Dermatology Flashcards
Which infections can trigger TEN?
90% HSV
EBV
Mycoplasma pneumonia
What is pathology of LP?
Autoimmune
Erosions ie loss of epidermis only (loss of dermis are ulcers)
What is the histology of LP?
Lymphoctytic infiltrate in upper dermis
How is LP treated?
Topical potent steroids Clobetasol 0.05% EMollinets If vaginal- prednisolone suppositories If poor response- Tacrolimus 0.03%
What is the histology of LS?
Thinned epidermis
Band of collagen
Inflammatory lymphocytic infiltrate
Hyaline layer
What is eccyhmosis a sign of in LS?
active disease
List some causes of genital ulcers
LGV HSV Syphilis Apthous Lipschultz Crohn's Coeliac- Vitamin B12/folate/iron deficiency/anti gliadin Behcets
What is genetic predisposition in Behcets?
HLA B51 or B101
Common in mediterranean/ middle or far East, silk route, Japan
More common in women
What is the criteria required for a diagnosis of Behcets?
Recurrent oral apthosis (3 or more/eyar)
Plus any 2 of
genital ulcers
eye lesions (iritis/uveitis)
Skin lesions (folliculitis, papule-pustular lesions)
Positive pathergy test (papule over 2mm diameter at site of hypodermic needle puncture)
What are the ulcers like in Behcets?
Deep, painful, punched out
In men usually on scrotum
Often coalesce
What treatment can be given in Behcets?
Clobetasol 0.05%
Tacroloimus 0.1%
If severe Prednisolone 40-60mg
How do you diagnose genital blistering conditions?
Pemphigus vulgaris, bullous pemphigoid, Mucous membrane pemphigoid Blisters DEROOF Biopsy- immunofluorescence Immunglobulins in skin Pemphigus antibody
What is Hailey Hailey?
Rare benign familial pemphigus
Superficial blisters usually in axilla/groin
Biopsy- suprabasal acantholysis
Other features of Behcets?
Psychiatric changes
Arthritis
Thrombophlebitis
GI involvement
Which HPV type is most commonly linked with SCC?
HPV 16 is related to at least 75% of SCC compared with HPV 18 (<10%).
Which HPV type is most commonly linked with VAIN and AIN?
Many cases of VAIN 1 and anal intraepithelial neoplasia (AIN) 1 are related to the non-oncogenic HPV types 6 and 11, and are thought now to be usually transient infections.
Is HPV linked to lichens sclerosis and VIN?
HPV-related lesions can occur with LS
high-grade VIN related to oncogenic HPV infection has been linked with LS in around 33% cases.
Around 20% of women with LS are likely to carry HPV 16 incidentally.
The role of long-term LS treatment with high-strength steroids in the persistence and progression of HPV infection is not known.
Risk factors for VIN, PIN, AIN, VAIN
Disrupt general or local immune mechanisms: HIV Other immunosuppression Herpes simplex virus type 2 Smoking
what is Bowenoid papulosis?
Bowenoid papulosis is a rare form of intraepithelial neoplasia that occurs in women (as VIN) and men (PIN).
single or multiple small, red, brown or flesh-coloured papules, most commonly on the labia or penile shaft, but can occur anywhere on genital skin.
Bowenoid papulosis is associated with HPV and is considered a sexually transmitted disease.
Men and women are equally at risk and the peak incidence is in sexually active persons under 30 years of age. Most cases do not progress but a minority, thought to be associated with oncogenic HPV, can progress to SCC.
Diagnosis is confirmed by skin biopsy.
Glandular neoplasia of the cervix is caused by which type of HPV?
Type 18
What is the treatment for Bowenoid papillomatosis?
Treatment is the same as for genital warts, and the aim is to eliminate the lesions and stimulate anti-HPV immunity.
What is the mean age of women presenting with VIN
On average, women with VIN present at 45-50 years.
The incidence of VIN among younger women is increasing, most probably due to oncogenic HPV infection, and adolescents can present with VIN.
VIN is more common in fair-skinned women.
What is the most common type of vulval cancer?
Over 90% of vulval cancers are SCC. Clinically and pathologically, two types are recognised:
What is the aetiology of ‘usual’ type vulval cancer?
Warty basaloid or ‘usual’ type are highly related to oncogenic HPV
What is the aetiology of differentiated vulval cancer?
Simplex or differentiated type are usually related to LS and other lichen disorders.
These latter often develop more rapidly in older women, and are keratinising on examination
Where are other rarer causes of vulval cancer?
Other rare cancers of the vulva include melanoma and basal cell carcinoma, both of which have been reported in association with LS.
Aetiology of vaginal cancer?
Infection with oncogenic HPV types
Smoking
Diethylstilbestrol (DES)
DES l was widely prescribed for pregnant women from 1938 to 1971, mistakenly thought to prevent miscarriage.
Around 1 in 1000 women given DES in pregnancy are at risk of vaginal cancer.
What are types of PIN?
PIN includes Bowenoid papulosis
Bowen’s disease of the penis
Erythroplasia of Queyrat
These terms describe different clinical appearances and an increasing risk of progression to SCC but are within a spectrum of clinical PIN.
Risk factors for PIN and penile cancer?
Uncircumcised males over 50 years of age are at the highest risk of PIN.
Oncogenic HPV.
PIN has been associated with chronic irritation e.g. due to urine or repeated trauma.
HIV-positive men have an increased risk of penile carriage of oncogenic HPV.
HIV-positive men who have sex with men (MSM) with AIN
Male partners of women with CIN are at increased risk of carriage of oncogenic HPV and PIN lesions.
Other factors positively associated with invasive penile cancers include
Phimosis Smoking and chewing tobacco Injury to the penis Balanitis Genital warts.
Management of zoon’s balanitis?
Treatments include:
Improved hygiene
Regular washing beneath foreskin
Emollients
Mild topical steroids alone or in combination with anticandidal, antifungal or antibiotic products
Circumcision and removal of the foreskin is the definitive treatment
In many cases lichen sclerosus is often the condition underlying Zoon’s balanitis and patients should be assessed for this and treated appropriately once the Zoon’s has been cleared.
Clinical appearance of zoon’s balanitis?
Well demarcated shiny glistening moist red or brownish patches on the glans and adjacent preputial mucosa.
Histologically there is epidermal attenuation and an infiltrate of mainly plasma cells.
Predisposing factors for zoon’s balanitis?
Retention of urine and skin squames between tightly apposed mucosal surfaces with hyper-colonisation by normal skin organisms are thought to be important in the aetiology. This results in a non specific polyclonal reaction in the tissues.
LS in men where does it affect?
Usually glans
Common drugs causing fixed drug eruptions?
Tetracyclines salicylates Paracetamol Barbiturates Sulfonamides Hypnotics
Histology of fixed drug eruptions?
Basal layer degeneration
Epidermal detachment and necrosis
Erythroplasia of Queryrat- where does it affect?
Glans/prepuce/meatus
Premalignant
Triggered by coinfection with papilloma viruses
What is bowen’s disease?
Cutaneous carcinoma in situ
Bowen’s papillomatosis aetiology?
Carcioma in situ
Linked to HPB 18
Appearance of erythroplasia of Queryrat
Red velvety with ?rasied white areas
Histology of zoon’s balanitis or vulvitis?
mucosa -thinned/ eroded overlying a dense stromal infiltrate
The infiltrate contains numerous plasma cells which often form sheets.
