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Skin Lymph Blood Exam 2 > Dermopathology - Dr. Martin > Flashcards

Dermopathology - Dr. Martin Flashcards

1
Q

Freckle

A

Pigmentation and melanocytes disorders (usually after sun exposure)
High melanin in basal keratinocytes (hyperpigmentation)
Changes with seasons

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2
Q

Lentigo

What is it

A

Benign usually in children / infancy and mucus membrane and skin
(Check oral)
5mm - 10mm oval tan-brown macule or patch (no darkening with sunlight)
Pigmentation and melanocytes disorders (hyperplasia, linear, restricted to right above BM)

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3
Q

Melanocytic nevus (mole)

A

Pigmentation and melanocytes disorders

P16/INK4a does not arrest

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4
Q

Dysplasitic Nevi

A

Risk for melanoma by age 60yo
AD
CDKN2A or CDK4 gene that get the NRAS and BRAF mutation

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5
Q

Biopsy of a skin things like nevi

A

Do the periphery of it since the middle are more dead cells

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6
Q

Melanoma

A 
UV radiation damage 
High incidence 
(GI, GU, skin, eye, esophagus)
TX: immune checkpoint inhibitor 
Sporadic mostly (sunburns you’ve had)
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7
Q

Melanoma risks

A

Equator
Outdoor hobbies
Blistering sunburns
Lights skin and eyes

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8
Q

Melanoma in blacks and Asians should be examined where to find sx

A

Soles of feet
Palms
Nails
Mucous membranes

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9
Q

HMB-45 +

A

Staining into a LN

To see which one has the cell that started everything

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10
Q

Seborrheic keratoses (Seb K)

A

In scalp….

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11
Q

Ducts in skin biopsy

A

Shows it comes from a gland

= Cylendroma

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12
Q

AK

A 
Sun damaged skin and hyperkeratosis
Sandpaper 
Squamous cell carcinoma 
Certain = pink color 
Elastosis= blue
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13
Q

Dermatofibroma

A

Legs, adults, women
Goes down when pressed (not squeezed) = Dimple sign
Injury and inflammation can casue this benign thing
No capsule and well circumsribed
Spindle shaped

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14
Q

DFSP

A

COL1A1 PDGFB
Very firm and dense
Honeycomb look
Looks like fish swimming in circles

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15
Q

Ichthyosis

A

Fish scales looking

Not very serious

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16
Q

Testing for psoriasis

A

Lift one of the silvery scales and it bleeds

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17
Q

Seborrheic dermatitis

A

Sebum production in sebaceous glands

Can be associated with HIBV and Parkinson’s

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18
Q

Blistering Bullous Disease

Pemphigus vulgaris

A

IgG

Oral cavity

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19
Q

Exortiation

A

Traumatic lesions breaking skin (deep scratch)

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20
Q

Lichenification

A

Thickened rough skin (from repeated rubbing)

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21
Q

Macule

A

Circumcised flat lesion 5mm or smaller

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22
Q

Patch

A

Flat and circumscribed that is bigger then 5mm

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23
Q

Onycholysis

A

Separation of nail bed from nail plate

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24
Q

Papule

A

Elevated dome shaped or flat topped lesion 5mm or smaller

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25
Q

Nodule

A

Elevated dome shaped or flat topped lesion greater then 5mm

If flat -topped = plaque

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26
Q

Pustule

A

Pus filed raised lesion

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27
Q

Scale

A

Dry horny, platelike, usually from cornification not done right

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28
Q

Vesicle

A

Fluid pilled raised lesion 5mm or smaller

Also called a blister

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29
Q

Bulla

A

Raised fluid filled lesion grater then 5mm

Also called a blister

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30
Q

Wheal

A

Itchy transient elevated lesion (skin colored or lighter in color), can be red demo dermal edema

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31
Q

Acanthosis

A

Diffuse epidermal hyperplasia

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32
Q

Dyskeratosis

A

Abnormal, premature keratinization in the stratum granulosum

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33
Q

Erosion

A

Discontinuity of skin from incomplete loss of epidermis

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34
Q

Exocytosis

A

Inflammatory cells going to epidermis

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35
Q

Hydropic swelling

A

Ballooning (ICF edema or keratinocytes) usually in viral infections

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36
Q

Hypergranulosis

A

Stratum granulosa hyperplasia

Usually from intense rubbing

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37
Q

Hyperkeratosis

A

Stratum corneum thickening

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38
Q

Lentiginous

A

Linear pattern of melanocyte proliferation in the BM

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39
Q

Papillomatosis

A

Surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae

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40
Q

Parakeratosis

A

Keratinization of the nuclei of stratum corneum (usually seen in mucous membranes)

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41
Q

Spongiosis

A

Incracellular edema of epidermis

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42
Q

Ulceration

A

Discontinuity of the skin complete loss of epidermis revealing dermis and subcutis

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43
Q

Vaculoization

A

Formation of vaculoes in cells or next to cells (usually in the BM basal side)

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44
Q

neurofibromitosis

A

Freckles if not from a sun exposed area = neurofibromitosis cafe au lait spots
Aggregated melanosomes in cytoplasm of melanocytes (macromelanosomes)
** see clump of macromelanosomes right above BM**

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45
Q

Lentigo

Histology and what it looks like

A

Linear melanocytic hyperplasia
= restricte to cell layer above BM and in linear way
= Lentiginous (is a melanocytic tumor that can also look like this and grow like this), however in the BM layer

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46
Q

Melanocytic nevus (mole)

A

Benign
Mutation in RAS or BRAF = proliferation
p16/INK4a growth inhibitor problems also = melanoma
- Tan uniformed pigmentation, well defined boarders
- larger cells on the top (more melanin = nests) and gets smaller farther down beeper in tissue = cords or single cells
- deepest layer = Fusiform fascicles (looks like elongates cells or neural tissue

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47
Q

Junctional nevi

A

At dermoepidermal junction

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48
Q

Compound nevi

A

Into underlying dermis and epidermis

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49
Q

Intradermal Nevi

A

Only in dermis and usually older lesions

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50
Q

Dysplastic nevi

A

Risk of melanoma (50% by age 60yo)
CDKN2A and CDK4 gene causes this
* if NRAS + BRAF mutation it become melanoma

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51
Q

Dysplastic nevi histology

A

Greater then 5mm, and many of them
Variety of colors and irregular boarders
Nests can combine
- Lentiginous hyperplasia : linear growth along E-D junction
- Atypia : Ig nuclei , angulated nuclear contour, hyperchromasia
-Lymphocytic infilt : loosing melanin (melanin incontinence)
- Linear fibrosis : around epidermal rete ridges (see lymphocytes + bridging) —> shoulders

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52
Q

Shoulder region of nevi

A

Is the periphery of the mole (you don’t want to see the compound cells here, dermal nests)
The center is the compound potion

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53
Q

Melanoma is what and caused by what

A

UV radiation damaging DNA
Skin, oropharynx, GiGU, esophagus, meninges, uvea of eye
(Most is sporadic and not hereditary)

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54
Q

Lesions that are precursors to melanoma

A

Congenital or dysplastic nevi

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55
Q

Most common spots for melanoma

A

Upper back

Legs

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56
Q

Driver mutations for melanoma

A
  1. CDKN2A in 40% ——> p16, p15, ARF (mutation in these tumor suppressors)
  2. Increase RAS and P13K/AKT (from BRAF mutation)
  3. 70% sporadic is activating telomerase form the TERT**
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57
Q

What is a marker found in a LN that makes it the sentenial LN and shows melanoma

A

HMB-45+ (not always in every type of melanoma)

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58
Q

Radial growth phase

A

Macular areas (growing across skin)
= irregular nested single cell growth melanoma cells (inflammation in dermis also)
= cant metastasize

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59
Q

Vertical growth phase

A

Raised areas
= and nodular aggregates Of infiltrating cells
= growing downwards so can metastasize
= the deeper the invasion the more probability of metastasis

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60
Q

Specific histology of melanoma cell

A

Large nuclei, irregular contours, chromatin on periphery of nuclei , red eosinophilic nuclei

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61
Q

Breslow thickness

A

From the most superficial epidermal melanoma cell to the deepest intradermal tumor cell

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62
Q

EX of radial growth 3 of them

A
  1. Lentigo maligna : usually on face of elderly remaining radial for many years
  2. Superficial spreading : sun exposed areas (most common becoming melanoma)
  3. Acral / Mucosal Lentiginous : becomes melanoma not related to sun exposure
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63
Q

Worst prognosis points for melanoma

A 
Tumor depth deep
Many mitosis cells
Regression of immune system
Ulceration of skin
Tumor in flirting lymphocytes in dermis
Many LN involved (even 1 melanoma cell in a LN makes that LN completely involved)
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64
Q

Favorable prognosis of melanoma

A 
Thinner tumor depth
No regression of IS
No ulcer
Only some lymphocytes 
No mitosis
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65
Q

Seborrheic Keratosis (Seb K)

A

Spontaneous on head neck extremities, trunk (middle age and older)
= dark skinned
= waxy papules, coin -like , round flat**
= they are filled with keratin (not melanoma)**
= pseudo-horny cysts**
= Usually involved with FGFR-3 mutation (fibroblast GF)**

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66
Q

Lester Trélat sign

A

Paraneoplastic syndrome

Having spontaneous many Seborrheic Keratosis and it is associated with GI tract carcinoma

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67
Q

Seb K horny cyst are filled with

A

Keratin

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68
Q

Acnathosis Nigricans

A

Benign (80%) and malignant
= thickened hyperpigmentation + velvet like
= on skin fold areas
= obesity and diabetes, some AD inheritance
= mutation in FGFR3 causes malignancy

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69
Q

Acanthosis Nigricans that is malignant has what associations

A

Associated with GI adenocarcinoma
And FGFR3 mutation (like in Seb k)
DM2 causes hyperinsulinemia——> IFGR1 stimulation (insulin GF)

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70
Q

Acanthosis Nigricans histology

A

Enlarged dermal papillae (repeating peaks and valleys) + hyperkeratosis (no melanocytes), can also see hyperpigmentation

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71
Q

Fibroepithelial polyp

A

Skin tags = acrochordon (squamous papilloma)
= head neck trunk, face, skin folds
= obese, DM, intestinal polyps (Risks)
= soft and flesh colored, slender stalk

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72
Q

Fibroepithelial polyp histology

A

Fibrovascualr center with benign squamous epithelium covering it

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73
Q

Birt-Hogg Dube syndrome

A

Rare polyps + perifollicular mesenchymal tumors (fibroblasts + hair bulb)
= associated with Fibroepithelial polyps

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74
Q

Epithelial or Follicular Inclusion Cyst (wen)

A

Invaginatino and cystic expansion of epidermis or hair follicle
= can rupture and care KERATIN inside to spill into dermis —> extensive painful granulomatous inflammatory response

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75
Q

Wen or Epithelial / Follicular inclusion cyst are filled with what

A

Keratin from hair follicle or epithelium

76
Q

2 Adrenal Appendage tumors

A
  1. Cobden syndrome
  2. Cylidroma
  3. Eccrine Poroma
77
Q

Annexation appendage tumors are what

A

Hundreds of neoplasticism differentiating to appendages
Benign
Flesh colored and many papules and nodules
Can be confused with basal cell carcinoma

78
Q

Cowden syndrome

A

Many trichilemmomas=neoplastic cells differentiations forming benign tumor of the outer root sheath of sebaceous follicles
X PTEN
= risk for endometrial cancer and breast cancer
= will get hemartomas

79
Q

Cyindroma

A

Ductal differention of eccrine or apocrine ducts = forehead and scalp
= turban tumor, jigsaw puzzle = looks like this and on histology slide
= CYLD tumor suppressor gene mutation (can also associate with Familial TRichoepithelioma and Brooke-Spiegler

80
Q

Eccrine poroma

A

Palms and soles of feet have 3X more sweat glands

81
Q

Histology of sebaceous adenoma

A

Many bubbles inside of the cells in the duct

82
Q

Nevoid basal cell carcinoma

A

9q22, PTCH mutation

Many BCC and medulloblastoma, and jaw cysts

83
Q

Familial melanoma syndrome

A

9q21 CDKN2 mutation ——I cell cycle arrest = melanoma, pancreatic carcinoma
Increase p53 also melanoma and pancreatic carcinoma

84
Q

Muir- torre syndrome

A 
2q22
3q21
MSH2, MLH1 mutations 
= neoplasm in sebaceous glands from NO DNA repair 
= colon and internal malignancies
85
Q

Xerderma pigmentosum

A

9q22
XPA mutation
= NER repair mutation = melanoma and other skin cancers
= die young

86
Q

Actinic Keratosis

A

Sun damaged skin/ arsenic / ionizing radiation =hyperkeratosis in these areas
= face, arm, dorsum of hands
= usually light skinned
= rough sandpaper like and has ( Cutaneous horns, Dyskeratosis)
= becomes SCC over time *

87
Q

Cutaneous horns

A

Excessive keratin production causing this horn to grow outwards form skin

88
Q

Dyskeratosis

A

Pinkcytoplasm intracellular bridges, blue-gray elastosis (from sun damaged fibroblasts)
Parakeratosis (basal cel dysplasia of keratin growth)

89
Q

Actinic cheilitis

A

Actinic keratosis of the lips

90
Q

Intracellular bridges is found in what

A

SCC and actinic keratosis (not BCC)

91
Q

Top 2 common tumors from sun exposure in older people

92
Q

SCC

A

5% or less Metz in regional LN, if Metz then deeply invasive in subQ
= proportional to lifetime sun exposure (UV light)

93
Q

SCC risk factors after sun exposure

A
  1. Immunosuppressive ( HPV 5 + 8), chemo, transplant
  2. Epidermoysplasia verruciformis : from HPV, high risk
  3. Industrial carcinogens, chronic ulcers, tobacco, betel nut chewing
94
Q

SCC mutations involved

A
  1. TP53 (acquired in AK leading to SCC) = no DNA repair in G1 phase
  2. RAS and NOTCH signaling mutations
95
Q

Xeroderma pigmentosum mutation

A

XPA gene, NO NER, no Pyrimidine diners are repaired and high risk of SCC

96
Q

SCC looks like what if it is in situ (local)

A

Sharply defined, red, scaling plaques (large and hyperchromatic), involving all levels of dermis

97
Q

Invasive SCC looks like what

A

Nodular keratin lesions (hyperkeratosic =) can ulcerated

Dyskeratosis = Intracellular bridges

98
Q

BCC

A

Slow growing and no Metz, sunexposure and immunosuppressive and XP can all give rise to this

99
Q

BCC mutation

A

X SHH from PTCH gene mutation

100
Q

BCC what do you see

A
  1. Nevoid Basal cell carcinoma syndrome (basalis cell nests)
  2. Gorlin syndrome
  3. Basla cell nevus : many BCC less then 20yo + medulloblastoma, ovarian fibromas, pits arms soles
  4. Pearly papules with visible telangiectasis vessels, rodent ulcers = peripheral palisade glands (lined up linearly and parallel(
101
Q

Rodent ulcers

A

Basically eat off the face of the person and grows huge

102
Q

SHH role in PTCH and BCC

A

Unregulated SHH binds to PTCH so it CANT ——I SMO activity
SMO = activated TFs
(Mutation in BCC causes the PTCH to be constantly bound to and SMO is active all the time = Gorlin syndrome and sporadic bcc

There can also be loss of function PTCH and it cant block SMO (UV damage not fixed)

103
Q

Dermatofibroma (Benign Fibrous Histocytoma)

A

= BENIGN Adults, legs (middle age women)
= + dimple sign (press around the lesion towards it and it depressed down the skin (dos not squeeze down)**
= trauma, injury, inflammation response
= firm tan papules (flattens with time)

104
Q

Dermatofibroma histology (what do I see in the slide)

A

Spindle shaped cells, non-encapsulated mass in dermis
Epithelium above it is hyperplasia
elongated rete ridges that are hyperpigmented = Pseudoepitheliomatous hyperplasia
= collagen + fibroblasts

105
Q

Dermatofibrosarcoma Protuberans (DFSP)
Mutation causing this
What is it

A

Primary fibrosarcoma (hardening of soft tissue)
Slow aggressive localized,
COL1A1 + PDGFB (plt-derived factor B) mutation = tumor cell growth
= protuberant nodules usual in trunk, firm (can form plaque or ulcer)

106
Q

Dermatofibrosacroma Protuberans TX

A

PDGF-B receptor Tyrosine Kinase inhibitor (lifetime)

107
Q

Dermatofibrosarcoma Protuberans (DFSP) looks like what and histology

A

Close packed fibroblasts radially arranged, (storefront pattern like fish swimming in circles of spindle cells, and some Swiss cheese fats cells) = Honeycomb patterns on dermis and subQ fat
Epidermis above is thin

108
Q

Mycosis Fungoides (Cutaneous T-Cell Lymphoma)

A

CD4+ localized lymphoma that later in life becomes systematic
Scaly red brown patch

109
Q

Mycosis Fungoides stages

A

Patch —> plaque —> nodule

Eczema lesions in very early stage

110
Q

Mycosis Fungoides can be confused with what

A

Psoriasis (raised scaling plaques that are seen)

111
Q

Sezary syndrome

A

Erythroderma, scaling of entire body
Cerebriform cells
Band-like aggregates in dermis
Pautrier microabscesses : small cell clusters in epidermis

112
Q

Sezary syndrome and MF TX how

A

UV light therapy, topical steroids, or chemo if needed

113
Q

Mastocytosis

A

Urticaria Pigmentosa
Common in children
Mast cells fills up in lesions round oval red/brown papules or small plaques
Can for blister
= if popped can cause histamine release and cell degranulation
= you can write of skin

114
Q

Mastocytosis
Darier sign
Dermatographism

A

Darier sign : dermal edema look like wheals when skin is rubbed
Dermatographism : dermal edema hives looking, when stroking ski with pinpointed instrument

115
Q

Mastocytosis mutation

SX

A

KIT receptor tyrosine kinase = mast cell growth and survival
SX : pruritus and flushing from foods, temps, alcohol, rhinorrhea, bone pain

= can be associated with osteoporosis from excessive histamine release in BM

116
Q

Stain how mastocytosis

A

Giemsa purple granulated in mast cell cytoplasm

117
Q

Ichthyosis

A

X epidermal maturation, chronic keratin buildup
= fish like scales on skin
= X desquamation of skin (stratum corneum buildup)

118
Q

Acute inflammatory lesions (Dermatosis) usually you see which cells

A

Lymphocytes and macrophages

119
Q

Urticaria

What is it and SX

A
  1. Localized mast cell degranulation (from microvascular hyperpermeabulity)
    Ab mediated release of histamines form Mast cells (IgE)
  2. Wheals
  3. Angioedema : dermis and subQ fat edema
120
Q

Urticaria usually happens from what

A

Body parts exposed to pressure

Ab-mediated release from mast cells (hives)= IgE dependent

121
Q

Urticaria macro lesions

A

Small, pruretic papules to large edematous plaques

122
Q

Urticaria (hives) macro lesions

A

Sparse superficial infiltrate of mononucleosis cells + N

123
Q

What drug can cause urticaria

A

Aspirin form cause vasodilation

124
Q

Histology of urticaria

A

Space between the collagen bundles

125
Q

Acute Eczematous Dermatitis

External type and tx

A

External Ag or ingested food (some irritant like Urishiol in Poison IVY)

Corticosteroids

126
Q

T-cell mediated inflammatory reaction eczema

A

Type 4 hypersensitivity
SX: red papulovesicular oozing and crusted (impetigo) lesions
= can cause acanthosis hyperkeratosis

127
Q

Acute eczemstous dermatitis causes edema where

A

Edema in the instracellular space of other stratum spinosum

128
Q

Erythema Multiforme

Happens when

A

Self- limited hypersensitivity to infections and drugs (Herpes, histoplasmosis/mycoplasma, typhoid, leprosy) (PCN, sulfa….) (SLE)

129
Q

Erythema Multiforme is what

A

CD8+ injure keratinocytes (center of lesion)

CD 4 + M are in the periphery of lesion

130
Q

What happens in Erythema Multiforme

A

Many diverse types of lesions
Macule, papule, vesicle , bullae
1. Interface dermatitis : dermal edema, degenerative keratinocytes,
2. Steven-Johnson’s : children, oral, conjunctiva, genitals, skin lesions that can lead to sepsis if infected
3. Toxic epidermal necrolysis : necrosis and sloughing of cutaneous and oral epithelium (looks like extensive burns)

131
Q

Erythema Multiforme looks like what

A

Target lesions with dark spot in middle followed by light then dark raised then halo around

132
Q

Psoriasis what is it and tx

A

Autoimmune which brings CD8 and CD 4 cells in to local site on skin inducing cytokines soup
(Can be caused by trauma)
TNF and IL17 inhibitors

133
Q

Psoriasis SX

A

Pink salmon plaque
Loose silver scale on top of skin
Nail changes with holes (pitting), yellow-brown discoloring
Oncolsis
Auspitz sign +
Munro microabscesses : aggregation of PMNs

134
Q

Koebner phenomenal

A

When trauma induces psoriasis or Lichen Planus

135
Q

Auspitz sign

A

Lifting the scale on top of skin and it causes bleeding

136
Q

Psoriasis looks like what in histology

A

Elongated rete ridges test tube racks
Mitosis above Basal layer, high parakeratotic scale
9think layer of keratin)

137
Q

Seborrheic dermatitis

A

In places with high sebaceous glands
(Ear, scalp, nasolabial folds)
Inflammation of epidermis (has nothing to do with sebaceous glands)
Sebaceous glands therefore make a lot of SEBUM from androgen stimulation = lesions of flaky skin

138
Q

Seborrheic dermatitis can be found highly in what patient population

A

Parkinson’s since they make mire sebum from dopamine deficiency
TX : levodopa to lower oil
HIV patients also

139
Q

Seborrheic dermatitis on histology and how it looks

A

Follicular lipping, N

Red-yellow greasy base with scaling and crusting skin, looks like Dandruff

140
Q

Lichen Planus

SX

A 
6Ps
1. Prurstic
2. Purple
3. Polygonal 
4. Planar
5. Papules 
6. Plaques 
Resolved spontaneous in 1-2 years (skin and mucosa)
141
Q

After Lichen planus goes away what is left

A

Hyperpigmentation in that area

142
Q

Lichen Planus what do you see histology and how it looks

A
  1. Itchy violet flat-topped papules (Wickham striae = papules with white net like on top leaving dark dots in middle) = lace like pattern**, may look dark brown on darker people
  2. Symmetrical lesions
  3. Oral white net-like lesions
  4. Sawtoothing :zigzag dermoepithelial interphase (pointed retes)
  5. Colloid / CIVATTE BODIES : anucleated necrotic basal cells in papillary dermis
143
Q

Pemphigus

What is it

A

IgG Abs disrupting adhesion of epithelium = blister
IgG net like deposits
Acantholysis

144
Q

Acantholysis

A

Dissolution on intracellular bridges connecting skin cells

145
Q

Pemphigus Vulgaris what and histology

A

Most common
= mucosa and skin of face, scalp, axilla, groin, pressure points
= easily rupturing vesicles (crust and dried serum forms)
= above basal layer (suprabasilar blister) acantholytic blister
IgG——> Dsg1 and Dsg3

Histology : row tombstones

146
Q

Pemphigus Vegetans (foliaceus -> miler one)

A

Large moist verrucous (wart-like), vegetating plaques with pustules (groin, axilla, flexural surface)
= stratum granulosum level (subcorneal blisters), more superficial and not as erosive as vulgaris
IgG——> Dsg1 only

147
Q

Bullous pemphigold Ig and what

A

IgG ——> BGAG2
BM blister, subepidermal, doesn’t rupture easily

Elderly inner thighs + FLEXORS forearm, groin, axilla
Don’t rupture easily

148
Q

Dermatitis herpetiformis Ig and what

A

IgA to fibrils causing blisters
Urticaria of grouped vesicles = microabscesses
bilateral + EXTENSOR forearm elbows, knees, upper back, butt

149
Q

Dermatitis herpetiformis associated with what

A

Celiac disease

From IgA to gluten also attaching to reticulin = subepithelial blister

150
Q

Epidermolysis Bullosa :

A

subepidermal Blisters at sites of rubbing, pressure, trauma(at or right after birth)
= no inflammation (flexural creases)

151
Q

Porphyria

A

Inborn metabolic disturbance of porphyrins (pigments in Hgb, myoglobin cytochromes)
You get subepithelial blisters from sunlight
= no inflammation
= Rigid dermal papillae, abnormal superficial BVs
= Ig and glassy serum protein deposits in BVs

152
Q

Rosacea

SX and who

A 
Middle aged and older
Females usually 
= Slap cheek redness (flushing)
= persistent redness and telangiectasia
= pustules + papules
= Rhinophyma
153
Q

Rhinophyma

A

Thickening of the nasal skin

154
Q

Rosacea is associated with what

A

Cathelicidin (anti-microbial peptide) high amounts

= something cause in the micro bacterial effects causes this

155
Q

Erythema nodosum

A

HX of sarcodosis , pannicultis , painful nodule deep lesions

156
Q

Acne vulgaris

What is it, who, and 2 types

A

Universal in teens and all races except Asians milder
Induced by testosterone, corticosteroids, androgens, contraceptives, heavy clot IgM tropical climate
1. Open comedomes : central is black(oxidized melanin) keratin plug
2. Closed comedomes : keratin plug is beneath epidermis (can cause follicular rupture/ inflammation

157
Q

What causes acne vulgaris to happen in puberty

A
  1. Hypertrophy of sebaceous glands
  2. Propionibacterium acne’s colonize the hair follicle causing inflammation
  3. Androgens involved
158
Q

Acne conglobate

A

Severe variant of acne vulgaris and you have sinus tract formation and dermal scarring

159
Q

Panniculitis is what and found in what

A

Inflammmation in Sub Q fat, usually in lower legs

  1. Erythema nodosum
  2. Erythema induratum
160
Q

Erythema nodosum is what and what happens

A

CT septae separate from edema and fibrin/N exudate

Later the Lymphocytes and histocytes come

161
Q

Erythema nodosum SX

A

Very tender red plaque and nodules, ropy when palpated or seen
= over weeks it becomes flat and bruise like

162
Q

Reason erythema nodosum happens

A

Delayed hypersensitivity to microbiota or drug (** B-hemolytic strep, TB, histoplasmosis, leprosy, coccidiomycosis) (Sulfa, contraceptives)
Or a disease (sarcoidosis, IBD)

163
Q

Erythema Induratum

Who and what happens

A

Adolescents + menopause women’s

Primary vasculitis of deep vessels to fat ——> fat necrosis and inflammation

164
Q

Erythema induratum SX

A

Slightly tender nodule however usually ulcerated
Necrotizing vasculitis in deep dermis and subQ
Granulomatous inflammation (as seen in TB) = caseous necrosis

165
Q

Weber-Christian disease

A

Relapsing Febrile nodular panniculitis, red plaques and nodules on Lower extremities mostly + foamy M, L, N, giant cells

166
Q

Factitial panniculitis

A

Secondary panniculitis from sled-inflicted trauma or injection on something

167
Q

What can look like panniculitis

A

T- cell lymphoma (causing fat necrosis and superimposed inflammation)

168
Q

What can be associated with panniculitis

A

SLE (also causing inflammation of sub Q)

169
Q

Verrucae is also a

170
Q

Verrucea is what

Who

A

Squamous cell proliferation form HPV
Direct contact
Regress spontaneous is 6mo-2yrs

171
Q

Verrucae anogenital is caused by

A

Anogenital : HPV 6 and 11

172
Q

Verrucae HPV 16 does what

A

In situ SCC of genitals and Bowenoid papulosis (regresses usually)

173
Q

Verrucae HPV 5 and 8

A

Related to SCC and especially epidermodysplasia verruciformis (many flat warts that some progress to SCC)

174
Q

How does HPV cause warts

A

Interferes with NOTCH signaling = no maturation on keratinocytes = epidermal hyperplasia

175
Q

How does HPV cause cancer

A

When it produces E6 proteins that block p53 = no G1 arrest

176
Q

Verruca plana`

A

Warts on dorsal side of hands or face, smaller then verruca vulgaris

177
Q

Verruca planteris

Verruca Palmeris

A

Soles of feet and palms of hands

178
Q

Condylomata acuminatum (venereal wart)

A

Penis, GU areas, soft tan, cauliflower like can get big

179
Q

Verruca vulgaris

A

Epidermal hyperplasia , keratohyaline granules, koilocytosis (vacuole in cytoplasm)

180
Q

Molluscum contagiosum

Is what and looks like what inhistology

A

Pox infection causing Trunk and GU firm, pruritic, umbilicated papules= dimple down in center of papule
Molluscum bodies in stratum granulosum and stratum corneum in BS (cytoplasmic inclusion, ellipsoid)

181
Q

Pox virus looks like what

A

Brick shaped, dumbbell shaped DNA inside

182
Q

Stain for Tinea corporis (dermophyte fungus)

A

Periodic acid-Schaffer stain (PAS) = red hyphae in stratum cornuem

183
Q

Impetigo

A

Superficial bacteria infection of STAPH AUREUS on skin , very contagious,
= honey colored crust should be cleaned immediately (red macule forming and breaking)

184
Q

the toxin in staph aureus does what

A

toxin cleaves desmoglein 1 which injures the epithelium

185
Q

Tinea versicolor

A

Upper trunk fungal infection
Malassezia furfur (yeast) , not dermophyte
Many macule of different sizes and colors with fine peripheral scale

Skin Lymph Blood Exam 2 (9 decks)

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