Rosacea is a congestive blushing and flushing reaction of the central areas of the face. It is usually associated with an acneiform component (papules, pustules, and oily skin). It usually occurs in middle-aged and older people. The cheeks, nose, and chin, on the entire face, may have a rosy hue. Burning or stinging often accompanies episodes of flushing. It is much more common than lupus erythematosus, with which it is often confused. Rosacea is distinguished from acne by age, the presence of the vascular component, and the absence of comedones.
Folliculitis is characterized by red-ringed papules and pustules at hair follicles. Gramnegative folliculitis may be spread by contaminated hot tubs. Gram stain and culture will help to differentiate bacterial from nonbacterial folliculitis. History is important for pinpointing the cause of non-bacterial folliculitis.
Superficial honey-colored serous crusts are characteristic of this disorder. It is usually caused by a staphylococcus infection. Culture is rarely reliable.
These lesions are benign overgrowths of epithelium, largely appearing on the torso, face, and neck. They are seen on almost everyone over the age of 50. The borders are typically irregular, and they range in color from beige or gray-white to very dark brown. These “barnacles” of older skin can number only a few to as many as hundreds. Although often raised and dry, they can be flatter and greasier (seborrheic) in texture.
This is a vascular reactive nodule that develops as a response to a minor injury. The overgrowth of capillaries leads to a raised red lump which bleeds profusely when torn.
These lesions occur on sun-exposed skin, especially face, arms, and hands. Lesions are flat, and pigmented in shades of brown, with characteristically sharp borders. They tend to fade with sun avoidance.
The rash is pruritic and most prominent on the face,
scalp and trunk. It appears as multitudes of redringed
papules and vesicles in varying stages of
development. Crusts eventually form and slough off
in 7 to 14 days. Nondermatomal distribution and
lesions of varying stages distinguish primary
varicella from herpes zoster. Fever and malaise may be mild in children and
much more severe in adults.
Hand, Foot, and Mouth Disease
The disorder is characterized by stomatitis and
vesicular rash on palms of hands and soles of feet. It
is caused by Coxsackieviruses A5, 10, 16. The
development of mouth sores is most troublesome to
adults. The skin lesions are vesicopustules, 0.5 to 5
mm, red-ringed, more oval than round, on palms,
sides of fingers and soles.
The numerous discrete lesions, closely set, usually occur on face, dorsa of hands and shins. Lesions are flat-topped, slightly elevated, well demarcated, generally flesh-colored, with a matte-smooth surface. Lesions tend to spontaneously disappear.
This disorder is a common, but unexplainable, reaction. The initial lesion, “herald patch”, is red and scaly, followed in 1 to 2 weeks by widespread, oval, scaling, fawn-colored macules 4 to 5 mm in diameter over the trunk and proximal extremities. Pityriasis rosea is usually an acute self-limiting illness that lasts 4 to 8 weeks. It is not highly infectious.
Vesicular Hand Dermatitis
This disorder is a severely pruritic reaction in individuals with a personal or family history of allergic manifestations. It is characterized by flares of congestion resulting in deep and superficial blisters, followed by peeling, scaling, and a dry, reddened surface. Flares generally result from contact with irritants, but stress is also a significant factor.
Seborrheic dermatitis is generally limited to the scalp;
however, dry scales and underlying erythema can
occur on the face, ears, chest, back, and body folds.
Skin may be dry or oily. In infants, a widespread
reaction is associated with minimal discomfort. The
yeast organism, Pityrosporum, may be a factor. Mild
scaling without any erythema is often termed simple
dandruff. Tinea capitis may simulate dandruff or seborrheic dermatitis, and
scrapings should be taken for KOH examination and fungal culture, especially
in children, if hair loss is present.
A pruritic dermatosis, characterized by round to oval (coin-shaped) areas of vesiculation, superficial crusting, and redness. Number of lesions varies from few to many. More often this is a symmetrical pattern in young adults. Not related to atopic dermatitis.
Along with hair loss, the scalp surface shows seborrheic dermatitis-like scaling, impetigo-like crusting, pustules, inflammatory nodules or kerion. Identify tinea with KOH culture onto a fungal media. No longer a disease confined to children. If infection suspected, all family members should be examined.
Asymptomatic to mildly itchy macules that scale
readily on scraping. Lesions, usually occur on the
trunk, but may appear on upper arms, neck, face,
and groin. Caused by a yeast organism,
Pityrosporum orbiculare. Altered pigmentation can
be very subtle to obvious, both hypo and
hyperpigmented. KOH shows characteristic spores and hyphae. Fungal culture
is not useful.
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