Skin Pathology Review (Gomez) Flashcards
papule versus nodule
papule - 5 mm
vesicle
blister that is <5 mm
bulla
> 5 mm fluid filled
acantholysis
Loss of intercellular cohesion between keratinocytes
seen in pemhigus vulgaris
acanthosis
diffuse epidermal hyperplasia
seen in acanthosis nigricans
dyskeratosis
Abnormal, premature keratinization within cells below the stratum granulosum
hydropic swelling
Intracellular edema of keratinocytes, often seen in viral infections
lentiginous
A linear pattern of melanocyte proliferation within the epidermal basal cell layer
parakeratosis
where is this normal?
Keratinization with retained nuclei in the stratum corneum. On mucous membranes, parakeratosis is normal
seen in psoriasis
spongiosis
Intercellular edema of the epidermis
lamellar/pacinian corpuscle
encapsulated nerve ending
pressure receptors
found in deep dermis or hypodermis
meissner
touch receptors
confined to dermal papillae
FGF3 postage stamp middle age or older sometimes stimulate malignant melanoma proliferation of epidermal basal cells
seborrheic keratosis
what is Leser-Trelat
Sign of Leser-Trélat – acute onset of Seborrheic keratoses with malignancies (GI mostly)
hyperpigmentation
Epidermal hyperplasia of Stratum Spinosum
acanthosis nigricans
check for malignant adenocarcinoma
what is cowden syndrome
multiple tircholemmomas (hair follicle adnexal tumor)
dominant inheritance
what is Muir Torre Syndrome
sebaceous adenomas with association colorectal malignancy (variant of lynch syndrome HNPCC)
what is a cylindroma
on the forehead and scalp
adnexal tumor involving the eccrine gland (sweat gland)
what is a Turban tumor
massive confluent cylindromas on the forehead like a turban
Benign soft tissue neoplasm seen in adults, frequently on the legs of young – middle aged women
Tan-brown papules which are usually small (less than 1.0 cm) and may occasionally be tender
Benign Fibrous Histiocytoma (Dermatofibroma)
Hypermelanosis characterized by development of sharply demarcated blotchy, brown macules on face
Symmetrical distribution over the cheeks and forehead
Less frequently on upper lip and neck
appears in women
Occurs:
During pregnancy
In women taking oral contraceptives
At menopause
melasma
increase in melanin but not number of melanocytes
what is solar lentigo
Definition: benign, discrete hyperpigmented macule occurring on chronically sun exposed skin in adults, especially on the back of the hands and the forehead.
Cause: Increased melanin pigment in keratinocytes
Variable increase in number of junctional melanocytes
Note: Term “lentigo or lentiginous” means a proliferation of melanocytes.Lentigines arepigmented macules on skin and mucosa.
Lentigo maligna is the name given to an in situ melanoma arising in sun exposed skin of the face
what is the cause of acute transient vitiligo
Vitiligo, Acute Transient: Treat people with normally dark pigmented skin with a keratinolytic agents that removes layers of keratinocytes. The results are dramatic
defect in tyrosinase, an enzyme necessary for melanin production
albinism
acquired mutations in components of the Ras signaling pathway”
NRAS and BRAF
Melanocytic (Nevocellular) Nevi
Benign Neoplasms of Melanocytes
Increased telomerase activity from mutated TERT gene is present in 70%
of skin melanomas.
kit mutations seen in what
non sun exposed melanomas
what mutations are seen in both dysplastic nevus and melanoma familial syndromes?
P16 inhibition is inhibited by CDKN2A mutations
CDK4 mutations block p16 inhibition
cutaneous horn
premalignant
increased risk for SCC
actinic solar keratosis
Rapidly growing (days-weeks) neoplasm; occurs on sun-exposed areas (face, hands) of older adults (men more than women)
Often involutes and clears spontaneously within 3 to 4 months
Keratoacanthoma
autosomal dominant disorder
multiple basal cell carcinomas before age 20
pits of the palms and soles
odontogenic keratocysts
medulloblastomas
ovarian fibromas
Nevoid basal cell carcinoma syndrome (Gorlin syndrome)
Malignant superficial fibroblastic neoplasm (fibrosarcoma of skin)
Locally aggressive but rarely metastasizes
Bednar tumor is pigmented variant
Translocation of COL1A1 and PDGFB → ↑PDGFB
storiform (swirling) of spindled cells
dermatofibrosarcoma protuberans
CD4+ T-cell lymphoma of the skin (CLA, CCR4 & CCR10)
Aggressive neoplasm with median survival 8-9 years (M>F)
Phases
inflammatory erythrodermic pre-mycotic patch
plaque
tumor
mycosis fungoides
generalized exfoliative erythroderma (red man)
lymphadenopathy
hepatosplenomegaly
T cell lymphoma
cerebriform nuclei
suvival <3 years
sezary syndrome
type IV hypersensitivity epidermal edema lymphocytes in dermis and epidermis pediatrics papuovesicular lesions "boiling over"
flexure surfaces
eczema
Hypersensitivity (CD8+ cytotoxic T cells) reaction to drugs, infections, malignancy, collagen vascular disorders
Infections: Herpes simplex, deep fungal (Histoplasmosis), Salmonella typii, Leprosy
Drugs: Antibiotics, Salicylates, Anti-malarials
erythema multiforme
steven johnson syndrome
extensive symptomatic febrile form of erythema multiforme
children
erosions and hemorrhagic crusts involving the lips, and oral mucosa
toxic epidermal necrolysis
variant of erythema multiforme
diffuse necrosis and sloughing of cutaneous and mucosal epithelilal surface s
infection and fluid loss are the major concerns
Involves skin regions with high density of sebaceous glands (oil or sebum production)
scalp, forehead, especially glabella (space between upper eyebrow), nasolabial folds, skin of auditory canal, intergluteal folds)
Excessive dandruff in scalp common
Not due to sebaceous gland abnormality
Infection with superficial yeast (Malassezia furfur) may play important role since condition is improved by use of topical antifungal agents
seborrheic dermatitis
Affects skin of elbows, knees, scalp, lumbosacral area, intergluteal cleft, and glans penis
Typical lesion: well-demarcated, pink- to salmon plaque
Many different clinical presentations
HLA-Cw*0602 association – increased CD4+TH1 sensitized cells set off other T-cells causing increased cytokines leading to epidermal proliferation.
auspitz sign
psoriasis
Fairly common in 30-60 y/o females Stages Pre-rosacea (flushing) Erythematotelengiectatic Papulopustular Phymatous Pathophysiology uncertain Numerous triggers Abnormal cathelicidin may lead to inflammation Perifollicular inflammation with changes similar to acne vulgaris microscopically
rosacea
Involves mucosa and scalp, face, axilla, groin and other pressure points;
IgG antibodes against desmosomes
classic bullous disease Pemphigus vulgaris (80%):
In pemphigus vulgaris, autoantibodies against Dsg1 and Dsg3 cause blisters in the deep suprabasal epidermis,
more benign course; involves face, scalp, chest and back and spares mucous membranes
Epidemic form occurs in South America (fogo salvagem)
Pemphigus foliaceus
in pemphigus foliaceus, the autoantibodies are against Dsg1 alone, leading to superficial, subcorneal blisters.
Common in children and adolescents
generally self-limited – present 6 months - 3 years (unless a friendly relative intervenes)
Etiology: Human Papillomavirus (HPV) with over 150 subtypes of virus
most common cutaneous variety in humans is 2/4 and in anogenital 6/11
Distinct, gray-white to tan 0.1 to 1.0 cm papules
firm consistency, “cobble-stone” (roughed surface), firm to palpation.
verruca vulgaris
most common site where melanoma might metastasize
liver
elevated alk phos
the rash that itches
atopic eczema - mediated by IgE - AC fossa
prone to which infection
staph
toll like receptor 2 is the protein that is involved in the innate immune system which is activated in areas where there are blocked sweat ducts in the cases of eczema
use steroids to treat
8 year old that has lost none of his teeth
high IgE levels
history of staph abscesses
atopic eczema
has phagocytic dysfunction
Job’s ! -> hyper IgE and decreased IL-8/NCF
IL-8 is needed for white cells to chemotact to the right area
recurrent bacterial infections/abscess
increased IL-5–> more eo’s
increased IL-4–> acts on TH2 response pathway
thrombocytopenia and eczema
combinded immunodeficiency
Wiskott Aldrich
what is nummular eczema
lots of spots,
worse in the winter and with water?
coin shaped
treat with steroids
what causes psoriasis to flare up?
stopping steroids
certain drugs–> b-blockers, lithium, interferon
strep
itching
sudden flare up may be a marker for HIV
what do psoriatic plaque and atherosclerotic disease have in common
basic problem in ASVD and psoriasis is suppressed T reg cells and hyperactive T helper 1 Thepler 17 cells
oil drop spots
nail pits
psoriasis
where on the nail do fungal infections start?
distal portion
so if you see proximal superficial onychomyocosis think of trichophyton rubrum and AIDS!
worsens with cushings, malnutritions, or immunosuppression (steroids- help this grow)
dull yellow fluorescence under wood light
more prominent in sunlight
this is what
malassezia furfur- tinea versicolor on the trunk
scrapings show spaghettie and meatballs
coral pink fluorescence under wood’s lamp
corynebacterium
green on woodlamp
cat ringworm (microsporum canis) tinea
urine is wine red
and coral red when under woodlamp
Woman: BCP’s, hep C, elevated ALT
Man- increased temporal hair growth and exposure to polychlorinated aromatic hydrocarbons
what is the disease
porphyria
HUD deficiency
pt’s with urogen decarboxylase deficiency will have high levels of uroporphyrinogen and it is photosensitive –> deposits supepidermal
caterpillar bodies
coLD agglutinins
dry cough
target lesions - erythema multiforme
atypical pneumonia with mycoplasma
in the west which drugs cause steven johnson/ toxic epidermal necrolysis
east?
oxicam NSAID’s (peroxicam)
sulfas
east–> carbamazepine (tegretol) - check for HLA-B1502
allopurinol - HLA- B5801
what pathway does steven johnons work by
death receptor FasR
which organism is associated with lymphoreticular malignancies, colon or gyn malignancies
clostridium septicum
combination of aerobic and anaerobic cellulitis and necrotizing fascitis
h0t tub folliculitis
pseudomonal aeruginosa
a child with impetigo may be in danger of devloping what
glomerulonephritis (PSGN)
post streptococcal
strep pyogenes is the second most common cause
what is a cause of rosacea
demodex mit (bacillus olernius)
borrelia burgdorferi stage I
flu sydnrome with rahs (erythema chronicum migrans)
stage II borrelia burgdorfer
heart block joints nerves (bell's palsy) skin rash
stage III borrelia burgdoferi
joints and CNS and PNS
oligoarthritis, ecephalitis/memory loss, neuropathies
more common in orientals
associated with Hep C
sawtooth infiltrate of lymphocytes at dermal epidermal junction
lichen planus
6’ p’s
herpes type 8
kaposi sarcoma
if associated with HIV/immunosuppression its on head neck region
if a patient has pityriasis and herald patch what else should you check for
syphilis
ssDNA virus
glove and stocking purpuritic syndrome
slapped cheeks
worse after exercise (due to 5th’s disease)
parovirus B19
if parents get it they can get endocarditis, arthritis, and hemolytic anemia
rash spread cephalocaudad
togavirus +SS RNA
forchheimer spots (red dots back of throat)
maculopapular rash
lymphadenoopahty (postauricular)
blueberry muffin rash
German measles (Rubella)
koplik spots
fever, conjunctivitis, coryza -runny nose, cough
paramyxovirus (- SS RNA)
rash on head, spreads to trunk, then extremities
becomes confluent on face and trunk
Rubeola (measles)
what is DRESS
drug rash with eosinophilia and systemic syndrome
2-6 weeks after start of new medicine
acral edema–> generalized rash–> pinpoint pustules–> desquamation
lymphadenopathy, hepatomegaly, abnormal LFT’s
IL5 disease
HHV6 or HHV 7 poisiitve
poison ivy is what type of reaction
type IV a Gell-Combs (TH1 with macrophage activation)
what is the cause of angioedema
ACEinhibitors
ARB’s
acquired C1 esterase deficiency –> sets off bradykinin
–> screen with C4 which will be low
how can stress cause hives
b/c CRH increase stimulates mast cells
what type of reaction is bee sting
type I IgE reaction
what causes direct activation of mast cells without IgE
Anaphylactoid- non IgE degranulation
C5a CRH thermal and mechanical stimulation radiocontrast dyes opioids shellfish
PAS positive staining
CD4 T cells in the epidermis
patch- plaque- tumor
mycosis fungoides
RO/SSA
photosensitive
positive band test
offspring will have what
heart block
this is chronic cutaneous lupus erythematous
causes of erythema nodosum
1st oral contraceptives
2nd streptococcus
TB pregnancy coccidioomycosis ulcerative colitis sarcoid
