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Multisystems > CM- Inflammatory Dermatoses > Flashcards

CM- Inflammatory Dermatoses Flashcards

1
Q

What physical exam finding will you see if there is non-granulomatous inflammation and vascular dilation?

A

Erythema

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2
Q

What finding correlates with hyperkeratosis, parakeratosis?

A

scales

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3
Q

What correlates with:

  1. spongiosis
  2. subsequent serum/inflammatory cells in stratum corneum
  3. loss of epidermal barrier protection
A

serous crust

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4
Q

What correlates with induration [hardened skin]?

A

deep inflammation

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5
Q

What correlates to purpura?

A

Extravasated erythrocytes

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6
Q

What correlates to flaccid blister?

Tense blisters?

A

Flaccid blister = intraepidermal vesicle

Tense = subepidermal vesicle

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7
Q

What correlates with “hide-bound skin”?

A

sclerotic abundant collagen extending through the dermis

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8
Q

If there are ill-defined borders on the skin lesion, where is the inflammation most likely occuring?

A

subcutaneous inflammation

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9
Q

What is pattern analysis?

What are the two key facts that must be established first?

A

It is systemic approach to making accurate/reproducible dermatopathologic diagnoses by recognizing low-power changes to skin structure.

  1. what anatomic region the biopsy was taken from?
    - regional differences
    - certain diseases favor certain anatomic sites
  2. what method was used to get the biopsy?
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10
Q

What is the histology of superficial perivascular dermatitis without epidermal change?
How does this correlate to clinical presentation?

A
  1. epidermis is normal
  2. infiltrate surrounds superifical plexus [in papillary dermis]
  3. blood vessels are dilated

Clinical correlation:

  1. dilated vessels –> erythema
  2. mild increases in vascular permeability make LITTLE or NO dermal edema–> flat lesions [macules, patches]
  3. IF dermal edema is present–> papules, plaques
  4. normal epidermis–> smooth skin surface
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11
Q

What skin diseases manifest as superficial perivascular dermatitis without epidermal change?

A
  1. Viral exanthems - measles, rubella, erythema infectiosum

2. drug eruptions [morbilliform type]

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12
Q

Describe the histology of superficial perivascular dermatitis with interface change.

A
  1. vascular dilation with inflammation around superficial plexus
  2. altered dermoepidermal junction causing the epidermis to mature abnormally –> hyperkeratosis, parakeratosis
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13
Q

What are the 2 subtypes of interface dermatitis?

A
  1. vacuolar - vacuolated basal cells as a result of inflammation
  2. lichenoid - “lichen-planus like”
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14
Q

How would you describe the color, elevation and surface for superficial perivascular dermatitis with interface change?

A

Color:

  1. erythema due to vasodilation
  2. violaceous - lichen planus has combo of red and blue-brown which is the color of dermal melanin, [epidermal melanocytes drop their color in response to inflammation]

Elevation:
Papules/plaques due to dermal and epidermal involvement

surface:
Scale due to hyperkeratosis and parakeratosis

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15
Q

What skin diseases show superficial perivascular dermatitis with interface change?

A
  1. erythema multiforme
  2. dermatomyositis
  3. lichen planus
  4. mycosis fungoides, the most common cutaneous T cell lymphoma
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16
Q

Describe the histology of superficial perivascular dermatitis with spongiosis/

A

Epidermis:

  1. edema between keratinocytes
    - pale areas–> intraepidermal vesicle formation
  2. serum and inflammatory infiltrate in stratum corneum
  3. acanthosis and parakeratosis

Dermis:
1. superficial perivascular infiltrate

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17
Q

Describe the clinical presentation of superficial perivascular dermatitis with spongiosis in terms of color, elevation and suface.

A

Color:
Erythema due to vasodilation

Elevation:
Papules/Plaques due to epidermal and dermal changes

Surface:
Crust - serum/inflammatory infiltrate in stratum corneum

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18
Q

What diseases demonstrate superficial perivascular dermatitis with spongiosis?

A
  1. allergic contact dermatitis
  2. nummular dermatitis [coin shaped]
  3. tinea
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19
Q

Describe histology of superficial perivascular dermatitis with psoriasiform hyperplasia.

A

Epidermis:

  1. psoriasiform hyperplasia with even elongation of rete ridges
  2. diminished granular layer
  3. parakeratosis
  4. suprapapillary thinning above where the widened capillaries are
  5. neutrophils in the stratum corneum [Munro abscess]
  6. neutrophils in the spinous layer [spongiform pustule of Kogoj]

Dermis:

  1. superficial perivascular inflammation
  2. tortuous capillaries
20
Q

Describe the clinical presentation of superficial perivascular dermatitis with psoriasiform hyperplasia in terms of color, elevation, surface.

A

Color:
1. erythema due to dilated vessels

elevation:

  1. papules/plaques due to epidermal and dermal changes
  2. sharp circumscription of the lesion due to transition from psoriasiform epidermus to surrounding normal

Surface:
silver scale - parakeratosis

21
Q

What are the skin diseases associated with superficial perivascular dermatitis with psoriasiform hyperplasia?

A
  1. psoriasis

2. lichen simplex chronicus [more thick, uneven psoriasiform hyperplasia; no neutrophils in stratum corneum]

22
Q

What is the histology of superficial and deep perivascular dermatitis?

A

Dermis:

  1. inflammatory infiltrate around superficial and deep plexus
  2. lymphocytes, histiocytes, neutrophils

Epidermis:
Variable but could be spongiosis, psoriasiform, interface

23
Q

Describe the clinical presentation of superficial and deep perivascular dermatitis in terms of color and elevation.

A

Color:
erythema - dilated vessels

Elevation:

  1. papules and plaques
  2. induration due to deeper inflammation
24
Q

What are the 3 common skin diseases that show superficial and deep perivascular dermatitis?
What epithelial changes are associated with each?

A
  1. lupus erythematous and dermatomyositis - interface
  2. secondary syphilis - psoriasiform, lichenoid
  3. arthropod bite reaction - spongiosis
25
Q

Describe the histology [epidermis and dermis] for nodular and diffuse dermatitis.

A

Epidermis = non-specific changes

Dermis [nodular]
Perivascular aggregates of inflammatory cells in superficial and deep plexus [lympho, neutro, histo]

Dermis [diffuse]
coalescing nodular aggregates to form sheets

*granulomas are nodular infiltrates of histiocytes

26
Q

What will nodular/diffuse dermatitis look like clinically in terms of color and elevation?

A

Color:

  1. non-granulomatous [not nodular/histocytes] = erythema
  2. granulomas = red/brown by routine, yellow-brown when compressed on a glass slide [diascopy]

Elevation:
1. thicker lesion [papule, plaque, annular plaque, nodule]

27
Q

What are the 5 major skin diseases associated with nodular or diffuse dermatitis?
Tell what cell is in each and if it is nodular or diffuse.

A
  1. Hansen’s disease [leprosy]
    - nodular or diffuse depending on stage
    - granuloma = histiocyte
  2. TB
    - nodular histiocytes
    - granulmona
  3. Sarcoidosis
    - nodular histiocytes
    - granuloma
  4. Sweet syndrome
    - nodular or diffuse
    - neutrophils
  5. B-cell lymphoma
    - nodular or diffuse
    - lymphocytes
28
Q

How is vasculitis distinguished from perivascular dermatitis?

A

Vasculitis has histiologic evidence of blood vessel injury/destruction

29
Q

What are the 4 histiologic signs of cutaneous small-vessel vasculitis [post-capillary in papillary dermis]?

A
  1. leukocytoclasis - perivascular neutrophil fragments
  2. extravasated RBCs- in tissue out of lumen
  3. fibrinoid degeneration - fibrin in vessel wall
  4. endothelial cell necrosis
30
Q

What are the histiologic signs of cutaneous medium to large-vessel vasculitis?

A

Inflammatory cells in the wall or in the subendothelial space

31
Q

Describe the clinical appearance of vasculitis in terms of color and elevation.

A

Color:
1. purpura - bright to violaceous erythema that DOES NOT blanch because erythrocytes are in the dermis outside circulation

Elevation:

  1. small-vessel = macules, patches, papules, plaques
  2. medium-vessel = papulonodules
32
Q

What are 3 common causes of vasculitis?

Are they small-vessel or medium vessel?

A
  1. Leukocytoclastic vasculitis
    - small-vessel
    - HSP, connective tissue disorders
  2. Polyarteritis nodosa
    - medium
  3. Wegener’s granulomatous vasculitis
    - medium
33
Q

What are the 3 different histologic appearances of intraepidermal vesicular dermatitis?

A

They all involve vesicles entirely within the epidermis [no dermal involvement]

  1. acantholysis - loss of intercellular adhesions –> detached and rounding up of keratinocytes.
    - herpes, pemphigus
  2. ballooning degeneration - keratinocytes swell due to intracellular edema
    - herpes simplex, orf
  3. spongiosis- intercellular edema resulting in coalescing spongiotic foci to form vesicles, bullae
    - allergic contact dermatitis
34
Q

Describe the clinical appearance of intraepidermal vesicular dermatitis in terms of color.
What will the surface of the blister be like?

A

Color:

  1. translucent vesicle/bullae = serum&raquo_space;inflammatory cells
  2. erythema at the base = dermal inflammation and dilated vessels

Surface:

  1. roof formed by SOME of the epidermis –> flaccid lesion
  2. higher in cleavage plane, more fragile
  3. removal of room –> moist erosion
35
Q

What are 4 skin diseases that are intraepidermal vesicular dermatitis?
does each demonstrate acantholysis, spongiosis, or ballooning degeneration?

A
  1. pemphigus vulgaris
    - acantholysis
    - bullae
  2. herpes simplex
    - ballooning and acantholysis
    - vesicle
  3. impetigo
    - acantholytic pustule from staph
  4. allergic contact dermatitis
    - spongiosis
    - vesicle
36
Q

On clinical exam, you notice a translucent vesicle or bullae containing serum. There is erythema at the base of the blister. There is a thick, tense roof.
What type of lesion is this?

A

Supepidermal vesicular dermatitis

Translucent = serum»>inflammatory cells
Erythema if inflammatory, no erythema if bullous pemphigoid

thick roof = entire thickness of epidermis

37
Q

What 3 skin diseases cause subepidermal vesicular dermatitis?
What inflammatory cell predominates in each

A
  1. bullous pemphigoid
    - eosinophils
  2. dermatitis herpetiformis
    - neutrophils
  3. porphyria cutanea tarda
    - few inflammatory cells
38
Q

Describe the histology of fibrosing and/or sclerosing dermatitis.

A

Alterations in quantity OR quality of collagen.

  1. Fibrosis
    - collagen has fibrous quality and is densely crowded in bundles
    - increase in fibrocytes
  2. Sclerosis
    - collagen is homogenized, smudged with smooth color
    - decrease in fibrocytes
39
Q

What color, elevation and consistency is associated with fibrosing/sclerosing dermatitis?

A

Color:

  1. erythema - increased vascularity
  2. violaceous - active border of inflammation which precedes sclerosis in morpha and scleroderma

Elevation:

  1. papules/ plaques with increased total collagen
  2. depressed plaques with decreased total collagen

Consistency:

  1. Firm - increased abnormal collagen [keloid, hypertrophic scars]
  2. Bound down skin - sclerosis into subcutis and deep fascia [morphea, scleroderma]
40
Q

What 4 diseases commonly show fibrosing or sclerosing dermatitis?

A
  1. Scar- fibrosis
  2. Keloid- dense fibrosis
  3. Morphea - sclerosis
  4. scleroderma- sclerosis
41
Q

What is the histology of folliculitis?

A
  1. inflammatory cells WITHIN hair follicle
  2. follicular spongiosis, ballooning, acantholysis
  3. pustule when neutrophils cluster and distend/rupture the follicle
42
Q

What is the histology of perifolliculitis?

What are the 2 major types?

A

inflammation around the follicle

  1. granulomatous
    - histiocytes [rosacea]
  2. lymphocytic
    - around bulb = alopecia areata
    - interface changes along length of follicle = lupus
43
Q

What skin diseases have folliculitis and perifolluculitis?

A
  1. acne vulgaris and hidradenitis suppurativa
    - folliculitis and peri
  2. rosacea
    - both
  3. alopecia areata
    - peribulbar, perifolliculitis
44
Q

Describe the histology of the 2 different types of panniculitis.

A
  1. Septal
    - inflammatory cells in the fibrous septa
    - some cells “spill over” into periphery of lobules
  2. Lobular panniculitis
    - inflammatory cells in the lobules AND septa
    - more extensive fat degeneration
    - foamy macrophages
45
Q

A patient presents with erythema that is slightly violaceous and red-brown. The nodules/plaques have ill-defined boundaries and are fixed. What is the problem?

A

Panniculitis

46
Q

What are the 2 clinical conditions that are associated with panniculitis?

A
  1. erythema nodosum - septal

2. lupus profundus - lobular

Multisystems (29 decks)

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