PGY2-General Dermatology Flashcards
List 6 clinical variants psoriasis
- Plaque
- Pustular-multiple subtypes
- Guttate
- Erythrodermic
- Special locations-scalp, inverse, nail, oral
- Psoriatic arthritis: 5 subtypes
List 5 variants pustular psoriasis
- Generalized pustular psoriasis VEAL
o Von Zombusch
o Exanthematic
o Annular of lapier
o Localized
-Gestational/Impetigo herpetiformis - Acrodermatitis continua of Hallopeau
- Acrodermatitis repens of Crocker
- Pustular psoriasis of palms and soles
VEALGAAP
List psoriasis triggers
PITTED NAILS
- Psychogenic stress
- Infection (e.g., streptococcus)
- Trauma/koebner
- Terrible habits (e.g., EtOH and smoking)
- Endocrine (e.g., pregnancy, hypocalcemia)
- Drugs= NAILS (see below)
List 5 systemic associations with psoriasis
a. Metabolic dz
b. Diabetes
c. Obesity
d. IBD
e. PG
f. RA
g. Celiac
List 10 causes drug induced psoriasis
- NSAIDS-e.g. indomethacin
- Anti-malarial -CQ/HQ
- Anti-hypertensive (ACEi, betablockers)
- Infliximab and other anti-TNFs
- Interferon
- Imiquimod
- Lithium
- Steroids withdrawl
Others:
* Quinidine
* Gemfibrozil
* Clonidine
* Rapid taper of cyclosporine
* GM-CSF/G-CSF
* SSKI
* Bupropion/Wellbutrin
What are the variants of PsA
SODAS:
Spondylitis + sacroiliitis (5%): often HLA-B27 + (w/ IBD, uveitis)
Asymmetric Oligoarthritis + Mono (70%)
DIPs (OA-like, 5%): exclusively DIPs, classic, but uncommon
Arthritis Mutilans: (5%, least common)
Symmetric RA-like (MCPs, PIPs, 15%): sym polyarthritis of small-med joints
What 3 psoriasis sites in a patient are high risk for arthritis
- Scalp
- Nails
- Gluteal cleft
- Severe psoriasis
Name 10 histological signs in psoriasis
- Regular acanthosis
- Confluent parakeratosis
- Munroe’s micro abscesses (stratum corneum)
- Spongiform pustules of Kojog (stratum spinosum)
- Squirting papillae (neutrophils discharge from papillary dermal tips)
- Thinning supra-papillary plates
- Dilated and tortuous capillaries in dermal papillae
- Elongation dermal papillae
- Superficial perivascular infiltrate w/ lymphocytes and macrophages
- Decreased or absent granular layer
- Elongated and squared off rete ridges
What does PASI stand for? What min and max score?
a. Psoriasis Area and Severity Index
b. Erythema, scale, thickness/induration
c. Minimum: 0, Max: 72
Name 4 cytokines elevated in psoriasis
- IL-17
- IL-23
- IL-22
- TNF
- Also: IFN, IL-2, Il-1, IL-6
Name 5 classes of medications used for psoriasis
- PDE-4 inhibitor (Apremilast)
- Retinoids (Acitretin)
- Immunosuppressants (MTX, Cyclosporine)
- Biologics (TNF, 12/23, 23, 17)
- JAK inhibitor (Tofacitinib)
Name 4 systemic associations with prp
celiac sprue
myositis
MG
hiv
According to the Griffith classification, what are the 5 variants of pityriasis rubra? What is the 6th additional variant?
Type I- Classic adult (scalp erythema, keratitis follicular papules on red base, salmon plaques, islands sparing, orange-red waxy keratoderma)
Type II- Atypical adult (itchyosiform leg lesions, eczema and lamellate coarse ppt)
Type III-Juvenile classic
Type IV-Juvenile circumscribed (knees, elbows follicular pap)
Type V-Juvenile atypical (sclerodermoid hands and feet)
Type VI-HIV associated
Type VII-Facial discoid dermatosis
What are 6 morphological variants of Pityriasis Rosea?
Gigantea – confined to herald patch
Urticarial
Vesicular
Pustular
Inverse
Purpuric
EM-like
GUV PIPE:
What are 5 medications known to cause drug induced PR?
KFC BAGS TOH
Ketotifen
Flagyl
Clonidine
Beta blockers, bismuth, barbiturates, BCG vaccine
ACEi, Aresnic, accurate
Gold
Salvarsan
TNF in
omeprazole
HCTZ
Name top 5 causes erythroderma per Scott Walsh
Dermatitic- AD>contact>SD>actinic
Psoriasis
drug rxn
MF
idiopathic
List 10 causes of Erythroderma (please ensure that the first 5 are listed most common to least common)
- Dermatitis
- Psoriasis
- Drugs
- CTCL
- Idiopathic
- Seborrheic dermatitis
- Stasis dermatitis with autosensitization
- PRP
- Ichthyosis
- Bullous dermatoses-e.g. Bullous pemphigoid
- GVHD
- AI-CTD: e.g. Dermatomyositis
- Infestation-scabies
- Paraneoplastic
- Chronic actinic dermatitis
- Papuloerythroderma of ofuji
- Mastocytosis
- PER SCOTT WALSH
o Dermatitic -24% (AD>contact>seb>actinic)
o Psoriasis -20%
o Drug rxn -19%
o CTCL -8%
o Idiopathic
List 5 variants pustular psoriasis
- Generalized pustular psoriasis of von Zumbusch
- Exanthematous pustular psoriasis
- Annular pustular psoriasis of LaPierre
- Localized pustular psoriasis
- Gestational (Impetigo herpetiformis)
- Acrodermatitis continua of Hallopeau
- Acrodermatitis repens of Crocker
- Pustulosis palmaris et plantaris
Name which findings in psoriasis are due to what parts of nail bed?
Salmon patch
Oil drop sign
Splinter hemmorhages
Pitting
Beaus lines
Leukonycia
Erythema of lunula
Distal onycholysis
Sublingual hyperkeratosis
- Salmon patch/oil drop – NB
- Splinter hemorrhages – NB
- Distal onycholysis – NB
- Subungual hyperkeratosis – NB or distal matrix
- Pitting – PNM
- Beau’s lines – PNM
- Leukonychia – Distal nail matrix
- Erythema of lunula – DNM
Key:
* PNM - proximal nail matrix
* DNM - distal nail matrix
* NB - nail bed
* H - hyponychium
What are the HLA associations for each of the following? HLA Cw6, HLA B27, HLA B13/B17
- HLA-Cw6: early onset psoriasis, increased severity, fmhx
o Increased risk Caucasians (13x), Japanese (25x) - HLA-B27: reactive arthritis, sacroiliitis, pustular PsO
- HLA-B13/HLA-B17: erythrodermic PsO
From epidemiologic studies, what is the risk of psoriasis in an offspring if:
1 parent
both parents
1 sibiling
No parent/sibling
- One parent is affected? 14%
- Both parents are affected? 41%
- One sibling is affected? 6%
- No parent or sibling is affected? 2%
Define the following:
Auspitz sign
Woronoff ring
Koebner phenomenon
Woronoff: hypopigmented ring surrounding individual psoriasis lesions possibly due to inhibition of prostaglandin synthesis by treatments.
Koebner: traumatic induction of psoriasis on non-lesional skin.
The Auspitz sign: focal bleeding points that appear when the scale is removed due to dilated capillaries and thinned suprapapillary plates
Name 5 systemic associations w/ LP
Hep C
Dental amalgams
Drug
GVHD
paraneoplastic
List 10 variants lichen Planus
Annular
Actinic
Atrophic
Bullous
Eruptive/exanthematous
Hypertrophic
Linear
Lichen planopilaris
Lichen Plans pigmentosus
LP pemphigoides
Ulcerative
Oral
Inverse
Nail
Vulvovaginal
DLE/LP overalp
List 8 classes of drugs known to cause lichenoid drug eruptions.
Name
Anti 6 PANG (6 Antis then PANG)
Anti-hypertensives: ACEi, BB, methyl dopa, HCTZ
Anti-malarial: HCQ, Chloroquine, Quinacrine, quinidine
Anti-depressants: Amitryptiline, lithium
Anti-fungal: ketoconazole
Anti-TNFs: Etanercept, infliximab
Anti-cancer: Pembrolizumab, Nivolumab,, trosine kinase inhibitors e.g. matinib
PANG
Penicllamine
Allopurinol
NSAIDS
Gold salts
Name 10 features seen on histology for LP
Orthokeratosis
Hyperkeratosis
Irregular acanthosis
Saw tooth rete ridges
Wedge shaped hypergranulosis
Hypereosinophilia of keratinocytes at Malphigian layer
Lymphocytic band like infiltrate DEJ
Basal layer vacuolar degeneration
Colloid bodies papillary dermis
Civatte bodies basal layer
Pigment incontinence
Subepidermal clefts between epidermis and dermis: Max-Joseph spaces
Name 4 associations with PLCA and PLEVA
Hodgkins, B cell lymphoma
HIV
CTCL
Name 10 porokeratos variants
a. DSAP
b. DSP (non-actinic)
c. Porokeratosis palmaris et plantaris disseminate
d. Porokeratosis plantaris discrete
e. Punctate porokeratosis
f. Linear porokeratosis
g. Porokeratosis of Mibelli
h. Porokeratosis psychotropica
i. Porokeratoma
j. Pruritic papular porokeratosis
k. Porokeratotic adnexal ostial nevus
Name 4 mutations in porokeratosis
a. MVK-mevalonate kinase, PMVK phosphomevalonate kinase, MVD mevalonate diphosphate decarboxylase, FDPS farnesyl diphosphate synthase.
b. *End up with deficiency in cholesterol
c. Treat with topical statin (cholesterol inhibitor) and cholesterol
What is the highest risk porokeratosis for scc
linear porokeratosis
18) Name 5 conditions caused by malessizia furfur/sympodialis in yeast form and 1 in mycelium form
Yeast:
seb derm
head neck AD
pityrosporum folliculitis
CARP
Neonatal cephalic pustolosis
Mycelium
PV
19) EDV: Name the 2 HPV subtypes, the 2 clinical presentations, the genetics predispositions
EVER 1 and 2- regulate zinc transport in nucleus
HPV 5/8
PV like, flat wart like
Risk SCC in PV-like if photo exposed
Name 2 associations w; nekams
heme malig
IDA
Name 4 presentations/additional features seen in nekams
Seb derm like lesions
Aphthous ulcers
PPK
Blepharitis/conjuctivitis
*alopecia in children
How is drug induced lichen planus different from classic lichen planus
Older age in lichenoid drug eruption (65 vs. 50)
More generalized distribution on the trunk, often spares classic LP sites (forearms, wrists, genitals)
Whickam’s striae less common
Larger lesions, more eczematous, psoriasiform or PR-like morphology
Mucous membranes usually spared
Frequently photo distributed
What are 5 morphological variants of systemic ACD to nickel?
Eyelid dermatitis
Widespread nummular dermatitis
Hand dermatitis
Popmpholyx
Intertriginal dermatitis
Anogenital baboon syndrome
Erythroderma
a. Symmetrical eyelid dermatitis
b. Hand dermatitis
c. Pompholyx (dishydrotic eczema)
d. Dermatitis in skin folds
e. Anogenital baboon syndrome (peri-anal/genital)
f. Widespread nummular dermatitis
g. Erythroderma
h. Generalized mac pap
i. Recall dermatitis
j. Flare up genital site
k. Peri-orbital/perioral
List 5 allergens that can lead to systemic ACD.
Metals: nickel
Plants:
Poison ivy (Mangos/cashew exposure)
Balsam of Peru (sodas, citrus foods, spices like cloves, vanilla, toothpaste)
Sesqueterpene lactone –>chamomile tea
Meds:
Topical steroids (systemic steroids)
Neomycin–>aminoglycosides,
Quinolones
Ampicillin
Ethylenediamine hydrochloride –> aminophyline
Foods:
Sorbic acid–> sorbic acid
Formaldehyde –> aspartame
6 allergens that can lead to contact anaphylaxis
BAN PCR
Bacitracin
Ammonium peruslfate
Neomycin
PPD
Chlorehexidine
Rubber-latex
Describe the grading system for patch testing
i. +/- macular erythema/doubtful reaction
ii. + weak, non-vesicular with erythema, papules and infiltration
iii. ++ strong vesicular reaction with erythema, infiltration and papules
iv. +++ spreading bullous reaction
v. IR= irritant
vi. – is negative rxn
If a patient is unable to perform patch testing, what other alternatives exist and how is it performed?
Repeat open application test:
Apply product to unaffected area e.gg forearm for 1-22 weeks
List 6 contraindications to patch testing
a. History of severe allergic reaction
b. Generalized active dermatitis or angry back already
c. Immunosuppressive treatment (up to 15 mg pred ok)
d. Pregnancy/lactation
e. Potent topical steroids on site of application within 2 days prior
f. Recent sunburn -extensive
g. Infection at site of intended application
h. Unreliable patient/unwilling to comply with protocol
List 7 reasons for a false positive reading.
a. Irritant contact dermatitis
b. Concentration too high
c. Contamination
d. Adjacent to a strong positive reaction
e. Plaster reaction or allergy to finn chamber (aluminum)
f. Angry back syndrome (often in patient with severe or widespread dermatitis)
g. External manipulation or pressure artefact (e.g. scratching, bra strap)
h. Uneven dispersion
List 6 reasons for a false negative reading.
a. Oral immunosuppression
b. Recent sun exposure/sun burn
c. Too weak dilution
d. Patch falls off/poor placement
e. Sweating or getting patched areas wet
f. Reading results too early (e.g. no delayed reading for gold, drugs, steroids)
g. Topical immunosuppression within days before test
What are 7 adverse reactions that can occur from patch testing that the patient must be counseled about.
a. Blistering reaction
b. May trigger eczema flare
c. Infection
d. Pruritus
e. Anaphylaxis
f. Sensitization to new allergen
g. Pigmentation to clothes (dye allergens)
h. Hypopigmentation
i. Scarring
j. Angry back reaction
Name 5 formaldehyde-releasing preservatives
a. DMDM hydantoin
b. Quaternium-15
c. Imidazolidinyl urea
d. Diazolidinyl urea
e. 2-bromo-2-nitropronane-1,3-diol (Bronopol)
f. Tris(hydroxymethyl)nitromethane
DQ BDI T
Name 6 potential cross-reacting substances to paraphenylene diamine
Sulfonamide antibiotics (TMP-SMX)
Sulfonamide diuretics (HCTZ)
Sulfonamide anti-diabetics (Glyburide)
Benzacaine, procain, tetracaine
PABA-para-aminobenzoic acid
PTDA-paratoluene diamine
Celecoxib
Black rubber mix
Disperse yellow, disperse orange
What are 3 co-sensitizers with nickel allergy?
Cobalt
Chromate
Palladium
what are 5 cross reactors with poison ivy
Cashew oil
Mango rind
Poison sumac
Poison oak
Japanese lacquer tree
Gingko Balboa tree-fruit bulp
Brazilian pepper tree
Hawaiian Kahlil tree
What are 3 reasons why allergic contact dermatitis in leg ulcer patients is so prevalent?
Broken skin barrier
Multiple topical preparations used
Application under occlusion
Chronic wounds
Top 5 allergens in patients with chronic leg ulcers
Fragrances: Balsam of peru, colophony
Topical steroids HC, budesonide
Anti-septics: chlorhexidine
Antibiotics-bacitracin, neomycin
Preservatives-MCI/MI, formaldehyde, paraben
Vehicles-propylene glycol, lanolin
What are 4 groups of accelerators used in vulcanization of rubber that can result in allergic contact dermatitis
Thiurams
Thioureas
Carbamates
Benzothiazoles
What are 3 antioxidants used in vulcanization that can cause allergic contact dermatitis to rubber?
Amines–> Diphenyl-p-phenylenediamine, IPPD
Phenols–> Hydroquinone
Dithioacids–> dibutyldithiocarbamate
What are 6 plant-derived food allergens that comprise the “latex-fruit syndrome” of cross reaction?
a. Bananas
b. Avocado
c. Bell pepper
d. Potatoe
e. Chestnut
f. Kiwi
g. Passionfruit
h. Mango
What are the top 3 allergens causing non-occupational airborne allergic contact dermatitis?
a. Fragrances
b. Sesquiterpene lactone
c. Methylchloroisothiazolinone
What are the top 3 allergens causing occupational airborne allergic contact dermatitis?
Epoxy resins
MCI/MI (cleaning)
Formaldehyde
Chrome
Nickel
What are the top 3 allergens causing occupational airborne allergic contact dermatitis?
Epoxy resins
MCI/MI (cleaning)
Formaldehyde
Chrome
Nickel
12) What are 4 areas that you would examine to distinguish an airborne contact dermatitisfrom a photocontact/phototoxic dermatitis?
Retroauricular (Wilkinsons triangle)
Eyelids
Nasolabial fold
submental
13) What are the 2 major species of poison ivy and their differences?
Toxicodendron radicans
-eastern
-clinbing vine
Toxicodendron rydbergii
-western
-sprawling shrub
1) What does LASER stand for? What are the 3 C’s which characterize lasers?
a. Light amplification by stimulated emission of radiation
b. Monochromicity (single or well-defined wavelength), coherence (light waves travel in phase), collimation (parallel beams)
2) What are the 3 different LASER media that exist and determine the laser wavelength?
- Gas (e.g argon, krypton, CO2)
- Liquid (e.g. dye )
- Solid (e.g ruby, ND:YAG, alexandrite)
3) What are the 4 main safety concerns when using LASERS?
Cutaneous burns
Fires
Eye injury
Biohazardous plume production from laser
4) List the 12 LASERS from Figure 9-1 in Alikhan, along with their wavelength (nm)
EAK PRAD NETEC
Excimer: 308
Argon 488-514
KTP 532
PDL 585-600
Ruby 695
Alex 755
Diode 800
Nd:YAG 1064
Erbium: glass 1540
Thulium 1927
Erbium yağ 2940
CO2: 10600
5) List 3 chromophores that are frequent targets for LASERS.
Melanin
Hb
Water
List 2 vascular lasers
PDL
Long pulse ND:Yag
IPL
Diode
I love pulsed dye (IPL, Long pulse ND yag, PDL, Diode)
List 2 hair removal lasers
i. Diode, Nd:YAG (safest in richer skin tones), Alex, IPL
DANI
Diode, alex, nd , ipl
List 2 resurfacing lasers
Ablative: CO2, Er:YAG
Non-ablative: PDL, diode, NdYaG, Erbium glass
PEND)
Name 2 tattoo removing lasers
Q switch:
Ruby
Alexandrite
ND-YAG
- Again think melanin
List 4 commercially available botulinum toxins available. Provide both the generic name and the trade name for each.
a. Botox: Onabotulinumtoxin A
b. Dysport: Abobotulinumtoxin A
c. Xeomin: Incobotulinumtoxin A
d. Nuceiva: prabobotulinumtoxi A
e. Myobloc: Rimabotulinumtoxin B
List 5 broad categories of dermal fillers (based on material) and provide 1 example of each.
HA: Juvederm, restyle, parlance, beloetero
Calcium hydroxyapatite: Radiesse
Poly-L-Lactic acid: Scultpra
Silicone: Silikone 1000
PMMA/bovine: Bellafill/Artefill
Autologous fat
Autologous fibroblasts
9) What type of dermal filler is each of the following (based on material)
a. Zyderm:
b. Restylane:
c. Perlane:
d. Belotero:
e. Juvederm:
f. Artefill:
g. Sculptra:
h. Radiesse:
a. Zyderm: Bovine collagen
b. Restylane: HA
c. Perlane: HA
d. Belotero: HA
e. Juvederm: HA
f. Artefill: PMMA in Bovine collagen
g. Sculptra: Poly-L-Lactic acid
h. Radiesse: Calcium hydroxyapatite
List 5 complications that can occur with dermal fillers.
Blindness
Necrosis/ulceration
Ecchymoses
Nodules
Blue nodules
Anaphylaxis
3 categories sclerotherapy agents and 2 examples of each
a. Hyperosmotic: Hypertonic saline (12-23%), Hypertonic saline 10% + dextrose 25%
b. Chemical irritants: Glycerin, Polyiodide iodide
c. Detergents: Sodium tetradecyl sulfate, Polidocanol
4 contraindications to sclerotherapy
a. Allergy to sclerosants
b. DVT
c. Advanced arterial occlusive disease
d. Syptomatic PFO (for foaming sclerosants only)
What are 8 complications of sclerotherapy?
Urticaria
Intraterial injection
Ulceration/cutaneous necrosis
Telangiectatic swelling
Swelling
Anaphylaxis
Pain
Ecchymoses
PIH
What are the different categories of peels (based on depth)? Give 1 examples of each.
a. Superficial (papillary dermis)
i. Salycyclic acid, glycolic acid, TCA 10-25%, Jessner’s
b. Medium (upper reticular dermis)
i. TCA 35-50%
c. Deep (Deep reticular dermis)
i. TCA >50%
15) What are components of Jessner’s solution?
LESR
Lactic acid
Ethanol
Salicyclic acid
Resorcinol
1) List the 4 motor nerve danger zones on the head and neck.
Describe the following: i) Nerve affected; ii) Associated Adverse Events; iii) How to localize/landmark each danger zone.
a. Zygomatic arch/temple: Temporal nerve brow ptosis (unilateral frontalis paralysis). Draw a line from 0.5 cm below the tragus diagonally to 1.5 cm above the lateral brow, third line from lateral orbital rim along the zygoma, forms a triangle
b. Malar cheek: Zygomatic nerve inability to close eye, corneal desiccation. Mark highest point malar eminence, mandibular angle, oral commissure, forms a triangle.
c. Mandible: Marginal mandibular nerve Inability to raise mouth to smile, drooling. 2-3 cm inferolateral to lateral oral commissure as traverses over mandible.
d. Erb’s point: Spinal accessory nerve winged scapula, unable to abduct arm. 6.5 cm inferior to mastoid process in belly of SCM.
List 9 absorbable sutures (generic name and trade name).
-Fast absorbing gut
-Plain gut
- chromic gut
- Fast absorbing polyglactin (Vicryl rapide)
- Polyglactin 910 (Vicryl)
- Polyglecaprone (Monocryl)
-Polyglycolic acid (Dexon)
-Polyglyconate
-Polydioxanone (PDS 11)
List 5 non-absorbable sutures (generic name and trade name).
a. Silk
b. Nylon (Ethilon)
c. Polyprolene (Prolene)
d. Polyester (Ethibond)
e. Polybutester (Novafil)
Which absorbable suture has highest tissue reactivity? Which has the lowest?
Surgical gut > monocryl (polyglecaprone)
Which non-absorbable suture has highest tissue reactivity? Which has the lowest?
Silk > prolene
Which absorbable suture has initial tensile strength? Which has the lowest?
Monocryl (polyglecaprone) > plain surgical gut
Which non-absorbable suture has initial tensile strength? Which has the lowest?
Ethibond (of the non-metals)> silk
List 8 antiseptic used in dermatologic surgery. List 2-3 key points about each (bolded items in table 8-12).
a. Alcohol – fastest onset, broad spectrum, but inactive against spores and soiled hands, flammable
b. Chlorhexidine - rapid onset, broad spectrum, but toxic to eyes and ears, inactive against spores, longest acting
c. Iodine and iodophors- broad spectrum including bacterial spores, inactivated by blood and sputum, need to be dry to be effective, skin irritation
d. Soap and water- best for hands, great for norwalk and c.diff
e. Triclosan – binds enoyl-acyl carrier protein reductase, not overly effective
f. Quaternary ammonium compounds (Benzalkonium) – slow, inactivated by organic compounds (e.g. gauze), used in eyedrops
g. Chloroxylenol- slow, ineffective against pseudomonas
h. Hexachlorphene – NO LONGER USED-neurotoxic, teratogenic
9) What is the difference between electrosurgery and electrocautery?
a. Electrosurgery: high frequency alternating current to conduct energy through cold tipped electrode, relies on poor conductance of human tissue to halt the current and convert electrical energy into thermal energy, which allows for hemostasis
b. Electrocautery: direct application of heat to tissue through a hot tipped electrode generated by a direct current, there is no current flowing through the patient
Name 4 examples electrosurgery and 1 use for each, and whether biterminal or monoterminal
Mono:
Electrofulguriation- zap off seb k
Electrodescciation- ED&C
Biterminal:
Electrocoagulation -hemostasis
Electrosection- surgery
What is mono vs. biterminal
Mono=no grounding terminal
Biterminal= grounding terminal (grounding pad or biterminal forceps)
Safest method to use in ICD/pacemakrers?
Electrocautery
If electrosurgery-biterminal
11) What are the 4 stages in graft uptake physiology (include timings).
Imbibition: 24-48 hours
Inosculation-48-27, continues for 7-10 days
Neovascularization- finished by day 7
Renervation- 2mo-years
Differentiate full thickness skin graft from split thickness skin graft on:
Tissue match
durability
infection risk
Nutritional requirments
Adnexal structure function
Wound contraction
Sensation
FSTG better/good/higher in:
-better tissue match, slightly better durability, better sensation, better adnexal function
-higher nutritional requirements than STSG
-less wound contraction
Both low infection risk
List 7 surgical complications and the time frame when they usually occur.
Infection: 3-4 days
Bleeding: first 24-48 hours
Dehiscence: highest risk suture removal, first 1-2 weeks
Poor wound healing/abnormal: variable
Hematoma: 0-3 weeks
ischemia/necrosis: flaps first 24-48 hours
Nerve impairment-?immediate
List 7 surgical complications and the time frame when they usually occur.
Infection: 3-4 days
Bleeding: first 24-48 hours
Dehiscence: highest risk suture removal, first 1-2 weeks
Poor wound healing/abnormal: variable
Hematoma: 0-3 weeks
ischemia/necrosis: flaps first 24-48 hours
Nerve impairment-?immediate
List 6 broad categories of non-surgical modalities for scar improvement.
Massage
Pressure therapy
Topicals- e.g. silicone
Injection-ILK
Laser
Radiofrequency
15) List 4 broad categories of surgical modalities used for scar improvement.
Dermabrasion
Subcision
Excision
Re-orienting/lengthening
What is the scar tensile strength at 1 week, 3 weeks, 3 mo, 1 yr
5% at 1 week
20% at 3 weeks
40% at 3 months
80% 1 yr
List 5 streptococcal skin infections
Eryispelas
Cellulitis*
Non bullous impetigo
Blistering dactylitis
Necrotizing fascitis
Ecthyma
Perianal strep
Scarlet fever
Toxic shock syndrome
List 5 staphylococcal infections
Impetigo-bullous/non-bullous
Cellulitis
Abscess/furuncle/carbuncle
Folliculitis
Staph scalded skin syndrome
Toxic shock syndrome
Pyomyositis
Botryomycosis
List 5 pseudomonal skin infections.
Green nail syndrome
Otitis externa, malignant otitis externa
Psuedomonal folliculitis
Psuedomonal pyoderma
Psuedomonal hot foot
Ecthyma gangrenosum
List 10 different forms of cutaneous tuberculosis (broad categories: exogenous, endogenous, and tuberculid)
Exogenous:
1. Tuberculous chancre
2. Tuberculosis verruca cutis (high)
Endogenous:
3. Lupus vulgaris (high)
4. Scrofuloderma
5. Miliary TB
6. Tuberculous gumma
7. Oroficial TB
Tuberculid: All high immunity
8. Lichen scrofulosum
9. Papulonecrotic tuberculids
10. Erythema induratum of basin
5) List the types of leprosy according to the Ridley and Jopling classification system.
Tuberculoid (th1/high cell immunity)
Bordeline tuberculoid
Borderline borderline
Borderline lepormatous
Lepromatous (Th2, low cell)
List 6 cutaneous nerves that run superficially and should be palpated to assess for thickening in leprosy patients:
Medial
radial
ulnar
Greater auricular
CN 5
CN 7
Posterior tibial
Common perineal
List 6 dermatophytes that demonstrate endothrix growth during hair infection
Ringo Gave Yono Two Squeaky Violins
Trichophyton rubrum, T.Gourvilli, T.Yaounde, T.Tonsurans, T.Soudanense, T.Violaceum
8) List 5 dermatophytes (ectothrix) that fluoresce on Woods lamp examination due to the presence of what substance:
Pteridine
Cats And Dogs Fight and Growl Sometimes
M. canus
M. audouinii
M. Distortum
M. Ferrugenium
M. Gypseu,
T. Schloenni
What causes favus
T Schloenni
*May fluoresce dull gray green
Most common causes tinea wapitis:
-us
-worldwide
-favus
-kerion
Trichophyton tonsurans (#1 cause in
United States)
Microsporum canis (#1 cause worldwide; more inflammatory)
T. violaceum (East Africa)
Endothrix (black dot; arthroconidia within hair shaft): Ringo
Ectothrix (arthrospores around hair shaft)
1. Fluorescent (green via Wood lamp – pteridine): “Cats And Dogs”
- Nonfluorescent: MMR NGV
T. mentagrophytes, T. rubrum, M. nanum, T. megninii, T. gypseum, and T. verrucosum - Favus – T. schoenleinii mainly
- Kerion – M. canis, T. verrucosum,
T. mentagrophytes, and T. tonsurans
What are 4 clinical variants or presentations of tinea capitis?
Non inflam:
Grey Patch (ecto)
Black dot (endo)
Diffuse scale
Inflammatory:
Kertion
Favus
Diffuse pustular
What are 4 clinical presentations of tinea pedis?
Moccasin
Interidigital
Acute ulcerative
Acute vesiculobullous
List 4 clinical types of onychomycosis:
DLSO
Proxima white subungual
Superficial white
Total dystrophic
Endonyx
What are the vectors for leishmaniasis
Sand flies
Old world-Phlebotomus
New world-Lutzomyia
List 3 species that cause old world leishmaniasis
Major Tropical Infants in Ethiopia
a. Leishmania major, L. Tropica, L. infantum, aethiopica
List 3 species that cause new world leishmaniasis
a. L. mexicana, L. brasiliensis, L. amazonensis
BAM
15) What are 5 broad clinical variants of leishmaniasis?
Cutaneous-new and old
Diffuse cutaneous
Mucocutaneous
Visceral (Kala Azar)
Post Kala Azar
What are 5 risk factors for cutaneous larva migrans (CLM)?
Male, young/children, barefoot/bum, travelers to tropical climates (jamiaca, Dominican, Thailand), swimmers, broken skin, wet sand, beach with many cats/dogs
What is one major difference between new and old world leish?
TOC visceral and cutaneous leash
Not confirmed
a. Old world cutaneous–> typically presents with single ulcer verrucous w/ sporotrichoid spread, new world usually more varied: ulcerations (Chiclero ulcer = ear lesion in workers who harvest chicle gum in forest), impetigo-like, lichenoid, sarcoid-like, nodular, vegetating, and miliary
b. Mucocutaneous is almost always new world
c. Most cases of old world resolve in 15 months. 75% of L. Mexican new world resolve ) Mucocutaneous (new world) does NOT self resolve ((L. braziliensis and L. panamensis) does NOT self-resolve and requires treatment to prevent progressive destruction)
Visceral more old world
Cutaneous/mucocutaneous: pentavalent antimony
Visceral leishmaniasis: Amphotericin B (ToC)
18) List 2 organisms responsive for CLM.
Ancylostoma brasiliensis
Ancylsotoma caninum
19) List 5 treatment options for CLM.
Albendazole
Ivermectin
Thiabendazole-topical and oral
Liquid nitrogen
20) What is the classic cutaneous eruption seen in strongyloides? What is the treatment of choice for strongyloides?
Thumbprint purpura
Ivermectin
List 5 genodermatoses that can be associated with CALMS
a. NF I, NF II, Mosaic NF I (NF 5)
b. Legius syndrome
c. McCune Albright syndrome
d. Bloom syndrome
e. Noonan syndrome (Allelic w/ LEOPARD syndrome/Noonan with multiple lentigines)
f. Tuberous sclerosis
g. Fanconi
h. Ataxia telangiectasia
i. MENI
j. Constitutional mismatch repair
k. Ring chromosome syndrome
l. Cowdens
m. Proteus syndrome
n. Watson syndrome
List 5 syndromes associated with multiple lentigines.
a. Noonan syndrome with multiple lentigines (Formerly known as LEOPARD)
b. Carney complex (LAMB/NAME)
i. Lentigines, atrial myxoma, blue nevus
ii. Nevi, atrial myxoma, myxoid neurofibromas, Ephelids
c. Laughier-Hunziker (Oral, genital, melanonychia, r/o peutz Jegher)
d. Peutz Jegher (intra-oral)
e. Cowdens (penile-PTEN)
f. Bannayan-Riley-Ruvalcaba (penile-PTEN)
g. Xeroderma pigmentosum
What does LEOPARD stand for
L stands for (L)entigines
(E)lectrocardiographic conduction defects (abnormalities of the electrical activity and the coordination of proper contractions of the heart);
(0)cular hypertelorism (widely-spaced eyes);
(P)ulmonary stenosis (obstruction of the normal outflow of blood from the right ventricle of the heart); (A)bnormalities of the genitals; (R)etarded growth resulting in short stature;
(D)eafness or hearing loss due to malfunction of the inner ear (sensorineural deafness).
List 5 variants of dermal melanocytosis
a. Congenital dermal melanocytosis (Mongolian spots)
b. Nevus of ota
c. Nevus of ito
d. Hori’s nevus (acquired)
e. Sun’s nevus (acquired, unilateral Hori’s)
Which mutations are often associated with Blue Nevus
GNAQ
GNA11
Which gene is associated with inherited form of melanoma? Which proteins does it code for?
CDKN2A–> FAMM
Familial atypical multiple melanoma
P14-ARF and P16–> modulate cell cycle progression through P53 and Rb pathways, respectively
Name 8 mutations seen in melanomas
BRAF –> V600E MC (sup spreading)
NRAS
C-KIT (mucosal and acral)
CCND1/CDK4
TERT
GNAQ/GNA11: uveal melanoma, blue nevi, and nevus of Ota
BAP-1: Cutaneous melanoma, uveal melanoma, malignant cellular blue nevus, epithelia spitzoid nevi, MESOTHELIOMA, and renal cell carcinoma may be seen in a syndrome which is associated with which mutation?
List 5 variants melanoma
a. Nodular
b. Superficial spreading
c. Lentigo maligna melanoma
d. Acral lentiginous melanoma
i. Uveal melanoma
ii. Mucosal melanoma
iii. Desmoplastic melanoma
iv. Spitzoid melanoma
v. Malignant blue nevus
Acral and mucosal melanomas are associate with which mutations
C-KIT
Superficial spreading melanomas are associated with which mutation
BRAF-V600E
10) Uveal melanomas and blue nevi are associated with which mutation
GNAQ/GNA11
11) Cutaneous melanoma, uveal melanoma, malignant cellular blue nevus, MESOTHELIOMA, and renal cell carcinoma may be seen in a syndrome which is associated with which mutation?
BAP-1
12) According to AJCC 8, what do the following correspond to:
Name the T stages for melanoma
T1a- <0.8 mm no ulceration (1A)
T1b- <0.8 mm w/ ulceration, or 0.8-1.0mm (1B)
T2a- >1-2.0 m w/out ulceration (1B)
T2b- >1-2.0 mm w/ ulceration (2A)
T3a- >2-4.0 mm w/out ulceration
T3b- >2-4.0 w/ ulceration
T4a- > 4 mm w/o ulceration
T4b- > 4 mm w/ ulceration
Name the clinical staging for melanoma according to AJCC 8 edition
IA: T1a (anything <0.8 mm w/out ulcer)
IB: T1b, T2a (anything < 1mm w/ ulceration, 0.8-2 w/out ulceration
2A: T2b, T3a
2B: T3b, T4a
2C: T4b
3: Any T N>1 M0
4: Any T any N M >1
Which two gene mutation have been associated with seborrheic keratoses? List 7 clinical variants of SKs. List 6 histological variants of SKs.
PIK3CA
FGFR3
Variants:
-inverted follicular keratosis
-lichenoid keratosis
-stucco keratosis
-acrokeratosis verruciformis of hopf
-dermatosis papulosa nigra
-clear cell acanthoma
-large cell acanthoma
6 path variants: “CHRAIM”
-hyperkeratotic
-acanthotic
-clonal
-irritated
-reticulate
- melanoacanthoma
List 10 risk factors for invasive SCC
Ia. Immunosuppressed, CLL
b. Older age
c. Male
d. Fair skin
e. Genetic conditions: e.g. XP
f. UV- chronic>intermittent
g. HPV
h. Radiation
i. Chronic non healing wounds-Marjolin ulcer
j. Inflammatory dermatoses such as DLE, erosive oral LP, chronic LSA
k. Medications: BRAF inhibitors, voriconazole
List 6 genetic syndromes associated with SCC.
a. Photosensitive:
i. Oculocutaneous albinism
ii. Xeroderma pigmentosum
iii. Rothmund thompson
b. The D’s:
i. EDV
ii. Dystrophic EBA
iii. Dyskeratosis congenita
iv. KID syndrome-keratitis, ichthyosis, deafness
c. Misc:
i. Porokeratosis-linear
ii. Werner syndrome
iii. Chronic mucocutaneous candidiasis
What is verrucous carcinoma? Which HPV subtype is it associated with? What are the 3 clinical variants and where on the body does each variant present?
Low grade, locally destructive SCC
HPV 6/11
Clinical variants:
Buschke lowenstein Tumor - perianal
Epithelium cuniculatum - foot
Oral florid papillomatosis - oral cavity
Papillomatosis cutis carcinoides of Gottron
List 6 clinical variants of keratoacanthoma. What are 2 KA specific syndromes?
Variants:
Solitary
Multiple
Intraoral
Subungual
Giant
Keratoacanthoma centrifigum marginatum
KA syndromes:
Gryzbowski
Ferguson-Smith
Describe the two KA syndromes- acquired vs. genetic, onset, appearance
Ferguson-Smith-AD, rapid onset multiple large KAs, resole spont. 3rd decade
Gryzbowski: Sporadic, thousands milia-like KAs, later in life, can have airway involvement, scarring, ectropion
What is the most common mutation identified in BCCs. List 8 variants of BCCs. List 6 genetic syndromes associated with BCCs.
a. PTCH most common mutation
b. Variants
i. Superficial
ii. Nodular
iii. Morpheaform
iv. Fibroepithelioma of Pinkus
v. Micronodular
vi. Basosquamous
vii. Infundibulocystic
viii. Pigmented
Genetic syndromes
i. Basal cell nevus syndrome, Brooke Spiegler
ii. OCA, XP, Bloom syndrome, Rothmund Thomson, Werner
iii. Bazex Dupre Christol, Rombo syndrome, Schopf Shulz Passarge
Which syndrome is associated with multiple epidermoid cysts.
What are other features of this syndrome?
a. Gardner’s syndrome-APC (adenomatous polyposis coli)
i. Skin: Epidermoid cysts w/ pilomatricoma features, lipomas, fibromas (skin, subcutaneous, mesentery, retroperitoneal), osteomas
ii. GI manifestations: Desmoid tumors, premalignant polyposis
iii. Eyes: CHRPE
Cancer: colon duodenal , brain liver adrenals thyroid
iv. Others: Osteomas (subcutanesous), odontomas, supernumary teeth, sarcoma, papillary thyroid cancer (women), adrenal adenomas, brain tumors (gliblastomas and medulloblastoma in Turcot syndrome), pancreatic carcinomas
Who most frequently gets dermoid cysts and where are they most commonly located?
a. Along embryonic fusion lines, most common lateral eyebrow
b. Infants
Which syndrome is steatocystoma multiplex associated with? What are the gene mutations and other features of this syndrome?
a. Pacyhonychia congenita Type II
b. Gene mutations: KRT17»KRT6B
c. *In general: PPK, painful heels, thickened nails
d. Features:
i. Natal teeth
ii. Oral leukokeratosis
iii. Steatocystoma or other cysts
iv. Palmar plantar keratoderma-milder than type I
What are the 3 main findings in Brooke Spiegler
Trichoepithelioma
Spiradenoma
Cylindroma
Trichoblastoma
Which syndrome is cylindroma associated with? What is the gene mutation? What are the other features of this syndrome?
Brooke Spiegler
Gene mutation: CYLD
Features
i. Cylindroma (papules/nodules scalp)
ii. Trichoepithelioma (facial papules)
iii. spiradenoma (painful nodules head neck)
iv. Trichoblastomas,
What are 5 cancers that can occur in Brooke Spiegler
BCC
Spiradenocarcinoma
Cylindrocarcinoma
Salivary and parotid gland tumors
What syndrome is associated with multiple fibrofolliculomas/trichodiscomas?
What is the gene mutation?
List all cutaneous and 4 non-cutaneous features.
Birt-Hogg-Dube
Gene: FLCN (folliculin)
Cutaneous:
i. Fibrofolliculoma
ii. Trichodiscoma
iii. Achrocordons
iv. Angiofibromas
Non cutaneous features:
i. RCC
ii. Spont. Pneumothorax
iii. Pulmonary cysts
iv. Medullary thyroid cancer
v. Parotid gland onycocytomas
Which secondary adnexal neoplasms can arise in a nevus sebaceous? Which is the most common?
2 S’s, 2 T’s and a B
a. Trichoblastoma -most common
b. Trichilemmoma
c. Syringocystadenoma papilliferum
d. Sebaceoma
e. BCC
f. Others:
i. Eccrine poroma
ii. Tubular apocrine adenoma
List 2 syndromes with multiple trichoepitheliomas.
Brooke Spiegler
Rombo
Which gene/protein mutation is associated with pilomatricomas? List 4 syndromes associated with pilomatricomas.
CTNNB1 Gene–> B catenin
Myotonic dystrophy
Rubinstein Taybes
Gardner-pilomatricoma features in epidermoid cysts
Turners
What syndrome are multiple trichilemmomas associated with
What gene is mutated in this syndrome?
What are other features of this syndrome? List malignancies that are associated with this syndrome.
a. Cowden’s
b. PTEN mutation
i. LA HAS TOPS BET
1) Lipomas, angiolipomas, hemangiomas, acral keratoses, skin tags, trichelommomas, oral papillomas (cobble stoning to lips/gingival/oral mucosa), sclerotic fibromas
Malignancy: Breast, thyroid, endometrial
Others: Fibrocystic breasts, thyroid goiter, GI tract hamartomous polyps (low risk), ovarian cysts, uterine leiomyomas, menstrual irregularities,
bony cysts, kyphoscoliosis, craniomegaly, large hands/feet, adenoid facies, angiod streaks, myopia
What is the inheritance pattern for Muire-Torre syndrome (MTS)?
Which genes are associated with this?
What is the clinical presentation for MTS?
Which malignancies are patients with MTS at an increased risk for?
a. Inheritance pattern: AD
b. Phenotypic variant of Lynch
c. Genes: MLH1, MSH2 (90%), MSH6, PMS2
Sebaceous adenoma, sebaceous carcinoma, sebaceoma *Esp non facial, multiple KAs often w/ sebaceous differentiation (strong)
At risk for: Colon cancer #1, GU #2 (bladder, kidney, ureter etc.), gastric, ovarian, endometrial
17) Differential for painful skin tumors
BLEND AN EGG
Blue rubber bleb nevus
Leiomyoma
Eccrine spiradenoma
Neuroma
Dermatofibroma
Angiolipoma, angioleiomyoma
Neurilemmoma
Endometrioma
Gloms tumor
Granular cell tumor
18) Which syndrome is associated with multiple cutaneous leiomyomas? What is the gene mutation? What are the other clinical features?
Hereditary Leiomyomatosis and RCC syndrome/Reed syndrome
Fumarate hydratase
RCC
Leiomyomas-cutaneous and uterine
List 5 path variants of dermatofibroma.
Cellular DF
Hemosiderotic
Aneurysmal
Monster cells (DF with monster cells)
Xanthomatous
b. List 4 clinical (superficial) variants of fibromatosis.
Palmar
Plantar
Peyronies
Knuckle pads
List 3 clinical differences between and infantile hemangioma and vascular malformation.
a. Growth: IH rapidly proliferate for 4-6 mo, VM do not
b. Resolution: IH can spont. Resolve, VM either persist or resolve
c. Onset: IH not present at birth, VM present at birth
d. Appearance: IH are usually bright red but can be purple-blue if deeper; VM have variable clinical appearances but tend to persist and become more verrucous over time
Compare the epidemiology of infantile hemangiomas and vascular malformation.
IH: 4-5% of infants, more in Caucasians, F>M
Vascular malformation: F=M, most common are CMs, least common AV, low flow more common
What are the three phases in the natural history of an infantile hemangioma
Proliferating, plateau, involution
List 5 risk factors for infantile hemangiomas.
female sex
multiple gestations-twins
placental anomalies
premature
advanced maternal age
low birth weight
5) What are 4 potential complications of infantile hemangiomas?
a. Ulceration
b. Disfigurement – e.g. nasal tip, breast asymmetry, fibrofatty residual
c. Interference with function from location- e.g. periocular and vision loss
d. Extracutaneous involvement-e.g. internal hemangiomas, PHACES, beard hemangioma and laryngeal hemangiomatosis
Also death from airway involvement or high output cardiac failure
List 3 immunohistochemical markers that can be used to differentiate infantile hemangioma from vascular malformation.
a. GLUT-1
b. Lewis Y-Antigen
c. Merosin
d. Wilm tumor protein (WT-1)
e. FcγRII
f. *All positive in IH, negative in vascular malformation
What are the 4 segmental hemangioma patterns?
Frontotemporal
Maxillary prominence
Mandibular prominence
Frontonasal
What does PHACES stand for
a. P: Posterior fossa malformations (e.g., Dandy-Walker and cerebellar hypoplasia)
b. H: Hemangioma, segmental
c. A: Arterial anomalies (internal carotid arteries and cerebral arteries)
d. C: Cardiac anomalies (coarctation of aorta, ventral and atrial septal defects, and patent
e. ductus arteriosus)
f. E: Eye anomalies (microphthalmos, optic atrophy, cataracts, strabismus, and exophthalmos)
g. S: Sternal cleft or supraumbilical raphe
What is LUMBAR syndrome
Lower body/lumbosacral/lipoma /hemangioma
Ulceration/urogenital anomalies
Myelopathy (spinal dyspraphism)
Bony deformities (hip dysplasia, scoliosis)
Anorectal anomalies
Renal anomalies (hypo plastic single kidneys, bladder/ureter anomalies)
What does SACRAL stand for?
a. Spinal dysraphism
b. Anogenital anomalies
c. Cutaneous anomalies
d. Renal/urologic anomalies
e. Angioma in Lumbosacral area
What does PELVIS stand for?
- P: Perineal haemangioma
- E: External genitalia malformations
- L: Lipomyelomeningocele
- V: Vesicorenal abnormalities
- I: Imperforate anus
- S: Skin tag
List 3 clinical differences between infantile hemangiomas and RICH/NICH.
o Onset: IH develops in the first few months of life; RICH/NICH is apparent at birth
o Growth: IH undergoes rapid growth for 4-6 months followed by slow involution over years; RICH/NICH are fully developed at birth
o Resolution: RICH will involute over 1 year, IH will involute over several years, NICH will not involute
List 2 histopath differences in RICH/NICH vs. IH
IH: GLUT-1, WT-1, Lewis-Y-antigen POSITIVE (vs. RICH/NICH negative)
- striking lobularity with densely fibrotic stroma
- stromal hemosiderin deposits,
- focal thrombosis and sclerosis of capillary lobules,
- fewer mast cells
- coexistence of proliferating vasculature with multiple thin-walled vessels
What are 4 reasons to consider systemic therapy for infantile hemangioma?
a. Threaten vital function- vision, airway
b. Threatent life e.g. High output heart failure, airway involvement
c. Potential for disfigurement: columella, nasal tip, ear, rapidly growing lesion on face
d. Ulceration-severe or recalcitrant
What are the 5 major goals of management of infantile hemangiomas?
a. Preventing or reversing life or function- threatening complications
b. Preventing potential disfigurement
c. Treating ulcerations
d. Minimizing psychosocial impairment to patient and families
e. Avoiding overly aggressive procedures that could cause scarring
What are 6 extractable antigens
SSA-ro
SSB-la
Smith
SCL-70
RNP (U1RNP)–> high titers → MCTD; lower titles → SLE
J0-1
What are 3 non ENA targets
Centromere
dsDNA
Histone
List 3 antibody targets that are highly specific for SLE. What are they associated with?
dsDNA: lupus nephritis and activity, lupus disease activity, sun-protected non lesional skin lupus band
Smith- not much, more prevalent in Asian/African American patients
rRNP (ribosomal)–>neuropsychiatric
*NB
1. rRNP with lupus/neuropscyh lupus
2. RNA polymerase I/III with systemic sclerosis
3. U1RNP with MCTD
List 5 dermatomyositis associated antibodies, not including anti-synthetase syndrome. What are they associated with?
4) List 5 dermatomyositis associated antibodies, not including anti-synthetase syndrome. What are they associated with?
a. Mi-2: Classic DM findings, good tx response, no malig or ILD risk
Tiff-1-gamma (P155/P140): A/hypomyopathic, ++ malignancy, GI w/ severe dysphagia, severe skin (ovoid patch, psoriasiform lesions, palmar hyperkeratosis, atrophic hypopigmented patches w/ telangiectasias), No RP/ILD/arthritis
i. JDM: no malignancy, treatment refractory, lipodystrophy
MDA-5: Amyopathic, rapidly progressive ILD specific skin (cutaneous vasculopathy with oral/skin ulcers, tender palmar papules, mechanics hands, panniculitis)
- JDM ulcers, ILD, arthritis, mild muscle (i.e. similar)
NXP2 (P140, MJ): Malignancy in adults, calcinosis, peripheral edema,
-JDM: Severe calcinosis, severe muscle involvement, vasculopathy w/ gi bleeds
SRP: fulminant PM/DM, cardiac involvement, poor prognosis
SAE: Severe cutaneous dz, progressive muscle disease w/ dysphagia, fever/weight loss, erythroderma if given HCQ
g. Anti-synthetase: Jo-1, PL7, PL-12, OJ, EJ
i. Others include ARS, KS, HA, ZA
Which antibody is most specific for CREST? What is it associated with?
a. Anti-centromere–> Calcinosis, raynauds, esophageal dysmotiliy, sclerodactyly, telangiectasias
b. Associated with pulmonary HTN
Which antibody is most strongly associated with primary systemic sclerosis? What is it associated with?
a. SCL-70/Topoisomerase
b. Associated with ILD/pulm fibrosis
*RNA polymerase III is the third ab and related to renal crisis and severe skin
7) Which two antibodies are associated with linear morphea?
ssDNA (correlated w/ disease activity)
Anti-histone (lin and generalized, correlated w/ dz activity)
Which two antibodies can be detected in patients in RA? What are they associated with?
RF:
-high levels associated with severe erosive RA, vasculitis and neuropathy, can also be seen in mixed cryoglobulinemia
-Low level RF non specific
CCP: severe RA, development of RA
List 3 autoantibodies associated with Sjogren’s syndrome. What are they associated with?
SSA (neonatal LE and SCLE)
SSB
alpha fodrin (actin binding product)
Which antibody is detected in neonatal lupus?
RO/ssA
11) Which antibody is associated with mixed connective tissue disease?
U1RNP
List the components of the newest (EULAR/ACR) criteria for SLE (more recent than the SLICC criteria).
*Need 10 points
Must have + ANA for entry criteria
Constitutional domain: Fever
Cutaneous: ACLE, SCLE/DLE, non scarring alopecia, oral ulcers
Arthritis: synovitis or tenderness in 2+ jonts
Renal: Lupus nephritis, proteinuria
Serositis: Pleural or pericardial effusion, acute pericarditis
Neurologic: Delirium, psychosis, seizure
Labs: Leukopenia, thrombocytopenia, hemolytic anemia
Immunologic
i. dsDNA or smith
ii. APLS: ACA or LAC or B2GP
iii. Low C3 and/or C4
List the classification for dermatomyositis.
Adult
-Classic
-DM overlap
-Amyo
-Hypomyo
-Malignancy assoc.
Juvenile
-classic
-hypomyo
-amyopathic
List 5 variants of morphea
Localized: plaque, superficial, atrophoderma passini and piereni, , guttate, nodular, bullous
Linear: en coup de sabre, Perry-romberg, trunk-limb, atrophoderma of moulin
Generalized
Pansclerotic
Mixed
Skin findings in RA
a. Rheumatoid nodules
b. Rheumatoid vasculitis
i. Small, medium, EED, Bywaters lesions
c. Livedo reticularis and livedoid vasculopathy
d. Neutrophilic dermatoses
i. PG
ii. Sweet’s
iii. Rheumatoid neutrophilic dermatitis
iv. Palisading neutrophilic granulomatous dermatitis
v. Interstitial granulomatous dermatitis
vi. Superficial ulcerating rheumatoid necrobiosis
MTX induced papular eruption
List 5 entities on the ddx for systemic sclerosis.
GVHD
Nephrogenic systemic fibrosis
Scleredema, scleromyxedema, pretibial myxedema
Morphea
Eosinophilic fasciitis
Others:
Mucinoses
Localized: radiation induced, injection site (vitamin K, bleomycin)
Generalized: toxic oil syndrome, polyvinyl chloride, belomycine, taxanes, eosinophilic-myalgia (L tryoptophan)
Paraneoplastic: POEMS, carcinoma en cuirasse, amyloidosis, carcinoid
Metabolic: PCT, diabetic cheiropathy (diabetic stiff hand syndrome)
What are the different types of scleredema and their associations?
Post infectious- Type I
Monoclonal gammopathy related – Type II
Diabetic related -Type III
3) What is POEMS syndrome?
Polyneuropathic
organomegaly
endocrinopathy
monoclonal gammopathy
Skin changes-melanoderma/hyperpigmentation, hemangioma, hypertrichosis
List 4 major perforating disorders and 1 association with each.
a. Elastosis perforans serpiginosa (EPS):
i. MAD PORES
1. Marfans
2. Acrogeria
3. Downs
4. Penicillamine, PXE
5. OI
6. Rothmund Thompson
7. EDS
8. Scleroderma
b. Acquired perforating dermatosis (APD): Diabetes, renal failure
c. Reactive perforating collagenosis (RPC); Childhood onset, minor trauma
d. Perforating calcific elastosis (PCE): Obese, hypertensive, multiparous women
What are 4 broad categories of cutaneous crohn’s disease?
a. Specific lesions:
i. metastatic chrons, contiguous perianal or oral chrons
ii. Oral: cobblestoning of the buccal mucosa, tiny gingival nodules, gingival hyperplasia, aphthae-like ulcers, linear, knife-like ulcerations, angular cheilitis and ulceration, cheilitis granulomatosa, diffuse oral swelling, or indurated fissuring of the lower lip
b. Non-specific lesions/reactive
i. erythema nodosum, PG (UC>chrons), pyostomatitis vegetans (UC>chrons), erythema multiforme, finger clubbing, cutaneous small vessel vasculitis, epidermolysis bullosa acquisita, vitiligo, palmar erythema, a pustular response to trauma (pathergy),
c. Nutritional skin changes e.g. acrodermatitis enteropathica
d. Treatment related skin change
What are the 5 clinical findings seen in Lofgren’s syndrome?
EN
Fever
hilar LAD
migrating polyarthritis
uveitis
7) What are the clinical findings seen in Heerfordt’s syndrome?
Uveitis
Fever
parotid gland enlargement
CN palsies
8) What are the clinical findings seen in Mikulicz’s syndrome?
Salivary gland (parotid, submandibular) and lacrimal gland swelling
What are 5 examples of palisaded granulomas? (Figure 3-64)
a. GA (central mucin)
b. RA nodule (Central fibrin)
c. Necrobiotic xanthogranuloma (degenerative collagen)
d. Necrobiosis lipoidica diabeticorum
e. Annular elastolytic giant cell granuloma
f. Uric acid crystals gout
List 6 different types of cutaneous xanthomas.
Eruptive
Tendinous
Tuberous
Plane
Xanthelasma-plane xanthoma on eyelids
verruciform xanthoma
11) List 6 different types of physical urticarias.
a. Dermatographism
b. Aquagenic
c. Cholinergic
d. Solar
e. Vibratory
f. Delayed pressure
g. Cold-induced
12) What is the clinical criteria for Sweet’s syndrome?
c. Major:
i. Skin: abrupt onset painful cutaneous lesions
ii. Path: consistent with sweets
d. Minor
i. Leukocytosis
ii. Response to steroids
iii. Associated Dz: infection, vaccinations/drugs, inflammatory condition (IBD, AI-CTD, sarcoid, bechets), malignancy, pregnancy
1. Drug induced: GO SHLAM
a. G-CSF/GM-CSG
b. OCP
c. Septra
d. Hydralazine
e. Lasix
f. ATRA
g. Minocycline
iv. Fever or constitutional symptoms
13) What is the clinical criteria for pyoderma gangrenosum?
a. 2 Major + 2 Minor
b. Major:
i. Skin: Rapidly progressive painful cutaneous ulcer (50% growth in 1 mo), undermined, irregular violaceus border
ii. Causes: Other causes excluded
c. Minor
i. Pathergy- Hx suggestive pathergy (minor trauma) or cribiform base scarring
ii. Associated dz (IBD, IgA gammopathy, arthritis, malignancy)
iii. Response to treatment (rapid response to steroids)
iv. Path findings
What are 4 variants of pyoderma gangrenosum?
Bullous
Ulcerative
Pustular
Superficial granulomatous/
vegetans
Pyostomatitis vegetans/pyoderma also mentioned
Peristomal
What is the clinical criteria for Behcet’s disease?
a. Major (1/1):
Recurrent apthosis 3+ episodes for year
b. Minor (2/4)
i. Pathergy
ii. Eyes-anterior or posterior uveitis
iii. Genital ulcers
iv. Skin findings -EN, folliculitis
16) What do the following acronyms stand for: i) PAPA; ii) PASH; iii) PAPASH; iv) PASS; v) SAPHO
a. PAPA: Pyogenic arthritis, Pyoderma gangrenosum and Acne
b. PASH: Pyoderma gangrenosum, Acne and HS
c. PAPASH: Pyoderma gangrenosum, pyogenic arthritis, Acne, and HS
d. PASS: PG, Acne, HS, Ankylosing spondylitis
e. SAPHO: Synoviits, acne, pustulosis, hyperostosis and osteitis
17) What are 3 different types of miliaria?
Cyrstalina-corneum
Rubra-mid epidermis
Profunda - DEJ
18) List 5 causes of drug-induced acne:
18) List 5 causes of drug-induced acne:
a. Prednisone
b. Anabolic steroids
c. Androgens-Testosterone
d. JAK inhibitors
e. Halogens
f. Lithium
g. Isoniazid
h. Phenytoin
i. EGFR inhibitors, MEK inhibitors, Mtor inhibitors
j. IUD
k. OCP
l. Vitamin B2, B6,B12, biotin
SHIELD yourself from Vitamin T
i. “Steroids (anabolic, corticosteroids), Halogens, Isoniazid, EGFR inhibitors, Lithium, Dilantin (phenytoin), Vitamin B2, B6, B12, Testosterone and babies (OCP, IUD)
19) How is acne fulminans different from acne conglobate?
a. Systemic symptoms in fulminans-fevers, arthralgia, myalgias, malaise, osteolytic bone lesions
20) List 10 acne variants.
a. Acne vulgaris
b. Acne conglobata
c. Acne fulminans
d. Acne excoriee
e. Neonatal acne
f. Infantile acne
g. Acne cosmetica
h. Pomaid acne
i. Chloracne
j. Radiation acne
Name 5 GA variants
a. Generalized
b. Annular
c. Patch
d. Perforating
e. Subcutaneous/Deep
GAPPS
Ddx for eosinophilic spongiosis
BAD CHIP PIGS
BP
AD
Drug
Contact derm
herpes gestationis/pempigoid
IP
PV
PF
Grovers
scabies
infestation
- What clinical sign is associated with papuloerythroderma of ofuji? What histological finding is characteristically seen with Well’s syndrome?
Deck chair sign
Flame figures
What is the criteria for hypereosinophilic syndrome and what are the 2 major subtypes
peripheral eosinophils >1500/mm3 x 6 months or < 6 mo w/ end organ damage
No evidence underlying cause (parasite, allergy, drug etc.)
End organ damage
i. Myeloproliferative: MC FIP1L1A-PDGFRA translocation, tyrosine kinase, can tx w/ imatinib, , elevated tryptase, b12, constitutional symptoms, endomyocardial fibrosis, Hepatosplenomegaly, bad prognosis
ii. Lymphocytic: clonal proliferation that produced Th2 Il5, benign course but cardiac complications can occur still and increase risk T cell lymphoma,
What is the # 1 cause death HES
CHF
What are 5 common causes of flushing?
MR FAB D
Menopause
Rosacea
Fever
Alcohol
Benign cutaneous flushing-emotion, hot, spicy foods, exercise
Drugs:
niacin, alitretinoin, ACEi, BB, CCB, doxorubicin, opioids, vanco, eicosanoids, rifampicin, steroids, gold, sildenafil
What are 4 serious causes of flushing
A spicy red pineapple made me cry violently
Anaphylaxis
Scombroid poisoning
RCC
Pheo
medullary thyroid cancer
mastocytosis
carcinoid
ViPoma
What are 3 variants of eosinophilic folliculitis?
Eosinophilic pustular folliculitis of ofujii
Neonatal eosinophilic pustular folliculitis
HIV-associated
What is the follicular occlusion tetrad?
HS
Acne conglobata
Pilnodal sinus
Dissecting cellulitis
What are the clinical findings seen in Hurley stage 1, 2 and 3 HS
a. Stage 1: Solitary or multiple isolated abscesses, with no scarring or sinus tracts
b. Stage 2: Recurrent abscesses, with sinus tract or scarring
c. Stage 3: multiple interconnected sinus tracts and abscesses throughout an affected region; more extensive scarring (entire area usually)
What are the 3 diagnostic criteria for HS
- typical lesions of deep-seated painful nodules (known as “blind boils” without a purulent point) in early lesions and abscesses, sinuses, bridged scars, and “tombstone” open comedones (pseudocomedones) in secondary lesions.
Lesions occurring in at least 1 typical body location such as the axillae, groin, perineal and perianal region, buttocks, and inframammary and intermammary folds.
Chronic nature of disease, relapses, and recurrences.
- List 5 medications that can cause DRESS
a. Allopurinol
b. Antibiotics (septra, minocycline)
c. Anti-inflammatory- NSAIDS
d. Anticonvulsants (carbamazepine, phenobarbital, phenytoin, VPA, lamotrigine)
e. AZA, abacavir and nevirapine
f. Dapsone
- List 5 medications that can cause AGEP.
LiT BECA
Lamisil/terbinafine
Tetracycline
Beta lactam
Erythromycin/macrolides
CCB-diltiazem
Anti-malarial
- List 5 medications that can cause pseudoporphyria:
LATINO
Lasix
Amiodarone
Tetracycline
Isotretinoin
Naproxen
OCP
- List 5 medications that can cause a morbilliform drug eruption.
a. Penicillins
b. Cephalosporin
c. Anticonvulsants
d. Allopurinol
e. TMP-SMX
- List 5 medications that can cause SJS/TEN.
5 A’s
a. Antibiotics- septra, B-lactams
b. Anti convulsants – carbamazepine, VPA, phenytoin, phenobarb, lamotrigine
c. Anti-inflammatory - NSAIDS
d. Anti-retrovirals- abacavir, nevirapine
e. Allopurinol
What are 7 components of the SCORTEN score? (include specific values)
CA2B3S
CAABBBS
Cancer
Age >40
Area of body > 10%
Bicarb <20
BUN >10
Beats per minute >120
Sugar >14
- What are 5 medications that cause fixed drug eruption?
PAST
Psuedoephedrine
Anti-inflammatories: ASA, saids, acetaminophen, naproxen
Sulfonamides
Tetracycinlines
What are 5 conditions associated with photoaging
a. Solar elastosis, cutis rhomboidalis nuchae
b. Poikiloderma of civatte
c. Favre racouchot syndrome
d. Colloid millium
e. Erosive pustular dermatosis
List 5 photodermatoses.
PMLE
Solar urticaria
Actinic prurigo
Hydro vacciniforme
Actinic dermatitis
What are 3 cutaneous forms of amyloid? Which one has the highest risk of progression to systemic amyloidosis? Which one overlaps with notalgia paresthetica?
lichen Amyloid
Macular -notalgia
Nodular-highest risk, 7%
What are 5 categories of triggers for CSVV
Infection- strep, hep C>B
Autoimmune
Malignancy
Drug
Other-cryoglobulinemia, emboli, thrombi
List 5 causes of urticarial vasculitis
a. AI-CTD: lupus, sjogrens
b. Drug – Nsaids, MTX, TNF alpha, cimetidine, fluoxetine, SSKI
c. Infection-viral (hep)
d. Malignancy -leukemia/lymphoma, malignancies
e. Other-serum sickness
- List the systemic findings and symptoms of Granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatous with polyangiitis. Which ANCA type is associated with each?
GPA
i. Nasal/sinus: sinusitis, rhinorrhea, epistaxis
ii. Pulmonary: cough, hemoptysis, SOB
iii. Renal: GN w/ hematuria
iv. Other: Arthralgias, ocular findings
v. CNS: Peripheral neuropathy, CVA
vi. Skin: Palpable purpura, PG-like nodules and ulcers, gingival hyperplasia with strawberry gums, oral ulcers
vii. ANCA (PR3, C-ANCA)
- List the systemic findings and symptoms of Granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatous with polyangiitis. Which ANCA type is associated with each?
EGPA
i. Nasal/sinus: Allergic rhinitis, nasal polyps
ii. Pulmonary: Asthma
iii. Cardiac: cardiomyopathy, valvular disease
iv. GI: N/V abdo pain
v. Renal: Limited
vi. CNS: mononeuritis multiplex
vii. Cutaneous: Palpable purpura, painful subcutaneous nodules
viii. Labs: Peripheral Eos
ix. ANCA: P-ANCA > C-ANCA
