Clothing-related Eponyms and Signs

Abstract

The world of dermatology is pieced together by clinical conditions unique in their colors, morphology, and configuration. Dermatological signs and terms are influenced by etymology, language, and history. Eponyms also make dermatology a fascinating but linguistically challenging subject. This article reviews dermatological conditions described in relation to fashion, and what we wear in everyday life from top to toe, demonstrating that dermatology can be inspired even in the most common things.

What was known?

Dermatological eponyms have been used to aid in learning.

Introduction

Dermatological terms may be more than a mouthful; they can be difficult to remember and highly esoteric. An electronic and manual search of standard dermatology texts was done to compile these terms. This article is meant to serve as an interesting aid to dermatology, upon which residents can build their knowledge.

Head Gear- and Hair-Related Terms

• Cradle cap: It is a term used to describe the scalp in infantile seborrheic dermatitis characterized by yellowish scales

• Turban tumors: An informal term for rare skin appendage tumors known as cylindromas. These may exist as part of hereditary conditions such as Brooke–Spiegler syndrome and familial cylindromatosis[1]

• Woolly hair: This may occur as an isolated condition or as part of Naxos disease[1] and Noonan's syndrome

• Spun glass hair: Clinically it appears to be dry, light-colored hair that “cannot be made flat”[2] and may be found in association with some ectodermal dysplasias

• Beaded/necklace hair: It is also known as monilethrix where the hair shaft has narrowed segments between “nodes” or “beads” of normal thickness

• Ringed hair: This term describes hair in which there are scattered groups of air-filled “bubbles” along the hair shaft, appearing to be bright bands in reflected light

• Hidden hair sign: This was described as a trichoscopic structure of psoriasis and seborrheic dermatitis. Perifollicular, epidermal proliferation, and infiltration together with an altered hair shaft structure give rise to an appearance of the proximal hair shaft being “hidden” under thickened epidermis[3]

• Hair collar sign: The hair collar sign [Figure 1] is suggestive of cranial dysraphism and is seen encephaloceles, heterotopic brain tissue, and meningoceles. Rarely, it occurs in arteriovenous fistulas, arterial ectasias, and sinus pericranii[4]

• Hair pin vessels: This is a dermatoscopic sign recognized in seborrheic keratoses

• Crown vessels: This is a dermatoscopic sign recognized in sebaceous hyperplasia.

Figure 1.

The hair collar sign

Garment-Related Terms

• Lacy striae: This is most famously described as the appearance of Wickham striae in lichen planus [Figure 2]

• Velvety plaques: The plaques of acanthosis nigricans, erythroplasia of queyrat are described as velvety

• Moroccan leather: Pseudoxanthoma elasticum is described as papules or plaques resembling Moroccan leather [Figure 3]

• Silk road disease: It is also known more commonly as Behcet's disease which is a small vessel vasculitis causing recurrent oral aphthous ulcers, genital ulcers, and uveitis

• Harlequin armor: This is a term to describe infants with Harlequin-type ichthyosis where the skin is forms large, diamond-shaped plates separated by fissures [Figure 4]

• Bathing suit appearance: This is a term used to describe congenital melanocytic nevi [Figure 5], along with “cape,” “coat sleeve” and “stocking’ nevi. Bathing suit is a description also used in generalized ichthyosis

• Bare underbelly sign: In mycosis fungoides, the bare underbelly sign describes the tendency for the superficial perivascular lymphoid infiltrate to predominate above the vessel, with only scant lymphocytes below the vessel[5]

• Shoulder-pad sign: The “shoulder pad”[6] sign [Figure 6] results from amyloid deposition in periarticular soft-tissue and is pathognomonic for light chain amyloidosis which have an increased predilection for soft-tissue deposition

• Shawl sign: This sign is seen in dermatomyositis [Figure 7][1]

• Mask of pregnancy: This sign is seen in melasma in pregnancy

• Blue grey veil: This sign is an important dermatoscopic finding in invasive melanomas.[7] Histopathologically it corresponds to orthokeratosis and hypergranulosis

• Buttonhole sign: This occurs in Type 1 neurofibromatosis, anetoderma, and dermatofibromas[1]

• Gaiter region: This is a common site for ulcers resulting from chronic venous insufficiency

• Holster sign: This is seen in dermatomyositis. Holster dermatitis, or “Lucky Luke dermatitis” is also a unique diaper dermatitis considered to be an allergic contact dermatitis.

Figure 2.

The lacy appearance of Wickham striae

Figure 3.

The Morrocan leather appearance of pseudoxanthoma elasticum

Figure 4.

The Harlequin armor

Figure 5.

Congenial melanocytic nevi

Figure 6.

The Shoulder pad sign of amyloidosis

Figure 7.

The Shawl sign of dermatomyositis

Accessories-Related Terms

• Mitten hands/feet: This was described in Apert syndrome and severe generalized recessive dystrophic epidermolysis bullosa [Figure 8]

• Casal's necklace: This refers to the photosensitive dermatitis on the neck of patients with pellagra[1]

• Necklace of venus: Hypomelanosis may be seen in secondary syphilis and may present as small hypopigmented macules scattered within a larger area of hyperpigmentation on the neck giving rise to this sign[8]

• Epstein pearls: These are whitish cysts on the palate or gums of infants [Figure 9]

• String of pearls sign: This sign describes many conditions including linear IgA dermatosis in children, nodular scabies,[9] lipoid proteinosis (blepharosis moniliformis) and the dermatoscopic appearance of clear cell acanthomas. This sign is also present in histopathology of mycosis fungoides where there are lymphocytes are aligned within the basal layer[10]

• Pearly appearance: These are how the lesions are described in pearly penile papules, molluscum contagiosum, basal cell carcinoma, and sclerotic fibroma of the skin

• Beaded sign: This is seen under trichoscopy in monilethrix, moniliform blepharosis in lipoid proteinosis, and granuloma annulare

• Coral beads sign: This has been used to describe the periungual or nailfold papules in multicentric reticulohistiocytosis [Figure 10][1]

• Signet ring sign: This sign is described in scalp psoriasis and seborrheic dermatitis, along with cutaneous skin metastases of adenocarcinomas

• Brass knuckles sign: Histology examination of lobomycosis shows chains of thick-walled, yeast-like cells referred to as “brass knuckles”

• Safety pin sign: Donovan bodies appear like safety pins clustered in macrophages when stained with Giemsa or Wright stains and are diagnosis of Klebsiella granulomatosis causing donovanosis

• Chaining pattern: In exudates of chancroids, Hemophilus ducreyi is typically seen in a railroad or chaining arrangement

• Perivascular cuffing: Coat sleeving or perivascular cuffing of lymphocytes is seen in erythema annulare centrifugum

• Cuff sign: Lipedema is a painful hereditary disorder where women accumulate excess adipose tissue on their lower extremities causing enlarged calves above the malleoli but sparing the feet [Figure 11]. This sharp demarcation at the ankle is referred to as the cuff sign. Thirty percent of patients may have upper limb involvement resulting in cuff sign at the wrist as well[11]

• Rosette sign: This is a dermatoscopic sign seen in interstitial granulomatous dermatitis, and includes the Homer Wright rosettes of neuroblastomas and the Flexner–Wintersteiner rosettes of retinoblastomas

• Papular-purpuric gloves and socks syndrome: This syndrome is an exanthema characterized by petechiae and painful edema of the hands and feet thought to be caused by human parvovirus B19[12]

• Amniotic band syndrome: This is a congenital disorder where fetal limbs or digits may be entrapped in fibrous amniotic bands while in utero

• Keratodermic sandals: In pityriasis rubra pilaris, there is waxy hyperkeratosis of the sole in a sandal distribution [Figure 12].

Figure 8.

Mitten hands in dystrophic epidermolysis bullosa

Figure 9.

Pearly Epstein pearls

Figure 10.

The Coral beads sign of multicentric reticulohistiocytosis

Figure 11.

The Cuff sign of lipedema

Figure 12.

The Keratodermic sandals of pityriasis rubra pilaris

Conclusion

The deluge of examinations for residents can make memorizing a chore. Memory aids that are inspired by daily encountered items can relieve this stressful burden.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

What is new?

This article provides a review of dermatological descriptions and terms inspired by fashion and the garments, providing a unique perspective of eponyms beyond animals and food. This comprehensible article is meant to aid residents in learning dermatology by revealing the dermatology in daily life.