Lichenifcation & Acantholysis Flashcards
What is tiny perifollicular papules around hair follicles?
keratosis pilaris
What causes keratosis pilaris?
keratization causing plugging hair follicular
Where do you get keratosis pilaris?
upper thighs, lateral upper arms and cheeks
What is the treatment of keratosis pilaris?
moisturizers with ingredients like lactic acid, urea, salicyclic acid (Cerave SA, amlactin)
What type of condiation is ichthyosis vulgaris?
Autosomal dominant
Fine, adherent scale on extremities and trunk with sparing of flexures, larger scale on lower legs, hyperlinear palms and soles
Ichthyosis Vulgaris
What is the pathology of ichthyosis vulgaris?
absent stratum granulosum in some people, decreased or absent profilaggrin, also possible increased adherence of stratum corneum
What do pt have ichthyosis vulgaris with (secondary)?
malnutrition, infectious disease, sarcoidosis and other paraneoplastic disorders
How do you treat ichthyosis vulgaris?
reduction of scales as in KP
the patient has an itch in a particular location and begins to itch – the itching causes a cascade of itching/ scratching in a cycle which leads to thickening of the skin
Lichen Simplex Chronicus
When do lichen simplex chronicus pts complain of symptoms?
at rest, not when busy
What are the histologic findings for LSC?
epidermal thickening, hyperkeratosis, acanthosis, spongiosis. Papillary dermal fibrosis with vertical streaking of collagen bundles
What is the treatment for LSC?
topical steroid, itch prevention, oral snti-puritics including doxepin, phototherapy, psych referral
Darkening and thickening of the skin – marker of underlying disease
ACANTHOSIS NIGRICANS
Where does acanthosis nigricans present?
skin folds - axillae, groin, back of neck
What are the 7 types of acanthosis nigricans?
obesity related, syndromic (Cushings, PCOS), benign(over dorsal hands and feet in AA), drug induced (nicotinic acid, insulin, systemic steroids, hormonal tx), hereditary (autosomal dominant), malignant (stomach CA in 90%), mixed
When is acanthosis nigricans itchy?
malignancy
What is threatment for acanthosis nigricans?
topical retinoids for cosmetic apperance, creams with exfoliating properties
Chronic inflammatory skin condition that is a T cell mediated auto immune disease
lichen planus/ lichen planopilaris
Where does lichen planus occur?
nails, hair follicles, skin, oral mucosa, vaginal mucosa, penis
What can cause lichen planus/lichen planopilaris?
stress, genetic predisposition, skin trauma (koebnerization), herpes zoster, hepatitis (self antigen modification on surface of basal keratinocytes), meds such as quinidine, hydrxychloroquine, captopril
What is the skin findings for lichen planus?
usually symmetrical, scaly papules and plaques, purplish to pink, flat topped, mildly pruritic , may be linea
What do you see orally in lichen planus?
Wickham Striae
What do you see on the scalp with lichen planus?
telangectasia, erythemia, scarring
What is the dx for lichen planus?
get hepatitis hx
biopsy = positive DIF (IG at base of epidermis)
What is the treatment for lichen planus?
spontaneous resolution, topical steroids, calcineurin inhibitors
Transient acantholytic dermatosis
Grover’s disease
Who gets grover’s disease?
men over 50
What can grover’s disease be related to?
sweat or heat
Where do you get grover’s disease?
back and chest
What does grover’s disease look like?
Multiple tiny uniform perifollicular papules that are itchy
What is the treatment for grover’s disease?
topical steroids, topical aloe/anti-itch meds (AlcortinA gel, Novacort Gel)
Rare heriditary blistering disease caused by defective mortar between cells - Chronic acantholytic dermtosis
Hailey-Hailey
Where do you get hailey-hailey?
skin folds, axilla/groin, under breast and butt
What do skin lesions look like in hailey hailey?
ring-like then clear, sometimes secondarily infected, with malodor and weeping- no scars
What makes hailey hailey worse?
heat and sweating
What is the treatment for hailey hailey?
staying dry, avoid overheating, topical steroids, oral TCN
afamelanotide
Can go into remission after years and disease improves over time
What is things to know about hailey hailey?
gross smell and rare, no good treatment
Hereditary and chronic acantholytic dermatosis – autosomal dominant (50% inheritance rate)
Darier disease
When does darier disease start?
adolescence
What does skin like in darier disease?
Greasy scaly papules over hair bearing areas, flexural folds – malodor is common
Bumpy sebborheic dermatitis
What are some clinical presenations of darier diseas
small pits on the palms and soles and longitudinal pink nail stripes and V shaped nick at the free edge of the nail is very common
What are symptoms exaccerbated by darier disease?
sun, heat, bacterial infections
What is the treatment for darier disease?
Ranges from sun protection, moisturizers for mild disease to topical/oral retinoids for severe disease or even cyclosporine
What is the most common type of acanthosis and what is it related to?
obesity, insulin resistantce
What are the two disease states related to acanthosis nigricans?
PCOS and cushings
What malignancy is related to acanthosis nigricans?
GI tumors (stomach 90%)
Who gets a benign variant that doesnt indicate underlying disease in acanthosis nigricans?
AA, in hands and feet
What is the main clinical manifestation in grover disease?
pruritis
