1 tổn thương cơ bản

A 10 year old boy with low grade fever and viral symtpoms developed erythema chronicum migrans diagnostic of Lyme disease on his forearm.. This healthy 11-year-old boy developed erosions

T H S N G Ô M I N H V I N H

Tổn Thương Căn Bản

Dát (macule) – khoảng (patch)

 Tổn thương ngang bằng da (không có sự dầy lên hay teo lõm)  do đó không sờ được

 Sự thay đổi màu sắc da, cấu trúc da bình thường

 Giới hạn rõ hoặc không rõ, có kích thước và màu sắc rất đa dạng

 Dát < 0,5cm , khoảng > 0,5cm

Erythema

 Sự thay đổi màu sắc da hay niêm mạc do sự dãn

động mạch và tĩnh mạch trong lớp nhú , lớp lưới của bì

A 10 year old boy with low grade fever and viral symtpoms developed erythema chronicum migrans diagnostic of Lyme disease on his forearm His symptoms and the rash disappeared 36 hours into a course of oral amoxicillin erythema migrans

This healthy 11-year-old boy developed erosions in his mouth and lips and widespread target lesions

on his back, chest, and extremities He had a

history of recurrent herpes labialis and one

previous episode of erythema multiforme

Sẩn (papule)

Sẩn (papule) – mảng (plaque)

 Tổn thương đặc

 Nhô cao trên bề mặt da  có thể sờ nắn

 Màu sắc đa dạng

 Nhiều sẩn có thể họp lại tạo thành mảng

 Sẩn < 0,5cm, mảng > 0,5cm

biopsy showed the typical changes of spindle and epithelial cell

nevus

A stable bluish-black papule appeared at least 5 years earlier She had

a similar papule on her back

Biopsy of a chronic red crusted papule on the cheek of this

70 year old light complected man with a history of recurrent sun burns demonstrated a basal cell carcinoma

After local excision the area healed well without recurrence

of the tumor

Mảng (plaque)

A healthy 11 year old boy developed multiple infiltrated

papules which formed an asymptomatic oval plaque The

plaque resolved 9 months later without leaving a scar

granuloma annulare

This healthy 7-year-old girl developed an itchy expanding red annular plaque with pustules at the periphery a week ago The plaque cleared over 10 days with the application of a

topical antifungal cream twice a day tinea corporis tinea

faciei

This hemangioma shows early changes of regression with subtle graying over the center of the plaque hemangioma

A 69 year-old-man was evaluated for an expanding

pigmented plaque on the left ear Histology revealed a

superficial spreading melanoma with a Breslow index of 0.55mm No metastases were noted on physical

examination, and the scar was reexcised with a 1 cm

margin melanoma, superficial spreading melanoma

Cục (nodule)

 Thương tổn đặc

 Có hình cầu hay trứng

 Nhô lên trên bề mặt da

 Nằm ở lớp bì hay hạ bì, nhiều khi phát hiện bằng cách sờ nắn hơn là nhìn

This healthy 30-year-old woman developed a rapidly growing red nodule on her forehead Following several episodes of profuse bleeding, the lesions was excised and the base was cauterized.

pyogenic granuloma

This acquired pigmented nevus on the back had a 2 year history of increasing size and elevation nevus, pigmented, compound

This elderly man complained of a bleeding nodule on his

back for years A skin biopsy showed a thick melanoma

over 4mm deep melanoma

Nang (cyst)

 Chứa dịch hay bán dịch

 Hình tròn hay bầu dục

 Màu sắc tùy thuộc vào chất lỏng ở trong

This heatlhy 10-month-old boy was noted to have a small cyst of the right nipple at birth These lesions usually

resolve without treatment nipple retention cyst

This 22-year-old man with a 2 year history of severe nodulocystic acne was treated with oral 13-cis retinoic acid

Sẩn phù (wheal)

 Sẩn hay mảng phù nề do thâm nhiễm dịch ở lớp bì

 Đặc tính quan trọng : chỉ xuất hiện thoáng qua, chỉ kéo dài vài giờ; 24 – 48h (fitzpatrick)

 Màu hồng hay đỏ tái

This 4-year-old boy developed urticaria following pressure to the buttock and thigh

urticaria dermatographism

This 34-year-old man complained of itchy skin

Symptoms worsened with scratching Note the linear wheals resulting from scratching for this demonstration

of dermatographism dermatographism urticaria

Sẹo (scar)

 Sự tái lập mô sợi từ khiếm khuyết do loét hay vết thương

 Sẹo có thể phì đại do sự phát triển quá mức của chất tạo keo, hoặc có thể teo lại

 Trên mặt sẹo, da trơn mỏng và không có các bộ phận phụ như lông, tuyến

This healthy 25-year-old woman developed a hypertrophic scar after

an accidental kerosene burn on her right hand and wrist

keloid burn, thermal

This 25 year old man with acne developed keloids on his back, shoulders, and chest as a complication of cystic acne

Trợt (erosion)

 Chỉ tróc mất lớp thượng bì do đó khi lành không để lại sẹo

 Có giới hạn rõ

 Thường do từ các mụn nước hoặc bóng nước

This 4 year old boy was recovering from chicken pox when he developed a new fever and multiple expanding blisters filled with pus Gram stain of the pus showed Gram positive cocci in

clusters, and the culture grew Staphylococcus aureus

varicella chicken pox impetigo, bullous

A 28 year old woman complained of painful and pruritic recurrent blistering and erosions on her skin creases, back, chest, and back

of the neck and scalp She had no lesions in her mouth, and her general health was good Her father had a similar eruption

confined to intertriginous areas Histology demonstrated the typical features of benign familial pemphigus Hailey-Hailey disease pemphigus, benign familial

Loét (ulcer)

 Bị thương tổn tới lớp bì hoặc sâu hơn nên khi lành để lại sẹo

This elderly diabetic man with chronic venous insufficiency and varicose veins developed a large irregular ulcer with ragged borders and red base covered with purulent exudate on the right lower leg just above the medial malleolus

This 60 year old woman had a history of slowly growing ulceratd plaque with hyperpigmented pearly rolled up border involving the right side of her nose and adjacent upper lip and lower cheeck for the last seven years.The biopsy of the lesion confirmed the diagnosis of basal cell carcinoma

Teo da (atrophy)

 Teo thượng bì: do có nhiều nếp nhăn, dễ xếp nếp, hơi trong nên có khi thấy được tĩnh mạch bên dưới

 Teo bì: da bị lõm xuống, teo bì có thể đi kèm với teo thượng bì như vết rạn da

This woman with longstanding pyoderma gangrenosum developed atrophic plaques

on her thighs and buttocks after chronic use

of moderate to high potency topical steroids

This young woman developed lipoatrophy 3-4 weeks following an injection of

triamcinolone acetonide into her hip

lipoatrophy

Mụn nước (vesicle) – bóng nước (bulla)

Mụn nước (vesicle) – bóng nước (bulla)

 Thương tổn nhô lên trên mặt da

 Chứa đầy chất lỏng, chất lỏng có thể là huyết thanh, máu

 Sau khi hình thành một thời gian, mụn vỡ ra chảy

nước và đóng mài như trong tổ đỉa, chàm cấp

 Bóng nước có thể căng hay chùn

 Mụn nước <0,5cm; bóng nước >0,5cm

A healthy toddler developed a widespread vesicular eruption with vesicles in various stages of evolution typical of varicella

varicella chicken pox

This healthy adolescent developed a widespread primary Herpes simplex virus infection 2 days after returning from a beach vacation Herpes simplex virus infection

Mụn mủ (pustule)

Mụn mủ (pustule)

 Thương tổn giới hạn rõ

 Trong chứa mủ (bạch cầu, +- vi khuẩn, +- tế bào)

 Tùy thuộc vào sự vô trùng, dịch tiết có thể màu trắng, vàng hoặc vàng xanh

 Có kích thước đa dạng, có thể hợp lại với nhau

This adolescent was disturbed by his worsening acne He was begun on a topical retinoid and oral antibiotic acne vulgaris

This 19-year-old man complained of painful pustules on his leg

folliculitis Staphylococcal infection

Vảy (scale)

 Là những phiến thượng bì mỏng tróc trên mặt da

 Dễ tróc hoặc khó tróc

 Kích thước đa dạng

This 60-year-old woman had a two year history of

multiple,symmetric,salmon pink,pruritic plaques covered with silvery scales on and around her buttocks and upper lateral thighs.The smaller lesions coalesed to form large plaques

psoriasis

This healthy 7-month-old boy developed coarse

non-inflammatory scale 4 months ago ichthyosis, vulgaris

Mài (crust)

 Dịch tiết từ các mụn nước, bóng nước có thể khô lại trên bề mặt

 Mài có thể mỏng, dễ vụn hoặc dầy, dính chặt

This 25-year-old man developed an itchy red eruption on his face after applying a topical antibiotic to areas of dry skin The contact allergic dermatitis became impetiginized with

Staphylococcus aureus, and cleared with oral antibiotics, cool tap water compresses, and topical steroids

This 6 year old boy developed multiple expanding superficial vesicles, pustules, and bulla with central crusting His

brother (see related images) and subsequently 5 other

siblings developed similar lesions All members of the family with impetigo were treated with oral cephalexin with rapid clearing of the rash impetigo, bullous

lichenification

 Do gãi hay cọ xát thường xuyên Da dày có màu

nâu, các rãnh ngang dọc nằm sâu vẽ thành ô không đều Các ô láng, bóng, sáng, đôi khi có vẩy hay vết xước Thương tổn thường thấy trong chàm mạn

tính

A 6 year old boy with atopic dermatitis and a history of severe chronic scratching developed lichenifiec papules, nodules and plaques on his arms and legs His face and torso were spared He did not respond well to topical steroids and lubricants and started a trial of topical tacrolimus ointment in April

A 6 year old boy with atopic dermatitis and a history of severe chronic scratching developed lichenifiec papules, nodules and plaques on his arms and legs His face and torso were spared He did not respond well to topical steroids and lubricants and started a trial of topical

tacrolimus ointment in April

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