JAAD Flashcards
Reactive angioendotheliomatosis (RAE), rare, benign entity characterized by proliferation of endothelial cells within vascular lumina. Tx: steroids & treat underlying disorder (SLE, infection, heart dx)
Kaposi’s varicelliform eruption
Which of the following factors does not increase risk of herpes infection in patients with atopic dermatitis?
A. Increased IFN-g levels
B. Increased total IgE levels
C. Impaired skin barrier
D. Filaggrin mutation FLGR501X
E. Increased Staphylococcus aureus (S. aureus) colonization
A. Increased IFN-g levels
IFN-g levels are decreased in patients with AD because of an upregulation of interleukin 4 and interleukin 5. IFN-g has a decisive role in viral defense mediated by CD8 T lymphocytes; its reduction may induce susceptibility to HSV.
Examples of septated fungi?
Aspergillus, Fusarium, and Candida species
Pauci-septated fungal hyphae branching at right angles is seen in?
Mucormycetes
What virulence factor do mucormycotic infections utilize?
A. Iron sequestration
B. Melanin production
C. Polysaccharide capsule
D. Thermal dimorphism
E. Hydrolytic enzyme secretion
A. Iron sequestration
Mucormycetes sequester iron from their host to support their survival. For this reason, patients with a state of iron overload have an increased incidence and severity of invasive mucormycosis.
What is the most likely diagnosis?
A. Exanthematous drug eruption
B. Symmetrical drug-related intertriginous and flexural exanthema
C. Urticaria
D. Unilateral laterothoracic exanthem (ULE)
E. Atypical pityriasis rosea
D. Unilateral laterothoracic exanthem (ULE)
Also known as asymmetric periflexural exanthem, this is an uncommon uni- lateral self-limited morbilliform rash often depic- ted in children in which the cause is unknown but viral origin is suspected. It can be quite pruritic, persists an average of 5 weeks, and heals with desquamation. ULE has been previously reported following both COVID-19 infection and vaccina- tion, both mRNA and recombinant; therefore, COVID-19 testing is advised to rule out active infection.
Which of the following has NOT been reported as a cutaneous reaction after mRNA COVID-19 vaccinations?
A. Delayed large local arm reactions
B. Cosmetic filler reactions
C. Bazex syndrome
D. Chilblain-like lesions
E. Herpes zoster
C. Bazex syndrome
Bazex syndrome, also known as acrokeratosis paraneoplastica, is a paraneoplastic syndrome in which hyperkeratotic lesions appear on acral surfaces in association with internal malignancies. There have been no reported cases of Bazex syndrome occurring after COVID-19 vaccination.
What is the most likely diagnosis?
A. Kimura disease
B. Scrofuloderma
C. Rosai-Dorfman disease
D. Hodgkin lymphoma
E. Autosomal dominant hyper-IgE syndrome
A. Kimura disease
Kimura disease is a rare chronic inflammatory disorder of unknown etiology that often presents with painless lymph nodes or subcutaneous lymphoid masses in the head and neck region. The disease occurs predom- inantly in Asian individuals, and men are more commonly affected than women. Elevated serum IgE level and peripheral eosinophilia are helpful clues.
Which of the following is a prom- ising long-term treatment option for this patient with Kimura disease?
A. Corticosteroids
B. Cyclosporine
C. Surgery
E. Radiation therapy
F. Dupilumab
F. Dupilumab
Dupilumab is an inter- leukin 4 (IL-4) alpha antagonist that inhibits IL-4 and IL-13 signaling and has been shown to be an effective long-term treatment option in patients with Kimura disease. It would also be helpful for our patient’s comorbid conditions, atopic dermatitis, and asthma.
Histopathology of Monkeypox (Orthopox virus)?
Ballooning degeneration of keratinocytes with the presence of eosinophilic intracytoplasmatic inclusion bodies (Guarnieri bodies) is consistent with infection from Orthopox virus.
Dermoscopy with the trizonal pattern of central necrosis, white peripheral halo, and a paler pink zone has been also described as a reproducible and additional supportive tool to integrate clinico- pathological correlation when dealing with lesions potentially related to monkeypox.
What is the most typical presentation of secondary multiple miliary osteoma cutis?
A. Male patient, lesions on the face
B. Female patient, lesions on the face
C. Male patient, lesions on the trunk
D. Female patient, lesions on the trunk
E. Monomorphous pink papules on the face and trunk
B. Female patient, lesions on the face
Secondary MMOC typically occurs on the face and tends to affect middle-aged women with a sex ratio of 8:1
Which of the following drugs is the most common trigger of this condition (photo recall dermatitis)?
A. Methotrexate
B. Simvastatin
C. St. John’s wort
D. Trastuzumab
E. Doxycycline
A. Methotrexate
Photo recall dermatitis is most commonly precipitated by chemothera- peutic agents. Methotrexate, an antimetabolite anti- neoplastic is the most commonly implicated drug in the development of this condition.3 Other common implicated drugs include taxanes, which our patient received, and antibiotics.
What is the pathophysiologic mechanism of bullae formation in pemphigoid gestationis?
Th2 response to placental tissues causing degradation of the dermoepidermal junction.
Gestational hormonal changes cause a Th2 immune response to placental tissue leading to the formation of bullous pemphigoid-180 auto- antibodies that activate complement and chemo- taxis of eosinophils. Eosinophilic degradation of the dermoepidermal junction leads to the formation of bullae.
What location is most common for verrucous xanthomas to appear?
Oral cavity. In most cases, verrucous xanthomas appear as a solitary slow growing lesion affecting the oral cavity. A large case series, including 212 cases, reported that more than 50% of lesions were located on the gingiva.
Excision of the lesion is sufficient treatment of the lesion, with recurrence being rare.
What is the most likely diagnosis?
A. Leukocytoclastic vasculitis (LCV)
B. Erythema multiforme
C. Pityriasis lichenoides et varioliformis acuta (PLEVA)
D. Leukemia cutis
E. Lymphomatoid papulosis (LyP)
C. Pityriasis lichenoides et varioliformis acuta (PLEVA)
PLEVA can present with acute, recurrent erythematous-to-red-brown papules that may crust or ulcerate. Histological features include parakeratosis, interface dermatitis with a lichenoid band, and a wedge-shaped lymphocytic infiltrate.1 This patient specifically has Febrile Ulceronecrotic Mucha Haberman Disease (FUMHD), diagnosed as the most severe transformation of pityriasis lichen- oides. It may be characterized by painful necrotic lesions, a high fever, and other systemic symptoms; however, there is no definitive criteria for diagnosis.
Angina bullosa hemorrhagica (ABH). ABH is a poorly understood condition characterized by recurrent, short-lived, hemorrhagic bullae located on the mucous membrane lining the oral cavity.1 The bullae rapidly expand and then spon- taneously rupture and heal without scarring or discomfort. Histologic findings in ruptured lesions show epidermal erosions. In this case, H&E stained sections reveal a submucosal bulla with denuded but otherwise unremarkable mucosa (Fig 2, A and B). The dermis is notable for marked papillary edema with a mixed inflammatory infiltrate consist- ing predominantly of lymphocytes and scattered neutrophils. (Fig 2, C and D). No vasculitis or intraepidermal separation is identified, and DIF studies are negative.
Tumors involving the eyelid margin with pagetoid spread next step in management?
Conjunctival map biopsies
Which of the following is the most common initial presentation of EGPA?
A. Adult-onset asthma
B. Pulmonary nodules
C. Polyneuropathy
D. Cardiomyopathy
E. Glomerulonephritis
A. Adult-onset asthma
EGPA progresses through 3 phases—an initial prodrome of atopic disease, an eosinophilic phase with systemic involvement, and a vasculitic phase. Adult-onset asthma has been reported in 96% to 100% of cases during initial presentation. Additionally, sinusitis and recurrent allergic rhinitis are common findings.
Which enzyme is involved in the pathway of ochronosis?
Homogentisate oxidase
This patient’s hyperpigmentation is a result of the local competitive inhibition of homogentisic oxidase by hydroquinone.4 This leads to the accumulation of homogentisic acid in the skin.
Tinea pedis, tear-drop shaped microconidia, producing port-wine pigment?
T. rubrum
Medlar bodies “copper pennies” are diagnostic of infection with which organism?
Chromomycosis
Which of the following dermo- scopic findings is commonly seen in BCC but uncommon in trichoblastoma?
A. Arborizing vessels
B. Blue ovoid nests
C. Ulceration
D. Crystalline structures (chrysalis)
E. Blue-grey globules
B. Blue ovoid nests
The clinical and dermoscopic findings for both trichoblastoma and BCC are extraordinarily similar, which presents a diagnostic challenge. Clinically, both tend to pre- sent as slow-growing telangiectatic nodules, often on the head and neck in older patients. Even under dermoscopy, BCC and trichoblastoma share many of the same findings such as arborizing vessels and blue-grey globules; however, the finding of blue ovoid nests is frequently seen in BCC (64%) but is uncommon in trichoblastoma (15%).
What’s the diagnosis? Treatment?
Papular acantholytic dyskeratosis (PAD) (of the genitocrural folds). Discrete white to skin-colored smooth or verrucous papules that coalesce into plaques on the vulva and perineum reflect the morphology of PAD. PAD is a rare chronic acantholytic dermatosis that presents in young women with asymptomatic but persistent lesions limited to the genital, inguinal, and perineal skin. PAD occurs less frequently in men and can involve the penis, scrotum, perineum, or thighs. Histology shows overlapping features of Hailey-Hailey and Darier disease, including suprabasilar acantholysis, parakeratosis, and dyskeratosis. Tx: Combination oral magnesium, low-dose naltrexone, and isotretinoin.
What is Laugier-Hunziker syndrome?
A benign, acquired condition that involves gradual progression of asymptomatic macular hyperpigmentation of the mucocutaneous surfaces and nails.
What is the most likely diagnosis?
A. Nevus comedonicus
B. Milia en plaque (MEP)
C. Syringoma
D. Sebaceous hyperplasia
E. Follicular mucinosis
B. MEP
MEP is a rare primary milia characterized by an erythematous plaque containing numerous milia. The region commonly involved is the retroauricular area. Biopsy of this patient shows a keratin-filled cyst in the dermis.
What is the most likely diagnosis?
A. Erythrokeratolysis hiemalis
B. Erythrasma
C. Tinea corporis and cruris
D. Erythrokeratodermia variabilis (EKV)
E. Progressive symmetric erythrokeratoderma (PSEK)
D. EKV
EKV, an AD disorder, presents with transient erythematous patches and stable hyperkeratosis. Individual erythematous lesions persist for minutes to hours, although they may last for days. Simultaneously or over time hyperkeratosis evolves. Sharply demarcated, yellow-brown to pink-brown plaques with figurate borders progressively develop on the limbs, buttocks, and trunk in nearly symmetrical distribution. Histopathology shows orthokeratosis, basket-weave hyperkeratosis, moderate-to-severe acanthosis with prominent granular layer, papillomatosis, and dilated elongated capillaries with minimal perivascular inflammation in the papillary dermis.
