Dermatology Flashcards
Seborrheic dermatitis is associated with what other disorders?
- CNS (especially Parkinson Disease)
- HIV
Pruritic, erythematous plaques with fine, loos, yellow, and greasy-looking scales that effects the scalp (dandruff)), face (eyebrows, nasolabial folds, and external ear canal/posterior ear), chest, and intertriginous arease
Seborrheic dermatitis
This is characterized by erythema, edema, and telangiectasias affecting primarily the central face. Flushing and local discomfort can be triggered by hot or spicy foods, emotional stressors, or temperature fluctuations
Rosacea
effective treatment of Seborrheic dermatitis
topical antifungal
What is used to treat skin conditions caused by rapid cell division such as actinic keratoses and superficial basal cell carcinomas?
Topical 5-fluorouracil
Describe the ugly duckling sign in suspicion for melanoma
-In a patient who has multiple pigmented lesions, a lesion with an appearance that is substantiially different from other (eg, dark brown rather than light brown, nodule rather than flat) may represent melanoma
Benign pigmented lesions are usually asymptomatic; therefore, biopsy should be considered for moles that itch or bleed, particularly in the presence of other concerning features. If melanoma is suspected, what is the management?
Patient should undergo excisional biopsy with initial margins of 1-3 mm of normal tissue
This is characterized by complete depigmentation (from melanocyte destruction, possibly due to autoimmune mechanisms), most commonly on the face and hands
Vitiligo
What is the only tinea infection that is not caused by dermatophytes (which require keratin for growth)
Tinea versicolor: Malassezia species –> pityriasis versicolor
What should be considered for patients with Molluscum contagiosum, especially if the lesions are widespread or involve the face
HIV testing
This is a chronic, inherited skin disorder characterized by diffuse dermal scaling. It is caused by mutations in the filaggrin gene and is significantly worse in individuals who are homozygous. The skin appears dry and rough with horny plates resembling fish or reptile scales
- Ichthyosis vulgaris
- This is a lifelong condition, but symptoms in early life are frequently mild and may be attributed to simple dryness. However, the condition often worsens later in life
- Often worsens in the winter due to decreased ambient humidity
Management of Ichthyosis vulgaris
-If simple emolliencts are ineffective, keratolytics (eg, coal tar, salicylic acid) and topical retinoids are useful for controlling symptoms
This should be suspected in patients with a rough, scaly nodule or nonhealing, painless ulcer that develops in the setting of a scar or chronic inflammatory lesion
Squamous cell carcinoma
-Sun exposure is the most common cause of SCC, but other risk factors include radiation exposure; immunosuppression; and chronic wounds, burns, or scars
Describe the management of suspected squamous cell carcinoma of skin
- Dx should be confirmed with skin biopsy (punch, shave, or excisional) that includes the deep reticular dermis to assess the depth of invasion
- Small or low-risk lesions are usually managed with surgical excision or local destruction (eg, cryotherapy, electrodessication);
- Lesions that are high risk or located in cosmetically sensitive areas should be referred for Mohs micrographic surgery
This is a skin infection of the DEEP dermis and subcutaneous fat usually caused by beta hemolytic strep (nonpurulent) or Staph aureus (purulent)
Cellulitis
This is similar in etiology (generally streptococci) and clinical presentation to cellulitis. However, this is limited to the EPIDERMIS and SUPERFICIAL dermis, which gives it a characteristic raised, sharp border and intense erythema
Erysipelas
This is a delayed hypersensitivity reaction usually characterized by subcutaneous, bilateral, anterior leg nodules (inflammation of subcutaneous tissues). It is associated with infectious (eg, strep pharyngitis), autoimmune (eg, sarcoidosis), or inflammatory (eg, IBD). Polyarthralgia, fever, and malaise are common
Erythema nodosum
this typically presents as a target lesion with erythematous, iris shaped macules htat can also contain vesicles or bullae. The lesions can be painful or pruritic, last for several days, and are usually symmetrically distributed on extensor surfaces of extremities and the palms and soles
Erythema multiforme
this is usually due to mast cell activation in the DEEPER dermal and subcutaneous tissues. It can occur with or without urticaria and typically presents as non-pitting and non-pruritic edematous swelling involving subcutaneous tissues, abdominal organs, or the upper airway
Idiopathic angioedema
This is due to mast cell activation in the SUPERFICIAL dermis, which increases release of multiple mediators (eg, histamine) that cause pruritis and localized swelling in the upper layers of the skin
Urticaria
This usually presents after a prodrome of fever with non-pruritic erythematous maculopapular eruptions lasting for days
Viral exanthem
This typically presents as small papules evenly distributed in a ring around the corona of the glans penis. It is a benign non-infectious condition, though patients often request removal to avoid the appearance of having a STD
Pearly pink penile papules which are a common anatomic variant
These are verrucous papilliform lesions located in the anogenital region. these lesions are caused by HPV which is the most common sexually transmitted disease in the US. Certain serotypes (especially 16 and 18) are associated with squamous cell carcinoma of the anus, genital organs, and throad
Condyloma ACUMINATA (anogenital warts)
These are a manifestation of secondary syphilis and characterized by flattened pink or gray velvety papules. These are most commonly at the mucous membranes and moist skin of the genital organs, perineum, and mouth
Condyloma LATA
This is a benign pigmented lesion with a well-dermarcated border and a velvety or greasy surface. It is often described as having a “stuck on” appearance
Seborrheic keratosis
This is characterized by scaly papules or plaques on the scalp, face, lateral neck, and dorsal surface of the hands?
risk factor?
Malignant potential?
- Actinic keratosis
- Chronic sun exposure is the major risk factor
- Actinic keratosis can progress to SCC, but the likelihood of malignant progression of an individual lesion is low
This causes small, punctate lesions with surrounding erythema, classically in linear tracks or clusters. Bites on the palms and soles are uncommon due to the thickness of the skin
Bed bugs
This is an autoimmune disease most commonly affecting individuals age > 60. Patients have a prodrome of eczematous or urticarial lesions and subsequently develop tense bullae and plaques affected the flexural areas, groin, or axilla
Bullous pemphigoid
Describe treatment of Vitiligo
- Limited disease: Topical corticosteroids
- Extensive/unresponsive disease: oral corticosteroids, topical calcineurin inhibitors, PUVA
This is an autosomal dominant disorder characterized by PATCHY absence of melanocytes. It is usually noticed at birth and is confined to the head and trunk
Piebaldism
3 types of acne vulgaris
- Comedonal Acne
- Inflammatory acne
- Nodular (cystic acne)
Comedonal acne is characterized by closed or open comedones on forehead, nose, and chin. They may progress to inflammatory pustules or nodules. What is treatment?
-Topical retinoids; salicylic, azelaic, or glycolic acid
Inflammatory acne has inflamed papules (< 5 mm) and pustules; erythema. What is treatment?
- Mild: topical retinoids + benzoyl peroxide
- Moderate: Add topical antibiotics (eg, erythromycin, clindamycin)
- Severe: add oral antibiotics
Nodular (cystic) acne has Large (> 5 mm) nodules that can appear cystic. Nodules may merge to form sinus tracts with possible scarring. What is treatment?
- Moderate: Topical retinoid + benzoyl peroxide + topical antibiotics
- Severe: Add oral antibiotics
- Unresponsive severe: ORAL ISOTRETINOIN
Patient who has an outdoor occupation with significant sun exposure and who has developed a persistent, indurated, ulcerating LOWER lip lesion has typical features of what?
SCC
SCC is the most common malignancy of the lip, with 95% of cases occurring where?
in the lower lip vermilion likely due to higher exposure to sunlight
Diagnosis of SCC is confirmed with biopsy. Typical pathologic finding include what?
invasive cords of squamous cells with KETATIN PEARLS
Like SCC, Basal Cell Carcinoma, can form ulcerating lesions and is associated with sun exposure. What are some clues that lean towards BCC
- BCC of the lip is much less common than SCC
- typically affects the upper rather than lower lip
BCC is characterized histologically by what?
Invasive clusters of spindle cells surrounded by palisaded basal cells
These are characterized by shallow, fibrin-coated ulcerations with underlying mononuclear infiltrates.
Aphthous ulcers (canker sores) -These are recurrent, self-limiting ulcerations of the oral cavity and do not affect surfaces covered by keratinized stratified squamous epithelium
Features of Drug-induced acne are: -Monomorphic papules or pustules -Lack of comedones, cysts, and nodules -Location and age of onset may be atypical for acne What are common triggers?
- Glucocorticoids, androgens
- Immunomodulators (eg, azathioprine, EGFR inhibitors)
- Anticonvulsants (eg, phenytoin), antipsychotics
- Antituberculous drugs (eg, isoniazid)
Is BCC or SCC more likely to cause neural invasion?
SCC
This is usually seen in immunosuppressed patients. The skin is the most common site and it presents as multiple, discrete, flesh- to red-colored papules of varying size with slight central umbilication
Disseminated cryptococcosis
What is the most common skin malignancy in patients on chronic immunosuppressive therapy for a history of organ transplant
SCC
Dermatitis herpetiformis causes intensely pruritic erythematous papules, vesicles, and bullae that occur symmetrically in grouped clusters on the extensor surfaces of the elbows, knees, back, and buttocks. DH represents an autoimmune dermal reaction due to dietary gluten and is commonly associated with celiac disease, although it may precede the GI manifestations. What does skin biopsy and immunofluorescence show?
- Skin biopsy: supepidermal microabscesses (blisters) at the tips of the dermal papillae
- Immunofluorescence: deposits of anti-epidermal transglutaminase IgA in the dermis
Treatment of Dermatitis herpetiformis?
Initial: Dapsone, which has anti-inflammatory and immunomodulatory properties and provides rapid relief of symptoms
Long term: gluten free diet
this is an autoimmune disorder characterized by painful, flaccid bullae, mucosal erosions, and separation of the epidermis from the dermis on light friction. The roof of the bullous lesions is fragile and rapidly desquamates, leaving raw ulcers
Pemphigus vulgaris
Seborrheic keratosis are benign lesions, although sudden onset of multiple SKs may indicate an occult internal malignancy . .what sign is this
Leser-Trelat sign
The diagnosis of an Seborrheic keratosis is clinical and biopsy is not usually necessary but what would it show?
Small cell resembling basal cells, with variable pigmentation, hyperkeratosis, and keratin-containing cysts
This is a flesh-colored papule usually seen in regions of the body subjected to friction such as the neck, axillae, and inner thighs . .. . skin tag
Acrochordon
These are cutaneous tumors that usually present as dome-shaped nodules with a central keratinous plug. They are generally benign, although rare cases with malignant transformation and metastasis have been reported
Keratoacanthoma
These are small, red, cutaneous papules common in aging adults. They do not regress spontaneously, but they are benign and generally do not require treatment
Cherry hemangiomas
These appear during the first weeks of life. They initially grow rapidly and then frequently regress spontaneously by age 5-8. They are bright red when near the epidermis and more violaceous when deeper
Strawberry (infantile) hemangiomas
These consist of bright-red central arterioles surrounded by several outwardly radiating vessels. They blanch with pressure. They are estrogen dependent and are commonly seen in pregnancy, oral contraceptive use, and cirrhosis-related hyperestrogenemia
Spider angiomas
Bullous pemphigoid has an increased incidence in those with malignancy or neurological disorder like what?
- Parkinson Disease
- MS
Describe the pathology and immunofluorescence in Bullous pemphigoid
- IgG autoantibodies against the hemidesmosomes and basement membrane zonse
- linear IgG and C3 deposits along the basement membrane
First line treatment of Bullous pemphigoid
-High-potency toplical glucocorticoid (eg, clobetasol)
This is a common skin disorder characterized by small pale/yellow papules at the central face. Lesions are stable in size and appearance
Sebaceous hyperplasia
Vitiligo is an autoimmune condition characterized by areas of depigmenttion due to destruction of melanocytes. It can be associated with other autoimmune condition such as what?
- Pernicious anemia
- Autoimmune thyroid disease
- Type I DM
- primary adrenal insufficiency
- hypopituitarism
- alopecia areata
Describe the management of basal cell carcinoma
- Nodular BCC has low metastatic potential but should be removed with either electrodessication and curettage or surgical excision
- Mohs micrographic surgery, in which thin layers are removed and inspected microscopically to ensure clear margins, is used for high-risk lesions in delicate or cosmetically sensitive areas
Who is at risk for more severe and widespread molluscum contagiosum?
-Patients with impaired cellular immunity (eg, HIV disease)
this is a benign nodule containing squamous epithelium that produces keratin. It presents as a dome-shaped, firm, freely movable cyst or nodule with a small central punctum. The lesion can remain stable or gradually increase in size but may produce a cheesy white discharge; it usually resolves spontaneously
Epidermal Inclusion cyst
This is a benign fibroblast proliferation that typically appears as a firm, hyperpigmented nodule, most often on the lower extremities. They have a fibrous component that causes dimpling in the center when the area is pinched (“dimple” or “buttonhole” sign)
Dermatofibroma
Lipomas are benign, painless subcutaneous masses with normal overlying epidermis. Contrast it to an epidermal cyst?
usually soft to rubbery and irregular and do not typically regress and recur
Patient with skin fragility, ecchymosis, and normal lab studies (blood counts and coags) is consistent with this which is a noninflammatory disorder that is most common in the elderly but can also be seen in middle-aged patients with extensive sunlight exposure
Senile Purpura (solar or actinic purpura)
Senile purpura is caused by what?
loss of elastic fibers in perivascular connective tissue
This is an IgM or IgG immnoglobulin that prolongs the activated partial thromboplastin time (aPTT) by binding to phospholipids used in the assay. The prolonged aPTT is a lab artifact as this is not a physiologic anticoagulant but actually increases the risk of thrombosis
Lupus anticoagulant
Vitamin K deficiency depletes vitamin K dependent clotting factors, 2, 7, 9, 10 . . which coag value does this increase
PT . . . aPTT to lesser extent
