Skin Flashcards
1
Q
What is eczema?
A
skin condition causing chronic itch
2
Q
Where does eczema commonly affect?
A
flexures of elbows and knees
3
Q
Who does eczema commonly affect?
A
children
4
Q
What is eczema associated with?
A
other atopic conditions like asthma and hay fever
5
Q
WHat can be seen in the slide?
A
atopic eczema
top arrow shows spongiosis
bottom arrow shows perivascular inflammation in superficial dermis
6
Q
What is spongiosis?
A
accumulation of fluid in the epidermis
7
Q
What cells are seen in atopic eczema?
A
lymphocytes
less common: eosinophils and mast cells
8
Q
What is chronic plaque psoriasis?
A
well demarcated, red, scaly, thickened areas of skin
silvery scale
9
Q
Where does chronic plaque psoriasis commonly affect?
A
extensors of knees and elbows
can involve skin and nails
10
Q
Describe this slide
A
chronic plaque psoriasis
chronic inflammation
thickening of epidermis with epithelial hyperplasia - ACANTHOSIS
hyperkeratosis
11
Q
What is not normally seen in chronic plaque psoriasis biopsies?
A
eosinophils
12
Q
What is erythema multiforme?
A
hypersensitivity reaction
acute skin eruption with characteristic targetoid lesions
13
Q
What causes erythema multiforme?
A
usually infection triggered
rarely drug induced
14
Q
How is erythema multiforme trated?
A
self limiting
resolves itself without complication usually
15
Q
What is lichen planus?
A
itchy, purple, polygon-shaped, flat, raised skin lesion
16
Q
Where does lichen planus normally affect?
A
wrists
ankles
lower back
17
Q
Why does lichen planus occur?
A
idiopathic
18
Q
What does lichen planus look like histologically?
A
band-like chronic inflammatory cell infiltrate along dermal-epidermal junction
19
Q
What is lichen sclerosus?
A
chronic skin condition
white patches on ale anf female genital skin
20
Q
What symptom does lichen sclerosus cause?
A
itch
21
Q
What is lichen sclerosus associated with?
A
increased cancer risk?
22
Q
What is lichen sclerosus called in males?
A
BXO
balantis xerotica obliterans
23
Q
What does lichen sclerosis look like histologically?
A
band of hyalinisation/sclerosis in superficial dermis
24
Q
What are 2 CT diseases?
A
lupus
dermatomyositis
25
What causes these CT diseases?
chronic inflammation along dermal-epidermal junction
26
What is erythema nodosum?
red tender nodules on shins
27
What is the underlying causes erythema nodosum?
panniculitis - chronic inflammation of subcutaneous fat
28
What are some causes for erythema nodosum?
```
streptococcal throat infection
antibiotics
contraceptive pill
pregnancy
inflammatory bowel disease
sarcoid
```
29
What are the 3 autoimmune blistering diseases?
pemphigus vulgaris
bullous pemphigoid
dematitis herpetiformis
30
Which autoimmune disease is seen in this immunofluorescense?
pemphigus vulgaris
31
What is seen in pemphigus vulgaris immunofluroescence?
chicken wire pattern due to IgG positivity on surface of epithelial cells
epithelial cells falling apart from each other
32
Where does pemphigus vulgaris affect and how does it affect them?
```
severe blistering
mucous membranes
mouth
nose
throat
genitals
```
33
Where does the blistering occur in pemphigus vugaris?
intra-epidermal
34
What antibodies are associated with pemphigus vulgaris?
anti-desmosome Ab
35
What autoimmune blistering condition is seen on this immunofluorescence?
bullous pemphigoid
36
What is seen in immunofluorescence of bullous pemphigoid?
linear IgG deposition along basement membrane
37
Where does bullous pemphigoid usually affect?
skin
| occassionally mouth
38
Where does the blistering occur in bullous pemphigoid?
sub-epidermal
39
What antibodies are present in bullous pemphigoid?
anti-basement Ab
40
What is dermatitis herpetiformis?
itchy blistering skin disease
41
What is dermatitis herpetiformis associated with?
coeliac disease
42
Where does dermatitis herpetiformis cause blistering?
sub-epidermal
43
What antibodies cause dermatitis herpetiformis?
IgA anti-endomysial
| IgA tissue transglutamase tTG
44
What are the 3 types of non-infectious granulomatous inflammation?
cutaneous sarcoidosis
granuloma annulare
necrobiosis lipoidica
45
What are granuloma annulare and necrosis lipoidica grouped together as?
necrobiotic granulomatous inflammation
46
What is cutaneous sarcoidosis?
papules and plaques anywhere on the body
47
Describe what is seen histologically in cutaneous sarcoidosis
non-caseating granulomatous inflammation
| fungus and mycobacterium stains are negative
48
What is granuloma annulare?
annular pink/purple patches on bony sites
49
What is seen histologically in granuloma annulare?
zones of degenerate collagen surrounded by rim of histocytes or macrophages
50
What is necrobiosis lipoidica?
tender yellow/brown patches on lower legs
| overlying skin fragile and prone to ulcerrating
51
What is a risk factor for necrobiosis lipoidica?
type 1 and 2 diabetes mellitus
52
What viral skin infections can you get?
herpes simples virus
| molluscum contagiosum virus
53
What happens skin with HSV?
localised intra-epidermal blistering
| lips, genitals, rectum
54
What is seen here?
HSV infection
| at higher mag: intracellular viral inclusions present
55
What does cutaneous infection by molluscum contagiosum virus cause?
multiple raised lesions with central crater
56
How do you treat molluscum contagiosum?
resolves without treatment
57
What is seen here?
molluscum contagiosum viral infection
58
What are 3 bacterial cutaneous infections?
fish tank granuloma
impetigo
cellulitis
59
What is impetigo?
infection of superficial epidermis
60
What is usually the causative organism for impetigo?
S. aureus
61
What is cellulitis?
infection of dermis and subcutaneous fat
62
What are the causes of cellulitis?
Strep pyogenes and S. aureus
63
What causes fish tank granuloma?
mycobacterium marinum
64
What happens Z-N stain in fish tank granuloma?
positive
65
What type of infection is seen in the slide?
fungal
66
What stain is used in fungal infection?
PAS (periodic acid Schiff)
67
What is seen histologically in fungal cutaneous infection?
fungal spores and hyphae in superficial layer of epidermis
68
3 types of pre-cancers
squamous dysplasia
melanocytic
glandular
69
What is acitinic keratosis?
mils and moderate dysplasia of sun exposed skin
70
What is severe dysplasia of sun-exposed skin known as?
Bowen's disease or carcinoma in situ
71
How are mild, moderate and severe dysplasias of perineum/vulva classified?
intraepithelial neoplasia 1, 2 and 3
72
What are examples of dysplasia in the large intestine?
adenomatous polyps
| tubulovillous adenomas
73
What is dysplasia in the cervical epithelium known as?
cervical intraepithelial neoplasia
74
What are risk factors for squamous dysplasia in sun-exposed skin?
chronic sunlight
immunosuppression (renal transplant patients)
previous irradiation
chemical carcinogens
75
What is the risk factor for squamous dysplasia in the groin/perineum?
human papilloma virus infection
76
What is the difference between mild, moderate and severe squamous dysplasia?
abnormal hyperchromatic nuclei and increased numbers of mitotic figures occupy:
MILD: lower 1/3 epidermis
MODERATE: lower 2/3 epidermis
SEVERE: full thickness epidermis
77
What is full thickness/severe squamous dysplasia known as?
carcinoma in situ
78
What is a dysplastic naevus?
melanocytic lesion with atypical histological features
| no evidence of invasive melanoma
79
If the dysplastic naevus is familial then what tumour suppressor gene can be idetified?
cyclin-dependent kinase inhibitor 2A
80
What is lentigo maligna?
melanoma in situ of the face when slow growing
81
What is melanoma in situ?
severe dysplasia of melanocytes within epidermis
82
What is Paget's disease of the nipple?
abnormal glandular/mucinous cells within epidermis which have migrated along the lactiferous duct
83
What can Paget's disease of the nipple look like?
eczema
84
Where can exta-mammary Paget's disease occur?
hair body parts like groin and axillae
85
What is the breakdown of invasive cancers?
epithelial (non-melanoma) skin cancers
malignant melanoma
cutaneous T-cell lymphoma
Kaposi sarcoma
86
What is the origin of BCC?
undifferentiated stem cell within basal layer of epidermis
87
Where is high risk for BCC?
H-zone of face
88
What is seen histologically in BCC?
peripheral pallisading
89
What is peripheral pallisading?
cells at periphery of tumour are columnar and parallel to each other
90
What is SCC?
invasive tumour showing squamous differentiation
91
What is a risk factor for malignant melanoma?
dysplastic naevus
92
What is malignant melanoma?
malignant tumour of melanocytes which have invaded the dermis
93
What are risk factors for malignant melanoma?
sunlight
| sunbeds
94
How does malignant melanoma spread?
Pagetoid: upwards
radial: horizontally
95
What must be measures in malignant melanoma?
Breslow's depth or thickness
96
What is Breslow's depth?
distance between granular layer of epidermis and deepest malignant cell
97
What must be done if malignant melanoma is suspected?
red flag referral to secondary care for urgent removal
98
What should be checked in malignant melanoma?
BRAF oncogene
99
If BRAF oncogene positive what treatment should be given?
vemurafenib
100
What is cutaneous T-cell lymphoma?
non-Hodgkin lymphoma
| Mycosis fungoides involving epidermis and dermis
101
What can mycosis fungoides resemble?
eczema?
102
What can mycosis fungoides turn into?
Sézary syndrome
103
What is Sézary syndrome?
more advanced/aggressive lukaemic stage of mycosis fungoides
| tumour cells now in circulation as well as skin
104
What is Kaposi sarcoma?
malignant vasular poliferation within dermis
105
What 4 clinical settings is Kaposi sarcoma seen in?
HIV
tranplant
classic
endemic
106
Where are patients usually from in classic Kaposi?
middle east
eastern europe
mediterranean
107
Where are patients from with endemic Kaposi?
equatorial Africa
108
What is Kaposi sarcoma caused by?
human herpesvirus 8
109
What is a cutaneous cyts?
keratin "cheesy" filled spherical structure lined with epithelium within dermis
110
What layer is a cutaneous cyst found?
dermis
111
What do clinicians often refer to cutaneous cysts as?
sebaceous cyst
112
What are the 2 common types of cutaneous cyst?
```
epidermal inclusion cyst
pilar cyst (scalp)
```
113
What is seborrhoeic keratosis?
flat based, dark, warty, greasy "stuck on" lesion
114
Who normally gets seborrhoeic keratosis?
elderly
115
What is a skin tag also known as?
fibroepithelial polyp
116
What is a fibroepithelial polyp?
round structure of squamous epithelium encasing connective tissue core
117
Where are fibroepithelial polyps often found?
skin fold areas
| groin/axilla
118
What is a squamous papilloma?
proliferation of squamous epithelium
119
What can cause squamous papilloma?
human papillomavirus
120
What is a dermatofibroma?
fibroblastic proliferation within dermis
121
What do fibroblasts look like?
boomerang shaped nuclei
122
Where does a dermatofibroma often occur?
lower legs
123
What is an ulcer?
full thickness loss of epidermis
| bed of ulcer contains new blood vessels and inflammatory cells (lymphocytes and neutrophils)
124
What are the causes of ulcers?
```
diabetes
arterial/venous insufficiency
trauma
surgery
immobility
```
125
What is a pyogenic granuloma?
polypoid proliferation of small blood vessels which can ulcerate and bleed
126
What does a pyogenic granuloma look like?
raw mince meat
| raspberry
127
What are causes of pyogenic granulomas?
pregnancy
trauma
infection
medication
128
What is a pilonidal sinus?
fragmented hair shaft material within sinus tract in dermis surrounded by inflammatory cells and fibrous scar tissue
129
Where are pilonidal sinuses often seen?
sacral/cleft area of hair men's buttocks
| hairdressers hands "barber's interdigital pilonidal sinus of hand"
130
What is a freckle?
increase in basal pigmentation with NO increase in melanocytes
131
What is solar lentigo?
flat pigmented lesion
increase in basal pigmentation
small increase in basal melanocytes
no nuclear atypia
132
What is a junctional naevus?
nests of benign melanocytes within the epidermis
133
What is an intradermal naevus?
nests of benign melanocytes within dermis
134
What is a compound naevus?
combined features of junctional and intradermal naevus
135
What is a halo naevus?
prominent lymphocytic infiltrate as well as melanocytic lesion
136
Why does the pale halo form in halo naevi?
immune-mediated regression of lesion
137
What is a blue naevus?
deeply pigmented bluish melanocytes that have stretched out into spindle shape
138
What is a Spitz naevus?
in children
| present like malignant melanoma
