Delicious Dermatology: Baked-Up Eponyms
Year: 2025
Type: article
Abstract: Introduction Dermatology is a field where the visual identification of skin disorders is paramount. The ability to accurately describe and remember the appearance of various dermatological conditions is crucial for diagnosis and treatment. In Western culture, bread and other flour-based foods are staple dietary components. One effective mnemonic technique is to liken the appearance of these conditions to everyday items, particularly baked goods. This approach not only aids in memorization but also provides a relatable framework for understanding the visual characteristics of different skin diseases. This article presents a compilation of dermatological disorders described through the lens of baked items. We have attempted to provide actual images of these food items to understand the eponyms better. A. Clinical: Blueberry muffin rash:The term “blueberry muffin baby,” first coined in 1980 in relation to rubella infection, describes infants with purpuric rashes appearing as non-blanching papules or blue-red macules on the head, neck, and trunk. Pathogenesis involves prolonged dermal erythropoiesis.[1] The causes of blueberry muffin rash include: Infections: cytomegalovirus, rubella, herpes virus, syphilis, parvovirus, coxsackie virus, and toxoplasma Hematological diseases: hemolytic disease of the newborn, hereditary spherocytosis Medications: pyrimethamine and sulfadiazine Malignancies: metastatic neuroblastoma and congenital leukemia Vascular: hemangiomas of infancy, multifocal lymphangioendotheliomatosis, multiple glomangiomas, blue rubber bleb nevus syndrome Others: Langerhans cell histiocytosis, neonatal lupus erythematosus Brownie nose:Brownish pigmentation of the tip of the nose (“chik sign” or the “brownie nose appearance”) is a characteristic presentation of Chikungunya [Figure 1]. It occurs due to intraepidermal melanin retention triggered by the virus and exposure to ultraviolet radiation.[2]Doughnut sign:Scleromyxedema, also known as generalized papular and sclerodermoid lichen myxedematous, is a cutaneous mucinosis characterized by a triad of expanded fibroblast proliferation, mucin deposition, and fibrosis. Clinically, it presents as indurated plaques with a central depression and elevated rim, resembling a doughnut, particularly on the proximal interphalangeal joints [Figure 2].[3]Doughnut lesions:Group A streptococcus pharyngitis can present with erythematous papules with a pale center on the soft and hard palate, known as doughnut lesions. These lesions are crucial indicators for diagnosing this type of pharyngitis in children.[4,5]Doughnut wart:Doughnut wart, also known as ring wart or annular wart, is a complication from wart treatment. It appears as a wart with a central clearing and an annular recurrence, often due to improper application of treatment modalities like salicylic acid.[6]Doughnut lifting sign:Subcutaneous entomophthoromycosis is a rare fungal infection in children, typically presenting as a discoid subcutaneous mass that can be easily lifted from deeper tissues, known as the “doughnut-lifting sign.” These lesions are primarily found in the lower half of the body. The doughnut-lifting sign, where insinuating fingers can lift the mass underneath it, is a newly described and useful diagnostic feature for identifying this condition.[7]Hot cross bun skull:Syphilis can cause a characteristic “hot cross bun skull” appearance, also known as a natiform skull. This condition involves frontoparietal bossing, noticeable skull suture lines, and stigmata from healed gummatous osteoperiostitis.[8]Marble cake:Incontinentia pigmenti, an X-linked dominant disorder caused by a mutation in the IKBKG gene, presents with hyperpigmented plaques that follow Blaschko’s lines, resembling the pattern of marble cake swirls of brown pigment along the lines of Blaschko. This distinctive appearance is typical in the hyperpigmented stage of the disease.[9]Pink doughnut sign:In individuals with nodular and/or sclerosing basal cell carcinoma, the pink doughnut sign denotes a firm, pinkish scar on the perilesional rim with pearly nodules and telangiectasias, often seen in “atypical” ulcers.[10]Toasted skin syndrome:Toasted skin syndrome, or erythema ab igne, is a reticular, hyperpigmented rash caused by prolonged exposure to moderate heat. The heat causes basal cell and elastic fiber degeneration, resulting in dark, lacy discoloration.[11] Figure 1: Brownie nose appearance in a 24-year-old man with ChikungunyaFigure 2: Doughnut sign on the interphalangeal joint of a 55-year-old woman with scleromyxedemaB. Histopathology: Cookie cutter sign:Morphea, or localized scleroderma, is characterized by sclerosis, fibrosis, and atrophy of the skin and subcutaneous tissue. On biopsy, the dense collagen bundles and lymphohistiocytic infiltrates produce straight, parallel lateral edges that resemble a cut made by a cookie cutter [Figure 3].[12]Hamburger sign:Trichotillomania, a condition characterized by compulsive hair pulling, can show a “hamburger” appearance on biopsy. Histopathology shows vertically oriented hair splits containing proteinaceous material and erythrocytes lodged within the defect, resembling a hamburger within a bun.[13]Layered cake:Necrobiosis lipoidica, a rare chronic granulomatous disorder often associated with diabetes mellitus, shows a “layered cake” appearance in histopathological sections. The most common site of this condition is the lower limb. Biopsy reveals multiple horizontal layers of granulomas composed of histiocytes and multinucleated giant cells interspersed with inflammatory infiltrates, predominantly lymphocytes, plasma cells, and eosinophils.[14]Sandwich sign:Dermatophytosis, a common fungal infection, can be diagnosed through various methods, including biopsy. In biopsy samples, the hyphae of dermatophytosis are found squeezed between the cornified layers of the skin. The upper zone consists of normal stratum corneum, while the lower zone contains orthokeratosis and parakeratosis [Figure 4]. This “sandwich” appearance helps confirm the diagnosis, particularly with periodic acid-Schiff staining.[15]Pizza sign:Trichoblastoma, a benign follicular tumor, histologically displays a “pizza” appearance. It consists of a peripheral zone with dark, palisading basophilic cells and a central zone with pale, eosinophilic squamoid cells.[16] Figure 3: H and E-stained section showing a cookie cutter sign—dense collagen bundles with straight, parallel lateral edges characteristic of morphea (H and E, 40×)Figure 4: H and E-stained section showing a sandwich sign—hyphae in the corneal layer fissure (H and E, 40×)C. Dermatosurgery: Croissant flap:The croissant flap technique is used in reconstructive surgery to address cheek defects after skin cancer excision. An axial pattern flap of neck skin below the mandible with a posterior random extension is used to reconstruct the cheek and preauricular areas, with the flap’s shape resembling a croissant [Figure 5].[17]Swiss roll technique:Persistent paronychia, often a type of hand dermatitis rather than a fungal infection, can be effectively treated with the Swiss roll surgical technique. This method involves making an incision on either side of the nail fold, allowing for drainage and promoting quick healing without leaving a skin defect [Figure 6].[18] Figure 5: Diagrammatic illustration of the croissant flap technique used for reconstructing cheek defects following skin cancer excisionFigure 6: Diagrammatic illustration of the Swiss roll technique for paronychiaD. Trichoscopy: Eastern pancake sign:Pseudocysts of the scalp, also known as alopecia and aseptic nodules of the scalp, present with skin-colored, dome-shaped nodules surrounded by normal skin. Trichoscopy reveals fine vellus hair, yellow and black specks, and broken hair shafts, resembling an Eastern pancake.[19] In conclusion, comparing dermatological disorders to baked items provides a creative and memorable way to understand and identify these conditions. This comparative approach not only aids medical professionals in diagnosis but also helps educate patients about their conditions in a relatable manner. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) The preparation of this manuscript was carried out entirely by the author without the use of artificial intelligence technologies.
Authors: Tanigassalame Pavithren, Mira Tharani Srinivasan, Logamoorthy Ramamoorthy, Kaliaperumal Karthikeyan
Institution: Sri Manakula Vinayagar Medical College and Hospital
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414084062