pathogenic mechanism of skin disease

Question 1

stratum lucidum is seen in

Answer 1

feet/hands

Question 2

Pemphigoid
Pemphigus
Dermatitis Herpetiformis

Answer 2

Autoimmune disorders resulting in bulla/blister formation

Question 3

targets older patients (60-80yo)
Intensely pruritic red plaques and tense bullae
Histology shows a subepidermal blister on H&E
Direct immunofluorescence exhibits linear IgG and complement along the basement membrane
Autoantibodies targeting BP230 and BP180 antigens-components of hemidesmosomes.

Answer 3

Bullous pemphigoid

Question 4

treatment of Bullous pemphigoid

Answer 4

calm down the inflammation by topical steroids

Question 5

hemosdomes attacking process

Answer 5

Pemphigoid

Question 6

split within the epidermis- katynocytes break apart process and has mucosal involvement

Answer 6

pemphigus

Question 7

Flaccid bullae formed by intraepidermal acantholysis.
Pts typically age 40-60.
Lesions are painful rather than pruritic.
50-70% start with mucous membrane symptoms, but nearly all eventually have mucosal involvement.
Disease can be progressive without treatment.
Antibody mediated autoimmune disease targeting dsg3 primarily, as well as dsg1-both components of desmosomes.

Answer 7

Pemphigus vulgaris

Question 8

treatment of pemphigus

Answer 8

need systemic treatment, tropical treatments are not enough

Question 9

IgG process against the desmosomes

Answer 9

pemphigus

Question 10

Associated with various systemic processes including lymphoma, adenocarcinoma, castleman’s, thymoma, and others.

Answer 10

paraneoplastic pemphigus

Question 11

Intensely pruritic immunobullous disorder affecting extensor surfaces and lower back.
Rarely see blisters on exam-usually excoriated.
Often associated with a gluten enteropathy.
Autoantibody (IgA) to epidermal transglutaminase 3.
Neutrophil dominant disorder-IgA attracts neuts, as opposed to the IgG mediated BP and PV which attract eosinophils.

Answer 11

dermatitis herpetiforms

Question 12

extensor skin involvement

Answer 12

dermatitis herpetiformis

Question 13

IgA mediated process in the epidermal junction and associated with gluten

Answer 13

dermatitis herpetiformis

Question 14

treatment of dermatitis herpetiforms

Answer 14

dapsone (also is used as a diagnostic tool) and diet-modification

Question 15

Neural crest derived cells
5-10% of cells in the basal layer
Produce melanin that is then transported into neighboring keratinocytes
Role is protection from UV radiation

Answer 15

melanocytes

Question 16

melanin is produced by _______ and transferred to ______

Answer 16

produced by melanocytes and transferred to kerationocytes

Question 17

Absorbs most UV (~99%) radiation
Derived from tyrosine
Most humans express eumelanin
Redheads express pheomelanin-not as effective

Answer 17

melanin

Question 18

oculocutaneous albinims is due to a defect in

Answer 18

tyrosine metabolism

Question 19

normal melanocyte number but no melanin

Answer 19

albinism

Question 20

Well demarcated patches of depigmentation
Complete loss of melanocytes
Pathogenesis unclear-autoimmune, cytotoxicity, genetics, etc.

Answer 20

vitiligo

Question 21

melasma

Answer 21

increased activity of melanin due to increased hormones such as progesterone or estrogen maybe from OCP

Question 22

-Patchy Hyperpigmentation commonly found in women
-Often involves the cheeks, forehead and upper lip
-More common in skin of color but may develop in anyone
-Often triggered by hormonal change
Oral Contraceptives
Pregnancy

Answer 22

melasma