Misc Skin Notes Sebaceous cysts Benign lesion containing a sebum due to a blocked sebaceous gland. Keratoacanthoma Well differentiated squamoproliferative keratotic lesions Low risk histology variant of SCC Rapidly growing, firm and dome shaped nodule or papule with central keratotic plug -> crateriform tumor. May grow by 1-2cm over the course of weeks to months. Usually located on sun exposed areas. Can be solidary (common) or multiple. Typically, 1 to 2 cm in size and can grow up to 20 cm. Skin warts Are small, fleshy, grainy bumps on the fingers or hands. Also occur on knees, back of fingers or toes and around the nails. They have rough texture and may feel like tiny pebbles. Black dots within the warts may be seen. Indicate clotted blood vessels. Have cauliflower like papules with a rough, papillomatous (wart-like_ and hyperkeratotic (thickened surface). Can range from 1 mm to 1 cm or more. Skin abscesses Localised erythematous, tender and swollen. Affected area may feel warm to touch. May discharge purulent material -> pus. Dupuytren’s contracture Fibroproliferative disorder affecting the palmar fascia mainly affecting the 4 th and 5 th fingers especially in males. Causes: Genetic and family history Diabetes Alcohol abuse Liver cirrhosis Recurrent trauma Autoimmunity Clinical features 4 th and 5 th fingers are most commonly involved . Palmar nodule Palmar cords. Flexion contracture of the affected fingers. Skin puckering near the proximal flexor crease -> earliest sign. Pyronie disease Diagnosis Usually clinical Positive tablet top test: Inability to flatten the palm against the surface of a table to contractures in the MCP joints. Ultrasound of the palm demonstrating: Nodules and cords of the palmar fascia. Fasting sugar levels. Treatment and management Trigger Finger Pathophysiology Fibrocartilaginous metaplasia of the tendon sheath of the A1 annular pulley -> loss of smooth gliding of the flexor tendons under the annular pulley -> finger catching or becoming locked in a flexed position. Clinical features Most often affects the ring finger or the thumb. Pain, tenderness and/or palpable nodule at the palmar base of the affected finger. Palpable crepitus with movement. Catching or locking in a flexed position with painful popping on flexion or extension.