Skin Flashcards
What are Warts?
Warts: Benign infection with papilloma viruses
What is Congenital melanocytic nevus?
Congenital melanocytic nevus: congenital lesion, with risk of melanoma high if >20cm
What is epidermolysis bullosa?
Epidermolysis bullosa: defective epidermal cell adhesion (acantholysis)
Characteristics (4) of Cyst?
o Cyst: Raised Fluid filled cavity Encapsulated Lined with the epithelium
What causes albinism?
o Melanocytes: attach with hemidesmosomes to the basal membrane, makes melanin granules to provide ultraviolet barrier. Mutation in tyrosinase gene will cause albinism and make patient susceptible to cancer
Characteristics (2) of Crust?
o Crust:
Surface change
Hardened deposit from serum, blood, or pus
Characteristics (3) of Scale?
o Scale: (ex: tinea pedis)
Skin surface change
Desquamation
Flake arising from stratum corneum
What is a secondary skin lesion?
Evolution of primary skin lesion or what the patient did themselves (like scratching)
Causes of Acute atopic eczema/dermatitis? (5)
Causes: fungus, immunosuppression, staphylococcus, psoriasis, scratching, etc
What is Basal cell carcinoma (BCC)?
Most common skin cancer with low risk of metastasis, often with pearly rolled up border
Clinical subtypes of melanoma: from most common to least? (3)
- Superficial spreading: horizontal (flat) to vertical growth (papule)
- Nodular: vertical growth (greater risk of metastasis)
- Acral lentiginous: palms, soles, nails (present in darker skin phototypes)
What is the Atopic March?
Atopic March: atopic dermatitis is often followed, with age, by food allergy, then asthma, then rhinitis
Treatment of Non melanoma skin cancer (NMSC)? (5)
o Biopsy to classify o Curettage and Electrodessication o Cryotherapy o Radiotherapy o Topical therapy
Give the three benign skin lumps/bumps
- Seborrheic keratosis: benign papule or plaque with a warty surface that appears in adulthood
- Cherry angioma: benign vascular lesion that appears as form red capsule
- Solar lentigo: benign melanocytic proliferation due to UV exposure
Major criteria for Acute atopic eczema/dermatitis? (5)
Major criteria: - Pruritus - Typical morphology - Chronic - Personal or family history of atopy: o Asthma o Allergic rhinitis o Atopic dermatitis
What are the clinical features of Dress Syndrome? (4)
Clinical features: o Happens 2-6 weeks after ingestion of drug o Facial red swelling o No mucosal erosions o Presents with hepatitis
Characteristics (2) of Pustule?
o Pustule:
Raised
Fluid-filled, but with pus
Name the dermatologic emergencies (10)
Acute purpura Toxic shock syndrome Necrotizing fasciitis Erythroderma Stevens-Johnson syndrome/Toxic epidermal necrolysis Dress syndrome Acanthosis nigricans Vasculitis Erythema nodosum Necroboisis lipoidica
o Basement membrane is connected to dermis via what? (5)
o Basement membrane is connected to dermis via collagen VII, collagen III, collagen I and elastin (which also requires microfibrils/fibrillin)
Where on the skin are melanomas most often found?
Melanoma sites: in men, it’s upper back. In women, it’s the legs (calves)
What is a primary skin lesion?
Lesion resulting directly from the disease process
Clinical features of Stevens-Johnson syndrome/Toxic epidermal necrolysis? (4)
o 1-3 days prodrome of skin pain and fever
o Tender dusky red or purpuric macules
o Skin detachment showing dermis
Diagnosis: Nikolsky’s sign and Asboe Hansen’s sign (can also indicate Erythema multiforme and Mycoplasma mucositis)
Contributing factors of Acute atopic eczema/dermatitis? (4)
Contributing factors: - Microbial dysbiosis - Irritant contact dermatitis - Allergic sensitization: o Type 1: systemic, immediate skin prick tested o Type 4: delayed type patch tested
What is Marfan’s syndrome?
Marfan’s syndrome: Fibrillin-1 gene mutation leading to aortic aneurysm, lax joints and dislocation of the lens
Characteristics (3) of Papule?
o Papule: (ex: molluscum contagiosum)
Raised
Different color from surrounding skin (but can be the same actually)
<0.5cm
What is Necrobiosis lipoidica?
Necrobiosis lipoidica: waxy brown atrophic yellow plaque present in diabetes
What is Dress Syndrome? Treatment?
Dress syndrome: strong, drug-specific immune reaction that triggers viral reactivation (T cell expansion causing tissue damage by CD8 lymphocytes)
Treatment: Steroids
What are the three types of epithelia?
o Ectoderm: lining of oral, nasal, cornea and skin
o Endoderm: lining of GI and respiratory tract, liver pancreas
o Mesoderm: renal tubules, reproductive tract, blood vessels
What is Ichthyosis?
Ichthyosis: abnormal keratinization or glycolipic processing/release
Risk factors of Non melanoma skin cancer (NMSC)? (3)
- Non melanoma skin cancer (NMSC): usually on head an neck (photo-exposed area)
Risk factors:
o Skin type I-III (super-white to well, hum, like, almost white?)
o Previous skin cancer
o Immunosuppressed (favors more BCC than SCC)
Melanoma risk factors? (4)
- Phenotype (skin phototype I-III, red/blood hair and freckles)
- Sun exposure
- Family history, previous skin cancer
- Immunosuppressed
Characteristics (3) of Nodule?
o Nodule: (ex: basal cell carcinoma)
Raised, solid but with depth
<0.5cm
What is Staphylococcal scalded skin syndrome Treatment?
Staphylococcal scalded skin syndrome: disease of childhood where there’s a decrease renal toxin clearance and/or lack of toxin-neutralizing antibodies
Treatment: Beta-lactamase-resistant antibiotic
Clinical features of toxic shock syndrome? (6)
o Capillary leak syndrome with fever o Exanthema o Strawberry tongue o Hypotension o Multiorgan dysfunction o Convalescent desquamation
Characteristics (4) of Urticaria?
o Urticaria: Raised Any size or shape Last <24h Edema and erythema
What is Dysplastic nevus? What is the treatment?
Dysplastic nevus: can come with dysplastic nevus syndrome if there’s a family history of >50nevi or size >5-6mm
Treatment: biopsy, sun protection and monthly self exam
What is Squamous cell carcinoma? What is it called when it’s in situ?
Squamous cell carcinoma: 2nd most common skin cancer caused by lifetime IV light exposure, low risk of metastasis, scaly red plaque
When SCC is in situ, it is called Bowen’s disease
What is Basal cell carcinoma?
Basal cell carcinoma: destructive of basal cells, but not metastatic
What is Acquired melanocytic nevi?
Acquired melanocytic nevi: “mole” or beauty spot”, occur at all age, all skin types. Uniform in color and shape, and <6mm. Melanoma risk is low
What are the two types of necrotizing fasciitis?
o Type 1: polymicrobial present in adulthood (immunosuppressed, diabetes, ulcers)
o Type 2: streptococcus present in children
Characteristics (3) of Ulcer?
o Ulcer: (ex: diabetic ulcer)
Lack of substance
Non-moist circumscribed depression
Due to loss of epidermis and all or part of dermis
What is found Stratum basale/germinativum? (two adhesion structures and two cells)
Presence of cuboidal cells (keratinocytes that release lipid lamellated granules), mitoses
Has two adhesion structures:
• Hemidesmosomes (integrins) for cell-matrix adhesion
• Desmosomes (cadherins) for cell-cell adhesion
What is Erythema Nodosum?
Erythema nodosum: bruises that appear and disappear out of the blue, due to fat inflammation under the skin
Characteristics (3) of Erosion?
o Erosion: (ex: pemphigus vulgaris)
Lack of substance
Moist circumscribed depression
Due to loss of epidermis and all or part of dermis
Characteristics (3) of Tumor?
o Tumor: (ex: basal cell carcinoma)
Raised, solid but with depth
>0.5cm
What is Stevens-Johnson syndrome/Toxic epidermal necrolysis?
Stevens-Johnson syndrome/Toxic epidermal necrolysis: rare, acute life-threatening detachment of the skin caused by extensive keratinocyte necrosis as a reaction to drug. This can lead to sepsis, since you lose the skin barrier
What are the three types of Acquired melanocytic nevi?
o Junctional (between dermis and epidermis): flat and dark o Intradermal (within the dermis): raised and lighter o Compound (junctional and intradermal components): slightly lighter and elevated
What are the two subtypes of Non melanoma skin cancer (NMSC)?
o Basal cell carcinoma (BCC)
o Squamous cell carcinoma
Characteristics (3) of Vesicle?
o Vesicle: (ex: herpes zoster)
Raised
Clear, fluid-filled
<0.5cm
What is the morphology of Acute atopic eczema/dermatitis? (5)
Morphology:
- Erythematous
- Edematous
- Scale crust
- Oozing/weepy
- Ill-defined borders
Give the epithelial layers of the skin (5)
o Stratum corneum (keratinized layer) o Stratum lucidum o Stratum granulosum o Stratum spinosum o Stratum basale/germinativum
What is Acute atopic eczema/dermatitis?
Acute atopic eczema/dermatitis:
Irritation (micro-fissures) leading to decreased water binding and skin moisture, which leads to a decrease in skin surface lipids (ceramides)
Causes of Erythroderma? (5)
Causes: from most common to least common o Idiopathic o Dermatitis o Psoriasis o Drug reactions o Cutaneous T cell lymphoma
Clinical features of necrotizing fasciitis? (3)
o Extreme pain (distinguishes it from cellulitis)
o Skin is shiny, gray-blue color
o Septic, and does not respond to antibiotics
Risk factors (1) and drugs culprits (3) in Stevens-Johnson syndrome/Toxic epidermal necrolysis?
Risk factors: o Immunosuppressed (HIV infection) Common drugs culprit: o Allopurinol o Antibiotics (sulfonamides, mostly) o Oxicam NSAIDs
What is the melanocyte? What does it do?
o Melanocytes: attach with hemidesmosomes to the basal membrane, makes melanin granules to provide ultraviolet barrier. Mutation in tyrosinase gene will cause albinism and make patient susceptible to cancer
What are Desmosomes?
• Desmosomes (cadherins) for cell-cell adhesion
Characteristics (3) of Patch?
o Patch: same as macule, but larger
Flat
Different color from surrounding skin
>0.5cm
Characteristics (3) of Macule?
o Macule:
Flat
Different color from surrounding skin
<0.5cm
What are the three types of Acanthosis nigricans?
- Acanthosis nigricans: Three types: o Malignancy associated o Familial o Acutely caused by insulin resistance (endocrinopathy): most common, with Acromegaly, Cushing, hypothyroidism, Addison’s, hypogonadism, cancer of GI tract
Causes of toxic shock syndrome? (2)
o Staphylococcal
o Streptococcal
Characteristics (3) of Bulla?
o Bulla: (ex: bullous pemphigoid)
Raised
Clear, fluid-filled
>0.5cm
What is Erythroderma?
- Erythroderma: increased skin perfusion with exfoliation, causing protein and electrolyte loss, and high-output cardiac failure
Characteristics (3) of Atrophy?
o Atrophy: (ex: striae)
Lack of substance
Wasting/failure of tissue to form
Clinically thinner or depressed
Treatment (2) for Acute atopic eczema/dermatitis
Treatment: traditional skin barrier care (ex: Vaseline), then, if it doesn’t work, steroids targeting Th2
Characteristics (3) of Plaque?
o Plaque: (ex: Psoriasis)
Raised
Different color from surrounding skin (but can be the same actually)
>0.5cm
What are the clinical features of Staphylococcal scalded skin syndrome Treatment? (4)
o Periorificial crusting (hallmark)
o Disruption of the epidermis
o Bulla formation
o Painful skin tenderness
What is Squamous cell carcinoma?
Squamous cell carcinoma: target the keratinocytes, and is metastatic
What cells are found in - the connective tissue/Papillary layer of dermis? (6)
o Mesenchymal cell o Fibroblast/Fibrocyte o Adipocyte o Macrophage/Histiocyte o Mast cell o Plasma cell
What are Hemidesmosomes?
• Hemidesmosomes (integrins) for cell-matrix adhesion