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7th > Chapter 143 - Pigmented Purpuric Dermatoses > Flashcards

Chapter 143 - Pigmented Purpuric Dermatoses Flashcards

1
Q

PPD is characterized by (3)

A

Petechiae
Pigmentation
Telangiectasia

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2
Q

Common histopathologic features of PPDs

A

Superficial lymphocytic infiltrate
Erythrocyte extravasation
Hemosiderin deposition

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3
Q

Ppds occur more frequently in males, except for ____, which occur more commonly in females

A

Majocchi purpura (purpura annularis telangiectodes)

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4
Q

Most common of PPDs to occur in children

A

Schamberg disease

Progressive Pigmentary Dermatosis

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5
Q

It is an eruption of irregularly shaped reddish brown patches with pin head sized reddish puncta resembling cayenne pepper

A

Schamberg disease

Progressive Pigmentary Dermatosis

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6
Q

It presents with annular patches of follicular and punctate reddish brown macules with telangiectasias and purpura on lower extremities

A

Majocchi purpura

Purpura annularis Telangiectodes

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7
Q

It is characterized by presence of reddish brown round or polygonal lichenoid papules and plaques, with a background of purprura or telangiectasia

A

Pigmented purpuric lichenoid dermatosis of Gougerot and Blum

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8
Q

It can be mistaken for Kaposi sarcoma

A

Pigmented purpuric lichenoid dermatosis of Gougerot and Blum

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9
Q

Asymptomatic, seasonal eruption occurring in spring and summer with mild scaling overlying pinpoint erythematous macules and patches with associated pruritus

A

Eczematid-like Purpura of Doucas and Kapetanakis

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10
Q

Aside from common histopathologic features like superficial lymphocytic infiltrate, erythrocyte extravasation, and hemosiderin deposition, spngiosis can also be observed in

A

Eczematid-like purpura of Doucas and Kapetanakis

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11
Q

All PPDs have abrupt presentation, except for

A

Schamberg disease

PPD Lichenoid of Gougerot and Blum

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12
Q

Presents with more localized and persistent lesions with circumscribed macules or papules that are a distinctive gold, rust, or orange color common in young adult males

A

Lichen aureus/Lichen purpuricus

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13
Q

Often localized to one lower extremity with segmental distribution

A

Lichen aureus

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14
Q

Presents with disseminated orange-brown to purpuric lesions associated with severe pruritus

A

Itching purpura (disseminated pruriginous angiodermatitis)

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15
Q

PPDs with linear and pseudodermatomal pattern

A

Unilateral linear capillaritis

Segmental pigmented purpura

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16
Q

Subtypes of unilateral linear capillaritis

A

Quadrantic capillaropathy

Segmenta pigmented purpura

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17
Q

Spontaneous resolution occurs more commonly than in other subtypes of PPD

A

Unilateral Linear capillaritis

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18
Q

Common subtype in Asian descent

A

Granulomatous variant of PPDs

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19
Q

Granulomatous variant of PPD has been relatively associated with

A

Hyperlipidemia

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20
Q

Most likely to predict progression to MF

A

T cell monoclonality

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21
Q

The most important feature to distinguish early MF from others is with the presence of

A

Lymphocytes with extremely convoluted, medium to large nuclei, single or clustered in epidermis and in small sheets in the dermis

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22
Q

Important role in the pathogenesis of PPD

A

Cellular reaction especially with Langerhans cells

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23
Q

In early Schamberg disease, the ff cell types (2) predominates

A

CD4+ cells

CD1a dendritic cells

24
Q

3 theories on pathogenesis of PPDs

A
  1. Disturbance or weakness of cutaneous blood vessels
  2. Humoral immune response (C3,C1q,IgM, or IgA)
  3. Cellular immune response
    (Lymphocytes, macrophages, Langerhans cells)
25
Q

Majority of PPD cases are ___ (etiology)

A

Idiopathic

26
Q

Diagnosis is gemrally made ___ and supported by ____

A

Clinically; histopath exam

27
Q

Measurement of capillary fragility by application of sphygmomanometer

A

Hess test

28
Q

Increased capillary fragility is consistently seen in PPD

True or False

A

False

29
Q

Hemosiderin can be highlighted by ____ stain

A

Prussian blue

30
Q

In older lesions, extravasated RBCs may no longer be present

True or False

A

True

31
Q

PPD is a true capillaritis

True or False

A

False

Due to lack of fibrin in luminal walls and absence of thrombi

32
Q

Subtype of PPD with granulomatous infiltrate in the papillary dermis, or in mid to deep dermis, which is separated from a more superficial lichenoid infiltrate

A

Granulomatous PPD

33
Q

Variant of PPD, on HPx presents as band like mononuclear infiltrate in upper dermis separated from epidermis by thin rin of uninvolved collagen

A

Lichen aureus

34
Q

Variant of PPDs with shorter course and more favorable overall prognosis

A

Unilateral linear capillaritis

Drug-induced PPDs

35
Q

Common initial therapies for PPD

A

Topical steroids

antihistamines

36
Q

Treatment with ___ BiD for ____ weeks cleared lichen aureus lesions

A

Topical pimecrolimus; 10

37
Q

___ given for 4 weeks lead to clearance in all lesions with maintenance of remission 3 months after treatment for chronic PPD

A

Oral bioflavanoid (Rutoside 50mg BID) + Ascorbic acid 500mg BiD

38
Q

Used for recalcitrant Schamberg disease

A

Colchicine 0.5mg BID

39
Q

MOA of Pentoxifylline 400mg TiD for PPD

A

Inhibits T cell adherence to endothelial cells and keratinocytes

40
Q

Immunosuppressants (oral corticosteroids, MTX, cyclosporine) are rarely indictaed for the benign nature of this condition
TRUE or FALSE

A

True

41
Q

Used for Majocchi purpura

A

MTX 15 mg weekly for 4 weeks

42
Q

MOA of PUVA in treating PPD

A

Inhibits T cell intereukin 2 production leading to resolution of perivascular lymphocytic infiltrate

43
Q

Affects both immunomodulation and vascular destruction

A

PDT

44
Q

Other treatments for PPD

A

Ca dobesilate 500mg BiD for 3 mos, sustained for 1 year
Griseofulvin 500-750mg OD for 1 month
Minocycline

45
Q

Sucessful clearance of Schamberg using a ___ nm PDL after 5 monthly treatments

A

595 nm

46
Q

Drug-induced PPD are more likely to present in lower extremities
True or False

A

False, more likely to be generalized

47
Q

Lab testing is required for diagnosis

True or False

A

False, not required

48
Q

Rule out other causes of purpura

A

Coagulation studies

49
Q

Used to confirm diagnosis of Drug-induced PPD

A

Rechallenge

50
Q

___ &; ___ account for lesions localizing in lower extremities

A

Gravity and increased venous pressure

51
Q

Itching purpura are more apparemt along (4)

A

Waistline
Axilla
Antecubital
Popliteal fossa

52
Q

Suspicious for MF: (4)

A

PPDs with large areas of confluence
Reticular arrangement
Superimposed violaceous hue
Pruritus present/relapsing for years

53
Q

Possible agents that cause contact dermatitis leading to PPDs (8)

A 
Benzoyl peroxide
Black rubber
Cobalt
Disperse dyes
Epoxy resin
Eutectic mixture of local anesthetics
Methylmethacrylate
PPD
54
Q

Hess test is reliable as capillary fragility is consistently seen in PPD
True or False

A

False, not reliable, not consistent

55
Q

MOA of PUVA for PPD

A

Inh T cell IL2 production, resolution of perivascular infiltrate

56
Q

For immunomodulation and vascular destruction

A

Photodynamic therapy

7th (23 decks)

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