Nikolsky sign” or “Nikolsky II sign”) refers to the extension of
a blister to adjacent unblistered skin when pressure is put on the top of the
bony phalanges. Acroosteolysis has two patterns of resorption in adults:
diffuse and band like.A diffuse pattern of resorption has a wide differential
diagnosis and can include the following: pyknodysostosis, collagen vascular
disease and vasculitis, Raynaud’s neuropathy, trauma, epidermolysis bullosa,
psoriasis, frostbite, sarcoidosis, hypertrophic osteoarthropathy. A band like
pattern of resorption may be seen with polyvinyl chloride exposure and
Hadju-Cheney syndrome. A mnemonic commonly used for acro-osteolysis is PINCHFO
– Pyknodysostosis, Psoriasis, Injury (thermal burn, frostbite), Neuropathy
(diabetes), Collagen vascular disease (scleroderma, Raynaud’s),
Hyperparathyroidism, Familial (Hadju-Cheney, progeria), Occupational (polyvinyl
septum: It is
the nodular form of the tuberculosis in nasal mucosa. It begins in the
vestibule and extends to adjoining skin and mucosa. It is the result of direct
inoculation. It presents as glistening reddish brown or skin colored nodules
also known as ‘apple jelly nodules’. An attempt to blench them with a glass
slide [Diascopy] makes them more prominent, as they tend to stand out amidst
blenched surrounding. These nodules may
coalesce to form characteristic ulcer with a pale granular base and undermined
margins. Untreated patients tend to progress to scarring and resultant
disfigurement of the external nose.
fontanelles may remain open until adulthood, but the sutures often close with
interposition of wormian bones. Bosses of the frontal, parietal, and occipital
regions give the skull a large globular shape with small face. The
characteristic skull abnormalities are sometimes referred to as the
“Arnold head” named after the descendants of a Chinese who settled in
South Africa and changed his name to Arnold.
sclerosis. They are white or lighter patches of skin that may appear anywhere
on the body and are caused by a lack of melanin. These are usually the only
visible sign of diseases at birth. In fair-skinned individuals a Wood’s lamp
(ultraviolet light) may be required to see them.
bleeding spots when psoriasis scales are scraped off, named after Heinrich
Auspitz.This happens because there is thinning of the epidermal layer overlying
the tips of the dermal papillae and blood vessels within the papillae are
dilated and tortuous, which bleed readily when the scale is removed.
line : Dermatological
sign that consists of pressure by a sharp object (such as a fingernail)
producing a white line on the skin that quickly turns red. It is present in
consists of fine telangiectasias around the nail (periungually). They may be
associated with connective tissue diseases.
relocalization in nape of the neck resembling the buffalo’s hump
may also cause severe swelling in the neck, that resembles the bull’s hump
of a nodule when pressed with a finger, a characteristic of neurofibromatosis
are follicular hyperkeratotic plugs causing a carpet tack appearance as they
project from the undersurface of the scale when it is removed from advanced
lesions. The dyspigmentation of older lesions often presents as central
hypopigmentation and peripheral hyperpigmentation.
known as Furrowed /Grooved/ Lingua Fissurata/Lingua Plicata/Lingua Scrotalis/Plicated
characterized by intention tremor, nystagmus, dysarthria
head and face become enlarged and deformed causing an abnormal appearance
resulting in a typical “chipmunk facies” appearance. This occurs because the
bone marrow, the site of red blood cell production, becomes hyperactive [enlarged]
in an attempt to produce sufficient red cells to overcome the effects of the
the signs of tetany seen in hypocalcemia. It refers to an abnormal reaction to
the stimulation of the facial nerve. When the facial nerve is tapped at the
angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of
the face will contract momentarily (typically a twitch of the nose or lips)
because of hypocalcemia (i.e. from hypoparathyroidism,
pseudohypoparathyroidism, hypovitaminosis D) with resultant hyperexcitability
of nerves. Though classically described in hypocalcemia, this sign may also be
encountered in respiratory alkalosis, such as that seen in hyperventilation,
which actually causes decreased serum Ca2+ with a normal calcium
level due to a shift of Ca2+ from the blood to albumin which has
become more negative in the alkalotic state.
squamous epithelium occurring on buccal mucosa and gingival.
papillary hyperplasia, Heck’s disease
of axillary (armpit) freckling in people with neurofibromatosis type I
known as a Dennie–Morgan line or an infraorbital fold, is a fold or line in the
skin below the lower eyelid caused by edema in atopic dermatitis. The presence
of Dennie–Morgan folds is used as a diagnostic marker for allergy
are a fleeting enanthem seen as small, red spots (petechiae) on the soft palate
in 20% of patients with rubella. They precede or accompany the skin rash of
rubella. They are not diagnostic of rubella, as similar spots can be seen in measles
and scarlet fever. The sign is named after Frederick Forchheimer
screw driver shaped.
to touch the tip of the nose with tongue and touch the elbow with the tongue
the surface of a psoriasis plaque with a glass slide will remove the loosely
attached scales and reveal a shiny surface peppered with fine bleeding points.
These bleeding points represent the dilated and tortuous capillary blood
vessels in the papillary dermis, one of the characteristic pathological events
taking place in psoriasis affected skin. This sign is known as Auspitz sign, which is a diagnostic
sign of psoriasis.
sign (AKA Hammond’s sign or Hammond’s crunch) is a crunching, rasping sound,
synchronous with the heartbeat, heard over the precordium in spontaneous
mediastinal emphysema produced by the heart beating against air-filled
tissues.It is named after Johns Hopkins clinician Louis Hamman. This sound is
heard best over the left lateral position. It has been described as a series of
precordial crackles that correlate with the heart beat and not the
respirations. Also heard together with spontaneous pneumothorax; small and not
a total lung collapse, on the left side. Sounds like bubbles hitting the inside
of the chest. Can be felt/seen. Hamman’s crunch is caused by pneumomediastinum
or pneumopericardium, and is associated with tracheobronchial injury due to
trauma, medical procedures (e.g., bronchoscopy) or proximal pulmonary bleb
rupture. It is commonly seen in Boerhaave syndrome.
nasal deformity, and destruction of the nasal cartilage are also noted along
with the damage may result in anesthesia of the soft palate, enlargement of the
uvula, dysphonia, and various degrees of airway obstruction.
unilateral enlargement of the sternoclavicular portion of the clavicle, seen in
congenital syphilis. It is an end result of neonatal periostitis.
on the tip of the nose precedes the development of ophthalmic herpes zoster
Hypoplasia of incisor (Pegged laterals, screw driver shaped central incisor and
mulberry molars), Eighth nerve deafness and Interstitial keratitis.
iris pearls near the pupillary margins, which are spherical yellowish opaque
micronodules upto 2 mm in size.
Lichen planus, pemphigus, Epidermolysis bullosa dystropica. Also called the
“Koebner response” or the “isomorphic response”, refers to
skin lesions appearing on lines of trauma. The Koebner phenomenon may result
from either a linear exposure or irritation. Conditions demonstrating linear
lesions after a linear exposure to a causative agent include: molluscum contagiosum,
warts and toxicodendron dermatitis (a dermatitis caused by a genus of plants
including poison ivy). Warts and molluscum contagiosum lesions can be spread in
linear patterns by self-scratching (“auto-inoculation”).
Toxicodendron dermatitis lesions are often linear from brushing up against the
plant. Causes of the Koebner phenomenon that are secondary to scratching rather
than an infective or chemical cause include vitiligo, psoriasis, lichen planus,
lichen nitidus, pityriasis rubra pilaris, and keratosis follicularis (Darier
disease). Also seen in Psoriasis, Pityriasis rubra pilaris, Lichen planus, Lichen
nitidus, Vitiligo, Lichen sclerosus, Elastosis perforans serpiginosa, Kaposi
sarcoma, Necrobiosis lipoidica and Systemic Lupus Erythematosus. Warts and
molluscum contagiosum are often listed as causing a Koebner reaction, but this
is by direct inoculation of viral particles.
prodromic viral enanthem of measles manifesting two days before the measles
rash itself. They are characterized as clustered, white lesions on the buccal
mucosa near each Stensen’s duct (on the buccal mucosa opposite the maxillary
2nd molars) and are pathognomonic for measles
pigmented hamartomatous nodular aggregate of dendritic melanocytes affecting
the iris, named after Austrian ophthalmologist Karl Lisch.
Livedo reticularis is a common skin finding consisting of a mottled reticulated
vascular pattern that appears like a lace-like purplish discoloration of the
skin.The discoloration is caused by swelling of the venules owing to
obstruction of capillaries by thrombi. It can be caused by any condition that
makes venules swell. The condition may be normal or may be related to more
severe underlying pathology. It has a broad differential diagnosis, broadly
divided into possible blood diseases, autoimmune (rheumatologic) diseases,
heart (cardiovascular) diseases, cancers, and endocrine disorders. It can
usually (in 80% of cases) be diagnosed by biopsy.
the ear (Milian’s ear sign) is a distinguishing feature for erysipelas since
this region does not contain deeper dermis tissue.
pemphigus, Severe Steven –Johnson syndrome, Prophyria, Toxi Epidermolysis
Necrosis, Staphylococci Scalded skin syndrome. The sign is present when slight
rubbing of the skin results in exfoliation of the outermost layer, forming a
blister within minutes.
discolouration in the nail bed that resembles a drop of oil beneath the nail
sign – This is a sign to be elicited in case of secondary syphilis and
cutaneous vasculitis, where there is deep dermal tenderness on pressing the
lesion (e.g., papular lesions of syphilis) with a pinhead.
Pastia lines or Thompson’s sign is a clinical sign in which pink or red lines
formed of confluent petechiae are found in skin creases, particularly the
crease in the antecubital fossa, the soft inside depression on the inside of
the arm; the folding crease divides this fossa where the forearm meets the
(upper) arm (the biceps, triceps, humerus section of the upper extremity); the
inside of the elbow (the inside flexor depression (fossa) of the elbow. It
occurs in patients with scarlet fever prior to the appearance of the rash and
persists as pigmented lines after desquamation.