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Dermatology > Pathology of Rashes > Flashcards

Pathology of Rashes Flashcards

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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
Where can lichen plaus affect?
Skin, mucous membranes, genetalia, scalp
26
What are the different types of immunobullous disorders?
Pemphigus Bullous pemphigoid Dermatitis herpetiformis
27
What is pemphigus?
An autoimmune bullous disease that causes bullae dut to a loss of integrity of epidermal cell adhesion
28
Why is there a loss of integrity in the epidermal cell adhesion?
IgG autoantibody is produced that attackes desmoglein 3 in prickle cell layer
29
What is the pathogenesis of pemphigus vulgaris?
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
What areas of the skin can be affected by pemphigus vulgaris?
Skin esp. scalp, face, axillae, groin and trunk | Can affect mucosa e.g. mouth, resp. tract
31
Where does bullous pemphigoid attack?
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
What does immunoflourescence show for bullous pemphiogoid?
Linear IgG and complement deposited around the basement membrane
33
What GI condition is dermatitis herpatiformis assocaited with?
Coeliac disease | Autoimmune bullous disease
34
Where is dermatitis herpetiformis most likely to present?
Elbows Knees Buttocks
35
What does dermatitis herpetiformis show histologically?
Papillary dermal microabscesses | Deposts of IgA in dermal papillae
36
Where is acne most common?
Face Upper back Anterior chest
37
What is the aetiology of acne?
Increased androgens at puberty which increases the activity of sebaceous glands Pilosebacous units get plugged with keratin Infection with anaerobic bacterum corynebacterium acnes
38
What are the hallmarkes of rosacea?
Recurrent facial flushing Telangiectasia Pustules Thickening of skin around nose - phinophyma
39
What can trigger rosacea?
Sunlight Alcohol Spicy foods Stress
40
What can be used to treat rosacea?
Tetracyclines
41
What is the pathology of rosacea?
``` Vascular ectasia Patchy inflammation with plasma cells Pustules Perifollicular granulomas Follicular demodex mites ```
42
What are the different types of psoriasis?
Psoriais vulgaris Guttate psoriasisi Palmoplantar pustular Erythrodermic pustular
43
What systemic effects can psoriasis have?
``` Psoriatic arthritis Metabolic syndrome Crohn's disease Malignancies Depression Uveitis ```
44
What is the metabolic syndrome?
Obestiry Hypertension Diabetes Lipid abnormalities
45
What therapies can be used for psoriasis?
``` Vitamin D analogues Coal tar Dithranol Steroid ointments Emollients UV phototherapy Immunosuppresion with methotrexate ```
46
Why is isotretinoin only able to be prescribed by secondary care?
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
What is the difference between a black and whitehead?
A blackhead it an open comedone | A whitehead is a closed comodone
48
What is the morphology of acne vulgaris?
Comedones Pustules and papules Cysts Erythema
49
What is acne excoriee?
A type of pschogenic acne whereby patients pick at their acne causing erosions and scarring
50
What are the different types of topical treatment avaliable to treat acne?
``` Benzoly peroxide (keratolytic, antibacterial) Topical vitamin A (retinoid) - drying effect Topical antibiotics (antibacterial and anti-inflammatory) ```
51
What are the systemic treatment avaliable for acne?
``` Tetracycline antibiotics (antibacterial and anti-inflammatory) Isotretinoin (oral retinoid) - effect on sebacous gland activity ```
52
What is the morphology of acne rosacea?
Papules, pustules and erythema but no comedones Prominent facial flushing exaerbated by a sudden change in temp, alcohol or spicy food Rhinophyma Conjunctivitis
53
How is rosacea managed?
Reduce aggravating factors (dietary triggers, sun exposure, avoid topical steroids)
54
What topical therapies are avaliable for roseacea?
Metrondiazole | Ivermectin (to reduce dermox mite)
55
What oral therapies are avaliable for rosacea?
Oral tetracycline | Istretinoin if severe
56
How can telangiectasia be managed?
Vascular laser
57
How can rhinophyma be managed?
Surgery/ laser shaving
58
What is wickham's striae?
Fine lace-like pattern on surface of papules and buccal mucosa
59
How is lichen planus treated?
Topical or oral steroids
60
How can you remember the difference between bullous pemphigoid and pemphigus?
Bullous pemphigoiD - split is Deeper through the DEJ | PemphiguS - split is more Superficial, intra-eppidermal
61
What is nikolsky's sign?
The top layers of the skin slip away from the lower layers when slightly rubbed Indicated pemphigus
62
How are pemphigoid and pemphigus treated?
Systemic steroids Other immunosuppresive agents Pemphigoid = tetracytcline antibiotics Topicals: emollients, topical steroids, topical sntiseptics
63
How is pemphigus and pemphigoid investigated?
Skin biopsy with direct immunofluorescence | Indirect immunofluroscence

Dermatology (24 decks)

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