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Patho II > The Skin > Flashcards

The Skin Flashcards

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1
Q

What are the three layers of the skin?

A

Epidermis
Dermis
Hypodermis

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2
Q

What is the epidermis?

A

Provides a waterproof barrier and creates the skin tone

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3
Q

What is the dermis?

A

Contains tough connective tissue, hair follicles, and sweat glands

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4
Q

What is the hypodermis?

A

Made of fat and connective tissue

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5
Q

What is the stratum corneum of the epidermis made of?

A

Dead keratinocytes

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6
Q

What is the stratum spinosum of the epidermis made of?

A

Dendritic cells

Living Keratinocytes

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7
Q

What is the stratum basale of the epidermis made of?

A

Melanocytes
Dividing Keratinocytes
Tactile cells

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8
Q

What are the primary skin lesions of the skin?

A 
Macule
Patch
Papule
Nodule
Placque
Wheal
Vesicle
Bulla
Pustule
Cyst
Telangiectasia
Tumor
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9
Q

What are secondary skin lesions of the skin?

A 
Scale
Lichenification
Excoriation
Fissure
Erosion
Ulcer
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10
Q

What is a macule?

A

Flat, circumsized area that is a change in color of skin

< 1cm in diameter

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11
Q

What are examples of macules?

A 
Freckles
Flat moles (Nevi)
Petechiae
Measles
Scarlet Fever
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12
Q

What is a patch?

A

Flat, nonpalpable, irregular shaped macule more than 1 cm in diameter

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13
Q

What is an example of a patch?

A

Vitiligo

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14
Q

What is a papule?

A

An elevated, firm, circumsized area

< 1 cm in diameter

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15
Q

What are examples of papules?

A 
Wart
Elevated Moles
Lichen Planus
Fibroma
Insect Bite
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16
Q

What is a nodule?

A

Elevated, firm, circumsized lesion

Deeper in dermis than a papule

1-2 cm in diameter

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17
Q

What is an example of a nodule?

A

Lipomas

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18
Q

What is a placque?

A

Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter

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19
Q

What are examples of placques?

A

Psoriasis

Seborrheic and Actinic Keratoses

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20
Q

What is a wheal?

A

Elevated, Irregular shaped area of cutaneous edema

Solid, transient

Variable diameter

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21
Q

What are examples of wheals?

A

Insect bites
Urticaria
Allergic reactions

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22
Q

What is a vesicle?

A

Elevated, circumsized, superficial

Does not extend into dermis

Filled with serous fluid

< 1 cm. in diameter

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23
Q

What are examples of vesicles?

A

Chickenpox
Shingles
Herpes Simplex

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24
Q

What is a bulla?

A

Vesicle more than 1 cm in diameter

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25
What are examples of bulla?
Blister | Pemphigus vulgaris
26
What is a pustule?
Elevated, superficial lesions Similar to a vesicle but with purulent fluid
27
What are examples of pustules?
Impetigo | Acne
28
What is a cyst?
Elevated, circumsized, encapsulated lesion In dermis or subcutaneous layer Filled with liquid or semisolid material
29
What are examples of cysts?
Sebaceous cyst | cystic acne
30
What is Telangiectasia?
Fine (0.5-1.0mm), irregular red lines produced by capillary dilation Can be associated with acne rosacea, venous hypertension, systemic sclerosis, or developmental abnormalities
31
What is a tumor?
Elevated, solid lesion May be clearly demarcated Deeper in dermis More than 2 cm in diameter
32
What are examples of tumors?
``` Neoplasms Benign tumor Lipoma Neurofibroma Hemangioma ```
33
What is a scale?
Heaped-up, keratinized cells Flaky skin Irregular shape Thick or thin Dry or oily Variation in size
34
What are examples of scale?
Flaking of skin with seborrheic dermatitis following scarlet fever Flaking of skin following a drug reaction Dry skin
35
What is Lichenification?
Rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation Often involves flexor surface of extremity
36
What is an example of lichenification?
Chronic Dermatitis
37
What is excoriation?
Loss of epidermis Linear, hollowed out, crusted area
38
What is an example of excoriation?
Abrasion or scratch Scabies
39
What is a fissure?
Linear crack or break form the epidermis to the dermis May be moist or dry
40
What are examples of fissures?
Athlete's foot Cracks in corner of mouth Anal fissure dermatitis
41
What is erosion?
Loss of part of the epidermis Depressed, moist, glistening Follows rupture of a vesicle or bulla or chemical injury
42
What is an ulcer?
Loss of epidermis and dermis Concave Varies in size
43
What is an example of an ulcer?
Pressure ulcer
44
What is psoriasis?
Complex autoimmune inflammatory disease that occurs in genetically susceptible individuals
45
What is psoriasis characterized by?
Well-demarcated erythematous placques with silver scale
46
What are the risk factors for psoriasis?
Genetics = PSORS1 locus within MHC on HLA gene and IL-23 related genes Smoking Obesity = TNF-alpha Drugs = beta blockers, lithium, antimalarial Alcohol Infections
47
What are patients with psoriasis at a higher risk of getting?
``` Obesity Insulin resistance Metabolic syndrome Atherosclerosis Cardiovascular disease Depression/Stress ```
48
What occurs in pre-psoriasis skin?
1) macrophages, dendritic cells, T cells, many cytokines/chemokines cause the pathological changes in this skin 2) Differentiation of T cells is stimulated by dendritic cells producing IL-23
49
What occurs in Psoriasis skin?
1) On exacerbation or onset, activated dendritic cells mainly produce TNFalpha 2) TNF-alpha amplifies inflammation and induces adhesion molecules 3) The clinical success of TNF-blocking agents is therefore not surprising
50
What is Steven Johnson Syndrome/Toxic Epidermal Necrolysis?
Severe mucocutaneous reactions most commonly triggered by medications
51
What is SJS/TEN characterized by?
Extensive necrosis and detachment of the epidermis
52
What is the difference between SJS and TEN?
SJS = desquamation < 10% of body surface TEN = desquamation > 30% of body surface
53
What are the three theories of pathogenesis of SJS/TEN?
1) Medication might upregulate a death receptor mediated apoptotic pathway 2) Drug specific CD8+ cytotoxic T cells release perforin and granzyme B that kill keratinocytes 3) Drug may also trigger the activation of CD8+ T cells, NK cells, and NKT cells to secrete granulysin
54
What is acne vulgaris?
Most common cutaneous disorder affecting adolescents and young adults Disease of Pilosebaceous follicles
55
What are the precursors for clinical lesions of acne vulgaris?
Microcomedo
56
What is a closed comedo?
Whitehead Accumulation of sebum and keratinous material formed form a microcomedo
57
What is an open comedo?
Blackhead Folliciular orifice is opened with continued distension Densely packed keratinocytes, oxidized lipids, adn melanin make the dark color
58
What is caused by follicular rupture in acne vulgaris?
Inflammatory papule or nodule
59
What are the four factors involved in acne vulgaris pathogenesis?
1) Follicular hyperkeratinization 2) Increased sebum production 3) Propionibacterium acnes within the follicle 4) Inflammation
60
What is Rosacea?
Common chronic inflammatory skin with a variety of clinical manifestations primarily localized on the central face
61
What are the four main clinical subtypes of rosacea?
Erythematotelangiectatic Papulopustular Phymatous Ocular
62
What are the triggering factors for Rosacea?
``` UV radiation Demodex colonization Microbial Stimuli heat Stress ```
63
What three things are associated with Rosacea pathogenesis?
1) Immune dysfunction 2) UV radiation 3) Vascular hyperreactivity
64
What is the immune function pathogenesis of Rosacea?
Contributes to the development of chronic inflammation and vascular abnormalities TLR-2 stimulates release of epidermal proteases and KLK-5
65
What is the pathogenesis of Rosacea from UV radiation
UVB radiation induces cutaneous angiogenesis in mice and can stimulate the secretion of VEGF-2 and FGF-2 from keratinocytes Also stimulates production of ROS
66
What is the pathogenesis of vascular hyperreactivity in Rosacea?
Frequent and prolonged flushing is a common feature in rosacea Triggers of flushing can be spicy foods, alcohol, and extremes of temperature
67
What is melanocytic nevus?
Benign proliferations of a type of melanocyte known as a nevus cell
68
What is the difference between melanocytes and nevus cells?
melanoctyes are evenly distributed as single units Nevus cells cluster as nests within lower epidermis and/or dermis
69
What is a junctional nevi?
Nests are at the dermalepidermal junction
70
What is a compound nevi?
Nests are at the dermalepidermal junction and in the dermis
71
What is an intradermal nevi?
Nests are in the dermis
72
What occurs when there is progressive migration of melanoctyes from dermal-epidermial junction into the dermis?
Nevi become more elevated and less pigmented
73
What are the predisposing factors of Melanocytic nevi?
Heredity Germline Polymorphisms = IRF4 and TERT Degress of sun exposure during childhood, especially when intense and sporadic Phenotypic characteristics such as skin type
74
What are Atypical Acquired Nevi?
Benign acquired melanocytic nevi that share, usually to a lesser degree, some of the clinical features of melanoma such as: Assymmetry Border Irregularities Color Variability Diameter > 6mm
75
Where do Atypical acquired nevi usually appear?
On areas of the body that receive sporadic sun exposure
76
What is an eclipse nevus?
Type of compound nevus on the scalp of children, a tan center, and brown Have benign behaviour
77
What is a congenital Melanocytic Nevi (CMN)?
Proliferations of benign melanocytes that arise during embryogenesis
78
What is the pathogenesis of CMN?
Cellular proliferation via mitogen-activated protein kinase (MAPK)
79
What are the clinical features of CMN?
Classically defined as Melanocytic nevi present at birth or within the first few months of life
80
What are complications of CMN?
Melanoma can occur after puberty
81
Which phase is it best to catch Melanocytic nevus in?
Radial Growth Phase
82
What may stimulate melanocyte proliferation in Melanocytic nevus?
FGF released by keratinocytes
83
What is melanoma?
Most serious form of cancer Aggressive neoplasms that may spread in an unpredictable manner to involved virtually any organ in the body
84
How does a melanocyte develop?
Modulated by microphthalmia-associated transcription factor (MITF) MSH stimulated the MC1R Induction of MC1R activated the expression of MITF causing production of melanin pigments
85
How does tanning cause melanoma?
Keratinocyte damage from UV radiation --> p53 mediated induction and POMC expression --> Secretion of MSH and stimulation of MC1R in epidermal malanocytes
86
What is activated in almost all melanomas?
MAPK pathway Growth factor activates in nonmalignant cells but BRAF mutations activate it in invasive melanoma
87
Which melanomas are associated with poorer prognosis?
Those with mutations of BRAF
88
What are the ABCDE warning signs of melanoma?
``` A= assymetry B = Border C = Color D = Diameter E = Evolving ```
89
What is basal cell carcinoma?
Common skin cancer arising from basal layer of epidermis Referrd to as "epithliomas" because of their low metastatic potential
90
What are the risk factors for basal cell carcinoma?
Sun exposure Fair skin, light colored eyes, red hair, northern European ancestry, older age, childhood freckling, and an increased number of past sunburns Tanning beds Ionizing radiation
91
What are the two things that contribute to Basal Cell Carcinoma pathogenesis?
UV induced inflammation | PTCH1 gene
92
What is the UV induced inflammation of BCC?
Clinically results in visible erythema Prostaglandin synthesis is markedly increased in part through induction of COX2
93
What is the SHH signaling pathway?
directs embryonic development of a variety of organs
94
What happens to the PTCH1 gene to cause BCC?
PTCH1 has mutations that inactivate it which causes overexpression of the SHH signal
95
What is Cutaneous Squamous Cell Carcinoma (cSCC)?
Arising from malignant proliferation of epidermal keratinoctyes Second most common type of skin cancer in the US
96
What are the risk factors for cSCC?
UV light exposure = UVA induced p53 mutations and UVA from tanning beds Ionizing radiation Immunosupression
97
What is the hallmark of cSCC?
Malignant transformation of epidermal keratinocytes
98
What is the pathophysiology of cSCC?
1) Malignant transformation 2) UV induced mutations in p53 gene 3) Mutation in RAS pathway
99
What is impetigo?
A contagious superficial bacterial infection observed most frequently in children 2-5 years
100
What are the risk factors for impetigo?
Crowding Poor Hygeine Underlying Scabies
101
What organisms cause impetigo?
S. aureus | Beta-hemolytic streptococci Group A
102
What are the clinical features of impetigo?
Non-bullous impetigo Bullous Impetigo Ecthyma
103
What is Non-bullous impetigo?
Lesions begin as papules that progress to vesicles surrounded by erythema causing rapidly forming crusts with a golden appearance
104
What is bullous impetigo?
Strains of S. aureus that produce exfoliative toxin A causing loss of cell adhesion in the epidermis
105
What is Ecthyma?
An ulcerative form of impetigo that extends through into the dermis Consists of "punched out" ulcers covered with yellow crust
106
What is Acanthosis Nigricans?
Common condition characterized by velvety, hyperpigmented placques on the neck and axillae
107
What is the clinical significance of Acanthosis Nigricans?
Mainly associated with obesity and diabetes mellitus
108
What three types of receptors have abnormalities and cause Acanthosis Nigricans?
IGFR1 FGFR EGFR
109
What is Vitiligo?
An aquired pigmentary disorder of unknown origin, is the most frequent cause of depigmentation worldwide
110
What is Vitiligo characterized by?
Development of white macules due to the loss of functioning melanocytes in the skin or hair or both
111
What is the Koebner phenomenon?
Repeated mechanical trauma (friction) and other types of physical trauma causing vitiligo
112
What is the pathophysiology behind Vitiligo?
generation of autoimmune responses against melanocytes Depigmentation results from hyperactive response of the immune system against melanocytes Defects of T cell subsets Increased Autoreactive CD8+ and CD4+ cells Generation of Anti-melanocyte autoantibodies

Patho II (16 decks)

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