DermPath- Dr. Martin Flashcards
1
Q
excoriation
A
Traumatic lesion breaking the epidermis and causing a raw linear area (i.e., deep scratch); often self-induced
2
Q
Name the 5 Disorders of Pigmentation & Melanocyteses
A
- Freckles
- Lentigo
- Melanocytic nevus
- Dysplastic nevi
- Melanoma
3
Q
A child presents with a 1mm, tan-red macule. The macule changes shade with season changes and is caused by hyperpigmentation (Inc melanin). What is the dx?
A
Freckle (ephelis)
4
Q
What is a type of freckle that arises independently of sun exposure? Has a neurological source (neurofibromatosis)
A
Café au lait
5
Q
What do café au lait spots contain?
A
Macromelanosomes (aggregated melanosomes in the cytoplasm of melanocytes)
6
Q
Plaque
A
Elevated flat-topped lesion, usually greater than 5mm across (may be caused by coalescent papules)
7
Q
Pustule
A
Discrete, pus-filled, raised lesion
8
Q
Scale
A
Dry, horny, platelike excrescence; usually the result of imperfect cornification
9
Q
Vesicle, Bulla, Blister
A
Fluid-filled raised lesion 5mm or less across (vesicle) or greater than 5mm across (bulla). Blister is the common term for either.
10
Q
Wheal
A
Itchy, transient, elevated lesion with variable blanching and erythema formed as the result of dermal edema
11
Q
Name the 5 Disorders of Pigmentation & Melanocytes
A
- Freckles
- Lentigo
- Melanocytic nevus
- Dysplastic nevi
- Melanoma
12
Q
Acanthosis
A
Diffuse epidermal hyperplasia
13
Q
Dyskeratosis
A
Abnormal, premature keratinization within cells below the stratum granulosum
14
Q
Erosion
A
Discontinuity of the skin showing incomplete loss of the epidermis
15
Q
Exocytosis
A
Infiltration of the epidermis by inflammatory cells
16
Q
Hydropic swelling (ballooning)
A
Intracellular edema of keratinocytes, often seen in viral infections
17
Q
Hypergranulosis
A
Hyperplasia of the stratum granulosum, often due to intense rubbing
18
Q
Hyperkeratosis
A
Thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin
19
Q
Lentiginous
A
A linear pattern of melanocyte proliferation within the epidermal basal cell layer
20
Q
Papillomatosis
A
Surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae
21
Q
Parakeratosis
A
Keratinization with retained nuclei in the stratum corneum. On mucous membranes, parakeratosis is normal.
22
Q
Spongiosis
A
Intercellular edema of the epidermis seen in eczema
23
Q
Ulceration
A
Discontinuity of the skin showing complete loss of the epidermis revealing dermis or subcutis
24
Q
Vacuolization
A
Formation of vacuoles within or adjacent to cells; often refers to basal cell-basement membrane zone area
25
A child presents with a 1mm, tan-red macule. The macule changes shade with season changes, and is caused by hyperpigmentation (Inc melanin). What is the dx?
Freckle (ephelis)
26
What is a type of freckle that arises independently of sun exposure? Has a neurological source (neurofibromatosis)
Café au lait
27
What do café au lait spots contain?
Macromelanosomes (aggregated melanosomes in cytoplasm of melanocytes)
28
What is a disorder of pigmentation that is initiated in childhood/infancy that has to do with benign localized hyperplasia of melanocytes?
Lentigo
29
What skin lesion has...?
- uniform pigmentation
- well-defined rounded borders
- 3 forms (junctional, compound, intradermal)
- benign histology
- can be flat macules or elevated papule
Melanocytic nevus (mole)
30
Histology of lentigo
restricted to basal cell layer
31
Where do compound nevi nest?
in epidermis and dermis
| junction + derm
32
Histology of lentigo
restricted to basal cell layer
33
Describe melanocytic nevi in the superficial, deeper, and deepest layers.
▪Superficial = nests, large-round cells, ↑ melanin
▪ Deeper = cords or single cells, smaller cells, ↓pigment
▪ Deepest: fusiform, fascicles resembling neural tissue (MELANOMA)
▪ Helpful in differentiating benign nevi from melanoma
34
dysplastic nevus syndrome has what genes that are mutated?
CDKN2A or CDK4
35
What cancer occurs at all ages, in skin and uvea of the eye, is cured surgically, and requires biopsy*?
(Biopsy of the center of cell as well as the periphery because the cells in the center are dead- not useful in diagnosing this cancer.)
Melanoma
36
Melanoma has a high incidence. What therapy has contributed to the downward trend in death rates?
Reflects the effectiveness of immune checkpoint inhibitor therapy.
37
Describe melanocytic nevi in the superficial, deeper, and deepest layers.
▪Superficial = nests, large-round cells, ↑ melanin
▪ Deeper = cords or single cells, smaller cells, ↓pigment
▪ Deepest: fusiform, fascicles resembling neural tissue
▪ Helpful in differentiating benign nevi from melanoma
38
How do the nuclei in dysplastic nevi change in size as they go deeper
Some of the nuclei of the melanocytes get larger as they go deeper; which is why it's "dysplastic growth"
39
What is the most deadly skin cancer that is acquired through UV radiation from sunlight (DNA damage)?
Melanoma
40
can radial growth of melanoma metastasize?
nope
41
Melanoma has a high incidence. What therapy has contributed to the downward trend in death rates?
Reflects the effectiveness of immune checkpoint inhibitor therapy.
42
Do males or females have melanomas in their upper backs?
Males
43
What driver mutation in melanoma activates telomerase?
TERT (most common)
44
What kinase do growth factors activate the signaling circuits of? Melanoma
Tyrosine Kinase (KIT)
45
What is the stain for melanoma cells in lymph nodes?
HMB-45+
FYI: it is a monoclonal antibody that stands for Human Melanoma Black
46
Dysplastic nevi often require activating mutations in
NRAS and BRAF genes
47
dysplastic nevi are larger than
5 mm
48
Histo characteristics of dysplastic nevi
Variegated pigmentation
irregular borders of lesions
Enlarged epidermal nests that may coalesce with other nests
Lentiginous hyperplasia: single nevus cells replace basal cells along E-D junction
Atypia: lg nuclei, irreg angulated nuclear contour, hyperchromasia
Lymphocytic infilt of superf dermis, melanin incontinence (loose melanin)
Linear fibrosis surrounds epidermal rete ridges
49
How do the nuclei in dysplastic nevi change in size as they go deeper
Some of the nuclei of the melanocytes get larger
50
What driver mutation in melanoma disrupts cell cycle control genes?
Mutation in CDKN2
(fyi: encodes p15, p16, ARF) --> tumor suppressor genes
51
What driver mutation in melanoma activates pro-growth signaling pathways? And is the target of drug treats!
Increased RAS & P13K/AKT signaling
| mutation in BRAF
52
What driver mutation in melanoma activates telomerase?
TERT (most common)
53
What kinase do growth factors activate the signaling circuits of? Melanoma
Tyrosine Kinase (KIT)
54
What is the stain for melanoma cells in lymph nodes?
HMB-45+
55
What does radial growth of melanoma mean?
horizontal spread of melanoma within epidermis
56
can radial growth of melanoma metastasize?
nope
57
What are large nuclei with red nucleoli characteristic of?
Melanoma
abnormal mitotic figures - more proliferation
chromatin is clumped at the periphery of the nuclear membrane
58
vertical growth of melanoma is when tumor cells travel...
downwards
59
What is the thickening of the epidermis caused by an increased number of squamous cells?
Acanthosis nigricans
| a cutaneous sign of several underlying benign & malignant conditions
60
A child going through puberty presents with thickened, hyperpigmented, velvet-like, skin with velvet-like texture in flexural areas & intertriginous areas.
1. What is this benign epithelial tumor?
2. What are the 2 most common causes?
(intertriginous areas - skin rubs together)
1. Acanthosis nigrican
| 2. Obesity & Diabetes
61
favorable prognosis: melanoma
```
thinner tumor depth
NO (<1 per mm²)mitosis
brisk tumor infiltrating lymphocyte response
NO regression
lack of ulceration
```
62
What is the gene related to increased growth factor receptor signaling in the skin in acanthos nigricans and seborrheic keratosis?
FGFR3
63
What gene in pts with DM contributes to acanthos nigricans?
IGFR1
DM2, hyperinsulinemia believed → ↑ stimulation of insulin-like growth factor receptor-1 (IGFR1)
64
A child going through puberty presents with thickened, hyperpigmented, velvet-like, skin with velvet-like texture in flexural areas & intertriginous areas.
1. What is this benign epithelial tumor?
2. What are the 2 most common causes?
(intertriginous areas - skin rubs together)
1. Acanthosis nigrican
| 2. Obesity & Diabetes
65
a type of benign epithelial tumor that arises spontaneously primarily in the trunk, extremities, head, and neck
Seborrheic Keratosis (Seb K)
66
People of color mainly have this type of benign epithelial tumor and it appears as multiple small lesions on the face
Dermatosis papulosa nigra (a type of Seb K)
67
where is the carcinoma usually that's associated with Leser-Trelat
carcinomas of GI tract
68
what is the type of benign epithelial tumor associated with the presence of a skin tag
Fibroepithelial polyp aka acrochordon
69
name of the paraneoplastic syndrome associated with Seb K
Leser-Trelat
70
where is the carcinoma usually that's associated with Leser-Trelat
carcinomas of GI tract
71
Follicular Inclusion Cyst (Wen) spills ______ into the dermis
keratin
72
what is the type of benign epithelial tumor associated with the presence of a skin tag
Fibroepithelial polyp
73
fibroepithelial polyp associated with what diseases
diabetes, obesity, intestinal polyposis
74
what is the type of benign epithelial tumor associated with a painful granulomatous inflammatory response
Epithelial or Follicular Inclusion Cyst (Wen)
75
Follicular Inclusion Cyst (Wen) spills ______ into the dermis
keratin
76
What gene in pts with DM contributes to acanthos nigricans?
IGFR1
DM2, hyperinsulinemia believed → ↑ stimulation of insulin-like growth factor receptor-1 (IGFR1)
77
Does acanthosis nigricans have melanocytic hyperplasia?
No
FYI: Histo: epidermis & underlying enlarged dermal papillae undulate sharply →numerous repeating peaks and valleys. Variable hyperplasia may be seen, along with hyperkeratosis & slight basal cell layer hyperpigmentation (but no melanocytic hyperplasia).
78
Compare removal of fibroepithelial polyp and Follicular Inclusion Cyst
the polyp is easily removed at the stalk whereas the follicular inclusion cyst (wen) has to be removed by the whole sac or else keratin will still be getting filled inside the cyst
79
typical location of follicular inclusion cyst (wen)
mainly on scalp
80
fibroepithelial polyp typically located at
head, neck, trunk, face and intertriginous areas
81
name of adnexal (appendage tumor) that has an increased risk for breast cancer
Cowden syndrome
82
Cowden syndrome has loss of function in
PTEN
83
name of adnexal tumor that looks like a "jigsaw" puzzle or is also called "turban tumor"
Cylindroma
84
Adnexal tumor that is associated with Muir Torre syndrome
Sebaceous adenoma
85
Familial Cancer Syndromes with Cutaneous Manifestations
Chromosomal Location: 9q22 and others
Gene/Protein: XPA /XPA and others
Normal Function/Manifestation of Loss: Nucleotide excision repair/melanoma and nonmelanoma skin cancers
Xeroderma pigmentosum
86
What are the 3 Premalignant & Malignant Epidermal Tumors
▪Actinic Keratosis
▪Squamous Cell Carcinoma
▪Basal Cell Carcinoma
87
Proliferation of basaloid cells that forms primitive structures resembling hair follicles
Histology: Buds of basaloid cells
Trichoepithelioma
88
Ghost cells: no nucleus
Pilomatrixoma
89
Apocrine decapitation
Apocrine carcinoma
90
Key characteristics of Actinic Keratosis are?
Cutaneous horn: excessive keratin production
| Dyskeratosis: pink cytoplasm, intracellular bridges, elastosis (due to sun damage), parakeratosis
91
Familial Cancer Syndromes with Cutaneous Manifestations
Chromosomal Location: 9q22
Gene/Protein: **PTCH** /PTCH
Normal Function/Manifestation of Loss: Developmental patterning gene/multiple basal cell carcinomas; medulloblastoma, jaw cysts
Nevoid basal cell carcinoma syndrome
92
What carcinoma in younger people (<20 y/o) is related to medulloblastoma, ovarian fibromas, odontogenic keratocysts, pits of palms & soles?
Nevoid basal cell carcinoma syndrome (NBCCS) aka Gorlin syndrome
93
What carcinomas have these properties?
Pearly papules, telangiectasia (vessels), rodent ulcers, & peripheral palisading (arranged radially with their long axes in parallel alignment) with cleft separating nest from adjacent stroma
Basal Cell Carcinoma (BCC)
94
What are the 2 Tumors of the Dermis?
Benign Fibrous Histiocytoma (Dermatofibroma)
Dermatofibrosarcoma Protuberans
95
A young-middle age women presents with a dimple sign on her legs with hx of antecedent trauma.
Histology:
- Benign spindle-shaped cells, well-defined, non-encapsulated mass in mid dermis.
- Pseudoepitheliomatous hyperplasia (epidermal hyperplasia)
Benign Fibrous Histiocytoma (Dermatofibroma)
- Dimple sign: lateral pressure on the skin produces a depression
- Indv collagen bundles & fibroblast are also present.
96
What is the second most common tumor arising in sun exposed skin?
SCC
97
cowden syndrome is?
trichilemmomas (benign tumor of skin involving hair follicle)
98
Histology
- Storiform (fibroblasts arranged radially)
- Rare mitoses, overlying epidermis is thinned (opposite of dermatofibroma
- Honeycomb pattern = deep extension from the dermis into the subQ fat
Dermatofibrosarcoma Protuberans (DFSP)
99
What are the 3 Premalignant & Malignant Epidermal Tumors
▪Actinic Keratosis
▪Squamous Cell Carcinoma
▪Basal Cell Carcinoma
100
Does SCC metastasize?
yes, less than 5% metastasize to regional lymph nodes
101
Ghost cells: no nucleus
Pilomatrixoma
102
Apocrine decapitation
Apocrine carcinoma
103
What are the acquired mutations in SCC
p53
RAS signaling
decrease in Notch signaling
104
What carcinoma is associated with Hedgehog signaling, PTCH gene?
Basal Cell Carcinoma (BCC)
105
Characteristics of invasive SCC
lesions are nodular
keratin producing (hyperkeratotic)
may ulcerate
106
Xeroderma pigmentosum increases the risk for SCC
mutation in nucleotide excision repair pathway
107
What are the 2 Tumors of the Dermis?
Benign Fibrous Histiocytoma (Dermatofibroma)
Dermatofibrosarcoma Protuberans
108
Does SCC metastasize?
yes, less than 5% metastasize to regional lymph nodes
109
A young-middle age women presents with a dimple sign on her legs with hx of antecedent trauma.
Histology:
- Benign spindle-shaped cells, well defined, non-encapsulated mass in mid dermis.
- Pseudoepitheliomatous hyperplasia (Overlying epidermal hyperplasia, downward elongation of hyperpigmented rete ridges)
Benign Fibrous Histiocytoma (Dermatofibroma)
110
SCC causes immunosuppression and causes risk of infection by which oncogenic virus?
HPV 5 & 8
111
Name of syndrome that causes an increase in cutaneous SCC and is also HPV implicated
Epidermodysplasia verruciformis
112
What are the acquired mutations in SCC
p53
RAS signaling
decrease in Notch signaling
113
Characteristics of in situ SCC
sharply defined
red
scaling plaques
enlarged and hyperchromatic nuclei involving all levels of epidermis
114
Characteristics of invasive SCC
lesions are nodular
keratin producing (hyperkeratotic)
may ulcerate
115
What is a well-differentiated primary fibrosarcoma of the skin, locally aggressive, with a protuberant” nodule?
Induration: Localized hardening of soft tissue of the body.
Dermatofibrosarcoma Protuberans (DFSP)
116
Translocation collagen 1A1 (COL1A1) & PDGFB, promoting tumor cell growth
Dermatofibrosarcoma Protuberans (DFSP)
117
Histology
- Storiform (fibroblasts arranged radially)
- Rare mitoses, overlying epidermis is thinned (opposite of dermatofibroma
- Honeycomb pattern = deep extension from the dermis into the subQ fat
Dermatofibrosarcoma Protuberans (DFSP)
118
Xeroderma pigmentosum increases the risk for SCC
mutation in nucleotide excision repair pathway
119
What describes a spectrum of rare disorders characterized by increased numbers of mast cells in the skin and, in some instances, in other organs as well?
Mastocytosis
120
What describes multiple, widely distributed lesions, round-oval, red-brown, nonscaling papule & sm plaques?
cutaneous form, children, >50% of mastocytosis cases
Urticaria pigmentosa (Mastocytosis)
121
Sezary syndrome characterized by
erythroderma
cerebriform contour to CD4 cells
there are band-like aggregates in superficial dermis
small clusters of cells in the epidermis: Pautrier microabscesses
122
What 2 things are released when mast cells degranulate?
Histamine & heparin
123
What sign describes localized area of dermal edema & erythema (wheal) when skin is rubbed?
Darier Sign (Mastocytosis)
124
What is this called?
area of dermal edema resembling a hive, result of local stroking skin with pointed instrument
Dermatographism (Mastocytosis)
125
What are systemic signs of Mastocytosis?
1. pruritus & flushing
2. rhinorrhea
3. rarely GI or nasal bleeding (anticoagulant effect of heparin)
4. bone pain (mast cell infiltration or osteoporosis)
126
In what population besides men face osteoporosis due to excessive histamine release in the BM?
premenopausal women
127
What gene mutation is associated with Mastocytosis?
Point mutations in **KIT** receptor tyrosine kinase,→ mast cell growth & survival
128
What are the 2 Tumors of Cellular Migrants to the Skin?
▪Mycosis Fungoides (Cutaneous T-Cell Lymphoma)
| ▪ Mastocytosis
129
What are the three Chronic Inflammatory Dermatoses?
▪ Psoriasis
▪Seborrheic Dermatitis
▪Lichen Planus
130
Pt presents with AIDS &
1. Pink to Salmon colored plaque covered by loosely adherent silver scale
2. Nail changes: Pitting, yellow-brown discoloration, & oncolysis (separation of the nail plate from the underlying bed)
3. Histology: elongation of rete ridges “test tubes in a rack” & parakeratotic scale
Psoriasis
131
What is the name of the phenomenon that induces psoriatic lesions in susceptible pts by local trauma, starts a self-perpetuating local inflammatory response?
Koebner phenomenon
132
What is a feature of psoriasis where small PMN aggregates in parakeratotic stratum corneum?
Munro microabscesses
| Neutrophils, eosinophils, and basophils are PMN
133
Three types of acute inflammatory dermatoses
Urticaria
Acute Eczematous Dermatitis
Erythema Multiforme
134
What is a cause of erythroderma (total body erythema and scaling)?
Psoriasis
135
What condition is treated excellently by TNF & IL-17 inhibitors?
Psoriasis
136
What is a disease of the product of sebaceous gland and not the glands themselves?
It is more common than psoriasis and involves an inflammation of the epidermis.
Seborrheic dermatitis
137
What are 2 causes of increased sebum production, associated with Seborrheic dermatitis?
1. in response to androgens
| 2. Dopamine deficiency, seen in Parkinson's Disease
138
A severe form of seborrheic dermatitis that is difficult to treat was once common in many HIV individuals with low CD4 counts, but its incidence has fallen with what therapy?
Antiviral therapy
139
What condition is associated with follicular lipping?
Seborrheic dermatitis
(Mounds of parakeratosis containing neutrophils and serum are present at the ostia of hair follicles = follicular lipping)
140
What condition is associated with macules and papules on an erythematous-yellow, often greasy base & dandruff?
Seborrheic dermatitis
141
What are inflammatory & non-inflammatory blistering DOs?
Inflammatory Blistering DOs
▪ Pemphigus
▪Bullous Pemphigoid
▪Dermatitis Herpetiformis
Noninflammatory Blistering DOs
▪Epidermolysis Bullosa & Porphyria
142
What disease produces dramatic lesions which can be fatal if untreated?
Bullous dzs
| Blisters occur at different levels of the skin; histology needed for accurate diagnosis
143
What Inflammatory Blistering DOs involves IgG autoantibodies disrupt intracellular adhesions (within the epidermis & mucosal epithelium) → blisters; may be fatal without TX?
Pemphigus
Net-like pattern of intercellular IgG deposits; vulgaris = all levels, foliaceus = superficial
144
Which type of Pemphigus is suprabasal?
Pemphigus Vulgaris: most common
▪ Mucosa & points of pressure
▪ Superficial vesicles rupture easily → shallow erosions with dried serum & crust
▪ Histology: Fishnet-like pattern in fluorescence stains, tombstones (stand up in oral cavity)
145
Which type of Pemphigus is more benign form that is endemic in Brazil & at stratum granulosum level?
Pemphigus foliaceus
delicate superficial (subcorneal) blisters are much less erosive than those seen in pemphigus vulgaris
146
What kind of Noninflammatory Blistering DOs has blisters at sites of pressure, rubbing, or trauma?
inherited defects in structural proteins
Occurs at flexural creases. Subepidermal blister, no inflammation
Epidermolysis Bullosa
in newborns
147
What kind of Noninflammatory Blistering DOs has scarring, exacerbated by sunlight?
Inborn or acquired disturbances in porphyrin metabolism
Porphyria
| Porphyrins: pigments normally present in Hgb, myoglobin, & cytochrome
148
What is a noninflammatory blister at the dermoepidermal junction; with seemingly rigid dermal papillae at the base that contain abnormal superficial vessels?
Porphyria
149
What are two forms are Panniculitis: inflammatory rxn in subQ adipose tissue?
```
Erythema Nodosum (most common form)
& Erythema Induratum
```
150
What inflammatory rxn preferentially affects (1) the lobules of fat or (2) the connective tissue that separates fat into lobules?
Panniculitis
151
What condition is treated excellently by TNF & IL-17 inhibitors?
Psoriasis
152
A self-limited hypersensitivity rxn to certain infections and drugs
Erythema Multiforme
153
erythema multiforme is mediated by
CD8 cytotoxic T lymphocytes
154
erythema multiforme is characterized by
```
targetoid lesions
interface dermatitis (dermal edema, lymphocyte infiltration, degenerating keratinocytes)
```
155
Stevens Johnson syndrome is associated with
erythema multiforme in children in oral mucosa, conjunctiva, urethra, genial, and perianal areas
156
what is toxic epidermal necrolysis
it's associated with erythema multiforme and is characterized my diffuse necrosis and sloughing of cutaneous and mucosal epithelia
157
infections that cause erythema multiforme
herpes simplex, mycoplasma, histoplasmosis
158
What is a disease of the product of sebaceous gland and not the glands themselves?
It is more common than psoriasis and involves an inflammation of the epidermis.
Seborrheic dermatitis
159
What are 2 causes of increased sebum production, associated with Seborrheic dermatitis?
1. in response to androgens
| 2. Dopamine deficiency, seen in Parkinson's Disease
160
A severe form of seborrheic dermatitis that is difficult to treat was once common in many HIV individuals with low CD4 counts, but its incidence has fallen with what therapy?
Antiviral therapy
161
What condition is associated with follicular lipping?
Seborrheic dermatitis
(Mounds of parakeratosis containing neutrophils and serum are present at the ostia of hair
follicles = follicular lipping)
162
What condition is associated with macules and papules on an erythematous-yellow, often greasy base & dandruff?
Seborrheic dermatitis
163
Other characteristics of lichen planus
sawtoothing--> zigzag of dermoepidermal juct
| civatte bodies--> anucleate, necrotic basal cells
164
What disease produces dramatic lesions which can be fatal if untreated?
Bullous dzs
Blisters occur at different levels of the skin; histology needed for accurate diagnosis
165
```
Pt presents with:
pruritic
purple
polygonal
planar
papules
plaques
```
Lichen Planus
166
self-limited condition that MAY resolve spontaneously in 1-2 years
Lichen Planus
167
If lichen planus occurs in chronic mucosal and paramucosal lesions can become
SCC
168
Koebner phenomenon occurs in both
lichen planus
| psoriasis
169
Wickham striae is associated with
lichen planus, they are papules highlighted with white dots, created by areas of hypergranulosis
170
Other characteristics of lichen planus
sawtoothing--> zigzag of dermoepidermal juct
| civatte bodies--> anucleate, necrotic basal cells
171
What Inflammatory Blistering DOs involves IgG autoantibodies disrupt intracellular adhesions (within the epidermis & mucosal epithelium) → blisters; may be fatal without TX?
Pemphigus
Net-like pattern of intercellular IgG deposits; vulgaris = all levels, foliaceus = superficial
172
Which type of Pemphigus is suprabasal?
Pemphigus Vulgaris: most common
▪ Mucosa & points of pressure
▪ Superficial vesicles rupture easily → shallow erosions with dried serum & crust
173
Which type of Pemphigus is more benign form that is endemic in Brazil & at stratum granulosum level?
Pemphigus foliaceus
174
What kind of Noninflammatory Blistering DOs has blisters at sites of pressure, rubbing, or trauma?
Epidermolysis Bullosa
175
inflammatory blistering DO that is common in the elderly, is at the inner aspect of the thighs, and is usually on the flexor surfaces of forearms
bullous pemphigoid
176
where do antibodies deposit in bullous pemphigoid
at the dermoepidermal junction
177
name of the antigen associated with bullous pemphigoid
BPAG= bullous pemphigoid antigens
178
inflammatory blistering DO that is usually seen as grouped vesicles on extensor surfaces (elbows, knees)
Dermatitis herpetiformis
179
condition associated with celiac disease, IgA antibodies to gluten, and Abs that cross react with reticulin--> subepidermal blister
Dermatitis herpetiformis
180
What kind of Noninflammatory Blistering DOs has scarring, exacerbated by sunlight?
Inborn or acquired disturbances in porphyrin metabolism
(Porphyrins: pigments normally present in Hgb, myoglobin, & cytochrome)
Porphyria
181
What is a noninflammatory blister at the dermoepidermal junction; with seemingly rigid dermal papillae at the base that contain abnormal superficial vessels?
Porphyria
182
What are two forms are Panniculitis: inflammatory rxn in subQ adipose tissue?
```
Erythema Nodosum (most common form)
& Erythema Induratum
```
183
What inflammatory rxn preferentially affects (1) the lobules of fat or (2) the connective tissue that separates fat into lobules?
Panniculitis
184
2 disorders of Epidermal Appendages
Acne Vulgaris
| Rosacea
185
```
Pt presents with:
flushing
persistent erythema and telangectasia
pustules and papules
Rhinophyma: permanent thickening of nasal skin
```
Rosacea
186
Rosacea is associated with high cutaneous levels of the.....
antimicrobial peptide cathelicidin
187
skin condition that is virtually universal in middle-late teens, present in all races
acne vulgaris
188
antibiotic treatment for propionibacterium acnes
13-cis-retinoic acid (isoretinoin)= antisebaceous action
189
acne vulgaris: closed comedones
keratin plug trapped beneath epidermal surface, potential for follicular rupture and inflammation
190
acne vulgaris: multifactorial
1) keratin block blocks outflow of sebum
2) hypertrophy of sebaceous glands (puberty), 3)Propionibacterium acnes colonizing hair follicles, 4)secondary inflammation of follicles
191
severe variant of acne vulgaris--> causes dermal scarring and causes sinus tract formation
acne conglobate
192
antibiotic treatment for propionibacterium acnes
13-cis-retinoic acid (isoretinoin)= antisebaceous action
193
uncommon type of panniculitis
erythema induratum
194
pt will usually be an adolescent or menopausal females, will present with primary vasculitis of deep vessels supplying fat lobules of the subQ--> fat necrosis and inflammation
erythema induratum
195
Other types of panniculitis
Weber-Christian disease (relapsing febrile nodular panniculitis):
rare form of lobular, nonvasculitic panniculitis, children and adults.
crops of erythematous plaques or nodules, predominantly on lower extremities
created by deep-seated foci of inflammation containing aggregates of foamy macrophages with lymphocytes, neutrophils, &giant cells
Factitial panniculitis:form of secondary panniculitis caused by self-inflicted trauma or injection of foreign or toxic substances
T-cell lymphoma: home to fat lobules, producing fat necrosis &superimposed inflammation that mimics panniculitis
Systemic Lupus erythematosus: may occasionally cause inflammation of the subcutis &an associated panniculitis
196
Which panniculitis has a subacute presentation & poorly defined, exquisitely tender erythematous plaques & nodules, more readily palpated (ropy) than seen?
Erythema nodosum
197
Which panniculitis is associated with infectious β-hemolytic streptococcal infection, tuberculosis?
Erythema nodosum
198
a squamoproliferative DOs caused by HPV 6 & 11
verrucae (warts)
199
What skin condition is associated with staphylococcus aureus → toxin causing epidermal injury?
What does the toxin cleaves?
Impetigo
desmoglein 1
200
HPV 5 & 8 related to
SCC esp in individuals with epidermodysplasia verruciformis
201
molluscum contagiosum giemsa or H&E stain will show
molluscum bodies= ellipsoid, homogenous, cytoplasmic inclusions
202
pt presents with pruritic, pink-skin colored umbilicated papules, curd-like material can be expressed from umbilication
molluscum contagiosum
203
molluscum contagiosum giemsa or H&E stain will show
molluscum bodies= ellipsoid, homogenous, cytoplasmic inclusions
204
What is a common superficial bacterial infection of the skin?
Highly contagious; otherwise healthy kids, occasionally adult in poor health
Impetigo
205
What skin condition is associated with staphylococcus aureus → toxin causing epidermal injury?
What does the toxin cleaves?
Impetigo
desmoglein 1
206
Describe the crust in Impetigo.
Honey-colored crust: drying serum, if crust not removed, new lesions form around periphery & extensive epidermal damage may occur
▪Eliminate bacteria, lesion heals
207
superficial fungal infections are confined to
stratum corneum
208
tinea capitis
dermatophytosis of the scalp
209
tinus barbae
dermatophyte infection of the beard
210
tinea corporis
superficial fungal infection of the body surface
211
tinea cruris
inguinal areas of obese men during warm weather
212
tinea pedis (athlete's foot)
most of the reaction due to bacterial superinfection and is not directly related to the primary dermatophytosis
spread to nail is referred to as onychomycosis
213
tinea versicolor
upper trunk
usually due to the yeast Maassezia furfur
