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****MS 2 Unit 2 Pathology > Skin Pathology > Flashcards

Skin Pathology Flashcards

1
Q

Skin Overview

A

-barrier against <b>environmental insults and fluid loss</b>

  • <b>Epidermis</b>: made of keratinocytes and has 4 layers:
  • –Stratum Basalis: regenerative
  • –Stratum Spinosum: desmosomes between keratinocytes
  • –Stratum Granulosum: granules in keratinocytes
  • –Stratum Corneum: keratin in anucleate cells

-<b>Dermis</b>: made of CT, nerve endings, blood and lymphatic vessels, adnexal structures (i.e. hair shafts, sweat glands, sebaceous glands)

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2
Q

Inflammatory Dematoses

A
  1. Atopic (Eczematous) Dermatitis
  2. Contact Dermatitis
  3. Acne Vulgaris
  4. Psoriasis
  5. Lichen Planus
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3
Q

Blistering Dermatoses

A
  1. Pemphigus Vulgaris
  2. Bullous Penphigoid
  3. Dermatitis Herpetiformis
  4. Erythema Multiforme
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4
Q

Epithelial Tumors

A
  1. Seborrheic Keratosis
  2. Acanthosis Nigrans
  3. Basal Cell Carcinoma
  4. Squamous Cell Carcinoma
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5
Q

Disorders of Pigmentations/Melanocytes

A
  1. Vitiligo
  2. Albinism
  3. Freckle (Ephelis)
  4. Melasma
  5. Nevus (Mole)
  6. Melanoma
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6
Q

Infectious Disorders

A
  1. Impetigo
  2. Cellulitis
  3. Staphylococcal Scalded Skin Syndrome
  4. Verruca (Wart)
  5. Molluscum Contagiosum
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7
Q

Atopic (Eczematous) Dermatitis–> cause, clinical features

A

<b>-type I hypersensitivity reaction associated with asthma and allergic rhinitis</b>
-causes: pruritis, erythematous, oozing rash with vesciels and edema involving face and flexor surfaces

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8
Q

Contact Dermatitis–> cause, clinical features

A

<b>-exposure to allergens (could be type IV)</b>

  • causes: pruritis, erythematous, oozing rash with vesciels and edema
  • treatment: topical glucocorticoids
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9
Q

Acne Vulgaris–> cause, clinical features, treatment

A
  • comedones, pustules, nodules
  • chronic inflammation of hair follicles & sebaceous glands

<b>comedones can be formed by hormone-associated increase in sebum production and excess keratin blocking follicles</b>

-treament: benzoyl peroxide & vitamin A derivatives (reduction of keratin production)

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10
Q

Psoriasis–> cause, histology, treatment

A

-autoimmune association with <b>HLA-C</b> causing lesions in areas of trauma (environmental trigger)

Histology: <b>acanthosis</b> (epidermal hyperplasia), <b>parakeratosis</b> (hyperkeratosis with retention of keratinocyte nuclei in stratum corneum), <b>Munro microabscesses</b> (collections of neutrophils in stratum coreum), <b>thining of epidermis, elongated dermal papillae, Auspitz sign (pinpoint bleeds)</b>

-treatment: corticosteroids, UV light with psoralen (PUVA), immune-modulating therapy</b>

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11
Q

Pemphigus Vulgaris–> cause, clinical features, IF

A

-<b>autoimmune destruction of desmosomes between ketatinocytes</b> due to IgG Ab against desmoglein

  • Clinical features–> skin & oral mucosa bulla:
    1. <b>Acantholysis</b>: separation of stratum spinosum keratinocytes causing suprabasal blisters
    2. <b>Tombstone appearance</b>: hemidesmosomes keep basal layer cells attached to BM
    3. <b>Thin-walled bullae ruptures easily</b> (Nikolsky sign)
    4. <b>IF highlights IgG surrounding ketatinocytes in “fish net” pattern</b>
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12
Q

Bullous Pemphigoid–> cause, clinical features, IF

A

-<b>IgG Ab against hemidesmosome components (BP180) of BM leading to autoimmune destruction of hemidesmosomes</b>

  • blisters (basal cell layer is detached from BM, tense bulla do not rupture easily)
  • oral mucosa is spared

*IF highlights IgG along BM- “linear pattern”

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13
Q

Dermatitis Herpetiforms

A

-autoimmune deposition of IgA at tips of dermal papillae presenting as pruritic vesicles and bullae that are grouped

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14
Q

Erythema Multiforme–> causes, clinical features

A
  • hypersensitivity reaction with targetoid rash (central epidermal necrosis surroinded by erythema) & bullae
  • associated with <b>HSV infection</b>, Mycoplasma infection, drugs, autoimmune disease and malignancy
  • involved in SJS
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15
Q

Stevens-Johnson syndrome

A

<b>Erythma Multiforme + Oral mucosa/lip involvement & fever</b>

-severe form–> toxic epidermal necrolysis (diffuse sloughing off of the skin probably from drug reaction)

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16
Q

Seborrheic Keratosis–> features, sign

A
  • tumor of squamous cells in the eldery
  • raised, discolored, plaques (waxy ‘stuck on’ appearance)

<b>characterized by keratin pseudocysts on histology</b>

**Leser-Trelat sign: sudden onset suggesting underlying carcinoma of GI tract

17
Q

Acanthosis Nigricans–> cause, clinical features

A
  • epidermal hyperplasia with darkening of the skin
  • axilla or groin
  • associated with insulin resistance or malignancy <b>(i.e. gastric carcinoma)</b>
18
Q

Basal Cell Carcinoma–> cause, risk factors, characteristics, histology

A
  • malignant proliferation of basal cells of the epidermis
  • risk factors: UVB-induced DNA damage, albinism, xeroderma pigmentosum
  • <b>presents as elevated nodule with central, ulcerated crater surrounded by dilated vessels</b>

*pink, pearl-like papule usually on upper lip
<b>histology: peripheral palisading</b>

19
Q

Squamous Cell Carcinoma–> cause, risk factors, characteristics

A
  • malignant proliferation of squamous cells with <b>formation of keratin pearls</b>
  • risk factors: same as basal cell carcinoma along with <b>immunosuppressive therapy, arsenic exposure & chronic inflammation</b>
  • ulcerated nodular mass usually on lower lip
  • <b>Actinic keratosis</b>: precursor; hyperkeratotic, scaly plaque
20
Q

Keratoacanthoma

A
  • well-differentiated squamous cell carcinoma
  • develops rapidly and regresses spontaneously
  • <b>presenting as a cup-shaped tumor filled with keratin debris</b>
21
Q

Melanocytes

A
  • derived from neural crest, present in basal layer of epidermis
  • responsible for skin pigmentation
  • <b>synthesize melanin in melanosomes (precursor= tyrosine)</b>
  • pass melanosomes to keratinocytes</b>
22
Q

Vitiligo

A

autoimmune <i>destruction of melanocytes</i> causing localized loss of skin pigmentation

23
Q

Albinism

A

congential lack of pigmentation due to enzyme defect (tyrosinase) <i>impairing melanin production</i> and can involve the eyes (ocular form) or eyes & skin (oculocutaneous form); <b>increased risk of cancer from reduced UVB protection</b>

24
Q

Freckle (Ephelis)

A

macule from <i>increased melanosomes</i> that darkens in sunlight

25
Q

Melasma

A

cheek hyperpigmentation associated with pregnancy and OCs

26
Q

Nevus (Mole)

A

benign neoplasm of <i>melanocytes producing flat macule or raised papule at birth (associated with hair) or acquired,<b>dysplasia may arise–> melanoma precursor</b></i>

<b>Acquired: junctional (nests of melanocytes at dermal-epidermal junction commonly in children), compound (extension into dermis), intradermal (junctional component is lost commonly in adults)</b></i>

27
Q

Melanoma

A

malignant neoplasm of <i>melanocytes</i> due to UVB DNA damage, albinism, xeroderma pigmentosum, dysplastic nevus syndrome; <b>radial growth and vertical growth (Breslow thickness= increased risk of metastasis); variants:</b>

<b>Superfical spreading (radial), Lentigo maligna melanoma (radial), Nodular (vertical), Acral lentiginous (palms or soles in dark-skinned individuals)</b></b>

28
Q

Impetigo–> cause, presentation

A
  • superficial bacterial skin infection due to S. aureus or S. pyogenes affecting children
  • <b>erythematous macules–> pustules–> rupture–> erosions & dry, crusted, honey-colored serum</b>
29
Q

Cellulitis–> cause, presentation

A
  • deeper (<b>dermal and subcutaneous</b>) infection due to S. aureus or S. pyogenes
  • <b>red, tender, swollen rash with fever that can progress to necrotizing fasciitis with necrosis of subcutaneous tissues due to infection with anaerobic “flesh-eating” bacteria</b>

-production of CO2–> crepitus (gas bubbles in skin)

30
Q

Staphylococcal Scalded Skin Syndrome

A
  • sloughing off of skin (significant skin loss) with erythematous rash and fever due to S. aurreus
  • <b>A & B toxins–> epidermolysis of stratum granulosum</b>

*distinguished from toxic epidermal necrolysis by level of skin separation (dermal-epidermal junction)

31
Q

Verruca (Wart)

A
  • papules with rough surface

- <b>due to HPV infection of keratinocytes</b>

32
Q

Molluscum Contagiosum

A
  • umbilicated papules due to <b>poxvirus</b>

- Molluscum Bodies: cytoplasmic inclusions in affected keratinocytes

****MS 2 Unit 2 Pathology (4 decks)

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