Test 3 Reverse Flashcards
Top layer of skinContains keratin & fillagrin surrounded by lipid matrix that provides a water barrier
Describe the stratum corneum
A protein in the granular cell layerHolds waterFound in stratum corneum
What is fillagrin?
- Keratinocytes2. Melanocytes3. Langerhans
What are the types of skin cells?
90% of skin cellsMigrate from basal layerDesquamation 40-56 daysSpiny layer, held together by desmosomes -stripes/spines
Describe keratinocytes
atopic dermatitis
Defects in fillagrin causes?
psoriasis
Defects in keratinocytes causes?
basal layer of skinproduce melanin which is transferred to the keratinocytes
Describe melanocytesres
mid-epidermis cellsResponsible for delayed hypersensitivity immune response reactions
Describe langerhans
- Macule2. Petechiae3. Ecchymosis4. Telangiectasia
What are the types of flat lesions?
- Papule2. Plaque3. Nodule4. Wheal5. Papilloma6. Vesicle7. Bulla8. Abscess9. Cyst10. Scales11. Lichenification
What are the types of elevated lesions?
raised, solid lesions <.5cm in daimeter
Papule
raised, solid lesions >0.5 cm in diameter
Nodule
plateau-like elevationconfluence of papules
Plaque
chronic, thickening of the epidermis leading to exaggerated, deep skin lines, usually due to chronic rubbing/scratching
Lichnification
round of flat topped evanescent lesion, changes rapidly in size & shape
Wheal
multiple wheals”hives”
urticaria
fluid filled lesion <0.5 cmoften thin walled
Vesicle
fluid filled lesion >0.5 cm
Bullae
abscess where hair follicle is involved
Furuncle
multiple furuncles
Carbuncle
liquid nitrogenWarts, seborrheic keratoses, actinic keratoses
What is cryotherapy?
Pigmented lesions >4mmAll lesions >6mm Deep dermis/subQ involvement
When do you perform an excisional biopsy?
- Incompletely excised BCC or SCC2. Primary BCC or SCC w/ indistinct borders3. Cosmetic areas4. Aggressive, rapidly growing lesions
Indications for Mohs surgery
- Nevi-melanocytic-atypical-blue2. Lentigines3. Seborrheic keratoses4. Malignant melanoma
Types of pigmented lesions
A - SymmetryB - Borders; irregularly, poorly definedC - Color - inconsistentD - Diameter/size >6mmE - Evolving/changing (shape, size, color)
Evaluation of a pigmented lesion
- Hx of melanoma2. Family Hx3. >100 acquired nevi4. Any new lesion >50 y/o5. Fair skin, blue eyes, freckles (Fitzpatrick skin II)6. Big sunburn
Risk Factors of melanoma
Meet 3/51. Poorly defined borders2. Irregular borders3. Irregular pigment4. Background erythema5. >5mm diameter
Classification of atypical nevi
Benign, may appear in 4th decadeNot on palms & solesPink, tan, dark brownTexture - velvety to wartyStuck on appearanceTx - cryotherapy, curetted
Seborrheic keratoses
Melanoma in elderly ptsSun exposed areasSlow growingHorizontal growth Clyde spots!
Lentigo
Melanoma common in Asians/blackshands, feet, nails Hutchinson sign - very aggressive w/ mets - line on nail
Acral lentiginous melanoma
Subtle w/o pigmentationDDx:diff. types of skin cancerpsoriasisdermatitis
Amelanotic melanoma
aka eczema”itch that rashes” Erythematous papules that coalesce into plaquesxerosis
Atopic dermatitis
50-80% of children will have another atopic disease1. Asthma2. Atopic dermatitis3. Allergic rhinitis
What is the atopic triad?
- Hx/FH2. Hx asthma/allergic rhinitis3. Xerosis4. Repeated skin infections-S. aureus
Risk factors of atopic dermatitis
- Topical steroids2. Calcineurin inhibitors (Elidel, Protopic)3. Antihistamines4. Tx secondary bacterial infections milds soaps, bath 1x/day, moisturizers, avoid wool & acrylics, sweat, heat & ointments
Tx atopic dermatitis
- Localized area of lichenification2. May be secondary to atopic dermatitis or other itchy conditions3. Hyperexcitability/abnormal itching4. Intense, may be unconscious habit Tx - break the itch! Steroids, antihistamines, occlusive/hydrocolloidal dressing
Lichen Simplex Chronicus
Chronic inflammatory conditionBimodal peak 20-30 or 50-60 Familial, waxes & wanes Risk factors:1. BMI2. Smoking3. EtOH4. Medications
Psoriasis & Risk Factors
- Plaque2. Guttate3. Inverse/flexural4. Erythrodermic5. Pustular
Types of psoriasis
Most common type of psoriasisSalmon colored plaques w/ silvery scales**May itchHyperproliferative disease - immune response causes excess cytokine release
Plaque psoriasis
Psoriasis bleeds when plaques removed
What is auspitz sign?
Considered seronegative spondyloarthropathies OFten affects hands, feet & spine
Psoriatic arthritis
Drop like lesions 1-10mmAcute onsetOften preceded by strep pharyngitis
Guttate psoriasis
Both rare but can be serious life threatening conditions
Erythrodermic & pustular psoriasis
Found in body foldsAxilla commonLacks scales due to moistureMay mimic candidiasis
Inverse/flexural psoriasis
Mild:1. Topical steroids2. Vit D analogs3. Keratolytic agents (salicylic/lactic acid)4. Topical retinoids5. Coal tarModerate to sever:1. PUVA (UV therapy)2. Retinoids
Tx psoriasis
Fawn/salmon colored plaques May be caused by herpes Peak age 10-35more common in femalesHerald Patch** - 2-10cm patch w/ peripheral scaling, central clearing often located on the back 1-2 wks later, full blown rash on trunk & proximal extremities Xmas tree distribution* Spares the face, palms & soles of feetNeg KOH scraping no Tx
Pityriasis rosea
Pityriasis rosea2-10 cm patch w/ peripheral scaling, central clearing often located on the back
What causes a Herald patch?
Pityriasis roseaspares the face, palms & soles of feet
Which rash has a Christmas tree distribution?
Scaly, greasy looking rashBeard, eyebrows, nasolabial fold, eyelids, under boobs, dandruff/cradle capMost likely caused by inflammatory rxn to fungus (Malassezia) or yeast
Seborrheic dermatitis
- Antifungals & topical steroids2. Selenium sulfide shampoo or zinc pyrithione3. Salicylic acid 4. Tx blepharitis by gently cleaning w/ soap
Tx Seborrheic dermatitis
Discoid lupus - DLE chronic scarring lesionsSubacute cutaneous - SCLE nonscarringMalar/butterfly rash -often pptd by sun exposure Sharply marginated w/ irregular borders Expansion peripherally w/ central regression leading to atrophy
Chronic cutaneous lupus erythematosus
Prevention - avoid sun1. Topical steroids2. Antimalarials3. Retinoids4. Thalidomide
Tx of lupus rash
aka cutaneous Tcell lymphomaIndolentPatches & plaques that may resemble psoriasisSezary cells Tx - PUVA, retinoids
Mycosis fungoides & Tx
Small lesions 0.2-0.6 cm Macular or papulesPinkish/flesh colored rough patchesOften in sun-exposed areas Premalignant deformation of keratinocyte may develop into SCC
Actinic keratoses
- Liquid nitrogen2. Topical agents -Fluorouracil cream-Imiguimod 5%
Tx actinic keratoses
Usually in sun exposed areas White fair skinInc. mortality rate compared to BCC 1. Papule, plaque or nodule2. Pink, red or flesh colored3. Scaly4. Grows outward5. Firm6. May have cutaneous form7. Friable (bleed easily)8. May be pruritic
Squamous Cell Carcinoma
- In situ- Bowen: localized to intraepidermal layer 2. Invasive - involvement of dermis
Types of SCC
- In situ - curette & desiccation, topical 2. Invasive - wide & local incision, MOHS
Tx of SCC
Unilateral red scaling plaqueDx w/ BxTx - mastectomy, chemo
Mammary Paget disease
aka vesiculobullous hand eczemaTapioca vesicles affecting hands & feetBlisters, pruritic, may become scaly & fissured Tx - topical/oral corticosteroidskeep dry - white cotton socks
Dishidrotic eczema & Tx
Blisters on dorsal surface of hands Skin fragility Hypertrichosis (facial hair)Causes:1. Sun exposure2. Liver disease/alcoholism3. Hep C4. HemosiderosisDx - urinary uroporphyrins
Porphyria cutanea tarda & causes
- Avoid sun (suncreen doesn’t help)2. Avoid/remove other triggers3. Phlebotomy4. Antimalarials
Tx of porphyria cutanea tarda
Exposure to chemicals or allergensIrritant - additive, soaps, detergentsAllergic - plants, antimicrobials, adhesive tape, jewelry, rubber Hypersensitivity rxn taking 10-14 days 1st time or 12-48 hrs repeated
Contact dermatitis causes
Irritant - erythematous, flat, scalyAllergic - vesicular, weepy, crusting Itching & burningLinear distribution
Contact dermatitis presentation
Uroshiol1. Poison ivy2. Poison oak3. Poison sumacType of contact dermatitis
Rhus dermatitis causes
May appear 8-12 y/oPeaks 15-18 y/oOften resolves by 25 y/o Men>women
Acne vulgaris
- Production of sebum (androgen mediated)2. Keratinous obstruction of sebaceous outlet 3. Baterial colonization - Propionionbacterium acnes4. Inflammatory rxn
Pathophysiology acne vulgaris
black head seen w/ acne vulgaris
What is an open comedone?
white headseen w/ acne vulgaris
What is a closed comedone?
- Topical antibiotics2. Benzoyl peroxide - helps open pores3. Topical retinoid w/ severe - accutane - contraindicated in pregnancy
Tx acne vulgaris