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Day 3 of #DistanceMedEd for #dermtwitter and #medtwitter! We've done 2 of the 5 reaction patterns so far, so let's focus in on the....
DERMAL reaction pattern!
#MedEd #FOAMEd #tweetorial #medthread PC: @dermnetnz
Day 3 of #DistanceMedEd for #dermtwitter and #medtwitter! We've done 2 of the 5 reaction patterns so far, so let's focus in on the....
DERMAL reaction pattern!
#MedEd #FOAMEd #tweetorial #medthread PC: @dermnetnz
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As opposed to the papulosquamous reaction pattern, the dermal pattern implies the action is DEEP in the DERMIS. This means that without epidermal alteration, you shouldn't see scale!
There is of course an exception with overlying xerosis or if you have another process on top!
As opposed to the papulosquamous reaction pattern, the dermal pattern implies the action is DEEP in the DERMIS. This means that without epidermal alteration, you shouldn't see scale!
There is of course an exception with overlying xerosis or if you have another process on top!
3/
When you see something dermal, you have to think about what is infiltrating the skin. A few possibilities/examples:
Edema/fluid 👉 urticaria (1)
Inflammatory cells (reactive) 👉 granuloma annulare (2)
Inflammatory cells (cancer) 👉 CBCL (3)
Collagen 👉 Morphea (4)
When you see something dermal, you have to think about what is infiltrating the skin. A few possibilities/examples:
Edema/fluid 👉 urticaria (1)
Inflammatory cells (reactive) 👉 granuloma annulare (2)
Inflammatory cells (cancer) 👉 CBCL (3)
Collagen 👉 Morphea (4)
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One caveat: even though this group of diseases can be thought of as dermal, I would also include those diseases that primarily affect the subcutaneous fat in this group as well. The easiest example of this would be erythema nodosum. Perhaps a better name is "non-epidermal."
One caveat: even though this group of diseases can be thought of as dermal, I would also include those diseases that primarily affect the subcutaneous fat in this group as well. The easiest example of this would be erythema nodosum. Perhaps a better name is "non-epidermal."
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One more point - we think of plaques as raised, but one of the finer details is that it's any change in elevation. So even atrophic plaques that don't have scale I lump in this group. A good example is lupus panniculitis seen here.
One more point - we think of plaques as raised, but one of the finer details is that it's any change in elevation. So even atrophic plaques that don't have scale I lump in this group. A good example is lupus panniculitis seen here.
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Ultimately, a lot of these diseases are recognizable on clinical exam alone without a need for a biopsy. A biopsy of course can be done if there's confusion, but remember that a good sample including the SQ fat needs to happen if we really want to look at that layer!
Ultimately, a lot of these diseases are recognizable on clinical exam alone without a need for a biopsy. A biopsy of course can be done if there's confusion, but remember that a good sample including the SQ fat needs to happen if we really want to look at that layer!
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RECAP:
If indurated/atrophic without scale --> consider this reaction pattern as you know it's not a primarily epidermal process.
If you need a biopsy, make sure you get to the layer you're looking for.
I'd add that the presence/absence of inflammation and distribution helps!
RECAP:
If indurated/atrophic without scale --> consider this reaction pattern as you know it's not a primarily epidermal process.
If you need a biopsy, make sure you get to the layer you're looking for.
I'd add that the presence/absence of inflammation and distribution helps!
8/
Thus far we've covered 3 out of the 5 reaction patterns! I'm hoping that with all of these together, you can get an idea of how we approach certain skin eruptions/lesions!
Drop a note below with suggestions. Thanks!
Thus far we've covered 3 out of the 5 reaction patterns! I'm hoping that with all of these together, you can get an idea of how we approach certain skin eruptions/lesions!
Drop a note below with suggestions. Thanks!
