Skin Path Flashcards
Give a couple functions of skin? It is composed of what? Epidermis is comprised of … and has what? List contents of the dermis
- Barrier against environmental insults and fluid loss
- Dermis and epidermis
- Has keratinocytes and four layers: a. stratum basalis (regenerative, stem cell, layer) b. stratum spinosum (desmosomes between keratinocytes) c. stratum granulosum (granules in keratinocytes) d. stratum corneum (keratin in ANUCLEATE cells)
- Dermis with CT, nerve endings, blood and lymphatic vessels, and adnexal structures (hair shafts, sweat glands, sebaceous glands)
Atopic (eczematous) dermatitis is what? Could be caused by what?
- Pruritic, erythematous, oozing rash with vesicles and edema; often involves face and flexor surfaces!!
- Type I hypersens reaction; associated with asthma and allergic rhinitis
Edgar Allen POE has been FLEXING HIS ELBOW to touch his FACE a lot recently, and he VEnts a lot now. Maybe he’s befuddled by what the FIRST letter of the ALPHABET is!!!
Contact dermatitis: what’s involved? how is it caused? treat?
- Pruritic, erythematous, oozing rash with vesicles and edema
- Arises upon allergen exposure (poison ivy and nickel jewelry, or type IV hypersens; irritant chemicals like detergents; drugs like penicillin)
- Involves removal of offending agent and topical glucocorticoids, if needed
Edgar Allen POE continues to VEnt and now he’s annoyed with poison ivy, his WATCH, and he’s IRRITATED that his son uses DRUGS. I would say get rid of his WATCH and also give him some glucocorticoids.
Acne Vulgaris
- Comedones (whiteheads and blackheads), pustules (pimples), and nodules; extremely common, especially adolescents
- Chronic inflammation of hair follicles and associated sebaceous glands: hormone-associated increase in sebum production and excess kertain production block follicles, forming COMEDONES; propionibacterium acnes infection produces lipases that break down sebum, releasing proinflammatory FA’s, resulting in pustule or nodule formation
- Treat: benzoyl peroxide (antimicrobial) and vit A derivatives (isotretinoin) to reduce keratin production
Carlos Nancilla Pimps (comedones, nodules, pustules);
Sebum, keratin, follicle blockage = comedones;
P. acnes, lipases, FA’s = nodules, pustules;
BP: for Bacteria (antimicrobial)
Vit A to reduce KERATIN
Psoriasis: involves, causes, labs, treatment
- well-circumscribed, salmon-colored plaques with silvery scale, usually on EXTENSOR surfaces and the SCALP; maybe pitting of nails
- excessive keratinocyte proliferation; possible autoimmune etiology (HLA-C assocation and lesions often in areas of TRAUMA!!)
- Histo: acanthosis (epidermal hyperplasia), parakeratosis (hyperkeratosis with retention of keratinocyte nuclei in the stratum corneum), collection of neutrophils in stratum corneum (Munro microabscesses), thinning of epidermis above elongated dermal papillae and bleeding if scale picked off (Auspitz sign)
- Treatment involves corticosteroids, UV light with PSORALEN, or immune-modulating therapy
I’m PLAGUED from trying to catch SILVER tuna and SALMON and now my ELBOW and HEAD hurt. Took a toll on my NAILS too.
Has LACey recovered from her punch and checked out Auspitz’s AWESOME Munro Parakeet Collection? It’s NEUTROPHILIC!! Corticosteroids, UV light, immune-modulating
Licen planus: involves, histo, causes
- Pruritic, planar, purple papules, polygonal, often with reticular white lines on their surface (Wickham striae); usually involves wrists, elbows, and oral mucosa (this actually has Wickham striae);
- inflammation of the dermal-epidermal junction with a “saw-tooth” appearance
- Etiology is unknown: associated with CHRONIC HEP C VIRUS INFECTION
Wicki in Germany was telling me about the SIX P’S since he OWEd me information. As he was talking I saw his SAW-TOOTH. I hope he doesn’t have chronic Hep C!!!
Pemphigus vulgaris: what’s involved and the cause; presentation?
- Autoimmune destruction of desmosomes between keratinocytes
- IgG antibody against desmoglein (type II hypersens)
- Skin and oral mucosa BULLAE: acantholysis (separation) of stratum spinosum keratinocytes results in suprabasal blisters, basal layer cells remain attached to BM via hemidesmosomes, a “tombstone” appearance, thin-walled bullae rupture easily (Nikolsky sign), leading to shallow erosions with dried crust, immunofluorescence highlights IgG surrounding keratinocytes in a “fish net” pattern
It’s VULGAR when someone breaks one’s BASE from beneath them. Maybe I’m just TOO SENSITIVE, but they get up and their SKIN and MOUTH are bloodied thanks to that BULLY. Now you might as well make a TOMBSTONE for those kids, thanks to fucking NIKOLSKY. Oh well, I’m Going to Go FISHING.
Bullous pemphigoid: involves, caused by, presentation, lab
- Autoimmune destruction of hemidesmosomes b/w basal cells and underlying BM
- IgG antibody against hemidesmosome components (BP180) of BM
- Blisters of the skin, usually in elderly, but ORAL MUCOSA spared: basal cell layer detached from BM, and tense bullae do not rupture easily (clinically milder than pemphigus vulgaris)
- Immunofluorescence highlights IgG along BM (linear pattern)
On the SUBWAY, I saw this guy hit an OLD MAN with ONE LEG AND ONE ARM. He got up and SEEMED to be MILD. His mouth wasn’t even bleeding, and he was able to still walk in a STRAIGHT LINE.
Dermatitis herpetiformis: involves, presentation, association
- Autoimmune deposition of IgA at tips of dermal papillae
- Presents as pruritic vesicles and bullae that are grouped
- Association with CELIAC; resolves with GLUTEN-FREE diet
That guy was ITCHING for some sex, so he BULLIED her into licking his Ass and sticking his FINGER TIPS into her mouth. Hope she doesn’t also have Celiac!!!
Erythema multiforme: involves, associations, special form
- Hypersens reaction with targetoid rash and bullae (targetoid appearance due to central EPIDERMAL NECROSIS surrounded by erythema)
- Associated most commonly with HSV infection, also Mycoplasma infection, drugs (penicillin and sulfonamides), autoimmune disease, and malignancy
- EM with oral mucosa/lip involvement and fever is termed Stevens-Johnson syndrome: toxic epidermal necrolysis is a severe form of SJS with diffuse sloughing of skin, resembling a large burn; most often due to ADVERSE DRUG REACTION
In the ME, they get HYPERSENS to women cheating so they BULLY them and TARGET them for stoning. The woman could end up with HERPES, while the men might get really MMAD.
Stevens Johnson is in the Front Office for Eastern Michigan. He wants to move to the big TEN, and it BURNS him inside right now that he can’t do it, so he’ll start SNORTING COCAINE.
Seborrheic keratosis: what is it, presentation, other signs?
- benign squamous prolif: common tumor in ELDERLY
- presents as RAISED, DISCOLORED plaques on extremities or face, with a coin-like, waxy, ‘STUCK-ON’ appearance (keratin pseudocysts on histo)
- Leser-Trelat sign is sudden onset of MULTIPLE SEBORRHEIC KERATOSES and suggests underlying carcinoma of the GI tract
Dino at the pool is PLAGUED with issues in his ARM, LEGS, FACE. He will never spare COINS, but as long as nothing comes up, won’t have to worry about LT tackling them and hurting their GUT.
Acanthosis Nigricans: what is it, associated with what?
- epidermal hyperplasia with darkening of skin (velvet-like skin), often involves AXILLA OR GROIN
- associated with insulin resistance or malignancy (GASTRIC CARCINOMA)
These BLACKS get DARKER and they have that PUBIC HAIR. They need to stop eating WATERMELON and try not eating too much CHICKEN.
BCC: what is it, risk factors, presentation, histo, treatment
- Malignant prolif of basal cells of epidermis (MOST COMMON CUTANEOUS MALIGNANCY)
- UVB-induced DNA damage and prolonged exposure to sunlight, albinism, xeroderma pigmentosum
- elevated nodule with central ulcerated crater surrounded by dilated (telangiectatic) vessels: ‘pink, pearl-like papule’; look at the UPPER LIP
- Nodules of basal cells with peripheral palisading
- Surgical excision (metastasis RARE)
PPP; Also the PP, or peripheral palisades
Squamous Cell Carcinoma: what is it, risk factors, presentation, treatment, precurosr, developed version
- malignant prolif of squamous cells with formation of KERATIN PEARLS
- risk factors: UVB-induced DNA damage and prolonged exposure to sunlight, albinism, and xeroderma pigmentosum, along with immunosuppressive therapy, aresenic exposure, chronic inflammation (scar from burn)
- ulcerated nodular mass, usually on FACE (lower lip)
- excision (metastasis uncommon)
- actinic keratosis a precursor of SCC: hyperkeratotic, scaly plaque, often on the face, back, or neck
- Keratoacanthoma: well-differentiated SCC that develops rapidly and regresses spontaneously (cup-shaped tumor filled with keratin debris)
Forensic Files: in Texas a lady who was getting poisoned was IMMUNE to CHRONIC ARSENIC. She had some mass on her lower lip. AK-47’s are given to kids, who join the Shooting Company Core, to make them Killers who drink their dead enemies blood out of CUPS.
What are melanocytes? Where do you get them from, and what are some other things about them?
Responsible for skin pigmentation and present in BASAL layer of epidermis;
derived from NEURAL CREST;
synthesize MELANIN in melanosomes using tyrosine as a precursor molecule;
pass MELANOSOMES to keratinocytes
Vitiligo is
localized loss of skin pigmentation due to AUTOIMMUNE destruction of MELANOCYTES
