EFFLORESCENCE

INDA ASTRI, SARAH DIBA

Department of Dermatology & Venereology

Faculty of Medicine Sriwijaya University
2022
 THE ART AND SCIENCE OF
DERMATOLOGIC DIAGNOSIS
Morphology lesi dianggap sbg bentukan
•primary lesion
•color, texture
General Impression •secondary changes
• Well or ill •shape and configuration
•Obese, cachectic, or normal •Distribution of Lesions General Physical
weight Examination
•Skin Color •Vital signs
•Skin Temperature •Abdominal
•Skin Surface: xerosis, seborrhea, examination
turgor, hyppo/hyperhidrosis, •Pulses
texture •Lymph node
•Photoaging: lentigines, rhytides
Physical
Examination
in
Dermatologic
Diagnosis

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S,
Amagai M, Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill
Companies; 2019. p. 1-17
 LESIONS OF THE SKIN
ketika ada kelainan kulit
ada lesi primer

lebih dari 1 cm= patches

PRIMARY SECONDARY
bercak merah
• Macules (or patches) • Scales
• Papules (or plaques) • Crusts lesi pecah jd koreng
• Nodules • Fissures merah2 dan pecah
• Tumors • Scars
• Wheals - erosions
- ulcers
• Vesicles lesi berisi air
• Bullae lesi isi air yg ukuran >1 cm
• Pustules lesi berisi nanah
• Erosions
• Ulcers

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
 LESIONS OF THE SKIN
patch>wheal

tonjolan diikuti subkutan

vesicle >1cm

jerawat isi air

bulla pecah jd lecet
erosions jd bolong(?)
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 MACULE /tahi lalat

A circumscribed changes in skin color

without elevation or depression
(nonpalpable)

e.g: hyperpigmentation,
hypopigmentation, vascular
abnormalities, erythema, purpura

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical dermatology13th ed.
New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M, Bruckner AL,
Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 PATCHES

A ‘large macule’, 1 cm or greater in diameter

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
 PAPULE

A circumscribed, solid
elevation with no visible
fluid, varying in size from a
pinhead to 1 cm

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 PUSTULE
A small elevations of the skin
containing purulent material, usually
necrotic inflammatory cells

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 PLAQUE
A broad papule (or confluence of
papules), 1 cm or more in diameter.
perkumpulan papul >1cm yg warna putih->scales (kyk sisik)->white scales
klo warna merah->plak erithromatosa

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 NODULE

Morphologically similar to papules but

are larger than 1 cm in diameter.

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 WHEAL
edema pada lapisan dermis kulit

Evanescent, edematous, plateaulike elevations of various sizes

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 VESICLES & BULLAE
• circumscribed
• fluid-containing elevation
• vesicle: 1-10 mm
• bullae: ≥ 1 cm

bullae
bullae berisi darah->bullae hemmoragic
vesicle

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 TUMOR

Soft or firm, freely movable or fixed masses of various sizes

and shapes but usually greater than 2 cm diameters

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology.13th ed. New York: Elsevier.2016.p11-17
Heppt MV, Schlager G, Berking C. Epithelial Precancerous Lesions. In: Kang S, Amagai M, Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS,
editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1857-83
Picture: courtesy of Sarah Diba
 CYST letaknya lebih dalam drpd?

An encapsulated
cavity or sac lined with
a true epithelium

Contains fluid or
semisolid material
(cells and cell products
such as keratin)

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 SCALES
Ostraceous scale,
psoriasis

Dry or greasy, laminated

masses of keratin
Ichthyosiform scale,
ichthyosis vulgaris
Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 ga harus dihafal<3
TYPES OF SCALE

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 CRUST

Dried serum, pus, or blood, usually

mixed with epithelial and sometimes
bacterial debris

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 EROSIONS
dari luka bakar (misal)->pecah

Loss of all or
portions of
the epidermis
alone

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 EXCORIATIONS

Punctate or linear
abrasion produced by
mechanical means,
usually involving only
the epidermis but
sometimes reaching the
papillary layer of the
dermis

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
 ULCER /borok

Rounded or irregulary shaped excavations that result from

complete loss of the epidermis plus some portion of dermis

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology13th ed. New York: Elsevier.2016.p11-17
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 FISSURES
mirip erosi tp linear

Linear cleft
through the
epidermis or
into the dermis

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology. 13th ed. New York: Elsevier.2016.p11-17
 ATROPHY
nenek2/wrinkle

Diminuation in the size of a

cell, tissue, organ or part of
the body.

Glossy, almost transparent,

paper thin and wrinkled,
and may not retain normal
skin lines.
penuaan atau efek samping obat

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 SCARS hasil dari perbaikan kulit

bekas yg menonjol
lapisan dermis bentuk jaringan baru tp diganti dgn bahan yg tidak sama dgn kulit sblmnya

Composed of new
connective tissue that
has replaced lost
substance in the dermis
or deeper parts resulting
from injury or disease, as
a part of the normal
reparative process
yg menonjol
yg menurun scar hipotrophic

Cutaneus sign and diagnosis. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews disease of the skin clinical
dermatology. 13th ed. New York: Elsevier.2016.p11-17
 LICHENIFICATIOND

Thickening of skin

Accentuation of skin markings

garis kulit keliatan

Results from repeated rubbing

and frequently develops in
persons with atopy.

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 KERATODERMA
Excessive accumulation of scale (hyperkeratosis) that
results in a yellowish thickening of the skin, usually on
the palms or soles, that may be inherited or acquired

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 ESCHAR
jaringan mati membentuk krusta yg tebal (tdk bisa dilepas)/koreng

A circumscribed,
adherent, hard, black
crust on the surface
of the skin that is
moist initially, protein
rich, and avascular
hrs diangkat/dibuang biar kulit bisa memperbaiki lapisan

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 COMEDO
Hair follicle infundibulum that is dilated and plugged by keratin

Closed comedo Open comedo

(white comedo) (black comedo)

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 HORN sel bertanduk kyk kutil

Hyperkeratotic conical mass of

cornified cells arising over an
abnormally differentiating epidermis

CALCINOSIS
Deposits of calcium in the dermis or
subcutaneus tissue may be appreciated as
hard, whitish nodules or plaques, with or
without visible alteration of the skin’s surface

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 POIKILODERMA

Combination of athrophy,
telangiectasia and varied
pigmentary change over
an area of skin

Dappled appearance to
the skin

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 VASCULAR LESIONS
Erythema pemb. darah melebar jd merah

•capillary dilatation

Telangiectases kapiler melebar secara permanen krn pake steroid berlebihan

•permanent dilatations of capillaries

•may/not disappear with application of pressure
Purpura (stlh ditabok ada dots merah)

•extravasated red blood cells

Petechiae
•small, pinpoint purpuric spots
•often seen in thrombocytopenic states
▪Ecchymoses
•larger, bruiselike purpuric lesions

Infarct
•an area of cutaneous necrosis
•resulting from occlusion of blood vessels, as in vasculitis and bacterial embolism

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 kulit menipis

Telangiectasia Purpura
matinya jaringan akibat pemb. darah ..?

Infark

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 CUTANEOUS DIAGNOSTIC SIGNS

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 ada papul+squamous
REACTION PATTERN
Papulosquamous Reaction Pattern Eczematous Reaction Pattern
• Psoriasis Same or Similar Histology
• Lichen planus • Atopic
• Pityriasis rosea • Irritant contact
• Pityriasis rubra pilaris • Allergic contact
• Pityriasis lichenoides chronica • Nummular
• Syphilis (secondary) • Dyshidrosis Dishidrotic
• Mycosis fungoides • Xerotic/asteatotic
(MF)/parapsoriasis • Stasis
• Drug (lichenoid, pityriasis • Photoallergic drug eruption
rosea-like) • Actinic dermatitis/actinic prurigo
• Subacute and discoid lupus, • Id or “autoeczematization”
dermatomyositis • Eczematous drug eruption
• Tinea corporis • Seborrheic dermatitis
• Tinea versicolor • Lichen simplex chronicus
• Seborrheic dermatitis Mimickers-Scraping, Biopsy May Be Helpful
• Nutritional deciency • Scabies
• Lichenoid id reaction • Tinea
• Porokeratosis • Some blistering disorders (bullous pemphigoid,
• Supercial basal cell carcinoma dermatitis herpetiformis)
• SCC in situ • Mycosis fungoides
• Nutritional deficiency
• Polymorphous light eruption
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 REACTION PATTERN

Vesiculobullous Reaction Pattern

Pustules Vesicles/Bullae Vesicles/Pustules as
• Psoriasis • Acute eczematous Secondary Processes
• Acute generalized process • Infection (cellulitis,
exanthematous • Allergic contact necrotizing fasciitis, deep
pustulosis (AGEP) dermatitis fungal, atypical
• Sneddon–Wilkinson/IgA • Bullous arthropod mycobacteria scabies)
pemphigus • HSV/VZV • Edema
• Candida • Coxsackie • Chemical/thermal/Ultravi
• Herpes Simplex Virus or • Bullous tinea olet burn
Varicella Zoster Virus • Autoimmune blistering • Necrosis
• Follicular pustules diseases • Fixed drug eruption,
(acne/rosacea, bacterial • Porphyria cutanea tarda, erythema multiforme,
folliculitis) pseudoporphyria SJS/TEN
• Impetigo • Polymorphous light • Neutrophilic dermatoses
• Miliaria pustulosa eruption (vasculitis, Sweet
• Inherited blistering syndrome, pyoderma
diseases gangrenosum)
• Impetigo • Halogenodermas
• Miliaria crystallina
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 REACTION PATTERN

Macular Reaction Pattern

Pink Red
• Vascular anomaly or • Red to red-purple
neoplasm • Vascular anomaly or neoplasm
• Exanthems (drug, viral) (telangiectasia, port-wine stain)
• Macular granuloma annulare, • Petechiae (trauma, thrombocytopenia,
interstitial granulomatous scurvy)
drug eruption • Ecchymosis
• Tinea versicolor (can induce • Red to red-brown
scale) • Pigmented purpura
• Telangiectasia macularis eruptive perstans
(TMEP)
• Fixed drug eruption

Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 REACTION PATTERN
Macular Reaction Pattern
Brown White
• Melasma • Vitiligo
• Lentigo • Contact leukoderma
• Junctional melanocytic nevus • Inherited (piebaldism, nevus anemicus)
• Melanoma • Postinflammatory pigmentation
• Some birthmarks (Café au lait • Pityriasis alba
macule, nevus spilus) • Hypopigmented MF
• Postinflammatory pigmentation • Tuberculoid leprosy
• Tinea versicolor • Guttate hypomelanosis
• Patch-stage KS • Flat warts
• Flat warts • Progressive macular hypomelanosis
• Diabetic dermopathy • Bier spots
Gray/Blue
• Blue nevus
• Nevus of Ota
• Mongolian spot
• Lichen planus pigmentosa and related disorders
• Drug effect (minocycline, amiodarone, hydroxychloroquine)
• Deposition (ochronosis, silver)
• Tattoo
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 REACTION PATTERN
Erythemas
Exanthems Urticaria/Urticaria
• Viral • Urticaria
• Bacterial (toxic shock • Neutrophilic urticaria
syndrome, scarlet fever, • Papular urticaria
meningococcus, • Urticarial vasculitis
mycoplasma) • Dermal hypersensitivity reaction
• Drug (morbilliform • Polymorphous eruption of pregnancy
eruption, DIHS) • Urticarial bullous pemphigoid
• Graft-vs-host disease • Acute hemorrhagic edema of childhood
• Kawasaki disease
• Miliaria rubra

Figurate Targetoid
• Erythema annulare • Erythema multiforme
centrifugum • Mycoplasma-induced rash and mucositis
• Deep gyrate erythemas • Fixed drug eruption
• Erythema migrans • Urticarial vasculitis
• Erythema marginatum • Paraneoplastic pemphigus
• Rowell-type lupus
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17
 REACTION PATTERN
Purpuric Reaction Pattern
Vasculitis Infectious
• Small vessel • Meningococcemia
• Hypersensitivity vasculitis (to drug or • Purpura fulminans
infection) • Ecthyma gangrenosum
• Henoch–Schoenlein purpura (IgA • Hyperinfection strongyloidiasis
vasculitis) • Aspergillus, mucor, and other
• ANCA+ vasculotropic fungi
• Connective-tissue disease associated
• Polyarteritis nodosa
• Churg–Strauss
• Levamisole hypersensitivity
Embolic Vasculopathy
• Cholesterol emboli • Calciphylaxis
• Septic emboli (endocarditis and others) • Cryoglobulin, cryobrinogen
• Antiphospholipid antibody
syndrome, livedoid vasculopathy
• Coumadin/heparin necrosis
• Levamisole hypersensitivity
• Other hypercoagulable states
Amerson EH, Burgin S, Shinkai K. Fundamentals of Clinical Dermatology: Morphology and Special Clinical Considerations. in: Kang S, Amagai M,
Bruckner AL, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill Companies; 2019. p. 1-17