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Dermatology Flashcards

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1
Q

Mast cells location

A

Present in small vessels of the skin

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2
Q

Collagen and Elastin skin

A

Collagen stretch, elastin returns to proper location..Elastin lost with age hence wrinkles

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3
Q

Time it takes for cell to travel from basal layer upwards

A

14 days..another 14 days from granulosum(?) layer all the way to the top..Hence there are 28 days for skin regeneration

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4
Q

Scale formation

A

Stratum corneum forms the scale

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5
Q

Patterns of distribution

A

Localized vs Generalized vs Exposure (chemicals, UV) vs Dermatomal vs Christmas Tree (Ptoryias roseum)

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6
Q

Lesions Growth

A

Linear (posion ivy)
Clusters = herpetiform (shingles, herpes) BTW dermatitis Herpetiformis is DIFFERENT FROM THIS! related to celiac disease!
Rings = in ring

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7
Q

PRIMARY Lesion types

A

Macules = flat lesion. Different from surrounding skin (Can be variegated or homogenous in pigment)

Papule/Nodule/Tumor= elevated lesions. May be due to
- epidermal hyperplasia from WARTs
(Lichen Planus are flat topped papules, Molluscum are papules which are dome shapped wit or without central umbiication- viral infection)
- infiltration of dermis by cells (eg. MALIGNANT B CELL LYMPHOMA or KELOID where excess dermal collagen formed), Hive/Urticarial lesions: - Dermal edema due to dilated vessels, Angioma:- red papular lesions due to endothelial cell proliferations
- proliferation of dermal elements,
- depositions!

Vesicles/Bullae (>5mm):- Are Fluid filled. BLOOD oR SERUM

  • if blood, its vasculitis and immune complexed, if serum it can be pemphigus- Vulgaris (epidermis, antibodies to desmosomes holding keratinocytes together), bullous (antibodies to dermal epidermal junction, it separates)
  • if linear, e.g. allergic contact dermatitis from poison ivy

Scales:- Impairement of desquamation of stratum corneum

  • Silvery due to trapping of air
  • Ichthyosis:- thickening, fish like scales
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8
Q

Tyndall effect

A

Melanin deep in skin looks blue

-Called Nevus of Ota…Blue skin in kids

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9
Q

Violaceous colon of nodules (BIG FOUR)

A

Lupus, Sarcoid, Lymphomas and Leukemias

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10
Q

Poison ivy due to allergic contact dermatitis versus hives/urticaria

A

(in hives, plasma just stays in dermis hence elevated lesions, in poison ivy, toxins stays on surface, delayed typed hypersensitivity, plasma tripples up into dermis goes into spongiosis or spaces in keratinocytes, pulls them apart, blisters, fluid breaks into top of skin hence its wet skin

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11
Q

Secondary Lesions

A

Ulcerations (pyoderma gangreosum versus self induced- later most gross)

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12
Q

Alopecia

A

Scarring:- Scalp hurt,LUPUS
Areata:- Scalp not as hurt

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13
Q

Contact Dermititis

A

Acute-subacute-chronic
Can develop generalized eczema IF UNTREATED
Autosensitization/autoeczematization reaction helps)

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14
Q

Cutaneous inflammatory Diseases:-

Eczemous or spongiotic dermatitis

A

ECZEMATOUS DERMATITIS (Just means edema in dermis)
1) Atopic (patchy/non sharp borders, bumby. behind knee, elbow, face, allergy rhinitis/asthma/AD in family hx. Increased risk of secondary staph infx)- only wear cotton, sweat makes worse, allergic to lanolin (wool wax). GIVE topical steroids, anti staph, topical calcineurin inhibitors
2) Dyshidrotic (palms and soles, pruiritic/vesicular)
3) Seborrheic (sebaceous glands! ear, labial folds, more in elderly)
4) Contact (anywhere, including clothing. Can be due to irritant hence cytotoxic, or can be immune mediated which can itch more or streak/involves sensitization to antigen- LINEAR vesicles can be poison ivy/oak, nickle, neomycin, rubber)
5) Nummular (round, coin like, has fine vesicles on surface, chronically recurs)
6) Stasis : due to incompetent valves, tissue edema, hapens in lower extremities and in adult
Treatment:-
1. Regardless of cause, soak cotton sheet, squeeze not wring, lay on area of dermatitis and evaporated water cools skin, vasoconstriction, momentarily relieves itch, blood vessels not as permeable. DONT use towels/wash cloths as NO evaporation.
2. Then put topical steroid

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15
Q

Fluorinated Steroids

A

Cause fragility and atrophy of skin- not good for collagen. Hydrocortisone does not cause this!!!
-If used around the eye, can cause increased ICP there hence glaucoma

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16
Q

inflammatory Diseases:-

Psoriasis

A

-Knees, elbows are main areas. Can happen in diaper region/intergluteal, nail pit, penis shaft
-Silvery Scale due to air
-With eczema there is no sharp borders, here there is
-Can be plaque like, gut tape/drop like, pustular, white micaceous scale
- can be pruiritic
PSORIASIS= TOO MUCH STRATUM CORNEUM, skin turning over too much
-Incited/exacerbated by GAS/infx/URI,
Treat with
-Emollients
-Topical steroids, Calcipiotriene, retinoids, coal tar
-UVA (longer wavelength), used with skin to make one photosensitive, try B first without that drug before A
-Use biologics anti TNFs
-MTX

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17
Q

Cutaneous Inflammatory Diseases

Pithyriasis Rosea

A

Pithyriasis Rosea

  • Follow lines of cleavage (christmas tree distribution)
  • Resolves 6-8 weeks
  • Many, thin
  • HHV7 reactivation?
  • Young patients
  • Herald patch appears first! tends to be mistaken for ring worm
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18
Q

Cutaneous Inflammatory Disease

Lichen Planus

A 
Can be cutaneous or mucosal
-involves shins
-sun exposed areas
-nails
Can be precipitated by sun exposure(middle eastern)
T cell autoimmune mediated/
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19
Q

Bacterial Skin infections

A

Impetigo, Scalded Skin, Cellulitis/Erypsipelas, Lyme

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20
Q

Impetigo (types of impetigo)

A
  • Impetigo Contagiosum? Staph and strep. Oral antibiotics. superficial
  • Bullous impetigo (a type of staph aureus causes it). Its a blister, toxin cleaves skin. cleaves granulosum. This type of staph causes scalded skin syndrome that is toxin mediated (exfoliatin), systemic will not grow bacteria. Bullous impetigo can culture the bacteria. Systemic antibiotics are used on a case by case basis
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21
Q

Cellulitis

A
  • Cellulitis. Much deeper. Strep, Staph and H.flu for the face.
  • Erysipela is a variant. Caused by strep and has sharp borders. Superficial dermis. Treat with systemic antibiotics for 10 days.
22
Q 
Tinea corporis or ring worm
Tinea Pedis
Onychomycosis
Tinea Capitis
Kerion
Tinea Versicolor
Candidiasis
A

Fungal infection of the superficial dermis

  • red, scaly annular patch
  • if scaly, scrape. Chlorazol black scale fungal stain
  • Topical anti-fungals

Tinea Pedis

  • interdigits web space, skin macerated (wet stratum corneum), or
  • Moccasin:- diffuse scaly
  • Worsened by increased moisture

Onychomycosis

  • Dermatophytes infection of nail plate and bed.
  • Nail rises (onycholysis), hyperkeratotic, yellow and crumbly nails
  • KOH
  • SYSTEMIC antifungals (terbinafine) vs topicals

Tinea Capitis

  • infection of hair shaft, african american kids
  • KOH of hair shaft, very infectious
  • Black dot. scale, LAD, rarely scar
  • Griseofulvin PO

Kerion

  • Boggy inflammatory reaction to tinea capitis
  • Crusting and pustules
  • May result in scarring alopecia
  • Griseofulvin + PREDNISONE +/- antibiotics (secondary infection)

Tinea Versicolor

  • Malassezia furfur (Pityrosporum orbiculare are lipophylic yeast thats also normal flora- spaghetti and meatball look
  • Hypopigmented, well demarcated macules with fine scale on neck, chest, back and face
  • Can have varying colors
  • Topical more than oral (selenium sulfide and antifungals)

Candidiasis buzz words ‘red patches with satellite lesions’ and pustules, white plaques. Candida likes the scrotum!

  • KOH shows pseudohyphae
  • Nystatin
23
Q 
Scabies
Pediculosis Capitis (head lice_
A

Scabies
-5mm linear scaly lesions, there are borrows where the female mite has burrowed into the skin to lay eggs. WIDELY distributed. Papules/vesicles/pustules are reactive response
-Intractable itch
-Permethrin cream (overnight, repeat in 7 days), Oral ivermectin (repeat in 14 days. Eggs resistant). Wash cloth
and beddings. Skin to skin transmission

Head Lice

  • Pruirius, red macules on nape on neck and scalp, nits on hair
  • Head to head contact
  • 6 legged, wingless bug
24
Q

What skin disease goes in line with Hepatitis C

A

Lichen Planus

  • the P’s! Purple Polygonal Pruritic Papules and Plaques on flexor surfaces, mouth and glans
  • Koebnerization:- when scratched, lesion is spread
25
Q

Interphase dermatitis (epidermal-dermal junction has vacuolar change, with necrosis of the epidermis under an intact stratum corneum)

A

DIFFERENTIAL

  • GVHD, Connective tissue disorders
  • SPECTRUM IS
  • Erythema Multiiforme - Steven Johnsons- Toxic Epidermal Necrolysis

Scalded skin syndrome is different!

26
Q

toxic epidermal necrolysis causes

A

Sulfonamides, anti convulsants, allopurinol, NSAIDS

  • Also related to SJS and EM
  • TEN tend to involve the mucosa
  • Give sulfadiazine (antibacterial)
  • The great steroid debate
  • Compresses
27
Q

Lupus

A
  • malar/butterfly rash spares the nasolabial fold
  • livedo reticularis (netlike vascular patterns on extremities
  • nail fold has ragged cuticles and telengiectasias
  • raynauds:- white, blue, then red again
28
Q

Dermatological Descriptions Shorthand

A
  • On the (body part)
  • are —(shape or size) of primary lesion
  • color (secondary changes)
29
Q

types of lupus

A

Discoid (chronic cutaneous lupus erythematosus):- 5-10% develop SLE. hypopigmented centrally and hyperpigmented peripherally. INTERFACE DERMATITIS

Subacute Cutaneous Lupus Erythematous (SCLE):- typically photosensitive. Are annular! Look ringworm like. No scarring or induration. May anti rho positive (same antibody seen in Sjogrens!). 10-15% develop disease. 35% can be drug induced

Neonatal:- children born to mothers with anti-Rho. Look like SCLE. Monitor for congenital heart block. Scaly erythematous plaques:- favors face/periorbital

30
Q

Dermatomyositis

A

Heliotrope rash around eyes
Dilated telengiectasis around the cuticles
Gottrons papules are pathognomonic
Usually are paraneoplastic
-anti Jo1 antibodies
-CD4 cells in septa and fascicles versus myositis (cd8 t cells infiltrate endomysium)

31
Q

Scleroderma

A
  • Begins with edematous phase
  • Then skin tightening
  • Pitted scarring in finger tips to go with scarring.
32
Q

Sarcoidosis

A
  • Nose (lupus pernoid)

- Periorbital papules, slightly yellow brown

33
Q

Bullous Pemphigoid versus Pemphigus Vulgaris

A

Bullous:- Older people, come in with itchy skin

  • Epidermis intact, subepidermal blistering, antibodies to components of hemidesmosome
  • Hydrosteroids like prednisone, MTX (takes 3 months to kick in)

Pemphigus:- Middle aged, come in with pain

  • involves mucous membranes
  • desmoglein 1 and 3 antibodies
  • rituximab
34
Q

Paraneoplastic

A

-Acanthosis nigrans
Hyperpigmented/velvety plaques, seen in insulin resistance, armpits and neck..Can happen in palms. In palms its more malignancy related

-Sweet syndrome (febrile neutrophilic dermatosis)
Associated with AML. Some kind of cellulitis, painful, can happen in palms and soles

35
Q

GI disease

A

-Pyodermal Gangrenosum (Neutrophil mediated)
Starts at a small red papule and involves into large ulceration
-Classic (gun metal grey borders, ulcer)
-Peristomal: in patients with IBD. Happens post traumatically
-Atypical (dorsal hands)
50% systemic illness associated: IBD, UC, and Crohns. Also associated with leukemia/pre leukemic states
-Can look like sweets
-Steroids

-Erythema Nodosum
Septal panniculitis (panniculitis is fat inflammation, fat lobules in dermis are separated by septum, erythema indoratum is related to tuberculosis, usually in calves and not shins and is a lobular panniculitis)
-Shins symmetrically
-reactive secondary to Strep/URI/Coxackie infx, meds (OCPS, sulfa, PCN, Br, Io), or internal diseases like IBD/Crohns/Sarcoid)
-NSAIDS and rest

36
Q

benign skin manifestation

A

epidermal inclusion cyst or epidermoid cyst:- in dermis, has dermal
lipoma:-
neurofibroma:- spindle cells proliferate in dermis, nuclei are sharp hence mural origin, due to the NF 1 (17), NF2 (22)
nevi
dermatofibroma- dimple sign with pinching lesion

37
Q

SCC

A

Spinous Layer of keratinocytes in epidermis, scaly/pink to skin colored firm papules, ulcerated. Sun exposed layers
Evolves from AKs (actinic keratosis)
-Can ulcerate
-Pain legs with 5FU
-Put soft cast on it
-Strong propensity to invade locally and metastasize
-HPV related (anal SCC)

Keratoacanthoma or KA:- Epithelial neoplasm, variant of SCC

-Treatment is 5FU. cryotherapy (liquid nitrogen), cemical peel, excision, co2 laser, Mohs

38
Q

Other Cancers

A

Basal Cell:- can ulcerate
Malignant Melanoma
-ABCDE
-Nodular, Acral lentiginous (palms and soles, sublingal), metastatic
-Excise them down to fat and fascia to get clean margins

39
Q

Urticaria Hives

A

Blachable pink, edematius wheaks
annular papules and plaques on hair baring skin
IgE related

40
Q

fixed drug eruption

A

Bactrim
Genitalia, face, upper lip, mucous membranes, shoulder
occur at the same site usually
Happens with NSAID

41
Q

Erythema multiforme

A 
Acute hypersensitivity
-to infections
-drugs
Targetoid, annular, can have central crust
-Can be minor or major
42
Q

Stellate purpura

A
  • Happens in meningococcemia

- Stellate purpura implies its following a blood vessel!

43
Q

Leukocytoclastic vasculitis

A
  • Infections
  • HSP post infectious
  • Drugs like PCN,NSAIDs,sufa, cephs, PTU, biologics
  • Hepatitis related
  • Can be due to malignancy, infection or autoimmune
  • Complex deposit in vessels leads to vasculitis
44
Q

Mobilliform

A
  • Measles

- Drugs

45
Q

Nevi- Main division

A
  • Junctional (dermoepidermal) colored brown papule, not raised
  • Intradermal (in the dermis)- usually flesh colored, raised papule. Maturation with depth within the dermis
  • Compound (both)
46
Q

Other types of Nevi

A

Others are
-atypical or dysplastic (mild. moderate. severe) e.g. BK’s syndrome. Some lymphocytic infiltrate, irregularly spaced papilae. FOLLOW UP!

  • halo:- white area of depigmentation around it..Due to brisk inflammatory infiltrates which causes regression of nevus. Ok in kids/young pts, if older, its likely melanoma
  • congenital:- Tend to be hypertrichosis (lots of hair). Followed up, removed in stages!
  • blue:- looks like melanoma. Dermal proliferation of melanocytes (round, oval, dendrytic), lots of pigment. Penetrate deep in the dermis (Tyndall effect)
47
Q

Most prognostic variable in Melanoma

Causes

A

DEPTH (from upper lesion, granular cell layer to deepest point of invasion, reported in mm)
Clark levels:- tells you depth of invasion (1 is insitu, 2: papillary dermis, 3:- fills it, 4: reticular dermis 5. Subcutaneous fat)

Sun exposure, sensitivity, atypical nevi

use ABCDEs:- Assymetry, Border, Color, Diameter (>6mm), Evolving

48
Q

Types of Melanoma

A

Lentigo:- older ppl, sun exposed
Nodular
Superficial spreading
Amelanotic! NO PIGMENT (differential is warts, BCC, SCC, contact dermatitis).
Can happen on scalp!
-Can be BRAF associated
-If within epidermis, good prognosis (once above basement membrane its still insitu, even if follicular hair cell)

49
Q

Seborrhaic keratosis

A

Keratinocytes proliferate

If soo many, look for internal malignancy

50
Q

Actinic Keratosis

A 
Parakeratosis
Buds of atypia keratinocytes in basal region
Precursor to SCC
Treat with cryotherapy
P53 mutations common here
51
Q

SCC risk factors

A

-Burns and scars
-Benzenes
-Immunosuppresed
-HPV
Lip in a special site

52
Q

BCC

A

Basaloid cell:- form aggregates, proliferate from epidermis to dermis, blue, form islands, look like basal cell
Near eye, ear
-shiny papules and nodules
-raised translucent border
-central crust
In young patients think about Basal cell nevus syndrome, PATCH gene associated, SHH pathway
-Dont really metastasize, patients do really well!

General Knowledge from Class (3 decks)

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