Dermis & SubQ

Question 1

Ehlers-Danlos Syndrome (cause, 2 types, sxs, tx)

Answer 1

Genetic: Mutations in collagen or post-translational modifications of collagen
Type 1 (Classic) - hypermobile joints, extensive skin stretch, fragile skin, atrophic or “fish mouth” scars. Normal recoil.
Type IV - may involve blood vessels causing bruising and GI / arterial rupture. No tx, just minimize trauma.

Question 2

Pseudoxanthoma Elasticum (inheritance, onset, sxs)

Answer 2

Autosomal recessive. Appears in first or second decade of life.
Clumped elastic fibers.
Yellow papules of neck, axillae, decreased vision,
CV: claudication (pain in legs w/ walking), high BP, angina, MI

Question 3

Marfan Syndrome (inheritance, cause, sxs)

Answer 3

Autosomal dominant mutation in fibrillin
Skeletal: tall, long limbs / digits, scoliosis, pectus excavatum, flexible joints
Stretch marks on skin.
CV: aortic dilation / dissection, mitral valve prolapse
Eyes: myopia (near-sighted), dystopia lentis (lens displaced), and detached retina

Question 4

Livedo Reticularis (cause, sxs, associated disorders)

Answer 4

Due to hypo perfusion of blood vessels
Reticulate ("net-like") macular erythema
Accentuates w/ cold weather
Benign
Associated w/ autoimmune or coagulation disorders

Question 5

How does vasculitis affect the skin? (4 sxs)

Answer 5

Palpable purpura (Firm red bump that is non-blanching)
Necrotizing livedo reticularis
Ulceration
Leukocytoclastic vasculitis (LCV)

Question 6

Leukocytoclastic vasculitis (LCV) (mechanism, triggers, sxs, tx)

Answer 6

Inflammation of small cutaneous vessels
Palpable purpura, most common on legs
Triggers: medications, infection, CT disease, autoimmune disease
May affect renal vasculature
Tx - treat or remove trigger

Question 7

3 phases of wound healing

Answer 7

Inflammatory
Proliferative
Maturation

Question 8

Keloid (presentation, cause, tx)

Answer 8

Firm scar extending beyond borders of wound
Caused by injury, inflammation, or acne
Tx: avoid injury, intralesional steroids, NOT excision (gets bigger)

Question 9

Local factors that delay wound healing

Answer 9

Vascular insufficiency
Tissue edema
Infection (due to biofilm)
Dry wound bed
Excess granulation tissue
Chronic radiation injury

Question 10

Systemic factors that delay wound healing

Answer 10

Old age, malnutrition, diabetes, CT disease

Question 11

Morphea (sxs)

Answer 11

Affects trunk (mainly), scalp, and extremities
Expanding, erythematous, depressed plaque. Slowly becomes indurated (firm). Central portion becomes hypopigmented w/ lilac-colored rim.
Atrophy and firm scar-like changes
May be linear and associated w/ hair loss or permanent scarring
Inactive lesions are often hyper pigmented

Question 12

Limited Systemic Scleroderma (sxs)

Answer 12

Affects face and distal extremities w/ tight, thickened skin
CREST Syndrome: Calcinosis cutis (Ca deposition in digits), Raynaud’s Syndrome (Hypersensitivity to cold weather:
Skin becomes white —> blue —> red), Esophageal dysmotility (choke on liquids), Scleroderma, Telangiectasias (dilated capillaries)

Question 13

Scleroderma (sxs and types)

Answer 13

Fibrosis / thickening of dermis.
Localized includes morphea and linear scleroderma
Systemic includes limited and diffuse scleroderma

Question 14

Morphea (sxs)

Answer 14

Affects scalp, trunk, and extremities
Hypopigmented, depressed plaque w/ lilac-colored rim
Atrophy and firm scar-like changes
May be linear and associated w/ hair loss or permanent scarring
Inactive lesions are often hyper pigmented

Question 15

Diffuse Systemic Scleroderma (location and sxs)

Answer 15

Affects trunk and proximal extremities
Cutaneous fibrosis
Raynaud's syndrome
Systemic: Pulmonary fibrosis, renal insufficiency, cardiac disease
Poor prognosis

Question 16

Panniculitis (cause, sxs, triggers, tx)

Answer 16

Inflammation of fat lobules or fibrous septae in subcutis
Erythema nodosum most common
Tender, erythematous nodules w/ poor-definied borders (due to being deep)
Triggers: OCPs most common, strep infection, medications, sarcoidosis (inflammation of lungs / skin), IBS,
Tx: remove medication, tx infection, rest, elevate limbs, NSAIDS, KI

Question 17

Adnexal structures

Answer 17

Hair, sebaceous (oil) glands, apocrine and eccrine sweat glands.

Question 18

Elastic fibers composed of?

Answer 18

Elastin and fibrillin

Question 19

Livedo Reticularis (cause, sxs, associated disorders)

Answer 19

Due to hypoperfusion of blood vessels, most often due to cold weather.
Reticulate (“net-like”) macular erythema
Most common on legs
Benign
Associated w/ autoimmune or coagulation disorders

Question 20

Pyogenic granuloma

Answer 20

Looks like jelly bean of blood popping through skin.
Rapidly growing vascular lesion that often arises at sites of trauma. Proliferating vascular tissue fails to reepithelialize unless the lesion is cauterized or surgically removed.

Question 21

Photoaging

Answer 21

Atrophy (skin thinning), lentigines (large freckles), rhytides (wrinkles), dilated pores, yellow skin / loss of rebound (both due to fractured elastic fibers)

Question 22

Poikiloderma of Civatte

Answer 22

Due to photoaging.
Telangectasias, hyperpigmentation, hypopigmentation, and atrophy.
Most common on lateral neck of “V” of chest.

Question 23

Actinic purpura

Answer 23

Minor trauma leading to focal bleeding into skin due to UV related thinning of collagen in blood vessels.

Question 24

Wound that affects epidermis only

Answer 24

Erosion

Question 25

Wound that affects epidermis and dermis

Answer 25

Ulcer