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Pathology > 4th Exam: Skin Diseases > Flashcards

4th Exam: Skin Diseases Flashcards

1
Q

Macule:

A

Flat, often circumscribed color difference, often red, brown, ex: measles

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2
Q

Papule:

A

Elevated, dome shaped, diameter < .5cm, ex: Lichen planus

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3
Q

Plaque:

A

Elevated lesions, flat top, larger than papules, diameter > .5cm, ex: eczema

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4
Q

Vesicle:

A

Blisters, water-filled, diameter <0.5 cm, ex: Herpes simplex

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5
Q

Bulla:

A

Larger blister than vesicles, diameter > 0.5cm, ex: bullous pemphigoid

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6
Q

Pustule:

A

Raised, yellow or white, polys in vesicles, ex: Herpes simplex

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7
Q

Crusting:

A

Vesicles or pustules break, contents dry and harden, ex: Herpes simplex

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8
Q

SCale:

A

White lesions, thickened Stratum Corneum, hyperkeratosis, ex: psoriasis, ichthyosis

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9
Q

Hyperkeratosis:

A

Thickened Stratus Corneus of keratin layer (causes SCales), ex: psoriasis, ichthyosis, actinic keratosis

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10
Q

Parakeratosis:

A

Nucleated cells in stratum corneum (normally no nuclei, keratin, dead cells), rapid proliferation of epi, ex: psoriasis

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11
Q

Papillomatosis:

A

Epidermis forms papillae, hyperplastic, ex: wart

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12
Q

Acanthosis:

A

Thickened epidermis, uniform or irregular, ex: lichen planus

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13
Q

Spongiosis:

A

Intercellular edema, vacuoles bw epi cells, cause: acute injury, ex: eczema

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14
Q

Acantholysis

A

Loss of cohesion bw keratinocytes, spaces bw cells, ex: Pemphigus

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15
Q

Eczema:

A

Nonspecific clinical term, prototype for many rashes, acute/ subacute/ chronic, red, vesicular, oozing, crusting, later: raised scaling plaques, pruritis (itchy)

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16
Q

Causes of Eczematous Rashes:

A

Contact dermatitis, atopic dermatitis/ allergy, seborrheic dermatitis, red, vesicular rash, spongiosis gives way to vesicles

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17
Q

Contact dermatitis causes:

A

Detergent, nickel, poison ivy

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18
Q

Rash not where the allergy is:

A

Atopic dermatitis/ allergy

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19
Q

Atopic dermatitis/ allergy:

A

Often kids, cause unknown, genetic in some cases, stimulus: food or clothing?, Pt often has asthma, allergic rhinitis, often chronic w acute episodes

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20
Q

Seborrheic dermatitis:

A

Stasis dermatitis (sluggish leg veins), drug reaction, type of eczematous rash, common, 5-10% of healthy, 1/3rd of AIDS pts, chronic, waxing and waning, hairy regions, esp face, eyebrows, scalp, around sebaceous glands, bilateral, symmetrical, itching variable, lipophilic yeast, Pityrosporum ovale, mildest form: dandruff; fine white scale, may have erythema, patches/plaques

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21
Q

Tx for Seborrheic dermatitis:

A

Anti-fungal, shampoo 2-3 X wk, zinc pyrithione (Head and Shoulders), selenium sulfide, ketoconazole

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22
Q

Inflammatory Scaling Papule & Plaques:

A

Dermatophytes, psoriasis, pityriasis rosea, 2’ syphilis, lichen planus

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23
Q

Pityriasis rosea:

A

“bran-like scale”, young adults, seasonal, usually winter, often URI before, cellular Type IV immune response, antigen unknown, acute, self-limited, mostly trunk, neck

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24
Q

Pityriasis rosea rash:

A

Herald patch (initial rapidly enlarging oval-shaped red papulosquamous lesion, usually trunk, heralding widespread eruption of pityriasis rosea in 7-14d), first, often largest, many lesions after several days, round to oval, tan/salmon color, look like bran/ corn flakes, itching is common, delicate scaling, elevated patches

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25
Q

Ddx of Pityriasis rosea:

A

Psoriasis, lichen planus, tinea corporis (ringworm), 2’ syphilis

26
Q

Tx for Pityriasis rosea:

A

Usually spontaneous remission in 2-4wks, recurrence rare

27
Q

Lichen planus:

A

Cause unknown, probably immune-mediated, more common in women, Ig deposits at dermal-epidermal jx, some cases assoc w Hep C, involves skin & mucous membranes, oral lesions, 70% pts, esp. wrist and ankle, oral manifestation: red gum tissue, multiple lesions, purple, planar (flat) or papular, polygonal, pruritic (itchy), self-limited, resolves in mos-2yr, multiple papules w Wickham striae (whitish lines visible in papules of lichen planus and other dermatoses, typically the macroscopic appearance of the histologic phenomenon hypergranulosis), white dots = thickened granular layer

28
Q

Histology of Lichen planus:

A

Hyperkeratosis, thickened granular layer (almost diagnostic), irregular acanthosis (saw tooth D-E jx), band-like lymphocytic infiltrate (degeneration of basal layer)

29
Q

Vesicles of Lichen planus are often:

A

exanthems

30
Q

exanthems:

A

widespread rash usually occurring in children

31
Q

Possible causes of exanthems:

A

Varicella, herpes simplex, herpes zoster, enterovirus

32
Q

bullous/vesicular skin diseases (large, fluid filled)

hard or flaccid:

A

Pemphigus vulgaris, bullous pemphigoid, dermatitis herpetiformis (DH), porphyria, contact dermatitis, drug reaction/eruption, impetigo, scalded skin syndrome

33
Q

Pemphigus vulgaris:

A

Middle aged+, generalized bullae, anywhere on skin surface, oral lesions common, bullae flaccid, 1-10 cm, rupture easily → bleeding erosions → skin infection, mortality 8-10%, INTRAepidermal, suprabasilar bullae, only disease to have suprabasilar → DIAGNOSTIC, Begins w acantholysis, intercellular IgG, C3, autoantibodies to desmoglein 3 (adhesion molecule), Ab titer predicts course

34
Q

Tx for Pemphigus vulgaris:

A

Steroids

35
Q

only disease to have suprabasilar, DIAGNOSTIC:

A

Pemphigus vulgaris

36
Q

acantholysis:

A

loss of intercellular connections such as desmosomes resulting in loss of cohesion bw keratinocytes, not seen in bullous pemphigoid

37
Q

Autoantibodies to desmoglein 3:

A

located in desmosomes, Anti-desmoglein 3 Ab → Intercellular fluorescent deposits

38
Q

Bullous pemphigoid:

A

50-70yo, bullae in flexor areas (groin, axilla), ral lesions: 1/3 pts, very pruritic, tense bullae, 1-5 cm, heals wo scar, most subside in mo-1yr, subepidermal bullae, linear IgG, C3 at BM (lamina lucida), autoantibodies to hemidesmosome proteins, BP 180 and BP 230, intracellular and lamina lucida location, Ab binding to Ag seen in skin BM (LL – lamina lucida, LD - lamina densa), immunofluorescent deposits at BM (Only at the DE junction), like lichen planus, DM, SLE

39
Q

Rx for Bullous pemphigoid:

A

steroid, like pemphigus vulgaris

40
Q

Porphyria cutaea tarda:

A

Abnormal porphyrin metabolism (urodecarboxylase missing in cutaneous porphyria), most common porphyria, familial, autosomal dominant, uroporphyrinogen decarboxylase deficiency → build up of porphyrins, Dark brown urine; ↑ uroporphyrin, lesions precipitated by alcohol, sunlight, photosensitive skin lesions, esp hands (dorsum)

41
Q

Photosensitive skin lesions, esp hands (dorsum)

A

Subepi bullae, excess hair, esp forehead, temples, cheeks, neck

42
Q

Recap of pemphigoid:

A

tense bullae, subepidermal, Ig at BM, hemidesmosomes

43
Q

Recap of pemphigus:

A

flaccid ullae, suprabasillar, Ig are intracellular, desmoglein 3

44
Q

Recap of porphyria CT:

A

Tense bulla, subepidermal, Ig at De jx, absent UPDC

45
Q

These both have tense bullae and are subepidermal:

A

pemphigoid, porphyria

46
Q

Generalized erythema:

A

Drug eruption, Viral, Toxic, SLE, DM

47
Q

Viral, generalized erythema may be due to:

A

Rubella, measles, Roseola (HHV6), erythema infectiosum (parvo B19)

48
Q

Toxic, generalized erythema may be due to:

A

Scarlet fever-GAS, fever, pharyngitis (erythrogenic exotoxin, rash on face (circumoral pallor), arms, legs, trunk), scalded skin-Staph toxin, infants, fever, toxic shock syndrome-Staph and GAS

49
Q

Localized lesions w erythema:

A

Cellulitis, erysipelas-GAS, face, well-demarcated, fever, acute, swelling (type of cellulitis), rapid progression, impetigo- Staph/GAS, preschool children, face & neck, erythema nodosum, erythema multiforme, erythema migrans-Lyme disease

50
Q

Erythema nodosum:

A

Assoc w infections/immune mediated disease, type of panniculitis (subcutaneous), acute presentation (fever, malaise), often self-limited, but may be recurrent, rash: often lower legs (multiple, deep, tender nodules)

51
Q

infections/immune mediated disease assoc w erythema nodosum:

A

TB, sarcoidosis, IBD, beta strep infections

52
Q

panniculitis:

A

subcutaneous, below the skin- looks like a skin disease, but isn’t

53
Q

Tx for Erythema nodosum:

A

aimed at underlyling disease

54
Q

Early histo findings of Erythema nodosum:

A

polys, fibrin, deposits of Ig and C

55
Q

Semi-progressed histo findings of Erythema nodosum:

A

granulomatous inflammation, looks like TB

56
Q

Late histo findings of bands of Erythema nodosum:

A

bands of fibrosis

57
Q

Erythema nodosum is marked by chronic inflammation w this cell type:

A

giant cell

58
Q

Erythema mulitforme causes:

A 
o	Drugs 
•	Sulfonamides, penicillins, salicylates 
o	Infection, esp herpes simplex
o	Cancer 
o	Collagen disease 
o	Idiopathic
59
Q

Pathogenesis of Erythema mulitforme:

A
  • Epidermal cells killed by T cells

* Cytotoxic CD8+ lymphocytes located at D-E jx

60
Q

population most affected by Erythema mulitforme:

A

older children, young adults

61
Q

Lesions of Erythema mulitforme:

A

Symmetrical, often extremities, classically look like a target (erythematous rim and center- diagnostic/signature lesion (esp if on extremities) )

62
Q

Histology of Erythema mulitforme:

A

Red, round, circumscribed, target-like, multiple, lymphocytes at D-E jx (migrate into epidermis, attack keratinocytes)

Pathology (23 decks)

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