Dermatology notes

Sine qua non

refers to an indispensable and essential action, condition, or ingredient. It was originally a Latin legal term
for "[a condition] without which it could not be", or "but for..." or "without which [there is] nothing".
A rash consisting of papules is called a papular exanthem. Papular exanthems may be grouped
(lichenoid) or disseminated (dispersed).
VITILIGO
depigmentation of parts of the skin. It occurs when melanocytes, the cells responsible for skin
pigmentation, die or are unable to function. The cause of vitiligo is unknown, but research suggests
that it may arise from autoimmune, genetic, oxidative stress, neural, or viral causes.
Exposing the skin to UVB light from UVB lamps is the most common treatment for vitiligo.
Diascopy
Diascopy is a test for blanchability performed by applying pressure with a finger or glass slide and
observing color changes.
It is used to determine whether a lesion is vascular (inflammatory), nonvascular (nevus), or hemorrhagic
(petechia or purpura). Hemorrhagic lesions and nonvascular lesions do not blanch; inflammatory lesions
do.
Diascopy is sometimes used to identify sarcoid skin lesions, which, when tested, turn an apple jelly color.
Caf au lait spots or caf au lait macules are pigmented birthmarks.
[1]
The name caf au lait is
French for "coffee with milk" and refers to their light-brown color.
Having six or more caf au lait spots greater than 5 mm in diameter before puberty, or greater
than 15 mm in diameter after puberty, is a diagnostic feature of neurofibromatosis type I, but
other features are required to diagnose NF-1.
Neurofibromatosis type I (NF-1) is a tumor disorder that is caused by the mutation of
a gene on chromosome 17 that is responsible for control of cell division. NF-1 causes tumors
along the nervous system. Common symptoms of NF-1 include scoliosis(curvature of the
spine), learning disabilities, vision disorders, and epilepsy.
They can be treated with lasers.

Lichenification is a less well-defined, large plaque where the skin appears thickened and the
skin markings are accentuated. Lichenification occurs in atopic dermatitis, eczematous
dermatitis, psoriasis, lichen simplex chronicus and mycosis fungoides.
Urticaria (from the Latin urtica, "nettle" from urere, "to burn")
[1]
commonly referred to
as hives, is a kind of skin rash notable for pale red, raised, itchy bumps. Hives might also
cause a burning or stinging sensation.Hives are frequently caused by allergic reactions;
however, there are many nonallergic causes. Most cases of hives lasting less than six weeks
(acute urticaria) are the result of an allergic trigger. Chronic urticaria (hives lasting longer
than six weeks) is rarely due to an allergy.
Shaping Letters into Words: Further Characterization of Identified
Lesions
Color Pink, red, purple [purpuric lesions do not blanch with pressure with a glass slide
(diascopy)], white, tan, brown, black, blue, grey, yellow. The color can be uniform or
variegated.
Margination Well defined (can be traced with the tip of a pencil), ill defined.
Shape Round, oval, polygonal, polycyclic annular (ring-shaped), iris, serpiginous
(snakelike), umbilicated.
Palpation Consider (1) consistency (soft, firm, hard, fluctuant, boardlike); (2) deviation
in temperature (hot, cold); and (3) mobility . Note presence of tenderness , and
estimate the depth of the lesion (i.e., dermal or subcutaneous).

Forming Sentences and Understanding the Text Evaluation of Arrangement, Patterns, and Distribution
Number Single
or multiple lesions.
Arrangement
Multiple lesions may be
o (1)
grouped : herpetiform,
arciform, annular,
reticulated (net-
shaped), linear,
serpiginous
(snakelike); or (2)
disseminated :
scattered discrete
lesions.
Confluence
Yes or no.
Distribution
Consider
o (1)
extent : isolated (single
lesions), localized,
regional, generalized,
universal, and
o (2)
pattern : symmetric,
exposed areas, sites of
pressure, intertriginous
area, follicular
localization, random,
following dermatomes
or Blaschko lines.


HISTORY
Demographics History :
Age, race, sex,
occupation.

1. Constitutional symptoms
Acute illness syndrome: headaches, chills, feverishness, weakness
Chronic illness syndrome: fatigue, weakness, anorexia, weight loss, malaise
2. History of skin lesions. Seven key questions:
When? Onset
Where? Site of onset
Does it itch or hurt? Symptoms
How has it spread (pattern of spread)? Evolution
How have individual lesions changed? Evolution
Provocative factors? Heat, cold, sun, exercise travel history, drug ingestion, pregnancy, season
Previous treatment(s)? Topical and systemic,

3. General history of present illness as indicated by clinical situation, with particular attention to
constitutional and prodromal symptoms
4. Past medical history
Operations
Illnesses (hospitalized?)
Allergies, especially drug allergies
Medications (present and past)
Habits (smoking, alcohol intake, drug abuse)
Atopic history (asthma, hay fever, eczema)

5. Family medical history (particularly of psoriasis, atopy, melanoma, xanthomas, tuberous sclerosis)
6.Social history, with particular reference to occupation, hobbies, exposures, travel, injecting drug use
7.Sexual history: history of risk factors of HIV: blood transfusions, IV drugs, sexually active, multiple
partners, sexually transmitted disease?