Pigmentary/Vascular Disorders Flashcards
What is caused by hyperpigmentation due to excessive deposition of melanin into the epidermis or dermis
Melasma
Risk factors for melasma include
Middle-eastern, Spanish/Hispanic, Asian, skin types IV and V, hormone replacement therapy, pregnancy, oral contraceptives, UV exposure, photosensitizing medications
Melasma involving the epidermis presents:
Symmetrical tan/brown macules and patches
Melasma involving the dermis presents:
Symmetrical Grey-brown patches and macules
Regimen for use of hydroquinone 4% to treat melasma
BiD for 3 to 6 months. Maximum effect is 2 months so if no improvement by 2-3 months, discontinue.
What medication can be used off-label to treat melasma?
Azelaic acid 15 or 20% BID
What combination therapy can be used to treat melasma?
Fluocinolone 0.01%, tretinoin 0.05% and hydroquinone 4% at bedtime daily for 8-24 months
Ocular manifestations with Sturge Weber syndrome include
Glaucoma
Early neurological manifestations with Sturge Weber syndrome include
Seizures
A pink colored patch located at the nape of an infant’s neck is
Port wine stain
The fluency of the pulse dye laser settings to treat port wine stain should be
11-12 joules
A port wine stain located on the axillary area is labeled as
V2 area
The term buphthalmos refers to
One eye being larger than the other
A port wine stain has a higher risk of neurological involvement when located where?
Bilateral forehead and eye areas
Squamous atypua may be associated with
Erythema ab igne
The presence of a white forelock is often noted in
Piebaldism
A common dermatologic medication that is linked to ochronosis
Minocycline
50% of all cases of oculocutaneous albinism is due to a mutation in which gene?
P
Melanin synthesis in temperature sensitive oculocutaneous albinism is most likely to occur in what location?
Lower legs
The correct twrm to describe hypopigmentayion is
Leukoderma
The number of melanocytes in oculocutaneous albinism is
Normal
Dyskeratosis congenital is often linked with leukoplakia in the genital and/or oral mucosa. This leukoplakia is linked to possible development of?
SqCC
Pegged teeth are often associated with what condition?
Incontinetia pigmenti
The medication of choice to treat prurigo pigmentosa is
Dapsone
Diffuse bluish gray discoloration on the palms is termed
Argyria
The first stage of incontinentia pigmenti is characterized by which type of lesions?
Vesicles
A patient diagnosed with post inflammatory hyperpigmentation has lesions that appear grayish blue. The color of lesion is associated with hyperpigmentation of the
Dermis
An autoimmune type of disorder that often accompanies vitiligo is
Thyroid
The most common classification type of vitiligo that occurs in children is
Segmental
Piliosis describes vitiligo in which area
Scalp hair
Vitiligo is estimated to affect what percentage of the general population?
2%
Where does repigmentation of vitiligo occur?
Often appears in the perifollicular areas
A preferred treatment option for pregnany woman with vitiligo is
Narrow Band UVB
50% of patients with CARPreapond favorably to which antibiotic?
Minocycline
Minocycline in the treatment of CARP does what?
Inhibits neutrophils migration, inhibits protein kinase C and downregulates cytokines
The most common pattern of melasma is
Centrofacial
Which pigment depth of melasma is most responsive to treatment?
Epidermal
Velvety hyperpigmented plaques favoring intertriginous areas describes what condition?
Acanthosis Nigricans
What patients are predominantly affected by acanthosis nigricans?
African Americans, native Americans and hispanics
Acanthosis nigricans is associated with what conditions
Diabetes, insulin resistance, obesity, PCOS, genetic syndromes
What type of malignancy is acanthosis nigricans associated with?
Gastric Adenocarcinoma
Acanthosis nigricans associated with malignancies is described as
Middle-age or older adult onset and unusual locations
What labs should be checked in a patient with acanthosis nigricans?
HgB A1C, serum insulin and TSH
Treatment of acanthosis nigricans includes
Topical retinoids, topical vitamin D analogs, urea, salicylic acid, systemic retinoids, chemical peels and weight loss
Hyperpigmented hyperkeratouc macules/papules often coalesce into reticulated patches/plaques that favor the neck, chest, upper back and axilla.
Confluence and Reticulated Papillomatosis
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
Segmental
Treatment of segmental vitiligo includes
Topical corticosteroids, calcineurin inhibitors (off label), targeted phototherapy and surgical grafting
Non-segmental vitiligo treatment includes
Topical corticosteroids, calcineurin inhibitors (off-label), ruxolitinib BID
Active vitiligo treatment includes
First line therapy is systemic glucocorticoids. NbUVB, systemic immunosuppression (Methotrexate, cellcept, cyclosporin)
Progressive macular hypomelanosis wood’s lamp findings include:
Orange to red follicular fluorescence
Treatment of progressive macular hypomelanosis includes
Combination of phototherapy and topical ABX, BPO is combo with clindamycin 1%, PUVA, NBUVB and oral isotretinoin
What medication causes bluish-gray discoloration of nails, face, sclerae, hard palate and/or pretibial areas?
Hydroxychloroquine
Topical tacrolimus can cause what shade of discoloration
Brown
