Other general dermatology Flashcards
Name the diagnosis.
- What are classic areas of involvement?
- What lab value abnormality is notable?
- What disorders or medications is this associated with?
Eruptive xanthoma
- Numerous red-yellow papules on extensor surfaces, buttocks, intertriginous areas
- Triglycerides > 3,000 mg/dL
- Associated with type I, IV and V hyperlipidemias, oral retinoids
Name the diagnosis.
- What are classic areas of involvement?
- What lab value abnormality is notable?
- What disorders or medications is this associated with?
Eruptive xanthoma
- Numerous red-yellow papules on extensor surfaces, buttocks, intertriginous areas
- Triglycerides > 3000 mg/dL
- Associated with type I, IV and V hyperlipidemias, oral retinoids
Name the diagnosis.
- What are classic areas of involvement?
- What lab value abnormality is notable?
- What disorders or medications is this associated with?
Eruptive xanthoma
- Numerous red-yellow papules on extensor surfaces, buttocks, intertriginous areas
- Triglycerides > 3,000 mg/dL
- Associated with type I, IV and V hyperlipidemias, oral retinoids
Name the diagnosis.
- What is the best treatment option?
Xanthelasma
- Plane xanthoma on eyelids
- Only 50% have hyperlipidemia
- Surgery is best treatment option
Name the diagnosis.
- What is the best treatment option?
Xanthelasma
- Plane xanthoma on eyelids
- Only 50% have hyperlipidemia
- Surgery is best treatment option
What percentage of patients with xanthelasma have hyperlipidemia?
50%
Name the types of cutaneous xanthomas. (6)
- Eruptive xanthomas
- Tuberous xanthomas
- Tendinous xanthomas
- Plane xanthomas
- Xanthelasma
- Verruciform xanthoma
What is the classic histopathology of cutaneous xanthomas?
- What is present in the dermis?
- What may also be present?
- Foam cells (macrophages with lipidized cytoplasm) in dermis
- Foam cells are predominantly of superficial dermis in plane xanthomas and deeper in dermis/subcutis in tuberous and tendinous xanthomas
- Touton giant cells may also be present
Name the diagnosis.
- Where is this mainly found?
- What disorders is this seen in?
Tuberous xanthomas
- Yellow-pink indurated nodules
- Mainly on elbows and knees
- Most strongly associated with type II and III hyperlipoproteinemias
Name the diagnosis.
- Where is this mainly found?
- What disorders is this seen in?
Tuberous xanthomas
- Yellow-pink indurated nodules
- Mainly on elbows and knees
- Most strongly associated with type II and III hyperlipoproteinemias
Name the diagnosis.
- Where is this mainly found?
- What disorders is this seen in?
Tendinous xanthoma
- Firm nodules on Achilles tendon and extensor tendons of fingers/hands
- Usually seen in type II hyperlipidemia ( > type III)
Name the diagnosis.
- If this is found on the palmar/finger creases, what is it called, and what disorder is it pathognomonic for?
- If this is found on the intertriginous areas and web spaces, what disorder is it pathognomonic for?
Plane xanthoma
- Occurrence in palmar/finger creases (xanthoma striatum palmare) is pathognomonic for dysbetalipoproteinemia
- Occurrence in intertriginous areas and web spaces of fingers usually diagnostic for homozygous familial hypercholesterolemia (type II hyperlipidemia)
Name the diagnosis.
- If this is found on the palmar/finger creases, what is it called, and what disorder is it pathognomonic for?
- If this is found on the intertriginous areas and web spaces, what disorder is it pathognomonic for?
Plane xanthoma
- Occurrence in palmar/finger creases (xanthoma striatum palmare, as in this case) is pathognomonic for dysbetalipoproteinemia
- Occurrence in intertriginous areas and web spaces of fingers usually diagnostic for homozygous familial hypercholesterolemia (type II hyperlipidemia)
Name the diagnosis.
- Where is this typically found?
- Is this associated with a hyperlipidemia?
- What is the histopathology of this? What occurs in the epidermis and dermal papillae?
Verruciform xanthoma
- Verrucous plaque(s) typically in mouth or genital area
- NOT associated with hyperlipidemia
- Unique histology: papillomatous epidermal hyperplasia with foam cells in the dermal papillae
What is the suspected pathogenesis of cutaneous amyloidosis?
- What is its histopathology?
- Extracellular deposition of amyloid, a fibril protein in a cross-beta-pleated sheet
- Basic histology: homogenous, eosinophilic, fissured masses that stain with Congo red and have green birefringence with polarized light
Name the diagnosis.
Lichen amyloidosis
Name the diagnosis.
Macular amyloidosis
Name the diagnosis.
Nodular amyloidosis
Name the diagnosis.
Nodular amyloidosis
Name the three types of localized cutaneous amyloidosis.
- Macular amyloidosis
- Lichen amyloidosis
- Nodular amyloidosis
What is the derivation of the amyloid in the following (i.e., what makes up the amyloid)?
- Macular
- Lichen
- Nodular
- Macular: Keratinocyte tonofilaments (usually keratin 5)
- Lichen: Keratinocyte tonofilaments (usually keratin 5)
- Nodular: IgG light chains
What does cutaneous amyloidosis stain with? (4)
- Congo red (classic association)
- Crystal violet
- PAS
- Thioflavin T
Describe primary systemic amyloidosis.
- What is the usual underlying cause?
- What are the notable exam findings?
- What should be checked?
- Amyloid light chain-type (AL) amyloidosis
- Can involve several organ systems
- Look for mucocutaneous lesions (30% of patients)
- Due to underlying plasma cell dyscrasia
- Waxy, translucent or purpuric papules/nodules/plaques
- Ecchymoses/pinch purpura (eyelids, neck, anogenital, axillae)
- Macroglossia
- Carpal tunnel syndrome
- Check UPEP/SPEP and immunofixation electrophoresis (IFE)
Describe secondary systemic amyloidosis.
- What is it usually a sequela of?
- What is it composed of?
- Where does it deposit usually?
- Sequela of chronic inflammatory disease
- I.e., TB, scleroderma, ankylosing spondylitis
- Made up of AA amyloid
- Rarely deposited in skin; mainly kidneys, liver, spleen, adrenals, heart
What composes the amyloid classically seen in hemodialysis patients?
- What area is usually involved?
A-beta-2M amyloid (a.k.a. beta-2 microglobulin)
- Usually no skin involvement, but may see subcutaneous nodules on the lower back
What disorder is this finding classically associated with?
Primary systemic amyloidosis (amyloid light chain-type, AL)
(Macroglossia)
What disorder is this finding classically associated with?
Primary systemic amyloidosis
(Pinch purpura)
What are the classic histology findings of primary systemic amyloidosis?
- Where is amyloid deposited?
- Amyloid throughout the dermis and subcutis, in sweat glands and blood vessel walls
Name the diagnosis.
Melasma
- Symmetric, light to dark brown/gray irregular patches on face
- Three patterns: centrofacial, malar and mandibular
- Four types: epidermal, dermal, mixed and indeterminate
- Epidermal areas accentuated with Wood’s lamp; dermal areas are not
Name the diagnosis.
Melasma
- Symmetric, light to dark brown/gray irregular patches on face
- Three patterns: centrofacial, malar and mandibular
- Four types: epidermal, dermal, mixed and indeterminate
- Epidermal areas accentuated with Wood’s lamp; dermal areas are not
Name the diagnosis.
Melasma
- Symmetric, light to dark brown/gray irregular patches on face
- Three patterns: centrofacial, malar and mandibular
- Four types: epidermal, dermal, mixed and indeterminate
- Epidermal areas accentuated with Wood’s lamp; dermal areas are not
Describe the histopathological findings of melasma.
- What happens to melanin, melanophages and melanocytes?
- Increased melanin in all layers of epidermis
- Increased melanophages
- Normal-to-increased epidermal melanocytes
Name the diagnosis.
- What is this due to?
- What is this physical exam finding called?
- What may also be seen?
Pellagra
Vitamin B3 (niacin) deficiency
- This physical exam finding is called “Casal’s necklace”
- Also see photosensitivity (esp. dorsal hands), cheilitis
Name the diagnosis.
- What is this due to?
- What is this physical exam finding called?
- What may also be seen?
Pellagra
Vitamin B3 (niacin) deficiency
- This physical finding is called “Casal’s necklace”
- Also see photosensitivity (esp. dorsal hands), cheilitis
Name the diagnosis.
- What is this due to?
- What is the physical exam buzzword?
Phyrnoderma
(vitamin A deficiency)
- Keratotic follicular papules resembling toadskin
Name the diagnosis.
- What is this due to?
- What may also be seen?
Pellagra
Vitamin B3 (niacin) deficiency
- Findings are Casal’s necklace, photosensitivity (especially of dorsal hands), cheilitis
Name the diagnosis.
- What is this due to?
- What may also be seen? (3)
Scurvy
(vitamin C deficiency)
- Corkscrew hair
- Perifollicular hemorrhage and hyperkeratosis
- Hemorrhagic gingitivitis
- Splinter hemorrhage of nails
Name the diagnosis.
- What is this due to?
- What may also be seen? (3)
Scurvy
(vitamin C deficiency)
- Corkscrew hair
- Perifollicular hemorrhage and hyperkeratosis
- Hemorrhagic gingivitis
- Splinter hemorrhage of nails
Name the diagnosis.
- What is this due to?
- What may also be seen? (3)
Scurvy
(Vitamin C deficiency)
- Corkscrew hair
- Perifollicular hemorrhage and hyperkeratosis
- Hemorrhagic gingitivitis
- Splinter hemorrhage of nails
What nutritional deficiency is this?
Acquired zinc deficiency
- Perianal, perioral and acral erosions
What nutritional deficiency is this?
Zinc deficiency
- Perianal, perioral and acral erosions
- Can look like a diaper rash
Name the diagnosis.
- What is in the tissue?
- At what sites is this most common?
Gout
- Monosodium urate crystals in tissue
- Gouty tophi (firm white-yellow subcutaneous nodules)
- Most common on:
- Ear helix
- Skin over small joints (fingers, toes)
Name the diagnosis.
- What is in the tissue?
- At what sites is this most common?
Gout
- Monosodium urate crystals in tissue
- Gouty tophi (firm white-yellow subcutaneous nodules)
- Most common on:
- Ear helix
- Skin over small joints (fingers, toes)
Name the diagnosis.
- What is in the tissue?
- At what sites is this most common?
Gout
- Monosodium urate crystals in tissue
- Gouty tophi (firm white-yellow subcutaneous nodules)
- Most common on:
- Ear helix
- Skin over small joints (fingers, toes)
Name the diagnosis.
Colloid milium
- Happens in adults on photodamaged skin (yellow papules in photo-exposed areas)
- Also a juvenile form
Name the diagnosis.
Colloid milium
- Happens in adults on photodamaged skin (yellow papules in photo-exposed areas)
- Also a juvenile form
What are the key histology findings in androgenetic alopecia?
- What types of hairs are more abundant and less abundant?
- What phase is shortened?
- Increased vellus and miniaturized hairs
- Decreased terminal hairs
- Shortened anagen phase (a.k.a. “catagen/telogen shift”)
-
Increased fibrous streamers
- Fibromucinous tracts underneath miniaturized hairs
- Hairs cycling more rapidly out of anagen phase
What is the pattern of hair loss of androgenetic alopecia in men?
- Progressive frontotemporal hairline recession
- Thinning over frontal crown and vertex scalp
What is the pattern of hair loss of androgenetic alopecia in women?
- What is preserved?
- Where does thinning occur?
- What is the physical exam buzzword?
- Preservation of frontal hairline with progressive thinning from vertex to frontal scalp
- Increased central part width creates “Christmas tree” pattern
