Derm Path Flashcards by Jacob Townsend

Symptoms: *Warts. Soft, tan-colored cauliflower-like lesions. Epidermal hyperplasia, hyperkeratosis, koilocytosis. Verruca vulgaris on hands,; condyloma acuminatum on genitals (caused by HPV).

Verrucae

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Symptoms: *Common mole that has hair growing from it (melanomas don’t have hair growing from it). Pathophysiology: *Benign neoplasm of basal melanocytes. Intradermal (adult) are papular while Junctional (children) are flat macules.

Nevocelluar nevus (Melanocytic Nevus)

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Symptoms: Hives. Intensity pruritic wheals that form after mas cel degranulations. Lab Values: ** Pathophysiology: ** Treatment: *

Utricaria

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Symptoms: *Freckle. Hyperpigmentation due to increased number of MELANOSOMES. Normal number of melaoncytes. Darkens with sunlight.

Ephelis

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Symptoms: Commonly on face and flexor surfaces. Pruritic, erythematous, ooozing rash with vesicles and edema. Lab Values: ** Pathophysiology: *Often associated with other atopic diseases (asthma, allerigc rhinitis). Starts on the face in infancy and then moves to the antecubital fossae.

Atopic dermatitis (eczema)

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Symptoms: Type IV hypersensitivity that follows epxosure to allergin; lesions occur at site of contact (nickle, poison ivy). Lab Values: ** Pathophysiology: ** Treatment: *

Allergic contact dermatitis

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Symptoms: Papules and plaques with silvery scaling especially on knees and elbows. Acanthosis (thickening of dermis) with parakeratotic scaling (nuclei still in stratum corneum); increase stratum spinosum and decreased stratum granulosum. Lab Values: Auspitz sign (bleeding spots when scales are scraped off; due to elongated dermal papillae). Munro microabscesses in stratum corneum. Pathophysiology: Associated with nail pitting and psoriatic arthritis. Treatment: *Corticosteroids, UVA light with psoralen.

Psoriasis

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Symptoms: *Flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (pseudo horn cysts). Looks “pasted on.” Lesions on head, trunk, extremeitis. Pathophysiology: Common benign neoplasm of older persons. Treatment: *

Seborrheic keratosis

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Symptoms: *Sudden appearance of multipe seborrheic keratosis indicating an underlying malignancy (GI, lymphoid). Due to mutation in TGF alpha.

Sign of Leser-Trelat

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Symptoms: May involve eye or bot skin and eye. Normal number of melanocytes. Lab Values: ** Pathophysiology: Due to defect in tyrosinase or migratinon of neural crests. Increased risk of skin cancer. Treatment: *

Albinism

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Symptoms: Irregular areas of complete depigmentation. Lab Values: ** Pathophysiology: Due to local autoimmune destruction of melanocytes. Treatment: *

Vitiligo

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Symptoms: Hyperpigmentation of cheeks associated with pregnancy (“mask of pregnancy”) or oral contraceptive use. Lab Values: ** Pathophysiology: ** Treatment: *

Melasma

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Symptoms: Very superficial skin infection usually from S. aureus or S. pyogenes. Highly contagious. Honey color crusting. Lab Values: ** Pathophysiology: ** Treatment: *

Impetigo

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Symptoms: Acute, painful spreading infection of dermis and subcutaneous tissue. Usually form S. pyogenes or S. aureus. Lab Values: ** Pathophysiology: ** Treatment: *

Cellulitis

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Symptoms: Deeper tissue injury usually from anaerobic bacteria and S. pyogenes. Results in crepitus from methane and CO2 production. Lab Values: ** Pathophysiology: ** Treatment: *

Necrotizing fasciitis

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Symptoms: Exotoxin destroys keratinocyte attachments to the stratum granulosum only. Fever, generalized erythematous rash with sloughing of upper layers of epidermis. Seen in young children. Lab Values: ** Pathophysiology: ** Treatment: *

Staphyloccal scalded skin syndrome

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Symptoms: White, painless plaques on tonguet hat cannot be scraped off. EBV mediated. Occurs in HIV positive patients. Lab Values: ** Pathophysiology: ** Treatment: *

Hairy leukoplakia

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Symptoms: Acantholysis of skin AND oral mucosa. Positive Nikolsky’s sign (separation of epidermis upon manual stroking of skin). Lab Values: Autoantibody (IgG) to desmoglein (desmosomes). Reticular or netlike pattern on IF. Pathophysiology: Autoimmune disorder (type II hypersensitivity). Treatment: *

Pemphigus vulgaris

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Symptoms: Similar but less severe than pemphigus vulgaris - affects skin but SPARES ORAL MUCOSA. Negative Nikolsky’s sign. Blisters. Lab Values: Autoantibody (IgG) to hemidesmosomes. Linear pattern on IF. Eosinophiles with tense blisters. Pathophysiology: Autoimmune disorder (type II hypersensitivity). Treatment: *

Bullous pemphigoid

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Symptoms: Pruritic papules and vesicles in a person with Celiac disease. Lab Values: Deposits of IgA at tips of dermal papillae. Pathophysiology: ** Treatment: *

Dermatitis herpetiformis

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Symptoms: Presents with multiple types of lesions - macules, papules, vesicles, and target lesions. Lab Values: ** Pathophysiology: Associated with infections (mycoplasma, HSV), drugs (sulfas, penicillins, phenytoin), cancers, and autoimune disease (SLE). Treatment: *

Erythema multiforme

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Symptoms: Prodrome of malaise and fever followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital) . Skin lesions progress to epidermal necrosis and sloughing. Lab Values: ** Pathophysiology: ** Treatment: *

Stevens-Johnson syndrome

Symptoms: *Pruritic, purple, polygonal papules. Occurs in wrists, elbows, and oral mucosa. * Lab Values: *Sawtooth infiltrate of lymphocytes at dermal-epidermal junction. * Pathophysiology: Associated with chronic hepatitis C infection. Treatment: *

Lichen planus

Symptoms: *Premlaignant lesions caused by UVB exposure. Small, rough, erythematous or brownish papules. “Cutaneous horn.” * Lab Values: ** Pathophysiology: Risk of carcinoma is proprotional to epithelial dysplasia. Treatment: *

Acitinic keratosis

* Symptoms: *Hyperplasia of stratum spinosum with darkening of the skin.* Lab Values: ** Pathophysiology: * Associated with hyperinsulinemia (Cushing's, disease, DM2) and VISCERAL MALIGNANCY.* Treatment: *

Acanthosis nigricans

* Symptoms: *Inflammatory lesions of subcutaneous fat, usually on anterior shins. Associated with cocciodiomycosis, histoplasmosis, TB, leprosy, streptococal infections, sarcoidosis.* Lab Values: Shows early septal widening and lymphohistiocyte infiltration without vasculitis.

Erythema nodosum

* Symptoms: *Herald patch" followed days later by "Christmas tree" distribution. Multiple papular eruptions that remits spontaneously.* Lab Values: ** Pathophysiology: *Associated with HHV-7* Treatment: *

Pityriasis rosea

* Symptoms: *Benign capillary hemangioma of infancy. Appears in first few weeks of life, grows rapidly and regresses at 5-8 years of age. Most common tumor of infants.* Lab Values: ** Pathophysiology: ** Treatment: *

Strawberry hemangioma

* Symptoms: *Benign capillary hemangioma of the elderly. Does not regress; increase frequency with age.* Lab Values: ** Pathophysiology: ** Treatment: *

Cherry hemangioma

* Symptoms: *Common on hands and face. Locally invasive but rarely metastasizes. Ulcerative red lesion. Associated with chronic draining sinuses.* Lab Values: *Keratin pearls.* Pathophysiology: *Associated with excessive exposure to UVNB sunlight or arsenic exposure. Acitinic keratosis is a precursor to squamous cell carcinoma.* Treatment: *

Squamous cell carcinoma of skin

* Symptoms: *Variant of squamous cell carcinoma that grows rapidly (4-6 weeks) and regresses spontaenously (4-8 weeks).* Lab Values: *Very well differentiated SCC. Cup-shaped tumor filled with keratin debris.* Pathophysiology: ** Treatment: *

Keratoacanthoma

* Symptoms: *Most common in sun-exposed areas of body, especially UPPER LIP. Locally invasive, but almost never metastasizes.* Lab Values: *Elevated nodule with central ulceration surroudned by telangiectasis. Pearly papules. Tumors have peripheral "palisading" nuclei.* Pathophysiology: *Due to exposure to UVB sunlight.* Treatment: *Cryotherapy.

Basal cell carcinoma

* Symptoms: *Common tumor with significant risk of metastasis. Dysplastic nevus (atypical mole) is a precusor to melanoma. Look for assymetry, border irregularity, color variation, diameter > 6 mm, and a history of change.* Lab Values: *S-100 tumor marker. Atypical pagetoid (upward spreading). BRAF activating mutation. P16 mutation.* Pathophysiology: *Fair skinned persons at increased risk. DEPTH of tumor correlates with risk of metastasis.* Treatment: BRAF kinase inhibitor (vemurafenib) in pts with metastatic/unresectable melanoma with BRAF V600E mutation.

Melanoma

* Symptoms: *Flat discoloration < 1 cm (Tinea versicolor).

Macule

* Symptoms: *Macule > 1 cm

Patch

* Symptoms: *Elevated skin lesion < 1 cm (acne vulgaris)

Papule

* Symptoms: *Papule > 1 cm

Plaque

* Symptoms: *Small fluid containing blister (VZV)

Vesicle

* Symptoms: *Transient vesicle (hives)

Wheal

* Symptoms: *Large fluid-contianing blister (bullous pemphigoid)

Bulla

* Symptoms: *Irregular, raised lesion resulting from scar tissue hypertrophy (trauma to skin; Treponema pertenue)

Keloid

* Symptoms: *Blister containing pus

Pustule

* Symptoms: *Dried exudates from a vesicle, bulla, or pustule (impetigo)

Crust

* Symptoms: *Increased thickness of stratum corneum (psoriasis)

Hyperkeratosis

* Symptoms: *Hyperkeratosis with retention of nuclei in stratum corneum (psioriasis)

Parakeratosis

* Symptoms: *Separation of epidermal cells (pemphigus vulgaris)

Acantholysis

* Symptoms: *Epidermal hyperplasia (increased spinosum)

Acanthosis

* Symptoms: *Inflammation of the skin

Dermatitis

* Symptoms: ** Lab Values: ** Pathophysiology: *Hormone related increase in sebum and exces kertain block follicles (comedones) followed by inflammation of hair follicles and sebaceous glands by Proprionibacterium acnes infection.* Treatment: *Benzoyl peroxide (antimicrobial), isoretinoin (lowers keratin production)

Acne vulgaris

* Symptoms: *Airses on palms or soles in dark skinned individuals. Pathophysiology: *Not related to UV light exposure.

Acral lentiginous melanoma

- Chronic excessive keratin accumulation (hyperkeratosis) resembling fish scales. - Primary deficit is increased cel-cell adhesions resulting in abnormal desquamation. - Compacted stratum corneum.

Ichthyosis

- Firm, pink umbilicated papules due to poxvirus. - Most often in children but also in sexually active adults and immunocompromised. - Hallmark is molluscum bodies in the affected keratinocytes. - Cheesy material from central umbilications contain molluscum bodies.

Molluscum Contagiosum

Four Types: 1. Superficial Spreading (radial growth), good prognosis 2. Nodular: early vertical phase, poor prognosis 3. Lentigo maligna: Remains along the dermal/epidermal junction - good prognosis 4. Acrolentiginous: On palms/soles of dark-skinned individuals. Not related to UV Light Exposure

Melanoma