
SIMPLEX

Appear on the face

and trunk and
rapidly xtent (4
days) to their
maximum extent
Macular >>>
desquamation >>>
atypical targets with
purpuric centers
>>> coalesce form
bullae then slough
Vesicles are
intraepidermal
Dermis & epidermis
containing infiltrates
of leukocytes &
serous exudates
Ballooning
degeneration of the
epidermal cells to
produce
acantholysis
Minute eosinophilic
intranuclear bodies
Recurrent
Erythema
Multiforme Minor:
papules >>> classic
target lesion

AGE OF
PREDILECTION

AREA OF
PREDILECTION
Oral mucosa and
conjunctiva

Orolabial Herpes:
lips near the
vermilion
Herpes
Gladiatorum: face,
sides of nec, inner
arms
Herpetic Whitlow:
infection of pulp of
fingerip
Herpetic
Keratoconjunctiviti
s: eye
Recurrent
Erythema
Multiforme Minor:
palms, elbows,
knees, and oral
mucosa

HALLMARK

ETIOLOGY

Fever and
influenza like
symptoms
precede eruption

Medications:
Trimethoprim/sulfamet
hoxazole, Fansidar-R,
sulfadoxone plus
pyrimethamine &
carbamazepine

Skin biopsy:
lymphocytic
infiltrate at
dermoepidermal
junction w/
necrosis of
keratinocytes
Tzanck Smear:
multinucleate
epidermal giant
cell
Orolabial
Herpes:
Onset - high
fever, regional
lymphadenopath
y, and malaise
Presentation
cold-sore or
fever blister
Herpetic
Whitlow:
tenderness &
erythema of
lateral nail fold
Herpetic
Keratoconjunctivi
tis:
Punctate or
marginal keratitis
or as a dendritic
ulcer cause
disciform keratits
and leave scars
that impair vision

HSV-1: orolabial
herpes simplex, more
common
HSV-2: genital herpes
Herpetic Whitlow:
children: HSV1
adults: HSV-2

PREDISPOSING
FACTORS

TREATMENT
Similar to patients
with extensive burn
Intravenous
immunoglobulin

HIV patients
Orolabial Herpes:
UVB

Acyclovir

OTHER INFO
Involves less
than 10% body
surface
Most common
sequelae:
Ocular scarring,
vision loss &
siccalike
syndrome
Herpetic
Sycosis
following attack
of facial herpes
simplex, patient
who shaves;
transient
Herpes
Gladiatorum
HSV-1,
wrestlers, rugby
players
Recurrent
Erythema
Multiforme
Minor:
recurrent SV-1
orolabial
disease

LESION
HERPES
ZOSTER

SCABIES

Eruption >>>
ppapules and
plaques of erythema
in the dermatome

Pruritic popular
lesions and burrows
w/c house the
female mite and her
young

AGE OF
PREDILECTION

AREA OF
PREDILECTION
Sensory dorsal root
ganglion cells
Ophthalmic
Zoster: ophtlamic
division of the 5th
cranial nerve
Ramsay Hunt
Syndrome: facial &
auditory nerves

Circle of Hebra
axillae, elbow,
flexures, wrists,
hands and crotch
Mite burrows in
stratum corneum

HALLMARK

ETIOLOGY

Tzanck Smear:
multinucleate
epidermal giant
cell

Varicella zoster virus

Histopathology:
intraepidermak
vesicles, ballon
cells, acidophilic
inclusion bodies

Active scabies:
Dull Red nodules
Fierce itching at
night

PREDISPOSING
FACTORS
Immunosupression
and age
(Herpes Zoster
Generalisatus): old
or debilitated,
lyphoreticular
malignancy, AIDS

TREATMENT

OTHER INFO

Bed rest, local

application oh heat &
gentle pressure,
antiviral treatment
(Acyclovir)

Disseminated
Herpes Zoster
(Herpes
Zoster
Generalisatus)
more than 20
lesions outside
the dermatome
Postherpetic
Neuralgia:
major
complication;
pain 1 month
after onset
Other
complications:
motor nerve
neuropathy

Sarcoptes scabei

Immunocompromised
& institutionalized
(Crusted Scabies),
malnourished
patients, w/
neurologic dsorders

Premethrin 5%
cream

Transmission:
close personal
contact

6. BULLOUS DERMATOSIS
LESION
BULLOUS
IMPETIGO

-strikingly large,
fragile bullae
-ruptures & leaves
circinate, weepy or
crusted lesions
(impetigo circinata)

FIXED DRUG
ERUPTION

-begins as an
erythematous
patch that soon
evolves to an iris
or target lesion and
may eventually
blister & erode
-6 or fewer lesions
occur but
frequently single
-prolonged
inflammation
results to
hyperpigmentation

AGE OF
PREDILECTION
-newborn infants
(4th & 5th days of
life)
-may occur at any
age

-any age

AREA OF
PREDILECTION
-newborn: face &
hands

HALLMARK

ETIOLOGY
-Staphylococcus
aureus

PREDISPOSING
FACTORS
-insect bite

TREATMENT
-systemic
antibiotics

-adults: axilla,
groin, hands

-anywhere but half

occurs on oral &
genital mucosa

-recur at the
same site with
each exposure to
the medication

-medications
usually taken
intermittently
(NSAIDS,
pyrazolone
derivatives,
naproxen,
mefenamic acid,
etc.)

-persons with FDE

to pyrazolone
derivatives are
usually HLA-B22
positive

-stop offending
medication &
replace with
alternative drug

OTHER INFO
-weakness, fever,
diarrhea with
green stools,
bacteremia,
pneumonia, or
meningitis, fatal
termination
-early
manifestation of
HIV infection
-Nonpigmented
FDR: occurs
occasionally;
characterized by
large, tender,
often symmetrical
erythematous
lesions that
resolves; normally
caused by
pseudoephedrine
hydrochloride
-Baboon
Syndrome:
buttocks, groin &
axilla are
preferentially
involved

LESION
IRRITANT
CONTACT
DERMATITIS

-non-allergic
inflammatory
reaction of the
skin

AGE OF
PREDILECTION
-any age

AREA OF
PREDILECTION
-in areas that has
come in contact
with irritants

-erythema
vesicles, erosions,
crusts, scaling

HALLMARK

ETIOLOGY
-alkalis: soaps,
detergent,
ammonia, lye,
toilet bowl
cleaners
-acids:
hydrofluoric
acids, HCl, nitric,
sulfuric acids

PREDISPOSING
FACTORS
-condition of skin
upon contact
-skin may be
vulnerable by
reason of
maceration from
excessive humidity
or exposure to
water, heat, cold,
pressure or friction

-Ca, Cu, Hg, Ni,

Ag, Br, Cl, Fl, I
-chlorinated
compounds:
Chloracne

TREATMENT
-alkalis:
immediate
application of a
weak acid
(vinegar, lemon
juice, 0.5% HCl)
-oxalic acids: lime
water
-phenol: 65%
EtOH or isopropyl
alcohol
-fluorine:
magnesium oxide
-periungal burns:
10% calcium
gluconate solution

-dog collars: Flea

Collar Dermatitis
-capsaicin: Hunan
hand

-phosphorus
burns: rinse with
water & apply
copper sulfate
-titanium HCl:
wipe away, do not
rinse!

ALLERGIC
CONTACT
DERMATITIS

-erythema,
vesicles ,
erosions, crusts,
scaling

-any age

-in areas that has

come in contact
with allergen (but
it has to be
previously
sensitized)

-previous exposure
to allergen

OTHER INFO