B-38/39/40 Rosacea/follicular Dz/eccrine Disorders

Front 1

Four Subtypes of Rosacea

Back 1

Erythematotelangiectatic (Vascular) Rosacea
Papulopustular (inflammatory) Rosacea
Phymatous
Ocular

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Variants of Rosacea

Back 2

1. Granulomatous - histo shows perifollicular, noncaseating epitheliod granulomas (Lupus Miliaris Disseminatus Faciei overlaps w/ this except it has central caseation)
2. Periorificial dermatitis - histo and rx similar to rosacea
3. Pyoderma faciale - in young females, no prior hx. may rx with prednisone & accutane
4. Steroid rosacea -- Rx is d/c steroid... rx flare with TCNs, accutane, or topical tacrolimus

Front 3

Four Variants of rhinophyma

Back 3

glandular
fibrous
fibroangiomatous
actinic

Front 4

% of rosacea pts with ocular sx?

Back 4

50%
Severity is NOT proportional to facial dz, may show up years before cutaneous dz

Front 5

Proposed pathogenesis of ocular rosacea?

Back 5

Meibomian gland impaction leads to decreased lipids in tear film which increases evaporation and leads to irritability of eye

Front 6

Medications that can induce flares of rosacea or cause rosacea-like eruptions?

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Amiodarone
Topical Steroids
Nicotinic Acid
Vitamins B6 and B12
EGFR Antagonists

Front 7

Treatment options for Roseacea

Back 7

Avoidance of triggers
Topicals: Metrogel, Azelaic Acid, Benzoyl Peroxide, Sodium sulfacetamide, Topical tretinoin, oral ABx - TCNs, Accutane, LASERs

Front 8

Most common fungi in Tinea Barbae? Majocchi's granuloma?

Back 8

T. mentagrophytes or T. verrucosum (male farm workers)
T. rubrum (women from shaving legs)

Front 9

Causes of Drug-induced Folliculitis

Back 9

(Morphology: Monomorphic Follicular Papules, neg comedones)
Corticosteroids
androgenic hormones
iodides
bromides
lithium
isoniazid
anticonvulsants
ACTH

Front 10

Bugs assoc with Gram-Neg Folliculitis

Back 10

Klebsiella, Enterobacter, Proteus. TOC: accutane

Front 11

Name the three types of Eosinophilic folliculitis

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Eosinophilic pustular folliculitis
AIDS-associated eosinophilic folliculitis
Eosinophilic pustular folliculitis in infancy

Front 12

Eponym for Eosinophilic pustular folliculitis

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Ofuji's Disease

Front 13

Main assoc w/ Ofuji's Dz?

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- explosive crops of follicular papulopustules
- annular and serpiginous plaques
- Japanese Men
- Peripheral eosinophilia
NO systemic symptoms
involutes in 7-10 days, relapse in a month

Front 14

Treatment of Ofuji's?

Back 14

UVB & Oral Indomethacin

Front 15

What level CD4 is assoc with AIDs assoc eos folliculitis?

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CD4<300
Improves with HAART

Front 16

How is AIDS assoc different than Ofuji's?

Back 16

no large pustules and/or figurate lesions

Front 17

Eosinophilic pustular folliculitis in infancy: common? boys vs girls? onset? course?

Back 17

Rare and self-limited; boys > girls
Onset as early as first 24 hours
Cyclical course for 3mo - 5 yrs

Front 18

What is similar to Eosinophilic pustular folliculitis in infancy? How do you differentiate?

Back 18

Must consider: Erythema Toxicum Neonatorum
Similar histo, but ETN is onset in 1st 48 hours, resolves in a week

Front 19

Eponym for "goose bumps"

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Hitch & Lund Disease
aka disseminate & recurrent infundibulofolliculitis

Front 20

Tx for Hitch & Lund?

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topical steroids, lactic acid/urea, PUVA, accutane

Front 21

Describe Keratosis Circumscripta rash. onset? histo? overlap? from what country?

Back 21

groups of folliculocentric papules: knees, elbows, nape of neck, hips, sacrum w/ assoc palmoplantar thickening.
Onset: 3-5 years
similar to psoriasis, overlaps with juvenile PRP & lichen spinulosus
Tx: keratolytics, peels, ablative laser
from AFRICA

Front 22

Rash from Vit A deficiency?

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Phrynoderma -- follicular papules w/ conical keratotic plugs -- extensor surfaces of extremities (thighs and forearms)

Front 23

Level of Vit A seen in Phrynoderma

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Serum level < 20mg/100mL

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Risk group for Phrynoderma

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in Asia & Africa
Bariatric Surgery

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Assoc findings w/ Phrynoderma

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Ocular (night blindness, xerophthalmia, Bitot spots)
Mucosal (erythematous glazed tongue)
Systemic (muscle weakness, neuritis, diarrhea)
Rx: Vit A, lesions clear in 1-4 months

Front 26

Follicular Ichthyosis more common in boys or girls?

Back 26

MC in Boys (XLR?), seen on head and neck, appears in early infancy and early childhood

Front 27

Generic name for Vaniqa

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Eflornithine
(alpha-difluoromethylornithine)
hair growth inhibitor

Front 28

Follicular Occlusion Tetrad?

Back 28

Acne Conglobata
Hidradenitis Suppurativa
Dissecting Cellulitis of the scalp
Pilonidal Sinus (added later)

Front 29

What drug can cause hidradenitis suppurativa? is this condition androgen sensitive?

Back 29

Lithium
No - apocrine glands are not androgen sensitive

Front 30

Describe Acne fulminans

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eruptive cystic acne
fever
leukocytosis
myalgias
constitutional symptoms
osteolytic bone lesions

Front 31

Where are eccrine glands absent?

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Clitoris, glans penis, labia minora, external auditory canal and lips

Front 32

What fibers innervate eccrine glands?

Back 32

Sympathetic cholinergic fibers

Front 33

Sources of Neural hyperhidrosis? Non-Neural?

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Neural:
Cortical, Hypothalamic, Medullary, Spinal, Axon reflex
Non-neural:
Local heat, drugs, changes in blood flow or sweat glands

Front 34

Prevalence of Axillary Hyperhidrosis? % of those with Family History in Cortical Hyperhidrosis?

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25% axillary hyperhidrosis, appears post-puberty
75-80% with Fmily Hx --> AD likely

Front 35

Medical Treatment Options for Hyperhidrosis?

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Aluminum Chloride
Anticholinergics: Probanthine, Robinol, Ditropan

Front 36

Treatment Options for Hyperhidrosis besides medication

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Iontophoresis
Botox Injections (50U per axillae)

Front 37

Mechanism of action of Botulinum toxin? What is the specific protein invoved?

Back 37

Binds to proteins responsible for ACH receptors; specifically, light chain of BTX-A cleaves SNAP-25 (synaptosome-associated Protein)

Front 38

What level Endoscopic Transthoracic Sympathemectomy for Palmar vs Axillary?

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Palmar = T2-T3
Axillary = T4-T5

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Skoog-Thyresson Surgery

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No secretory mapping
Plastic surgeons dissect out axillary sweat glands

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Hurley-Shelley Surgery

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sweat mapping
surgical ablation of active loci

Front 41

Name other Cortical Hyperhidrosis

Back 41

Unna-Thost keratoderma
Vorner's (diffuse epidermolytic keratoderma)
Progressive diffuse keratoderma (Greither)
Howel-Evans Keratoderma
Mutilating keratoderma of Vohwinkel
Mal de Meleda
Olmstead (Diffuse keratoderma c keratosis periorificialis)
Acrokeratoelastoidosis
Pachyonychia congenita
Localized EB Simplex

Front 42

What is Pel-Ebstein?

Back 42

Night sweats assoc with Lymphoma

Front 43

MC Cause of Hypothalamic (thermal) Hyperhidrosis

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defervescence of fever

Front 44

How do CNS lesions causes hyperhidrosis?

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a Hypothalamic cause:
release of cortical inhibitory influence on the hypothalamus (contralateral hyperhidrosis)

Front 45

Pathogenesis of Medullary (gustatory) hyperhidrosis? Types? Demographics?

Back 45

MOA: Taste receptors in mouth afferent input --> glossopharyngial nerve and/or vagal nerve --> nuclei in medulla oblongata
Physiologic: foods, alcohol; seen in children/young adults/warm climate; familial tendency
MOA: transposition of the postganglionic sympathetic and parasympathetic nerve fibers (except for CNS)
Pathologic: disease or injury to PAROTID GLAND, also in CNS d/o like syringomelia or encephalitis, also in alteration or trauma of THORACIC SYMPATHETIC TRUNK

Front 46

Frey's Syndrome

Back 46

aka auriculotemporal syndrome;
salivary stimulation that leads to sweating on the cheek and adjacent neck;
seen in 40% of pts who undergo parotid surgery

Front 47

Chorda tympani syndrome

Back 47

gustatory hyperhidrosis involving the submandibular gland;
sweat over chin and lower jawline

Front 48

What is "crocodile tear" syndrome?

Back 48

Injury to facial nerve, gustatory lacrimation

Front 49

Name some conditions with increased sweating due to increased blood flow to the affected areas?

Back 49

Nevoid angiomatous lesions
Mafucci's syndrome
Congenital AV fistulas
Glomus tumors (pain or blood flow)
Blue rubber bleb nevus syndrome (pain or blood flow)

Front 50

What is Shy-Drager?

Back 50

Progressive Autonomic Failure (PAF) with multiple system atrophy

Front 51

What is Ross' syndrome?

Back 51

Holmes-Adie syndrome (tonic pupils) , absent DTRs w/ Anhidrosis

Front 52

Horner's syndome

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unilateral anhidrosis, miosis, ptosis of eyelid

Front 53

Atarabine (quinacrine) dermatitis

Back 53

damage of sweat glands; infiltrated by fluorochrome atarabine (fluoresce a bright orange-yellow w/ wood's light)

Front 54

Angiokeratoma corporis diffusum eponym?

Back 54

Fabry's disease

Front 55

Franschetti-Jadassohn syndrome?

Back 55

Reticulated hyperpigmentation plus ectodermal dysplasia

Front 56

Helwig-Larssen syndrome

Back 56

Familial anihidrosis w/ labyrinthitis

Front 57

What are the three types of miliaria (sweat retention vesicle)?

Back 57

Crystallina - stratum corneum
Rubra - stratum corneum to DEJ, miliaria pustulosa variant w/ sterile pustules, most common*

Profunda - upper dermis, asymptomatic b/c below itch receptors, rare

Front 58

Trimethylaminuria?

Back 58

Defect in Flavin-containing monooxygenase 3 (demethylating enzyme) can cause this syndrome. Get "fishy odor" sweat after ingesting foods with choline & lecithin (fish, egs, kidney, liver)

Front 59

Chromhidrosis?

Back 59

Eccrine chromhidrosis (exogenous):
Piedra or corynebaterium
Copper miners = blue-green sweat
Clofazamine = red sweat

Front 60

Apocrine Chromhidrosis

Back 60

Intrinsic cause of colored sweat due to excretion of lipofuscin in large amounts

Front 61

Granulosis rubra nasi

Back 61

pinhead sized erythematous papules of nose, cheeks, upper lip, chin; begins in infacny, associated with cortical/emotional hyperhidrosis of palms and soles, cyanosis, and chilblains; rare & resolves spontaneously

Front 62

Keratolysis exfoliativa

Back 62

superficial desquamative process, scaling in annular or circinate patterns, occurs in healthy pts

Front 63

Who is at risk for Neutrophilic Eccrine Hiradenitis?

Back 63

Cancer patients (90% of pts with this condition have a malignancy!)
Assoc with Chemotherapy, esp cytarabine (also w/ MTX, Cyclophos, 5FU, AZT, GCSF)

Front 64

Palmoplantar Eccrine Hiradenitis

Back 64

Young, healthy children or young adults
clinically like E.N. of the palms
Triggers: wet shoes, cold/damp weather

Front 65

Papular-purpuric gloves and socks syndrome

Back 65

partially blanchable, erythematous, purpuric patches -- assoc with prior URI

Front 66

What is Fox-Fordyce Disease?

Back 66

Apocrine Miliaria, rare, in females; most commonly in Axilla & Areola; very pruritic; remission after menopause; Rx - topical or intralesional steroids; topical tretinoin may reduce pruritus but not appearance; clinda bid, OCPs may help