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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
Describe the histology [epidermis and dermis] for nodular and diffuse dermatitis.
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
What will nodular/diffuse dermatitis look like clinically in terms of color and elevation?
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
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.
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
How is vasculitis distinguished from perivascular dermatitis?
Vasculitis has histiologic evidence of blood vessel injury/destruction
29
What are the 4 histiologic signs of cutaneous small-vessel vasculitis [post-capillary in papillary dermis]?
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
What are the histiologic signs of cutaneous medium to large-vessel vasculitis?
Inflammatory cells in the wall or in the subendothelial space
31
Describe the clinical appearance of vasculitis in terms of color and elevation.
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
What are 3 common causes of vasculitis? | Are they small-vessel or medium vessel?
1. Leukocytoclastic vasculitis - small-vessel - HSP, connective tissue disorders 2. Polyarteritis nodosa - medium 3. Wegener's granulomatous vasculitis - medium
33
What are the 3 different histologic appearances of intraepidermal vesicular dermatitis?
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
Describe the clinical appearance of intraepidermal vesicular dermatitis in terms of color. What will the surface of the blister be like?
Color: 1. translucent vesicle/bullae = serum >>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
What are 4 skin diseases that are intraepidermal vesicular dermatitis? does each demonstrate acantholysis, spongiosis, or ballooning degeneration?
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
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?
Supepidermal vesicular dermatitis Translucent = serum>>>inflammatory cells Erythema if inflammatory, no erythema if bullous pemphigoid thick roof = entire thickness of epidermis
37
What 3 skin diseases cause subepidermal vesicular dermatitis? What inflammatory cell predominates in each
1. bullous pemphigoid - eosinophils 2. dermatitis herpetiformis - neutrophils 3. porphyria cutanea tarda - few inflammatory cells
38
Describe the histology of fibrosing and/or sclerosing dermatitis.
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
What color, elevation and consistency is associated with fibrosing/sclerosing dermatitis?
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
What 4 diseases commonly show fibrosing or sclerosing dermatitis?
1. Scar- fibrosis 2. Keloid- dense fibrosis 3. Morphea - sclerosis 4. scleroderma- sclerosis
41
What is the histology of folliculitis?
1. inflammatory cells WITHIN hair follicle 2. follicular spongiosis, ballooning, acantholysis 3. pustule when neutrophils cluster and distend/rupture the follicle
42
What is the histology of perifolliculitis? | What are the 2 major types?
inflammation around the follicle 1. granulomatous - histiocytes [rosacea] 2. lymphocytic - around bulb = alopecia areata - interface changes along length of follicle = lupus
43
What skin diseases have folliculitis and perifolluculitis?
1. acne vulgaris and hidradenitis suppurativa - folliculitis and peri 2. rosacea - both 3. alopecia areata - peribulbar, perifolliculitis
44
Describe the histology of the 2 different types of panniculitis.
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
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?
Panniculitis
46
What are the 2 clinical conditions that are associated with panniculitis?
1. erythema nodosum - septal | 2. lupus profundus - lobular

Multisystems (29 decks)

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