MICA

Skin, mucosa & appendages

Observe the images and explore this collection’s sheets.

← Clinical semiology

13 sheets

Gottron papules

Violaceous papules over dorsal finger joints, suggestive of dermatomyositis.

Colour: Erythematous-violaceous
Elevation: Papules or plaques
Site: Dorsal finger joints
Direction: Assess for dermatomyositis

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Figure 1: clinical appearance in the published congenital lipodystrophy and confirmed acromegaly case. This association is unusual.

Endocrinology & metabolism

Generalised lipodystrophy and acromegaloid appearance

Abnormal fat distribution with prominent musculature.

Observation: Prominent musculature accompanies unusual fat distribution.
Limitation: A photograph cannot quantify fat mass.

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Skin, mucosa & appendages

Nail psoriasis

Nail plate and bed abnormalities: pitting, separation, salmon patches or hyperkeratosis.

Matrix: Pitting
Nail bed: Salmon patch
Plate: Onycholysis
Context: Skin and joints

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Bilateral red areas on the legs, several circled in the original photograph. Tenderness and nodule depth require clinical examination.

Skin, mucosa & appendages

Erythema nodosum: nodules on the legs

Recognise a pretibial distribution and investigate a systemic cause.

Appearance: Inflammatory nodules
Site: Anterior shins
Examination: Palpation is essential
Next step: Investigate the underlying context

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Figure 1 from Charlton et al.: enlarged fingertips and curved nails. Original context retained.

Respiratory

Digital clubbing

Enlarged distal digits with increased nail curvature.

Observation: The photograph shows enlarged fingertips and curved nails.
Limitation: The photograph cannot establish pulmonary disease.

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Skin, mucosa & appendages

Koilonychia

Spoon-shaped nail plate concavity whose cause cannot be inferred from shape alone.

Shape: Concave, spoon-shaped
Plate: Thin or brittle
Association: Possible iron deficiency
Specificity: No single cause

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Numerous separate pinpoint red-purple spots on a lower leg, with a few accompanying crusts.

Skin, mucosa & appendages

Petechiae

Pinpoint haemorrhagic macules; distribution and fever determine urgency.

Size: Pinpoint, usually ≤2 mm
Elevation: Flat macules
Pressure: Do not blanch
Context: Associated fever and bleeding

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Skin, mucosa & appendages

Urticaria

Transient itchy oedematous wheals; the duration of each lesion is decisive.

Lesion: Oedematous wheal
Symptom: Common itching
Individual duration: Usually <24 h
Association: Possible angioedema

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Skin, mucosa & appendages

Ecchymoses

Areas of bleeding beneath intact skin, described with their extent and context.

Lesion: Larger cutaneous haemorrhage
Surface: Usually intact skin
Context: Trauma or spontaneous bleeding
Predisposition: Skin fragility, medicines

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Skin, mucosa & appendages

Oral aphthae

Painful round, often recurrent ulcers that must be distinguished from other oral ulcerations.

Border: Round or oval
Base: White-yellow fibrinous base
Halo: Erythematous
Symptom: Pain

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Skin, mucosa & appendages

Purpura

Haemorrhagic spots that persist under pressure; elevation and systemic findings guide assessment.

Mechanism: Blood extravasation
Blanching test: No blanching
Elevation: Flat or palpable
Direction: Platelets, coagulation, vessels

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Skin, mucosa & appendages

Oral candidiasis

White plaques or erythematous mucosa; appearance and risk factors guide assessment without identifying species.

Form: Pseudomembranous or erythematous
Plaques: Often removable
Beneath plaque: Red mucosa
Predisposition: Dry mouth, corticosteroids, immunosuppression

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An irregular reddish-purple network surrounds paler areas. The photograph does not show persistence or the response to warming.

Cardiovascular / vascular medicine

Livedo: a violaceous skin network

Describe the network and separate the skin sign from its cause.

Appearance: Violaceous network
Assess: Response to warming
Look for: Ulceration, pain, ischaemia
Limitation: No cause established by a photograph alone

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