Dermatology Review Flashcards
Epidermis layers
Stratum corneum
Stratum granulosum
Stratum spinosum
Stratum basalis
Zones of the Dermis
Papillary dermis
- upper layer
- thin collagen bundles
- interlocks with epidermal rete
- increases strength
- increases surface area
Reticular dermis
- deeper layer
- thick collagen bundles
- visible elastic fibers
- Collagen – forms the tensile strength
- Elastic fibers – allow for resilience
- Ground substance – facilitates diffusion
Major constituents of the dermis
Acquired disorder of elastin
Solar elastosis
Congenital disorder of elastin
Pseudoxanthoma Elasticum
Acquired blistering disorder of DEJ
Bullous pemphgoid
Papillary dermis
- upper layer
- thin collagen bundles
- interlocks with epidermal rete
- increases strength
- increases surface area
Reticular dermis
- deeper layer
- thick collagen bundles
- visible elastic fibers
Zones of the Dermis
Congenital blistering disorder of DEJ
Epidermolysis bullosa
Proximal Subungual White Onychomycosis/ Trichophyton rubrum
Associated with HIV disease
Major constituents of the dermis
- Collagen – forms the tensile strength
- Elastic fibers – allow for resilience
- Ground substance – facilitates diffusion
- upper layer
- thin collagen bundles
- interlocks with epidermal rete
- increases strength
- increases surface area
Papillary dermis
- deeper layer
- thick collagen bundles
- visible elastic fibers
Reticular dermis
Anagen Effluvium
Loss of growing hairs- Often due to chemotherapy
Telogen Effluvium
Hairs go into resting cycle
May be due to medications, post partum
Nummular Dermatitis
distinct, coin-shaped (nummular) or oval sores on their skin
Atopic Dermatitis
An itchy inflammation of the skin
Seborrheic Dermatitis
A skin condition that causes scaly patches and red skin, mainly on the scalp
Irritant Dermatitis
is inflammation of the skin typically manifested by erythema, mild edema, and scaling.
Irritant contact dermatitis is a nonspecific response of the skin to direct chemical damage that releases mediators of inflammation predominately from epidermal cells.
Four Types of Hypersensitivity Reactions
Type I: Anaphylactic Reactions
Type II: Cytotoxic Reactions
Type III: Immune Complex Reactions
Type IV: Delayed Type Hypersensitivity Reactions
Involves reactions to circulating antigens
Antibodies bind antigen and form immune complexes which deposit in organs
These immune complexes activate complement and cause damage due to inflammatory cascade
Example: serum sickness reactions
Type III: Immune Complex Reactions
Langerhans cells are the antigen presenting cell
Memory T cells then become sensitized to locally deposited antigens
Local reaction occurs and this does not involve antibodies
Type IV: Delayed Type Hypersensitivity Reactions
__________ produce IFN-gamma, IL-2 and TNF-beta, evoke cell-mediated immunity and phagocyte-dependent inflammation
Th1 cells
______ produce IL-4, IL-5, IL-6, IL-9, IL-10, and IL-13, and evoke strong Ab responses (IgE) with eosinophil accumulation
Th2 cells
Impetigo
yellow/honey crust
Neurofibromatosis Type 1: Diagnosis requires 2 or more of the following criteria
- 6+ café au lait macules
- 2+neurofibromas, or 1 plexiform neurofibroma
- Axillary or inguinal freckling (Crowe’s sign)
- Optic glioma
- Two or more Lisch nodules
- thinning of the long bone cortex
- FDR with the disorder
Seborrheic Keratosis“Barnacles of Life”
Primary lesion
Color- white to gray to tan to brown to black
Exophytic papule- “stuck-on appearance”
Smooth to verrucous
Often friable
Surface often studded with small pits (pseudohorncysts
Growth patterns of moles
Intradermal nevus
Junctional nevus
Compound nevus
Malignant Melanoma
ABCDE Guidelines
A = Asymmetry B = Border irregularity C = Color variation D = Diameter greater than 6 mm E = Evolution (or change) The Ugly Ducklin
- 6+ café au lait macules
- 2+neurofibromas, or 1 plexiform neurofibroma
- Axillary or inguinal freckling (Crowe’s sign)
- Optic glioma
- Two or more Lisch nodules
- thinning of the long bone cortex
- FDR with the disorder
Neurofibromatosis Type 1: Diagnosis requires 2 or more of the following criteria
UVR Effects on the Skin
- Damage to DNA, RNA, lipids, proteins
- Pro-inflammatory effects
- Immunosuppressive effects
- Induction of innate defenses
- Induction of apoptosis
- Vitamin D synthesis
Photodermatoses
Connective Tissue Disease
Lupus Erythematosus
Dermatomyositis
Mixed Connective Tissue Disease (MCTD or Sharp’s Syndrome
Acanthosis NigricansTREATMENT
Treat the underlying disorder
Keratolytics such as ammonium lactate or urea cream
Dermatomyositis
CLINICAL
Photodistributed, violaceous poikiloderma
Favors scalp, periocular and extensor skin sites
Heliotrope = Eruption on the upper eyelids +/- periorbital edema
Samitz sign
= ragged cuticles
*DermatomyositisCLINICAL
Gottron’s papules
lichenoid papules overlying knuckles, elbows, knees
DermatomyositisCLINICAL
Dermatomyositis- MALIGNANCY
Age appropriate malignancy screen including: mammogram, CXR, colonoscopy, PAP smear, PSA, CBC
Skin Defenses Against Ultraviolet Radiation
- DNA Repair
- Apoptosis of Cells with DNA Damage
- Defenses Against Reactive Oxygen
- Melanin
Ointments vs. creams
To lubricate, creams must be applied every 2 hours; ointments only every 12 hours
Creams require preservatives that may cause contact irritation or allergy
Pyoderma Gangrenosum- TREATMENT
Conservative wound care
AVOID SURGERY AND DEBRIDEMENT
Oral and topical anti-inflammatory agents such as steroids
Purple, polygonal, pruritic papules
Wickham’s striae: an overlying lace-like pattern of white lines on the surface
Lichen Planus
Inflammatory Bowel Disease relates to?
Pyoderma Gangrenosum
Acanthosis NigricansASSOCIATIONS
Familial: AD, rare, onset in childhood
Obesity
Diabetes mellitus: Insulin Resistance
Endocrinopathies
Macule
flush
less 1 cm
Papule
solid
raised
less 1 cm
Lichen PlanusASSOCIATIONS
Hepatitis C
Prevalence of HCV was 2-13.5 fold higher in patients with LP than with controls
In one study, 12 of 22 pts (55%) with LP were HCV positive
Patch
flush
>1 cm
Acanthosis Nigricans- MALIGNANCY
Malignancies include adenocarcinoma of the stomach (60%), lung and breast cancer
Wickham’s striae:
an overlying lace-like pattern of white lines on the surface
Plaque
raised
larger than 1 cm
Nodule
cystic elevation greater 1 cm
Bulla
circumscribed
elevated
clear/bloody fluid
> 1cm
Scale
flakes on skin surface
Tumor
solid/cystic elevation over 2 cm
Vesicle
circumscribed
elevated
clear/bloody fluid
< 1cm
Flat area of color change
Less than 1.0 cm
Flat: Macule
Atrophy
depression on skin surface
loss of epi/dermis
Flat area of color change
Greater than 1.0 cm
Flat: Patch
Discrete, solid, elevated body
Less than 1.0 cm in diameter
May be further classified by surface change
Scale, Crust
Papule
Erosion
depression with loss of epidermis
Pustule
vesicle containing purulent exudate
Ulceration
loss of at least some of dermis
Crust
dried exudate
Wheal
circumscribed flat top
firm elevation
well demarkated
palpable
Solid, flat-topped, elevated area of skin
Greater than 1.0 cm and broader than thick
May be further classified by surface change
Plaque
Firm and well-defined lesion
May be dermal or subcutaneous
Greater than 1.0 cm
Nodule
Fluid filled cavity or elevation
Form within or just below epidermis
Less than 1.0 cm in diameter
Vesicle
Fluid filled “blister”
Greater than 1.0 cm in diameter
Bulla
Circumscribed elevation that contains pus
Less than 1.0 cm in diameter
Color usually whitish-yellow
Pustule
Individuals with truncation mutations in the gene coding for filaggrin are strongly predisposed to a severe form of dry skin,________, and/or eczema.
ichthyosis vulgaris
Guttate psoriasis is associated with _____
strep infection
