Sebaceous hyperplasia appears as 1-to-3-mm yellow umbilicated papules with overlying telangiectasias on the face of middle-aged individuals. They represent a benign proliferation of sebaceous glands. The lesions are sometimes mistaken for basal cell carcinoma.
Perioral dermatitis occurs mainly in young women, characterized by discrete erythematous micropapules and micropapulovesicles that often become confluent on the perioral and periorbital skin. Note presence of tiny papules and a few pustules around the eye. This is a much less common site than the lesions around the mouth.
The cutaneous form of leishmaniasis is caused by a protozoan (Leishmania tropica) that is transmitted by the bite of a sandfly (of the genus Phlebotomus) in certain endemic regions (the Middle East, China, Africa, India, the former Soviet Union). The primary process in the skin starts as a macule of erythema, evolves into a papule as shown.
Leprosy, or Hansen's disease, is a chronic multisystem disease that is caused by Mycobacterium leprae, an acid-fast bacillus. The highest incidence of the disease is in areas of South America, Africa, and Asia. It is not rare in children. The clinical manifestations of this illness depend on the host response to infection. At one end of the spectrum is lepromatous leprosy (LL), which represents a diminished host response to the leprosy bacillus. Cutaneous lesions in this form of the disease vary. Nodular lesions of the earlobe, as shown, are particularly common in lepromatous leprosy. LL is the form most likely to cause widespread nerve damage and ocular disease.
This condition is characterized by numerous shallow, discrete pits on the plantar surface of the feet, usually in the weight-bearing areas. Although the condition is asymptomatic, there is usually hyperhidrosis and the feet may be malodorous. Painful erosions may occur. The condition is caused by Micrococcus species. Topical clindamycin or topical erythromycin is the treatment of choice.
Scarlet Fever - Desquamation of the hands, feet, elbows, and knees occurs during healing. Occasionally, peeling in these locations may be the sole cutaneous manifestation of a mild, resolving streptococcal infection.
Miliaria Rubra (Prickly Heat)
This is the most common form of miliaria. It occurs when there is plugging of the eccrine ducts within the malpighian layer and release of sweat into the adjacent skin. Miliaria rubra is characterized by discrete erythematous papules and papulovesicles. The forehead, upper trunk, and intertriginous areas are commonly affected. Unlike miliaria crystallina, miliaria rubra is characterized by spasmodic pricking sensations. A decrease in environmental heat and humidity is the only treatment required.
The lesions in this condition are small, clear, thin-roofed vesicles that develop when the sweat duct is obstructed within the stratum corneum. They occur after sunburn or in response to excessive sweating in high environmental heat and humidity. Fever may also be a cause. The scalp, face, trunk, and intertriginous areas are sites of lesions. Itching is not a symptom. The vesicles resolve rapidly with the elimination of the causative environmental factor.
This cutaneous disorder is characterized by recurrent episodes of intensely pruritic pustules and papulovesicles on the hands and feet. Lesions are most common on the palms and soles but may be seen on the dorsal surfaces as well. Lesions may also occur on the ankles, forearms, and, rarely, the face, scalp, and upper trunk. The age at onset is typically between 2 and 10 months.
Eosinophilic Pustular Folliculitis
Children with this rare disorder develop repeated crops of pruritic erythematous papules, yellow or white pustules, which vary in size from 1 to 3 mm. Most lesions are located on the scalp and distal extremities. Tzanck smear may reveal numerous eosinophils, and there may also be a peripheral eosinophilia when flaring. Eosinophilic pustular folliculitis is associated with no systemic symptoms and eventually resolves spontaneously. Therapy with topical steroids is somewhat beneficial.
Transient Neonatal Pustular Melanosis
Transient neonatal pustular melanosis. This is a benign neonatal dermatosis that is most common among African- American infants. The original lesion is a vesiculopustule, which may be present at birth. This small blister quickly ruptures and leaves a typical collarette of superficial scale processes, such as neonatal herpes simplex. Tzanck smear of a pustule of erythema toxicum neonatorum will reveal numerous eosinophils but no multinucleated giant cells or bacteria. Occasionally, peripheral eosinophilia is also present. The cause of this condition is not known, and it resolves spontaneously within 10 days. No treatment is required
Transient Neonatal Pustular Melanosis
This is a benign neonatal dermatosis that is most common among African-American infants. The original lesion is a vesiculopustule, which may be present at birth. This small blister quickly ruptures and leaves a typical collarette of superficial scale. In some infants, the pustule and collarette stages seem to occur in utero, and the sole cutaneous manifestations are the typical macules. Lesions of transient neonatal pustular melanosis favor the forehead, neck, chin, and lower back but may be very widespread and may involve the palms and soles. Scraping the base of an unroofed pustule reveals polymorphonuclear leukocytes but no bacteria, pseudohyphae, or multinucleated giant cells. A biopsy of a pustule, which is rarely necessary, shows an intraepidermal collection of polymorphonuclear leukocytes.
Impetigo. A bacterial skin infection caused by the staphylococcus or, more rarely, streptococcus bacteria. The first sign of impetigo is a patch of red, itchy skin. Pustules develop on this area, soon forming crusty, yellow-brown sores that can spread to cover entire areas of the face, arms, and other body parts. Most patients are children. Treatment is by antibiotics.
Bartonellosis: cat-scratch disease with axillary adenopathy. Acute, very tender, axillary lymphadenopathy in a child; cat scratches were present on the dorsum of the ipsilateral hand.
Folliculitis: An infection of the hair follicles of the skin. Infection of the hair follicles can occur when the skin is disrupted or inflamed due to a number of conditions, including acne, skin wounds or injuries, friction from clothing, excessive sweating, or exposure to toxins. The symptoms vary and include small, red bumps or blisters around hair follicles, blisters filled with pus, or itching and tenderness of the involved area. When the deeper parts of the hair follicle are infected, a painful lump or mass may be felt. "Hot tub folliculitis" refers to a folliculitis arising from infection with Pseudomonas bacteria which can be present in hot tubs where the acidity and chlorine levels are not well controlled.
Rosacea is an inflammatory condition of the midface characterized by the presence of erythema, papules, pustules, telangiectasias, and, in the later stages, hyperplasia of the sebaceous glands of the nose. The absence of comedones helps to distinguish this condition from acne vulgaris, although the two conditions may coexist. Although usually seen in middle age, this condition may start in late adolescence.
Rosacea (say "roh-ZAY-sha") is a skin disease that causes redness and pimples on your nose, cheeks, chin, and forehead. The redness may come and go. People sometimes call rosacea "adult acne" because it can cause outbreaks that look like acne. It can also cause burning and soreness in the eyes and eyelids. Rosacea often flares when something causes the blood vessels in the face to expand, which causes redness. Things that cause a flare-up are called triggers. Common triggers are exercise, sun and wind exposure, hot weather, stress, spicy foods, alcohol, and hot baths. Swings in temperature from hot to cold or cold to hot can also cause a flare-up of rosacea.Rosacea can be embarrassing. And if it is untreated, it can get worse. If the symptoms bother you, see your doctor and learn ways to control rosacea.
Furuncle (S. Aureus)
Furuncle: S. aureus. Soft-tissue swelling of the forehead with central abscess formation, nearing rupture.
Hidradenitis suppurativa is a condition in which there are multiple abscesses that form under the armpits and often in the groin area. These areas are a result of local inflammation of the sweat glands. This form of skin infection is difficult to treat with antibiotics alone and typically requires a surgical procedure to remove the involved sweat glands in order to stop the skin inflammation.
Ice Pick Scars Treatment
Ice-pick scars are narrow, deep, vertical, cylindrical depressions at the site of the infundibulum. Given their depth, they are more resistant to laser therapy. Punch excisions, followed by nonablative fractional resurfacing, can be helpful. Improvement of ice pick scars 1 week after suture removal (pictured). Further improvement was achieved with non ablative resurfacing.
Ice-pick scars are narrow, deep, vertical, cylindrical depressions at the site of the infundibulum. Given their depth, they are more resistant to laser therapy. Punch excisions, followed by nonablative fractional resurfacing, can be helpful. Above are ice pick scars prior to punch excisions.
Erythematous Deep Acne Scars
Acne scarring is a common sequel of severe inflammatory or cystic acne. It can present in a mild or cosmetically disfiguring form. The best prevention of acne scarring Is aggressive treatment of acne vulgaris at the time of presentation, including, when appropriate, isoretinoin. Acne scars have several varieties including atrophic, ice-pick, rolling, and boxcar scars. Treatments vary according to the type of scar being treated. Seen here are erythematous deep acne scars.
Cystic acne is a type of abscess that is formed when oil ducts become clogged and infected. Cystic acne affects deeper skin tissue than the more superficial inflammation from common acne. Cystic acne is most common on the face and typically occurs in the teenage years.
Pink pimples ("neonatal acne") are often caused by exposure in the womb to maternal hormones. No treatment is needed, just time. They can last for weeks or even months on baby's skin. In the first few months of a baby's life, any rash associated with other symptoms (such as fever, poor feeding, lethargy, cough) needs to be evaluated by a pediatrician as soon as possible.
Exactly what causes acne? Acne develops when cells and natural oils begin to block up tiny hair follicles in the skin. Bacteria work their way into the plugged up follicles and start multiplying. When the body's immune cells move in to attack the bacteria, the results of the battle are the classic symptoms of acne -- swelling, redness, and pimples. Acne medications help by interrupting this process in different ways. Some over-the-counter and prescription acne creams help by unplugging the follicles. Others - such as antibiotics - kill the bacteria that move into the follicles. The oral retinoid Accutane works differently by reducing the amount of oil secreted by glands in the skin. There is no best acne treatment. Some people do fine using one acne cream, although many need a combination of approaches to control their teen acne.
Acne Vulgaris Nodulocystic
Inflammatory nodules, cysts, and pustules (left). Ruptured cysts have coalesced and have led to painful disfiguring inflammatory nodules. This 23-year-old female was resistant to oral and topical treatment and has developed some scarring. The photograph on the right exhibits a remarkable remission of the disfiguring acne following a course of oral isotretinoin, 1 mg/kg, over a period of 4 months.
Rocky Mountain Spotted Fever (Ankles)
Rocky Mountain spotted fever: early Erythematous and hemorrhagic macules and papules appeared initially on the ankles of an adolescent.
Rocky Mountain Spotted Fever (Hand)
Rocky Mountain spotted fever: early Erythematous and hemorrhagic macules and papules appeared initially on the wrists of a young child.
Rocky Mountain Spotted Fever (Legs)
Rocky Mountain spotted fever (RMSF): An acute febrile (feverish) disease initially recognized in the Rocky Mountain states, caused by Rickettsia rickettsii transmitted by hard-shelled (ixodid) ticks. Occurs only in the Western Hemisphere. Anyone frequenting tick-infested areas is at risk for RMSF. The onset of symptoms is abrupt with headache, high fever, chills, muscle pain. and then a rash. The rickettsiae grow within damaged cells lining blood vessels which may become blocked by clots. Blood vessel inflammation (vasculitis) is widespread. Early recognition of RMSF and prompt antibiotic treatment is important in reducing mortality. The first person to describe the disease was an ear, nose and throat specialist, Edward Ernest Maxey. Maxey reported the disease in 1899. Seven years later, a pathologist named Howard Taylor Ricketts showed that it was transmitted by a tick bite. The agent that causes the disease was named for him -- Rickettsia rickettsii. Rocky Mountain spotted fever is also called spotted fever, tick fever, and tick typhus.
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