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78 Cards in this Set
- Front
- Back
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what is a primary lesion?
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A lesion that appears as a direct result of the pathological process
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What is a secondary lesion?
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A lesions that appears as a result of alterations or evolution of a primary lesion
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What is a macule?
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A small non-palpable spot <1cm
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What is a patch?
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A large non-palpable spot, >1cm
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What is a papule?
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A small superficial bump <1cm
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What is a plaque?
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A large superficial bump, >1cm
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What is a nodule?
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A small bump with a deep component (<1cm)
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What is a tumor?
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A large bump with a deep component (>1cm)
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What is a vesicle?
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A small fluid filled bubble which is usually superficial (<0.5 cm)
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What is a bulla?
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A larger fluid filled bubble which is usually superficial (>0.5 cm)
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What is a pustule?
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A pus containing bubble; characterized according to whether or not they are related to hair follicles
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What is a follicular pustule?
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A pus containing bubble associated with a hair follicle generally indicative of local infection
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What is a non-follicular pustule?
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A pus containing bubble not associated with hair follicles which is generally indicative of a systemic infection
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Describe the characteristics of Basal cell carcinoma
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- Manifests most commonly as a translucent nodule or plaque on the skin with prominent telangiectic vessels; or later, an ulcer with a raised rolled edge
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Give the etiology of BCC
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- Most common form of skin cancer
- rarely metastasize - appear on parts of skin intermittently exposed to large amount of sunlight (back, shoulders, chest) |
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What are the treatments for Basal Cell Cancinoma?
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1. Electrodessication and curettage
2. Simple surgical excision 3. Micrographic surgery (rarely) 4. Radiation surgery (in the elderly) |
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Describe the characteristics of Squamous Cell Carcinoma
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- Usually begin as a pink scaling patch on areas of maximal sun exposure (actinic keratosis)
- evolve into hard pink or white nodule, often surrounded by scaling (squamous cell carcinoma) |
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What are the treatments for actinic keratoses
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1. Liquid nitrogen
2. Topical 5-fluorouracil |
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What are the treatments for squamous cell carcinoma?
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1. Surgical excision
2. Radiation therapy |
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What are the treatments for melanoma
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Surgical, with chemo if there is systemic spread
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Describe the etiology of Roseola infantum
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HHV6
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Describe the clinical features of Roseola infnatum
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1. Incubation 10 to 15 days
2. Fever 39.5 to 40 lasts 3 to 5 days 3. As temp falls rash starts 4. Rash: rose-pink maculopapules, neck and trunk which fades in 1 to 2 days |
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Describe the clinical features of Varicella
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1. incubation: 14 to 17 days
2. Mild fever 3. Rash: vesicles appear in crops over 2 to 4 days, most numerous on trunk |
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What herpes virus is Kaposi's sarcoma?
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HHV-8
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Describe the features of molluscum contagiosum
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Virus which incubates 14d to 6 m and results in shiny, domed papules with central umbilication. Should resolve after 6 to 12 months
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Describe the features of HPV
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Infection can result in common plana filiform anogenital lesions
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Describe the features of togaviridae
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Incubates for 14 to 21 days with minimal symptoms. Rash first appears on face and then spreads to trunk, limbs; pink macules that become confluent
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Describe the features of paramyxovirus
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Incubates for 10 days with fever, malaise, cough and photophobia.
Rash: Koplik spots (2nd day); rash begins on day 4 on head and spreads to rest of body. Maculo-papular in nature with fine desquamation |
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Describe the features of parvovirus B19
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low grade fever followed by a slapped cheek rash on face and an erythematous eruption on the trunk neck and extremities
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Describe the features of HIV
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Acute inf'n: maculopapular rash
Neoplastic lesions: kaposi's sarcoma (most common), SCC, BCC, melanomas |
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Characterize Lichen Planus
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Characterized by the 5 Ps:
Pruritic, purple, planar, polygonal, papules |
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When is it appropriate to punch biopsy?
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1. Inflammatory skin diseases
2. BCC, before definitive therapy |
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When is it not appropriate to use punch biopsy?
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Not ideal for melanoma or SCC
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What is the etiology of psoriasis?
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- Prevalence of 1 to 3%
- positive family history in 30% of patients; inheritance is "multifactorial" - can develop at any time |
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What are the clinical features of psoriasis?
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Five cardinal morphological features of psoriasis
1. Plaque (raised lesions) 2. Well circumscribed margins 3. Bright salmon red colour 4. Silvery micaceous scale 5. Symmetric distribution |
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Where are the sites of predilection for psoriasis?
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1. Extensor surfaces over bony prominences
2. scalp, retro-auricular and ears 3. Palms and soles 4. Umbilicus 5. Penis 6. Lumbar 7. Shins 8. Nails |
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Describe guttate psoriasis
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An acute extensive eruption of small psoiatic papules over trunk and proximal extremities; usually in association with group A strep infections and may recur with each reinfection
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Describe inverse psoriasis
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Occurs in flexural sites with lack of scale and moist, macerated lesions
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Describe pustular psoriasis
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Can be life threatening and usually associated with fever and leukocytosis
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Describe erythrodermic psoriasis
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The entire body is affected and is red with scales
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What is the pathogenesis of psoriasis?
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- Chronic immunological disease of the skin characterized by profound cutaneous inflammation and epidermal hyperproliferation
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What is the treatment for psoriasis?
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1. Topical creams: gluccorticoids, etc
2. Phototherapy with UVB or UVA light combined with psoralens 3. Systemic therapy |
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What is atopic dermatitis also known as?
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eczema
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Describe the characteristics of atopic dermatitis
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- intenselt pruritic inflammatory skin disorder associated with atopy: asthma, hayfever and allergic conjuntivitis
- Strong familial aggregation - The itch that rashes |
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What are the clinical features of atopic dermatitis?
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Can be:
- xerosis (dry,scaly skin) - Ill defined erythema - tiny coalescing edematous papules or papulovesicles - lichenfication - excoriations - Crusting |
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What are the three phases of atopic dermatitis?
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1. Infantile (2m to 2y): facial and extensor distribution
2. Childhood: greater tendency to xerosis, flexural distribution, lichenfication and excoriations 3. Adult: Can improve or remit, can primarily affect hands at this point |
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What is the pathenogenesis of atopic dermatitis?
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- Cutaneous inflammation mediated by Th2 cells
- Elevated IgE - Impaired cutaneous barrier function - Skin colonization by S. aureus |
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What is the treatment for atopic dermatitis?
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- avoid irritants
- restore cutaneous barrier with emollients and moisturizers - topical glucocorticoids - topical immunomodulators - antibiotics - oral antihistamines |
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What is the pathogenesis of seborrheic dermatitis?
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- probably involves sebum and P.fungus
- Probably a host response against increased numbers of fungus on skin |
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What are the clinical features of seborrheic dermatitis in adults
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- Dandruff
- ill defined areas of erythema |
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Describe rashes caused by medications
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Drug eruptions
- adverse cutaneous drug reactions can mimic almost any clinical reaction involving the skin |
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Name the distinctive drug reaction cutaneous patterns
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- Uticaria
- Maculopapular / exanthematous/ morbilliform (measles like) - Erythema multiforme - localized inflamed plaques that occur in the same location at every exposure |
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What is acne vulgaris?
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A disease of the philosebaceous unit characterized by the presence of "comedones" (plugged hair follicles)
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What is the epidemiology of acne vulgaris?
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Primarily a disease of adolescence, peaking in the middle to late teenage years, but can persist into the 20s and 30s esp in women.
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Describe the pathogenesis of acne vulgaris
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1. Abnormal follicular keratinization
2. Overproduction of sebum 3. Over-growth of follicular bacteria |
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Define: mild acne
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mostly comedonew with a few inflammatory lesions - no scars
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Define: moderate acne
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Comedones and papules as well as pustules, but no deep cysts or nodules withe few scars
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Define: severe acne
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Cysts or nodules with significant scaring
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How is mild acne treated?
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1. topical (retinoic acids, benzoyl peroxide, antibiotics, azelaic acid)
2. surgical adjunctive therapy (comedone extraction) 3. Gentle cleansing 4. Minimizing use of cosmetic facial preps |
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How is moderate acne treated?
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1. System antibiotics (tetra, Doxy, Mino)
2. Hormonal therapy (OCP) 3. Retinoic acid |
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How is severe acne treated?
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1. Accutane
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What is Rosacea?
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A chronic inflammatory facial dermatosis of adults that is characterized by prominent facial flushing and erythema
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What is the epidemiology for Rosacea?
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Starts as blushing and flushing in the 20s and becomes fixed erythema in the 30s and 40s. The peak of onset is in the 40s and 50s. female to male ratio is 3:1
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What is the pathogenesis of Rosacea?
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Unknown
Multifactorial? 1. Genetic 2. Microvascular dilation 3. Demodex folliculorum mites |
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What is the single most common location for melanoma to occur in women?
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Legs
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What does a hair follicle consist of?
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1. Hair follicle
2. Sebaceous gland 3. Arrector pili muscle 4. Apocrine gland |
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Define the isthmus of the hair follicle
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Sebaceous duct entrance to insertion of arrector pili muscle
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Where are merkel cells most commonly found?
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palms, soles, mucous membranes of lips
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The epidermal layer is from what primitive origin?
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Ectoderm
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Where are the cell bodies of melanocytes found?
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Epithelial basal layer
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Which layer do the keratinocytes typically lose their nuclei?
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Stratum corneum
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How long does it take a keratinocyte to lose its nucleus and be shed fromthe skin?
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28 days
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What is the definition of spongiousus?
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Intra-epidermal inter-cellular edema
(typically occurs in eczematous processes) |
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Which glands of the skin are not affected by emotional factors?
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sebaceous glands (sebum secretion is constant)
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Which fungal infection requires the longest and most aggressive treatment?
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Tinea unguium
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Guttate psoriaisis is most commonly associated with which bacteria?
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Streptococci
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What is the classic histological finding for dermatitis herpetiform?
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Multilocular vesicle with microabsess of the tip of each papilla
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What is pathognomonic of scabies?
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A burrow found int he skin
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