Lesiones Cutáneas Secundarias

Escamas

Las escamas son masas secas o grasosas de queratina que representan un estrato córneo engrosado.

Los LOS Neisseria tipos característicos de las escamas son:

• Escamas de color blanco plateado: psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis
• Escamas grasosas/cerosas, amarillentas: dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) seborreica
• Escamas secas, difusas y parecidas a de los LOS Neisseria peces en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la parte inferior de las piernas (ictiosiformes): ictiosis vulgar
• Escamas finas: tiña versicolor
• Descamación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hojas: escarlatina
• Escamas foliculares (como tapones queratósicos): queratosis pilaris
• Escamas arenosas (como papel de lija): queratosis actínica

Costra

• Exudado seco de los LOS Neisseria fluidos corporales (sangre, pus o sebo) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un área de piel dañada
• El color de la costra da pistas sobre su causa:
  • Las costras amarillas surgen del sebo
  • Las costras de color amarillo verdoso se forman a partir de pus.
  • Se forman costras rojas o marrones a partir de la sangre (costra hemorrágica).
• La forma puede indicar lesión previa:
  • Redonda/ovalada: antigua vesícula/ bulla Bulla Blister filled with fluid, > 1 cm diameter Generalized and Localized Rashes o pústula
  • Lineal: excoriaciones
• Puede ser delgada, delicada y fácil de quitar o gruesa y profundamente adherida a la piel.
• Ejemplos incluyen:
  • Tiña de la cabeza
  • Impétigo
  • Costras en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum heridas curativas

Erosión

• Discontinuidad de la piel que presenta pérdida incompleta de la epidermis Epidermis The external, nonvascular layer of the skin. It is made up, from within outward, of five layers of epithelium: (1) basal layer (stratum basale epidermidis); (2) spinous layer (stratum spinosum epidermidis); (3) granular layer (stratum granulosum epidermidis); (4) clear layer (stratum lucidum epidermidis); and (5) horny layer (stratum corneum epidermidis). Skin: Structure and Functions
• No penetra por debajo de la unión dermoepidérmica y, por lo tanto, cicatriza sin dejar cicatriz
• La lesión está húmeda, bien delimitada y deprimida.
• Puede ser traumática, inflamatoria o debido a enfermedades infecciosas de la piel.
• Ejemplos incluyen:
  • Tiña del pie
  • Candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis
  • Enfermedad eccematosa
  • Herpes simple

Excoriación

La excoriación es una abrasión lineal producida por medios mecánicos (rascados, frotamientos o pellizcos) que suele afectar solo a la epidermis Epidermis The external, nonvascular layer of the skin. It is made up, from within outward, of five layers of epithelium: (1) basal layer (stratum basale epidermidis); (2) spinous layer (stratum spinosum epidermidis); (3) granular layer (stratum granulosum epidermidis); (4) clear layer (stratum lucidum epidermidis); and (5) horny layer (stratum corneum epidermidis). Skin: Structure and Functions pero puede llegar a la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions papilar.

Úlcera

• Una ruptura de la piel que muestra pérdida completa de la epidermis Epidermis The external, nonvascular layer of the skin. It is made up, from within outward, of five layers of epithelium: (1) basal layer (stratum basale epidermidis); (2) spinous layer (stratum spinosum epidermidis); (3) granular layer (stratum granulosum epidermidis); (4) clear layer (stratum lucidum epidermidis); and (5) horny layer (stratum corneum epidermidis). Skin: Structure and Functions y, a menudo, porciones de la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions y la grasa subcutánea.
• Las úlceras siempre dan como resultado una cicatriz.
• Las causas incluyen:
  • Traumatismo (e.g., calor Calor Inflammation, frío, eléctrico, químico)
  • Infecciones (e.g., bacterianas, virales, fúngicas)
  • Estasis venosa crónica
  • Compromiso vascular (e.g., úlceras por decúbito y enfermedad arterial periférica)

Fisura

• Una grieta lineal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel que suele ser estrecha y se extiende a través de la epidermis Epidermis The external, nonvascular layer of the skin. It is made up, from within outward, of five layers of epithelium: (1) basal layer (stratum basale epidermidis); (2) spinous layer (stratum spinosum epidermidis); (3) granular layer (stratum granulosum epidermidis); (4) clear layer (stratum lucidum epidermidis); and (5) horny layer (stratum corneum epidermidis). Skin: Structure and Functions hacia la dermis Dermis A layer of vascularized connective tissue underneath the epidermis. The surface of the dermis contains innervated papillae. Embedded in or beneath the dermis are sweat glands; hair follicles; and sebaceous glands. Skin: Structure and Functions
• Provocada por tensión externa o exceso de sequedad de la piel
• Las fisuras comúnmente ocurren en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria ángulos de la boca (queilitis angular).
• Los LOS Neisseria ejemplos también incluyen eccema (puntas de los LOS Neisseria dedos) e intertrigo.

Atrofia

• Pérdida de tejido que puede ser epidérmico, dérmico o subcutáneo
• La piel atrófica suele aparecer delgada, translúcida y arrugada.
• Producida por la exposición prolongada al AL Amyloidosis sol, el envejecimiento y algunas enfermedades cutáneas inflamatorias y neoplásicas, como el lupus eritematoso sistémico y el linfoma cutáneo de células T
• La atrofia también puede ocurrir como resultado del uso prolongado de corticosteroides tópicos.

Liquenificación

• Engrosamiento e hiperpigmentación de la piel como resultado del roce repetido
• Las marcas normales de la piel/pliegues cutáneos se vuelven más prominentes.
• Ejemplos incluyen:
  • Liquen simple crónico
  • Prurigo Prurigo A name applied to several itchy skin eruptions of unknown cause. The characteristic course is the formation of a dome-shaped papule with a small transient vesicle on top, followed by crusting over or lichenification. Secondary Skin Lesions
  • Dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) atópica

Abordaje para el Diagnóstico de Enfermedades de la Piel

Antecedentes médicos completos

• Afecciones subyacentes (e.g., trastornos autoinmunes, diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus)
• Síntomas acompañantes (e.g., ardor, prurito)
• Medicamentos
• Alergias
• Evolución y duración de la lesión cutánea, factores agravantes y atenuantes
• Antecedentes sociales, sexuales y de viajes

Examen físico

Se debe realizar un examen físico general, así como un examen dermatológico dirigido:

• Piel y sus anexos, así como membranas mucosas
• Realizado a simple vista y utilizando un dermatoscopio

Características de la piel y afecciones y/o lesiones de la piel comúnmente asociadas a considerar:

• Textura:
  • Levantada: pápula, placa, nódulo, quiste, roncha
  • Deprimida: úlcera, atrofia
  • Plana: mácula, parche
  • Llena de líquido: vesícula, bulla Bulla Blister filled with fluid, > 1 cm diameter Generalized and Localized Rashes, forúnculo, pústula, absceso
• Morfología:
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de cúpula: hemangioma Hemangioma A vascular anomaly due to proliferation of blood vessels that forms a tumor-like mass. The common types involve capillaries and veins. It can occur anywhere in the body but is most frequently noticed in the skin and subcutaneous tissue. Imaging of the Liver and Biliary Tract
  • De punta plana: verruga plana
  • Umbilicada: molusco contagioso
  • Acuminada: condilomas acuminados
  • Verrugosa: verruga vulgar
  • Pedunculada: acrocordones (etiqueta de piel)
• Diámetro: varía según la condición
• Composición: llena de líquido, llena de pus, llena de sangre o sólida
• Bordes: regulares o irregulares, planos o elevados
• Color: hipopigmentación, hiperpigmentación o eritema
• Disposición: agrupada (herpetiforme)/dispersa
• Configuración:
  • Anular: tinea corporis Tinea corporis Dermatophytes/Tinea Infections, granuloma anular
  • Redonda/discoide/numular: eccema, lupus discoide
  • Policíclica: urticaria Urticaria Urticaria is raised, well-circumscribed areas (wheals) of edema (swelling) and erythema (redness) involving the dermis and epidermis with associated pruritus (itch). Urticaria is not a single disease but rather is a reaction pattern representing cutaneous mast cell degranulation. Urticaria (Hives)
  • Arqueada: urticaria Urticaria Urticaria is raised, well-circumscribed areas (wheals) of edema (swelling) and erythema (redness) involving the dermis and epidermis with associated pruritus (itch). Urticaria is not a single disease but rather is a reaction pattern representing cutaneous mast cell degranulation. Urticaria (Hives)
  • Lineal: sarna madriguera, liquen nitidus
  • Reticular: livedo reticularis Livedo reticularis A condition characterized by a reticular or fishnet pattern on the skin of lower extremities and other parts of the body. This red and blue pattern is due to deoxygenated blood in unstable dermal blood vessels. The condition is intensified by cold exposure and relieved by rewarming. Chronic Kidney Disease
  • Serpiginosa: larva migrans cutánea
  • Lesiones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum diana: eritema multiforme
  • Verticilada: incontinentia pigmenti

Procedimientos diagnósticos

• Biopsia de piel (lesión extirpada, cortada u obtenida mediante biopsia con sacabocados)
• Preparación de KOH:
  • Se raspa la lesión y se coloca en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un portaobjetos de vidrio para microscopio, donde se trata con 1 o 2 gotas de una solución de 10%–20% de KOH.
  • Si se sospecha infección por hongos
• Frotis de Tzanck: técnica citológica cuando se observan condiciones vesiculares (infecciones por virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology herpes simplex Herpes Simplex A group of acute infections caused by herpes simplex virus type 1 or type 2 that is characterized by the development of one or more small fluid-filled vesicles with a raised erythematous base on the skin or mucous membrane. It occurs as a primary infection or recurs due to a reactivation of a latent infection. Congenital TORCH Infections o virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology varicela zoster).
• Diascopia: evalúa la palidez bajo presión, diferenciando las lesiones vasculares/inflamatorias (que palidecen) de las lesiones purpúricas debidas a la extravasación de sangre (que no palidecen)
• Luz de Wood:
  • Utiliza luz ultravioleta de 360 nm para evaluar lesiones
  • Condiciones: eritrasma (color rosa coral), infección de herida por Pseudomonas Pseudomonas Pseudomonas is a non-lactose-fermenting, gram-negative bacillus that produces pyocyanin, which gives it a characteristic blue-green color. Pseudomonas is found ubiquitously in the environment, as well as in moist reservoirs, such as hospital sinks and respiratory equipment. Pseudomonas (azul), vitíligo (blanco)
• Prueba de parche: se colocan alérgenos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la espalda del paciente bajo vendajes oclusivos y luego se verifica si hay reacciones de hipersensibilidad 48 horas después