1. Acanthosis nigricans

Brown-grey papillomatous/keratotic skin lesions on flexor surface, neck and axillae
Rare paraneoplastic syndrome assoc with highly malignant internal carcinoma
Most commonly secondary to gastric malignancy

2. Erythema gyratum repens

Concentric erythematous/exfoliant arcs and rings spread across skin at 1cm/day
Commonly associated with internal malignancy including lung (most common), breast, bladder and stomach
Extensive screen for occult malignancy required at least 5-10 yrs after disappearance of rash

3. Necrolytic migratory erythema

Rare psoriasiform skin disorder affecting the genital and anal region, buttocks, groin and lower legs
Fluctuates in severity; ring shaped erythema → blistering and crusting; painful and itchy
Possible association with Glucagonoma – slow growing tumour of α-cells of pancreas (affects over 50’s)

4. Heliotrope rash (dermatomyositis)

Patchy violet heliotrope rash on face, neck, upper chest, elbows, knees, knuckles and back
Gottron’s lesions – erythematous scaly lesions on elbow and knees
Periocular oedema seen
Adult onset form is associated with several malignancies including stomach and breast

5. Superficial Thrombophlebitis

Widespread/recurrent forms associated with carcinoma of the tail of the pancreas
Redness, swelling and tenderness along the course of a vein (eg long saphenous vein)

Below are some commonly used dermatological words with a brief definition followed by typical examples:

• ABSCESS – pus filled lesion, erythematous, tender, fluctuant, painful, may discharge
• Typically results from staphylococcal infection
• Incision and drainage; swab if oozing, antibiotics only if septic

• BLISTERS – vesicles <5mm, bullae >5mm; intra-epidermal vs sub-epidermal (intra are easily ruptured)
• Burns, scalds, friction, viruses (varicella zoster, herpes zoster, herpes simplex), impetigo, insect bites, papular urticaria, scabies, photosensitivity, drugs (barbiturate OD)
• Swab and culture if infection suspected

• CRUSTING – dried exudate (pus, blood, serum),
• Blepharitis – may be staphylococcal, contact dermatitis, seborrhoeic (incl scalp, brows and ears)
• Infection → Lid hygiene, topical AB’s (fusidic acid gel)
• Allergic → Avoid allergen, short course mild steroid cream
• Seborrhoeic → Meticulous daily cleaning of affected areas, remove scales daily from lids

• CYSTS – epithelial lined cavity containing viscous/semi-solid epithelial degradation products
• Epidermal/pilar (hair follicles), ganglion (joint synovium/tendon sheaths)
• Infected epidermal → incision, drainage, culture, antibiotics
• Uninfected epidermal → remove under LA; ensure all remnants are removed as frequently recur
• Pilar cysts → excision
• Ganglion → spontaneous resolution, aspiration, steroid injection if recurs

• ERYTHEMA – red skin due to vasodilation, should blanch on pressure
• Slapped cheek disease (human erythrovirus B19), erythema multiforme, erythema nodosum, multiple causes
• Treat underlying cause

• ERYTHRODERMA – generalised redness of >90% of body SA.
• Psoriasis, eczema, urticaria
• Treat systemically, can result in high output cardiac failure so IV access and fluids are essential

• EXCORIATION – superficial loss of substance, such as skin due to scratching

• GRANULOMA – a discrete region of granulomatous inflammation (defined by histology)
• Infection (tuberculosis, leprosy, syphilis, brucellosis, Schistosomiasis, Cryptococcus neoformans)
• Inorganic material (silica, beryllium, asbestos, pneumoconiosis, talc, zirconium)
• Systemic diseases (sarcoidosis, rheumatoid arthritis, Wegener's granulomatosis, Crohn's disease)
• Caseating = dead tissue = TB, non-caseating = no necrosis = sarcoidosis, Crohns etc

• KERATINISATION – disruption of keratinisation causes several common disorders.
• Corns/callosities (due to pressure), keratosis pilaris (grey, hard follicular plugs and red papules on outer aspect of upper arms and thighs – common in adolescence)

• LICHENIFICATION - chronic thickening of the epidermis with prominence of the normal skin markings
• Chronic scratching/rubbing, common in eczema

• MACULE - flat - ie non palpable - area of altered skin colour or texture < 1cm

• NODULE - raised solid lesion, larger than 0.5 cm both width and depth, may be inspected or palpated

• PAPILLOMA - benign tumour caused by overgrowth of all elements of the skin; pedunculated, smooth, soft, solid and of any shape, < 1cm, common on face and neck, common in elderly

• PAPULE - small, superficial elevation < 0.5 cm in diameter

• PETECHIAE - purpura < 1 cm diameter
• Thrombocytopenia (viruses, marrow infiltration, alcohol, megaloblastic anaemia, SLE, heparin induced, DIC, thrombotic thrombocytopaenic purpura, haemolytic uraemic syndrome)
• Platelet dysfunction (myelodysplasia, dysproteinaemia, uraemia, liver disease, hypoglycaemia, cardiopulmonary bypass, anti-platelet antibodies, DIC, drugs e.g. aspirin)
• Small vessel disease (septicaemia, endocarditis, Cushings, steroid abuse, vasculitis)

• PLAQUE - elevated, disc-like lesion, > 2 cm, no substantial depth

• PURPURIC RASH - skin lesions < 2 mm diameter (leakage of blood into the skin) Non-blanching, typical rash of meningococcal septicaemia

• PUSTULE – pus filled lesion < 1cm diameter
• Folliculitis, acne vulgaris, rosacea, pustular psoriasis, halogen eruptions, infected eczema, fungal infections

• WEAL - elevated, oedematous, evanescent area surrounded by a zone of erythema

Feel free to send us more dermatology definitions and we will continue to add them to this page

Liver disease- with any condition affecting the liver (Viral hepatitis, autoimmune hepatitis, alcoholic liver disease, paracetamol overdose, Haemochromatosis, wilson’s disease or alpha-1 antitrypsin defieciency), you can get a spectrum of presentations. These are: Acute liver disease, fulminant hepatic failure and chronic liver disease. The most important aspects of each of these are highlighted below.

Acute liver disease

1. Short-term liver inflammation which is self-limiting
2. Jaundice, nausea, anorexia, RUQ pain, fever and fatigue
3. Causes are: Viral hepatitis, Autoimmune hepatitis, wilson’s disease, Haemochromatosis, alcohol

Fulminant hepatic failure (is kind of like acute liver failure)

1. Progression from normal liver to liver failure within 8 weeks
2. Clinical features are encephalopathy, jaundice and haemorrhage
3. Management- resuscitate, broad spectrum antibiotics and transplantation

Chronic liver failure

1. Can be divided into compensated and decompensated. Compensated implies a relatively well patient, whereas those with decompensation have substantial symptoms and/or signs
2. This progresses to liver fibrosis and cirrhosis (due to long term liver damage)
3. Cause portal hypertension and GI bleed, ascites, encephalopathy
4. Treatment: Varices (as for GI bleed), ascites (spiranolactone and salt restriction) and encephalopathy (lactulose-to reduce nitrogenous waste)

With all three of the above also need to treat the underlying condition!

Some Examples: Click here to view an enlarged version of this table in .pdf format