Non-neoplastic skin Flashcards
acute inflammatory dermatosis with spongiosis and formation of intraepidermal vesicles
Acute Eczematous Dermatosis (Eczema)
oozing/ crusted erythematous papulovesicular lesion with pruritic scaling plaques
Eczema
Self limiting Type 4 hypersensitive acute inflammatory dermatosis with keratinocyte injury mediated by CD8+ T cells
Erythema Multiforme
Causes of erythema multiforme
Infection
- HSV
- Histoplasma
- Coccidiomycosis
- Typhoid
- Leprosy
Drugs
- Sulfa
- Penicillins
- Barbiturates
- Salicylates
- Hydantoins
- Anti-malarials
SLE
Polyarteritis nodosa
Dermatomyositis
Immunizations
- Erythematous maculopapular rash, progressing into target lesions
- Pruritic or burning sensations
- symmetrical distribution to dorsal hands and feet, followed by proximal spread
- can include palms and soles
- only in major case will mucocutaneous surfaces be affected
Clinical Presentation of Erythema Multiforme
What is the difference between Stevens-Johnson Syndrome and TEN?
SJS is less than 10% of total body surface
TEN includes > 30% of the body’s surface
Leukopenia
increased BUN
Increased transaminases
Hyperglycemia
subepidermal splitting at dermo-epidermal junction
Diagnostics of SJS/ TEN
Infections
- CMV
- Herpes
- Mycoplasma
Drugs
- Sulfa
- Aminopenicillins
- Rifampin
- Corticosteroids
- Nevirapine
- Antiepileptics
- Piroxicam
- Allopurinol
Vaccinations
Graft vs Host Disease
Triggers of SJS/ TEN
Prodromal Phase
ALWAYS has Mucocutaneous Manifestations
Positive Nikolsky sign
Necrosis and sloughing of full epidermal thickness
Involves face and trunk
Lesions form bullae/ vesicles
Clinical Presentation of SJS/ TEN
Chronic inflammatory dermatosis with sensitized CD4+ T cells causing keratinocyte death by CD8+ T cells
Leads to hyperkeratosis
Psoriasis Pathology
Associations of Psoriasis
arthritis
myopathy
enteropathy
staph/ strep infections
mechanical irritation
Drugs (beta-blockers, chloroquine, lithium, interferon)
HLA-Cw
Diagnostics of Psoriasis
positive Auspitz sign
increased inflammatory markers
stratum corneum cells still have nuclei
increased stratum corneum
decreased stratum granulosum
What is an Auspitz sign
small pinpoint bleeding that occurs when scaled skin is scraped off
Acanthosis
Parakeratosis
Munro microabscesses
Psoriasis Morphology
Well demarcated pink plaques covered by loosely adherent silver scales
primarily appears in extensor surfaces
pruritis
Koebner phenomenon
Positive Auspitz sign
Psoriasis
acanthosis
epidermal hyperplasia
Wickham’s striae
pattern of white lines on lesion surface
Koebner Phenomenon
physical stimuli leading to skin lesions typical of underlying condition on previously healthy skin
oily skin
stress
androgenic alopecia
immunodeficiency
familial history
increased sebum production
Malassezia furfur
Associations of seborrheic dermatitis
Erythematous plaques with patchy scaling and greasy yellow crusting
usually distributed along areas of hair and oily skin
dandruff
pruritis/ burning sensations
originates in the dermis
Clinical presentation of seborrheic dermatitis
Pathology of seborrheic dermatitis
increased sebum production and colonization of yeasts in sebaceous areas or exposure to irritants
Chronic, but Self-limited CD8+ immune response associated with Hep C
Lichen Planus
Diagnostics of Lichen Planus
Wickham’s striae
Band-like lymphocytes at dermo-epidermal junction
irregular saw tooth acanthosis
hyperkeratosis
wedge-shaped hypergranulosis
Purple, pruritic, planar, polygonal, papules and plaques of the skin and mucosa
involves stratum corneum and granulosum
Lichen planus
Antibody-mediated attack against desmogleins 1&3 causing the disruption of intercellular adhesions
Pathology of Pemphigus Vulgaris
Drugs
- ACE Inhibitors
- Penicillamine
- Phenobarbitol
- Penicillins
Viruses
UV radiation
Diet changes
Paraneoplastic syndromes
Associations of Pemphigus Vulgaris
Easily rupturable thin roofed bullae
spontaneous flaccid intraepidermal blisters on the oral mucosa and skin
shallow erosions covered with dried serum and crust
Re-epithelialization with hyperpigmentation
No Scarring
Clinical presentation of Pemphigus Vulgaris
Positive Nikolsky sign
Positive Tzank smear
Deposition of IgG in a fishnet pattern in intracellular epidermal spaces
Suprabasal acantholysis, forming intraepidermal blisters
Single layer of intact basal cells that form tombstone blister
Diagnostics and Morphology of Pemphigus Vulgaris
Most common bullous autoimmune disease
Bullous Pemphigoid
Antibodies against hemidesmosomes cause separation of basal keratinocytes from the basement membrane, forming bullae
Pathogenesis of Bullous Pemphigoid
Antibodies against BPAg1 &2
Subepidermal vesicle formation
eosinophil rich infiltrates underlying the dermis
Linear deposition of complement and Ig/ C3 along the dermo-epidermal junction
Diagnostics and morphology of Bullous Pemphigoid
Tense subepidermal blisters that are hard to rupture
ulcers form in the place of ruptured blisters
intensely pruritic lesions that heal without scar formation
Clinical presentation of Bullous Pemphigoid
HLA-DR3
HLA-DQ2
Sensitivity to potassium iodide
Celiac Disease
Associations of Dermatitis Herpetiformis
Antibodies against tissue transglutaminases and endomysium
Subepidermal vesicle formation
Neutrophilic papillary microabscesses
Deposition of granular IgA in dermal papillae
Diagnostics and Morphology of Dermatitis Herpetiformis
urticaria
pruritic plaques and groups of vesicles
distributed symmetrically
usually on extensor surfaces
Clinical presentation of Dermatitis Herpetiformis
Nikolsy sign
upper epidermal layer is easily removed by rubing
separates dermis and forms a blister
Tzank test relevance in Pemphigus Vulgaris
shows presence of multinucleated giant cells
Acantholysis
separation of epidermal cells due to dissolution of intercellular bridges
What is the purpose of Reticulin
component of anchoring fibrils that tether epidermal basement membranes to the superficial dermis
- composed of collagen III, causing limited elasticity by good tensile strength
