Dermatological Pathology Flashcards
1
Q
What is Erythroderma?
A
Sign of various dermatological conditions, inflammatory skin disease affecting 90% of the total skin surface.
Red all over.
2
Q
What are some causes of Erythroderma?
A
Psoriasis Eczema Drugs Cutaneous Lymphoma Hereditary disorders Idiopathic
3
Q
What is Steven Johnson Syndrome (SJS)?
A
Rare disorder effecting the skin, mucous membranes, eyes and genitals. Usually caused by an adverse reaction to medication.
4
Q
What are the symptoms of SJS?
A
Flu like symptoms Target like red patches across skin. Blisters Erosions Maculopapular. Mouth ulcerations Ulceration of other mucous membranes.
5
Q
What are the drugs that commonly cause SJS and TEN?
A
Antibiotics
Anticonvulsants
Allopurinol
NSAIDs
6
Q
What is Toxic Epidermal Necrolysis (TEN)?
A
Rare disorder effecting 90% of the skin, mucous membranes, eyes and genitals. Usually caused by an adverse reaction to medication. A more severe version of SJS.
7
Q
What are the symptoms of TEN?
A
Prodromal febrile illness.
Ulceration of mucous membranes.
Rash- may be macular, purpuric or blistering but rapidly becomes confluent.
Large areas of epidermal loss.
8
Q
How is SJS and TEN managed?
A
Identify cause of reaction and stop its use.
Supportive therapy.
High dose steroids
IV immunoglobulins
Anti-TNF therapy
Ciclosporin
9
Q
How is TENs severity measured?
A
SCORTEN
One point given for having each of the following criteria:
Age>40 Malignancy Heart rate>120 Initial epidermal detachment >10% Serum urea>10 Serum glucose>14 Serum bicarbonate <20
The higher the score the your mortality.
10
Q
What is Erythema Multiforme?
A
Hypersensitivity reaction usually triggered by infection. Most commonly HSV or mycoplasma pneumonia.
11
Q
How does erythema multiform present?
A
Acute onset - 100s of lesions in 24hrs. Distal to proximal Palms and soles Mucosal surfaces Target like lesions Pink macules that may becomes elevated and blister in centre. Usually resolves within 2 weeks.
12
Q
What is Drug Reaction with Eosinophilia ad Systemic Symptoms (DRESS)?
A
A rash alongside other symptoms such as fever, Lymphadenopathy, eosinophilia, deranged liver function etc due to an adverse drug reaction. Typically latent and occurs 2-8 weeks after drug administered.
13
Q
What is Pemphigus?
A
A rare and serious autoimmune condition that involves the blistering of mucous membranes and the skin. The mouth usually blisters first, then the skin a few weeks later.
14
Q
What are the clinical features of Pemphigus?
A
Antibodies targeted at desmosomes.
Skin is covered in flaccid blisters that rupture and cause erosions very easily.
Commonly seen on face, axillae and groins.
Nikolsky’s sign may be positive.
15
Q
What is Pemphigoid?
A
Autoimmune blistering skin disease. That usually effects the axillae, groins and abdomen.
16
Q
What are the clinical features of pemphigoid?
A
Antibodies directed at demo-epidermal junction.
Intact epidermis from roof of blister.
Blisters are usually tense and do not rupture.
17
Q
What is Erythrodermic psoriasis?
A
Inflammatory form of psoriasis that usually effects the majority of the skin.
18
Q
What are the symptoms of Erythrodermic psoriasis?
A
Severe redness and shedding of skin. Skin looks burnt Severe itching. Fever. Tachycardia. Ankle oedema.
19
Q
What are some triggers for erythrodermic psoriasis?
A
Severe sunburn Infection Alcoholism systemic steroids. Adverse drug reaction. Emotional stress.
20
Q
How is Erythrodermic psoriasis treated?
A
Exclude underlying infection.
Avoid steroids
Bland emollient.
Systemic therapy and anti-TNF drugs.
21
Q
What is Eczema herpeticum?
A
Disseminated herpes virus infection on a background of poorly controlled eczema.
22
Q
What are the symptoms of Eczema Herpeticum?
A
Fever Punched out erosions Clusters of itchy blisters Lethargy Painful.
23
Q
What are the causes of Eczema Herpeticum?
A
Herpes simplex virus type 1 &2.
24
Q
What is the treatment for Eczema herpeticum?
A
Antiviral medication.
Aciclovir
Mild topical steroid to treat eczema.
Ophthalmology if periocular disease.
25
What is Staphylococcal Scaled Skin Syndrome (SSSS)?
Staphylococcal aureus infection that causes red blistering of the skin that often looks like burns.
Staph aureus produces toxin which targets Desmoglein 1.
26
What are the symptoms of SSSS?
```
Fever
Irritability
Redness
Peeling skin.
Bullae in armpits, groins and orifices.
Positive Nikolsky sign.
```
27
How is SSSS treated?
IV antibiotics initially.
Generally resolves within 5-7 days.
Avoid corticosteroids as they slow down healing.
28
What is Urticaria?
Also known as hives or weals.
| Central swelling of variable size surrounded by erythema. Dermal oedema.
29
What type of hypersensitivity reaction is urticaria?
Type 1 - mast cell degranulation causing an inflammatory response. Histamine is released into the dermis.
30
What is the treatment for acute urticaria?
Oral antihistamine.
| Avoid opiates and NSAIDs as they exacerbate symptoms.
31
What is the treatment for chronic urticaria?
```
Rarely a type 1 reaction.
Anti-histamines
Anti-leukotriene
Tranexamic acid if angioedema present.
Omalizumab.
```
32
What is considered mild acne?
Non-inflammatory
| Open and closed comedones.
33
What is considered moderate acne?
Inflammatory lesions - papules, pustules, nodules and cysts.
Open and closed comedones.
34
What is considered severe acne?
Pseudocysts
Inflammatory lesions
Permanent scar and post inflammatory pigmentation.
35
What is acne fulminans?
Most severe form of cystic acne characterised by the abrupt onset of nodular and suppurative acne with systemic manifestations e.g fever, arthralgias, myalgias, hepatosplenomegaly.
36
What is acne excoriee?
Papules and comedones that have been picked off leaving crusted lesions that may scar.
37
What are some treatment options for Acne?
Topical retinoids
Benzoyl Peroxide - antiseptic
Topical antibiotics - clindamycin, erythromycin.
Azelaic acid - anti-inflammatory.
Antibiotic tablets - lymecycline, tetracyclin
Combined oral contraceptive pill.
Isotretinoin - acts on keratinisation and reduced the production of sebum.
38
What is rosacea?
Chronic skin condition that usually effects the face.
39
What are some clinical features of Rosacea?
Affect central convex ares of the face.
Vascular changes with episodic flushing and no sweating.
Erythema with burning sensation.
Papules and pustules in more advanced cases but no comedones.
Persistent tissue thickening due to oedema, fibrosis and glandular hyperplasia.
40
What is Vascular Rosacea?
Rosacea with recurrent blush. Telangiectasias (superficial dilated blood vessels).
Gets worse with sunlight, hot drinks and stress. Not related to caffeine.
41
What is inflammatory Rosacea?
Small papule and pustules to occasional deep cysts.
No comedones
Deep red colour and soft or solid facial oedema.
42
What is Phymatous Rosacea?
Overgrowth of sebaceous glands.
Swollen skin and smoother.
Pores become more apparent.
Gradually a lumpy surface develops.
43
What is ocular rosacea?
```
Dryness of eyes
Tired eyes
Oedema
Tearing
Pain
Chalazia - cyst on the eyelid
Corneal damage.
```
44
What is used to treat Rosacea?
```
Metronidazole cream or gel.
Azelaic acid.
Ivermectin cream.
Tetracyclines
Surgery for rhinophymas.
Avoid vasodilators and irritants.
```
45
What are seborrhoeic keratoses?
Benign skin tumour that presents as warty growths with a stuck on appearance.
Become more common with age and patients often have multiple cherry angiomas.
46
How is seborrhoeic keratoses treated?
Benign so often left untreated however if troublesome then curettage or cryotherapy.
47
What is the Leser-trelat sign?
Abrupt onset of widespread seborrhoeic keratosis indicating internal malignancy as part of paraneoplastic syndrome. Usually have other symptoms along with it - weight loss, abdominal pain etc.
48
What are viral warts?
Growths of skin caused by the human papilloma virus. They have a rough hyperkeratotic surface.
49
How are viral warts treated?
Will clear when immunity to virus is developed but cryotherapy and wart paints can be used to stimulate the immune system slightly.
Curette in severe cases.
50
What are cysts?
Encapsulated lesion containing fluid or semi-fluid material. Usually firm and fluctuant.
51
What are some different types of cyst?
```
Epidermoid cysts
Pilar cyst
Steatocytoma
Dermoid cyst
Hidrocystoma
Ganglion cyst.
```
52
How are cysts treated?
Treated with excision
| If they rupture and become infected then treat with antibiotics, intralesional steroid and incision and drainage.
53
What are Dermatofibroma?
Benign fibrous nodule caused by the proliferation of fibroblasts. Often on limbs. Pale pink or brown.
54
What are Lipomas?
Benign tumour consisting of fat cells. Smooth and rubbery subcutaneous mass.
55
What is an Angioma?
Overgrowth of blood vessels in the skin due to proliferating endothelial cells. Includes cherry angiomas, spider nave and venous lakes.
56
What is a Pyogenic Granuloma?
Rapidly enlarging red/raw growth, often at the site of trauma. Bleeds easily. Common on head and hands.
57
What are the stages of cell damage?
```
Normal/benign
Hyperplasia
Dysplasia
In-situ disease
Invasive malignancy.
```
58
What is actinic keratoses?
Rough scaly patches of skin caused by sun damage.
59
How are actinic keratoses treated?
Cryotherapy
Curettage
Diclofenac gel
Imiquimod.
60
What is Bowen's disease?
Squamous cells carcinoma in situ. Full thickness dysplasia contained within the epidermis. Irregular scaly erythematous plaque.
61
How is Bowen's disease treated?
Cryotherapy
Curettage
Photodynamic therapy
Imiquimod - stimulates cytokine release to modify the immune response.
62
What is meant by melanoma in situ?
Melanoma cells confined to the epidermis. There is not metastatic potential. Treated with excision.
63
What is Eczema?
Atopic dermatitis.
| Inflammatory skin condition that normally effects flexural areas of body. Multiple types that vary in their severity.
64
What are some causes of Eczema?
```
Genetics - filaggrin gene
Family history
Epidermal barrier dysfunction
Environmental factors
Idiopathic.
```
65
What is spongiosis?
Intercellular oedema
66
What is Acanthosis?
Thickening of the epidermis
67
What are the clinical features of Eczema?
```
Itch
Pruritus
Erythema
Scale
Papules
Vesicles
Exudate
Crusting
Excoriation
Lichenification ( thickening got skin so it become shard and leathery)
Plaques
Fissuring.
```
68
What are some other types of Eczema?
```
Contact dermatitis
Lichen simplex
Photoallergic/aggravated eczema.
Discoid
Venous
Seborrhoeic
Pompholyx
Juvenile plantar dermatitis
Asteatotic
```
69
What type of hypersensitivity reaction is allergic contact dermatitis?
Type 4 hypersensitivity. Can take 48-72hrs to present.
70
What is irritant contact dermatitis?
Eczema caused by an irritant but not an immune response. Usually friction or environmental factors e.g cold, over exposure to water.
71
What is infantile seborrhoeic dermatitis?
Eczema that presents in children <6months old. Usually effects the scalp and proximal flexures. Believed to be linked to their developing sebaceous glands.
72
How does Seborrhoeic Eczema present in adults?
Usually starts on scalp as dandruff and then malassezia yeast increased and it progresses to redness, irritation and scaling.
73
How is seborrhoeic eczema treated?
Topical anti-yeast (ketoconazole)
| Consider HIV test if severe.
74
What is discoid eczema?
Circular plaques of eczema. May develop at sites of irritation or trauma.
75
What is pompolyx eczema?
Eczema on the palms and soles. Intensely itchy and has the sudden onset of vesicles.
76
How does Asteatotic eczema present?
Very dry skin commonly on the shins. Cracked scaly appearance. Usually caused by heat or excessive washing/soaps.
77
How does venous eczema present?
Increased venous pressure causing oedema and ankle and lower leg eczema.
78
How is Eczema treated?
Avoidance of causative or exacerbating factors.
Emollients
Soap substitutes.
Intermittent topical steroids - hydrocortisone, betamethasone.
Antihistamines or antimicrobials.
Calcineurin Inhibitors - topical pimecrolimus, tacrolimus.
If severe UV light or immunosuppressants may be used.
79
What are some future treatments of Eczema?
Crisaborole - topical PDE-4 inhibitor.
Dupilumab - biologic, IL-4/IL-3 inhibitor.
80
What is Psoriasis?
A chronic genetically determined, immune-mediated inflammatory skin condition that usually presents as defined, scaly plaques. May also involve nails, hair and joints.
81
What other conditions is psoriasis associated with?
Diabetes
Heart disease
Depression.
82
What does psoriasis look like?
```
Red scaly plaques
Symmetrical distribution usually.
Pustular
Erythrodermic.
Commonly effects flexures, scalp, nails and palms.
```
83
What are some causes of Psoriasis?
```
Overactivity of the immune system.
Excessive production of TH1 cytokines including TNF-alpha.
Genetics
Vascular proliferation
Infection - candida, strep
Drugs
Sunlight
```
84
What happens histologically to skin when diagnosed with Psoriasis?
```
Hyperkeratosis - thickening of stratum corneum.
Neutrophils enter the stratum corneum.
Hypogranulosis.
Thickening of squamous cell layer.
Elongated rete ridges.
Dilated dermal capillaries
T cell infiltration.
```
85
What is chronic plaque psoriasis?
Commonest type of psoriasis. Salmon coloured scaly plaques mainly on elbows and back.
86
What is Guttate Psoriasis?
Drop like pink patches of plaques that occur suddenly. Usually post viral infection. Responds well to phototherapy.
87
What is palm-plantar Psoriasis?
Psoriasis on the soles and palms. Thick, scaly and red with yellowy brown lesions at the edges.
88
What is Scalp Psoriasis?
Hyperkeratotic plaques within the scalp and hairline. Severe dandruff.
89
What is Nail Psoriasis?
Pitting of nail.
| Onycholysis - nail detaches from the nail bed.
90
What is Flexural/ Inverse Psoriasis?
Psoriasis within the flexures. Shiny pink to red plaques with NO scaling.
91
What is Pustular Psoriasis ?
Acute onset of red tender patches. Within the patches are multiple yellow pustules.
92
What are some methods of initial treatment for Psoriasis?
```
Emollients
Vitamin D3 analogues
Topical steroids.
Salicyclic acid - keratolytic
Tar creams
Dithranol
Anthralin.
```
93
What are some second line treatments for Psoriasis?
```
UVB phototherapy
Acitretin
Methotrexate
Cyclosporin
Inpatient tar.
Biologics - need to have tried 2 previous medications that have then failed.
```
94
What is Vitiligo?
Destruction of melanocytes resulting in patches of skin without their pigment. Most common areas are hands, face and skin creases.
95
What is Imeptigo?
Bacterial infection.
Staph aureus or sometimes Strep pyogenes.
Begins as red macules that rapidly evolve into vesicles and pustules. These then erupt with honey coloured yellow crust formation.
96
How is Impetigo treated?
Local wound care and if severe then topical antibiotics.
97
What is folliculitis?
Infection of the hair follicle.
Usually stay aureus.
Effects the face, chest, back, axillae or buttocks.
98
What are some predisposing factors for folliculitis?
```
Occlusion
Maceration
Hyper hydration
Shaving
Waxing
Diabetes
Topical steroid.
```
99
How is folliculitis treated?
Antibacterial washes
| Antibacterial ointments.
100
What is Erysipelas?
Infection of the dermis with lymphatic involvement.
Usually caused by group A streptococci.
Presents with erythema with well defined margins.
Face and lower extremities.
101
What I the treatment for Erysipelas?
10-14 day course of penicillin.
102
What is cellulitis?
Infection of the deep dermis and subcutaneous tissue.
Strep pyogenes or staph aureus.
Erythema with warmth, pain and swelling. Ill-defined with non palpable borders.
103
What is the treatment for Cellulitis?
Antibiotics depending on systemic symptoms.
104
What is Syphilis?
Complex STI caused by Treponema pallidum.
| Episodic disease with latent periods.
105
How does primary syphilis present?
Ulcer (chancre) at the site of infection entry. (usually genitals, anus or mouth).
Unilateral enlargement of lymph nodes close to the ulcer develops 5 weeks after acquiring the infection.
106
How does secondary syphilis present?
3 weeks to 3 months after primary.
| Wide spread skin rash - may be rough, red/brown papules or patches. Typically in the trunk, palms and soles. Not itchy.
107
How does tertiary syphilis present?
Solitary granulomatous lesions may be found on skin, mouth, throat or occur in bones.
Brain, spinal cord, heart, liver and eyes may also be effected.
108
What investigations are carried out for Syphilis?
Serological tests turn positive about 5-6weeks after infection.
Non-specific non- Treponemal tests (VDRL)
Specific anti-treponema antibody tests (TTPA)
109
What is the treatment for syphilis?
Penicillin by injection depending on stage of disease.
110
What is Herpes Simplex Virus 1&2?
Viral infections
Type 1 is coldsores.
Type 2 is genital infection.
Sore areas with erythematous base and vesicles. These then form pustules and ulcerations.
111
What is Chicken pox?
```
Viral infection
Varicella-zoster virus.
Highly contagious.
Red macules - vesicles - pustules - crusts.
Acute fever.
Dew drops on a rose petal.
```
112
What is Shingles?
Localised, blistering, painful rash caused by re-activation of varicella-zoster virus.
Complications include infection and post herpetic neuralgia.
113
What are viral warts?
Caused by human Papilloma virus.
| Hyperkeratotic papules/plaques.
114
How are viral warts treated?
Salicyclic acid
| Cryotherapy.
115
What is Molluscum contagiosum?
Viral skin infection caused by a poxvirus.
Lesions are firm, umbilicate pearly papules with a waxy surface.
Skin folds and genital region.
116
What is Dermatophytoses?
Fungal infection also known as ringworm.
| Can affect multiple areas of the body. Red itchy, scaly circular rash.
117
What are Mucocutaneous Candida infections?
Fungal infections by Candida albicans.
Erythematous patches often accompanied by satellite pustules.
Submammary, inguinal creases, finger spaces.
118
How are Mucocutaneous Candida infections treated?
Remove predisposing factors e.g occlusion, antibiotics, diabetes, hyperidrosis, immunosuppression.
Topica antifungals, oral antifungals.
119
What is Pityriasis versicolour?
Fungal infection by Malassezia sp.
Multiple oval round patches with mild scale.
Likes high temperature, humidity, oily skin and excessive sweating.
120
What is Scabies?
Infestation of sacroptes scabiei mite.
| Very itchy and more severe at night. Grey irregular tracks in web spaces, palms and wrists.
121
What is the treatment for Scabies?
Antiscabetic topical treatment for patient and its close contacts. Repeat course after a week.
Oral medicine may be needed in some cases.
122
What are head lice?
Infestation of lice onto scalp and nape of neck.
Red brown spots on skin are due to excreted digested blood.
Very itchy.
123
What is the treatment for head lice?
At least 2 applications of insecticide with physical combing. Treat all members of family at same time.
