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MBBS 4 Dermatology > Pigmentation Disorders > Flashcards

Pigmentation Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

What determnes skin colour?

A

The number of melanocytes is equal in all skin types
- In darker skin melanosomes are larger, more numerous and they contain more melanin

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2
Q

What are the Fitzpatrick skin types?

A

I - burns, does not tan
II - burns, tans a little
III - burns slightly, tans evenly
IV - burns sometimes
V - burns rarely, brown skin
VI - never burns, dark brown skin

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3
Q

What is lichen planus?

A

a chronic inflammatory disease characterized by skin and/or mucosal lesions
- the skin lesions are characterized by the 6Ps (planar, polygonal, pruiritic, purple papules and plaques
- involvement of the oral mucosa manifests as reticular white lines (Wickam striae)

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4
Q

What is lichen simplex?

A

a benign skin condition characterized by lichenified plaques with excoriations and moderate to intense pruritis that leads to persistent rubbing and/or scratching to provide symptom relief
- result from habitual behaviour or is a manifestation of chronic ecxematous inflammation
e.g. scratching in resonse to stress

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5
Q

What is post inflammatory hyperpigmentation?

A

an acquired hyperpigmentation disorder that results from injury (skin abrasion), inflammation (atopic dermatitis) or procedures (crypotherpay, radiation)
- manifests as pigmented macules or patches with irregular borders and can persist if the underlying cause is not treated
- typically this affects individuals with dark skin

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6
Q

Treatment for post-inflammatory hyperpigmentation?

A

Topical treatment
1. retinoids: tretinoin, tazarotene, adapalene
2. hydroquinone
Procedures
3. glycolic, salycilic acid, lactic acid
4. sunscreen

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7
Q

Best sunscreen to use in PIH?

A
  • Sun Protection Factor 50
  • Tinted sunscreens containing iron oxides protect against Visible Light as well as UVLight
  • Tinted sunscreens containing pigments such as ferrous oxide
    combined with zinkoxide or titanium dioxide
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8
Q

What can be used to bleach the skin?

A

corticosteroids
e.g. hydroquinone

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9
Q

Why do people bleach?

A
  1. smooth and healthy skin
  2. beauty enhancement
  3. social factors (job, marriage prospects)
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10
Q

Hydroquinone side effects?

A
  1. Vitiligo-like depigmentation
  2. Allergic contact eczema with postinflammatory hyperpigmentation
  3. Exogenic ochronosis
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11
Q

How bleaching creams work?

A

Corticosteroids inhibit melanocyte proliferation, melanocyte secretory function and inflammation
- They should only be used for medical combination treatment of PIH,
e.g. with retinoids, for a short period of time

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12
Q

Side effects of topical corticosteroids?

A
  1. Atrophy of dermis and epidermis
  2. Masking of infections
  3. Peri-oral and peri-orbital dermatitis, steroid acne
  4. Striae, esp in arm pits and groins
  5. Teleangiectasia
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13
Q

Name hypopigmented disorders?

A
  1. Vitiligo variants
  2. Congenital
  3. Infections
  4. Other acquired
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14
Q

What is vitiligo?

A
  • Chronic acquired auto-immune skin disease
  • Acquired, chalk-white, welldefined depigmented macules
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15
Q

Prediliction sites for vitiligo?

A
  • periorbital, fingers, lips, nose, perineum, axillae
  • points of pressure: elbow, knees, lumbosacral
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16
Q

Does a vitiligo patient have melanocytes?

A

no

17
Q

Psychosocial burden of vitiligo?

A

Can result in severe difficulties in social adjustment, stigma

18
Q

Epidemiology of vitiligo?

A
  • Prevalence 0.1 – 2 %
  • Male : female 1:1
  • Onset: any age, 50% 10-40 years
  • Mostly < 25% of BSA involved
  • More progressive - if onset at young age
19
Q

Genetics in vitiligo?

A

30-45% positive family history

20
Q

Pathogenesis of vitiligo?

A

Autoimmune theory
* Selected melanocytes destroyed by autoimmune reaction (apoptosis)

21
Q

Treatment for vitiligo?

A
  1. Topical
    * Steroids / calcineurin inhibitors
    * Vit D Analogs
    * Combinations
    * Sunscreens/ Covering
    * Janus-Kinase (JAK)-inhibitors
  2. Camouflage
  3. Phototherapy
  4. Surgery only for small stable areas
    or segmental vitiligo, eg minigrafts,
    single hair grafts
22
Q

Surgical methods in treating vitiligo?

A

possibly helpful for small areas, segmental vitiligo
1. Minigrafts
2. Single hair graft,
3. Split skin graft,
4. Future: Cultured melanocytes?

23
Q

Reducing psychosocial burden of vitiligo?

A
  1. patient support groups
  2. role models
  3. psychological support
24
Q

What is epidermal naevus?

A
  • Present at birth or occur in infancy
  • Hyperplasia of epidermal structures
  • Closely set verrucous papules, circumscribed, often linear, may appear in Blaschko´s Lines on the trunk
25
Q

What is achromic naevus?

A
  • Cutaneous mosaicism
  • altered clone of melanocytes with a decreased ability to make melanin
26
Q

What is xeroderma pigmentosum?

A
  • Rare genodermatosis, autosomal recessive inheritance
  • Inability of a cell to repair DNA damage caused by UV
    ➢ photosensitivity
    ➢ premature skin aging
    ➢ skin, ocular, neurological & oral lesions
    ➢ cutaneous & internal malignancies at early age
  • No cure, early mortality
27
Q

What is leprosy?

A

a chronic infection caused by Mycobacterium leprae that typically manifests with hypopigmented skin lesions, nerve thickening, and peripheral nerve palsies

28
Q

What is onchoceriasis?

A

aka river blindness
- caused by onchocerca volvulus
- ocular involvement may cause blindness
- onchocercomata (subcutneous nodules): deep, nonpalpable nodules containing adult worms that are found over various bony prominences
- generalized pruritic lesions
- skin atrophy causing a cigarette paper appearance

29
Q

What is pityriasis versicolor?

A
  • Round hypopigmented sharply defined, scaling macules
  • affecting trunk and chest, neck and shoulder area, abdomen, upper arms and thighs
  • hypomelanosis can remain long after treatment
30
Q

What is used to test for pityriasis versicolor?

A

Stretch test
- gentle abrasion of the surface accentuates the scaling

31
Q

Ddx for acquired hypopigmentation?

A

Inflammatory or post-inflammatory
1. Guttate hypomelanosis
2. Pityriasis alba
3. Scars
4. CDLE
5. Bullous diseases
6. Psoriasis, Seborrhoic dermatitis
7. Lichen sclerosus
8. Chemical
9. Burns, Cryotherapy, Dermabrasion

32
Q

What is alopecia areata?

A
  • History of / or ongoing hair loss
  • No loss of pigment from scalp, only white hair
33
Q

What is idiopathic guttate hypomelanosis?

A
  • Common, shins
  • Complete pigment loss
  • Sun damaged skin
  • Other trauma
34
Q

What is pityriasis alba?

A

dry, scaly, hypopigmented skin lesions that are self limiting and harmless
- commonly seen in children

35
Q

What is hirsutism?

A
36
Q

What is chronic discoid lupus erythematodes?

A
  • onset 20-45 years,
  • Females > males,
  • Chronic, indolent
  • Well demarcated, scaly, indurated, red, later atrophic, scarring, hypopigmented discoid plaques
37
Q

What is bullous pemphigoid?

A

an autoimmune blistering skin disorder caused by circulating antibodies against BP antigen on hemidesmosomes
- tense subepidermal blisters develop and can become hemorrhagic or turbid
- recurrent lesions typically occur in skin flexures (groin, axilla) and over the abdomen, mucous membranes are usually spared

38
Q

What is anogenital lichen sclerosus?

A

chronic inflammatory dermatosis that is characterized by pruritic, white plaques with epidermal atrophy and scarring
- ass. with increased risk of squamous cell carcinoma and most commonly affects postmenopausal women

MBBS 4 Dermatology (21 decks)

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