Skin Disorders Flashcards
Skin’s 4 main functions
protection, sensation, thermoregulation, metabolic function
Skin and subcutaneous tissue provides a major source for vitamin ___
Vitamin D
Primary Lesion - Macule
Flat lesions observed due to change in color.
Primary Lesion - Patch
Flat lesions > 1 centimeter
Primary Lesion - Papule
Lesions raised above the skin; increase in consistency.;
Primary Lesion - Plaque
Raised lesion > 1 cm
Primary Lesion - Nodule
Raised dome shaped lesion > 1.0 cm
Primary Lesion - Tumor
Large lesion, greater than nodule
Primary Lesion - Wheal
Increased fluid in tissue (edema/swollen); blanchable
Primary Lesion - Vesicle
Sharply marginated elevated lesion with fluid-filled lesion,
Primary Lesion - Bullae
Sharply marginated elevated lesion with fluid-filled lesion, > 1 cm
Primary Lesion - Pustule
Focal epidermal accumulation of inflammatory cells, serum, sometimes microorganisms; discolored (i.e., yellow/green) entrapped fluid pocket within epidermis
Freckles, drug rash, birthmark, vitiligo, malignant melanomas, these are examples of
Macules
Neurofibroma, breast carcinoma, keratoacanthoma are examples of
Tumors
Hives, dermatographism are examples of
Wheals
Bullous pemphigoid; Pemphigus are examples of
Bullae
Pustular psoriasis, impetigo are examples of
Pustules
Secondary Lesion - Crust
Oozing from vesicles or drying up of vesicles
Secondary Lesion - Scale
Excess of surface keratin material
Secondary Lesion - Fissure
Linear Break in epidermis
Secondary Lesion - Erosion
Shallow scooped out break in epidermis
Secondary Lesion - Ulcer
Complete removal of epidermis with discrete margins, and may extend into dermis and /or fat
Secondary Lesion - Scar
Repair of skin with fibrous tissue
Secondary Lesion - Atrophy
Loss of tissue with little or no replacement
Examples of Scars
Acne ice-pick scar, Hypertrophy, Keloid
Examples of Scales
Psoriasis, ichthyoses, desquamation
Examples of Atrophy
Striae
Special Lesions - Alopecia
Loss of hair
Special Lesions - Comedo
Involves a hair follicle and the duct or opening of the sebaceous gland
Special Lesions - Sebaceous cyst
Large encapsulated cavity filled with sebaceous material
Special Lesions - Folliculitis
Superficial pustules or inflammation in hair follicles only
Special Lesions - Furuncle
Deeper larger infection of hair follicle
Special Lesions - Abscess
Cavity filled with pus
Special Lesions - Telangiectasia
Dilatation of small blood vessels that are permanently enlarged
Special Lesions - Ecchymoses
Large area of bleeding into skin
Special Lesions - Lichenification
Thickening of the skin
Epidermis consists of a 4-layered keratinized squamous epithelium, the layers are:
• Stratum corneum • Stratum granulosum • Stratum spinulosa • Basal cell layer
Dermis
fibroelastic vascularized tissue
Subcutaneous tissue (hypodermis)
contains various amounts of adipose tissue dependent on location, gender, etc.
Epidermal appendages are developed from
developed embryologically from the downward growth of epidermal epithelium
Epidermal appendages include
• Hair follicles • Sweat glands • Sebaceous glands • Nails
Atypical lymphocytic epidermotropism on biopsy indicates
Mycosis Fungoides (MF) or Cutaneous T cell Lymphoma (CTCL)
Red, scaly lesions that worsen in dry, cold climate
seborrheic dermatitis
Child w/ food allergies and asthma + rash would likely indicate
atopic dermatitis
Oil spots and nail pitting are associated with
Psoriasis
+ Auspitz =
Psoriasis
Histology shows munro micro abscesses
Psoriasis
Histology shows Pautrier’s microabscess
Mycosis Fungoides (MF) or Cutaneous T cell Lymphoma (CTCL)
pruritic psoriaform rash on buttocks, non-responsive to steroids
Mycosis Fungoides (MF) or Cutaneous T cell Lymphoma (CTCL)
Pruritic lesions + gluten sensitivity
Dermatitis Herpetiformis
IF shows IgA deposition w/in dermal papillae
Dermatitis Herpetiformis
Child nose/mouth vesicular lesions + previous Strep or Staph infection
Bullous impetigo
“Honey-crusted” lesions
Bullous impetigo
Oral ulcers and flaccid blisters that easily rupture
Pemphigus (Vulgaris Variant)
IgG and C3 around each keratinocyte (fish net appearance)
Pemphigus (Vulgaris Variant)
“Nikolsky Sign”
Pemphigus (Vulgaris Variant)
Histology: bullae just above the basal cell layer (suprabasal).
Pemphigus (Vulgaris Variant)
Tense bullae on flexor aspects, primarily of legs
Bullous Pemphigoid
Subepidermal bullae (clefting b/w D-E) associated with eosinophils
Bullous Pemphigoid
IF shows Linear deposits of IgG along basement membrane
Bullous Pemphigoid
IF shows a granular band of Ig and complement along the D-E junction
Chronic Discoid Lupus Erythematosus (CDLE)
pruritic polygonal, purple papules on wrist
Lichen Planus
Band like lymphocyte infiltrate at D-E junction with basal cell degeneration
Lichen Planus
(scattered “Colloid or Civatte bodies”): wedge shaped thickening of granular cell layer
Lichen Planus
“saw toothing”
Lichen Planus
fibrotic thickening of fat septa, giant cells
Erythema nodosum
Painful tender nodules on lower legs
Erythema nodosum
Pearly papule on nose
Basal Cell Carcinoma (BCC)
Most common skin malignancy
Basal Cell Carcinoma (BCC)
Lymphoplasmacytic infiltrate at periphery
Medullary Carcinoma
High grade features with low-grade behavior
Medullary Carcinoma
Blue Dome Cysts
Pure Fibrocystic Change w/ no increased risk for breast cancer
Mucin lakes with malignant cell islands
Colloid Carcinoma
nests of uniform tumor cells suspended in mucin lakes
Colloid Carcinoma
Seborrheic Keratosis Clinical Presentation
middle age, elderly - face & trunk “stuck-on” raised pigmented papule
Seborrheic Keratosis Histological Presentation
horn cyst formation, sharply demarcated
Dermatosis Papulosa Nigra
smaller Seborrheic Keratoses on face of black ppl
Lesser-tralet sign
sudden onset of many papules due to paraneoplastic syndrome (Hormone excreting tumor)
Seborrheic Keratosis is from
keratinocytes
Ancanthosis Nigricans Clinical Presentation
Thick, hyperpigmented velvety skin in flexural areas ie. axilla, groin, neck, anogenital
Ancanthosis Nigricans Histological Presentation
papillated hyperkeratosis, rete ridges
Ancanthosis Nigricans typically seen in
Obese, Endocrine Disorders (diabetics)
Fibroepithelial polyp Clinical Presentation
soft, flesh colored “skin tag”/acrochordon on neck, trunk, face, intertriginous/skin folds
Fibroepithelial polyp Histological Presentation
slender, fibrovascular stalk
Keratoacanthoma Clinical Presentation
flesh colored dome-like nodule w. central keratin-filled crater , on face, hand in sun-exposed Caucasians > 50
Keratoacanthoma Histological Presentation
cup-shaped epithel prolif w. central keratin plug, may have atypical keratinocytes
Keratoacanthoma possibly is due to
HPV
Keratoacanthoma treatment
r/o SCC, self-limited
Epithelial Inclusion Cyst/Epidermoid cyst Clinical Presentation
firm dermal or subcutaneous nodule with down-growth and cystic expansion of epidermis