- Punched out monomorphic lesions - Eczema simplex

Dermatology Flashcards by Erin Timmoney

Is acantholysis seen in Bullous Pemphigoid?

NO, pemphigus vulgaris

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HLA DQ2, coeliac, IgA dermal papillae

Dermatitis Herpetiformis

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Types of collagen in the dermis?

Type I and III

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Koebner phenonomen

New lesions arrive at a site (psoriasis)

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How does Actinic Lentigines arise?

Epidermis elongated rete ridges

Increase melanin and basal melanocytes

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Architectural atypia AND cellular atypia

Dysplastic naevia

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Naevi,

Spitz naevi

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Leser-Trelat sign

In Seborrhoeic Keratosis, eruptive appearance of many lesions may indicate internal malignancy

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Horn cysts

Seborrhoeic Keratosis

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What do skin cancer precursors show?

Squamous dysplasia

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What are the viral precursors of melanoma?

Viral genital lesions often dysplastic
Erythroplasia of Queryat-penile Bowen’s
Associated with Human papillomavirus

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What is Mycosis fungoides?

Cutaneous T cell lymphoma

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Sites of psoriasis

Scalp, sacrum, hands, feet, trunk

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Demodex mite association

Rosacea

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Rosacea treatment

Topical metronidazole

Oral tetracycline long term

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What is Spongiosis?

Oedema between the keratinocytes

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Chronic changes in Eczema

Lichenification
Excoriation
Secondary infection

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Eczema herpeticum

Punched out monomorphic lesions

- Eczema simplex

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What is stasis eczema secondary to?

hydrostatic pressure
oedema
red cell extravasation

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Pompholyx eczema

Spongiotic vesicles

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Indicators of a severe drug reaction

Involvement of mucous membrane and face. • Facial oedema &amp; erythema.
• Widespread confluent erythema.
• Fever (>38.50C).
• Blisters, purpura, necrosis.
• Lymphoadenopathy, arthalgia.
• Shortness of breath, wheezing.

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Drugs which can cause Acne?

Glucocorticoids (steroid acne)

- Androgens (therapeutic), lithium, isoniazid, phenytoin

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Drugs which can induce Bullous Pemphigoid

ACE inhibitors, penicillin, furosemide

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Types of Drug reactions

Exanthematous (most common, type IV, mucous membranes spared)
Fixed
Pustular/bullous

Drugs associated with Exanthematous drug reactions?

- Penicillins - Erythromycin - NSAIDs - Chloramphenicol

Drug reaction which is well demarcated, red, painful and resolves with persistent pigmentation when the drug is stopped. Can present as eczematous lesions, papules, vesicles or urticaria

Fixed drug reaction

Most common type of drug reactions, type IV, mild and self limiting, mucous membranes spared, itch, presents 4-21 days after taking drug

Exanthematous drug reaction

Drugs associated with fixed drug reactions?

- Tetracycline, doxycycline - Paracetomol - NSAIDS - Carbamazepine

Cutaneous phytotoxicity: drug which causes exposed telangiectasia?

Ca channel antagonists

Porphyria Cutanea Tarda enzyme defect and metabolite

-Uroporphyrinogenecarboxylase leading to accumulation of Urophorynogen III

Hyperpigmentation Hypertrichosis Solar urticaria Morphoea

Porphyria Cutanea Tarda

Erythropoietic protoporphyria defect and metabolite

Defect in ferrochelase leading to accumulation of Protophyrin IX

How does Erythropoietic protoporphyria present?

Cold soaked towel on hands

Management of Erythropoietic protoporphyria?

6 monthly LFTs and RBC porphyrins

Acute Intermittent Porphyria defect

PBG deaminase leading to accumulation of Porphyroinoggen

Lipodermatosclerosis Hyperpigmentation Malleolus

Venous Ulcer

What is a Keratoacanthoma?

- A skin lesion in sun damaged skin which grows "like a volcano" and may shrink and resolve by itself - May be a precursor of non-melanoma skin cancer - "central crater"

What are the sun exposure patterns in: a) SCC b) BCC c) Melanoma

a) Chronic cumulative UV exposure b) Intermittent , intense sunburn episodes c) Intermittent , intense sunburn episodes

What is the increased risk of developing melanoma in a child who has been sun-burned?

Risk increases 4 fold

Genetic risk factors for skin cancer?

- Xeroderma Pigmentosum - Oculocutaneous albinism - Naevoid basal cell carcinoma (Gorlin’s) syndrome - Recessive dystrophic epidermolysis bullosa (RDEB)

What are the 5 layers of the scalp?

- Skin - Connective tissue - Aponeurosis - Loose connective tissue - Periosteum

What is the role of keratinocytes in the immune response?

- Sense pathogens via cell surface receptors - Produce AMP to directly kill the pathogen - Produce cytokines and chemokine

AMP level in patients with psoriasis

High

What is the role of langerhans in the immune response?

- Antigen presenting cells characterised by Birbeck granules | - Process lipid antigen and present them to the T cells

Where are CD8 cells found?

Epidermis

Where are CD4 and CD8 found?

Dermis

TH1

Psoriasis

TH2

Atopic dermatitis

TH17

Psoriasis and Atopic dermatitis

What are the two types of dendritic cells in the dermis?

- Dermis DC (Ag presenting) | - Plasacytoid DC (Diseased skin)

TH1 and TH17

Psoriasis

Mutations in fillagrin gene associated with severe/early onset disease. ↓AMP in skin

Atopic Eczema

What is a Arthus reaction?

Skin testing in type III hypersensitivity leads to an Arthus reaction, which is slower than a type I skin response, but faster than a type IV skin response

Tuberose Sclerosis has Genetic Heterogeneity, what is this?

The mutation may be in either TSC1 or TSC2

What is Pruritoceptive itch?

- Something in the skin that triggers itch | - Insect bite

What is Neuropathic itch?

Damage of any sort to central or peripheral nerves causing itch

What is Neurogenic itch?

- No evident damage in CNS, but itch caused by, e.g. opiate effects on CNS receptors - Primary Biliary cirrhosis

What is Psychogenic itch?

Psychogenic: psychological causes with no (currently detectable) CNS damage e.g. itch in delusions of infestation