Dermatopathology 3 Flashcards
Pemphigus vulagris what happens
IgG autoantibodies against desmogleins 1 and 3 in desomosomes in suprabasal deep epidermis and mucosal epithelium
what is Nikolsky sign and what are Pemphigus vulgaris tests results
pressure on blister causes lateral spread of lesion
- positive
where do 80-90% of pemphigus vulgaris begin
oral lesions
what forms the roof of the blister for pemphigus vulagris
stratum corneum
what happens in pemphigus foliaceus
autoantibodies against Dsg1 alone
histo for pemphigus
row of tombstomes
acantholysis
net like pattern of intracellular IgG deposists
what does pemphigus vegetans look like
large, moist, verrucous, plaques rather than blisters
common lesion site for pemphigus vegetans
oral lesions
what other disorder is pemphigus vegetans related to
ulcerative colitis
what country is pemphigus foliaceus found
Brazil
what happens in bullous Pemphigoid
autoantibodies bind BPAg1 and BPAg2 ( only one causing blister) in hemidesosome
At what layer of the skin does bullous Pemphigoid form a blister
lamina lucida of the basement membrane
age groups of pemphigus and Bullous Pemphigoid
P: 30-50
BP: elderly
target antigen for pemphigus and Bullous Pemphigoid
P: demoglein 1 and 3
BP: BPAg1 and BPAg2 in hemidesmosomes
Blister ( bulla) pemphigus and Bullous Pemphigoid
P: suprabasal, ancantholytic, positive Nikosky sign
BP: subepidermal, nonacantholytic, sturdy
oral mucosa for pemphigus and Bullous Pemphigoid
P: many early lesions
BP: few after cutaneous lesions
what happens in Dermatitis Herpetiformis
IgA autoantibodies to transglutaminases bind to TG in gut and cross-react with reticulin in fibrils in skin
what is the onset and gender of Dermatitis Herpetiformis
20-60
males
clinical presentation of Dermatitis Herpetifromis
symmetrically grouped lesions
-papules and plaques progressing to vesicles and bullae
For Dermatitis Herpetiformis what other disease is present and what is used to show this
Gluten senstive
small bowel biopsy
Histo feature for Dermatitis Herpetiformis
subepidermal blister
microabscesses at dermal papillae
what is epidermolysis bullosa
group of disorders caused by inherited defects ( 10 genes) in proteins that lend stability to skin
when do symptoms of Epidermolysis bullosa occur
at or soon after birth
Name 4 types of Epidermolysis Bullosa
simplex
junctional
dystrophic
non-Herlitz junctional
Simplex type
mutations in gene encoding keratin 14 or 5 ( form keratin fiber)
- basal cell layer defect
Junctional type
blisters formed from separation lamina lucida
Dystrophic types
blisters below lamina densa, from defect in collagen VII
Non-Herlitz Junctional
defect in laminin Vbeta3
histo for Epidermolysis Bullosa? similiar to what?
fibrin deposition in floor of blister cavity
- bullous pehphigoid
what happens in prophyria cutanea tarda
uroporphyrinogen decarboxylase (UROD) deficiency - excessive accumulation of porphyrins
who is prone for Prophyria cutanea tarda
30-50 yrs
- females on OCP
- alcohol
- hep C
what are the types of Porphyria cutanea tarda
Type I: acquired
type II: autosomal dominant, deficient in RBC and fibroblasts
what does Porphyria cutanea tarda do to skin
make it photosenstivie
what does Porphyria cutanea tarda do to face
hypertrichosis ( hairy face)
how does one diagnose Porphyria cutanea tarda
uroprophryin in urine
what 3 things must be avoided for porphyria cutanea tarda
alcohol
estrogens
fungicides
histo for porphyria cutanea tarda
subepidermal vesiculation
- protuberance of rigid dermal papillae into blister cavity( festooning
- thickening of walls of superficial dermal vessels
what happens in acne vulgaris
obstruction of sebaceous follicles by sebum
-promotes proliferation of propionibacterium acnes ( anaerobe)
what do obstructive acne look like
closed
whiteheads
flesh colored dome
what do inflammatory acne look like
papules/pustules to nodules to cysts
Risk factors for Acne vulgaris
male puberty Cushing oily complexion androgen excess
what are 4 components of acne vulgaris
- keratinization of lower portion of follicular infundibulum
- development of keratin plug, block outflow of sebum - hypertrophy of sebaceous gland
- lipase-synthesizing bacteria ( propionibacterium acnes_ colonizing upper hair follicle
- inflammation of follicle
- release of cytoxic and chemotactic factors
Acne Rosacea what is it
chornic inflammatory disorder that affects blood vessels and pilosebaceous units
4 stages of acne rosacea
- flushing
- persistent erthyema and telangiectasias
- pustules and papules
- Rhinophyma
what is rhinophyma
skin on nose becomes thick and greasy, hyperplasia of sebaceous glands, connective tissue and vasculature
what areas of the face are impacted with acne rosaceae
nose and cheeks including nasolabial folds
histo for rosacea
perfollicular infiltrate of lymphocytes
Panniculitis
inflammation of lobules or connective tissue septa separating fat lobules
what is Erythema nodosum
inflammatory reaction of connective tissue septa separating fat lubules
gender of who gets it more for Erythema nodosum
females
clinical for Erythema nodosum
red, painful, elevated nodules, poorly circumscribed
where is erythema nodosum usually ocur
anterior aspect of tibial
what are some crazy things that cause Erythema nodosum
strep pregnancy OCP syphilis TB
histo erythema nodosum
widening of septa from fibrin, edema, and neutrophilic infiltrate
what is warts
infection of epidermal cells with human papilloma virus
who usuallly gets warts
children and young adults
who are warts transmitted
skin to skin
in warts, intralesional borwn-black dots are pathognomonic and represesent what
thrombosed vessels
scientific name for common wart
Verruca vulgaris
scientific name for flat wart?
location
verruca plana
-chin, dorsum of hand, legs
scientific name for war on foot? what can cause this
Verruca platnaris
HPV1
Condyloma acuminatum
anogenital wart
what causes Condyloma acuminatum
most common STD, HPV6 and 11
hist for warts
Church spire
who usually gets Molluscum contagiosum
viral infection in kids and sexually active adults
what causes Molluscum contagiosum
poxvirus
how is Molluscum contagiosum transmitted
skin to skin
clinical representation of Molluscum contagiosum
asymptomatic smooth, dome-shaped papules with central umbilication
hist for Mollluscum contagiosum
Molluscum bodies in stratum corneum and granulosum
what is impetigo
superficial bacterial infection of skin
what are the two forms of impetigo
nonbullous and bullous
what is the most common form of impetigo
nonbullous
what is the most common cause of impetigo
Staph aureus
histo for impetigo
neutrophils beneath stratum corneum
Sacabies how long in incubation
1 month
scabies is infection with
Sarcoptes scabiei
where does scabies usually occur
finger webs, wrists, and penis
the egg and feces causes what reaction to the body
type IV hypersensitivity
- extremem itching at night
how does one confirm scabies
scraping burrow with scalpel
look under microscope
what is Xanthelasma ( Xanthoma)
collection of macrophages containing lipid droplets
Mongolian spots clinical picture
single-gray-blue lesion over lumbosacral area
who usually gets Mongolian spots
Asian and Native Americans
what goes wrong in Mongolain spots
melanocytes located in dermis instead of epidermis
what is cherry angioma
bright red, domed, vascualar lesions on trunk
- increase with age
what is the most common tumor of infancy
Hemangioma of infancy
what is Hemangioma of infancy? what does it look like
benign hyperplastic blood vessels,
- blanchable bright red to deep purple lesions
over time what happens to hemangioma of infancy
regressses
when do you treat hemangioma of infancy
do not treat until ulcerates or blocks ears, eyes, larynx
what are the 3 phases of hair devleopment
anagen
catagen
telogen
what is alopecia
common cause of hair loss in adults
Xeroderma pigmentosum how is it inherited?
Autosomal recessive
Xerdomera pigmentosum
decrease ability to repair DNA following UV damage
timeline of Xeroderma pigmentusm
1st year of life: scaling
later: atrophy
5-6 yeras: squamous and basal cell cancer
Chediak-Higashi syndrome
immunodiciency due to defect in neutrophil phagosome lysosome fusions
-abonormal giant lysosomal inclusions visible on peripheral blood smear
Wiskott-Aldrich Syndrome
X-linked immunodeficiency Exzema thrombocytopenia B and T lymphocyte disorder
albinsim
melanocytes normal in number and location
- production of melanin defective
- due to complete absence of tyrosinase
