Dermatology Patients

Question 1

Actinic keratosis

Answer 1

result from a clone of abnormal squamous cells caused by UV light-induced gene alteration and therefore only develop on sun-damaged skin. They are the initial lesion in a disease continuum that progresses to invasive squamous cell carcinoma. Ill-defined macules, papules or plaques that are usually asymptomatic.

Question 2

Alopecia areata

Answer 2

• A non-scarring alopecia (hair loss)
• Occurs as round or oval patches of hair loss
• Short “exclamation point” hairs, broader at the distal end
• Hairs often re-grow with depigmentation
• Clinical subtypes
• Patchy focal
• Ophiasis pattern
• Diffuse variant
• Alopecia totalis
• Alopecia universalis
• Average lifetime risk 1.7%
• Up to 40% have an atopic diathesis (allergic rhinitis, asthma, atopic dermatitis) compared to 20% in the general population
• May be associated with other autoimmune diseases including: thyroid, vitiligo and inflammatory bowel disease

Question 3

Cherry angiomas

Answer 3

is a benign bright cherry-red, round, palpable angiomas that begin after age 30. Etiology is unknown

Question 4

Dermatofibromas

Answer 4

is a common cutaneous nodule, more common in women of unknown etiology that usually forms on the extremities.

Question 5

Epidermolysis Bullosa

Answer 5

an inherited blistering disorder.

Question 6

Granuloma Annulare

Answer 6

Granulomatous inflammation of the dermis in an annular configuration. May occur in children and adults. Usually localized to acral areas such as the elbows, hands and feet.

Question 7

Lamellar Ichthyosis

Answer 7

is an autosomal recessive and presents soon after birth and evolves into large quadrilateral dark scales that are free at the edges and adherent at the center. Hair may be sparse and fine.

Question 8

Lichen Planus

Answer 8

Inflammatory skin disorder which may be associated with hepatitis C infection. On the skin, purple, polygonal, pruritic, papules are noted with lacy white overlay called Wickham’s striae. May also affect the mucosal surfaces (oral lichen planus), nails and may cause a scarring alopecia (lichen planopilaris).

Question 9

Lipomas

Answer 9

are slow growing, solitary, soft benign mobile tumors of fat.

Question 10

Lupus erythematosus

Answer 10

a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs). 4 of 11 criteria must be met to make the diagnosis of systemic lupus:

1. Malar rash – a rash over the cheeks and nose, often in the shape of a butterfly
2. Discoid rash – a rash that appears as red, raised, disk-shaped patches
3. Photosensitivity – a reaction to sun or light that causes a skin rash to appear or get worse
4. Oral ulcers – sores appearing in the mouth
5. Arthritis – joint pain and swelling of two or more joints in which the bones around the joints do not become destroyed
6. Serositis – inflammation of the lining around the lungs (pleuritis) or inflammation of the lining around the heart that causes chest pain which is worse with deep breathing (pericarditis)
7. Kidney disorder – persistent protein or cellular casts in the urine
8. Neurological disorder – seizures or psychosis
9. Blood disorder – anemia (low red blood cell count), leukopenia (low white blood cell count), lymphopenia (low level of specific white blood cells), or thrombocytopenia (low platelet count)
10. Immunologic disorder –anti-DNA or anti-Sm or positive antiphospholipid antibodies
11. Abnormal antinuclear antibody (ANA)

Question 11

There are also skin only forms of lupus:

Answer 11

subacute cutaneous lupus and discoid lupus.

Question 12

Melasma

Answer 12

Hyperpigmentation, usually on the face, triggered by pregnancy, oral contraceptive pills and hormone replacement therapy.

Question 13

Morphea

Answer 13

May occur in oval plaques or linear bands. A violaceous or lilac- colored active inflammatory border is a highly characteristic for active morphea

Question 14

Neurofibromatosis 1 (NF1)

Answer 14

also known as von Recklinghausen NF or Peripheral NF. Occurring in 1:3,000 births, web characterized by multiple cafe-au-lait spots and neurofibromas on or under the skin. Enlargement and deformation of bones and curvature of the spine (scoliosis) may also occur. Occasionally, tumors may develop in the brain, on cranial nerves, or on the spinal cord. About 50% of people with NF also have learning disabilities.

Question 15

Nevi

Answer 15

are commonly called moles. They are sharply circumscribed and chronic, and brown/black in color, as they are composed of melanocytes. The etiology is unclear. Large congenital nevi are >/= 20 cm at birth and do carry a higher risk of melanoma.

Question 16

Port wine stain

Answer 16

a congenital vascular malformation of the capillaries which can thicken and darken with age, becoming deeply violaceous and nodular.

Question 17

Pemphigus Vulgaris

Answer 17

is an autoimmune blistering disease, affecting patients 40-60 years old. Oral lesions are a common site, though superficial bullae can occur anywhere on the body. +Nikolsky’s sign – the epidermis is easily detached from underlying skin.

Question 18

Psoriasis

Answer 18

is a common skin disorder characterized by excessive proliferation of keratinocytes resulting in the formation of thickened, silver-scaly plaques, itching, and inflammatory changes of the epidermis and dermis. The lesions are symmetric and sharply demarcated and occur mainly on extensor surfaces.

Question 19

Rosacea

Answer 19

is a common chronic inflammatory facial skin disorder seen in in ages 30-60, females more commen than males. Features include central flushing, erythema, telangiectasias, papule, pustules, ocular lesions, edema and rhinophyma.

Question 20

Seborrheic keratosis

Answer 20

is a benign wart-like growth on the superficial skin, that appear after age 40 and are often located on the face or trunk. They are painless, and may be yellow, brown, or black with slightly elevated flat surface, round-to oval in shape.

Question 21

Scleroderma

Answer 21

is a rare multisystem, chronic disorder characterized by tissue fibrosis, small blood vessel vasculopathy and autoimmunity. Dermatologic presentation includes skin thickening on the extremities, face and trunk in a symmetric pattern; salt and pepper discoloration on extremitites, sclerodactyly, Raynaud’s phenomenon, and telangiectases. Systemic findings include esophageal dysmotility, pulmonary fibrosis, joint contractures, ulcerations and calcinosis with CREST.

Question 22

Solar Lentigo

Answer 22

Brown macule on chronically sun exposed skin. Biopsy would show excess melanocytes compared to normal skin. This is a benign skin change and is commonly referred to as a “liver spot”.

Question 23

Tinea pedis

Answer 23

also known as athlete’s feet, is causes by a localized fungal infection. The most common symptom is cracked, flaking and peeling skin between the toes. The areas are erythematous and pruritic, and may cause burning and stinging.

Question 24

Vitiligo

Answer 24

is the result of melanocyte destruct on but the cause is unknown. It is characterized by hypopigmented and depigmented lesions, on sun-exposed skin, body folds and around body orifices. Lesions tend to be bilateral and symmetric. Hair in the affected areas may also be white. This is an acquired anomaly. It may be associated with an autoimmune disease.
• Acquired depigmented patches due to loss of melanocytes
• Incidence: 0.5-2%
• Commonly seen in periorificial and acral locations
• Microscopic finding is a complete absence of melanocytes
• Commonly associated with thyroid disease (up to 30% of all cases)
• Hashimoto’s thyroiditis
• Graves’ disease
• Diabetes Mellitis
• Pernicious Anemia
• Addison’s disease