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78 Cards in this Set

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  • Back
what is a primary lesion?
A lesion that appears as a direct result of the pathological process
What is a secondary lesion?
A lesions that appears as a result of alterations or evolution of a primary lesion
What is a macule?
A small non-palpable spot <1cm
What is a patch?
A large non-palpable spot, >1cm
What is a papule?
A small superficial bump <1cm
What is a plaque?
A large superficial bump, >1cm
What is a nodule?
A small bump with a deep component (<1cm)
What is a tumor?
A large bump with a deep component (>1cm)
What is a vesicle?
A small fluid filled bubble which is usually superficial (<0.5 cm)
What is a bulla?
A larger fluid filled bubble which is usually superficial (>0.5 cm)
What is a pustule?
A pus containing bubble; characterized according to whether or not they are related to hair follicles
What is a follicular pustule?
A pus containing bubble associated with a hair follicle generally indicative of local infection
What is a non-follicular pustule?
A pus containing bubble not associated with hair follicles which is generally indicative of a systemic infection
Describe the characteristics of Basal cell carcinoma
- 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
Give the etiology of BCC
- Most common form of skin cancer
- rarely metastasize
- appear on parts of skin intermittently exposed to large amount of sunlight (back, shoulders, chest)
What are the treatments for Basal Cell Cancinoma?
1. Electrodessication and curettage
2. Simple surgical excision
3. Micrographic surgery (rarely)
4. Radiation surgery (in the elderly)
Describe the characteristics of Squamous Cell Carcinoma
- 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)
What are the treatments for actinic keratoses
1. Liquid nitrogen
2. Topical 5-fluorouracil
What are the treatments for squamous cell carcinoma?
1. Surgical excision
2. Radiation therapy
What are the treatments for melanoma
Surgical, with chemo if there is systemic spread
Describe the etiology of Roseola infantum
HHV6
Describe the clinical features of Roseola infnatum
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
Describe the clinical features of Varicella
1. incubation: 14 to 17 days
2. Mild fever
3. Rash: vesicles appear in crops over 2 to 4 days, most numerous on trunk
What herpes virus is Kaposi's sarcoma?
HHV-8
Describe the features of molluscum contagiosum
Virus which incubates 14d to 6 m and results in shiny, domed papules with central umbilication. Should resolve after 6 to 12 months
Describe the features of HPV
Infection can result in common plana filiform anogenital lesions
Describe the features of togaviridae
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
Describe the features of paramyxovirus
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
Describe the features of parvovirus B19
low grade fever followed by a slapped cheek rash on face and an erythematous eruption on the trunk neck and extremities
Describe the features of HIV
Acute inf'n: maculopapular rash
Neoplastic lesions: kaposi's sarcoma (most common), SCC, BCC, melanomas
Characterize Lichen Planus
Characterized by the 5 Ps:
Pruritic, purple, planar, polygonal, papules
When is it appropriate to punch biopsy?
1. Inflammatory skin diseases
2. BCC, before definitive therapy
When is it not appropriate to use punch biopsy?
Not ideal for melanoma or SCC
What is the etiology of psoriasis?
- Prevalence of 1 to 3%
- positive family history in 30% of patients; inheritance is "multifactorial"
- can develop at any time
What are the clinical features of psoriasis?
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
Where are the sites of predilection for psoriasis?
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
Describe guttate psoriasis
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
Describe inverse psoriasis
Occurs in flexural sites with lack of scale and moist, macerated lesions
Describe pustular psoriasis
Can be life threatening and usually associated with fever and leukocytosis
Describe erythrodermic psoriasis
The entire body is affected and is red with scales
What is the pathogenesis of psoriasis?
- Chronic immunological disease of the skin characterized by profound cutaneous inflammation and epidermal hyperproliferation
What is the treatment for psoriasis?
1. Topical creams: gluccorticoids, etc
2. Phototherapy with UVB or UVA light combined with psoralens
3. Systemic therapy
What is atopic dermatitis also known as?
eczema
Describe the characteristics of atopic dermatitis
- intenselt pruritic inflammatory skin disorder associated with atopy: asthma, hayfever and allergic conjuntivitis
- Strong familial aggregation
- The itch that rashes
What are the clinical features of atopic dermatitis?
Can be:
- xerosis (dry,scaly skin)
- Ill defined erythema
- tiny coalescing edematous papules or papulovesicles
- lichenfication
- excoriations
- Crusting
What are the three phases of atopic dermatitis?
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
What is the pathenogenesis of atopic dermatitis?
- Cutaneous inflammation mediated by Th2 cells
- Elevated IgE
- Impaired cutaneous barrier function
- Skin colonization by S. aureus
What is the treatment for atopic dermatitis?
- avoid irritants
- restore cutaneous barrier with emollients and moisturizers
- topical glucocorticoids
- topical immunomodulators
- antibiotics
- oral antihistamines
What is the pathogenesis of seborrheic dermatitis?
- probably involves sebum and P.fungus
- Probably a host response against increased numbers of fungus on skin
What are the clinical features of seborrheic dermatitis in adults
- Dandruff
- ill defined areas of erythema
Describe rashes caused by medications
Drug eruptions
- adverse cutaneous drug reactions can mimic almost any clinical reaction involving the skin
Name the distinctive drug reaction cutaneous patterns
- Uticaria
- Maculopapular / exanthematous/ morbilliform (measles like)
- Erythema multiforme
- localized inflamed plaques that occur in the same location at every exposure
What is acne vulgaris?
A disease of the philosebaceous unit characterized by the presence of "comedones" (plugged hair follicles)
What is the epidemiology of acne vulgaris?
Primarily a disease of adolescence, peaking in the middle to late teenage years, but can persist into the 20s and 30s esp in women.
Describe the pathogenesis of acne vulgaris
1. Abnormal follicular keratinization
2. Overproduction of sebum
3. Over-growth of follicular bacteria
Define: mild acne
mostly comedonew with a few inflammatory lesions - no scars
Define: moderate acne
Comedones and papules as well as pustules, but no deep cysts or nodules withe few scars
Define: severe acne
Cysts or nodules with significant scaring
How is mild acne treated?
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
How is moderate acne treated?
1. System antibiotics (tetra, Doxy, Mino)
2. Hormonal therapy (OCP)
3. Retinoic acid
How is severe acne treated?
1. Accutane
What is Rosacea?
A chronic inflammatory facial dermatosis of adults that is characterized by prominent facial flushing and erythema
What is the epidemiology for Rosacea?
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
What is the pathogenesis of Rosacea?
Unknown
Multifactorial?
1. Genetic
2. Microvascular dilation
3. Demodex folliculorum mites
What is the single most common location for melanoma to occur in women?
Legs
What does a hair follicle consist of?
1. Hair follicle
2. Sebaceous gland
3. Arrector pili muscle
4. Apocrine gland
Define the isthmus of the hair follicle
Sebaceous duct entrance to insertion of arrector pili muscle
Where are merkel cells most commonly found?
palms, soles, mucous membranes of lips
The epidermal layer is from what primitive origin?
Ectoderm
Where are the cell bodies of melanocytes found?
Epithelial basal layer
Which layer do the keratinocytes typically lose their nuclei?
Stratum corneum
How long does it take a keratinocyte to lose its nucleus and be shed fromthe skin?
28 days
What is the definition of spongiousus?
Intra-epidermal inter-cellular edema
(typically occurs in eczematous processes)
Which glands of the skin are not affected by emotional factors?
sebaceous glands (sebum secretion is constant)
Which fungal infection requires the longest and most aggressive treatment?
Tinea unguium
Guttate psoriaisis is most commonly associated with which bacteria?
Streptococci
What is the classic histological finding for dermatitis herpetiform?
Multilocular vesicle with microabsess of the tip of each papilla
What is pathognomonic of scabies?
A burrow found int he skin