Derm Final Concepts Flashcards
Type of skin cancer; slow growing pink pearly papule/nodule with telangiectasis; fair skin and found on sun exposed areas (UV exposure is greatest risk); metastases RARE; Keratinocyte origin but no pre-cancer precursor like SCC; can be superficial or pigmented
Basal Cell Carcinoma
Pink macule or patch or thin papule (Superficial/Pigmented)
Superficial BCC
Seen in darker skin types (Superficial/Pigmented)
Pigmented BCC
Treatment for BCC
Surgical: Mohs surgery, curettage, excision
Non-surgical: Imiquimod
Pigmented skin cancer; Melanocyte origin; can arise de novo or from a pre-existing nevus; demonstrates any of the ABCDEs (asymmetry, borders, color, diameter and evolving); risk factors include lighter skin, hx of sunburns/tanning bed use, family hx, higher # of moles, red hair
Melanoma
melanoma in the epidermis or epidermal-dermal junction only with no invasion of dermis
Melanoma in situ
KEY prognostic factor for Melanomas; measurement from s. granulum to deepest point of melanoma invasion in dermis
Breslow depth
Type of biopsy needed for melanoma diagnosis
Excision biopsy (remove the entire lesion to accurately measure Breslow depth)
Tx for Breslow depth <0.8 mm
wide local excision or Mohs surgery
Tx for Breslow depth >0.8 mm
wide local excision and ALSO sentinel lymph node biopsy to assess for metastatic disease
If melanoma biopsy confirms metastatic disease, what needs to be confirmed for treatment?
genetic mutations to dictate the most effective immunotherapy
What genetic mutations are the most common in melanoma?
BRAF & CDKN2A
Pinpoint pink papules around nose, mouth, maybe eyes; can last up to months but not long-term like rosacea; can be triggered by aerosolized steroids and worsened by topical steroids
Perioral Dermatitis
Treatment for perioral dermatitis
topical metronidazole + oral antibiotics (doxy or minocycline)
a very common chronic skin disease due to inflammatory response to Malassezia (fungi); diffusely through areas of high sebum production (scalp, ears, central chest); erythema with overlying greasy yellow scale; infantile type is called “Cradle Cap”; hypopigmentation in darker skin
Seborrheic Dermatitis
Severe disease of _____ can be seen in untreated HIV or parkinson disease
Seborrheic Dermatitis
Treatment for Seborrheic Dermatitis
topical steroids (for flares) and ketoconazole (for Malassezia)
chronic disease that presents as largely symmetric erythematous well-defined plaques with overlying silvery scale; extensors (elbows, knees) and scalp, buttocks, sacrum, umbilicus are common locations; thought to be due to cytokines triggering a hyperproliferative state resulting in thick skin and excessive scale
Psoriasis
MOST COMMON type of psoriasis
Plaque Psoriasis (silvery scale)
type of psoriasis commonly seen in younger people; often seen after STREPTOCOCCAL pharyngitis
Guttate Psoriasis
type of psoriasis morphology; lesions located in SKIN FOLDS (axilla,groin, etc.); may lack scale due to moistness of area
Inverse/Flexural psoriasis
type of psoriasis; widespread, generalized erythema covering nearly ALL (>80%) of the body surface; hospitalization is sometimes needed
Erythrodermic psoriasis
type of psoriasis morphology; pustules; triggered by corticosteroid withdrawal; generalized; can be LIFE-THREATENING
Pustular psoriasis
indicates higher risk of psoriatic arthritis (90% have it); can involve pitting, onycholysis (separation of nail plate from nail bed) and hyperkeratosis
Nail Psoriasis
Psoriasis is complicated ____ driven disease involving cytokines (TNFa and IL-23)
T-cell
What cytokine stimulates Th17 cells to release IL-17 and IL-22 leading to proliferation of keratinocytes and dermal inflammation?
IL-23
High levels of ____ correlate with psoriasis severity
IL-22
What gene accounts for up to 50% psoriasis?
PSORS1
Histopathology of psoriasis
- Regular acanthosis with elongated rete ridges
- Vessels in dermal papillae
- Parakeratosis and lack of s. granulosum
- munro microabscesses (neutrophils on top of parakeratosis)
Treatment for Psoriasis
- Topical steroids first for limited disease
2. Phototherapy, Biologic agents (TNF-a inhibitors) and Oral meds (Methotrexate) for systemic/widespread disease
Acute red scaly rash that occurs in adolescents/young patients; starts as a HERALD patch (ring-shaped with clear center) and will progress to a CHRISTMAS TREE pattern along skin lines on trunk; unknown etiology but maybe associated with HHV6 infection; SELF-LIMITING in 6-8 weeks; no treatment needed
Pityriasis rosea
Type I hypersensitivity reaction (Th2 cytokine predominance) that commonly impacts infants and young children; itchy (pruritus) rash; associated with other atopic diseases (seasonal allergy, asthma); commonly seen in flexural areas; increased serum IgE
Atopic Dermatitis
Atopic dermatitis is caused by what mutation?
FLG (filaggrin) gene mutation –> epidermal barrier dysfunction –> transepidermal water loss
Atopic dermatitis puts at risk for what secondary infections?
staph causing impetigo (crusting lesions)
Treatment for atopic dermatitis
Repair epidermal barrier function (topical steroids first line tx & thick moisturizers to treat xerosis)
What must be avoided as tx for Atopic Dermatitis?
systemic steroids (oral like prednisone) can cause rebound symptoms
50-80% of children with Atopic Dermatitis will have another atopic disease, like Asthma or Allergic Rhinitis
Atopic Triad/March
Eczema seen classically in lower legs in adults, very itchy and nummular (coin shaped)
Nummular Eczema
Eczema described as “dry riverbed”, superficial fissuring from extreme dry skin leading to dermatitis; common in lower legs in winter months
Asteatotic Eczema
Tx for Eczema (nummular and asteatotic)
moisturizer, topical steroids
Skin disease seen in patients with lower extremity edema who then develop overlying dermatitis; DO NOT confuse with bilater lower extremity cellulitis; no fever, chills
Stasis dermatitis
Tx for Stasis dermatitis
compression stockings, topical steroids
Autoimmune blistering disease; generalized tense bullae; 20% involve mouth; intensely itchy (Pruritic)
Bullous Pemphigoid
Elderly (Chronic); histology shows subepidermal bullae with eosinophils; DIF shows linear IgG and C3 at the basement membrane zone
Bullous Pemphigoid
TX for Bullous Pemphigoid
potent topical steroids if localized; prednisone (Short term); steroid-sparing agents (Maintainance)
Autoimmune blistering disease; generalized erosion with crusting; mouth always involved; erosion rather than blisters; Positive Nikolsky sign
Pemphigus Vulgaris
Histology shows intraepidermal split (no eosinophils), DIF shows fishnet IgG and C3 in the epidermis
Pemphigus Vulgaris
TX for Pemphigus Vulgaris
potent topical steroids if localized; prednisone (Short term); steroid-sparing agents (Maintainance)
Very itchy, red-pink edematous papules and vesicles; linear (poison ivy) or geometric shapes to the rash; Delayed-type hypersensitivity (4)
Allergic contact dermatitis
The most common cause of allergic contact dermatitis is
Nickel
- then fragrances, neomycin, poison ivy
TX for Acute allergic contact dermatitis
Topical steroid or prednisone depending on the severity
Fungal skin infection often caused by microsporum canis; causes fragility and breakage of the hair leading to multiple patchy ALOPECIA and black dot patches on scalp; reversible; 2 types
Tinea Capitis
type of tinea capitis in which spores coat the hair
ectothrix
type of tinea capitis in which spores are in the hair
endothrix
Treatment for Tinea Capitis
oral antifungals since TOPICAL INEFFECTIVE
What tinea is more common in kids than adults?
Tinea Capitis
presents within minutes to hours of ingestion; transient, pruritic erythematous edematous plaques anywhere on the body: wheals
Acute Urticaria
skin disorder due to mast cell degranulation and release of histamine
Acute Urticaria
tx for acute urticaria
Stop the offending medication, H1 antihistamines, +/- second-generation H1 antihistamines, +/- prednisone taper
flesh-colored or brown verrucous papules and plaques occurring anywhere except mucus membranes/palms/soles; Very common in late middle age/elderly; Look “stuck on”; sun exposure is a risk factor;
Seborrheic keratosis
