Skin Disorders Flashcards
1
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2
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Skin’s 4 main functions
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protection, sensation, thermoregulation, metabolic function
3
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Skin and subcutaneous tissue provides a major source for vitamin ___
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Vitamin D
4
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Primary Lesion - Macule
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Flat lesions observed due to change in color.
5
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Primary Lesion - Patch
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Flat lesions > 1 centimeter
6
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Primary Lesion - Papule
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Lesions raised above the skin; increase in consistency.;
7
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Primary Lesion - Plaque
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Raised lesion > 1 cm
8
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Primary Lesion - Nodule
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Raised dome shaped lesion > 1.0 cm
9
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Primary Lesion - Tumor
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Large lesion, greater than nodule
10
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Primary Lesion - Wheal
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Increased fluid in tissue (edema/swollen); blanchable
11
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Primary Lesion - Vesicle
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Sharply marginated elevated lesion with fluid-filled lesion,
12
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Primary Lesion - Bullae
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Sharply marginated elevated lesion with fluid-filled lesion, > 1 cm
13
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Primary Lesion - Pustule
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Focal epidermal accumulation of inflammatory cells, serum, sometimes microorganisms; discolored (i.e., yellow/green) entrapped fluid pocket within epidermis
14
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Freckles, drug rash, birthmark, vitiligo, malignant melanomas, these are examples of
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Macules
15
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Neurofibroma, breast carcinoma, keratoacanthoma are examples of
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Tumors
16
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Hives, dermatographism are examples of
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Wheals
17
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Bullous pemphigoid; Pemphigus are examples of
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Bullae
18
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Pustular psoriasis, impetigo are examples of
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Pustules
19
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Secondary Lesion - Crust
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Oozing from vesicles or drying up of vesicles
20
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Secondary Lesion - Scale
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Excess of surface keratin material
21
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Secondary Lesion - Fissure
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Linear Break in epidermis
22
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Secondary Lesion - Erosion
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Shallow scooped out break in epidermis
23
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Secondary Lesion - Ulcer
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Complete removal of epidermis with discrete margins, and may extend into dermis and /or fat
24
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Secondary Lesion - Scar
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Repair of skin with fibrous tissue
25
Secondary Lesion - Atrophy
Loss of tissue with little or no replacement
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Examples of Scars
Acne ice-pick scar, Hypertrophy, Keloid
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Examples of Scales
Psoriasis, ichthyoses, desquamation
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Examples of Atrophy
Striae
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Special Lesions - Alopecia
Loss of hair
30
Special Lesions - Comedo
Involves a hair follicle and the duct or opening of the sebaceous gland
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Special Lesions - Sebaceous cyst
Large encapsulated cavity filled with sebaceous material
32
Special Lesions - Folliculitis
Superficial pustules or inflammation in hair follicles only
33
Special Lesions - Furuncle
Deeper larger infection of hair follicle
34
Special Lesions - Abscess
Cavity filled with pus
35
Special Lesions - Telangiectasia
Dilatation of small blood vessels that are permanently enlarged
36
Special Lesions - Ecchymoses
Large area of bleeding into skin
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Special Lesions - Lichenification
Thickening of the skin
38
Epidermis consists of a 4-layered keratinized squamous epithelium, the layers are:
• Stratum corneum • Stratum granulosum • Stratum spinulosa • Basal cell layer
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Dermis
fibroelastic vascularized tissue
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Subcutaneous tissue (hypodermis)
contains various amounts of adipose tissue dependent on location, gender, etc.
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Epidermal appendages are developed from
developed embryologically from the downward growth of epidermal epithelium
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Epidermal appendages include
• Hair follicles • Sweat glands • Sebaceous glands • Nails
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Atypical lymphocytic epidermotropism on biopsy indicates
Mycosis Fungoides (MF) or Cutaneous T cell Lymphoma (CTCL)
44
Red, scaly lesions that worsen in dry, cold climate
seborrheic dermatitis
45
Child w/ food allergies and asthma + rash would likely indicate
atopic dermatitis
46
Oil spots and nail pitting are associated with
Psoriasis
47
+ Auspitz =
Psoriasis
48
Histology shows munro micro abscesses
Psoriasis
49
Histology shows Pautrier’s microabscess
Mycosis Fungoides (MF) or Cutaneous T cell Lymphoma (CTCL)
50
pruritic psoriaform rash on buttocks, non-responsive to steroids
Mycosis Fungoides (MF) or Cutaneous T cell Lymphoma (CTCL)
51
Pruritic lesions + gluten sensitivity
Dermatitis Herpetiformis
52
IF shows IgA deposition w/in dermal papillae
Dermatitis Herpetiformis
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Child nose/mouth vesicular lesions + previous Strep or Staph infection
Bullous impetigo
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"Honey-crusted" lesions
Bullous impetigo
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Oral ulcers and flaccid blisters that easily rupture
Pemphigus (Vulgaris Variant)
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IgG and C3 around each keratinocyte (fish net appearance)
Pemphigus (Vulgaris Variant)
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“Nikolsky Sign”
Pemphigus (Vulgaris Variant)
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Histology: bullae just above the basal cell layer (suprabasal).
Pemphigus (Vulgaris Variant)
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Tense bullae on flexor aspects, primarily of legs
Bullous Pemphigoid
60
Subepidermal bullae (clefting b/w D-E) associated with eosinophils
Bullous Pemphigoid
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IF shows Linear deposits of IgG along basement membrane
Bullous Pemphigoid
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IF shows a granular band of Ig and complement along the D-E junction
Chronic Discoid Lupus Erythematosus (CDLE)
63
pruritic polygonal, purple papules on wrist
Lichen Planus
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Band like lymphocyte infiltrate at D-E junction with basal cell degeneration
Lichen Planus
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(scattered “Colloid or Civatte bodies”): wedge shaped thickening of granular cell layer
Lichen Planus
66
“saw toothing”
Lichen Planus
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fibrotic thickening of fat septa, giant cells
Erythema nodosum
68
Painful tender nodules on lower legs
Erythema nodosum
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Pearly papule on nose
Basal Cell Carcinoma (BCC)
70
Most common skin malignancy
Basal Cell Carcinoma (BCC)
71
Lymphoplasmacytic infiltrate at periphery
Medullary Carcinoma
72
High grade features with low-grade behavior
Medullary Carcinoma
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Blue Dome Cysts
Pure Fibrocystic Change w/ no increased risk for breast cancer
74
Mucin lakes with malignant cell islands
Colloid Carcinoma
75
nests of uniform tumor cells suspended in mucin lakes
Colloid Carcinoma
76
Seborrheic Keratosis Clinical Presentation
middle age, elderly - face & trunk "stuck-on" raised pigmented papule
77
Seborrheic Keratosis Histological Presentation
horn cyst formation, sharply demarcated
78
Dermatosis Papulosa Nigra
smaller Seborrheic Keratoses on face of black ppl
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Lesser-tralet sign
sudden onset of many papules due to paraneoplastic syndrome (Hormone excreting tumor)
80
Seborrheic Keratosis is from
keratinocytes
81
Ancanthosis Nigricans Clinical Presentation
Thick, hyperpigmented velvety skin in flexural areas ie. axilla, groin, neck, anogenital
82
Ancanthosis Nigricans Histological Presentation
papillated hyperkeratosis, rete ridges
83
Ancanthosis Nigricans typically seen in
Obese, Endocrine Disorders (diabetics)
84
Fibroepithelial polyp Clinical Presentation
soft, flesh colored "skin tag"/acrochordon on neck, trunk, face, intertriginous/skin folds
85
Fibroepithelial polyp Histological Presentation
slender, fibrovascular stalk
86
Keratoacanthoma Clinical Presentation
flesh colored dome-like nodule w. central keratin-filled crater , on face, hand in sun-exposed Caucasians \> 50
87
Keratoacanthoma Histological Presentation
cup-shaped epithel prolif w. central keratin plug, may have atypical keratinocytes
88
Keratoacanthoma possibly is due to
HPV
89
Keratoacanthoma treatment
r/o SCC, self-limited
90
Epithelial Inclusion Cyst/Epidermoid cyst Clinical Presentation
firm dermal or subcutaneous nodule with down-growth and cystic expansion of epidermis
91
Epithelial Inclusion Cyst/Epidermoid cyst Histological Presentation
well circumscribed
92
Milium
small Epithelial Inclusion Cyst
93
Tricholemmal cyst
Hair follicular epithelium-derived on scalp
94
Trichilemomma Clinical Presentation
flesh colored papules, on central face, perioral areas from hair follicle origin
95
Cowden’s Disease
Trichilemomma may be internal marker for malignancy assoc w. breast CA and thyroid CA
96
Cylindroma Clinical Presentation
single or multiple coalescing nodules on forehead & scalp sweat gland origin
97
turban tumor
multiple coalescing cylindromas on forehead & scalp
98
Cylindroma Histological Presentation
"jig-saw puzzle" islands of basaloid cells in dermis
99
Syringoma Clinical Presentation
Multiple small tan papules Near lower eyelid; women - sweat gland origin
100
Syringoma Histological Presentation
“Tadpole” shaped islands of basaloid
101
Syringoma can mimic
Microcystic Adnexal Carcinoma
102
Muir Torre Syndrome (HNPCC)
Sebaceous Adenoma: Microsatellite Instability - a variant of Lynch Syndrome!!!!
103
Sebaceous Adenoma
May be associated with Muir Torre syndrome; microsatellite instability
104
Actinic Keratosis Clinical Presentation
Premalignant, dysplastic lesion Typically
105
Actinic Keratosis Histological Presentation
atypia in lower epidermis, basal cell hyperplasia & dyskeratosis, damaged collagen -\>blue-grey elastic fibers
106
Actinic Keratosis is seen commonly in
elderly, light-skinned, sun-exposed
107
SCC Clinical Presentation
non-healing ulcerated nodule in sun-exposed ind, xeroderma pigmentosum, etc
108
SCC may show what orally?
white thickened plaques on mucosa (leukoplakia)
109
SCC Histological Presentation
In situ SCC has full thickness epidermal atypia; Invasive SCC breaks thru D-E junction into underlying dermis (more advanced)
110
Bowen’s Disease
demarcated red scaling plaques = In situ SCC
111
BCC Clinical Presentation
pearly papules, surrounded by telangectasias, due to sun exposure
112
BCC Histological Presentation
basal cell prolix into dermis + "peripheral palisading" (basaloid islands; NOT cylindroma or syringoma)
113
most common type of skin CA malignancy?
BCC
114
Nevoid Basal Cell Syndrome/Gorlin syndrome
rare, AD, many BCCs throughout life
115
BCC is associated w/ what gene
activated SHH - loss of PTCH + p53 gene function
116
Lentigo Clinical Presentation
hyperpigmented macules 5-10mm on skin & MM, do not darken in sun, common from infancy
117
Cutaneous Horns may be present in
Actinic Keratosis --\> SCC
118
Lower Lip skin nodule/ulcer think
SCC
119
Upper Lip skin nodule/ulcer think
BCC
120
Lentigo Histological Presentation
"lentiginous growth" or hyper pigmented, linear hyperplasia of melanocytes (elongated, thin rete ridges)
121
Lentigo vs Freckle
Lentigo do not darken in sun, larger, darker, skin or mucous membrane
122
Melanocytic Nevus - 6 types
Common, may present in childhood or adulthood: Junctional, Compound, Intradermal, Blue, Halo, Dysplastic
123
Middle aged + pimple on nose that won't go away; you should think =
BCC
124
Junctional Nevus Clinical Presentation
flat, smooth, uniformly pigmented (brown to black)
125
Junctional Nevus Histological Presentation
symmetric nest of melanocytes at DE junction (young)
126
Compound Nevus Clinical Presentation
raised, smooth border, uniform pigment
127
Compound Nevus Histological Presentation
nests of melanocytes in BOTH D & DE junction (aging nevus proceeds from junction into D)
128
Intradermal Nevus Clinical Presentation
raised, smooth border, uniform pigment (or flesh-colored)
129
Intradermal Nevus Histological Presentation
nests of melanocytes in dermis entirely (not at DE Jct)
130
Blue Nevus Clinical Presentation
small, blue-black nodules
131
Blue Nevus Histological Presentation
heavily pigmented dendritic melanocytes
132
Halo Nevus Clinical Presentation
white zone around mole
133
Halo Nevus Clinical Presentation
lymphocytic infiltrates surrounding compound or intradermal melanocytes
134
Dysplastic Nevus (BK or Clarks mole) Clinical Presentation
irregular borders/pigment, sun exposed or non-exposed
135
Dysplastic Nevus Syndrome or Familial Melanoma Syndrome
Numerous dysplastic nevi (genetic)
136
Dysplastic nevus presence increases risk for
Melanoma
137
Dysplastic Nevus (BK or Clarks mole) Histological Presentation
Cytologic and architectural atypia → Shows features of pre-melanoma
138
Dysplastic Nevus gene involvement
p161NK4A, BRAF, CDK4
139
Which malignancy has the highest increase in incidence?
Malignant melanoma - 90% increase over 30yrs
140
Most common malignancy in young adults?
Malignant melanoma
141
Malignant melanoma risk factors:
FHx, red/blonde hair, freckling, 3+ blistering sunburns, 3+ outdoor jobs, presence of actinic keratosis, dysplastic nevi syndrome, tanning-UVA
142
1-2 risk factors for Malignant melanoma increases your risk by
3.5X
143
3+ risk factors for Malignant melanoma increases your risk by
20X
144
ABCDE of Malignant Melanoma
Asymmetric shape, Border irregularity, Color - nonuniform, Diameter \>5mm, Elevated
145
Melanoma can be found on whack body parts
skin, oral, conjunctiva, orbit, nail bed, esophagus
146
Melanoma prognosis is dependent on
Depth of invasion and clinical stage
147
Types of Melanoma
Superficial spreading melanoma Nodular melanoma: (vertical growth) Lentigo maligna melanoma (Hutchinson’s freckle): early phase radial growth Acral lentiginous melanoma: adial growth
148
Breslow Depth measures
Depth of invasion of melanoma below the stratum granulosum
149
Melanoma Histological Presentation
atypical melanocytes w. nuclear hyperchromasia, mitosis, prominent nucleoli, individual necrosis, lack maturation amelanotic = melanin absent from cells
150
Clarks Level I - Melanoma
(In situ) Intra-epidermal - 100% survival rate of 5 years
151
Clarks Level II - Melanoma
Invades papillary dermis - 90% survival rate of 5 years
152
Clarks Level III - Melanoma
Fills papillary dermis - 70% survival rate of 5 years
153
Clarks Level IV - Melanoma
Invades reticular dermis - 40% survival rate of 5 years
154
Clarks Level V - Melanoma
invades SubC fat - 25% survival rate of 5 years
155
Clinical Stage of Melanoma
Lymph node involvement, distant metastases - 5 year survival
156
Benign Fibrous Histiocytoma (Dermatofibroma) Clinical Presentation
Typically on legs of adults (trauma), tan-brown, firm papule "dimple in center” w/ lateral compression
157
Benign Fibrous Histiocytoma (Dermatofibroma) Histological Presentation
non encapsulated prolif of spindle shaped fibroblasts
158
Dermatofibrosarcoma protoberans DFSP Clinical Presentation
On trunk - firm, indurated solid nodules; may ulcerate
159
Dermatofibrosarcoma protoberans DFSP Histological Presentation
slow growing fibrosarcoma, locally aggressive, rare metastasis; radially oriented (storiform pattern) fibroblasts, mitosis
160
Dermatofibrosarcoma protoberans DFSP gene involvement
translocation of COLIAI and PDGFb
161
Mastocytosis Clinical Presentation
pruritus, flushing, rinorrhea, dermal edema & erythema (wheal), dermatographism
162
Mastocytosis Histological Presentation
high # mast cells, purple cytoplasmic granules
163
Darier's Sign indicates
Mastocytosis or Urticaria Pigmentosum
164
Urticaria Pigmentosum Clinical Presentation
Mastocytosis that is localized to the skin with round to oval red-brown papules and plaques
165
Urticaria Pigmentosum Histological Presentation
high # mast cells, eosinophils, edema (metachromatic stain: giemsa, toludine)
166
Mycosis Fungoides or Cutaneous T cell Lymphoma Clinical Presentation
\> 40y/o, scaling patch (like psoriasis), indurated plaque, re-brown nodule, disseminated
167
Mycosis Fungoides or Cutaneous T cell Lymphoma Histological Presentation
Pautrier’s microabscess, bandlike atypical lymphocyte infiltration in dermia, mycosis cells w/ cerebriform-like nuclei
168
Patch stage of Mycosis Fungoides Histological Presentation
lymphocytic epidermatropism
169
Tumor stage of Mycosis Fungoides Histological Presentation
Pautrier’s microabscess (cluster of infiltrative atypical CD4+ lymphocytes in epidermis), mycosis cells with cerebriform nuclei
170
Sezary Syndrome
systemic mycois fungoides - white scaly hands/palms
171
Urticaria Clinical Presentation
Hives, wheals: Type I Hypersensitive (IgE) response to an Ag + histamine (mast cells)
172
Urticaria Histological Presentation
dermal edema, sparse dermal inflammation
173
Eczema Clinical Presentation
Allergic Contact Dermatitis, Atopic Dermatitis, Seborrheic Dermatitis
174
Eczema Histological Presentation
intraepidermal vesicles; dermal edema w. possible eosinophils/lymphocytes; w/ overlying parakeratosis
175
Allergic Contact Dermatitis
Type IV HSN - poison ivy, jewelry, etc
176
Atopic Dermatitis Clinical Presentation
Type I HSN; Infant/Child w/ +FHx of eczema, asthma, allergies w/ pruritic rash, erythema, excoriation, lichenfiation of skin (FLEXURAL areas, not nasolabial)
177
Seborrheic Dermatitis Clinical Presentation
NASOLABIAL FOLDS, ears, eyebrows, scalp (oil distribution); red, scaly, itchy, dry flakes; ‘comes and goes’; SEASONAL
178
Erythema Multiforme Clinical Presentation
bull’s eye target lesion; limited hypersensitivity to drugs (sulfamide, dilantin, barbituate, penicillin)
179
Erythema Multiforme Complications
EM Major/SJS: mucous membrane involvement TEN: epithelial necrosis and sloughing
180
Erythema Nodosum Clinical Presentation
15-30y/o lower legs/shins, red painful nodules
181
Erythema Multiforme etiology
HSV, mycoplasma, idiopathic
182
Erythema Multiforme drugs
sulfamide, dilantin, barbituate, penicillin
183
Erythema Nodosum Histological Presentation
fibrosis thickening of fat septa, giant cells
184
Erythema Nodosum etiology
beta hemolytic strep, herpes, fungal; BCP, sulfonamides; UC, sarcoidosis, Behcet’s syndrome
185
Erythema Induratum clinical presentation
adolescents & menopausal women, back of legs
186
Erythema Induratum Histological Presentation
granulomatous inflam of fat lobules & necrosis
187
Psoriasis Clinical Presentation
salmon-colored papules + silver scales on EXTENSOR surfaces; Usually assoc w/ RA, AIDS, etc
188
Koebner’s phenomenon
psoriasis lesions develop at site of trauma
189
Auspitz sign
psoriasis removal of scale induces miniscule blood droplets from dilated vessels in dermal papillae
190
Psoriasis nails
oil spot, pitting, onycholysis
191
Psoriasis Histological Presentation
Munro Microabscesses: neutrophils w/in the epidermis, Periodic thinning of epidermis where it overlies dermal papillae + acanthosis + parakeratotic hyperkeratotsis w/ nuclei retained in corneum
192
Von Zumbush Syndrome
acute onset pustular psoriasis with fever & arthritis = life threatening
193
Lichen Planus Clinical Presentation
polygonal purple papules, pruritic, may coalesce into plaques, highlighted by white lines (Wickham striae) found on wrist, shin, scalp alopecia, lumbar, buccal mucosa; drug-induced possibly
194
Lichen Planus Histological Presentation
Colloid/Civatte bodies (basal cell degeneration), saw-tooth rete + acanthosis
195
Lupus Erythematosus Clinical Presentation
AID of CT; worsens in sun, macular butterfly rash with acute SLE
196
Chronic Discoid LE Clinical Presentation
sharp margins, scaly, atrophic red plaques on sun-exposed areas (anti-DNA, RF) – basal cell degeneration (vacuolization): epidermal atrophy with keratin plugging
197
Chronic Discoid LE Histological Presentation
Lymphocytic infiltrates along D-E junction,
198
IF for Chronic Discoid LE
granular band of Ig along D-E Jct "Lupus Band"
199
Acne Vulgaris Clinical Presentation
Adolescents, comedones (w- and b-heads), acne
200
Rosacea Clinical Presentation
middle-ages women, flushing -\> red/telangiesctasia -\> pustules -\> rhiniophyma
201
Bullous Impetigo Clinical Presentation
"honey crust" subcorneal blister, on face, hands, trunk due to Staph or Strep; typically in children/infants
202
Bullous Impetigo Histological Presentation
subcorneal pustules with neutrophils & gram pos agents
203
Pemphigus (Vulgaris variant) Clinical Presentation
flaccid vesicles & bullae (rupture easily; oral mucosa, scalp, trunk; AI disorder of desmosomes protein; 40-60y/o
204
Nikolsky Sign
pressure on flaccid bullae --\> lateral extension of blister = Pemphigus (Vulgaris variant)
205
Pemphigus (Vulgaris variant) Histological Presentation
Tombstone row of basal cells - suprabasilar, thin bulllae covering
206
IF for Pemphigus (Vulgaris variant)
Fish-net, IgG around every keratinocyte
207
Bullous Pemphigoid Clinical Presentation
Tense bulla, do not rupture easy, skin, mucosa, lower legs; AI disorder of hemidesmosomes (lamina lucida); elderly
208
Bullous Pemphigoid Histological Presentation
subepidermal bulla, + eosinophils, few lymphocytes & neutrophils
209
IF for Bullous Pemphigoid
linear deposits IgG along BM
210
Dermatitis Herpetiformis Clinical Presentation
Recurrent pruritic, tiny, grouped vesicles; Associated w/ Celiac; IgA to gluten Xreacts w/ fibrils of BM
211
Dermatitis Herpetiformis Histological Presentation
tips of dermal papillae filled w. neutrophils (microabscesses)
212
IF for Dermatitis Herpetiformis
granular IgA deposits at dermal papillae tips
213
Verruca Clinical Presentation
benign epithelial hyperplasia due to HPV
214
Verruca Types
vulgaris (most common, anywhere esp hands); plana (flat); plantaris; palmaris; acuminatum (cauliflower-like venereal wart on genitalia/perianal/rectal)
215
Verruca Histological Presentation
papillated epidermis, koilocytotic (viral) changes = irregular nuclei surrounded by cytoplasmic halo
216
Molluscum Contagiosum Clinical Presentation
discrete, umbilicated, pearly-white papules of the neck, trunk, eyelids; POX virus
217
Molluscum Contagiosum Histological Presentation
cup-like epidermal hyperplasia, bright pink glassy cytoplasmic inclusions (molluscum bodies)
218
Tinea capitus
fungal - scalp w. painful boggy nodules, hair loss, detect with Wood’s lamp
219
Tinea barbae
fungal - beard area in men
220
Tinea cruris
fungal - inguinal
221
Tinea pedis
fungal - athlete foot (webs)
222
Onchomycosis
fungal - nails, discolored & thickened
223
Tinea Corporis
ring-worm - body surface, expanding, round, slightly red annular plaque
224
Scabies
sarcoptes scabei burrows in stratum corneum - interdigital skin, genital skin (homeless)
225
Lyme
spirochete infection (Borrelia burgdorferi) - annular lesions, erythema migrans
226
Lice
Pediculosis capititis and pediculosis pubis
