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Dermatology > Pathology of Rashes > Flashcards

Pathology of Rashes Flashcards

1
Q

What are the prominent cells in the prickle cell layer?

A

Desmosomes

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2
Q

What cells make up the epidermis?

A

Stratified keratiising squamous epithelium

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3
Q

What makes up the dermis?

A

Matrix of type 1 and type 111 collagen, elastic fibres and ground substance (hyaluronic acid and chondroitin sulphate)

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4
Q

Where does the papillary dermis lie?

A

Thin layer that lies just beneath the epidermis

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5
Q

Where does the reticular dermis lie?

A

In thicker bundles, type 1 collagen

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6
Q

What does the reticular dermis contain?

A

Sweat glands, pilosebacous units

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7
Q

What is hyperkeratosis?

A

Increased thickness of keratin layer

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8
Q

What is parakeratosis?

A

Persistence of nuclei in the keratin layer due to the epidermis turning over too quickly

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9
Q

What is acanthosis?

A

Increased thickenss of epitheium

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10
Q

What is the papillomatosis?

A

Irregular epithelial thickening

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11
Q

What is spongiosis?

A

Oedema fluid between squames appears to increase in prominence of intercellular prickles
If severe the vesicles filled by odemea fluid develop

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12
Q

What is an example of papilllomatosis?

A

Acanthosis nigricans in diabetes which is where there is thick velvety folds in the axillae

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13
Q

What is an example of a spongiotic-intraepidermal oedematous disease?

A

Eczema

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14
Q

What is an example of a psoriasiform-elongartion of the rete ridges?

A

Psoriasis

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15
Q

What is an example of lichenoid-basal layer damage?

A

Lichen planus and lupus

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16
Q

What is an example of vesiculobullous-blistering?

A

Pemphigoid, pemphigus and dermatitis herpetiformis

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17
Q

What is the pathogenesis of psoriaisis?

A

Epidermal hyperplasia
Heriditary factors
Associated specific HLA types
Complement mediated attack on keratin layer (complement attracts neutrophils to keratin layer creating munro micro abscesses)

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18
Q

What is the koebner phenomenon?

A

New lesions can arise at site of trauma

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19
Q

How would you describe a psoriasis rash?

A

Well defined, erythematous plaque with scales on the surface
On extensor surfaces and often symmetrical

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20
Q

What effect can psoriasis have on the nails?

A 
Fungal infection 
Onchylosis 
Nail dystrophy
Nail pitting
Subungal hyperkeratosis
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21
Q

What does psoriasis look like histologically?

A

Elongated rete ridges
Aggregates of neutrophils at the upper end of the dermis
Parakeratosis
Auspitz sign

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22
Q

What is auspitz sign?

A

Appearance of small bleeing points after successive layers of scale have been removed from the surface of psoriatic papules or plaques

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23
Q

What are lichenoid disorders?

A

Conditions characterised by damage to the basal epidermis

Itchy flat topped violaceous papules

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24
Q

What does lichen planus look like histologically?

A

Irregular sawtooth acanthosis (diffuse epidermal hyperplasia)
Hypergranulosis and orthohyperkeratosis (hyperkeratosis without parakeratosis)
Band-like upper dermal infiltrate of lymphocytes
Basal damage with formation of cytoid bodies

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25
Q

Where can lichen plaus affect?

A

Skin, mucous membranes, genetalia, scalp

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26
Q

What are the different types of immunobullous disorders?

A

Pemphigus
Bullous pemphigoid
Dermatitis herpetiformis

27
Q

What is pemphigus?

A

An autoimmune bullous disease that causes bullae dut to a loss of integrity of epidermal cell adhesion

28
Q

Why is there a loss of integrity in the epidermal cell adhesion?

A

IgG autoantibody is produced that attackes desmoglein 3 in prickle cell layer

29
Q

What is the pathogenesis of pemphigus vulgaris?

A

Desmoglein 3 attacked by IgG autoantibodies
Immune compexes form on cell surface
Complement activation and protease release
Disruption of desmosomes
End result in acantholysis (lysis of epithelial cell attachments)

30
Q

What areas of the skin can be affected by pemphigus vulgaris?

A

Skin esp. scalp, face, axillae, groin and trunk

Can affect mucosa e.g. mouth, resp. tract

31
Q

Where does bullous pemphigoid attack?

A

Subepidermal blister with no evidence of acantholysis
Ciculating IgG antibodies attack hemidesmosomes which anchor basal cell to the basement membrane causing local complement activation and tissue damage

32
Q

What does immunoflourescence show for bullous pemphiogoid?

A

Linear IgG and complement deposited around the basement membrane

33
Q

What GI condition is dermatitis herpatiformis assocaited with?

A

Coeliac disease

Autoimmune bullous disease

34
Q

Where is dermatitis herpetiformis most likely to present?

A

Elbows
Knees
Buttocks

35
Q

What does dermatitis herpetiformis show histologically?

A

Papillary dermal microabscesses

Deposts of IgA in dermal papillae

36
Q

Where is acne most common?

A

Face
Upper back
Anterior chest

37
Q

What is the aetiology of acne?

A

Increased androgens at puberty which increases the activity of sebaceous glands
Pilosebacous units get plugged with keratin
Infection with anaerobic bacterum corynebacterium acnes

38
Q

What are the hallmarkes of rosacea?

A

Recurrent facial flushing
Telangiectasia
Pustules
Thickening of skin around nose - phinophyma

39
Q

What can trigger rosacea?

A

Sunlight
Alcohol
Spicy foods
Stress

40
Q

What can be used to treat rosacea?

A

Tetracyclines

41
Q

What is the pathology of rosacea?

A 
Vascular ectasia 
Patchy inflammation with plasma cells
Pustules
Perifollicular granulomas
Follicular demodex mites
42
Q

What are the different types of psoriasis?

A

Psoriais vulgaris
Guttate psoriasisi
Palmoplantar pustular
Erythrodermic pustular

43
Q

What systemic effects can psoriasis have?

A 
Psoriatic arthritis 
Metabolic syndrome 
Crohn's disease 
Malignancies
Depression
Uveitis
44
Q

What is the metabolic syndrome?

A

Obestiry
Hypertension
Diabetes
Lipid abnormalities

45
Q

What therapies can be used for psoriasis?

A 
Vitamin D analogues 
Coal tar
Dithranol
Steroid ointments
Emollients 
UV phototherapy
Immunosuppresion with methotrexate
46
Q

Why is isotretinoin only able to be prescribed by secondary care?

A

Causes profound birth defects so patients need to be on birth control
Will initially cause a flare up of the acne before it calms down

47
Q

What is the difference between a black and whitehead?

A

A blackhead it an open comedone

A whitehead is a closed comodone

48
Q

What is the morphology of acne vulgaris?

A

Comedones
Pustules and papules
Cysts
Erythema

49
Q

What is acne excoriee?

A

A type of pschogenic acne whereby patients pick at their acne causing erosions and scarring

50
Q

What are the different types of topical treatment avaliable to treat acne?

A 
Benzoly peroxide (keratolytic, antibacterial) 
Topical vitamin A (retinoid) - drying effect
Topical antibiotics (antibacterial and anti-inflammatory)
51
Q

What are the systemic treatment avaliable for acne?

A 
Tetracycline antibiotics (antibacterial and anti-inflammatory) 
Isotretinoin (oral retinoid) - effect on sebacous gland activity
52
Q

What is the morphology of acne rosacea?

A

Papules, pustules and erythema but no comedones
Prominent facial flushing exaerbated by a sudden change in temp, alcohol or spicy food
Rhinophyma
Conjunctivitis

53
Q

How is rosacea managed?

A

Reduce aggravating factors (dietary triggers, sun exposure, avoid topical steroids)

54
Q

What topical therapies are avaliable for roseacea?

A

Metrondiazole

Ivermectin (to reduce dermox mite)

55
Q

What oral therapies are avaliable for rosacea?

A

Oral tetracycline

Istretinoin if severe

56
Q

How can telangiectasia be managed?

A

Vascular laser

57
Q

How can rhinophyma be managed?

A

Surgery/ laser shaving

58
Q

What is wickham’s striae?

A

Fine lace-like pattern on surface of papules and buccal mucosa

59
Q

How is lichen planus treated?

A

Topical or oral steroids

60
Q

How can you remember the difference between bullous pemphigoid and pemphigus?

A

Bullous pemphigoiD - split is Deeper through the DEJ

PemphiguS - split is more Superficial, intra-eppidermal

61
Q

What is nikolsky’s sign?

A

The top layers of the skin slip away from the lower layers when slightly rubbed
Indicated pemphigus

62
Q

How are pemphigoid and pemphigus treated?

A

Systemic steroids
Other immunosuppresive agents
Pemphigoid = tetracytcline antibiotics
Topicals: emollients, topical steroids, topical sntiseptics

63
Q

How is pemphigus and pemphigoid investigated?

A

Skin biopsy with direct immunofluorescence

Indirect immunofluroscence

Dermatology (24 decks)

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