Derm Review Flashcards by c k

Never tans, always burn

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Very easy to tan, very rarely burn

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Average tanning, sometimes burns

III

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Easily tans, rarely burns

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Tans with difficulty, usually burns

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Never burns

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Acquired autoimmune disorder against melanocyte

vitiligo

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Microscopic finding in vitiligo

complete absence of melanocyte

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Vitiligo common location

periorificial

acral

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Recessive dystrophic epidermolysis bullosa = genetic defect in

collage VII

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Recessive dystrophic EB

clinical?

extensive dystrophic scarring can produce pseudosyndactyly

flexion contractures

Increased risk of SCC

Infection complications

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Anitbodies to BP230 or BP180 in hemidesmosomes cause?

bullous pemphigoid

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autoantibodies to desmoglein 1 and 3 cause?

pemphigus vulgaris

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primary skin lesion in pemphigus vulgaris

flaccid bulla

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pathology of pemphigus vulgaris?

intraepidermal blisters

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Epidermolysis bullosa simplex = genetic defect in?

genetic defects in keratin 5 and 14

lacking proteins within desmosomes

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EB simplex

- clinical

generalized onset of blisters occuring shortly after birth

hands, feet, and extremities are the most common involvement

improves with age

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icthyosis vulgaris / atopic dermatitis are caused by?

defective skin barrier function due to loss-of function filaggrin mutations

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what happens when patients have mutated filaggrin?

they have significantly redcued levels of NMF in (natural moisturizing factor) in the SC and exhibit increased transepidermal water loss

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Papillary dermis

composition
interlocks with
function (2)

upper layer
thin collagen bundles
interlocks with epidermal rete
increases strength
increases surface area

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Reticular dermis

- composition

Reticular dermis
deeper layer
thick collagen bundles
visible elastic fibers

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Major consituents of dermis (3)

collagen - tensile
elastin - resilience
ground substance - diffusion

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acquired disorder of elastin

solar elastosis

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congenital disorder of elastin

pseudoxanthoma elasticum

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acquired blistering disorder of DEJ

Bullous pemphigoid

congenital blistering disorder of DEJ

Epidermolysis bullosa

Proximal sunungual white onychomycosis associated with? | due to?

HIV | Trichophyton rubrum

Growing hair?

anagen

Involuting hair?

catagen

Resting hair?

telogen

Anagen effluvium =

Loss of growing hairs - often due to chemo

Telogen effluvium =

Hairs go into resing cycle | - may be due to medication / post partum

Dermititis synonym =

eczema

Seborrheic dermatitis = in bambinos

cradle cap

Irritant dermititis synonym

intertrigo

when you see reddening / dermatitis in the extensor area think of a defect in ?

filaggrin

Lower extremity edema = associated with

stasis dermatitis

Malassezia furfur = associated with

seborrheic dermatitis

defective filaggrin = associated with

atopic dermatitis

common irritants = associated with

irritant dermatitis

common allergens = associated wtih

allergic contact dermatitis

_____________appears as red, inflamed skin covered by greasy or dry scales that may be white, yellowish, or gray. It can effect the scalp, eyebrows, forehead, face, folds around the nose and ears, the chest, armpits (axilla), and groin. Dandruff and cradle cap are mild forms and appear as fine white scales without inflammation.

Seborrheic dermatitis

__________ frequently affects the flexural areas? - e.g. elbows

psoriasis

rash consequence of new fragrance likely dx?

allergic contact dermatitis

Type I immune reactions

Immediate hypersensitivity (anaphylactic - IgE mediated)

Pathophysiology of Type I immune reactions

Plasma cells produce IgE ab specific to antigen IgE bind mast cells causing degranulation and release of histamine, which causes vasodilation and smooth muscle contriction (bronchospasm)

Example (derm) of Type I

Urticaria | angioedema

Type II immune reactions -

Cytotoxic reactions

Type II immune reactions - pathophysiology

IgG binds antigenic cell and lysis cell | Involved activation of complement

Examples of Type II immune reactions

Transfusion reactions due to incompatible blood type

Type III immune reaction

Immune complex Involves reactions to circulating antigens Antibodies bind antigen and form immune complexes which deposit in organs These immune complexes activate complement and cause damage due to inflammatory cascade

Type III example?

serum sickness

Type IV immune reaction?

delayed hypersensitivity

Type IV immune reaction - pathophysiology

langerhaans cells are the antigen presenting cell memory T cells then become sensitized to locally deposited antigen local reaction occurs and this does not involve antibodies

Derm example of type IV

Morbiliform drug eruption | allergic contact dermatitis

____________ cells produce interferon gamma, IL-2, TNF-beta, and evoke cell mediated immunity and phagocyte dependent inflammation

TH1

_________ cells produce IL4, 5, 6, 9, 10, and 13 and evoke strong Ab responses (IgE) with eosinophil accumulation

TH2

Atopic dermatitis is associated wtih?

asthma and allergic rhinitis

Allergic contact dermatitis is an example of which type of reaction?

Delayed hypersensitivity (type IV)

Allergic contact dermatitis confirmed with?

patch testing

___________ may be associated wtih increased risk of CV disease

psoriasis

stasis dermatitis location

lower legs

seborrheic dermatitis location

scalp

atopic dermatitis location

flexor surfaces

psoriasis location

extensor surfaces

When you see hypo/hyper pigmented patches with spaghetti and meatball culture - think?

tinea veriscolor

Barnacles of life =

seborrheic keratosis

``` color white to gray to tan to balck exophytic papule - stuck on appearance smooth to verrucous often friable surface often studded with small pits ```

Seborrheic keratosis | primary lesion

Skin defenses against UV? (4)

DNA Repair - Apoptosis of Cells with DNA Damage - Defenses Against Reactive Oxygen - Melanin

Biggest risk factor for melanoma?

FAMMM syndrome

- Damage to DNA, RNA, lipids, proteins - Pro-inflammatory effects - Immunosuppressive effects - Induction of innate defenses - Induction of apoptosis - Vitamin D synthesis

UVR effects on skin

What are photodermatoses?

Connective tissue disease

Photodermatoses associated conditions

SLE Dermatomyositis Mixed Connective Tissue Disase = Sharp's syndrome

Photodistributed, violaceous poikiloderma Favors scalp, periocular and extensor skin sites Heliotrope = Eruption on the upper eyelids +/- periorbital edema What are you thinking

Dermatomyositis

Samitz sign = ragged cuticles what are you thinking

Dermatomyositis

Gottron’s papules =

lichenoid papules overlying knuckles, elbows, knees

Gottron's papules - what are you thinking

dermatomyositis

Gottron’s sign =

poikiloderma over the knuckles, elbows, knees

Gottron's sign - what are you thinking ?

Dermatomyositis

Shawl sign =

poikiloderma across the back and shoulders sign of dermatomyositis

What do we worry about when we see dermatomyositis?

internal malignancy about 10%-50% varies

do we worry about malignancy in juvenile dermatomyositis?

average age for adults to develop dermatomyositis?

average age for children to develop dermatomyositis?

sex ratio | adult dermatomyositis?

6.2:1 | F:M

sex ratio | child dermatomyositis?

1:1.75 F:M

Dermatomyositis | Age appropriate malignancy screen including:

mammogram, CXR, colonoscopy, PAP smear, PSA, CBC repeat screen every 6-12 months for at least the first 2 years

Dermatomyositis | does risk of malignancy increase or decrease with time?

declines after first 2 years and reaches baseline at 5

Neurofibromatosis Type I | Dx requires?

Diagnosis requires 2 or more of the following criteria Six or more café au lait macules more than 1.5 cm in diameter (more than 0.5 cm diameter in children) Two or more neurofibromas, or 1 plexiform neurofibroma Axillary or inguinal freckling (Crowe’s sign) Optic glioma Two or more Lisch nodules Distinctive osseous lesion, such as sphenoid wing dysplasia or thinning of the long bone cortex A first degree relative (parent, sibling or child) with the disorder

Adenoma sebaceum

angiofibromas that begin in childhood (generally present between 2–5 years of age) and appear clinically as red papules on the face especially on the nasolabial folds, cheek and chin[1]:195 mostly thought to be acne not responding to treatment. Adenoma sebaceum may at times be associated with tuberous sclerosis

Hypomelanotic macules and Shagreen patches are associated with?

Tuberous sclerosis

Shagreen patch?

Flesh coloured orange-peel connective tissue naevi of varying sizes, usually on the lower back

What do you not do with pyoderma gangranosum?

debride!

How should you treat pyoderma gangrenosum

conservative wound care | oral and topical anti-inflammatory agents such as steroids

a rare condition that causes large, painful sores (ulcers) to develop on your skin, most often on your legs. No one knows exactly what causes _ but it appears to be a disorder of the immune system. People who have certain underlying conditions, such as inflammatory bowel disease or rheumatoid arthritis, are at higher risk of __ The ulcers of __ can develop quickly. They usually clear up with treatment, but scarring and recurrences are common.

pyoderma grangranosum

Pyoderma gangranosum associated conditions

IBD (20-30%) Arthritis (seronegative)(RA) (20%) Monoclonal gammopathy IgA 15% Other hematologic disorders

Purple, polygonal, pruritic papules Wickham’s striae: an overlying lace-like pattern of white lines on the surface

Lichen Planus

Lichen planus is associated wtih

hepatitis C | 2-13.5 x higher in patients with LP than controls

Velvety hyperpigmentation of the intertriginous surfaces and, less often, the extensor surfaces The areas most often affected are the neck, axillae, and dorsal hands Due to factors stimulating epidermal keratinocyte and dermal fibroblast proliferation

Acanthosis nigricans

``` Associations Familial: AD, rare, onset in childhood Obesity Diabetes mellitus: Insulin Resistance Endocrinopathies Hyperandrogenemia, Cushing’s syndrome, polycystic ovary syndrome, total lipodystrophy Drugs (rare) Nicotinic acid, systemic steroids ```

Acanthosis nigricans

malignancy associations May precede (18%), accompany (60%) or follow (22%) the onset of internal cancer Malignancies include adenocarcinoma of the stomach (60%), lung and breast cancer, and less often other types of cancer Rapid onset An associated with weight loss

Acanthosis nigricans

Acanthosis nigricans treatment

underlying disorder keratolytics such as ammonium lactate or urea cream

To lubricate how often must creams be applied vs ointment

creams every 2 hours | ointments every 12 hours

drawback of creams with irritation?

many required preservative which can cause irritation or allergy