Disease Image Presentation Treatment
Atopic eczema Dry, pruritic skin 1. Emollients
Lichenification 2. Topical corticosteroids
Flexural vs extensor 3. Tacrolimus
Atopy: asthma, allergic rhinitis 4. Phototherapy
5. Immunosuppressive agents
Contact Irritant contact dermatitis direct 1. Avoid exposure
dermatitis toxicity 2. Topical corticosteroids
Allergic contact dermatitis delayed 3. Tacrolimus
Eczema
hypersensitivity 4. Oral corticosteroids
Localised stinging, pruritus, blistering,
well-demarcated erythema, swelling
Discoid eczema Dry skin, centre is scaly to clear 1. Emollients
Bumpy exudate patchy + infected 2. Topical steroids
Seborrheic Erythematous, greasy, scaly patches 1. Topical steroids
dermatitis Central facial rash, like SLE 2. Coal tar
(M furfur fungus) Pruritic, white flakes 3. Tacrolimus
4. Antifungals
Asteatotic eczema Crazy paving appearance 1. Emollients
Red/pink fissures 2. Topical steroids
Varicose/stasis Can cause ulceration 1. Emollients
eczema Haemosiderin deposition 2. Topical steroids
Blistering 3. Zinc oxide bandages
Lichen simplex Circumscribed, lichenified, erythematous 1. Topical steroids
chronicus 2. Emollients
3. Lifestyle modiciation
4. Sedating antihistamine for
nocturnal pruritis
Acne rosacea Erythema, papules, pustules, 1. Metronidazole,
telangiectasia, dry eyes, rhinophyma, not tetracycline/erythromycin
painful or itchy 2. Azaelaic acid
3. Ivermectin cream
4. Avoid excessive head/spicy
food/hot drinks
5. Avoid strong sunlight, topical
steroids
Acne conglobate Nodulocystic 1. Isotretinoin 0.5-1 mg/kg
Can exudate/bleed, deep abscesses 2. Oral prednisolone
Obvious comedones, can cause scarring 3. Oral tetracycline/doxycycline
4. Dapsone
Acne fulminans Deep ulcerations and erosions 1. Oral prednisolone
Acne
Fever, arthralgia 2. Isotretinoin
Erythematous neovascular nodules 3. Infliximab
Pypderma faciale
Acne excoriee Scarring, excoriations 1. Psychotropics (TCA, SSRIs)
Self-inflicted wounds 2. Topical corticosteroids
3. Anticonvulsants
Acne mechanica Varies: small comedone, inflamed 1. Salicylic acid
papules, pustule 2. Benzoyl peroxide
Acne vulgaris Greasy skin 1. Isotretinoin
Comedones, papules, pustules 2. Topical doxycycline
Face, back, cheat, shoulders 3. Benzoyl peroxide
Scarring, excoriations, erythematous 4. Oral antibiotics
macules, pigmented macules
Nodular BCC Telangiectasia
Pearly
Rolled edge
Firm
Fibroepithelioma Pink
Polypoid
Similar to skin tag
Skin tumours
Superficial BCC Multiple
Ulcerated/bleeding
Lightly pigmented
Rim-like edges
Scaly
Morphoeic BCC Scarring
Skin-coloured
Waxy
Central depression
Ill-defined edges
Pigmented BCC Brown/blue/grey lesion
Nodular/superficial
Actinic keratosis Hard
Scaly
No induration
Erythematous
Cutaneous horn Horny lesion
Histology: mistaken for AK or SCC
Bowens disease Legs of elderly woman
(in situ SCC) Erythematous scaly plaques
DDx = discoid eczema, psoriasis,
superficial BCC
Keratoacanthoma Rapidly growing
Dome shaped nodule up to 2cm
Symmetrical
SCC Hyperkeratotic papule/plaque/horn
Small, non-healing ulcer
Firm ulcerated/crusted nodule
Friable/fungating tumour that
bleeds/weeps
Nodular Trunk
Grow vertically and rapidly
May ulcerate/bleed
>6mm,dome-shaped
Symmetrical
Crusting
Single/variable colour
Pruritic
Superficial spreading Lower leg
melanoma Macular
Variable pigmentation
Horizontal slow growth
Regression
>6mm, often 1-2 cm
Lentigo maligna Upper body
Irregular shape
Variable pigmentation
Smooth surface
Horizontal growth
^ melanin and melanocyte level
Lentiginous Trunk and lower limb version of lentigo
melanoma maligna
Vertical growth
Aggressive/invasive
Accral lentiginous Soles and palms
melanoma Dark skinned people
Thick, dry, warty
Ulcerating/bleeding
Congenital >1cm
Hairy
Protuberant
5% risk of MM
Junctional Flat macule
2-10mm
Light to dark brown
Round/oval
Palm, soles, genitalia
Naevi
Intradermal Raised dome-shaped
papule/nodule
Skin-coloured, pigmented
Face/neck
Compound Raised
Smooth surface
Pigmented
<10mm
Anywhere on skin
Blue naevus Steely-blue
Solitary
Mostly on extremities
Seborrheic Round/oval
Small papule
Other benign (dark) lesions keratosis Lightly pigmented becomes dark
Well-defined edges
Greasy appearance
Cornflake. Irregular surface
Skin tag Pedunculated, fibroepithelial polyp
Small
Often in obese
Epidermal cyst Keratin filled
Firm
Skin coloured
Mobile
1-3cm
Infection as complication
Milium White keratin cysts
Eyelids and upper chees
Often in children
Dermatofibroma Nodules
Asymptomatic
Proliferation of histiocytes and
fibroblasts
Keloid Dermal proliferation of connective tissue
Extends beyond limit of original injury
Campbell-de- Overgrowth of capillaries
Middle aged, elderly
Morgan spot
Dermal Small nodule
During childhood
neurofibroma Increases in number with age
Caf-au-lait Round or oval neurofibroma
Coffee coloured macule
1st year of life
>2 = neurofibroma
Pyogenic Bright red
Rapidly developing
granuloma Acquired haemangioma
Site of trauma, bleeds easily
Initially, eczema-like lesions.
Bullous Large, itchy blisters. Firm, dome-shaped.
pemphigoid Blister may burst, with raw skin healing.
Initially, ulcers in mucous membranes.
Pemphigus Flaccid blisters. Break easily, leaving erosions.
vulgaris Erosions can become crust, scabbed, leaving discoloured
marks.
Pempigus foliaceous shallow erosions on scalp, face,
Blistering
chest
Paraneoplastic pemphigus blisters on lungs in cancer
patients
Small, intensely itchy, symmetrical vesicles on extensor
Dermatitis surfaces.
herpetiformis Blisters excoriation crusting erosions
Flat, thickened plaques
Bimodal: 6m-10y, 14-83 years
Linear IgA Drug-induced in elderly
Clear round blisters
Vesicles/bullae
Target-shaped
Cluster of jewels sign
String of beads sign (cluster around primary lesion.
Onychomycosis AKA tinea unguium
Often affects big toenail
Results from untreated tinea pedis/manuum
Management: oral terbinafine or itraconazole
Chronic Candida albicans, pseudomonas
Contact with water frequently
paronychia Often co-exists with hand dermatitis
Nail disorders
Management: emollient, imidazole cream, oral itraconazole
Acute Staph aureus, herpes simplex (vesicular), strep pyogenes (fever)
Rapid development
paronychia Single nail fold
Management: topical antiseptic, oral antibiotics, aciclovir
Subungual Tender, throbbing sensation as blood collects
Management: drain blood by using heated needle to perforate nail
haematoma
Splinter Caused by trauma
Management: let it grow out
haemorrhage
Onychogryphosis Chronic trauma, prolonged pressure
Horn shape
Management: avulsion of nail plate
Beaus lines Severe systemic illness affecting growth of nail matter
Yellow nail syndrome Defective lymph drainage pleural effusions may occur
Clubbing Chronic lung infection
Infective endocarditis
Inflammatory bowel disease, thyrotoxicosis, biliary cirrhosis
Koilonychia IDA, lichen planus, repeated exposure to detergents
Nail fold Systemic sclerosis
SLE
telangiectasia Dermatomyositis
Ridging Transverse = eczema, psoriasis, chronic paronychia
Longitudinal = lichen planus, Dariers disease
Pitting Psoriasis
Eczema
Alopecia areata
Lichen planus
Alopecia areata Exclamation mark hairs 1. Leave it as hair will regrow
Nail pitting 2. Topical/intralesional steroid
triamcinolone acetonide
3. Local PUVA
4. Contact immunotherapy
diphencyprone (immunodistraction)
Tinea capitus Scaly and erythematous vs 1. Adults: oral tabinophine
alopecia areata 2. Child: oral griseofulvin
[Link] ringowrm
Localised non-scarring
Hair problems
Scalp psoriasis 1. Coal tar
2. Salicylic acid shampoo
Traction alopecia Traction from tight braids or 1. Hair grows back
pulling hair into a bun 2. Stop pulling/braiding hair
Trichotillomania Moth eaten hair appearance 1. TCA
Pulling out hair in stressful 2. SSRI
situations, or psychiatric disorder 3. Sedatives
4. CBT
Secondary syphilis may also cause patchy alopecia.
Androgenetic alopecia Male pattern baldness: inherited 1. Topical minoxidil
Diffuse non-scarring
Female pattern baldness: 2. Finasteride 1mg PO OD
menopause, thinning on top of 3. Hair transplantation
head
Telogen effluvium Due to childbirth, illness, weight Self-limiting
loss, discontinuing OCP, stress,
drug (beta blocker), fever
Lichen planopilaris Patchy permanent alopecia 1. Topical/intralesional steroids
Erythema, scaling, tenderness, 2. PUVA
burning sensation 3. Ciclosporin
Discoid lupus Ditto Ditto
Scarring alopecia
Chemical/burns
Hirsutism Male pattern hair growth (beard, 1. Treat underlying cause
nipples, male pubic area) 2. Shaving, plucking, waxing, laser
3. Eflornithin
4. Antiandrogen
Excessive hair
5. PCOS
Hypertrichosis Excessive hair growth in a non- Find underlying cause and
androgenic distribution (limbs, treat/withdraw drug
growth
trunk)
Mostly drug-induced
Vasculitis Large vessel: GCA, Takayasus 1. Prednisolone
arteritis 2. Azathioprine
Non-Haematological Purpura Medium vessel: polyarteritis
nodosa, Kawasaki disease
3.
4.
Methotrexate
Cyclophosphamide
Small vessel: granulomatous 5. Rituximab
(Wegener, Churg-Strauss),
polyarteririts, IgA, essential
cryoglobulinaemia
Senile purpura Dark purple macules, well Self-limiting. Use sun protection.
demarcated edge
Thin, inelastic skin
Extensor of forearm, dorsal hand,
neck, face
Schambergs Lower limbs, bilaterally 1. Topical prednisolone for itching.
Asymmetrical brown/orange 2. Graduated compression stockings
disease patches, non-blanchable purpura
and cayenne pepper spots,
pruritus.
Meningococcaemia Large purpuric skin lesions 1. Penicillin G
Pyrexia 2. Cephalosporin
Hypotension
DIC
