OLD PATTON LIM Flashcards
What immunobullous disease is treated with dapsone?
Linear IgA disease that is NOT associated with drugs, if it is then the Tx is to remove the drug; dermatitis herpetiformis
This is a dilated superficial blood vessel
telangiectasia
What is an erosion that is specifically caused by scratching?
Excoriation
What are the two biochromes of the epidermis?
melanin = brown and Carotenoids = yellow
What is a good way to Tx a keloid?
inject with steroids, re-excising would be dumb because they are known to be prone to keloid formation
What is the key feature in the allergic contact dermatitis from plants?
Linear nature of the rash
How is DRESS different from morbilliform drug reactions?
it involves organs not just skin, most commonly the liver
How is the oral disease of paraneoplastic pemphius different from pemphigus vulgaris and foliaceous?
It is the most severe and pemphigus foliaceous doesn?t have oral involvement anyway
This disease involves autoantibodies against type VII collagen
Epidermolysis bullosa acquisita NOT the hereditary epidermolysis bullosa
What is a macule?
a circumscribed FLAT discoloration
What is a circumscribed collection of blood greater than 0.5 cm
purpura
What is the most common cause of the morbilliform drug eruption?
When someone is mistreated with ampicillin when they have mononucleosis (doc thought they had strep throat)
MOA of ipilimumab
binds CTLA4 to disinhibit T cells for Tx of melanoma
How is the Tx of mucous membrane pemphigoid different from that of bullous pemphigoid and pemphigus vulgaris?
Mucous membrane pemphigoid involves more rigorous tx not only with corticosteroids but also cyclophosphamide because of the serious sequela that can occur
Hallmark of MCV infections
umbilicated lesions ZOMG
What is a linear loss of epidermis with sharply defined, nearly vertical walls?
fissure
This is a tumor of scar tissue that grows beyond the bounds of the initial cut
keloid
Telangiectasias are very characteristic of what CA?
Basal cell carcinoma
If you see lichenification, was the initial lesion most likely painful, itchy, or not noticed by the patient?
itchy, lichenification results from repeated scratching of the skin
What is the most common cause of allergic contact dermatitis?
reaction to toxicodendron plants (i.e. poison ivy, poison sumac)
What must you work up a patient for if they have porphyria cutanea tarda?
liver disease
Why do UV and radiated skin often have telangiectasias?
UV and other forms of radiation cause cutaneous atrophy and expose the dilated blood vessels
What does DRESS stand for?
Drug Rash Eosinophilia and Systemic Symptoms
What is the most common subtype of melanoma?
superficial spreading
When Txing melanoma, what drug inhibits MEK?
Trametinib
This is a circumscribed and flat bump in the skin that may be brown, blue, red (yellow, cerulean, indigo, sea green, red-orange, orange-red)
MACULE
What is the most common cause of erythema multiforme?
HSV-1 also Mycoplasma pneumoniae
Enzyme deficient in porphyria cutanea tarda
uroporphyrinogen decarboxylase; note, in case of distractor that acute intermittent porphyria is urobilinogen deaminase
If one felt inclined to differentiate between a depigmented macule and a hypopigmented macule, how would one embark on this endeavor?
One could use a Wood’s lamp. By doing so, one would note that a depigmented macule would have a “brilliant” purple color change. Conversely, with a hypopigmented macule, one would note a less “brilliant” color change
When you see vesicles or bullae in a linear pattern what should you be thinking?
contact dermatitis
What drug binds CTLA-4
Ipilimumab
What are vemurafinib and dabrafenib?
BRAF inhibitors for Tx of melanoma
What are the 3 diseases under the pemphigus grouping?
Pemphigus vulgaris, Pemphigus foliaceous, and Paraneoplastic pemphigus
T/F: one can make the diagnosis of dysplastic nevus clinically
nope, dysplastic nevus is a histological Dx
Why don?t erosions heal with scarring? Where else in the body does this occur?
Because the basal layer of epidermis remains intact. This also occurs in the GI tract? Think about Crohn’s Dz, you get stricture formation and creeping of the mesenteric fat because you have lost more than the basal layer of cells of the mucosa. Therefore, there will be scar formation. Same deal in skin.
What are the two biochromes of the dermis?
Oxyhemoglobin (bright red), Reduced hemoglobin (bluish red)
How can you get a definitive diagnosis of allergic contact dermatitis to everyday materials?
patch testing
Which drugs are the most common cause of DRESS, Stevens-Johnson syndrome, and Toxic Epidermal Necrolysis?
Aromatic anti-convulsants, sulfonamide antibiotics, and allopurinol
This is a circumscribed deposit of blood less than 0.5 cm in diameter
petechiae
What is a very common cause of cutaneous atrophy?
overuse of topical steroids or injection of SubQ steroid when it was supposed to be IM
What color are Spitz nevi?
pink to red
Autoantibodies to what kind of structures are present in the pemphigus group of immunobullous diseases?
desmosomes
These well circumscribed lesions contain a wall and a lumen and may contain solid or fluid matter?
Cyst
Compare and contrast the Tx of bullous pemphigoid and pemphigus vulgaris
They are actually the same? First use corticosteroids and follow up with steroid sparing drugs (mycophenolate moxetil and azathioprine) once under control. BUT rituximab seems to be reserved only for pemphigus vulgaris
What is the Tx of Linear IgA disease when not caused by an underlying drug problem?
Dapsone
How do you differentiate Stevens-Johnson syndrome from Toxic Epidermal Necrolysis?
less than 10% of body SA is involved in SJS and greater than 30 is involved in TEN? The inbetweeners are a mixed SJS-TEN Dx
T/F: there is no need to give systemic corticosteroids in allergic contact dermatitis
false, they are usually given d/t the severe nature of the rash
What are petechiae?
circumscribed deposit of blood less than 0.5 cm
What is the most common cause of erythema multiforme?
HSV
What is a lesion that involves a focal loss of epidermis ONLY? What is the next stage?
erosion, ulcer
What is the most common malignancy associated with paraneoplastic pemphigus?
Non-Hodgkin’s lymphoma
What is a patch?
A patch is a macule more than 3-4 cm in diameter
What is an excoriation?
An erosion caused specifically d/t scratching
What is the most common cause of Linear IgA disease?
Vancomycin and other drugs
What is the most common immunobullous disease?
bullous pemphigoid
What are excess dead epidermal cells produced by abnormal keratinization and shedding?
Scales
What is an area of thickening of the epidermis induced by scratching?
lichenification
What is a nevus that is present at birth?
Congenital nevus. OMG science
What eponym describes the ability to easily dissect through a bulla?
Nikolsky sign
Type of hypersensitivity in allergic contact dermatitis
Type IV
What is a cyst?
A circumscribed lesion with a wall and a lumen that may contain fluid or solid matter
Which type of melanoma contains no pigmentation?
amelanotic
Which subtype of melanoma is most likely to be present for a long time before being diagnosed?
Lentigo maligna melanoma
What occurs in the sensitization phase of allergic contact dermatitis?
exposure of the immune system to the hapten-peptide complex followed by clonal expansion of reactive T cells
T/F: most patients with dermatitis hepetiformis have celiac sprue
False? ALL patients with dermatitis herpetiformis have celiac sprue
What is a fissure?
a linear loss of epidermis AND dermis with sharply defined, near vertical walls
What are the autoantibodies targeting in pemphigus vulgaris?
desmoglein of desmosomes
What is a nevus that occurs in childhood or adulthood called?
A benign acquired nevus
What may be assoc. with hard and indurated skin?
scleroderma, myxedema, and amyloidosis
What does it mean to have a positive Nikolsky sign?
You can easly dissect your finger through the bulla
What is a nodule? What is a large nodule referred to as?
circumscribed elevated, and solid lesion greater than 0.5 cm? Large nodule = tumor
What is a dermal vesicle?
Okay, brace yourselves. It is a vesicle (i.e. free collection of fluid less than 0.5 cm in diameter) in? …THE DERMIS.
What are the autoantibodies against in pemphigus vulgaris? Bullous pemphigoid?
Pemphigus vulgaris = desmoglein of desmosomes; bullous pemphigoid = BPAg1 and 2
Which plant substance is involved in phytophotodermatitis?
furocoumarins (citrus fruit)
Name 5 secondary lesions
crusts, fissures, erosions, ulcer, scar
How is pemphigus foliaceous different from pemphigus vulgaris?
It is not as severe and they do NOT develop oral lesions
T/F: sentinal lymph node biopsy is a therapeutic procedure for mgmt of melanoma
False, it is done to obtain prognostic information
Where do fixed drug reactions tend to occur?
genital region
What does poor turgor indicate?
dehydration
Why is the center of the erythema multiforme lesion white while the surrounding areas are red?
At the center there is necrosis and surrounding it is erythema
What is the most serious complication of DRESS?
fulminant hepatic necrosis
What causes irritant contact dermatitis?
exposure to harsh solvents such as alkali or overexposure to mild solvents
How is a pustule different from a vesicle?
Pustule is a circumscribed collection of LEUKOCYTES and free fluid and vesicle is just free fluid
What are some of the most common causes of angular chelitis?
licking the lips and vitamin deficiencies
How does an ulcer heal? Why?
with scarring because the basal layer (stem cell layer) of epidermis is lost
Tissue at the base of an ulcer that is soft and friable is sometimes called ________ flesh
proud flesh
What are purpura?
circumscribed deposits of blood greater than 0.5 cm
Which type of melanoma has the highest rate of metastasis?
Nodular melanoma (because it grows down into skin and staging is by depth of invasion)
Which porphyria can be acquired with liver failure and HIV?
porphyria cutanea tarda
The necrotic, crusty (black) secondary lesions of herpes in the perianal area is called __________
herpes gangrenosum
How do you treat irritant contact dermatitis?
minimize exposure, for acute flares = topical corticosteroids, frequent emollient use
What is the main determinant of whether urticaria are acute or chronic?
the 6 week time period. If less than 6 weeks = acute, if greater than = chronic
If melanoma occurs in a congenital nevus, when is the earliest that is likely to occur?
puberty
Layterm for crusts
scab? Yes that’s right, only the modern medical intellects employ the fancy word “crust”
What is the most common cause of acute urticaria?
upper respiratory infection
What is the “knee-jerk” reaction as described by Dr. Lim when you see a polygonal plaque?
lichen planus, recall that a plaque is a confluence of papules
Damage to what layer is implied by the presence of a scar?
Dermis (at least) because the basal layer of epidermis is lost
What are other names for A) open comedone and B) closed comedone
A) blackhead B) whitehead
What happens to the amount of hair in Cushing’s dz and anemia?
more in Cushing’s Dz, less in anemia
4 general causes of erythema nodosum?
infections, medications (birth control!), IBD, and sarcoidosis
What dermatologic disease can rituximab (anti-CD21) be used to Tx?
Pemphigus vulgaris
What is the most common cause of autosensitization dermatitis?
stasis dermatitis
After removal of a melanoma, what dictates the next step in its management?
The thickness of the original tumor
Where are the lesions in pemphigus vulgaris?
In the mouth and skin? Bullous pemphigoid really does not involve the mouth unless it is just mucous membrane pemphigoid
What is (cutaneous) atrophy?
Depression in the skin from thinning of epidermis or dermis
What is the name of the feces of Scabies?
scybala
What may be assoc. with soft skin?
hypopituitarism or hypothyroidism
T/F: nuclear atypia in a dysplastic nevus is associated with a clinically benign outcome
True, dysplastic nevi are treated as benign conditions
What is the Tx of Linear IgA disease?
Removal of the offending agent
Where do melanomas most often arise?
In areas of skin where a nevus was not previously present
T/F: if a morbilliform drug eruption then the offending agent must be stopped immediately
false, it may be continued if necessary
What are the autoantibodies against in chronic autoimmune urticaria?
receptors on mast cells
What drugs are most likely to cause fixed drug eruption?
ibuprofen, naproxen, sulfonamides, and tetracyclines
What kind of urticaria develop after stressful events?
cholinergic urticaria
What’s the difference between a vesicle and a bulla?
A bulla is circumscribed collection of free fluid greater than 0.5 cm whereas a vesicle is less than 0.5 cm
What should you think if you see a burrow in the skin?
Scabies
What is the difference between a keloid and a hypertrophic scar?
A keloid is a tumor of scar tissue that grows beyond the bounds of the initial lesion whereas a hypertrophic scar is just an excessively thickened scar
Where does a pilar cyst come from? Where does an epidermal cyst come from?
Pilar cyst is from hair shaft, Epidermal cyst is from sebaceous gland and has a central punctum
What is the best way to remove a suspicious looking mole?
elliptical excision (as opposed to shave, saucerization, or punch)
When evaluating a patient for allergic contact dermatitis to everyday materials, what is the most important piece of information to receive?
ALL OF THE PRODUCTS THAT THEY ARE USING? It is more likely to be from something they have been using their whole life than something new
When is there a risk of melanoma in congenital nevi?
If they are very large
How do you treat allergic contact dermatitis?
topical and SYSTEMIC corticosteroids, systemic antihistamines, and soothing astringent wraps
4 places keloids tend to form?
neck, chest, shoulders, and upper back
What is the autoantigen in epidermolysis bullosa acquisita?
Type VII collagen
MOA of trametinib
Inhibits MEK when treating Melanoam
How do you tx porphyria cutanea tarda?
phlebotomy, the underlying cause is excess iron i.e. alcoholic cirrhosis, hemochromatosis and hepatocellular carcinoma? also LOW DOSE CHLOROQUINE
What is it called when macules coalesce? What about when papules coalesce?
macules = patch, papules = plaque
What is a circumscribed collection of leukocytes and free fluid that varies in size?
pustule
Give an example of a chemical that can cause vitiligo
phenols
What are scales?
Excess dead epidermal cells produced by abnromal keratinization and shedding
What are milia? How do you differentiate from a whitehead?
small superficial keratin cysts without a visible opening
What is dermatographism?
urticaria caused by rubbing or scratching the skin
This is the most common type of drug eruption
Morbilliform drug reaction
What is lichenification?
An area of thickening epidermis induced by scratching
This is a depression in the skin resulting from thinning of epidermis or dermis
atrophy
What are the autoantibodies targeting in bullous pemphigoid?
BPAg 1 and 2 (Bullous pemphigoid antigen 1 and 2)
Name the 2 BRAF inhibitors for melanoma
vemurafinib and dabrafenib
What does anasarca indicate?
could indicate severe liver or kidney disease with or without CHF
What are the steroid-sparing therapies for pemphigus vulgaris?
mycophenolate mofetil or azathioprine (and rituximab)
What demographic experiences the highest mortality rates with melanoma?
older men
What immune cells mediate phytophotodermatitis?
none it is not mediated by the immune system but by a phototoxic reaction
What differentiates erythema multiforme minor from major?
the amount of mucosal surface involvement
Which type of melanoma occurs mostly in African American, Africans, and Asians?
Acral lentiginous melanoma
What is the DOC for dermatitis herpetiformis?
dapsone but for long-term they need the gluten free diet
Involvement of what structues concurrent with congenital nevi carries a poor prognosis (regardless of malignant transformation)?
leptomeninges (pia and arachnoid)
What is the mainstay of Tx for pemphigus vulgaris?
Corticosteroids
What is a firm (i.e. indurated) edematous plaque resulting from infiltration of the dermis with fluid?
Wheal
What are the primary lesions of acne called?
Comedones
What is a vesicle?
Circiumscribed collection of free fluid up to 0.5 cm in diameter
Name 2 genes that have mutations which predispose to melanoma
CDKN2A and BRAF
What is the big issue with mucous membrane pemphigoid?
It results in scarring at whatever mucosal sites it involves (corneal blindness, esophageal stenosis, laryngeal stenosis)
What clinical sign can dermatologists use to tell which of a group of nevi is most likely to be melanoma
The Ugly Duckling sign–and these people need the highest board scores of all
What is the clinical manifestation of allergic contact dermatitis?
eczematous dermatitis = itch, edema, erythema, and vesicle formation if acute/subacute and lichenification if chronic
What kind of conditions are associated with acne excoriate?
neuroses, because they scratch like crazy (pun intended) at their acne leading to excoriations
