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6-01: Overview: Dermatologic Disorders

Kanade Shinkai; Lindy P. Fox

Dermatologic diseases are diagnosed by the types of lesions they cause. Identify the morphology of lesion(s) to establish a differential diagnosis (Table 6–1), and obtain the elements of the history, physical examination, and appropriate laboratory tests to confirm the diagnosis. Specific clinical situations, such as an immunocompromised or critically ill patient, lead to different diagnostic considerations.

Table 6–1.Morphologic categorization of skin lesions and diseases.
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Table 6–1. Morphologic categorization of skin lesions and diseases.
Pigmented Freckle, lentigo, seborrheic keratosis, nevus, blue nevus, halo nevus, atypical nevus, melanoma, actinic keratoses, Bowen disease, Paget disease
Scaly Psoriasis, dermatitis (atopic, stasis, seborrheic, chronic allergic contact or irritant contact), xerosis (dry skin), lichen simplex chronicus, tinea pedis/cruris/corporis, tinea versicolor, secondary syphilis, pityriasis rosea, discoid lupus erythematosus, exfoliative dermatitis, drug eruption
Vesicular Herpes simplex, varicella, herpes zoster, pompholyx (vesicular dermatitis of palms and soles), vesicular tinea, autoeczematization, dermatitis herpetiformis, miliaria crystallina, scabies, photosensitivity, acute contact allergic dermatitis, drug eruption
Weepy or encrusted Impetigo, acute contact allergic dermatitis, any vesicular dermatitis
Pustular Acne vulgaris, acne rosacea, folliculitis, candidiasis, miliaria pustulosa, pustular psoriasis, any vesicular dermatitis, drug eruption
Figurate (“shaped”) erythema Urticaria, erythema multiforme, erythema migrans, cellulitis, erysipelas, erysipeloid, arthropod bites
Bullous Impetigo, blistering dactylitis, pemphigus, pemphigoid, porphyria cutanea tarda, drug eruptions, erythema multiforme, toxic epidermal necrolysis
Papular

Hyperkeratotic: warts, corns, seborrheic keratoses

Purple-violet: lichen planus, drug eruptions, Kaposi sarcoma, lymphoma cutis, Sweet syndrome

Flesh-colored, umbilicated: molluscum contagiosum

Pearly: basal cell carcinoma, intradermal nevi

Small, red, inflammatory: acne, rosacea, miliaria rubra, candidiasis, scabies, folliculitis
Pruritus1 Xerosis, scabies, pediculosis, lichen planus, lichen simplex chronicus, bites, systemic causes, anogenital pruritus
Nodular, cystic Erythema nodosum, furuncle, cystic acne, follicular (epidermal) inclusion cyst, metastatic tumor to skin
Photodermatitis Drug eruption, polymorphic light eruption, lupus erythematosus
Morbilliform Drug eruption, viral infection, secondary syphilis
Erosive Any vesicular dermatitis, impetigo, aphthae, lichen planus, erythema multiforme, intertrigo
Ulcerated Decubiti, herpes simplex, skin cancers, parasitic infections, syphilis (chancre), chancroid, vasculitis, stasis, arterial disease, pyoderma gangrenosum

1Not a morphologic class but included because it is one of the most common dermatologic presentations.

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