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• Oily skin

• Pustules/pimples

• Papules

• Comedones: blackheads and whiteheads

• Locations: mostly on the face, chest, shoulders and upper back

• Common at age 12-30 years

• White skin, white/yellow hair, light eye colour

• Photophobia and visual impairment from birth

• Sunburn and freckling

• Rough spots

• Skin cancer (squamous cell carcinoma and basal cell carcinoma) at early age

• Cracks in the corner of the mouth

• Pain

• Itch

• Redness and/or whiteness in corner of mouth

• Often seen in patients with a history of eczema, bronchitis or hay fever

• Dry skin and itch

• Redness, scaling and small papules, lichenification (thickened skin) due to scratching

• Sometimes erosions, oozing, crusts due to infection (impetigo)

• Typical locations:

  • <2 years: face and neck, trunk, hands and feet

  • >2 years: elbow and knee folds, wrists and ankles, face and neck

• Often a family history (genetics) with eczema or allergies like hay fever

Pityriasis alba is a minor form of atopic eczema occurring in children and young adults which presents as dry, fine-scaled, light-coloured macules or patches on the face and trunk.

• Blisters can be localized on the skin and the mucous membranes (mouth, eyes, genitals)

• They may be blistering drug reactions or auto-immune disease:

  • Blistering drug reactions are often fatal

    • Days to weeks after starting the use of a drug: the skin and often also the mouth, eyes and genitals develop blisters and erosions.

    • Common causes are diuretics, antibiotics, anticonvulsants, NSAIDs and other drugs such as nevirapine
      NOTE: THIS IS A MEDICAL EMERGENCY!

  • Auto-immune blistering disease with deep blisters

    • Chronic bullous disease of childhood: in children, often > 5 years old sudden appearance of small and large blisters in the genital area and thighs. Later also on trunk, hands and feet. Small blisters appear around large blisters, forming a “string of pearls”

    • Bullous pemphigoid: tense blisters which may be localized or widespread often after a period of itchy, eczema-like rash
       

  • Auto-immune blistering disease with superficial blisters

    • Pemphigus vulgaris, pemphigus foliaceus. Superficial blisters that easily break forming crust-like lesions

• Symptoms develop in a few weeks or months

• First stage: a small painless swelling under the skin of about 3 cm

• Second stage: a large painless swelling of more than 3 cm with clearly marked borders. Followed by oedema/swelling (lymphedema) often involving the arms or the legs.

• Latest stage: wounds/ulcers that are not very painful, with undermined edges and often a whitish-yellowish colour in the center, which can become very large

• Typically seen on the exposed skin, but not in the face

• History of worsening when in contact with irritants, like chemical products, paint, cleaning products, soap, cosmetics, perfume, metal or rubber 

• Locations: often on both sides of the body, on hands, arms and lower legs or at location of irritant (e.g. belt, necklace, earring)

• Papules, vesicles and pustules

• Redness

• Oozing

• Crusts

• Lichenification (thickened skin) and scaling, often with itchiness

•  Very itchy, winding red trail of swollen skin

• Lesion can move 1-5 cm daily

• Scratching often causes infection

• Locations are often feet, thighs or buttocks are often affected

• Transmission is mostly from the soil through the skin

• Barefoot walking allows for infection from the soil

• Towels and clothes contaminated by soil may also be a source of infection

• It is associated with animals around the house (from cat or dog droppings/urine)

• If only the buttocks are affected and lesions disappear after a few days think of Strongyloides infection  

•  Weeks or months after a bite of a sand fly, a nodule or macule develops with some redness

• The nodule or macule turns into a painless ulcer

• When the ulcer heals it leaves a typical scar

• Locations are mostly on the face, arms and hands, legs and feet

  • Often localized near the eyes, nose or mouth 

• An inflammation of hair follicles, usually caused by infection with bacteria, specifically staphylococci

• Common locations: the face, the trunk and the buttocks, but any skin area with hair follicles may be affected

• Folliculitis can be mild and superficial or severe and deep

• Keloid-forming folliculitis of the neck (folliculitis keloidalis nuchae) may start after the neck is shaved; it is a form of chronic fibrosing folliculitis

Folliculitis can be a sign of HIV infection in case it is widespread and difficult to treat.

In HIV-infected patients yeast infections may be seen, particularly pityrosporon.

• A group of vesicles appears after a burning sensation, tenderness or pain and redness on that spot

• Locations are usually on the lips, genitals or buttocks

• It often appears repeatedly on the same spot and is self-healing

• Crusts form after the blisters rupture

• Sometimes fever, malaise

Herpes simplex can be a sign of HIV infection in case it is very extensive, rapidly recurrent or if the duration is > 1 month

• Burning sensation, tenderness or pain and redness locally, followed by vesicles and crusts. Often very painful, sometimes itchy

• On one side of the body only: does not cross the midline

• Often localized on face, chest or back

• More often seen in elderly people and immunosuppressed people

Herpes zoster can be a sign of an HIV infection

•  Pustules/pimples

• Small and/or large blisters

• Yellow (or honey-coloured) crusts and erosions 

• Family members or classmates may also be affected

• Location can be the scalp, neck, face, chest, back, arms, legs, genitals and buttocks

• If not in the face, there is often underlying eczema or scabies  

•  Typical purple-black, dark red brown nodules, plaques, macules

• The lesions feel very hard (like wood) on palpation

• Sometimes lesions become warty, ulcerating

• There may be lymph node enlargement and oedema/swelling (lymphedema)

• Locations can be face, palate, trunk, genitals, upper arms and legs

• When you think of Kaposi’s sarcoma: always look in the mouth at the palate!

Kaposi's sarcoma is very suspicious for AIDS.  

• Enlarged, raised scar caused by overgrowth of connective tissue

• Colour: skin-coloured, red or darker than the surrounding skin

• Appearance: shiny, hairless, hard and rubbery, bump/plaque/ridge/swelling.

• The keloid spreads beyond the boundary of the original injury

• Sometimes painful, burning or itchy

• Keloids usually form weeks-months after the initial injury and persist indefinitely

• One of the following two signs or symptoms are sufficient to diagnose leprosy 

  • One or more patches (usually less pigmented than the surrounding normal skin, sometimes reddish or copper-coloured) with loss of sensation (touch with whisk of cotton wool; do not stroke!)

  • An enlarged nerve with loss of sensation and/or loss of strength in hands or feet

• Other signs and symptoms may be:

  • Difficulties to firmly close the eyes

  • Disabled hand or foot

  • Ulcers

  • Signs of reactions, such as: nodules, redness, swelling, pain and generalized illness

•  Oedema/swelling (lymphedema) of legs and/or genitals that can be painful

• First the swelling comes and goes, later it stays continuously

• Inflammation of lymph vessels: deep red line in skin, often appearing from top to bottom

• Lichenification (thickened skin)

• Swelling of lymph nodes

• Locations are mainly legs (usually both upper and lower leg are affected), feet, genitals and sometimes chest, breasts, arms and hands are affected

• Affected areas have a warty appearance with folds and cracks in the lower legs and feet 

•  Round skin-coloured papule with a central dimple/depression

• Cheesy content

• Sometimes itchy

• Mainly face, neck, trunk, armpits and groins, but can be localized anywhere

• Common and self-limiting in healthy children

Molluscum contagiosum can be a sign of HIV infection in adults, or in children when lesions are very widespread 

• Localized swelling, nodules and fistula (‘tunnel’ under the skin) discharging/oozing pus with typical ‘grains’

• Slow development

• Involvement of deep tissue, leading to severe scarring and deformation

• Mainly the foot, or the upper back are affected, but can be localize anywhere

• Mostly occurs in people who walk barefoot

• Mostly in malnourished children aged 2-7 years who often lack healthcare access and/or suffer(ed) from other diseases in the past 3 months (e.g. infections incl. HIV/AIDS, leukaemia).

• The cause is unknown, but it is not contagious.

• Without antibiotics, deadly in ~90% of patients in 2 weeks.

• Stage 0 – simple gingivitis = gums inflammation: A warning sign. Gums bleed easily when touched/brushed and are swollen and red/purplish. Not all patients develop noma.

• Stage 1 – acute necrotizing gingivitis (ANG): Reversible stage. Spontaneous bleeding gums, painful ulceration of the gums; smelly breath (halitosis); excessive salivation (saliva). Not all patients develop later stages.

• Stage 2 – oedema: Reversible stage, 3-9 days after start ANG. Rapid extension ulceration in mouth; smelly breath, facial swelling/oedema; pain; fever; excessive salivation; eating problems; weight loss; swollen lymph nodes.

• Stage 3 – gangrene: Irreversible state, 15-30 days after start ANG. Extensive destruction of hard & soft oral tissue or hole in the face; eating problems; visible of teeth/bones; necrosis/dry ganrege (black dead tissue); losing weight; apathy.

• Stage 4 – scarring: Irreversible stage, 45+ days after the start ANG. Trismus (not able to open mouth) may occur; visible teeth/bones; eating problems; early scarring.

• Stage 5 – sequelae: Irreversible chronic stage. Possible signs: trismus; hole in the face; tooth displacement; visible bones; scars; eating + speech problems; bone fusion.