6-Diagnosis Of Scaling Disorders

Front 1

Definitions

Crust

Back 1

dried exudate --> flakes or plates

Front 2

Definitions

Guttate

Back 2

shaped like drops

Front 3

Definitions

munro microabscess

Back 3

small focal collection of pyknotic PMNs with the parakeratotic portion of the stratum corneum in psoriasis

Front 4

Definitions

Nummular

Back 4

shaped like a coin

Front 5

Definitions

Parakeratosis

Back 5

retained nuclei in stratum corneum

Front 6

Definitions

Pityriasis

Back 6

bran-like flakes of scale

Front 7

Definitions

scale

Back 7

pieces of stratum corneum

Front 8

Abnormal maturation, increased proliferation, or increased retention of keratinocytes in epidermis can lead to what

Back 8

scaling

Front 9

Patient has inflammatory cells in epidermis and dermis
-accumulation of PMNs in epidermis
-increased mitosis of keratinocytes
-parakeratotic hyperkeratosis
-underdevelopment/absence of granular layer

dx?\where are lesions commonly seen?

Back 9

psoriasis

scalp, extensor limbs, elbows, knees, shins, sacral region, palms. soles, nails

Front 10

Psoriasis

a. most common type
b. drop-shaped scaly lesions
c. axilla, gluteal cleft
d. diffuse involvement of body
e. localized to palms or soles, maybe generalized

Back 10

a. classic
b. guttate
c. inverse
d. erythrodermic
e. pustular

Front 11

Patient with parakeratotic hyperkeratosis and plaques on scalp and extensor limbs has
--koebner phenomenon
-nail onycholysis
-asymmetric artritis

dx?

Back 11

psoriasis (plaque type)

Front 12

Patient comes in with
-brown-red macules or papules on trunk, extremities, can include palms and soles
-diffuse hair loss, loss of lateral third of eyebrow
-may get vesicles or pustules or mucous patches

histology:
-epidermal hyperkeratosis
-perivascular dermial infiltrate of monocytes, lymphocytes, and plasma cells
-endothelial cell swelling

dx?
what should you do to confirm

Back 12

Secondary syphilllis

silver stain to see spirochetes

Front 13

Clinical: recurrent inflammation on scalp, eyebrows, eyelids, ears, nasolabila folds, etc

histo:
-focal parakeratosis at edges of follicular ostia
-spongiosis with modest PMN infiltrate

dx?

Back 13

classic seborrheic dermatitis

Front 14

Patient comes in with:
-herald patch on trunk that progresses to crops of smaller round to oval salmon-colored patches that follow lines of cleavage
-peripherally attached, thin scales (bran-like)

histo:
-parakeratosis containing serum
-focal spongiotic dermatitis with superifical pervascular lymphocytic infiltrate

dx?

Back 14

Pityriasis Rosea

Front 15

Patient presents with bright red edematous papules (that may erode or ulcerate)

Histo
-epidermis has parakeratosis and spongiosis, keratinocyte necrosis
-erythrocytes in epidermis
-wedge shaped inflammatory cell infiltrate in dermis

dx?

Back 15

Pityriasis Lichenoides - acute

Front 16

Patient presents with red-brown lesion with micaceous scale; post-inflammatory hyperpigmentation

Histo
-epidermis has parakeratosis and spongiosis, keratinocyte necrosis
-erythrocytes in epidermis
-wedge shaped inflammatory cell infiltrate in dermis

dx?

Back 16

chronic pityriasis lichenoides

Front 17

Patient gets purple, polygonal, pruritic papules that coalexce into plaques
-located on writsis, pretibial, and mucous membrnaes
-keobener phenomenon can occur
-white papules on buccal mucosa
-roughening, ridging, thinning, destructin, pterygium formation on nails

histo:
-hyperkeratosis with irregular acantosis
-focal hypergranulosis
-round eosinophilic deposits seen in lower epidermis or upper dermis
-dermis shows lymphcytes along junction, loss of melanin from basal cells (with accum in upper dermis)

dx?

Back 17

Lichen planus

Front 18

Clinical
-infants and young children present with edematous and erythematous papules and plaqes on cheeks, postauricular, neck, flexural surfaces of extremities, trunk

-lesions may be crusted from scratching

histo:
-acanthosis
-spongiotic dermatitis

dx?

Back 18

atopic dermatitis

Acute

Front 19

how does chronic atopic dermatitis differ from acute?

Back 19

chronic
-shares histo features with lichen simplex chronicus

-thickening accentuated skin lines and scale


acute lesions have
-acanthosis, spongiotic dermatitis
-edematous and erythematous papules and plaques

Front 20

Atopic dermatitis

follicular accentuation and pigmentation common in skin types III and up

Back 20

follicular eczema

Front 21

atopic dermatitis

common in children with darker skin --> hypopigmented patches

Back 21

pityriasis alba

Front 22

atopic dermatitis

prominent over scalp and face, vesicles and crusting common

Back 22

infantile

Front 23

atopic dermatitis

HIV superinfection of eczema

Back 23

eczema herpticum

Front 24

atoopic dermatitis

overlaps with irritant contact dermatitis, also called dyshirotic eczema

Back 24

hand dermatitis

Front 25

Patient presents with
-thick, frequently hyperpigmented plaque
-sharply demarcated
-pruritis

histopath: hyperplasia of epidermis with hyperkeratosis
-hypergranulosis
-acanthosis
-flattened rete ridges
-spongiosis common

dx?

Back 25

Lichen simplex chronicus

Front 26

Patient presents with
-non-inflamed scaling (fine scale to plate-like)

histo:
-nonspecific hyperkeratosis
-absent granular layer

dx?

Back 26

icthyosis vulgaris

Front 27

icthyosis vulgaris

Caused by what

Back 27

x-linked mutation in filaggrin