Matthys Flashcards
flat spot on skin measuring <1 cm?
> 1 cm?
Macule
Patch
nonpustular, nonvesicular lesion on skin <1 cm?
> 1 cm
papule
nodule
small blisters < 1 cm?
> 1 cm?
vesicle
bulla
a collection of leukocytes in the epidermis?
pustule
broad, elevated flat lesions > 1 cm
plaque
Description of lesions in atopic dermatitis
- erythematous popular
- areas of scaling
- pruritic
- appears as patchy, dry, scaly eruptions
location of lesions in atopic dermatitis
- facial rash on cheeks, sparing perioral and perinasal areas
- generalized erythematous popular rash on trun and extremities with sparing of diaper area
- no eruptions noted on interdigital web areas of toes or fingers
associated clinical findings with atopic dermatitis
- xerosis and icthyosis vulgaris
- pigmentary changes
- eye and periorbital changes
- hand and foot dermatitis
complications with Atopic Dermatitis
- infection
- exfoliative erythroderma
- mental and emotional anguish with growth disturbance
pathogenesis of Atopic Dermatitis
- T cell
- food allergy
- Aeroallergens
- irritant contactants
- Histology non specific with spongiosis, eos, and features consistent with LSC
Treatment of Atopic Dermatitis
- Moisturize
- Avoid irritants
- Avoid known food allergies
- Topical and oral antipruritic agents
- anti inflammatory agents
-Acute, rapidly spreading nonsuppurative infection of the skin and underlying soft tissue NOT including the muscle
Cellulitis
Clinical finding in Cellulitis
- Tender, warm poorly demarcated boggy plaque
- commonly on extremity
- Trauma
pathogenesis of cellulitis
- Trauma to an extremity either known or unknown
- concurrent ulcer
risk factors for cellullitis
- stasis dermatitis
- Lymphedema
Treatment of Cellulitis
- it is usually Staph or Strep pyogenes
- first gen cephalosporin, macrolide or clindamycin
- elevation
symmetric erythematous nodules and plaques located on the anterior lower extremities
erythema nodosum
age for erythema nodosum
peak 20-30
clinical findings in Erythema Nodosum
- Tender nodules and plaques on the bilateral knees, ankles, and shins
- sometimes thighs and upper extremity
- 1-15 cm in size
- rarely ulcerate
etiology of erythema nodosum
-hypersensitivity response (infection, medicine, herbs vitamins) . .can be brought on by birth control
Treatment of erythema nodosum
- anti inflammatory
- rest
Psoriasis: Koebner?
Ausptitz?
Woronoff’s ring?
- Recreate psoriasis based on trauma
- Peel off scale and get pinpoint bleeding
- Get rid of psoriasis and it leaves a sort of stain behind
Histology of Psoriasis
- Acanthotic epidermis with club shaped rete ridges and an ABSENT GRANULAR LAYER
- tortuous vessels seen in the papillary dermis
3 common types of psoriasis
- Plaque type
- Pustular
- Guttate
describe Plaque type psoriasis
- well demarcated scaly plaque
- elbows, knees, belly button
- coin shaped
- annular pattern
- thick
describe pustular type psoriasis
- Sterile sheets of pustules on an erythematous base
- Localized or generalized
- painful with fever
Describe Guttate type psoriasis
- children and young adult
- post strep infection
- some predisposition to psoriasis
- trunk with sparing of palms and soles
clinical findings for Herpes Zoster
- local radicular pain 2-3 days prior to the eruption
- Disseminated Zoster
- Herpes Zoster Ophthalmicus
- Postherpetic neuralgia
pathology of Herpes Zoster
Steel gray nuclei multinucleated giant cells with eosinophilic intranuclear inclusions
Treatment of Herpes Zoster
- Antivirals
- Contagious; can cause chickenpox
- Pain control
- vaccine at age 60
what are the papulosquamous diseases
- Psoriasis
- Seborrheic dermatitis
- Erythrasma
- Lichenoid eruptions
- Pityriasis rosea
- Dermatophyte infections
environmental factors fr psoriasis vulgaris?
Genetics?
- Smoking, sun, alcohol
- HLA-B13 autosomal dominant
drugs that can lead to psoriasis
- lithium
- B-blockers
- NSAIDs
pregnancy and psoriasis
can make it better
highlights for Seborrheic dermatitis
- Scalp/face/chest
- P. ovale
- Humidity, trauma, seasons
- HIV
pathophysiology of Seborrheic Dermatitis
- Abnormal immune response to P. Ovale with normal amount of the yeast
- Free Fatty acid release
describe the lesions of Seborrheic Dermatitis
- Branny greasy red scale on face/chest/penis
- mild flaking in hair baring areas
highlight of Erythrasma
- Corynebacterium minutissimum: gram + rod, part of normal skin flora
- CHRONIC
- Diabetes
- warm humid places
pathophysiology of erythrasma
- Bacterial infection affecting the intertriginous areas (toes/groin/axilla)
- red/brown scaly macules with on erosive collarette like scale
- WOOD’s LAMP
Highlights for Lichen Planus
- Hep C
- painful/burning
- Wrists/nails/oral cavity/genitalia . . SCC of the oral mucosa
- Wickham’s stria
- puruitic, purple, papules, and plaques
Highlights for Pityriasis Rosea
- rose or pink colored scaly patches or thin plaques
- spring and fall
- Herald patch
- pruritic eruption
- “Christmas tree” pattern
- if around pregnant woman they can have miscarriages at a higher rate
pathophysiology of pityriasis rosea
- viral exanthema
- increase in CD4 and Langerhan’s cells in the dermis
- unknown
Reddish-orange scaling plaques of unknown etiology with palmoplantar keratoderma and follicular keratotic papules
Pityriasis Rubra pilaris
highlights for pityriasis Rubra Pilaris
- Autosomal dominant inheritance
- Disease has many features of a vitamin A deficiency
Describe Griffith’s classification of Pityriasis Rubra Pilaris
- Type 1: classic adult type, most common, red brown plaques with “islands of sparing”
- Type 2: adult atypical, icthyosiform
- Type 3: classic juvenile, similar to 1 but before age 2
- Type 4: CIRCUMSCRIBED JUVENILE, well demarcated follicular hyperkeratosis along elbows and knees
- type 5: ATYPICAL JUVENILE, prominent follicular hyperkeratosis with scleroderma type changes on palms and soles
- Type 6: HIV, orange red plaques with follicular hyperkeratosis and islands of sparing, skin, mucous membranes, nails, eyes
Highlights of cutaneous T cell lymphoma
- T cell lymphoma affecting the CD4 helper cells
- lymph nodes and organs become involved during the disease process
- > 50 years of age
- 27:1 M:F
Pathophysiology of cutaneous T cell lymphoma
- HTLV
- unknown
- CD8
- B cells
Clinical features of cutaneous T cell lymphoma
- Scalin plaques which mimic eczema
- itchy
- multiple different shades of red-brown
- round, oval annular or bizarre shape
- CHECK FOR LAD
Diagnosis and treatment of cutaneous T cell lymphoma
- Biopsy, chest X ray, CBC with buffy coat
- topical steroids, PUVA, topical nitrogen mustard
highlights for Discoid Lupus Erythematosus
- scarring atrophic photosensitizing dermatosis
- 20-40
pathophysiology of discoid lupus erythematosus
- not well understood
- genetic predisposition
- Heat shock protein induced by UV light
Clinical features of discoid lupus erythematosus
- mild itching of lesions; most asymptomatic
- be aware of SLE symptoms; pericarditis, neurologic sx
- malignant transformations (SCC) can occur in chronic lesions
- Psoriasis, LP, PCT
- Erythematous papule or plaque with modest amount of scale
- hypo or hyperpigmented
- SCARRED
- mucosal, palms and soles
Diagnosis and treatment of discoid lupus erythematosus
- ANA and biopsy
- sunscreen
- topical steroid
- IL steroids
- surgery
- antimalarials
pathophysiology and different drugs for Drug eruption
- over dosage: purpura with Coumadin
- Accumulation: Argyria with silver nitrate
- phototoxic: doxycycline
- Imbalance of normal flora: candidiasis with antibiotics
- Jarisch-Herxheimer: reaction to killing of bacterial or fungal by appropriate agent
who is at 10x risk of getting drug eruption
immunocompromised
Clinical features of drug eruption
- morbilliform, erythematous macular popular eruption with minimal scale until progressed or cleared
- 2 weeks after new meds
- Review all meds of prior 2 months
Diagnosis and treatment of drug eruption
- Blood work
- Biopsy
- HISTORY!!!
- Clincal exam
- antihistamines
- Steroids
highlights for Impetigo
- highly contagious gram + bacterial infection of superficial layers of skin . . staph
- bullous/nonbullous
- <6 most common
pathophysiology of impetigo
- S. Aureus
- 30% nares small % groin, hand, rectum, pharynx
- normal flora
- exfoliative endotoxins A and B
- Neonates and infants most common for bullous
Clinical features of impetigo
- rapid blister, asymptomatic
- hot weather
- Crowded conditions
- poor immune function
- Atopic dermatitis, herpes infection, trauma
- honey colored crust
- Flaccid <1 cm bulla, usually ruptured
- collarete of scale
- no sore throat or LAD
- Face most common but can be anywhere
Treatment of Impetigo?
- Antibiotics
- Glomerulonephritis
highlights for staph scalded skin syndrome
- Toxin mediated exfoliative dermatitis
- severe impetigo to widespread skin denudation
- exfoliation followed by painful erythema
- Infants and young children
- Nurseries and daycare
pathophysiology of staph scalded skin syndrome
- S. Aureus
- Exotoxins (ET-1 and ET-2)
- Blister at the GRANULAR LAYER OF THE EPIDERMIS SPLITTING THE DESMOSOMES
Clinical features of staph scalded skin syndrome
- Focus of infection
- Fever, faint orange red macules
- nikolsky sign (skin is sloughed off by rubbing)
- Paper like wrinkling of the epidermis
- cultures are sterile
- Dramatic . . heals in 5-7 days
Treatment of staph scalded skin syndrome
- Antibiotics
- Fluids
- culture/biopsy . . frozen section
highlights for pemphigus vulgaris
- Autoimmune blistering disease of the skin and oral mucosa
- circulating immunoglobulin G antibody against the intraepidermal keratinocytes
pathophysiology of Pemphigus vulgaris
- Binding of IGG autoantibodies causes loss of adhesion b/t keratinocytes
- Desmoglein 3
- Circulating IGG1 and IGG4
- Disease activity correlated with circulating antibodies
clinical features of pemphigus vulgaris
- All races
- 50-70% oral mucosa involvement
- mucosa more than skin
- flaccid bulla on the skin with an erosion in the oral
- Nikolsky’s sign
- Asboe-Hansen sign- Lateral pressure on the bulla will spread the bulla to uninvolved skin
Causes of pemphigus vulgaris
- Genetic
- Age
- Disease Association . . MYASTHENIA GRAVIS AND THYMOMA
Diagnosis and treatment of pemphigus vulgaris
- Biopsy (DIF and HE)
- IDIF
- Prednisone, Imuran
- Ophthalmologist
highlights of Herpes Simplex
- 2 types; HSV 1 and 2
- M>W
- HSV 1 encephalitis 60-80% mortality
- Primary infection, latency, recurrence
pathophysiology of Herpes Simplex
- HSV 1 respiratory droplets
- HSV 2 genital contact
- cytolytic infection with fluid filled vesicles
- 70-90% of population has HSV1 and 22% has HSV2
Clinical features of Herpes simplex
- Asymptomatic to painful; prodrome of itching and burning
- Herpetic whitlow and herpes gladiatorum
- recurrent lesions common
- immune status
- encephalitis
- Vesicular or ulcerative on an erythematous base
- oral, genital, body, keratoconjunctival, encephalitis, anal
- Seizures, headaches
Diagnosis and treatment of Herpes simplex
- Culture or biopsy
- antivirals
pathophysiology of Chicken pox
- Primary varicella virus; herpes family type 3
- Respiratory and direct contact with skin
- 10-21 day incubation
- Infectious 1-2 days prior to the rash and until the lesion crust
clinical features of chicken pox
- history of recent outbreak
- Itchy rash
- “oval teardrop on a erythematous base”
- “dew drop on a rose pedal”
- Face, trunk
- Fever, shallow aphthous ulcers on oral mucosa
- Spares the distal extremity
Diagnosis and treatment of Chicken pox
- clinical, culture, biopsy
- NO ASPIRIN
- VZIG
- antivirals
- antihistamines
highlights for Bullous Pemphigoid
- Chronic, AUTOIMMUNE, subepidermal blistering disease that RARELY involves the oral mucosa
- Autoantibodies of IgG
- uncommon
Pathophysiology of bullous pemphigoid
- IgG binds to skin antibodies activating complement and inflammatory mediators
- Inflammatory cells release proteases causing bulla formation
- Serum levels of BP Ag 2 may correlate with disease activities in some pts
Clinical features of bullous pemphigoid
- subacute or acute formation of tense bulla
- UV radiation or drug induced
- Bullous, vesicular, urticarial, acral in children
- Causes include genetic, age, epitope spreading
Diagnosis and treatment of bullous pemphigoid
- Biopsy (HE and DIF)
- IDIF
- Prednisone and other immunosuppressive
Highlights for polymorphous light eruption
- idiopathic photodermatoses relating to sun exposure
- papules, vesicles, and plaques
- 75% American indian
- F 2-3X >M
Pathophysiology of polymorphous light eruption
- UNKNOWN
- type IV delayed hypersensitivity
- UV-A induced ICAM-1
Clinical features of Polymorphous light eruption
- sunlight is etiologic factor most of time
- Spring, lessens thoughout summer
- about 30 min after sun exposure
- papules, vesicles, urticarial or EM type features
- UV-A or UV-B
Diagnosis and Treatmet of polymorphous light eruption
- R/O porphyria, lupus
- Photopatch testing
- Photo testing MED
- topical steroid, oral or IM steroids, antimalarials
highlights for Dermatitis herpetiformis
- Immune mediated skin disease with a gluten sensitive enteropathy
- rare in African american
pathophysiology of dermatitis herpetiformis
- Skin and GI
- Circulating immune complexes are found
- IgA binds antigen in the bowel and skin
- Increased expression of HLA-B1, B8, DR8, DRQ
- Patient have uniform gluten sensitivity
Clinical features of Dermatitis herpetiformis
- Pruritic, burning skin blisters distributed in a symmetric fashion; grouped
- Last days to weeks
- Urticarial wheal to vesicle to bulla
Diagnosis and treatment of Dermatitis herpetiformis
- HE and DIF biopsy
- Clinical exam
- Be aware of associated diseases
- Dapsone and gluten free diet
highlights for Erythema multiforme
- Benign self-limited eruption classically seen as targetoid or iris shaped macules or vesiculopapules on the palms or soles
- 50% under age 20
pathophysiology of erythema multiforme
- not understood/HSV cell mediated immune response
- infection major cause
- Drug . . sulfa/phenytoin/PCN/allopurinol
- Foods, sunlight, contactants
Clinical features of erythema multiforme
- Dull red macules or papules with vesicles on palms or soles with little mucosa involvement
- iris or target like
- Bilateral and often symmetric
- Polycyclic or arcuate
- Koebner phenomenon
- Mucosal involvement in up to 70%
- Lips, anus, eyes, oropharynx
Diagnosis and treatment of erythema multiforme
- Biopsy
- antivirals
- steroids
Highlight of Toxic Epidermal Necrolysis (TEN)
- Extensive FULL THICKNESS skin detachment
- Erythema multiforme spectrum
- Early symptoms non specific
pathophysiology of TEN
- HLA-B12
- SLE
- HIV
- Medicines, infection: cell mediated cytotoxic reaction against epidermal cells, CD8 cells macrophages cytokines
Clinical features of TEN
- 1-3 week prodrome
- Fever, skin tenderness
- skin pain, burning
- newly added drugs most common
- Morbilliform, EM type eruption
- skin with crinkled surface
- Sheet like epidermal loss
- Nikolsky’s sign
- Mucosal membrane involvement
Diagnose and treatment of TEN
- D/C drug suspected
- IV fluids
- Burn unit
- Steroids as last resort
- IVIG
- Prevent infection
