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DERM Flashcards

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Dermatology Board Prep flashcards
1
Q
A

Pyogenic Granuloma

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2
Q

Psoriasis cytokines

A
  • TNFa, IL23( and 12), IL17
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3
Q

Epidermal Inclusion Cyst (EIC)

A
  • Benign, mobile SubQ nodule, often with underlying punctum
    • Arises from hair follicles
    • May discharge foul smelling white material
  • I&D only for ruptured EICs that create abscesses
  • Can be surgically removed if complaints of pain, discomfort, or Hx of inflammation
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4
Q

Epidermolytic Ichthyosis

A
  • KRT 1/10 mutation
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5
Q
A

Pyogenic Granuloma

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6
Q

Contact dermatitis

A
  • Irritant
    • TNFa driven
  • Allergic
    • Cell-cell mediated immune response (requires prior sensitization) - delayed reaction
    • Langerhans cells, lymphocytes, IgE production, IL-9 and IL-17
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7
Q
A

Seborrheic Keratosis

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8
Q

Bullous Pemphigold

A
  • Autoantibodies against collagen 17 (hemidesmosome protein)
  • Most common in older adults
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9
Q
A

Solar Lentigo

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10
Q

Cornified layer of epidermis

A
  • Cell death but cross-linked keratin bundles are preserved
  • Cornified envelope surround these corneocytes
    • Protein cross-links via transglutaminases (like TGM1)
    • Embedded in lamellar membrane of secreted, insoluble lipids
    • “Brick and mortar”
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11
Q

Merkel cells

A
  • Mechanoreceptors in the epidermis
  • Convey sense of light touch with nerve endings in basal layer
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12
Q

Staph-mediated desmosome cleavage via toxin occurs in…

A
  • Staphylococcal scalded skin syndrome (newborns)
  • Bullous impetigo (children)
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13
Q

Cherry angioma

A
  • Benign, shiny bright red papule
    • Common to have multiple spots
  • Common on trunk, but can be anywhere like face/scalp
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14
Q
A

Sebaceous Hyperplasia

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15
Q

Acrochordons

A
  • Aka skin tags
  • Benign soft fleshy papules that are skin colored to brown
    • Axilla, neck, groin, eyelids
    • Often pedunculated - connected to skin via small stalk
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16
Q

Hair follicle

A
  • Anagen (growth) phase → Catagen (involution) phase → Telogen (rest) phase
  • Of epithelial origin and associated with arrector pilorum muscles and sebaceous glands
  • Hair follicle bulge important multipotent stem cell niche for not only producing hairs but also healing epidermal wounds
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17
Q

Psoriasis treatment

A
  • Widespread
    • Biologics targeting TNFa, IL23(12), IL17
    • Cyclosporine, MTX
  • Local
    • High potency topical steroids (Clobetasol, triamcinolone)
    • Topical VitD analogs - Calcipotriene
  • Narrowband UVB light
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18
Q

Spinous layer of epidermis

A
  • Keratinocytes begin process of terminal differentiation
  • Keratin 1 and 10
  • Desmosomes at cell-cell junctions = integrity
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19
Q

Two layers of the dermis

A
  • Papillary dermis
    • Under epidermis, less dense CT
  • Reticular dermis
    • Between papillary dermis and SubQ fat
    • More dense CT
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20
Q

Foul smelling white discharge

A

Epidermal Inclusion Cyst (EIC)

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21
Q

Alopecia areata associations

A
  • Physiological/emotional distress
  • Thryoid disease (check TSH), vitiligo, diabetes,
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22
Q

Triggers of psoriasis

A
  • Streptococci (Strep pharyngitis)
  • Stress/trauma to skin
  • Drugs - lithium and B-blockers
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23
Q

Follows injury to skin like insect bite or inflammed hair follicle

A

Dermatofibroma

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24
Q

Elastic fiber disorders

A
  • Marfan syndrome
    • Mutation in fibrillin 1 gene (FBN1)
  • Elastolysis (Congenital cutis laxa)
    • Mutations in elastin gene (ELN) and other genes that affect elastic fiber formation
    • Skin slacks and hangs in folds
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25
Q

Collagen diseases disorders

A
  • Scleroderma
    • Chronic autoimmune disease with excess collagen deposition (fibrosis)
    • Vascular and autoantibody abnormalities
  • Keloids
    • Excess collagen → fibrous scars
    • More prevalent in pigmented individuals
26
Q
A

Hemangioma

27
Q

Solar Lentigo

A
  • Benign flat light brown macules
    • Due to sun damage - sun exposed regions
  • Aka sun spots, liver spots, age spots
  • No treatment required, but indicate patients at risk for skin cancer due to sun exposure
  • Histology: Increased melanin, no increase in melanocytes
28
Q

Langerhans cells

A
  • Bone-marrowed derived, dendritic APCs
  • Suprabasal layer of epidermis
  • Regulate immune responsiveness in skin (alert and dampen)
29
Q

Hemangioma

A
  • Benign, raised soft, easily compressed vascular growths
    • aka Strawberry hemangiomas
    • Usually solitary
  • Commonly head and neck, but can occur anywhere
  • Most common benign tumor of childhood, present at birth or within first few weeks of life
    • Slowly dissapears after first year of growth
30
Q

Pyogenic granuloma

A
  • Benign, eruptive, small solitary sessile or pedunculated vascular raised papule
  • Bleeds easily with trauma
  • Relatively quick onset
31
Q
A

Acrochordon (Skin tag)

32
Q

Pemphigus vulgaris/foliaceous

A
  • Autoantibodies against proteins found in desmosomes
    • Breaks connection between adjacent keratinocytes
33
Q

Pityriases rosea

A
  • Exanthema - salmon colored papules/macules
    • Herald patch → development of other smaller macules
  • Mostly trunk, Christman tree distribution
  • Self-resolving (lasts 3-8 weeks), only treat with topical steroid if complaint of itch
  • Possibly viral etiology - reactivation of HHV6/7
    • Cold/flu-like symptoms before rash
  • ​DDx: Secondary Syphilis
34
Q

Types of psoriasis

A
  • Guttate - smaller, coin-sized plaques
    • Precedes sore throat, strep, viral infection
  • Pustular
  • Palmo-plantar
  • Erythroderma - red, scaly involvement of entire body
35
Q

Distribution of AD with age

A
  • Infancy – Facial and scalp dermatitis
  • Toddler – Extensor dermatitis (over elbows and knees)
  • Older children/young adults – Flexural distribution (Antecubital and popliteal fossa; mentions anterior neck, wrist, ankles too)
  • Adults – More head (also eyelids), neck, hand lesions
36
Q

Follows injury to skin like insect bite or inflammed hair follicle

A

Dermatofibroma

37
Q

Dupilumab

A
  • IL-4/13 monoclonal antibody
  • Main SFx: Conjunctivitis (allergic/non-allergic) and injection site reaction
38
Q

Ichthyosis vulgaris

A
  • Caused by filaggrin mutations
  • Predisposes patients to eczema and other chronic inflammatory skin disorders
39
Q

Keloid

A
  • Benign firm plaque or nodule, often smooth.shiny surface
    • Hyperpigmented, pink, or red
  • Site of previous tissue trauma - burn, cut, acne, piercing
    • Excess scar tissue out of control
  • Can be tender, itchy
  • Treatment: Interlesional steroid injection can help flatten and alleviate itch/pain
40
Q

4 layers of epidermis (basement to surface)

A
  • Basal layer
  • Spinous layer
  • Granular layer
  • Cornified layer
41
Q

Seborrheic Keratosis

A
  • Benign superficial raised epidermal growths
    • Sometimes fissures and cracks
    • Tan/brown/black in color
  • Anywhere on body EXCEPT palms and soles
  • Common after 30yo
  • Often multiple, can be extensive, doesn’t go away
42
Q

Lipoma

A
  • Benign, soft ill-defined rubbery, painless subQ nodules
  • Usually larger than cysts and without pain/discharge
43
Q

Sebaceous Hyperplasia

A
  • Benign cream-colored or yellowish, round elevated papule with central depression
  • Usually face and multiple in number
  • 40yo age of onset
44
Q

Foul smelling white discharge

A

Epidermal Inclusion Cyst (EIC)

45
Q

Psoriasis

A
  • Chronic inflammatory skin disease that waxes and wanes, onset at any age, M=F
    • Improper keratinocyte maturation and shedding
  • Raised, well-defined scaly rash with silverly scale
    • Pink/salmon colored underneath
    • Redness - blood vessels closer to surface, proliferate, dilate
  • Anywhere, but commonly elbows and knees
    • Trunk, extremities, scalp, and genitals
  • Nail bed pitting and onycholysis
46
Q

Atopic dermatitis

A
  • FLG (Filaggrin 1) gene mutation
  • Inflammation driven by Th2 T cells releasing IL-4 and IL-13
    • Also leads to IgE elevation
  • Increased IL-31 expression → itch/pruiritis
    *
47
Q
A

Keloid

48
Q

Sebaceous gland

A
  • Acini cells that produce complex set of lipids
  • Ductal epithelial cells → keratinocytes that move from sebaceous gland duct into hair follicle canal
  • Holocrine secretion - dumping of contents from sebocytes into sebaceous gland
49
Q

Melanocytes

A
  • Neural crest-derived, pigment producing cells in epidermis
  • Synthesize melanin-containing melanosomes which are secreted directly into keratinocytes
50
Q

Basal layer of epidermis

A
  • Anchors to BM/ECM of underlying dermis via hemidesmosomes
  • Micture of proliferating and nonproliferating keratinocytes
  • Stem cells
    • Self-renewal
    • Wound repair
  • Keratin 5 and 14
51
Q

Epidermis Bullosa Simplex

A
  • KRT 5/14 mutation
  • Relatively mild blisters in hands/feet, usually improves with age
52
Q
A

Lipoma

53
Q

AD treatment

A
  • Mild AD
    • Topical agents: steroids and calcineurin inhibitors (tacrolimus)
  • Moderate/Severe AD
    • Systemic agents: Steroids/Tacrolimus, cyclosporine, mycophenolate mofetil, MTX, Azathrioprine
    • Light therapy and lasers
    • Dupilumab
54
Q

Seborrheic dermatitis

A
  • Redness and waxy scaly patches on scalp, hairline, eyebrows, nasolabial/melolabial folds, beard distribution
  • Etiology may be related to yeast (pityrosporum ovale)
  • Treatment: antifungals and low potency topical steroids
55
Q

Junctional Epidermolysis Bullosa

A
  • Mutation in COL17A1 (hemidesmosome gene)
  • Severe, often fatal subepidermal blistering
56
Q
A

Cherry Angioma

57
Q

AD associations

A
  • Weather/climate/environmental exposure
  • Obesity
  • Type 2 diabetes
  • HTN
  • HLD
58
Q

Granular layer of epidermis

A
  • Keratinocytes produce granules containing filament aggregating proteins (like profilaggrin)
    • Filaggrin bundles keratin filaments for barrier formation and prep for final stages of differentiation
  • Keratin 1 and 10
  • Tight junctions complement lipid barrier of cornified layer
    • Semipermeable = limits water loss, prevents entry of noxious agents and pathogens
59
Q

Sweat apparatus ducts

A
  • Eccrine and apocrine glands - secretory coil and duct
  • Eccrine - secretes products directly onto skin
    • Reabsorb sodium from secretory coil making product more hypotonic
  • Apocrine - secreted products in hair follicle canal
60
Q

Dermatofibroma

A
  • Benign solitary small round firm papule
    • Pink/Reddish brown/Hyperpigmented (Variable)
    • “Dimple sign”
  • Follows injuries to skin like insect bites or inflammed hair follicles, scars
  • Lower extremities

MSK/DERM (2 decks)

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