Derm Blistering And Inflammatory Dermatoses Flashcards
Patient presents with bullae on the skin and the oral mucosa that rupture easily. What is this called? What causes it? WhAt kind of hypersensitivity rxn? What does immunofluoresence show? Why does it rupture easily?
Patient has PEMPHIGUS VULGARIS caused by autoimmune destruction of desmosomes between keratinocytes due to IgG antibody against desmoglein which is a type 2 hypersensititivity. There is separation of stratum spinosum keratinocytes leading to supra basal blisters. IF shows IgG highlights surrounding keratinocytes in a fish net pattern.
Which layer has desmosomes and which has hemodesomosomes?
Stratum spinosum has desmosomes and stratum basalis has hemodesomosomes which give it a tombstone appearance in PEMPHIGUS VULGARIS.
Patient who lives in the nursing home presents with tense blisters in the skin. When examining the oral mucosa, you notice that there are no blisters inside the mouth. What disease presents with this? What is causing this? How does it look under IF?
Patient has BULLOUS PEMPHIGOID which is IgG mediated ai destruction of the hemidesmosomes between basal cells and the underlying basement membrane. These tense bullae don’t rupture easily and IF shows linear pattern along the basement membrane.
Patient presents to the gastroenterologist with discomfort after drinking wheat beer. She noticed that she developed an itchy rash on her right arm. What does she have? What is causing the rash?
She has dermatitis herpetiformis which is an autoimmune deposition of IgA at the tips of dermal papillae. Presents as pruritic vesicles and bullae that are grouped together. Strong celiac disease association, that’s why she should go on a gluten free diet.
37 year old teacher comes to your office with red rashes with a white center on her left hand. She does not have any rashes on her lips. Her history is positive for herpes infection. What does she have? What usually causes this?
She has erythema multiforme with is a hypersensitivity reaction with a targetoid rash and bullae. The white in the center is due to necrosis. Other causes are autoimmune diseases, penicillin , sulfonamide and mycoplasma infection.
37 year old teacher comes to your office with red rashes with a white center on her left hand. She has rashes on her lips. Her history is positive for herpes infection. What does she have? What usually causes this?
She has Steven Johnson syndrome. Toxic epidermal necrolysis is a severe form of SJS characterized by diffuse sloughing of skin, resembling a large burn. Most often due town adverse drug rxn.
Asthmatic patient comes to the clinic with a puffy face and an itchy red rash that is oozing. What does he have? What type of hypersensitivity? What other disease is associated with this?
He has ECZEMA (Atopic dermatitis) usually involving face and flexors. Type 1 hypersensitivity. Also associated with allergic rhinitis.
Asthmatic patient comes to the clinic with a puffy face and an itchy red rash that is oozing. He mentioned this started the day after his big birthday bash where he received some nice gifts especially his favorite watch from his dad. What does he have? What else causes this issue? How would you treat?
He has CONTACT DERMATITIS due to exposure to allergens such as poison ivy, nickel jewelry, irritant chemicals and drugs. Type 4 hypersensitivity. Treatment is removing offending agent and treating with glucocorticoids if needed.
A 15 yo teen comes to you with acne issues. He wants to know why this is happening to his skin and how he can treat it. What do you tell him?
He has acne VULGARIS (white and black heads). This is due to chronic inflammation of hair follicles and associated sebaceous glands. Hormone associated increase in sebum production coupled by follicle block due to excess keratin production creates a bottle neck forming comedones. Propionibacterium acnes infection produces lipases that break down the sebum releasing pro inflammatory fatty acids causing pustule formation. Tx with benzoyl peroxidase (anti microbial) and vitamin A (isotretinoin) to reduce keratin production.
A 19 year old patient presents with salmon colored plaques on her triceps and scalp with a silvery scale. Her nails also show some pitting. What is causing this? What would you see on histology and how would you treat?
She has psoriasis which is due to excessive keratinocytes proliferation. Possible autoimmune etiology with HLA-C. Lesions often arise in trauma areas. Histology shows epidermal hyperplasia, para keratosis (hyper keratosis with retention of keratinocyte nuclei in stratum corneum), neutrophil collection in stratum corneum, and thinking of epidermis above elongated dermal papillae, resulting in pinpoint bleeds when scale is picked (Auspitz sign). Tx is corticosteroid, UV light with psoralen (damages keratinocytes) or immune modulating therapy.
You are a pathology resident and you examine a slide that shows a lot of inflammation and a pattern that is saw tooth like at the epidermal dermal junction. When examining a patient with this histology, what would you expect on physical exam? What is this disease associated with?
This is LICHEN PLANUS. On physical exam, you will see 5ps, which are pruritic, planar, polygonal, purple papules with reticular white lines on their surface (Wickham Striae) and the mouth as well with Wickham pattern. Associated with chronic hep c.
