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Dermatology > Pathology of rashes > Flashcards

Pathology of rashes Flashcards

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Dermatology Board Prep flashcards
1
Q

What is hyperkeratosis?

A

Increased thickness of keratin layer

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2
Q

What is parakeratosis?

A

Persistence of nuclei in the keratin layer

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3
Q

What is acanthosis?

A

Increased thickness of the epidermis

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4
Q

What is papillomatosis?

A

Irregular epithelial thickening

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5
Q

What are the four main reaction patterns in rashes?

A

Spongiotic
Psoriasiform
Lichenoid
Vesiculobullous

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6
Q

Which condition is an example of a spongiotic rash?

A

Eczema

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7
Q

Which condition is an example of a psoriasiform rash?

A

Psoriasis

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8
Q

Which conditions are examples of a lichenoid rash?

A

Lichen planus

Lupus

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9
Q

Which conditions are examples of a vesiculobullous rash?

A

Pemphigoid
Pemphigus
Dermatitis herpetiformis

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10
Q

What is a spongiotic rash pattern?

A

Intraepidermal oedema

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11
Q

What can be seen histologically in a psoriasiform rash?

A

Elongation of the rete ridges

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12
Q

What can be seen histologically in a lichenoid rash?

A

Basal layer damage

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13
Q

What can be seen histologically in a vesiculobullous rash?

A

Blistering

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14
Q

What is the Koebner phenomenon?

A

A new psoriatic lesion may appear at site of trauma

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15
Q

What is the pathological process in psoriasis?

A

Epidermal hyperplasia - keratin migrates from the basal layer to the keratin layer much faster than normal
There is increased epidermal turnover which causes scaly plaques to form on the skin

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16
Q

Which sites are most commonly affected by psoriasis?

A 
Extensors (elbow, knee)
Scalp
Sacrum
Hands
Feet
Trunk
Nails
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17
Q

What do the plaques in psoriasis look like?

A

Symmetrical
Well demarcated
Erythematous
Scaly

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18
Q

What are some of the nail changes that can occur in psoriasis?

A

Onycholysis
Nail pitting
Dystrophy
Subungal hyperkeratosis

19
Q

What is acne vulgaris?

A

A chronic inflammatory disease of the pilosebaceous unit

20
Q

Where is acne vulgaris typically distributed?

A

Face
Upper back
Anterior chest

21
Q

At what age do patients typically present with acne vulgaris?

A

14 -17 years in females

16 -19 years in males

22
Q

What is the pathogenesis of acne vulgaris?

A

There is plugging of the pore by sebum
Bacterial colonisation of the pore occurs, and fills with keratin and sebum creating comedones (whiteheads and blackheads)
These rupture, causing inflammation

23
Q

What is acne rosacea?

A

Prominent facial flushing exacerbated by sudden change in temperature, alcohol or spicy food
A rash consisting of papules, pustules and erythema but no comedones

24
Q

Where is acne rosacea distributed?

A

Nose
Cheeks
Chin
Forehead

25
Q

What are immunobullous diseases?

A

Skin diseases/rashes that have blisters as the primary feature

26
Q

Which patients are typically affected by bullous pemphigoid?

A

Elderly patients

27
Q

What does the blister in bullous pemphigoid look like?

A

Large tense bullae on normal skin or erythematous base

28
Q

What is the pathology in bullous pemphigoid?

A

Splitting at the DEJ - pemphigoiD splits Deep at the DEJ

Circulating IgG antibodies attack the anchors that hold the basal cells to the basement membrane

29
Q

Which areas does bullous pemphigoid tend to affect?

A

Either localised to one area or widespread over proximal limbs and trunk

30
Q

What is pemphigus?

A

A rare autoimmune bullous disease resulting in loss of integrity of epidermal cell adhesion

31
Q

What is the most common form of pemphigus?

A

Pemphigus vulgaris

32
Q

What is the pathogenesis of pemphigus vulgaris?

A

IgG auto-antibodies made against desmoglein 3 which maintains desmosomal attachments
Immune complexes form on cell surface, and there is complement activation and protease release causing disruption of desmosomes
This causes acantholysis

33
Q

Which areas does pemphigus vulgaris tend to affect?

A 
Face
Axillae
Scalp
Groin
Trunk
Mucosal tissue e.g. eyes, genitals, mouth, respiratory tract
34
Q

In which cases might pemphigus vulgaris be fatal?

A

Extensive involvement of mucosal tissue e.g. respiratory tract

35
Q

What is Nikolsky sign?

A

A skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed

36
Q

Is Nikolsky sign positive or negative in bullous pemphigoid?

A

Negative

37
Q

Is Nikolsky sign positive or negative in pemphigus?

A

Positive

38
Q

What do the lesions in pemphigus vulgaris look like?

A

Flaccid vesicles/bullae – thin roofed
Lesions rupture to leave raw areas
Erosions rather than bullae

39
Q

What is the prognosis following diagnosis of an immunobullous disease?

A

Chronic self limiting condition: most patients achieve remission after 3-6 months
High mortality if left untreated

40
Q

Which immunobullous disease has a strong association with coeliacs disease?

A

Dermatitis herpeteformis

41
Q

Which gene is dermatitis herpeteformis associated with?

A

HLA-DQ2 haplotype

42
Q

What are the lesions in dermatitis herpeteformis?

A

Intensely itchy symmetrical lesions, often excoriated

Papillary dermal microabscesses

43
Q

Where are the lesions in dermatitis herpeteformis typically found?

A

Elbows
Knees
Buttocks

Dermatology (8 decks)

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