Pigmentary/Vascular Disorders

Question 1

What is caused by hyperpigmentation due to excessive deposition of melanin into the epidermis or dermis

Answer 1

Melasma

Question 2

Risk factors for melasma include

Answer 2

Middle-eastern, Spanish/Hispanic, Asian, skin types IV and V, hormone replacement therapy, pregnancy, oral contraceptives, UV exposure, photosensitizing medications

Question 3

Melasma involving the epidermis presents:

Answer 3

Symmetrical tan/brown macules and patches

Question 4

Melasma involving the dermis presents:

Answer 4

Symmetrical Grey-brown patches and macules

Question 5

Regimen for use of hydroquinone 4% to treat melasma

Answer 5

BiD for 3 to 6 months. Maximum effect is 2 months so if no improvement by 2-3 months, discontinue.

Question 6

What medication can be used off-label to treat melasma?

Answer 6

Azelaic acid 15 or 20% BID

Question 7

What combination therapy can be used to treat melasma?

Answer 7

Fluocinolone 0.01%, tretinoin 0.05% and hydroquinone 4% at bedtime daily for 8-24 months

Question 8

Ocular manifestations with Sturge Weber syndrome include

Answer 8

Glaucoma

Question 9

Early neurological manifestations with Sturge Weber syndrome include

Answer 9

Seizures

Question 10

A pink colored patch located at the nape of an infant’s neck is

Answer 10

Port wine stain

Question 11

The fluency of the pulse dye laser settings to treat port wine stain should be

Answer 11

11-12 joules

Question 12

A port wine stain located on the axillary area is labeled as

Answer 12

V2 area

Question 13

The term buphthalmos refers to

Answer 13

One eye being larger than the other

Question 14

A port wine stain has a higher risk of neurological involvement when located where?

Answer 14

Bilateral forehead and eye areas

Question 15

Squamous atypua may be associated with

Answer 15

Erythema ab igne

Question 16

The presence of a white forelock is often noted in

Answer 16

Piebaldism

Question 17

A common dermatologic medication that is linked to ochronosis

Answer 17

Minocycline

Question 18

50% of all cases of oculocutaneous albinism is due to a mutation in which gene?

Answer 18

P

Question 19

Melanin synthesis in temperature sensitive oculocutaneous albinism is most likely to occur in what location?

Answer 19

Lower legs

Question 20

The correct twrm to describe hypopigmentayion is

Answer 20

Leukoderma

Question 21

The number of melanocytes in oculocutaneous albinism is

Answer 21

Normal

Question 22

Dyskeratosis congenital is often linked with leukoplakia in the genital and/or oral mucosa. This leukoplakia is linked to possible development of?

Answer 22

SqCC

Question 23

Pegged teeth are often associated with what condition?

Answer 23

Incontinetia pigmenti

Question 24

The medication of choice to treat prurigo pigmentosa is

Answer 24

Dapsone

Question 25

Diffuse bluish gray discoloration on the palms is termed

Answer 25

Argyria

Question 26

The first stage of incontinentia pigmenti is characterized by which type of lesions?

Answer 26

Vesicles

Question 27

A patient diagnosed with post inflammatory hyperpigmentation has lesions that appear grayish blue. The color of lesion is associated with hyperpigmentation of the

Answer 27

Dermis

Question 28

An autoimmune type of disorder that often accompanies vitiligo is

Answer 28

Thyroid

Question 29

The most common classification type of vitiligo that occurs in children is

Answer 29

Segmental

Question 30

Piliosis describes vitiligo in which area

Answer 30

Scalp hair

Question 31

Vitiligo is estimated to affect what percentage of the general population?

Answer 31

2%

Question 32

Where does repigmentation of vitiligo occur?

Answer 32

Often appears in the perifollicular areas

Question 33

A preferred treatment option for pregnany woman with vitiligo is

Answer 33

Narrow Band UVB

Question 34

50% of patients with CARPreapond favorably to which antibiotic?

Answer 34

Minocycline

Question 35

Minocycline in the treatment of CARP does what?

Answer 35

Inhibits neutrophils migration, inhibits protein kinase C and downregulates cytokines

Question 36

The most common pattern of melasma is

Answer 36

Centrofacial

Question 37

Which pigment depth of melasma is most responsive to treatment?

Answer 37

Epidermal

Question 38

Velvety hyperpigmented plaques favoring intertriginous areas describes what condition?

Answer 38

Acanthosis Nigricans

Question 39

What patients are predominantly affected by acanthosis nigricans?

Answer 39

African Americans, native Americans and hispanics

Question 40

Acanthosis nigricans is associated with what conditions

Answer 40

Diabetes, insulin resistance, obesity, PCOS, genetic syndromes

Question 41

What type of malignancy is acanthosis nigricans associated with?

Answer 41

Gastric Adenocarcinoma

Question 42

Acanthosis nigricans associated with malignancies is described as

Answer 42

Middle-age or older adult onset and unusual locations

Question 43

What labs should be checked in a patient with acanthosis nigricans?

Answer 43

HgB A1C, serum insulin and TSH

Question 44

Treatment of acanthosis nigricans includes

Answer 44

Topical retinoids, topical vitamin D analogs, urea, salicylic acid, systemic retinoids, chemical peels and weight loss

Question 45

Hyperpigmented hyperkeratouc macules/papules often coalesce into reticulated patches/plaques that favor the neck, chest, upper back and axilla.

Answer 45

Confluence and Reticulated Papillomatosis

Question 46

What type of vitiligo spreads rapidly over 6-24 months with partial or compete distribution with dermatomal ot blaschko's lines distribution. Usually affects face (50%), followed by trunk, extremities and neck

Answer 46

Segmental

Question 47

Treatment of segmental vitiligo includes

Answer 47

Topical corticosteroids, calcineurin inhibitors (off label), targeted phototherapy and surgical grafting

Question 48

Non-segmental vitiligo treatment includes

Answer 48

Topical corticosteroids, calcineurin inhibitors (off-label), ruxolitinib BID

Question 49

Active vitiligo treatment includes

Answer 49

First line therapy is systemic glucocorticoids. NbUVB, systemic immunosuppression (Methotrexate, cellcept, cyclosporin)

Question 50

Progressive macular hypomelanosis wood's lamp findings include:

Answer 50

Orange to red follicular fluorescence

Question 51

Treatment of progressive macular hypomelanosis includes

Answer 51

Combination of phototherapy and topical ABX, BPO is combo with clindamycin 1%, PUVA, NBUVB and oral isotretinoin

Question 52

What medication causes bluish-gray discoloration of nails, face, sclerae, hard palate and/or pretibial areas?

Answer 52

Hydroxychloroquine

Question 53

Topical tacrolimus can cause what shade of discoloration

Answer 53

Brown