Papules

This completes one complete cycle of the genetic algorithm. The new papulation then becomes the current population ready for a new cycle. The algorithm repeatedly applies this sequence for a predetermined number of iterations and/or until it com erges. 

Most patients have a mixture of non-in-flamed and inflamed lesions. Inflamed lesions can be superficial or deep, and arise from non-inflamed lesions. The superficial lesions are usually papules and pustules (5 mm or less in diameter), and the deep lesions are large pustules and nodules. Papules are small, raised, red spots, while pustules are predominantly yellow (Figs. 11.3,11.4). Pustules frequently start as solid lesions, like papules, which soon liquefy. Usually, the roof of the pustule bursts, allowing the pus to escape. The pustule represents a par-... 

Rosacea is a chronic disorder affecting the central parts of the face, characterized by flushing, persistent erythema and teleangectasia. Inflammatory papules and pustules can develop within the areas of erythema. Rosacea typically occurs in adults with fair skin and light eye and hair color. In contrast to acne, rosacea is not typically follicular in nature and comedones and seborrhea are usually absent. Pyoderma fa-dale is deemed to be an explosive form of rosacea, often occurring in young women with a phenotype typical of rosacea patients, often in the context of stress (Fig. 11.16). 

Perioral dermatitis is characterized by erythema, scaling and small papules and pustules symmetrically distributed around the mouth, sometimes extending to the nasolabial folds and the cheeks. This condition typically occurs in females 20-40 years of age. Topical corticosteroids can exacerbate the disease and should be avoided. 

Actinic keratoses are the most common epithelial precancerous lesions which occur primarily on sun-exposed skin of middle-aged and elderly people as multiple erythematous macules or papules with a dry adherent scale (Figs. 12.1, 12.2 and 12.3). 

Fig. 12.1. Erythematous maculo-papules localized on the dorsum of the nose...

Solitary or multiple violaceous or brown flat-topped papules resembling lesions of lichen planus. 

Warty diskeratoma elevated papule with a keratotic umbilicated center, occasionally found on non-sun-exposed skin... 

Surgery an option only when the AK is a firm horny papule with the possibility of invading the deeper layers... 

Papulo-pustular persistent centro-facial erythema associated with inflammatory papules and pustules (Figs. 17.4,17.5 and 17.6)... 

Salicylic acid penetrates more deeply in the areas of inflammation and produces rapid drying of papules and pustules 1 or 2 days after the peeling. These beneficial effects are determined by the antimicrobic activity of salicylic acid, which also stimulates fibroblasts, inducing an improvement of the vascular component of rosacea. Application of salicylic acid in inflammatory rosacea is equally as safe and effective in residual or initial lesions. 

Dahl MV, Jarratt M, Kaplan D, Tuley MR, Baker MD (2001) Once-daily topical metronidazole cream formulations in the treatment of the papules and pustules of rosacea. J Am Acad Dermatol 45 723-730... 

In humans and rabbits contamination of the skin with TCDD produces chloracne-like lesions (3, 4). This disease is characterized by the appearance of hyperkeratosis, papules, comedones, and cysts. 

Fig. 1. Typical MPCM (urticaria pigmentosa) is the most common form of cutaneous mastocytosis, a In adults, lesions consist of numerous small red-brown macules and slightly elevated disseminated papules, b In less obvious cases, however, lesions arefewor less well recognizable and may be overlooked. 

Maculopapular rash—a rash that contains both macules and papules. A macule is a flat discolored area of the skin, and a papule is a small raised bump. A maculopapular rash is usually a large area that is red and has small, confluent bumps. 

Cuttate psoriasis presents as a sudden eruption of small, disseminated erythematosquamous papules and plaques, and is often preceded by a streptococcal infection 2 to 3 weeks prior. 

FIGURE 62-1. A spectrum of acne lesions is seen on the face of a 1 7-year-old male comedones, papules, pustules, and erythematous macules and scars at the site of resolving lesions. The patient was successfully treated with a 4-month course of isotretinoin there was no recurrence over the next 5 years. 

Propionibacterium acnes (P. acnes), an anaerobic organism, is also found in the normal flora of the skin. This bacteria proliferates in the mixture of sebum and keratinocytes and can result in an inflammatory response producing a closed comedo or whitehead. More severe acne lesions such as pustules, papules, and nodules can also form with inflammatory acne and result in significant scarring if treated inadequately (Fig. 62-2). 

Acne Severity Predominant Lesions Closed Comedones Open Comedones Papules Pustules Nodules Scarring... 

Moderate Inflammatory papules and pustules with some noninflammatory lesions Few to numerous Few to numerous Numerous Numerous Few Possible... 

Papules solid, elevated lesions less than 0.5 cm in diameter Pustules vesicles filled with purulent fluid less than 0.5 cm in diameter... 

FIGURE 62-5. Allergic contact dermatitis of the hand chromates. Confluent papules, vesicles, erosions, and crusts on the dorsum of the left hand in a construction worker who was allergic to chromates. (From Wolff K, Johnson RA. Eczema/ dermatitis. Fitzpatrick s Color Atlas Synopsis of Clinical Dermatology. 5th ed. New York McGraw-Hill, 2005 27.)... 

A 45-year-old female presents to a pharmacy with complaints of itching and wants a recommendation to treat it. Upon visual examination you see that she has erythematous papules on both legs. After further questioning, you learn that she has recently spent a great deal of time outside at a family picnic. She states that the picnic was in a wooded area near her home and that she and several others went on a short hike that day. She states that she was wearing shorts and "probably" came into contact with the grasses and weeds that lined the hiking trail. The rash appeared the same day as the picnic and she says that it seems to have spread since it first developed. From the information she has presented, you conclude that she has been exposed to poison ivy. 

Formation of papules, bullae, or ulceration Excessive oozing Presence of genital discharge Concurrent fever... 

Folliculitis presents as small, pruritic, erythematous papules. Location of the lesions and a good patient history are often all that are required in the diagnosis of folliculitis. While the papules may be cultured and Gram stains or potassium hydroxide stains done to help determine causative agent, it is not generally required because folliculitis often resolves spontaneously within a few days. 

Four to seven days after infection, a tender, erythematous papule usually develops and subsequently progresses to the pustular stage.37 The pustules often rupture after 2 to 3 days. 

Tinea corporis Presents with circular, scaly patch with enlarged border Lesions may have red papules or plaque in center that clears, leaving hypopigmentation or hyperpigmentation Itching may be present Commonly referred to as ringworm of the body... 

Invasive SCC firm or friable red papule or nodule covered with scale or crust... 

Precursor of invasive SCC (actinic keratosis) scaly erythematous macule or papule on areas of chronic sun exposure... 

Tuberoeruptive xanthomas Small yellow-red raised papules usually presenting on the elbows, knees, back, and buttocks. 

Acne Inflammatory disease of the sebaceous glands characterized by papules, comedones, pustules, or a combination thereof... 

Keratosis Lichen planus Any horny growth Inflammatory skin disease with wide, flat papules occurring in circumscribed patches... 

Miliaria An acute inflammation of the sweat glands, characterized by patches of small red papules and vesicles, brought on by excessive sweating... 

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