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Clinical Dermatology > Gen Derm 3 > Flashcards

Gen Derm 3 Flashcards

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1
Q

What is the most common type of juvenile idiopathic arthritis? What joints does it affect?

A

Oligo/pauciarticular arthritis (60%). Usually favors knees.

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2
Q

There are two types of oligo arthritis type JIA. What are they?

A

Type 1 is the most common type. In 1-8yo, have uveitis in 50%. ANA positive, RF negative. Type 2 is in 9-16yo, ANA -, RF-

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3
Q

Is JIA an autoimme disease?

A

No, should be classifed as an autoinflammatory sndrome as it is due to activation of innage immune system’s iL1

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4
Q

How does JIA present?

A

High episodic fevers with salmon pink rash in the late afternoon/evening

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5
Q

What does the two JIA rashes look like?

A

There’s the pink evanesent rash that favors the waist and axilla, and also koebnerizes. And there’s another one with persistent papules and plaques

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6
Q

What does the two JIA rash look like on histopath?

A

The evanescent one looks like urticaria but with more neutrophils. The persistent papules one look like urticaria + parakeratosis and superfically scattered necrotic keratinocytes

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7
Q

What are two types of good treatments for juvenile stills?

A

IL1 receptor inhibitor: anakinra, rilonacept, canakinumab and IL6 receptor inhibitor tocilizumab

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8
Q

What is a classic arthritic finding for adult onset stills?

A

Carpal ankylosis: limited range of motion with minimal pain

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9
Q

What does ANA, RF, ESR, CRP and ferritin look like for adult stills?

A

ANA RF negative for adults. ESR/CRP high and Ferritin >4000

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10
Q

If the JIA kid has polyarthritis instead of oligoarthritis, and the ANA and RF are positive, what does that mean?

A

That he has erosive joint disease and like will get rhueumatoid nodules

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11
Q

Most common type of morphea in adults and kids

A

plaque type in adults, linear in kids

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12
Q

What Borrelia spp is associated w morphea in europe and japan?

A

Borrelia afzelii and Borrelia garinii

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13
Q

most common site for linear morphea

A

legs

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14
Q

antibody for linear morphea?

A

ssDNA

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15
Q

What does atrophoderm of Pasini and Pierini look like clinically and histologically?

A

Hyperpigmented oval atrophic plaques with cliff drop borders. On histopath, you have decreased dermal thickness

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16
Q

How is linear atrophoderma of moulin different from other types of morphea?

A

less induration and less pigmentary changes

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17
Q

NSF, Scleromyxedema, morphea, scleroderma. Which ones lose CD34?

A

Morphea and scleroderma lose CD34+ dendritic cells

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18
Q

What antibody do all forms of morphea have?

A

All forms of morphea are positive for anti-topoisomerase 2 antibodies. They are all negative for topoisomerase 1 (scl70) and centromere. Those are positive in systemic sclerosis

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19
Q

Linear morphea and generalized morphea are most likes to be + for what antibodies?

A

ANA and antihistone and ssDNA

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20
Q

What Xray finding do you see in linear morphea?

A

Melorheostosis. Which is roughening long bone surfaces underlying area of linear morphea. Resembles wax dripping. Also seen in buschke Ollendorff

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21
Q

how do you treat superficial generalized morphea?

A

nbUVB

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22
Q

how do you treat deep generalized morphea?

A

MTX, pulsed intravenous corticosteroids + MTX

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23
Q

What is the profibrotic cytokine seen in scleroderm, morphea and eosinophilic fascitiis?

A

TGF BETAAAA

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24
Q

Nail dermoscopy for scleroderma?

A

dilated capillary loops alternating with capillary drop out

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25
Q

ventral pterygium

A

scleroderma

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26
Q

most common cause of death in scleroderma? How do you screen for it?

A

interstital lung disease. Screen with CT and PFTs

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27
Q

pulmonary problem in diffuse scleroderma

A

ILD

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28
Q

pulmonary problem in limited scleroderma? What does limited scleroderma look like clinically?

A

pulmonary hypertension. Also with sclerosis of distal fingers and face.

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29
Q

most common site of visceral disease in scleroderma?

A

esophageal dysphagia and dysmotility causing aspiration and esophagitis

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30
Q

diffuse systemic sclerosis patients should be given what to prevent scleroderma renal disease?

A

ACE-inhibitors

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31
Q

what can you give for digital ulcers in scleroderma?

A

IV iloprost (prostacycline analogue), Bosetan (endothelin receptor antagonist, prevent new ulcers)

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32
Q

what is scleroderma’s earliest presenting features?

A

raynauds and hand edema

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33
Q

what’s a new biomarker for skin and lung fibrosis and PAH?

A

CXCL4

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34
Q

does eosinophilic fasciitis have raynauds phenomenon?

A

no it does not

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35
Q

where is the eosinophilia in eosinophilic fasciitis?

A

pheripheral eosinophilia&raquo_space; tissue eosinophilia

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36
Q

what is a new serologic marker of eosiniphilic fasciitis activity?

A

metalloproteinase inhibitor-1 (TIMP-1)

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37
Q

cause of nephrogenic systemic fibrosis?

A

gadolinium-containing contrast exposure in the setting of acute kideny injury or CKD

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38
Q

onset of NSF fibrosis?

A

about 2-4 weeks after gadolinium exposure

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39
Q

What do you see in the eyes of nephrogenic systemic fibrosis patients?

A

scleral plaque (white yellow plaques) with dilated capillaries in patients <45yo

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40
Q

How does histopath of NSF fibrosis different from scleromyx?

A

the fibrosis of NSF goes down to the fat and fascia

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41
Q

NSF fibrosis is mediated by what cells?

A

CD34+ and Procollagen I+ cells

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42
Q

Tx for NSF?

A

skin is refractory to treatment. The treatment of kideny disease is most important

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43
Q

What types of scleredema can have facial involvement?

A

Types 1 (post-infectious) and Type 2 (monoclonal gammopathy)

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44
Q

Name the 3 types of scleredema?

A

Type 1 Strep pharyngitis. Type 2 IgGk monoclonal gammopathy. Type 3 Diabetes.

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45
Q

What is scleromyxedema associated with? Gammopathy. Extracutaneous involvement.

A

IgG lamda. GI:dysphagia, MSK: arthritis, proximal muscle weakness, carpal tunnel, Neuro: peripheral neuropathy

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46
Q

Glomeruloid hemangiomas associated with?

A

POEMs (polyneuropathy, organomegaly, endocrinopathy, M -protein, skin changes)

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47
Q

Diabetic cheiroarthropathy

A

symmetric painless loss of joint mobility , stiffness of joints with scleroderma-like thickening of the dorsal aspect of the hands and feet (prayer sign)

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48
Q

What exogenous substances cause scleroderma?

A

aniline contaminated rapeseed cooking oil, L-tryptophan (eosinophlia-myalgia syndrome), Polyvinyl Chloride, Bleomycin, taxanes (diffuse leg edema followed by sclerosis)

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49
Q

What agents can cause sclerosis at injection sites?

A

Vitamin K, bleomycin, opiods (methadone, pentazocine)

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50
Q

Familial and acquired perforating dermatosis difference? What is perforating?

A

Collagen. Familial reactive perforating is rare childhood onset at sites of trauma vs acquired perforating dermatosis is in adults and d/t diabetes and/or renal failure

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51
Q

Wher do you find EPS commonly on the body?

A

serpiginous plaques with keratotic papules along the rim on the lateral neck

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52
Q

MAD PORES is for what disease? What does it stand for

A

EPS (Marfans, Acrogeria, Downs, Penicillamine/PXE, Osteogenesis Imperfecta, Rothmund-Thomson, Ehers-Danlos, Scleroderma)

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53
Q

What is perforatin calcific elastosis?

A

Transepidermal elimination of clacified elastic fibers periumbilical multiparous black women

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54
Q

Anetoderma on histopathology

A

Normal H&E. elastic tissue stain shows near complete loss of elastic fibers in papillary and reticular dermis;fragmented elastic fiber remnants visible

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55
Q

What is follicular atrophoderma?

A

Ice pick depresseions on the doral hands/feet and cheek since childhood

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56
Q

What syndrome is follicular atrophoderma associated with?

A

Bazex Dupre Christol syndrome (follicular atrophoderma, BCC of the face, milia, hypohidrosis anove neck, hypotrichosis). Think of a priveliged french person with acne scars, cosmetic treatements that made him hairless, sweatless)

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57
Q

What is atrophoderma vermiculatum?

A

A variant of follicular atrophoderma on the face/cheeks exclusively

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58
Q

What syndrome is atrophoderma vermiculatum associated with?

A

Rombo (atrophoderma vermiculatum, BCC, milia, acral erythema, peripheral vasodilation with cyanosis) and Naicolau Balus (eruptive syringomas, atrophoderma vermiculata and milia)

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59
Q

Perforating GA most commonly on? Perforating with what?

A

Dorsal hands and fingers. Perforating with degenerated collagen

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60
Q

Interstitial granulomaous drug eruption culprit?

A

CCBs, ACE, TNFalpha

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61
Q

NXG clinical presentation?

A

Yellow-xanthomatous plaques in the periorbital region

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62
Q

NXG associated with what gammopathy? What other organ system can it also affect?

A

IgG kappa. Enodcardial involvement. Hepatosplenomegaly common.

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63
Q

Cutaneous Crohns disease can manifest as what skin diseases?

A

Erythema nodosum, PG, pyostomatitis vegetans, EB aquisita (IBD is the most common cause of EBA), acrodermatitis enteropathical-like syndrome

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64
Q

Genital crohns can look like what?

A

labial or scrotal edema with erythema +/- ulcerations and fissures

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65
Q

What does oral crohns look like?

A

cobblestoning of buccal mucosa, pyostomatitis vegetands, cheilitis granulomatosa

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66
Q

Sarcoidosis is a multisystem grnaulomatos disease cause by upregulation of what type of T cells?

A

Th1 cells

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67
Q

What are three drugs that can cause sarcoidosis?

A

Hepatitis C pts on IFN-alpha, and ribavirin, HIV patients on HAART, TNF alpha inhibitors

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68
Q

What percentage of sarcoid patient have skin lesions?

A

35%

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69
Q

why do sarcoid patients have hypercalcemia?

A

due to calcitriol synthesis by arcoidal granulomas (convert 25-hydroxyvitamin D) to more active 1,25-dihydroxyvitamin D

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70
Q

What laboratory or imaging tests do you need for sarcoidosis? What would it show?

A

CXR/CT scan to detect hilar lymphadenopathy, PFTs to detect restrictive lung disease (decreased TLC, DC, Vital Capacity), increased ACE levels (useful for monitoring response to treatment)

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71
Q

Is measuring ACE levels in Sarcoidosis useful?

A

Yes, useful for monitoring response to treatment

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72
Q

What is darier-roussy? Whats the prognosis?

A

subcutaneous sarcoid, painless, firm, often multiple lesions. A/w good prognosis

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73
Q

whats lofgren syndrome? Whats the prognosis?

A

acute form of sarcoidosis with erythema nodosum and hilar adenopathy and fever and acute iritis and polyarthritis. a/w good prognosis

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74
Q

What’s heerfordt’s syndrome?

A

Uveitis + parotid gland enlargmeent + fever + cranial nerve palsy (facial nerve)

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75
Q

Blau syndrome?

A

Early onset sarcoid-like disease caused by NOD2 mutation. Triad of skin, eye, and joint disease

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76
Q

what is the prognosis for lupus pernio?

A

strongly associated with chronic sarcoid lung (75%) and upper respiratory tract disease (50%) along with cystic degeneration of the bones. Poor prognosis

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77
Q

what color is the most comon cause of delayed reaction in tattoo?

A

Red (mercuric sulfide, cinnabar)

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78
Q

what colors are the most comon causes of photoallergic reaction in tattoo?

A

Yellow (cadmium sulfide), red ink (cadmium selenide), yellow-red (azo dye)

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79
Q

what type of reaction does red tattoo have on histopath?

A

Lichenoid dermatitis sor pseudolymphoma

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80
Q

what type of reaction does aluminum tattoo have on histopath?

A

granulomatous

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81
Q

Silica foreign body reactions are from penetrating injuries from what 4 things over 25 years?

A

Sand, soil, rocks, glass

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82
Q

what type of reaction does silica foreign body reaction have on histopath?

A

sarcoidal granulomas containing colorless, birefrigent crystals

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83
Q

Where do you find zirconium? What can it cause clinically?

A

in antiperspirants. Causes soft brown papules in axilla.

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84
Q

what does a zirconium foreign body reaction look like on histopath?

A

no polarizable particles seen

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85
Q

what 3 foreign body materials are too small to be seen by polarized light microscopy?

A

zirconium, beryllium, aluminum

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86
Q

Where do you find beryllium What can it cause clinically?

A

found in the manufacturing of fluorescent lights. Inhalation can cause granulomatous lung disease. Localized puncture wounds by fluorescent bulbs can cause slowly healing nodules/ulers

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87
Q

how do you diagnosis systemic berylliosis?

A

bronchioalveolar lavage

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88
Q

how do you get alumunium in the skin?

A

vaccine injection sites, hemostasis

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89
Q

how do you get zinc in the skin?

A

zinc-containing insulin shots

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90
Q

what does a zinc foreign body reaction look like on histopath?

A

birefringent rhomboid crystals

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91
Q

how do you get starch in the skin?

A

contamination of rounds from surgical gloves with starch lubricant

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92
Q

what does a starch foreign body reaction look like on histopath?

A

oivoid basophilic starch granules that stain postive with PAS

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93
Q

what does a ILK foreign body reaction look like on histopath?

A

Granuloma with central pale bluish material that resembles mucin on H&E

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94
Q

Is Silica PAS positive or negative?

A

negative

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95
Q

Is talc PAS positive or negative?

A

negative

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96
Q

Is zinc PAS positive or negative?

A

negative

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97
Q

Is keratin PAS positive or negative?

A

negative

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98
Q

Is sea urchin spine PAS positive or negative?

A

negative

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99
Q

Is sutures PAS positive or negative?

A

negative

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100
Q

Is arthropod parts PAS positive or negative?

A

negative

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101
Q

Is starch PAS positive or negative?

A

positive

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102
Q

Is cactus spines PAS positive or negative?

A

positive

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103
Q

Is wood splinters PAS positive or negative?

A

positive

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104
Q

Macrophage histiocytes stain positive for what 2 markers?

A

CD 68 and HAM 56

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105
Q

Dermal dendritic cells stain positive but singly for what 2 markers?

A

Factor 13a for papillary dermis dendritic cells and CD 34+ for reicular dermis dendritic cells

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106
Q

Langerhan cell histiocytosis have mutations in what?

A

BRAF V600E mutation (60%) and MAP2K1 mutations

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107
Q

Langerhan cell histiocytosis stain negatively for what?

A

Factor 13a, CD 68, HAM 56

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108
Q

2-6 year old kids that present with disseminated LCH have what triad?

A

Diabetes insipidus (Excessive urination and extreme thirst as a result of inadequate output of the pituitary hormone ADH (antidiuretic hormone, also called vasopressin)) , osteolyitic bone lesions in the skull, exophthalmos

109
Q

how do you treat diabetes insipidus

A

vasopressin

110
Q

Congenital self-healing reticulohistiocytosis vs benin cephalic histiocytosis. Which is a langeran cell histiocytosis?

A

CSRH

111
Q

Non-langerhan cell histiocytosis stain positive for? Negative for?

A

Positive for CD 68, Negative for Langerin

112
Q

CD1a and S100 is positive in what non-langerhan cell histiocytosis?

A

Indeterminate cell histiocytosis

113
Q

S100 and CD68 is positive in what histiocytosis?

A

Rosai Dorfman

114
Q

JXG can also involve what part of the eye?

A

Iris

115
Q

Risk factors for JXG eye involvement?

A

Multiple cutaneous JXGs and children <2yo

116
Q

Whats the triple association of JXG?

A

JXG, NF1, and JMML. >20x increased risk of juvenile myelomonocytic leukemia

117
Q

Describe Generalized eruptive histiocytosis. How does it present?

A

Adults, recurrent eruption of hundreds of small red-brown papules in the axial trunk, proximal extremities, face. No mucosal involvement

118
Q

Indeterminate cell histiocytosis stain?

A

S100 +, CD1a +, CD 68+, Langerin neg

119
Q

NXG people can have what complicatoins?

A

ophthalmic ( iritis, episcleritis) , hepatosplenomegaly, leukopenia

120
Q

Describe MRH clinically . Multicentric Reticulohistiocytosis

A

Coral bead along periungal reion, red brown nodules on the the head, dorsal hands, oral cavity

121
Q

What is MRH associated with?

A

Destructive arthritis (arthritis mutilans), solitary organ malignancy. melanoma, mesothelioma, lymphoma, and carcinomas of the penis, stomach, ovary, endometrium, breast, and cervix

122
Q

Describe solitary reticulohistiocytoma clinically

A

Solitary yellow-red nodule on the head

123
Q

Describe Rosai Dorfman clinical syndrome

A

bilateral cervical lymphadenopathy, fever, night sweats, polyclonal gammopathy,

124
Q

What % of Rosai Dorfman have skin symptoms? Where and What? Natural history?

A

10% have skin lesion, #1 site is eyelid and malar cheek. Self resolves

125
Q

Xanthoma Disseminatum triad?

A

cutanoue xanthomas, mucosal xanthomas (airway), diabetes insipidus

126
Q

What is xanthoma disseminatum assocated with?

A

Monoclonal gammopathy, plasma cell dyscrasia

127
Q

What monoclonal gammopathy is plane xanthomas associated with?

A

IgG

128
Q

What monoclonal gammopathy is EED associated with?

A

IgA

129
Q

What monoclonal gammopathy is POEMS associated with?

A

IgA and igG

130
Q

What monoclonal gammopathy is POEMS associated with?

A

Type one is monoclonal IgM and IgG, Type 2 is monoclonal IgM and polyglonal IgG

131
Q

Eruptive xanthomas as associated with what types?

A

type 1, 4, 5

132
Q

If you suspect Reiter’s syndrome, what labs should you draw?

A

HIV

133
Q

Which hyperlipoproteinemias have hypercholesterolemia and are associated with atherosclerosis?

A

Type 2 and 3

134
Q

Which hyperlipoproteinemia is associated with plane/palmar creases?

A

Type 3 with familial dysbetalipoproteinemia

135
Q

Which hyperlipoproteinemia is associated with plane xanthomas in the intertriginous and interdigital web spaces creases?

A

Type 2 familial hypercholesterolemia

136
Q

Eruptive xanthomas usually have triglycerides at what level?

A

triglycerides usually >3000 mg/dL

137
Q

tuberous xanthomas found where on the body? Associated with which type?

A

2 and 3

138
Q

verruciform xantomas are found in what areas of the body?

A

Mouth or genital area

139
Q

are verruciform xanthomas assoicated with hyperlipidemia?

A

no

140
Q

Veruciform xanthomas can be associated with what syndromes?

A

CHILD, Epidermolysis bullosa, LS&A, pemphigus, GVHD. Any disorder that causes epidermal damage

141
Q

what non-immunologic mechanisms causes mast cell degranulation?

A

opiates, C5a anaphylatoxin, stem cell factor, neuropeptides (substance P and VIP)

142
Q

Top 3 causes of acute urticaria

A

Idiopathic, URIs, Beta-lactams

143
Q

Top 3 causes of chronic urticaria

A

idiopathic/infection, physical, vasculitic

144
Q

What autoimmune disease is chronic urticaria associated with?

A

autoimmune thyroid, vitiligo, IDDM,

145
Q

What systemic symptoms do people with urticarial vasculitis have?

A

Arthralgias (50%), GI involvement (20%), obstructive pulmonary disease (20%)

146
Q

Treatment for schnitzler’s syndrome?

A

Anakinra.

147
Q

Hereditary Angiodema is AD or AR?

A

AD

148
Q

What ar the two types of hereditary angioedema? Mutation in what enzyme?

A

both due to mutations in C1 inh. Type 1 (most common) has decreased C1 inh, type 2 due to decrease in C1inh function

149
Q

Acquired angioedema is d/t what disorders?

A

B -cell lymphoproliferative disorders. Autoimmune CTDs. Plasma cell dyscrasias.

150
Q

For cases of angioedma lacking urticaria (HAE, AAE, ACE-induced), excess what is the cause?

A

bradykinin

151
Q

How do you distinguish between Type 1 and Type 2 Hereditary angioedema?

A

C1inh levels (decreased in type 1, normal or increased in type 2)

152
Q

Labs to draw for acquired and hereditary angioedema? What’s the screening test?

A

C4 (decreased ) and bradykinin (increased)

153
Q

How to distinguish between Hereditary and acquired angioedma?

A

only acquired angioedema has decreased C1q levels because the malignancy forms anti-C1 antibodies

154
Q

What ethnicity has an increased risk of ACE-inhibotr induced angioedma?

A

Black

155
Q

Is PCN induced angioedema via bradykinin?

A

no

156
Q

how long does angioedema last?

A

2-5 dyas

157
Q

Prophylaxis for C1inh deficiency?

A

danazol

158
Q

What types of sweets syndrome is associated with malignancy?

A

Ulcerative, bullous, and oral lesions

159
Q

Extracutaneous features of sweets include? Name 4

A

Fever, Leukocytosis, arthritis, ocular involvement

160
Q

Infectious trigger for sweets?

A

Strep and yersiniosis

161
Q

Cancer trigger for sweets?

A

AML

162
Q

Autoimmune trigger for sweets?

A

IBD

163
Q

Drug trigger for sweets?

A

G-CSF, GM-CSF, ATRA, Bactrim, Minocycline, OCPS

164
Q

Is pregnancy a trigger for sweets?

A

Yes

165
Q

What is Marshall syndrome?

A

Rare childhod disease tha thas Sweets like lesions that resolve with cutis laxa

166
Q

Location and cause of Pyoderma Gangrenosum in kids?

A

Head and anogenital region, associated with IBD or leukemia

167
Q

Bullous PG is associated with what disease?

A

AML, CML, MDS

168
Q

Behcet’s disease HLA association?

A

HLA B51

169
Q

Behcets disease is a syndrome of?

A

Oral ulcerations, genital ulceration, ocular lesions, and cutaneous papulopustules

170
Q

1 cause of morbidity in Behcets’s

A

Uvetitis, retinal vasculitis (may lead to blindness)

171
Q

what vascular problems do Behcets ppl have?

A

Superficial migratory thrombophlebitits and SVC thrombosis

172
Q

what’s MAGIC syndrome?

A

Behets and relapsing polychondritis

173
Q

what are patients who have had a jejunoileal bypass urgery and blind loops of bowel at risk for?

A

Bowel-assoiated dermatosis arthritis syndrome. Overgrowth of bacteria and then immune complexes w/ bacterial antigens that cause a serum sickness like symptoms

174
Q

What is the classic rash for bowel-associated dermatosis arthritis syndrome?

A

Red purpuric papulo pustules on proximal extremities and trunk AND EN-like lesions on lower legs

175
Q

Treatment for papuloerythroderm of Ofuji.

A

Systemic steroids, PUVA, oral retinoids. Deck chair sign

176
Q

what are flame figures?

A

collagen fibers coated with major basic protein

177
Q

Criteria for hypereosinophilic syndrome?

A

Eos >1500 mm3 for > 6 months or if <6 months, must have organ damage

178
Q

1 cause of death for Hypereos syndrome?

A

Congestive heart failure

179
Q

there are two types of hypereos syndrome? What are they, whats the prognosis and what is the treatment?

A

myeloproliterative HES and lymphocytic HES. Myeloproliferative worse prognosis with cardiomyopathy. Tx is imatinib for myeloproliferative type and prednisone for the lymphocytic type

180
Q

erythema marginatum d/t

A

group A beta-hemolytic strep infection of the pharynx (in 3% of untreated patients)

181
Q

erythema migrans d/t what bug, what is the natural host?

A

d/t borrelia burgdorferi. Carried by the Ixodes tick that lives on white-tailed deer and wood mouse

182
Q

what can the Ixodes tick transmit?

A

borrelia burgdorderi, babesiosis and human granulocyte anaplasmosis

183
Q

After how many hours does the robust transmission of lyme disease happen?

A

48-72hrs after the onset of feeding

184
Q

Average size of erythema migrans at presentation?

A

10cm

185
Q

Whe does the peak IgM response happen for lyme disease?

A

About 3-6 weeks into infection

186
Q

How do you test for lyme disease?

A

ELIS or IFA. If positive, then western blot

187
Q

Tx for lyme?

A

Doxy if >8yo. Amoxillin 500mg BID for 2 weeks if <8yo.

188
Q

Tx for lyme neuro disease?

A

IV ceftriaxone or Penicillin G IV. Both for 2 weeks

189
Q

what % of adults and kids with lyme diseaes develop Erythema migrans?

A

90% of kids. 50% of adults

190
Q

Whats the agar for borrelia?

A

barbour-stoenner-Kelly

191
Q

maglinancy for erythema gyratum repens?

A

lung, breast, GI

192
Q

at what rate does erytehma gyratum repens expand?

A

at 1cm/day. Rapidly

193
Q

propionibacerium acnes activates what TLR that retinoid downregulate?

A

TLR2

194
Q

propionibacerium acnes produces what what lites up on woods

A

Coproporphyrin 3

195
Q

acne fulminans can have what systemic fingind?

A

Fever, increase WBC, ESR, and STERILE OSTEOLYTIC BONE LESIONS (sternum, clavicle)

196
Q

what malignancy can be mistaken for neonatal acne?

A

Leukemoid reaction that neonates with trisomy 21 can develop a severe pustular eruption.

197
Q

Cause of chloracne?

A

Chlorinated aromatic hydrocarbons

198
Q

Tx for chloracne?

A

isotretinoin

199
Q

drug-induced acne mnmonic?

A

SHIELD yourself from acne with Vitamin T. Steroids, halogens, Isonizid, EGFR, Lithium, Dilatin (phenytoin), vitamin B 2,6,12 and Testosterone)

200
Q

Tx for EGRF induced acne? What not to give?

A

doxycline. Do not give irritating topical retoinds or benzoyl peroxide

201
Q

what is the most common site of inflammation for SAPHO syndrome?

A

Stenoclavicular area is the most common site of inflammation. Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis

202
Q

PAPA stands for

A

Pyogenic arthritis, PG, Acne

203
Q

PASH/GASH stands for

A

Pyoderma gangrenosum, Acne, Hidradenitis

204
Q

PAPASH stands for

A

Pyogenic arthritis + PG + Acne + hidradentis

205
Q

Haber syndrome

A

Genodermatosis with rosacea-like eruption and verrucous lesions

206
Q

LMDF clinical picture? What area of the face does it like to affect?

A

Smooth red monomorphous papules that prefer the eyelid skin

207
Q

Clear zone aroudn the vermilion lip?

A

Perioralficial dermatitis

208
Q

tx for gram negative folliculitis

A

isotretinoin

209
Q

hot tub folliculitis tx

A

self-resolves

210
Q

tx for eosinophilic folliculitis

A

oral indomethacin

211
Q

Red chromhidrosis cause?

A

clofazimine and rifampin

212
Q

what miliaria do adults in hot climates get?

A

miliaria profunda

213
Q

highest risk medications for rash?

A

Aminopenicillins, anticonconvulsants, Bactrim and NSAIDs

214
Q

culprit medications for HIV + patients with drug rash?

A

Bactrim #1, dapsone, betalactams, nevirapine, and abacavir

215
Q

what puts you at increased risk of anticonvulsant hypersensitivity syndrome?

A

if you cannot detoxify arene oxide metabolites

216
Q

What medication should you switch ppl who develop a drug rash to anticonvulsants?

A

valproic acid or levetiracetam

217
Q

what puts you at increased risk of allopurinol hypersensitivity syndrome? What are some end-organ damage?

A

renal failure puts you at risk. End organ: pancreatitis, diabetes, kidney failure

218
Q

what puts you at increased risk of sulfonamide hypersensitivity syndrome?

A

slow acetylator

219
Q

dapsone hypersensitivity syndrome can have elevated level of what and decreased levels of what?

A

Elevated bilirubin leading to jaundice. And low eosinophilia

220
Q

what puts you at increased risk of minocycline hypersensitivity syndrome?

A

glutathione S transferase deficiency

221
Q

what end-organ damage is minocyline DRESS associated with?

A

eosinophlic pneumonia, liver damage, cardiac damage

222
Q

What two drugs cause cardiac damage after DRESS?

A

ampicillin and minocycline

223
Q

is systemic steroids helpful for DRESS?

A

Yes for lung and heart damage.

224
Q

Name 2 non-drug causes of AGEP?

A

mercury exposure. Radiocontrast

225
Q

Top 3 drug culprit for AGEP

A

beta lactams (penicillin, cephalosporin, carbapenem, monopenum), macrolide (erythromycin), CCBs

226
Q

MOA of phototoxic drug reaction

A

drug metabolite reacts with UVA. Everyone that is given enough of the drug develops this reaction

227
Q

MOA of photoallergic drug reaction

A

UVA induces a chemical change in the drug and it becomes a photo allergen

228
Q

Phototoxic drugs are usually systemic or topical?

A

systemic medications

229
Q

Photoallergic drugs are usually systemic or topical

A

topical

230
Q

Common drugs for phototoxic rxns

A

tetracyclines, NSAIDs (piroxicam), fluoroquinolones, amiodarone, psoralens, voriconazole, st Johns wart, HCTZ

231
Q

Slate gray hyperpigmentation drugs

A

amiodarone, Tricyclic antidepressants, diltiazem

232
Q

Photolichenoid eruptions drugs

A

HCTZ and NSAIDS

233
Q

Common drugs for photoallergic reactions

A

oxybenzone, fragrance (musk ambrette), NSAIDs and ketoprofen

234
Q

how do you confirm photoallergy?

A

photopatch testing utilizing UVA

235
Q

most common drugs to cause hyperpigmentation

A

minocyline, chemotherapy, zidovudine, antimalarials

236
Q

most common drugs to cause hypopigmentation

A

phenols (hydroquinone, MBEH), sulfhydryls (methimazole), tyrosinase kinase (imatinib)

237
Q

Bleomycin can be associated with sclerodermoid. T or F

A

TRUE

238
Q

hyperpigmentation occurs in what percentage of pts taking antimalarials?

A

25%

239
Q

quinacrine hyperpigmentation look like?

A

diffuse yellow-brown discoloration of skin and eyes (mimics jaundice)

240
Q

arsenic drug-induced pigmentation looks like? When does it present? Where on the body

A

hyperpigmented patches with superimposed raindrops of hypopigmentation. On the intertriginous, palms/soles, pressure points. Presents after 20 years

241
Q

Gold hyperpigmentation looks like?

A

permanent blue-gray hyperpigmenation on face (periocular #1)

242
Q

mercury hyperpigmentation looks like?

A

acrodynia (acral sites are dusky, red and painful)

243
Q

silver hyperpigmentation looks like?

A

diffuse slate gray pigmentation accentuated on photo-exposed areas .

244
Q

Slate gray hyperpigmentation area for amiodarone, TCAs, diltazem silver and mercury.

A

Amiodarone (face), silver and TCA and diltazem(sun exposed ) ,mercury ( skin folds).

245
Q

OCPs have hyperpigmentation of what areas?

A

nipple and nevi

246
Q

Histology for amiodarone hyperpigmentation?

A

yellow-brown lipofucin (fontana masson +) in macrophages in a perivascular distribution.

247
Q

Electron microscopy fo ramiodarone hyperpigmentation?

A

Electron microscopy shows lipid-like lysosomal inclusions

248
Q

clofazamine pigmentation look like?

A

diffuse red-brown color of skin and conjunctiva. Or lesional hyperpigmentation

249
Q

diltaizem pigmentation occurs in what people?

A

African americans. Who present with slate-gray discoloration on photo-exposed skin

250
Q

fetal exposure to TCN can stain the teeth at different levels. What stains in the mid protion., What stains in the gingival one third?

A

Minocycline midportion. Tetracycline (gingival one third)

251
Q

Hand- foot skin reaction looks like what? Caused by what drugs?

A

Looks like toxic erythema of chemotherapy, but with prominent hyperkeratotic plaques on areas of friction. Caused by multi-kinase inhibitors (sorafenib, sunitinib, VEGF inhibitors)

252
Q

is hydroxyurea a phototoxic drug?

A

yes

253
Q

Irreversible alopecia drugs (2)?

A

busulfan, docetaxel

254
Q

treatment for mucositiis

A

palifermin (keratinocyte growth factor)

255
Q

extravasation reactions d/t what chemotherapy?

A

5FU, anthracycline (doxo, daunorubicin)

256
Q

nail hyperpigmentation

A

doxorubicin, 5FU, cyclophosphamide, hydroxyurea, bleomycin

257
Q

Hemorrhagic onycholysis

A

taxanes

258
Q

exudative hyponychial dermatitis

A

docetaxel and capecitabine (breast cancer settign)

259
Q

necrosis of psoriasis plaques

A

MTX

260
Q

What chemo drug can cause: flushing?

A

asparaginase

261
Q

What chemo drug can cause: sticky skin syndrome?

A

doxorubicin with ketoconazole

262
Q

What chemo drug can cause: sclerodermoid reaction

A

taxanes

263
Q

What chemo drug can cause: palmoplantar hyperkeratosis

A

Capecitabine

264
Q

What chemo drug can cause: acral sclerosis?

A

bleomycin

265
Q

What chemo drug can cause: hyperpigmentation of occluded skin?

A

Thiotepa

266
Q

What chemo drug can cause: periungal pyogenic granuloma? Name 4

A

isotretinoin, HAART (indinavir, efavirenz, lamivudine), EGFR inhibitors, MTX,

267
Q

What drug can cause digital ischemia?

A

beta blocker, bleomycin

268
Q

Texier disease

A

indurated morpheaform plaques . a pseudosclerodermatous reaction that occurs after injection with vitamin K, a subcutaneous sclerosis with or without fasciitis that lasts several years.

Clinical Dermatology (11 decks)

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