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Block 7; Week 2-Michelle > Dermatopathology-Fung > Flashcards

Dermatopathology-Fung Flashcards

1
Q

What are the 3 layers of the skin?

A

Epidermis
Dermis
Subcu

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2
Q

What is found in the epidermis?

A 
mainly keratinocytes--produce keratin, a water soluble barrier for the skin.
stratified squamous cells
melanocytes-UV protection.
inflammatory cells
langerhans cells
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3
Q

What is found in the dermis?

A

layer filled with collagen

adnexal structures: hair follicles, glands

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4
Q

What is found in the subcutaneous layer? What is its function?

A

lots of fat!
provides shock absorption
thermal insulation for the skin

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5
Q

What are the layers of the epidermis–from nearest the basement membrane up? Note: this is the same order of keratinocyte maturation.

A

Stratum Basale.
Stratum Spinosum
Stratum Granulosum
Stratum Corneum

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6
Q

What is the main function of the stratum basale?

A

responsible for regenerating keratinocytes

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7
Q

What is the main function of the stratum spinosum?

A

polyhedral keratinocytes

produce cytokeratins–these form tonofibrils & desmosomes.

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8
Q

What is the function of desmosomes? Note: these are partially formed in the stratum spinosum.

A

function: intercellular bridges

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9
Q

What is the appearance of the stratum granulosum? What is found there? What is its function?

A

It appears blue
keratohyalin granules are there!
keratohyalin granules combine with tonofibrils=keratin made!

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10
Q

What is found in the stratum corneum?

A

mature keratin

these keratinocytes don’t have nuclei or cytoplasm. It was spit out!

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11
Q

Which structure separates the epidermis & dermis?

A

the basement membrane

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12
Q

The epidermis has ridges that connect with the _____ layer of the dermis. What is the function of these ridges?

A

these ridges help the skin to withstand sheering forces

connects with the papillary layer of the dermis

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13
Q

Which layer is found beneath the papillary layer?

A

the reticular layer

has collagen bundles!

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14
Q

What are the 2 types of glands that are found in the dermis?

A

apocrine-non fcnl

secretory/eccrine-secrete sweat!

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15
Q

What is the main function of eccrine sweat glands?

A

thermoregulation!

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16
Q

Where are the apocrine glands found?

A

axilla & groin

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17
Q

What is different & special about the skin that is found on the soles of feet & palms of hands?

A

they have modified skin!
no adnexal structures in the dermis
bunches of thick keratin in the epidermis
can withstand more trauma

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18
Q

What is the macule’s larger buddy?

A

the patch.

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19
Q

What is the def & distinguishing features of a macule?

A 
Well circumscribed.
flat lesion.
Less than 5 mm
Sharply demarcated from the skin.
Noted b/c of pigmentation compared to rest of skin.
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20
Q

What is the definition of a patch?

A

well circumscribed
flat
>5 mm
different color

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21
Q

What is the definition of a papule?

A

well circumscribed
elevated dome-shaped or flat-topped lesion
<5 mm

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22
Q

What is the definition of a nodule?

A

well circumscribed
elevated dome-shaped or flat-topped
>5 mm

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23
Q

What is the papule’s larger buddy?

A

nodule!

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24
Q

What is the definition of a plaque?

A 
elevated
flat-topped lesion
>5 mm
ex: psoriasis
something seen in chronic inflammatory dermatosis
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25
Q

What is the definition of a pustule?

A

these are pus filled
raised lesions
no size criteria
seen in acne & abscesses

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26
Q

What is the definition of a scale?

A

dry, horny, platelike excrescence

b/c of imperfect cornification

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27
Q

What is the definition of a vesicle?

A

fluid-filled raised lesion
less than 5 mm
blister

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28
Q

What is the definition of a bulla?

A

fluid-filled raised lesion
greater than 5 mm
blister

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29
Q

What is the vesicle’s larger buddy?

A

bulla

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30
Q

What is the definition of an excoriation?

A

traumatic lesion breaking the epidermis

causes a raw linear area (deep scratch)

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31
Q

What is the definition of a wheal?

A

itchy transient elevated lesion
variable blanching
some blistering
erythema–dermal edema present

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32
Q

What is lichenification?

A

thickened
rough skin
usu result of repeated rubbing

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33
Q

What is acanthosis?

A

microscopic lesion
diffuse epidermal hyperplasia, thickened
seen in chronic inflammatory dermatosis

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34
Q

What is acanthosis’ friend?

A

papillomatosis

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35
Q

What is the definition of papillomatosis?

A

microscopic lesion
thickened epidermis, hyperplasia
distinct papillary fragment
enlarged contiguous dermal papillae

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36
Q

What is hyperkeratosis?

A

thickened keratin layer
stratum corneum is thickened
no nuclei, like normal

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37
Q

What is the friend of hyperkeratosis?

A

parakeratosis

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38
Q

What’s the deal with parakeratosis?

A

microscopic lesion
also a thickened keratin layer
abnormal in that it retains the nuclei in the keratinocytes. see blue dots in the stratum corneum.

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39
Q

What is hypergranulosis?

A

thickened stratum granulosum

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40
Q

what is spongiosis?

A

this is when you don’t see much space b/w the keratinocytes, edema has pushed them apart!
basically: intercellular edema of the epidermis

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41
Q

What is lentiginous, a microscopic lesion?

A

melanin is produced in the epidermal basal layer linearly

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42
Q

What is dyskeratosis?

A

abnormal premature keratinization due to malignant change
happens below the stratum granulosum, which is abnormal
when you see a bunch of pink in the epidermis

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43
Q

What happens in an acute inflammatory dermatosis?

A

it lasts from days-weeks

there are lymphocytic & macrophage inflammatory infiltrate & edema.

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44
Q

What happens in chronic inflammatory dermatosis?

A

months-years
changes in epidermal growth (atrophy or hyperplasia)
or changes in dermis, maybe fibrosis
skin is roughened due to excess or abnormal scale formation & shedding

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45
Q

What is urticaria, hives?

A

common disorders caused by local mast cell degranulation & dermal microvascular hyper permeability
get pruritic edematous plaques (wheals)
can be acute or chronic
acute if less than 6 weeks

46
Q

What is angioedema?

A

condition that is related to urticaria

edema of a deeper dermis & subcutaneous fat

47
Q

Which is fairly normal in urticaria: epidermis, dermis?

A

epidermis is fairly normal
papillary dermis exhibits edema
inflammation

48
Q

What are some possible causes of urticaria?

A 
Causes include
Immunologic mechanisms
Non-immunologic mechanisms
Physical stimuli
Skin contact
Small vessel vasculitis
49
Q

What are some treatment options for urticaria?

A

avoidance of allergen
oral h1 antagonists
epi

50
Q

What is acute eczematous dermatitis?

A

common skin disorder
results from t cell mediated inflammatory reactions
type IV DTH

51
Q

What are the 5 categories of acute eczematous dermatitis?

A 
Allergic contact dermatitis
Atopic dermatitis
Drug-related eczematous dermatitis
Photoeczematous dermatitis
Primary irritant dermatitis
52
Q

What are some microscopic features of acute eczematous dermatitis?

A

spongiosis: space b/w keratinocytes
parakeratosis: nuclei present in the stratum corneum
sometimes you get intaepidermal vesicles

53
Q

What are the 2 broad categories of causes of acute eczematous dermatitis?

A

Inside Cause: internal circulating antigen

Outside Cause: external application of an antigen

54
Q

What is the treatment of acute eczematous dermatitis?

A

removal of antigen

topical steroids

55
Q

What is erythema multiform?

A

self limited hypersensitivity reaction
associated with certain infections from viruses, bacteria, fungi
associated with exposure to some drugs
associated with cancer & collagen vascular disease

56
Q

What are some viral infections & bacterial infections associated with erythema multiform?

A

viral: herpes simplex
bacterial: mycoplasma, leprosy, typhoid

57
Q

What are some fungal infections associated with erythema multiform?

A

histoplasma

coccidioides

58
Q

What are some drugs that a pt can be exposed to and then develop erythema multiform?

A 
sulfonamides
penicillin
barbiturates
salicylates
antimalarials
59
Q

Stevens Johnson Syndrome is a febrile form of ________. with extensive skin involvement.

A

a form of erythema multiforme
can lead to sepsis
often seen in children

60
Q

Which additional areas of skin does stevens johnson syndrome include?

A

oral mucosa
conjunctiva
urethra
genital & perianal regions

61
Q

Toxic Epidermal Necrolysis is a form of _________. What is it characterized by?

A

form of erythema multiform
diffuse necrosis, sloughing of cutaneous & mucosal epithelial surfaces
similar clinical case to a burn pt

62
Q

What is the treatment for erythema multiform? For acute & chronic cases?

A 
Treatment
Acute --
Observation  
Oral antihistamines 
Topical steroids
Acyclovir-in treatment of recurrent herpes. 
Prednisone 
Chronic--
Antivirals (acyclovir) 
Dapsone 
Azathioprine
Cyclosporine
63
Q

What % of the pop. does psoriasis affect?

A

1-2%

64
Q

What is psoriasis?

A

Chronic inflammatory dermatosis that results from interactions of genetic and environmental factors
Associated with HLA-C
**Results from activated T cells in the skin stimulating the secretion of cytokines and growth factors that induce keratinocyte proliferation

65
Q

15% of psoriasis patients also have what?

A

associated arthritis

66
Q

What is the auspitz sign? Which condition is it associated with?

A

this is associated with psoriasis. It is when you get micro hemorrhages after scraping off plaques. this is when the b.v. of the papillary dermis reach the epidermis.

67
Q

Where can you sometimes see monroe abscesses in psoriasis?

A

within the parakeratosis

68
Q

What is the treatment for psoriasis?

A 
Treatment
Topical steroids
Intralesional steroid injection
UVB and tar
Methotrexate
Cyclosporine
Soriatane
69
Q

What is seborrheic dermatitis?

A

common chronic inflammatory dermatosis affects up to 5% of general pop.
involves regions of high density sebaceous glands

70
Q

What are some common areas to see seborrheic dermatitis?

A

remember: areas with sebaceous glands!

Scalp
Forehead
External auditory canal
Retroauricular area
Nasolabial folds
Presternal area
71
Q

What are the causes of sebhorreic dermatitis?

A

increased sebum production
colonization of the skin by Malassezia
can get a more severe form if you are HIV+ & have low CD4 counts

72
Q

What is the treatment for sebhorreic dermatitis?

A 
Treatment
Frequent washing of the affected area with antisebhorreic soaps
Topical steroids
Anti-yeast medications
Oral antifungals
73
Q

Lichen has 6 letters. So…lichen planus has 6 important Ps. What are they?

A
  1. pruritic
  2. purple
  3. polygonal
  4. planar
  5. papules
  6. plaques
74
Q

Describe the resolution process of lichen planus.

A

it is a self limited condition & resolves spontaneously 1-2 years after onset
resolution of lesions may leave post inflammatory hyper pigmentation

75
Q

What may develop in oral lesions of lichen planus?

A

squamous cell carcinoma

76
Q

What is wickham’s striae? Which condition is it associated with?

A

these are white lines that are seen within a purple plaque

sign of lichen planus

77
Q

What causes wickham’s striae?

A

hypergranulosis

78
Q

What is the treatment for lichen planus?

A 
Treatment
Topical steroids
Intralesional steroids
Systemic steroids
Azathioprine
Cyclosporine
Light therapy (PUVA & UVB)
79
Q

Give some examples of conditions that include blisters.

A

Herpes virus
Spongiotic dermatitis
Erythema multiforme
Thermal burns

80
Q

What are the characteristics of bullous blistering disorders?

A

group of diseases with blisters that are primary & distinctive features
inflammatory or not!

81
Q

Which layer of the skin are the pemphigus foliaceus blisters located?

A

subcorneal

right underneath the stratum corneum

82
Q

Which type of blistering disorder has blisters located above the basal layer?

A

pemphigus vulgaris

83
Q

Which type of blistering disorder has blisters located below the epidermal layer?

A

bullous pemphigoid

**occurs below the stratum basal…at the level of the basement membrane

84
Q

Pemphigus foliaceus which makes sub_____ blisters is directed against which desmoglein?

A

subcorneal blisters

directed against desmoglein 3

85
Q

Bullous pemphigoid is directed against what?

A

BPAG2 at the hemidesmosome level

86
Q

What is pemphigus?

A

inflammatory blistering disorder

caused by autoantibodies that result in dissolution of intercellular attachments w/i epidermis & mucosal epithelium.

87
Q

Which antibodies does pemphigus involve? What do they target?

A

involves IgG autoantibodies
to desmoglein 1 & 3
**affects desmosomes

88
Q

What are the 5 variants of pemphigus?

A 
pemphigus vulgaris
pemphigus vegetans
pemphigus foliaceus
pemphigus erythematosus
paraneoplastic pemphigus
89
Q

Which type of pemphigus is associated with cancer?

A

paraneoplastic pemphigus

90
Q

Which type of pemphigus is the most common, seen 80% of the time?

A

pemphigus vulgaris

91
Q

Which type of pemphigus is seen as plaques around the groin?

A

pemphigus vegetans

92
Q

Which type of pemphigus forms sub corneal blisters?

A

pemphigus foliaceus

93
Q

Which type of pemphigus forms less severe sub corneal blisters?

A

pemphigus erythematosus

94
Q

What would you see on histo of pemphigus vulgaris?

A

you would still see the basal layer, b/c the blisters are supra basal
see intraepithelial vesicles being formed

95
Q

What is the proper treatment of pemphigus?

A

immunosuppressive agents–decrease titers of pathogenic autoantibodies

96
Q

What is bullous pemphigoid?

A

blistering disorder (inflammatory) caused by autoantibodies against proteins that bind basal keratinocytes to the basement membrane

97
Q

What are the proteins that link the basal keratinocytes to the basement membrane?

A

BPAGs are the proteins that are a critical part of the hemidesmosomes

98
Q

What is the pattern of antibody deposition in bullous pemphigoid?

A

linear pattern at the dermoepidermal junction

99
Q

What happens when you touch the blister of a pt w/ bullous pemphigoid?

A

they don’t break when touched

they can even heal without scarring

100
Q

What is the treatment for bullous pemphigoid?

A

topical steroids
systemic steroids
methotrexate
azathioprine

101
Q

What is dermatitis herpetiformis?

A 
urticaria & grouped vesicles
strong association with HLA-B8, HLA-DR3, HLA-DQw2
develop IgA antibodies to dietary gluten
antibodies cross react w/ reticulin 
injury results in sub epidermal blisters
102
Q

Why is it that antibodies to reticulin could lead to sub epidermal blisters in dermatitis herpetiformis?

A

reticulin is a component of anchoring fibrils that attach the epidermal basement membrane to the superficial papillary dermis

103
Q

What is the treatment for dermatitis herpetiformis?

A

dapsone
sulfapyridine
**immunomodulatory agents

104
Q

What is an example of a non-inflammatory blistering disorder?

A

epidermolysis bullosa

105
Q

What is epidermolysis bullosa?

A

inherited defect in structural proteins that cause mechanical instability for the skin
soon after birth see blister formation at sites of pressure, rubbing, or trauma

106
Q

What are the 4 types of epidermolysis bullosa?

A

simplex
junctional
dystrophic
mixed

107
Q

How is the simplex type of epidermolysis bullosa inherited? What does it target?

A

aut dom inheritance
affects keratin 14 & 5
defects in the basal cell layer of the epidermis
gives sub epidermal blisters!!

108
Q

What are the 2 components of the basement membrane?

A

lamina densa

lamina lucida

109
Q

How is the junctional type of epidermolysis bullosa inherited? What does it target?

A

aut rec inheritance
born w/ defects in laminin
laminin deficiency–>makes lamina lucida of basement membrane defective.
blisters seen @ the level of the lamina lucida

110
Q

What does the lamina lucida bind to?

A

binds to hemidesmosomes

binds to anchoring filaments (bind basal keratinocytes to basement membrane)

111
Q

How is the dystrophic type of epidermolysis bullosa inherited? What defects are present?

A

aut dom inheritance or aut rec
defects in type VII collagen
causes blisters at the level of the lamina densa (in the basement membrane)
scarring disorder

112
Q

What is type VII collagen a major component of?

A

basement membrane anchoring fibrils

Block 7; Week 2-Michelle (4 decks)

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