Common Skin Disorders

What is it?
28 year old female
veteran complains
of burning,
blistering lesions
around her lips
after a day at the
beach.
Herpes Simplex
Common triggers: fever, stress, and sun
Most common on the lips and genitalia
Tzanck smear: multinucleated giant cells
What is it?
46 year old man
complains of painful,
burning rash on his
left chest.
Herpes Zoster
Recurrence of VZV in a specific nerve
Individual lesions are preceded by intense
local pain on then arise as grouped blisters
on an erythematous base, which may
become hemorrhagic and crusted
What is it?
46 year old healthy man with intense
itching of his groin and burning of his feet.
Tinea Cruris- jock itch
Chronic fungal infection of groin area,
usually associated with tinea pedis
Involves the groin, but NOT scrotum
Candida more likely to involve scrotum
Differential: erythrasma, candida
What is it?
Patient complains of enlarging rash in
groin without any itching.
Erythrasma
Caused by Corynebacterium minutissimum
Usually asymptomatic but can itch
Occur in flexural areas, especially in the groin and in
between toes; macules with fine scales and sharply
defined borders
Woods lamp: lesions are coral red because bacteria
produce fluorescent porphyrins
Differential:
Tinea cruris: raised scaly border
Candidiasis: often has peripheral pustules
Therapy: erythromycin (topical or oral)
Woods Lamp with Erythrasma
What is it?
64 year old obese
female with history
of diabetes
complains of rash
under her breast.
Candidal Infection
Occur in most intertriginous or moist areas
Obesity, diabetes, immunosuppression, and
antibiotics are important risk factors
Therapy: topical with nystatin or
imidazoles, but may require oral keto or
fluconazole
What is it?
52 year old woman
notices darkening
of the skin around
her neck.
Acanthosis Nigricans
Hyperkeratosis and hyperpigmentation
with velvety folds seen in the genital
region, axillary region, or nape of the
neck

Associated with insulin resistance,
obesity, or malignancy (especially
adenocarcinoma of the GI tract)
What is it?
32 year old
kindergarten teacher
grade teacher
complains of a diffuse
rash across his chest
and back. He states
that it started several
days after a severe
sore throat.
Psoriasis
Typical lesion is a round sharply bordered
erythematous patch with silvery scale
Lesions shown is second most common form,
guttate type, which usually occurs after
streptocoocal infection
Elbows, knees, scalp, lumbosacral region
Differential: pityriasis rosea, dermatitis,
secondary syphillis, drug eruption
Auspitz sign: when a patch is scraped away,
tiny blood vessels are seen
What is it?
42 year old man
complains of this
diffuse rash across
his back and chest.
One week ago it
started with the
large lesion in his
upper left chest.
Pityriasis Rosea
Initial lesion: herald patch (several cm wide erythematous
patch)
Secondary lesion several weeks later: Christmas tree
pattern on the back (several finely scaled papules arranged
along the skin line)
Differential: fungal infection, secondary syphillis, guttate
psoriasis, drug eruptions
Patients usually asymptomatic and lesions resolve in 2-3
weeks without treatment. In African Americans, tends to
be more pruritic and may require systemic steroids.
Hypopigmented rash?
Patient complains of a rash on
his chest and back which
started 3 weeks ago. He did
not have time to visit his PCP
prior his vacation, so he took a
picture of the rash to show his
doctor when he got back. He
was surprised that the area of
the rash did not get tan over
the week. He presents to his
PCP with his picture.
Tinea Versicolor
Caused by Pityrosporum orbiculare, previously
called Malassezia furfur
Sharply defined, yellowish-brown macules with
tiny scales on chest and back; these become
very visible by stroking with tongue depressor
KOH prep: spaghetti and meatball-like hyphae
and spores
Treatment: selenium sulfide lotion
What is it?
37 year old father
of toddler twins
presents with this
rash.
Ringworm
Caused by parasitic fungi
(Dermatophytosis)
May be spread by skin-to-skin contact, as
well as via contact with contaminated
items
Rx: Topical antifungals or pyrithione
zinc (Head & Shoulders) shampoo
What is it?
37 year old man
returns from a
camping trip in
Connecticut with
complaints of fatigue,
chills, headache,
muscle and joint aches,
and rash as seen on his
flank.
Lyme Disease
Borrelia burgdorferi is the predominant cause
Bacteria are transmitted to humans by the bite
of infected hard ticks belonging to the genus
Ixodes
Early manifestations include fever, headache,
fatigue, and a characteristic skin rash called
erythema migrans
Late manifestations involve the joints, heart,
and nervous system
Rx: doxycyline (adults), amoxicillin (children),
and ceftriaxone
What is it?
36 year old woman
with history of
recurrent HSV of the
lips presents with
these lesions.
Erythema Multiforme
Sharply defined, flat papules with sunken
centers; lesions have an iris or target
appearance
Caused by herpes, mycoplasama, or viral
infections; may also be caused by drugs
May progress to Stevens-Johnson syndrome if
mucosal involvement or toxic epidermal
necrolysis
Treatment: symptomatic treatment only;
systemic steroids may even be harmful in
severe cases
What is it?
Seberrhoic Keratosis
Exophytic waxy brownish papules and plaques;
appear that they can be easily scraped or
flicked off

Unknown etiology

Usually benign, however, when erupt suddenly,
they may represent a paraneoplastic syndrome
caused by tumor production of epidermal
growth factors
What is it?
82 year old man concerned about some
lesions on his forehead.
Actinic Keratosis
Sharply bordered, erythematous lesions
with slight scale that eventually can
become thick and crusted
Early lesions are often easier to find by
palpaion than by visual examination
Pre-cancer lesions of SCC (small % will
turn to cancer over 10-15 years)
Acne in an adult?
62 year old man
presents to your
office complaining
that friends have
noted worsening rash
on face and slight
enlargement of my
nose.
Rosacea
Central facial erythema with some
telangectasias initially, progressing to
papules and pustules
Etiology unknown but many patients
have an abnormal flushing response to
various substances
Therapy: topical metronidazole; severe
forms oral tetracycline or metronidazole
What is it?
Pt complains of sudden-onset of diffuse, itchy
rash across his chest, back, abdomen, arms, and
upper thighs. He states that he was started on a
new blood pressure medicine two days prior to
rash.
Drug-induced exanthem
Well recognized with many drugs including
Anticonvulsants
Aspirin and NSAIDs
Antibiotics: penicillins
Sulfonamides
Usually no specific investigation is undertaken
CBC may show leukopenia, thrombocytopenia, and
eosinophilia in patients with serious drug eruptions.
Rx: remove suspected drug(s); antihistamines
+/- steroids