Dx of the Connctive Tissues Dan Flashcards

Question

What is the classification of causes of elastolysis (loss of elasticity)?

Answer 1

Generalised elastolysis - congenital cutis laxa; AD, AR (3 types), X-L - assoc w/ inherited disease; PXE, SCARF - acquired Localised elastolysis Variants of elastolysis/anetoderma

Answer 2

``` CHiKEN SOUP With Lyme Complement deficiency High fever (febrile illness) Klippel Trenaunay Erythema multiforme Neoplastic such as Myeloma SLE/ Sarcoid/Syphillis/Systemic amyloid, Rheumatoid A Oedema / Angio-oedeam Urticaria Penicillin allergy or other drug allergy/ pseudo-PXE With - Wilson's disease Lyme disease - Acrodermatitis chronica atrophicans ```

Answer 3

``` PXE SCARF Costello’s syndrome Geroderma osteodysplastica NB the recessve and XL variants of congenital cutis laxa feature systemic features as well as skin disease but are considered variants not separate diseases like those listed above ```

Answer 4

``` Anetoderma Blepharochalasis Acrodermatitis chronica atrophicans Granulomatous slack skin Mid dermal elastolysis post inflammatory elastolysis and cutis laxa elastic tissue naevi ```

Answer 5

Focal dermal defect of elastic tissue Circumscribed, 1-2cm areas of flaccid skin, which may be elevated, macular or depressed Trunk/thighs/upper armsfine, irregular, twisted elastic fibres but no elastorrhexis (fragmentation) Can be primary or secondary Primary - Inflammatory and non inflammatory types - Cause unknown Secondary - Due to an underlying disease but doesn’t always develop at site of dermatosis - Assoc w/ antiphospholipid abs

Answer 6

PAP PUDDLES Penicillamine Acne Pityriasis versicolor + staph, VZV, TB, Lyme Dx(ACA) Pilomatrixoma Urticaria Pigmentosa DLE, SLE, CCLE(profundus/discoid) with C2 def, aPLS Dermatofibroma, neurofibroma, involuted IH Leprosy, Lymphoma, MF Electrode attachment + other perinatal injuries Sarcoidosis, Syphilis - occurs with secondary, latent, congenital or tertiary syphilis.

Answer 7

F 20-40yrs Crops of 0.5-1cm erythematous macules develop on trunk, thighs and upper arms, occasionally elsewhere Macules enlarge for short time then flatten and wrinkle can be grey, white or blue in colour 5->100 lesionsmay develop new lesions for years Lesions may coalesce resembling cutis laxa Examining finger can sink into distinct pit w/ sharp borders w/ buldge reappearing when pressure is released Cannot treat medically when established try to slow progression with Penicillin and ε(epsilon)-amino caproic acid or colchicine

Answer 8

Laxity of eyelid from defect in elastic tissue, cause unknown Usually sporadic, can be AD Develops at puberty

Answer 9

Widespread wrinkling of the crinkle type involving the entire skin surface of young to middle aged women, usually middle aged Caucasian discrete perifollicular papules Selective band like loss of elastic fibres in mid dermis on van Gieson stain Normal elastic fibres in rest of dermis Preservation of elastic tissue around hair follicles - gives perifollicular papules Triggers may include - UVR, AI-CTD, pregnancy, OCP, insect bites and Lyme Borreliosis No effective Rx

Answer 10

ARABCC6 gene on Chr 16 Calcium accumulates in elastic fibres of skin + tissues skin changes often present in childhood CHICS (skin looks like chicken skin) Comets, Angioid streaks + peau d'orange of eyes Haemorrhage (upper GI bleed) Ischaemic heart disease Claudication (PVD) >age 30 Squeaky valves; MR/AR/ aortic dissection NB also; May get reticulate pigmentation on abdo acneiform lesions Usually arises before 30. Occasionally old age. Persists indefinitely Changes similar to skin occur on all mucosal surfaces Exaggerated horizontal or oblique mental crease pathognomonic finding Eye changes due to calcification of Bruch’s membrane of retina Risk of; Bleeding - GI, intracranial Miscarriage

Answer 11

``` clumped, degenerate elastin fibres in mid-reticular dermis as seen on EVG stain calcium deposits (von kossa stain) ```

Answer 12

Can send for genetic testing for ABCC6 mutation Skin biopsy FBC, film, iron studies ELFTs Calcium, phosphate, Vit D Fasting lipids and BSL for CV risk Refer to ophth for fundoscopy Refer cardiology for coronary angiogram Consider; o Echoo Doppler legs vessels o CT head if neurology o FOBs, urine for blood There are complex diagnostic criteria - Major are clinical skin or histo criteria, eye criteria and genetic/FHx crieria 2 or more major criteria from different categries is enough for diagnosis Not much Rx for skin - low calcium diet may help; plastic surgery for most disfiguring Main management is appropriate referrals for monitoring and care - eye, cardiol, obstetric etc

Answer 13

False | UVB more important

Answer 14

acrokeratoelastoidalis marginalis collagenous and elastotic marginal plaques of hands Acquired papular eruption w/ keratoderma + changes in dermal connective tissue More often dominant hand Affects radial aspect of index finger, 1st web space + ulnar aspect of thumb can get SCC

Answer 15

External to annular lesion is solar elastosis Thickened annulus w/ histiocytic and giant cell infiltrate Central zone w/ little/no elastotic tissue remaining

Answer 16

Sun protection ILCS and tretinoin Isotretinoin/Acitretin has worked

Answer 17

Characteristic facies “hound dog” – broad nose, sagging cheeks and large ears premature aged appearance vocal cord laxity (deep voice) Risk of death with pulmonary emphysema Herniae, diverticulae, osteoporosis, arotic aneurysm, dental caries

Answer 18

blepharochalaxis + progressive enlargement of the upper lip due to hypertrophy and inflammation of the labial salivary glands May be excessive salivation

Answer 19

``` AD mutation in fibrillin-1 gene (FBN1) 30% new mutations MARFANS Mitral valve prolapsed, Myopia Aortic Regurge, Aneurysm, Dissection Retinal detachment Fibrillin gene, Chr Fifteen + PH(marPHan)- Pectus excavatum, High arched palate Arachnodactyly Negative Nitroprusside test (differentiates from homocystinuria), neural deafness (6%) Subluxated lens (Upward or up + lateral dislocation of Lens) Skin features - HESP Hyperexensible skin Elastosis perforans serpiginosa Striae atrophicae Papraceous scars ```

Answer 20

refer to cardio and ophthal Pregnancy unadvisable due to 50% risk of transmission and acceleration of CV disease and vascular rupture during pregnancy Genetic counselling Little skin Rx needed

Answer 21

``` Heterogeneous group of defects in connective tissue Collagen mutations or proteins which interact with collagens Causes defective collagen network Elastic fibres are normal so skin is hyperextensible but has normal recoil 9 types - types 1-4 account for 60% of cases >40% are types 1 or 2 - collagen 5 mutations Most common types are AD Key features are; Soft, Hyperextensible skin Joint hypermobility easy bruising vascular pathology scarring and poor wound healing dental abnormalities common no mental problems ```

Answer 22

False Type 1 mainly blue grey spongy tumours of connective tissue occuring at pressure points fibrous capsule containing fat and mucoid material which can be calcified

Answer 23

AD - Classical types of EDS allelic variants – different subunits of same gene affected Type 1 - Gravis = A1 region of collagen 5 (COL5A1) Type 2 - Mitis = A2 region of collagen 5 (COL5A2) account for 43% of EDS, Type II is milder soft velvety, hyperextensible skin easy bruising Wide atrophic scars; cig paper scars/sutures tear No striae in pregnancy piezogenic pedal papules Hyperextensible joints Spontaneous dislocations kyphoscoliosis Molluscoid pseudotumours, spheroids Facies - widely spaced eyes, wide nasal bridge, epicanthic folds, can be blue sclera Can have redundant palms/soles like a glove Later life get redundant skin folds esp blepharochalasis Poor muscle tone

Answer 24

small firm s/c nodules w/ calcification on X-ray on shins/forearms in one third of EDS pts

Answer 25

``` Hypermobility EDS AD, some are collagen 3 mutations, some tenascin-X rest unknown accounts for 10% of cases, most benign Smooth, velvety skin Only min scarring Joint hypermobility +++ Some get dysautonomia – syncope, palpitations, fatigue ```

Answer 26

Vascular EDS AD mutation in Collagen 3 (COL3A1) accounts for 6% of cases, rare, severe form Thin, translucent skin that show underlying vessels easy bruising (misdiagnosis child abuse) Scars and pseudotumours keloids Typical facies No/minimal Joint hypermobility or skin hyperextensibility often born prem and have short stature Get; Arterial aneurysms - dissection and rupture visceral rupture (bowel + uterus) pneumothorax Acrogeric type - premature aging w/ thin peaked nose and thin lips, hollow eyes Ecchymotic type - easy bruising predominates should avoid pregnancy, trauma, physical contact sports, and trumpet playing (raised ICP can trigger vascular rupture). Risk of sudden death from aortic dissection and rupture of colon and vessel perforation

Answer 27

Need to determine type as very different prognosis Identify clinical, biochemical and molecular abnormalities genetic counselling type VI may respond to Vit C – regulates collagen biosynthesis Type IV should avoid pregnancy, trauma, physical contact sports, and trumpet playing (raised ICP can trigger vascular rupture). Risk of sudden death from aortic dissection and rupture of colon and vessel perforation Try to manage bleeding conservatively, make surgeons aware Sutures will tend to pull out. Need to be buttressed. Arteriography also difficult, warn surgeons

Answer 28

``` porokeratoses, reactive perforating collagenosis, perforating GA, tinea, sarcoidosis, actinic granuloma, perforating PXE, DLE ```

Answer 29

Used to be called EDS type 9 or X-linked cutis laxa Rare Low copper Same gene as Menkes syndrome Mild skin laxity and extracutaneous features

Answer 30

AR, rare inborn error of collagen metabolism Deficiency of Prolidase required to make collagen Chronic skin ulceration, mental retardation, and recurrent resp infections Abnormal facies (no characteristic pattern) Spongy fragile skin with pitting, scarring and ulceration. Also photosensitivity, telangiectasia, purpura, premature greying and lymphoedema Also splenomegaly, recurrent infections and obesity

Answer 31

``` Skeletal abnormalities, Cutis laxa, Craniostenosis, Ambiguous genitalia, Retardation Facial abnormalities ```

Answer 32

Rare AD disease increased production of α1-procollagen Digital clubbing, cylindrical thickening of legs/forearms (due to tissue thickening) Hypohidrosis, seborrhoea, sebaceous gland hyperplasia, folliculitis results in thick, furrowed redundant skin on face and forehead/scalp (cutis verticis gyrata)(‘pachyderma’ = skin like pachyderms; elephant/rhino) symmetrical irregular periosteal ossification at distal ends of long bones on Xrays Can also get carpal and tarsal tunnel syndrome, chronic leg ulceration, and archilles tendon calcification

Answer 33

``` Occurs in males mostly, onset at puberty esp common in aboriginals benign form without associations called 'essential type' Can be assoc w/ neurologic and/or ophthalmologic abnormalities Can be secondary phenomenon due to; Myxoedema Acromegaly Turner syndrome ```

Answer 34

``` Leonine facies - many causes Extensive congential cerebriform melanocytic naevus on scalp Pachydermoperiostosis Acanthosis nigricans Dissecting cellulitis of scalp ```

Answer 35

3 or more of these features required to make diagnosis; Remember; 3-ENT-OVA Chondritis of ear, nose, throat(resp tract), Occular, vestibulocochelar, Arthritis; 1. recurrent chondritis of the pinna 2. chondritis of the nasal cartilage 3. chondritis of the larynx, trachea or respiratory tract 4. ocular inflammation 5. cochlear or vestibular lesions 6. non-erosive arthritis

Answer 36

Autoimmune - RA, SLE, DM, Sjogren’s, Still’s, Ank spond, Crohn’s, Hashimotos thyroiditis, vasculitis, thymoma, psoriasis, glomerulonephritis Infections - HepC- HIV Malignancy - myelodysplasia, myeloma, lymohoma, leukaemia - Carcinoma of bladder, breast, pancreas, lung, colon

Answer 37

``` Cutaneous and systemic vasculitis livedo reticularis neutrophilic dermatoses superficial thrombophlebitis toxic erythema oral and complex apthae papules, sterile pustules ulcerations Skin features of associated disease ```

Answer 38

Respiratory tract and/or costochondral joints (cough, hoarseness, choking, dyspnoea, wheeze, tender palpation of anterior neck) Larynx involvement may need tracheostomy Cardiovascular (aortic valvular inflammation (10%), AAA, myocarditis, pericarditis, MI) sudden valve rupture Neurological (headaches, nerve palsies, hemiplegia) Cerebral aneurysm Renal (glomerulonephritis) Joint pain (non-erosive arthritis) serous otitis media, Hearing loss (cochlear or vestibular lesions) Systemic vasculitis

Answer 39

Histo; Areas of damaged cartilage (loses basophilic staining) separated by lymphocytic infiltrate with neuts and plasma cell Later, separated by granulation tissueo Perichondrial fibrosis in older lesions Anaemia High WCC Eosinophilia Raised ESR Can have +ve ANA, RF, cANCA↑ urinary excretion of acid mucopolyscacharides during each relapse (classical feature) Xrays – joint cartilage destruction without changes in adjacent bone

Answer 40

False | Increased - classical feature

Answer 41

Helps to differentiate from infection (celuliits)

Answer 42

Diagnose and Rx early to prevent deformity and complications Pred 30 mg reducing for relapses – slow wean as settles Indocid/dapsone/ Colchicine have been use for acute flares also IV cyclophosphamide for renal disease Many other immunosupressants 2nd line Must assess for associations and complications and investigate and refer as necessary

Answer 43

Mouth and Genital Ulcers with Inflamed Cartilage | Combination Behcet’s + relapsing polychondritis

Answer 44

False | typically no striae even in pregnancy

Answer 45

V rara Linear blaschkoid atrophoderma May be variant of Atrophoderma of Pasini and Pierini - Pigmented bands of atrophy on trunk and limbs in Blaschko’s lines - starts in adolesence - No prior inflammation - No subsequent scleroderma - self limiting - Normal or thickened collagen bundles on histo

Answer 46

Panatrophy of Gower - No assoc sclerotic processes | Sclerotic panatrophy - morphea/sclerotic change preceding atrophy

Answer 47

``` AR or AD mutations in elastin or fibulin5 HALF BED Hernias Aged appearance (premature aging) Loose redundant pendulous skin folds Facies - Hound dog-like Bladder and Bowel diverticulae Emphysema (adults) or hypoplastic lungs (neonates) Deep voice (vocal cord thickening) Prognosis mainly depends on lung disease - usually normal life span ```

Answer 48

Benign proliferations of fibrous tissue, fibroblastic cells or spindle-shaped stromal cells with varying degrees of aggressive behaviour Part way between a benign fibroma and metastasizing fibrosarcoma Does not include reactive fibrous overgrowth or keloids 2 major groups; o Superficial: Palmar (Dupuytrens), plantar, penile (peyronies) and knuckle pads o Deep: Deep fibromatoses AKA Desmoid tumours (non metastasizing fibrosarcoma) – rapidly growing tumours with a tendon-like consistency which involve muscle and aponeuroses

Answer 49

``` Diabetes alcoholic cirrhosis epilepsy COPD gout trauma ulnar nerve damage Drug - phenytoin Can be inherited in AD fasion Can be part of polyfibromatisis syndrome - 5% have Dupuytrens ```

Answer 50

Benign fibromatosis on fingers of young males, rarely females Symmetrical swelling of dorsal+sides of prox middle, ring and index prox phalanges Histo - collagen extension to SC tissues, epiderm hyperplasia, dermal thickening

Answer 51

``` Juvenile hyaline fibromatosis Fibrous harmatoma of infancy Infantile myofibromatosis Infantile digital fibromatosis Calcifying aponeurotic fibroma Giant cell fibroblastoma ```

Answer 52

AR Disorder of glycosaminoglycan synthesis Most frequent fibromatoses in childhood hyaline accumulation in dermis Most commonly affected sites are head, neck and trunk skin papules/tumours, gingival enlargement, osteolytic lesions (in 50%), jt contractures, poor musculature Joint contractures - disabling More severe systemic form gets internal organ involvement and early death Normal intelligence

Answer 53

Rare tumour of children esp under 2 yrs Probably neoplastic rather than hamartoma Benign, fibroblastic/myofibroblastic deep dermal and subcut tumour Asymptomatic, solitary, skin coloured plaque or nodule. Few cm diameter Rarely pigmented or hairy Axilla, arm or shoulder girdle Tumour has 3 distinct pathological components; 1. Bundles of interlacing, elongated, wavy spindle cells in variable collagenous b/g. 2. Nests of more immature round cells associated with focal myxoid change 3. Mature adipose tissue

Answer 54

AKA Inclusion body (digital) fibromatosis A benign fibro/myofibroblastic proliferation with round pink intracytoplasmic inclusions. Present at birth or develops in infancy Almost always on fingers and toes esp 3-5th digits, never on thumb or great toe. Multiple small nodules. Observe or excise if bothersome

Answer 55

Common condition Rapidly enlarging subcutaneous nodule; can be in fascia or muscle M=F, any age often young adults Tender mass on UL> trunk> H&N can be in mouth or orbit Histo shows; Bundles of uniform fibroblasts and myofibroblasts which have pink cytoplasm, vesicular nuclei and a small nucleolus. In a vascular stroma Many mitoses but no abnormal mitoses Stroma shows myxoid change and mucin deposition – has ‘tissue culture-like’ appearance Often hyalinised collagen bundles which may look keloidal May be multinucleated giant cells which resemble osteoclasts. Usually excised

Answer 56

Group of rare syndromes w/ hard stiff skin and joint contractures starting in childhood Systemic hyalinosis Winchester’s syndrome (Still’s dx w/ stiff skin + cataracts) Congenital fascial dystrophy (AKA stiff skin syndrome) Restrictive dermopathy

Answer 57

Age (peak between puberty and 30) Race (B>W), Afro Caribeans Sites = ear lobes/ shin / neck/ shoulders/ upper trunk/ LL and sites that stretch Mechanism of injury; burns, scalds Infected wound Foreign material = sutures/ endogenous hair Scarring acne on back FHx Recent Roacutane + laser Polyfibromatosis syndrome = Dupuytren’s Other associations; acromegaly, post thyroidectomy, Dubowitz, Rubinstein-Taybi, EDS, pachydermoperiostosis Linear keloids in athletes taking anabolic steroids Keloid scarring can be triggered by pregnancy Spontaneous keloids - presternal region of chest, probably micotrauma. Can be seen in in syndromes; rubinstein-taybi, noonan and Dubowitz, Goeminne

Answer 58

extends beyond the defect does not regress spontaneously grows in a pseudotumor fashion with distortion of lesion tends to recur after excision Often painful and hyperaesthetic

Answer 59

``` Clinical; sclerotic BCC sarcoid DFSP DLE blastomycosis lobomycosis fibrosarcoma (rare) Histo; Dermatofibroma DFSP desmoplastic melanoma ```

Answer 60

``` Potent TCS under occlusion 20% silicone gel - for small lesions and for prevention Adjuvant XRT after surgery is the most effective - superficial XRT or electrom beam Local compression ILCS +/- prior LN2 cryo intralesional 5FU LN2 cryotherapy topical retinoids Laser - PDL, others have been used too IFN alpha ```

Answer 61

Classic inherited premature aging syndromes Congenital progeroid syndromes Photosensitivity syndromes Diseases causing elastolysis (cutis laxa group) e.g. De Bersey syndrome Fragile skin e.g. prolidase deficiency Thickened immobile skin e.g. diabetic cheiroarthropathy Loss of SC fat e.g. generalised lipodystrophy Diabetes Generalised cutaneous atrophy – RA, steroids Excessive exposure to radiation (UV) Smoking

Answer 62

Pangeria (Werner's) Progeria (Hutchinson-Gilford syndrome) Acrogeria (Gottron syndrome)

Answer 63

``` Syndromes other than classical premature aging syndromes which show some features of premature aging (not due to photosensitivity alone); WONDA MADA Wrinkly skin syndrome Osteodysplastic geroderma Neonatal pseudohydrocephalic progeroid syndrome Downs Acrogeric Type 4 EDS Mandibulo-acral dysplasia (MADA) ```

Answer 64

``` Bloom syndrome Rothmund-Thomson syndrome poikiloderma congenitale XP Cockayne syndrome ```

Answer 65

``` aka Hutchinsons-Gilford syndrome LMNA gene Small stature, mid facial cyanosis, bird like facies, prominent frontal tuberosities and scalp viens. Dry, thin and wrinkled with mottled hyperpigmentation. Hair loss in first 2 years of life No photosensitivity CVS - atheroma ```

Answer 66

=Gottrons COL3A1 Micrognathia; atrophy of skin on tip of nose Atrophic with telangiectasia and mottled hyperpigmentation on extremities. No leg ulcers, atheroma, DM, decreased life expectancy Hair and eyes normal

Answer 67

``` Werner's syndrome RecQ DNA helicase 2 gene defect (WRN gene) AR Small stature - Cessation of growth at 12y Beaked nose Skin of ears strophic and bound down Photosensitvity Skin is dry; Thick dermis, atrophic epi w/ poikiloderma Hair shows Premature greying @ 20y Hair loss @ 20-30 Bilateral cataract @ 20-30y, Keratopathy, Glaucoma Nails are normal Joint contractures Lower limb ulcers Hyperkeratosis over bony prominences Loss of SC fat Malignancy risk ++ Life expectancy 30-40y Die of severe atheroma ```

Answer 68

Dx: 1 major from 2 systems Probable: 2 major from same cat or 1 major + 1 minor from another category Major: 1) Skin yellow papules/plaques neck or body,Or bx with histo changes from affected skin 2) Eye: angioid streaks Or peau d'orange 3) Genetics: mutation of both alleles of ABCC6, Or 1st degree relative Minor: 1) eye: 1 streak shorter than 1 disk Diameter, comets in retina, 1 or more wing signs 2) Genetics: 1 allele mutation

Answer 69

Congenital/inherited - Familial Reactive perforating collagenosis (collagen fibres perforate) - Elastosis perforans serpiginosa (EPS) (elastic fibres perforate) Acquired - Acquired (reactive) perforating dermatosis (collagenosis) - Kyrles disease - Perforating folliculitis Secondary - Transepithelial elimination (TEE) seen incidentally as part of another dermatosis - TEE of substance secondary to an exogenous agent. E.g. Ca containing EEG paste, ILCS injections

Answer 70

perforating disease in adults (30yrs) perforation of collagen fibres acquired, and often idiopathic or assoc w/ hepatic/renal/diabetic disorders Keratinous red/brown papules/nodules w central keratin plug Can coalesce forming large keratotic plaque Legs/arms/head/neck Can be asymptomatic or intensely itchy

Answer 71

Largely same as Kyrles Affects 10% of ESRF pts - consider in these pts who are very itchy Also in diabetics and rarely liver disease or internal malignancy Can be perforation both collagen and elastic fibres Rx with topical C/S, ILCS, topical retinoids PHOTOTHERAPY most useful option - can help w renal itch too change dialysis tubing Allopurinol has been used successfully

Answer 72

affects children papules on prominences after superficial trauma - koebnerising small lesions enlarge to 5mm over few weeks keratinous umbilicated plug - bleeds if removed can be precipitated by cold, improves in warm weather persists into adulthood usuallly no Rx required

Answer 73

type of folliculitis on trunk and extremeties in young adults papules with keratinous plug that exude necrotic material cause unknown ??overlap with pityrosporum folliculitis

Answer 74

arcuate/serpiginous slightly erythematous flesh coloured keratotic papules on the upper trunk, face or limbs of young adults (M>F) Genetically determined defect of elastic tissue Extrusion of elastic fibres at sites of wear/may follow abrasion Idiopathic or assoc w/ CTD or drug flesh coloured, red, umbilicated papule 2-3mm with central, tightly adherent plug that bleeds if removed nape/ sides of neck/ Upper armscan be itchyhigh risk of keloids when biopsied

Answer 75

``` A DERM POP Acrogeria Down’s syndrome EDS Rothmund-Thomson Marfans PXE Osteogenesis imperfecta Penicillamine: produces abnormal elastin. (Disrupts desmosin cross links within elastin) ```

Answer 76

claw like epidermal down growths surrounds basophilic debris, fibrin, inflammatory and granulation tissue epidermis hyperplastic and acanthotic plug of crusting/ HK and variable PK aggregates of Neuts or Lymphocytes within plugs is horny material in upper 1/3, amorphous debris in lower 2/3 Foreign body giant cell rxn underlying plug brightly eosinophilic elastic tissue +++ in sup dermis Van geison stain = black

Answer 77

``` Cryo good Currettage and cautery NB; TCS under occlusion not very effective Caution w/ Electrosyrgery/ dermabrasion/ surgery - risk of keloids!! - best avoid these modalities Retinoid for widespread EPS cellotape stripping aggressive rx may result in scarring, be careful spontaneously resolve anyway ```

Answer 78

degenerative change of elastic fibres w/ yellowish/translucent papules/plaques on light exposed skin

Answer 79

``` Juvenile prior to puberty, often familial On face, small lesions Adult sun-exposed areas, lesions are larger Nodular type Drug-induced type - phenol in oils or hydroquinone ```

Answer 80

Colloidal material (usually eosinophilic) in dermal papillae Bands collagen surrounding the colloid globules Fibroblasts and small blood vessels preserved in colloid material Spares adnexae May be a Grenz zone Overlying compact orthokeratosis

Answer 81

Dermabrasion Ablative laser Can also try diathermy or cryotherapy

Answer 82

Asympotatic small white fibrous papules around the neck esp to middle aged and elderly men Bundles of thick collagen fibres in dermis No significance

Answer 83

Rare type of connective tissue naevus Adolescents or young adults Multiple oval white/yellow papules on trunk or limbs Non follicular based Reduced dermal elastic fibres Overlap w/ skin lesions of Buschke-Ollendorf

Answer 84

Constricting band around digit/limb Can be shallow/involving skin, or deeper involving fascia/bone - may autoamputate digit/limb Anhinum (African means saw) affects 5th toe in black africans Related to underlying abnormalities in blood supply (plantar arch) precipitated by mechanical trauma like walking May be related to infection like leprosy/Tb Pseudo-anhimun and other constricting bands May be congenital due to amniotic bands or acquired due to trauma, cold, neuropathy, PSS, Vohwinkels, Pachyonychia congenita, EPP, Olmsted’s

Answer 85

False | AD

Answer 86

False | extensor surfaces