Skin Flashcards by Mimin Parreno

Connects the keratinocytes in the stratum spinosum.

What is the disease process involved with auto antibodies targeting the desmoglein which is a component in this structure?

Desmosomes
— structural support via intermediate filament interactions: cytokeratin, desmoplakin

Pemphigus vulgaris

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Increased thickness in epidermis

Proliferation of keratinocytes

Acanthosis

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Excess keratin (hyperkeratosis) with retention of nuclei

Parakeratosis

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Acanthosis with parakeratosis

Psoriasis

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Collection of neutrophils within stratum corneum seen in Psoriasis

Munro microabscesses

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What is the mechanism behind Auspitz sign?

In psoriasis, dermal papillae is elongated. Epidermis above this is thinned (granulosum)
Easier to expose the blood vessels.
When silvery plaque is scraped, pin point bleed from exposed blood vessels — Auspitz sign

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Saw tooth appearance at the dermal epidermal junction (lymphocytic infiltration)

Lichen planus

6 Ps
Polygonal
Purple
Planar Papules
Pruritic
Plaques

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What infection is associated with Lichen Planus

Hepatitis C virus infection

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Separation of the epidermal cells

Acantholysis

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What is the pathophysiology in Pemphigus vulgaris?

Autoimmune destruction of desmosomes

IgG antibodies against desmoglein (component of desmosome)

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Why is the basement layer intact in Pemphigus Vulgaris?

Desmosomes connect the cells in stratum spinosum.

Hemidesmosomes anchor the basement membrane at the dermal epidermal junction and are unaffected in Pemphigus vulgaris.

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Affectation of Pemphigus vulgaris include

Skin

Oral mucosa

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Pemphigus Vulgaris immunofloresence finding.

Fish net/reticular pattern around epidermal cells

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Row of tombstones

Pemphigus vulgaris

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Autoimmune

IgG antibodies against hemidesmosomes (epidermal basement membrane)

Bullous pemphigoid

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Why is there tense bullae in Bullous pemphigoid?

Separation is under the epidermis, and so the bullae composed of the entire thickness of the epidermal layers

Contain eosinophils

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IF of Bullous pemphigoid

Linear patter at the epidermal-dermal junction

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T or F

Bullous pemphigous affects the oral mucosa

False

Spares the oral mucosa, affects the skin

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Associated with Celiac Disease

Dermatitis herpetiformis

Autoimmune deposition of IgA at the tip of the dermal papillae

Dermatitis herpetiformis

Deposition create little blisters at the tip of dermal papillae resembling herpes vesicles

Why is a gluten free diet in Celiac Disease, helpful in treatment of dermatitis herpetiformis?

IgA antibody are anti bodies against gluten that cross react with reticulin fibers that attach the basement membrane to the dermis

Targetoid rash bullae

Erythema multiforme

Targetoid appearance due to central necrosis

Stuck on appearance

Proliferation of squamous cells with pseudocyst/horn cysts (HM: circular spaces with abundant pink keratin)

Seborrheic keratosis

Sudden onset of multiple seborrheic keratoses

Leser-Trelat sign

What is a Leser Trelat sign associated with?

Underlying malignancy (GI, lymphoid, paraneoplastic process)

Associated with insulin resistance or malignancy Epidermal hyperplasia with hyperpigmentation

Acanthosis nigricans

Autosomal recessive defect in enzymes necessary for nucleotide excision repair? Carcinoma most at risk for is?

Xeroderma pigmentosum — no nucleotide excision repair pathway that excise and repair pyrimidine dimers from sun exposure At risk for — Basal Cell CA

Elevated nodule Central area of ulceration Surrounded with telangiactasia Classically arise in the upper lip

Basal Cell Ca

Classic finding in histology of Basal Cell CA

Peripheral palisading

How does UV B sunlight cause damage?

Induce DNA damage by forming pyrimidine dimers

Risk factors for squamous cell CA

Immunosuppressive therapy Arsenic poisoning Chronic inflammation

Ulcerated, nodular mass | Usually on the face, classically involving the lower lip

Squamous cell CA

Hyperkeratotic, scaly plaque on face back or neck Precursor to SCC

Actinic keratosis

Where is melanin made?

Melanosomes Passed of to keratinocytes resulting in skin pigmentation

Melanocytes are derived from which embryonic structure?

Neural crest cells

Autoimmune destruction of melanocytes | Localized

Vitiligo

Due to enzyme defect (usually tyrosinase) that impairs melanin production

Albinism

What is increased in freckles?

Melanosomes

Malignant neoplasm of melanocytes | Most common cause of death from skin CA

Melanoma

Most common subtype of Melanoma, dominant early radial phase, good px

Superficial Spreading

Lentiginous proliferation, good prognosis | Melanoma subtype

Lentigo Maligna melanoma

Early vertical phase Subtype melanoma Poor prognosis

Nodular

Arises on palms or soles Often in dark skinned Not related to UV light exposure

Acral lentiginous

Where is the separation at Staphylococcal Scalded Skin Syndrome?

Stratum granulosum

Where is the separation at TEN?

Dermal epidermal junction

Firm, pink umbilical papules | Most often arise in children

Molluscum contagiosum

What is the causative agent from molluscum contagiosum and what is the hallmark finding in LM

Pox virus, molluscum bodies (viral inclusion bodies of pox virus)