DERM: Nodules & Papules I & II Flashcards
verrucae / condyloma acuminatum - pathogenesis
- HPV infects underdifferentiated epithelial cells in the stratum basal then -> ascends thru upper layers -> infects terminally differentiated squamous cells = koilocytes
- HPV 6, 11 (m/c - low malignant risk)
- HPV 16, 18 (high malignant risk)
verruca vulgaris - presentation
d/t HPV
-
= common wart: papules that are
- keratotic
- velvet textured / rough
- tend to occur on the hands
condyloma acuninatum - presentation
d/t HPV
-
= anogenital wart
- cauliflower-surfaced
- pedunculated
- on genitalia / urethra / perianal / tissue OR lips
verrucae vulgaris / condyloma acuminatum - diagnosis
= presence of koilocytes:
- altered squamous epithelial cells with irregular nuclei:
- pyknotic, dense nucleus
- surrounded by clear perinuclear space (halo)
identify picture. what is its significance?
koilocytes: HPV infected squamous epithelial cells with abnormal nuclei: pyknotic & surrounded by clear pernuclear space
diagnostic of verrucae / condyloma accunimanatum
identify each picture
- verruca vulgaris: keratotic, velvet textured common warts typically on hands
- condyloma accuminatum: cauliflower-surfaced, pendunculated, anogenital warts
verrucae / condyloma acuminatum
- prognosis
- therapy
- prevention
- prognosis: m/c dissapear w/in 2 years
- therapy: removal - cryosurgery / curretage OR topicals
- prevention: safe sex & HPV vaccine (Gardasil 9)
condyloma latum - pathogenesis
= genital secondary syphyllis
treponema pallidum (a highly infectious STI) creates chanrce at innoculation site
condyloma lata - presentation
= treponema pallidum
- skin: papules that are
- hypertrophic
- smooth & flat
- white
- moist
- systemic: general prodrome
condyloma latum
- diagnosis
- prognosis
- therapy
- prevention
= treponema pallidum
- diagnosis:
- RPR / VDLR then FTA-ABS - m/c
- spirochetes in darkfield microscopy, also
- prognosis - follows that of syphyllis
- therapy - benzanthine penicillin G
- prevention - safe sex
identify picture - why is it significant?
darkfield microscopy showing spirochetes (treponema pallidum) - dx of condyloma latum
kaposi sarcoma - pathogenesis
-
HHV-8 infection of endothelial cells (capillary lining) leading to -> angioproliferative diseases, the progression of which depends on the demographic infected
- IC (AIDS / transplant recipients): fulminant (rapid) progression
- genetic predisposition: indolent (slow) progression
kaposi sarcoma - presentation
HHV -8
- systemic:
- genetic (indolent): lymphedema (leg edema)
- fulminant lesions: joint, GI
- skin: reddish-purple vascularized macules -> progress into tumors / nodules
- genetic (indolent) lesions: on lowers limbs
- fulminant lesions:
- sun-exposed skin
- mucous membranes
kaposi sarcoma - diagnosis
-
spindled endothelial cells with
- extravasated RBCs
- hemosiderin laden macrophaeges
kaposi sarcoma
- prognosis
- therapy
- prevention
- prognosis: is a latent incurable infection (HHV-8) though asymptomatic (rarely, multi-organ failure in fulminant pts)
- therapy:
- removal
- radiation
- chemotherapy
- prevention: avoid contracting HIV
identify lesions
kaposi sarcoma
reddish-purple vascularized macular / maculopapular nodes on exposed skin / mucous membranes
cutaneous tuberculosis
- pathogenesis
- presentation
- diagnosis
- pathogenesis. m tuberulosis (acid-fast aerobic bacillus) forms caseating (necrotic) granulomas
- can be triggered by BCG vaccination
- presentation: depends on if infection of primary or secondary:
- primary: enters skin via trauma sites
- no prior exposure to TB - > papule / nodule (“innoculation chancre”
- rrior exposure to TB -> warty lesions (“verrucosa cutis”)
- secondary: patient with TB In lung that dissseminates
-
tuburculoid granulomas
- red-brown
- painless
- on the head or the neck
-
tuburculoid granulomas
- primary: enters skin via trauma sites
- diagnosis:
- Mantoux test / IGRA test (no false + from vax)
- lesions beomes yellow-brown “apple jelly” upon application of pressure
leprosy / hansen’s disease
- pathogenesis
- presentation
- diagnosis
- prevention:
- pathogenesis: m. leprae (acid fast bacillus) -> type IV hypersenstivity reaction -> granulomas (caseating and non-caseating)
- presentation: 3 forms - all hypoesthetic
-
tuberculoid form: mild, confined to skin and peripheral nerves
-
ceseating granulomas (necrotic): tuberculoid granulomas:
- on buttocks / back / extremities / face
-
ceseating granulomas (necrotic): tuberculoid granulomas:
-
lepreomatous form: severe, in cool superficial locations:
- non-caseating granulomas: surrounded by foamy macrophages
- ENL (erythema nodosum leprosum): major cause of blindness
-
tuberculoid form: mild, confined to skin and peripheral nerves
- complications:
- possible orchitis
-
erythema nodosum lepromus - a reaction to therapy for leprosy / hansens
- = panniculitis: red, hot painful papules
- prevention: BCG vaccine
compare and contrast the etiological agents of
- cutaneous tuberulosis
- leprosy / hansen’s disease
- both are acid fast aerobic bacillus
- m. tuberulosis:
- NOT an obligate intracellular pathogen
- growth NOT restricted at 37 C
- m. leprae is
- obligate intracellulate
- growoth restricted at 37 C
- m. tuberulosis:
what type of mycobacterium infection leads thickened dermis with no visible lesions?
diffuse lepromatus
treatment of leprosy / hansen’s can lead to what reaction?
how does it present?
-
erythema nodosum (panniculitis): lesions that are
- red
- hot
- painful
endemic opportunistic cutaneous mycosis -> granulomas -> erythema nodosum
coccidioies - thick-walled spherules containing endospores
m/c in SW: CA, AZ, NM, TX
endemic opportunistic cutaneous mycosis -> granulomas -> erythema nodosum
coccidioies - culture (mold): arthroconidia
m/c in SW: CA, AZ, NM, TX
endemic opportunistic cutaneous mycosis
blastomycosis: broad-based budding yeasts
in N&C america: missippi, ohio, great lakes
endemic opportunistic cutaneous mycosis
blastomycosis: culture (mold) - hyphae with lollipop microconidia
in N&C america: missippi, ohio, great lakes
endemic opportunities cutaneous mycosis
histoplasmosis: narrow based budding in chains
N&C america - Missippo, Ohio, Great lakes AND from bat droppings
endemic opportunities cutaneous mycosis
histoplasmosis: culture (mold) tubuerlate macroconidia
N&C america - Missippi, Ohio, Great lakes AND from bat droppings
