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
T.tonsurans 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