Descriptive Metaphors

•	these are descriptive terms or phrases that have caught on in the dermatology lexicon and often succinctly capture the description of a finding by forming a quick mental picture

•	try to quiz yourself by covering the second column and seeing if you know what the description in the first column are referring to

antlers

describes the downward proliferation of the epidermis seen in histology of Dowling-Degos disease

bag of worms

plexiform neurofibroma (pathognomonic for NF1)

beanbag cells

large benign histiocytes displaying characteristic phagocytosis of lymphocytes, histiocytes, and platelets in histiocytic cytophagic panniculitis

blueberry muffin baby

extramedullary hematopoiesis

bramble bush

histologic description of the elastic fibers altered by D-penicillamine therapy (secondary EPS)

buckshot scatter

proliferation of atypical melanocytes in all layers of the epidermis (in SSM) (histology)

bubble gum balls

trapped collagen at edges of a DF (histology)

carpet tack sign

keratotic spikes that can be seen to project from the under surface of the scale when lifted from more advanced lesions of DLE

Casal’s necklace

circumferential dermatitis of the neck seen in pellagra (sometimes more like a brooch than a necklace)

caterpillar bodies

porphyria cutanea tarda; eosinophilic bodies in the epidermis of the blister roof that are elongate and sometimes segmented

chunks of coal

in LyP = large atypical cells (in some cases can be seen at low magnification because of their hyperchromatic nucleii)

church spire papillomatosis

acrokeratosis verruciformis

cigarette paper scars

knees and elbows of patients with Ehlers-Danlos

cliff drop border

largely an optical effect of the slate-grey discoloration (seen in atrophoderma of Pasini and Pierini)

cliff-drop sign

erysipelas - indurated, erythematous plaque, with sharply demarcated border

closed safety pin

the numerous encapsulated gram (-) bacilli seen in histiocytes (i.e. Donovan bodies) of granuloma inguinale

“cluster of jewels” appearance

lesions of chronic bullous disease of childhood often appear in clusters in the perineum and peri-oral region

Coast of California

cafe au lait (smooth) border in neurofibromatosis

Coast of Maine

cafe au lait (irregular) border in McCune Albright syndrome

coat sleeve

perivascular infiltrate of lymphocytes and histiocytes in EAC

coral-bead like lesions

occur around nail folds; pathognomonic for multicentric reticulohistiocytosis (vs. “string of pearls”)

deck chair sign

Papuloerythroderma of Ofuji (MF variant)

dirty feet

hyperpigmented rete ridges in UP (histology)

festooning

upward protrusion of dermal papillae into the blister cavity in PCT (histology)

flame figures

collagen fibers encrusted with intensely eosinophilic granular material representing major basic protein (a common finding in eosinophilic cellulitis, but may be found in any condition associated with an intense eosinophil infiltrate)

footprints in the snow

refers to dermal atrophy causing lesional depression in pseudopalade of Brocq

geographic skull

X-ray finding in Hand-Schuller-Christian disease

ghost cells

pancreatic panniculitis and pilomatricomas? (histology)

hockey sticks

the elongated rete ridges of a solar lentigo (histology)

honeycomb lung

chest X-ray finding in diffuse scleroderma (fibrosing alveolitis proceeding to interstitial fibrosis)

maltese cross

the birefringent lipid globules seen with polarizing microscopy in the urine of patients with Fabry’s disease

mickey mouse appearance

Cockayne's syndrome (large ears, large, cold hands and feet)

pink donuts in the dermis

leukocytoclastic vasculitis (histology)

nutmeg grater

the feel of the follicular papules on the dorsum of the fingers (and elsewhere) in PRP

rain drops on a dusty road

a stigmata of chronic arsenicism; hyperpigmented patches with small areas of depigmentation resembling “raindrops”

relief of a mountain range

papules/nodules in Sweet’s syndrome coalesce to form irregular, sharply bordered plaques

salt and pepper retinal pigment

Cockayne's syndrome

sand paper like nails

trachyonychia (i.e. twenty nail dystrophy)

spotted leopard

children with pityriasis lichenoides chronica (secondary hypopigmentation within resolving lesions)

stacks of pennies

describing the parallel lamellae seen in the Odland bodies of keratinocytes on electron microscopy

string of pearls

on eyelid in lipoid proteinosis (vs. “coral beading”); also used to describe arrangement of blisters in linear IgA disease and CBDC chronic bullous disease of childhood

string sign

the formation of a string of mucous between the examining finger and the lip in cheilitis glandularis

swarm of bees

heavy lymphocytic infiltrate surrounding anagen hair bulb in early stages of alopecia areata (histology)

tear drop sign

early pemphigoid gestationis; i.e. intense edema of the papillary dermis (histology)

tigertail hair

hair of trichothiodystrophy (when polarized)

tram-track calcification

in brain cortex beneath leptomeningeal malformation in Sturge-Weber syndrome

windblown look

of neoplastic epithelium in Bowen’s disease (the normal maturation pattern of keratinocytic epithelium is disturbed)