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Dermatology Flashcards

1
Q

What embryonic layer do skin cells come from?

A

The skin comes from the ectoderm.

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2
Q

At what week gestation does the stratification of the epidermis start? When does it end

A
  • Stratification of the epidermis begins at week 8 and ends at week 24
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3
Q

What is ectoderm dysplasia and name some defomrities that occur as a result?

A
  • Ectodermo-dysplasia: abnormality of ectoderm development during gestation
    • Deformities: no sweat glands, abnormal teeth, hair, and skin formation
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4
Q

What are the 5 main functions of the skin?

A
  • Mechanical support
  • Homeostasis
  • Physical barrier
  • Interacting with the environment
  • Social interactions (cosmesis)
    • Skin defects can result in considerable psychological distress
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5
Q

List the three cells that are involved in the epidermis.

A

Keratinocytes, Langerhans Cells, Melanocytes

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6
Q

What are the four layers of the keratinocytes and what is the function of each?

A
  • Layers (from top to bottom) - LABELED PIC ATTACHED
    • Stratum Corneum (SC): anuclear, dead cells that shed; barrier/immune defense (1)
    • Stratum Granulosum (SG): the glue; keratin protein and lipid accumulation (2)
    • Stratum Spinosum (SS): contains desmosomal junctions; integrity/barrier (3)
    • Basal: the basement; cell division (4)
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7
Q

What proteins are secreted by keratinocytes? Two types of proteins, but three total.

A
  • Proteins secreted
    • Keratin Type I: acidic
    • Keratin Type II: basic
    • Filaggrin: “filament aggregation protein”
      • Helps assemble keratins into KIFs
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8
Q

When there are mutations in keratin, what disease occurs and what is its manifestation?

A
  • Keratin mutations
    • Epidermolysis Bullosa Simplex: blistering due to lack of stable keratin in the epidermis
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9
Q

What is the function of the Langerhans Cells in the Epidermis? What can dysfunction of them lead to?

A
  • Langerhans Cells (dendritic cells of the skin/mucosa)
    • Resident immune cells used for antigen recognition and presentation to T-cells, initiating immune response
      • Reaches all layers except for stratum corneum
    • Dysfunction of dendritic cells can lead to skin conditions like eczema and allergies
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10
Q

What is the function of melanocytes and what layer of the epidermis are they found in? What can their dysfunction lead to?

A

Basal layer, protect from UV damage

Dysfunction: can lead to DNA damage and therefore XP

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11
Q

What is the general function of the dermis and what are the main cells in this layer (what is then function of these cells)?

A
  • Provides pliability, elasticity, and tensile strength to skin
  • Main cell: fibroblast, which produces collagen
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12
Q

What are the two layers of the dermis and how do they appear?

A
  • Two layers
    • Papillary dermis (closest to epidermis) - top black line
      • Lighter, thinner, more diffuse collagen fibrils
    • Reticular dermis (deep down dermis) - bottom black line
      • Large diameter collagen fibrils
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13
Q

What three diseases can result from dysfunction of the dermis? Discuss the defects in these three diseases.

A
  • Dysfunction
    • Ehlers Danlos: defect in type III collagen where joints dislocate and skin stretches
    • Marfans Syndrome: defect in fibrillin1 affecting elastic fibers where individuals are very tall, lanky, and have long fingers
    • Senile Purpura: aging causes fibroblasts to produce fewer dermal fibers, causing bruising
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14
Q

What occurs in the subcutis (hypodermis)?

A

Subcutis (Hypodermis)

  • Contains subcutaneous fat
  • Adipocytes and adipokines (leptin and ghrelin) are here
  • Dysfunction
    • Lipodystrophy: redistribution of fat
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15
Q

List the appendages of the skin.

A
  • Hair follicles
  • Nails
  • Sebaceous glands
  • Vascular plexi
  • Nerves
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16
Q

List the function and dysfunction (what condition) of hair follicles?

A
  • Hair follicles
    • Function: to produce hair shaft
    • Hair cycle is regulated by Wnt signaling pathway
    • Dysfunction: alopecia – immune system attacks hair
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17
Q

What is the anatomy of nails and what is a condition that is caused by the dysfunction of nails?

A
  • Dysfunction: nail psoriasis – inflammation of nail causes separation
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18
Q

What do sebaceous glands do, where do they attach, and what can dysfunction cause?

A
  • Sebaceous glands
    • Oil glands that produce sebum
    • Attached to hair follicles
    • Dysfunction: acne vulgaris
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19
Q

Where are the two places where the vascular plexi is located? What is the function and what can be caused by dysfunction?

A
  • Vascular plexi
    • Superficial (epidermis/dermis border)
    • Deep (dermis/subcutis border)
    • Function: nutrient supply and theroregulation
    • Dysfunction: Raynaud phenomenon – digital ischemia provoked by cold
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20
Q

What is caused by the dysfunction of nerves?

A
  • Nerves (sensory receptors)
    • Dysfunction: pruritis (itch), dysesthesia (abnormal sensation), loss of feeling
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21
Q

What are the phases of injury and regneration of the skin? 4 phases.

A

Injury Repair and Regeneration

  • Phases
    • Coagulation
    • Inflammatory phase
    • Proliferative-migratory phase (tissue formation)
    • Remodeling phase
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22
Q

What is the morphology and general distribution of psoriasis vulgaris?

A
  • Morphology: Pink-red with silvery scales, Dry, Raised, Definitive Borders
  • Distribution: Scalp, Elbows, Knees, Gluteal Cleft, Nails, Umbilicus
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23
Q

What is the morphology, distribution, and what is a similar skin condition of psoriasis inverse?

A
  • Morphology: Very pink, Definitive borders, Very little plaque
  • Distribution: Folds of the skin: under arm, under breast, belly
  • ***Hard to distinguish from seborrhea
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24
Q

What is the morphology or psoriasis guttate?

A

1000s of small scaly drops

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25
What is the morphology of psorias erythrodermic?
all over red (like a bad sunburn)
26
What is the morphology and distribution of eczema?
**Morphology** Acute = wet and blistering Chronic = pink lichenified with no edges Both have no scale **Distribution** Popliteal fossa and antecubital
27
What is the morphology and distribution of seborrhea?
**Morphology** Faint pink, greasy look to skin Neurological conditions **Distribution** Scalp, brows, ears, nose, chest, armpits
28
What is the morphology, distribution, and general diagnostic criteria of pityriasis rosea?
**​Morphology** Light pink, annular, raised patches **Distribution** Back, abdomen Herald patch: first lesion that is mistaken for tinea “Christmas tree” pattern **Diagnostic Criteria** KOH \*\*\*Hard to differentiate from guttate psoriasis \*\*Rule out syphilis (syphillis can be found on hand and palms)
29
What is the morphology, distribution, and diagnostic criteria of Lichen planus?
**Morphology** Leathery, pink-purple, Variable scale, itchy **Distribution** Wrists/arms, Ankles/legs, Mouth, Nails **Diagnostic Criteria** Hepatitis screening \*\*\*Psoriasis never occurs on the wrist
30
In terms of dermatologic appearance, what is the morphology, distribution, and diagnostic criteria of lupus?
**Morphology** Pink-Red-Brown Annular Variable scale Variable Scarring **Distribution** Discoid LE: regions exposed to sun Subacute LE: Chest, back Systemic LE: elbows **Diagnostic Criteria** Biopsy ANA, etc
31
For tinea, what is the morphology, distribution, and diagnostic criteria?
**Morphology** Pink annular, patches with advancing scale on edge Not raised Not continuous **Distribution** Anywhere with stratified squamous epitheium **Diagnostic Criteria** KOH \*\*\*DO NOT treat with steroids because it will spread fungus
32
What is this?
Onycholysis – lifting below nail This is often found in psoriasis vulgaris.
33
What is this?
pitting of nail, often found in psoriasis vulgaris
34
What is this?
Psoriasis Vulgaris.
35
What is this?
Psoriasis Guttate
36
What is this?
Psorias Erythrodermic
37
What is this?
Acute Eczema
38
What is this?
Chronic Eczema
39
What is this?
Seborrhea
40
What is this?
Pitysiasis rosea
41
What is this?
Lichen Planus
42
What is this?
Discoid LE rash
43
What is this?
General Lupus rash
44
What is this?
Tinea
45
What is the pathophysiology of psoriasis (know the cytokines involved)?
* Pathophysiology: environmental stimuli → activation of dendritic cells → stimulation of T-helper cells via release of TNF-alpha → release of IL-17 and IL-22 → cytokines cause premature maturation of keratinocytes → characteristic psoriatic lesion
46
What drugs are generally used to treat psoriasis?
* Topical steroids as a more affordable and baseline drug for all dermatoses except tinea * Since there are cytokine specificity in the immune response of psoriasis, specific cytokines can be targeted for therapy to not block entire immune system * TNF-alpha inhibitors * IL-17, IL-12, and IL-23 targets
47
Is there a genetic component to psoriasis?
* Genetic component and environmental stimuli play role
48
Is this normal histology of the skin or abnormal?
NORMAL
49
Is this normal histology of the skin or abnormal?
Abnormal. The histology shows dermatoses (psoriasis/eczema). The thickened epidermis with the fingerlike projections is especially characteristic.
50
Stevens-Johnson Syndrome Clinical Features? Distrubution? Etiology?
C: Sloughing of epidermis with blistering and 2 or more mucosal membranes affected D:\<10% of BSA E: Immediate medication reaction
51
Toxic Epidermal Necrolysis Clinical Features? Distrubution? Etiology?
C: Sloughing of epidermis with blistering and 2 or more mucosal membranes affected D:\>30% of BSA E: Immediate medication reaction
52
Erythema Multiforme Clinical Features? Distrubution? Etiology?
C:Typical 3-zoned target of purple, red, and white and 1 mucosal membrane affected D:Extremities E: Infections
53
Simple Drug Exanthem Clinical Features? Distrubution? Etiology?
C: Itchy rash \*\*Not an emergency (otherwise healthy) D:Spares face and mucosal membranes E: Medication reaction occurring 4-14 days after drug initiation
54
DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) Clinical Features? Distrubution? Etiology?
C: Polymorphous rash, facial edema, fever, and eosinophilia D:Everywhere E: Medication reaction occurring 2-6 weeks after start of medication
55
Acute Generalized Exanthematous Pustulosis (AGEP) Clinical Features? Distrubution? Etiology?
C: Erythroderma with tiny pustules all over D: Everywhere E: Medication reaction, especially IV antibiotic
56
Medically induced Psoriasis Clinical Features? Distrubution? Etiology?
C:Black scaling all over skin, Corpse-looking D: Everywhere E: Prednisone tapering
57
Kawasaki Disease Clinical Features? Distrubution? Etiology?
C: Red eyes, Strawberry tongue, Cervical adenopathy, Acral edema (puffy feet and hands),Polymorphous rash, 4 out of 5 + high fever and rash \*\*Requires aspirin and echocardiogram as treatment D: Everywhere E: Vasculitis
58
Purpura fulminans Clinical Features? Distrubution? Etiology?
C: Non-blanching purpura D: Everywhere E: Sepsis, Disseminated Intravascular Coagulation, Shock
59
Necrotizing Fasciitis Clinical Features? Distrubution? Etiology?
C: Pain out of proportion, necrotic tissue, subcutaneous crepitus, purple and black purpura D: Site of infection E: Bacterial infection
60
Pemphigus Vulgaris Clinical Features? Distrubution? Etiology?
C: Erosions – very rarely see blister formation, No fever D: Always involves oral mucosa (Dsg 3), May involve skin (with Dsg 1) E: Autoantibodies against keratinocytes desmosomes in epidermal layer of skin
61
Pemphigus Foliaceous Clinical Features? Distrubution? Etiology?
C: Crusting and scaling in sebaceous areas (corn flake skin) with no intact blisters D: Only skin (only Dsg 1) with no oral involvement E: Autoantibodies against keratinocyte desmosomes in epidermal layer of skin
62
Bullous Pemphigoid Clinical Features? Distrubution? Etiology?
C: Multicolored blisters D: Skin at juncture between epidermis and dermis E: Autoantibodies to BP antigen 1 and 2 (hemidesmosomes)
63
Stevens-Johnson Syndrome
64
Toxic Epidermal Necrolysis
65
Erythema Multiforme
66
Simple Drug Exanthem
67
DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)
68
Acute Generalized Exanthematous Pustulosis (AGEP)
69
Medically induced Psoriasis
70
Kawasaki Disease
71
Purpura fulminans
72
Necrotizing Fasciitis
73
Rocky Mountain Spotted Fever
74
Pemphigus Vulgaris
75
Pemphigus Foliaceous
76
Bullous Pemphigoid
77
Risk Factors for Melanoma (6)
* Skin phototype – lighter phototypes are more at risk * Family history/genetics * Familial – CDKN2A (most common) \> BRAF * De novo – BRAF * Dysplastic/atypical nevi * Greater than 25 common acquired nevi * Immunosuppression * UV exposure * Intermittent, intense sun exposure * Sunburns, especially blistering * Tanning bed
78
Diagnosis for melanoma
* A – Asymmetry * B – Border * C – Color * D – Diameter * E – Evolving * + the “Ugly Duckling” sign – one atypical nevi compared to rest * Gold standard for diagnosis is histology
79
Melanoma Subtype: Superficial Spreading Melanoma
* Most common * Horizontal growth
80
Melanoma Subtype: Nodular Melanoma
* Vertical growth (measured by Breslow’s Depth) * Rapid growth
81
Melanoma Subtype: Lentigo Meligna Melanoma
* Occurs in elderly in sun-exposed areas * Horizontal growth
82
Melanoma Subtype: Acral Lentiginous Melanoma
* Common in darker skin types * Palms, soles, nail plate
83
Management for Melanoma
* Initial: surgical * Adjuvant therapy * Dabrafenib (blocks BRAF) + Vemurafenib * Anti-PDL1
84
Prognosis for melanoma
* Tumor depth is predictor of survival
85
Junctional Nevus
* Junctional Nevus – cells limited to dermal-epidermal junction * Horizontal growth
86
Compound Nevus
* Compound Nevus – cells in dermal-epidermal junction and dermis * Vertical growth
87
Intradermal Nevus
* Intradermal Nevus – cells limited to dermis * Vertical growth
88
Melasma
Mask of pregnancy – polymorphous dots on face of women
89
Freckles
Occurs in children of fair complexion on sun-exposed areas
90
Solar Lentigines
* Age spots occurring in elderly population on sun-exposed areas * Must differentiate from lentigo maligna melanoma
91
Vitiligo
* Acquired disorder of melanocytes * White, sharply demarcated macules and patches without scales * Pathogenesis suspected to be autoimmune related * Systemic diseases * DATA: diabetes, Addison’s disease, thyroid disease, pernicious anemia
92
* “Pasted-on” dry and waxy plaque * Uniform in color: brown, black, pink, tan, white * Can be confused with melanoma
Seborrheic keratosis
93
* Vascular lesion that is very red due to increase in capillaries * Never turns into cancer
Angioma
94
* Growth of epidermis and dermis * Must be differentiated with melanoma by pinching around it * Dimples inward
Dermatofibroma
95
* Protuberant scar tissue that extends beyond site of injury * Excess collagen production causes excessive scarring
Keloid scar
96
* Hyperplasia of keratinocytes creating non-harmful appendages of skin * Genetic
Skin Tags
97
* Pocket of epidermis with keratin and bacteria * Bacteria feeds on keratin * Hole on surface of skin allows for cheesy-material to come out when squeezed
Epidermal inclusion cyst
98
Soft, squishy cyst due to proliferation of adipocytes
Lipoma
99
* Rough, braille-like scaling patches * Pink-tan color * Pre-malignant for squamous cell carcinoma
Actinic Keratoses
100
* Most common skin cancer * Arises from the basal cell layer of the epidermis * Can also appear as non-healing ulcers with slight erosion/scabbing * Arborizing vessels * Presents as a pink pearly growth on sun-exposed skin * Local invasion with almost no metastasis
Basal Cell Carcinoma
101
Treatment for basal cell carcinoma (2)
* Excision * Vismodegib: binds SMO (usually bound by PTCH1/2) to prevent downstream activation of TFs
102
Etiology for squamous cell carcinoma
Etiology beyond UV exposure: XR radiation, HPV, chronic inflammation, ulcer, immunosuppression
103
* Ulcerated scaling papule, plaque, or nodule * Rarely metastasis
Squamous Cell Carcinoma
104
dome-shaped nodule with rapid growth
Keratoacanthoma
105
Basal Cell Carncinoma – basal cells extend into dermis
106
* Squamous Cell Carcinoma – more differentiated epidermal cells are pleomorphic and have large nucleoli * Have keratinic pearls
107
* Squamous Cell Carcinoma – more differentiated epidermal cells are pleomorphic and have large nucleoli * Have keratinic pearls
108
Actopic dermatitis (eczema) Patho? Genetic?
* Family history of atopy (predisposition to allergies like asthma) * Triggered by allergens or irritants (foods, pets, heat, cold, etc.) * Fillagrin defect causes loose keratin cables, allowing allergens to enter into epidermis layers and react with Langerhans Cells
109
Actopic dermatitis (eczema) Presentation?
Clinical features: pruritus (itching) + eczematous rash (red and scaly) + early onset
110
Actopic dermatitis (eczema) Tx? Complication?
* Treatment: avoidance of triggers, moisturization, hydrocortisone cream * Secondary infections * Molluscum contagiosum: viral infection
111
Measles Presentation? Etiology?
Clinical features: rash that begins on face behind ears and spreads downwards Etiologic agent: paramyxovirus
112
Scarlet Fever Presentation? Etiology?
Clinical features: sudden fever with sandpaper rash, especially under skin folds, and strawberry tongue Etiologic agent: Group A Streptococcus
113
Erythema Infectiosum Presentation? Etiology?
Clinical features: “slapped cheeks” and lacy, reticulated rash on extremities Etiologic agent: parvovirus B19
114
Roseola Presentation? Etiology?
Clinical features: fever, fever, fever, fever, rash! Etiologic agent: HHV6
115
Hand, Foot, and Mouth Disease Presentation? Etiology?
Clinical features: flu like symptoms with grey oval vesicles on hands, feet, and mouth Etiologic agent: Coxsackie virus A16
116
Infantile hemangioma Stages?
* Gradual onset in first weeks of life * Proliferates for first year of life * Gradual resolution – does not have to go away completely
117
Infantile hemangioma Features, complications?
* Clinical features: deep red, undefined edges, raised body on face * Complications: hemorrhage and ulcerations
118
Subglottic IH
Subglottic IH: beard formation of hemangioma and can be deadly
119
Capillary malformation (“port wine stain”) stages, features?
* Stages * Present at birth * Affects fixed proportion of face * Clinical features: pink color that lies flat on face
120
Diaper dermatitis irritant
Irritant: spotted rash due to urine and feces, sparing creases of body
121
Diaper Dermatities Candidal
Candidal: beefy-red freckled rash due to growth of Candidia
122
Hand, foot, mouth disease
123
Irritant diaper rash
124
Candidal diaper rash

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