Derm Flashcards
1
Q
vitiligo
A
chronic depigmenting condition from complete loss of epidermal melanocytes
Autoantibody against melanin concentrating hormone receptor 1
2
Q
association for vitiligo
A
pernicious anemia and Hashimoto thyroiditis
may be autoimmune
3
Q
locations for vitiligo
A
predilection for acral areas (fingers, limbs, ears)
orifices (mouth, eyes, nose, anus)
4
Q
description of vitiligo rash
A
asymptomatic white macules with sharp borders that gradually enlarge
hair will also lose pigment
5
Q
treatment of vitiligo
A
topical steroids, calcineurin inhibitors (tacrolimus) and light therapy
6
Q
histology of vitiligo
A
giant melanosome in depigmented areas
7
Q
ephelis
A
freckle
basal layer hyperpigmentaiton
darken with sun exposure
no risk of malignancy
8
Q
lentigo
A
hyperpigmentation of cells just above the basement membrane
do not darken with sun exposure
9
Q
histology of lentigo
A
age or liver spot
rete ridges are elongated and appear club-shaped or tortuous
increased melanocytes in basal layer
melanophages appear in upper dermis
10
Q
melanocytic nevi
A
tan to brown
uniformly pigmented
well defined, rounded borders
11
Q
histology of melanocytic nevi
A
well nested at dermal-epidermal junction
melanocytes mature as they descend in dermis
no deep mitoses
no deep pigment in melanocytic nests
12
Q
histology of junctional melanocytic nevus
A
nests at dermal-epidermal junction
restricted to the tips and sides of rete
13
Q
compond melanocytic nevus
A
more raised and dome shaped than junctional nvus
14
Q
histology of compound melanocytic nevus
A
intraepidermal nevus cell nests and nests and cords in underlying dermis (mature and become smaller)
15
Q
dermal melanocytic nervus histology
A
epidermal nests are completely lost
16
Q
spitz nevus characteristics
A
composed of spindle and/or epithelioid cells
sharply defined laterally
symmetry from left to right
clefts separating nests from keratinocytes
17
Q
clinical characteristics of spitz nevus
A
common in children
deep red color, may be confused with hemangiomas
18
Q
dyskeratotic melanocytes (Kamino bodies)
A
eosinophilic bodies along dermal-epidermal junction
19
Q
histology of spitz nevus
A
nests of melanocytes within the epidermis
nests separated from epidermis by clefts
20
Q
dysplastic melanocytic nevus characteristics
A
commonly large, oval, and multiple
irregular pigment common
fading border or fied egg appearance
21
Q
histology of dysplastic melanocytic nevus
A
usually compound, concentric papillary dermal fibrosis
horizontally oriented nests with bridging of adjacent rete
at the tips and sides of rete
hyperchromatic, enlarged nuclei
22
Q
melanoma characteristics
A
malignancy of pigment producing cells (derived from neural crest)
found in skin, eyes, GI tract, letpomeninges, oral and genital mucosa
23
Q
number one cause of skin cancer deaths worldwide
A
melanoma
24
Q
determination of tumor stage
A
vertical phase
can lead to metastasis to lymph nodes, brain, GI, bone, liver and lungs
25
common mets in melanoma
brain (third after lung and breast cancer)
26
risk factors for melanoma
```
changing mole (number 1)
atypical nevi, numerous
large congenital nevi
previous melanoma or nonmelanoma
sun sensitivity
xeroderma pigmentosum
fair skin and history of blistering sunburns
```
27
management of suspicious lesions
```
asymmetry
border irregularity
color variation
diameter
evolving
```
28
biopsy lesion
full thickness skin extending into subcutaneous fat with 2mm lateral margins
excision, punch or incisional if large
29
radial growth phase
horizontal spread within the epidermis and superficial dermis
lack ability to metastasize
30
vertical growth phase
invade downward into deeper dermal layers as a mass
metastatic potential
cells do not mature
31
superficial spreading melanoma
most common melanoma
radial growth phase of uncertain length before vertical growth phase develops
may show multiple shades-red, tan, brown, blue, black, gray and white
32
typical location of superficial spreading mel
back of men and lower legs of women
33
histological superficial spreading mel
buckshot scatter of atypical melanocytes
not symmetrical
deep mitoses
typically fails to mature from top to bottom
34
lentigo maligna
slow growing lesion
long radial growth phase
tan-brown macule that graudally enlarges, devlops darker, asymmetric foci
35
location for lentigo maligna
face of old men
36
histological features of lentigo maligna
junctional growth of atypical melanocytes
poorly nested and confluent melanocytes at dermal-epidermal junction
adnexa extension
37
lentigo maligna melanoma
lentigo maligna with vertical growth phase
38
acral lentiginous melanoma
least common
most common melanoma in AA and Asians
palms, soles, beneath nail plate
39
Hutchinson's sign
sign of malignant melanoma on fingernail
40
nodular melanoma histology
vertical growth phase
no apparent radial growth
mitoses are frequent and often atypical
41
breslow measurement
actual measurement from skin surface
42
clark measurement
number of layers of skin that the tumor has penetrated
| most closely correlates with survival statistics
43
sentinel node biopsy
radioactive tracer and gamma probe
for intermediate tumors (1-4mm) or high risk thin tumors
helpful in staging
44
seborrheic keratosis
most common benign tumor in older individuals
looks like melanoma
begin as light brown, flat macules-then become velvety or waxy
45
sign of Leser-Trelat
multiple eruptive SK with internal malignancy
46
dermatosis papulosa nigra
brown to black, smooth, dome shaped papules
subtype of SK in AA
liquid nitrogen can cause hypopigmentation
47
histology of SK
sheets of small, basaloid cells
exuberant keratin production
horn cells and loose lamellar keratin
48
horn cysts
keratin filled cysts
49
acanthosis nigricans
hyperpigmentation and hyperplasia of stratum spinosum
| found in folds of neck, axilla, groin
50
acanthosis benign type
associated with endocrine abnormalities (DM)
51
malignant acanthosis
middle aged and older
| associated with visceral malignancy
52
epidermal inclusion cyst
common on head or neck of children
may be excised if inflammed
cyst wall resembles normal epidermis, filled with strands of keratin
53
actinic keratoses
can develop into SCC
palpation-rough or gritty skin, feels like broken glass
slightly erythematous papule or plaque with adherent scale
54
locations of actinic keratoses
face, scalp, ears, posterior neck, forearms and legs
55
histology of actinic keratoses
parakeratosis (retained nuclei) in stratum corneum
hyperplasia and cytologic atypia of basal cells
solar elastosis in superficial dermis
56
treatment of actinic keratoses
isolated-cryotherapy
5FU (causes intense inflammation)
excision, electrodissection, curettage, CO2 laser, Imiquimod, photodynamic therapy
57
side effect of cryotherapy
mild blistering and then scab
| if ulcerated or thickened-rule out SCC
58
most common cancer in the US
nonmelanoma skin cancer
80% BCC
20% SCC
59
SCC
arises in epithelium and is common in middle aged and elderly
60
risk factors for SCC
male, elderly, UV and ionizing radiation, fair skin, arsenic, HPV, burn scars and immunosuppression
MOST IMPORTANT IS DNA DAMAGE FROM UV LIGHT-UVB#1
61
common locations for SCC
scalp, dorsal upper extremities, ears
62
Bowen disease
sharply demarcated pink plaque and can arise on non-sun exposed skin
SCC in situ
63
erythroplasia of Queyrat
Bowen disease of glans penis
manifests ad one or more velvety red plaques
SCC in situ
64
Bowen histology
no invasion through basement membrane of dermoepidermal junction
atypical nuclei involve all layers of epidermis
65
SCC histology
invade basement membrane
lobules of polygonal cells, area of keratinization in well differentiated
anaplastic, necrosis, no keratin organization in poorly differentiated
66
intercellular bridges
SCC
67
invasive SCC
raised, firm, pink to flesh colored keratotic papule
metastases to regional lymph nodes
surface changes include scaling, ulceration, crusting or presence of cutaneous horn
68
diagnosis of SCC
requires biopsy (shave, punch, incisional, or excisional)
lymph node biopsy or FNA if lymphadenopathy is present
PET, ultrasound guided FNA and sentinel to determine nodal mets
69
treatment of SCC
```
surgical removal (less margin than melanoma)
ED and C not recommended
```
70
keratoacanthoma
benign epithelial tumor that may progress to SCC
look alike
appear suddenly on actinically damaged skin and regress
red to flesh colored dome-shaped papule with central keratinous plug
71
histology of keratoacanthoma
large, red, glassy squamoid cells
mitoses uncommon
neutrophil microabscesses common
eosinophils and lymphocytes are common in surrounding infiltrate
72
BCC
most common
pluripotential cells in basal layer of epidermis and follicular structures
can cause local destruction and disfigurement
73
BCC risk factors
UV radiation, xray, arsenic, immunosuppression
74
common presentation of BCC
non-healing lesion that bleeds
75
common location BCC
face, ears, scalp, neck, upper trunk
76
nodular BCC
most common type
face most common site
waxy with central depression
telangiectasias over surface
77
superficial BCC
trunk most common site
atrophic center with fine translucent micropapules on rim
light red color
78
diagnosis of BCC
biopsy to confirm
| shave or punch
79
histology of BCC
basaloid cells which palisade at border of nest
nests in fibromyxoid stroma
separation artifact-stroma separates from tumor nodules
80
treatment of BCC
```
currettage, excision with margin examination
Mohs micrographic surgery
radiotherapy
radiation
Imiquimod
5FU
```
81
Mohs surgery
removal of tumor and thin rim
frozen section allows examination of tissue while patient is in office
best long term cure rates of any treatment modality
82
acanthosis
diffuse epidermal hyperplasia
83
dyskeratosis
premature keratinization within cells below stratum granulosum
84
hydropic swelling
intracellualr edema of keratinocytes
| seen in viral infections
85
hypergraunulosis
hyperplasia of granulosum due to intense rubbing
86
hyperkeratosis
thickening of straum corneum due to qualitative abnormality of keratin
87
lentiginous
linear pattern of melanocyte proliferation within the epidermal basal cell layer
88
papillomatosis
surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae
89
parakeratosis
keratinization with retained nuclei in stratum corneum
| normal in mucous membranes
90
spongiosis
intercellular edema of epidermis
91
dermatofibroma
benign fibrous histiocytoma
very common benign lesion that occurs on lower legs
display dimple sign
fibrous reaction to some past trauma to skin
92
histology of dermatofibroma
proliferations of fibroblasts with collagen
whirling fibroblasts with collagen bundles
overlying hyperkeratosis and hyperpigmentation-reddish brown color
93
dermatofibrosarcoma protuberans histology
primary fibrosarcoma of skin
extends from dermis into subcutaneous fat in honeycomb pattern
fibroblasts in pinwheel pattern
94
mycosis fungiodes
T cell lymphoma that presents in skin and may evolve into generalized lymphoma
95
stages of mycosis fungiodes
patch-scaly, red-brown
plaque-raised, indurated, irregular, red, scaly
nodule-fungating, red-brown
96
histology of mycosis fungiodes
T helper cells form bands in superficial dermis
| invade epidermis as single cells or small clustures (Pautrier microabscesses)
97
urticaria pigmentosa
usually children
| round to oval, red-brown papules and plaques, pruritic and may blister, appear shortly after birth
98
systemic mastocytosis
usually adults
| skin lesions similar to urticaria pigmentosa plus multi-organ mast cell infiltration
99
organ involvement in systemic mastocytosis
bone marrow, liver, spleen, lymph nodes
100
darier sign
wheal when skin lesion is rubbed (sign of mastocytosis)
101
dermatographism
hive occurs when normal skin is stroked with pointed instrument (sign of mastocytosis)
102
cause of signs and symptoms in mastocytosis
histamine, heparin, other mast cell contents
103
histology of matocytoma
metachromatic granules within dendritic mast cells
fried egg cells-central nuceli
Giemsa to visualize mast cell granules
104
ichthyosis
disorders which impair epidermal maturation
| most cases congenital
105
ichthyosis vulgaris
associated with lymphoid and visceral malignancies
| stratum granulosum thin or absent
106
ichthyoses histology
build up of compacted stratum corneum with loss of basket weave pattern
107
stratum granulosum normal to slightly thickened
lamellar
x-linked
congential ichthyosiform eryhtroderma
108
urticaria
wheals
| from mast cell degranulation and microvascular hyperpermeability
109
pathogenesis of urticaria
antigen-induced mast cell degranulation through sensitization with specific IgE antibodies
follows exposure to multiple antigens-pollens, foods, drugs, insect venom
110
histology of urticaria
perivenular infiltrate, neutrophils then mononuclear cells
| collagen bundles more widely spaced due to dermal edema
111
contact dermatitis
inflammatory reaction caused by an exogenous chemical
| can be irritant or allergic
112
irritant contact dermatitis
produced by substance that has direct toxic effects on the skin (acids detergents, alkalis, frequent hand washing)
not an immunologic condition
rash begins shortly after exposure
113
allergic contact dermatitis
cell mediated, delayed type hypersensitivity reaction (type IV)
Ag on skin surface taken up to Langerhans cells
Migrate via dermal lymphatics to lymph nodes
Present Ag to CD4 T cells which become effector and memory cells
114
sensitization allergic contact dermatitis
sensitization occurs 1-2 weeks after 1st exposure to allergen
115
common allergens for allergic contact dermatitis
poison ivy, mangos, iodine, nickel, rubber, cosmetics
116
poison ivy contact dermatitis
produce urushiol as common allergic substance
| fluid contained in vesicles does not contain an allergen and cannot induce disease in others
117
clinical features of contact dermatitis
erythematous papules and vesicles with oozing to crusting and scaling
very pruritic
118
atopic dermatitis
prurutic
worse in winter due to decreased humidity
look for history of allergies, asthma, eczema
119
baby atopic dermatitis
face, diaper, extensor surfaces
120
adults atopi dermatitis
neck, face, axillae, antecubital, popliteal fossa
121
linchenification
epidermal thickening characterized by visible and palpable skin thickening with accentuated skin lines
122
nummular dermatitis
coin shaped red plaques
young adults
same treatment for atopic dermatitis
123
asteatotic dermatitis
old people-cracked skin
| avoid excessive bathing
124
histology of acute spongiotic dermatitis
spongiosis
| exocytosis of lymphocytes
125
histology of subacute spongiotic dermatitis
parakeratosis
acanthosis
spongiosis
exocytosis of lymphocytes
126
erythema multiforme
immune mediated, hypersensitivity reaction resulting in epidermal cell injury
attacked by CD8
target lesions are diagnostic
127
triggers of erythrema multiforme
HSV, mycoplasma, sulfa drugs, penicillin, phenytoin, allopurinol, barbituates
128
histology of erythema multiforme
perivascular lymphocytic infiltate, degenerating and necrotic keratinocytes early
later-lymphocytes into epidermis, epidermal necrosis with blister formation
129
Stevens-Johnson syndrome
more sever than EM
children>adults
mucous membranes-mouth and conjunctiva
130
frequent causes of SJS
sulfa drugs and anticonvulsants
131
treatment SJS
stop medication
| burn unit
132
toxic epidermal necrolysis
dermatologic emergency
| large area of epidermis detach
133
Pityriasis rosea
subacute spongiotic dermatitis
related to HHV 7
older children and young adults, common in winter
herald patch and Christmas tree pattern
134
herald patch
resembles ringworm
| found in Pityriasis Rosea
135
common sites of pityriasis rosea
trunk, upper arms, thighs
136
venous insufficiency
increased hydrostatic pressure and capillary damage leading to extravasation of RBC and serum
starts as edema and hyperpigmentation and leads to pruritic erythema and stasis dermatitis
137
cause of thickened, brown appearance in stasis dermatitis
hemosiderin
138
psoriasis
accelerated proliferation of skin cells resulting in scaling
average age is 35
stratum basale to shedding in 3-4 days instead of 28
139
rash in psoriasis
well demarcated, erythematous plaques and papules with silver scaling
Auspitz sign
symmetrical
140
Koebner phenomenon
trauma to skin and stress can cause exacerbations (psoriasis)
141
Auspitz's sign
pinpoint bleeding on removal of scale
142
histology of psoriasis
downward elongation of rete ridges
thinning of overlying stratum granulosum with parakeratosis abover
aggregates of neutrophils and spongiosis
capillaries in dermal papillae are brought close to surface
143
Guttate psoriasis
post strep infection
144
psoriasis on nails
oil spotting-focal brown discoloration of nail plate
onycholysis-distal separation of plate from bed
subungal hyperkeratosis
pitting
145
psoriatic arthritis
pencil in cup deformity where one articular surface is eroded creating a pointed appearance
146
arthritis mutilans
destructive form of psoriatic arthritis with periarticular bone resorption
147
treatment of psoriasis
```
corticosteroids
calcipotreiene-from vitamin D
tars-poor compliance
DO NOT GIVE ORAL STEROIDS-REBOUND
methotrexate-folate antagonist
light therapy
acitretin-vitamin A derivative
biologics
```
148
seborrheic dermatitis
chronic inflammatory process affecting areas rich in sebaceous glands
peaks in infancy and adulthood
thought to be caused by malassezia furfur
usually symmetrical distribution
149
associations with seborrheic dermatitis
HIV and Parkinson
150
histologic features of seborrheic dermatitis
spongiotic early and psoriasis later
parakeratosis with neutrophils and serum at ostia of hair follicles
perivascular infiltrate of lymphocytes and neutrophils
151
Linchen planus
```
idiopathic inflammatory disorders
pruritic, purple, polygonal, planar papules, plaques
most common on wrists and ankles
mucous membrane involvement is common
Koebner phenomenon
```
152
Wickham's striae
fine reticulated white lines
| associated with Lichen planus
153
association of lichen planus
hep C
154
histology of lichen planus
dense continuous infiltrate of lymphocytes along the dermoepidermal junction
degerneation and necrosis of basal keratinocytes
dermoepidermal interface more angulated-saw tooth
155
civatte bodies
incorporation of necrotic basal keratinocytes into infalmed papillary dermis (lichen planus)
156
SLE characteristics
autoimmune disease involving connective tissues and blood vessels
more common in AA
female: male 9:1
may present with fatigue, fever, weight loss, malaise, arthralgias, CNS symptoms
157
malar rash
butterfly rash eryhtematous, confluent, macular eruption with clear borders
spares nasolabial folds
158
other symptoms of SLE
oral ulcers, renal disease, pericarditis, pneumonitis, peritonitis, hepatosplenomegaly, myopathy, neuropathy, lymphadenopathy, seizures
159
false positives for SLE
RPR and VDRL
160
histology of SLE
lichenoid interface dermatitis
epidermal atrophy
thickening of basal membrane
161
pemphigus vulgaris
most common and most severe type
men and women equally
involves scalp, face, axillae, groin, trunk, points of pressure, oral ulcers
162
cause of pemphigus vulgaris
IgG autoantibodies against desmogleins 1 and 3 in desmosomes in suprabasal deep epidermis and mucosal epithelium
163
blisters in pemphigus vulgaris
flaccid blisters that rupture leaving erosions with crust
| positive Nikolsky sign (pressure on blister causes lateral spread of lesion)
164
histology of pemphigus vulgaris
acantholysis (lysis of intercellular adhesions connecting squamous epithelial cells)
single layer of intact basal cells forms blister base-row of tombstones
165
DIF on pemphigus vulgaris
net like pattern of intercellular IgG deposits
166
pemphigus vegetans
rare
large, moist, verrucous, vegetating plaques
oral lesions common
167
association of pemphigus vegetans
ulcerative colitis
168
pemphigus foliaceous
Brazil
Target Ag is Dsg1
subcorneal blister
169
bullous pemphigoid
elderly individuals
oral lesions uncommon (only after cutaneous lesions)
Ags to BPAg1 and BPAg2 in hemidesmosome-only 2 causes blister
170
site of blisters in bullous pemphigoid
inner aspects of thighs, flexor surfaces of forearms, axillae, groin and lower abdomen
171
blisters in bullous pemphigoid
sturdy-roof is full thickness
172
histology bullous pemphigoid
subepidermal, nonacantholytic blisters
early perivascualr infiltrate of lmyphocytes
eosinophils in blister cavity
173
direct immunofluorescence in bullous pemphigoid
linear deposition of C3 and IgG along dermoepidermal junction
174
associations in dermatitis herpetiformis
HLA-B8, HLA-DR, HLA-DQ
175
etiology of dermatitis herpetiformis
IgA autoantibodies to transglutaminases bind to TG in gut and cross react with reticulin in fibrils in skin
176
lesions in dermatitis herpetiformis
symmetrically grouped lesions
| papules and plaques progress to vesicles and bullae
177
common sites of dermatitis herpetiformis
buttocks
elbows
knees
scapular areas
178
GI related to dermatitis herpetiformis
gluten sensitive enteropathy occurs in nearly all patients
| there may be no GI symptoms
179
histology of dermatitis herpetiformis
microabscesses at dermal papillae
subepidermal blister
neutrophil microabscesses and fibrin deposition in tips of dermal papillae
basal cells overlying tips show dermoepidermal separation
180
immunofluorescence in dermatitis herpetiformis
discontinuous granular deposition of IgA in tips of dermal papillae
181
diagnosis of dermatitis herpetiformis
```
skin biopsy
antiendomysial antibodies (specific for TG)
endoscopy-blunting of villi in small bowel
```
182
treatment of dermatitis herpetiformis
gluten-free diet (slow response)
| dapsone-check G6PD, monitor methemoglobin and CBC
183
epidermolysis bullosa
inherited defects in proteins that lend stability to skin
blisters at points of pressure, rubbing, trauma
symptoms at or soon after birth
184
simplex epidermolysis bullosa
mutations to keratin 14 or 5
| results in basal cell layer defects
185
junctional type epidermolysis bullosa
from separation of lamina lucida
186
dystrophic type epidermolysis bullosa
below lamina densa from defect in collagen VII
| scar formation on healing
187
non-herlitz junctional epidermolysis bullosa
defect in laminin VBeta3
188
histology of epidermolysis bullosa
firin deposition in floor of blister
| dermal fibrosis may be present
189
associations of porphyria cutanea tarda
females on OCPs
alcohol use
Hep C
190
deficiency in porphyria cutanea tarda
uroporphyrinogen carboxylase deficiency (UROD)
191
type 1 porphyria cutanea tarda
exposure to drugs/chemicals
| hepatic UROD is inhibited
192
type 2 prophyria cutanea tarda
AD
| deficient in RBCs and fibroblasts
193
porphyria cutanea tarda
porphyrins make skin sensitive
| may also get hypertrichosis
194
exacerbations of prophyria cutanea tarda
```
iron
alcohol
smoking
estrogens
hep C
HIV
halogenated hydrocarbons
```
195
diagnosis of porphyria cutanea tarda
test for increase in uroporphyrin in urine
| fluoresce orange under Wood's lamp
196
histology of porphyria cutanea tarda
subepidermal vesiculation
acral skin with compact orthokeratosis
solar elastosis
festooning-protuberance of rigid dermal papillae into blister cavity
thickening of walls of superficial dermal vessels
197
pathogenesis of acne vulgaris
obstruction of sebaceous follicles by sebum promotes proliferation of P. acnes (anaerobe)
198
obstructive acne
closed comedones-whiteheads
| open comedones-blackheads (dilated pore with keratinous material)
199
inflammatory acne
lesions progress from papules/pustules to nodules to cysts
200
risk factors for acne
```
male
puberty
Cushing's syndrome
oily complexion
androgen excess
```
201
components of acne
keratinization of lower portion of follicular infundibulum with development of keratin plug blocking outflow of sebum to skin surface
hypertrophy of sebaceous glands with puberty
lipase syntehsizing bacteria colonize upper and midportion of hair follicle
inflammation of follicle associated with release of cytotoxic and chemotactic factors
202
acne rosacea
chronic infalmmatory disorder tha affects blood vessels and pilosebaceous units
between 30-50 yo
203
triggers of acne rosacea
sun exposure, alcohol, spicy foods, exercise, stress, temperature extremes
204
stages of acne rosacea
```
flushing episodes-pre rosacea
persistent erythema and telangiectasias
pustules and papules
rhinophyma
affects nose and cheeks including nasolabial folds
```
205
rhinophyma
skin on nose becomes thick and greasy
| hyperplasia of sebaceous glands, connective tissue and vasculature
206
treatment of acne rosacea
topical metronidazole and oral doxycycline
207
histology of acen rosacea
perifollicualr infiltrate of lymphocytes surrounded by dermal edema and telangiectasias
208
erythema nodosum
inflammatory reaction of connective tissue septa separating fat lobules
most common in females 20-30
209
location and appearance of erythema nodosum
painful, red, subcutaneous, elevated nodules-indurated and poorly circumscribed
usually on the anterior aspect of the tibia
bilateral but not symmetric
210
causes of erythema nodosum
```
idiopathic
strep
sarcoidosis
IBD
fungal infection
pregnancy
meds-OCP, sulfa, amiodarone, antibiotics
syphilis
TB
```
211
workup for erythema nodosum
CXR
VDRL for syphilis
(pregnancy test first)
212
treatmetn for eryhtema nodosum
bed rest, leg elevation, NSAIDs, heat for symptoms
| steroids only when infection excluded
213
histology of erythema nodosum
septal panniculitis
widening of septa from fibrin, edema, neutrophilic infiltrate
mononuclear cells and granulomatous inflammation of septum with fibrosis in chronic
214
warts
benign growths caused by infection of epidermal cells with HPV
transmitted by skin to skin contact
disrupt skin lines
215
intralesional brown-black dots on warts
thrombosed vessels
216
sites of verruca vulgaris
elbows
knees
fingers
palms
217
sites of verruca plana
chin
dorsum of hands
legs
218
plantar warts
HPV1
| may cause pain if on pressure areas
219
cause of condyloma acuminatum
HPV 6 and 11
| 16 and 18 can lead to cervical cancers
220
histology of verruca vulgaris
exophytic
| church spire
221
koilocytes
cells with vacuolated cytoplasm-clearing around the nucleus
222
molluscum contagiosum
viral infection in kids and sexually active adults
caused by poxvirus
transmitted by skin to skin contact
223
lesion in molluscum contagiosum
central umbilication
papules have cheesy core
anywhere on kids and genitals of sexually active adults
224
histology of molluscum contagiosum
```
cup-shaped lesion with scalloped border
verrucous acanthosis (epidermal hyperplasia)
molluscum bodies in cells of stratum cornum and granulosum (ovoid, homogeneous, cytoplasmic inclusion bodies)
```
225
impetigo
superficial bacterial infection
| painful lesions
226
nonbullous impetigo
most common
face and extremities
papules to vesicles on eryhtematous base
honey colored crust when ruptured
227
bullous impetigo
young children
vesicles enlarge to form flaccid bullae
trunk is more frequently affected
228
histology of impetigo
accumulation of neutrophils beneath stratum corneum
229
treatment of impetigo
mupirocin (bactroban) or hydrogen peroxide
| oral antibiotics for bullous type
230
scabies
infection with sarcoptes scabiei
common in school age children, nursing home patients, less developed children
incubation 1 month
231
sites for scabies
finger webs, wrists, penis
| linear burrows with dark dot-path of female mite in skin
232
reaction to feces and eggs in scabies
delayed type IV hypersensitivity
233
scabies treatment
permethrin or lindane lotion
oral ivermectin
treat all close contacts
itching may last for weeks but not contagious at that point
234
xanthelasma
macrophages containing lipid droplets
| always check lipids
235
associations of xanthelasma
```
familial hyperlipidemias
nephrotic syndrome
myeloma
pancreatitis
thyroid disease
primary biliary cirrhosis
```
236
mongolian spot
single gray-blue lesion over lumbosacral area
more common in Asians and Native American patients
no melanomas in this lesion
melanocytes in dermis instead of epidermis may be neural crest cells interrupted in migration
237
cherry angioma
bright red domed, vascular lesions on trunk
| benign and increase with age
238
hemangioma of infancy
most common tumor of infancy
more common in premature, Caucasian girls
tumor of hyperplastic blood vessels
blanchable bright red to deep purple lesions
grow in first year and regress by 10
239
treatment of hemangioma of infancy
only if it ulcerates or blocks ears, larynx, eyes
| propranolol, steroids, laser
240
phases of hair development
anagen (growing)
catagen (involution)
telogen (resting-shed at end)
241
angrogenetic alopeica
scalp 5 alpha reductase
| men and women equally affected
242
telogen effluvium
diffuse decrease in hair density due to rapid conversion of anagen to telogen
precipitated by stressful events, illness, fever, pregnancy
243
alopecia areata
autoimmune disorder causing patchy or diffuse hair loss
244
treatment for alopecia
areata-topical steroids
| androgenetic-topcial minoxidil or finasteride (inhibits DHT), spironolactone in women
245
xeroderma pigmentosum
AR condition
decreased ability to reapir DNA following damage by UV light due to defects in excision of abnormal nucleotides or defects in replacement of nucleotides following excision
246
signs of xeroderma pigmentosum
eryhtema, scaling, hyperpigmentation and lentigo on light-exposed area
skin later-atrophy, telangiectasia, intermingling areas of hyper and hypopigmentaiton
SCC, BCC, and melanoma as early as 5-6 yo
247
chediak-higashi syndrome
AR
immunodeficiency due to defect in neutrophil phagosome lysosome fusion causing giant lysosomal inclusinos visible on peripheral blood smear
pyogenic infections
albinism-abnormal melanin storage in melanocytes
nystagmus, peripheral and cranial neuropathies
248
wiskott-aldrich syndrome
```
x linked
immunodeficiency
eczema
thrombocytopenia
combined B and T lymphocyte disorder
```
249
albinism
melanocytes normal in number and location but production of melanin defective due to complete absence of tyrosinase
white hair, blue eyes and pink/white skin
