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98 Cards in this Set

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-silvery scales, plaques
-often on palms, soles, scalp, nails, extensor surfaces
-Koebner's phenomenon- physical trauma elicits lesions
-Auspitz sign: removal of scales-> appearance of minute blood droplets
-can be caused by glucocorticoids
-28x the normal production of epidermal cells
-T cell driven disease (TH1 response)
psoriasis
-redness and scaling in regions where sebaceous glands are most active (face,scalp, presternal, body folds)
-orange-red or gray-white skin, with greasy or white dry scaling macules and papules
-pityriasis sicca- dandruff
-infants: cradle cap
- malassezia furfur- role in pathogenesis
-pruritus is increased by perspiration
-butterfly rash on forehead
-Tx: selenium or ketoconzole shampoo, topical glucocorticoids
seborrheic dermatitis
-1st a single plaque (herald)
-then generalized secondary eruption
-oval, scattered papules and plaques with characteristic distribution with the long axes of the oval lesions following the lines of cleavage in a christmas tree pattern
-lesions mostly on trunk and proximal arms and legs (rare on face)
pityriasis rosea
-flat topped pink to violaceous shiny, pruritic polygonal papules on the skin and milky white reticulated papules in the mouth
-4Ps: papule, purple, polygonal, pruritic
-Wickham's stia: white lines
lichen planus (plane-flat)
-chronic, pruritic, inflammatory dermatitis in the form of coin-shaped plaques composed of groups of small papules and vesicles on an erythematous base
-usually in atopic individuals
-worse in winter
-S. aureus often present
nummular eczema
- vesicular type of dermatitis
-sudden onset of deep-seated pruritic, clear "tapioca like" vesicles
-later scaling fissures and lichenification
- caused by hyperhydrosis
- inhibit cholinergic eccrine sweat glands with botox
dyshidrosis: dyshidrotic eczematous dermatitis
-"an itch that rashes"
-lines under eyelid, denny lines, morgan folds or denny morgan lines
-itching from CNS
-treat with sedating anti-histamines
-chemical lobotomy: hydroxyzine
-deficiency of beta defensins and kaptulociden
-aka eczema, IgE dermatitis, atopic eczema
-langerhans cells involved with allergen
-TH2 helper cells get B cells involved- produce antibodies
-IgE elevated
-in chronic phase TH2 becomes TH1
atopic dermatitis
-result of sensitization to an antigen
-langerhans cell takes up antigen and presents with MHC 2 to T cells
- "spongiosus"
- cell mediated hypersensitivity
allergic contact dermatitis
-inflammation of the pilosebaceous unit
-manifests itself as comodones (keratin plugs)
-open comedones- blackheads
-closed comedones- whiteheads
acne
-chronic inflammatory acneform disorder of facial pilosebaceous unit coupled with increased reactivity of capillaries leading to flushing and telangiectasia
-aggrevated by hot,spicy food, sunlight, stress, alcohol
-risk of developing lymphoma in men
-tx. antiinflammatories
rosacea
-autoimmune disease of hair follicle
-exclamation point hair (distal ends are broader)
ophiasis pattern- snake surrounding head
-"going gray overnight"
-pitting of nails
alopecia areata
-hypertrophic scar that extends beyond site of original injury
-can become inflamed and ulcerate
-common in black or blood group A
keloids
-most commonly caused by T. rubrum, M. canis, T. tonsurans
-infect trunk, legs, arms, and/or neck
-plaques + or- vesicles
-sharply marginated
-peripheral enlargement and central clearing, arcuate lesions
tinea corporis
-T. rubrum
-dermatophyte infection of feet
-characterized by erythema, scaling, maceration, and/or bulla formation
-associated with hyperhydrosis
-moccasin type: well demarcated erythema, minute papules on margin, fine white scaling, hyperkeratosis
-can be secondarily infected, often with S. aureus
tinea pedis
-dermatophyte infection of toenails
-common in immunosuppressed and diabetics
-most often caused by Trichophyton mentagrophytes, T. rubrum
-always associated with tinea pedis
- superficial: invades dorsal surface of nail
-proximal subungual: enters by cuticle nail area, always associated with immunocompromised (HIV)
tinea unguium
-dermatophytosis of glabrous facial skin
-well circumscribed erythematous patch
-most common in children
tinea faciale
-caused by melassezia
-aka pityriasis versicolor
-does not produce keratinase- NON-DERMATOPHYTE
-fungus makes azoleic acid turns off melanocyte
tinea versicolor
-means vulnerable
-superficial infection of epidermis
-characterized by crusted erosions or ulcers
-often infected by S. aureus or group A strep (s.pyogenes)
impetigo
-superficial inflammation of hair follicle
folliculitis
-bacterial infection of DERMIS and epidermis
-ulceration with thick adherent crust
-associated with HTN
ecthyma
-bunch of furuncles (deep folliculitis)
carbuncle
CD4
-glycoprotein on surface of T cells, regulatory T cells, monocytes, macrophages, dendritic cells,
-TH2
CD8
-coreceptor for T cell receptor,
-expressed on cytotoxic T cells and NK cells
-TH1 response
verruca vulgaris
-caused by papilloma virus
-less malignancy with lower numbered strains
-black dots- thrombi in capillaries
-causes angiogenesis factor-capillaries in papillary dermis
verruca plana
-flat warts on face, hands, feet
molluscus contagiosum
-DNA pox virus in waxy coat
-humans only known reservoir
-looks like pearl-flesh colored, dome shaped, dimpled center
-spread by direct contact
- if more than 100 check for AIDS
herpes simplex
- herpes means: to creep
-stay in dorsal root ganglion of nerve
-vesicle, pustules
- no cure
-lesions usually do not cross midline
-tzank smear: multinucleated
herpes zoster
-shingles
-usually does not cross midline
-follows dermatomes
-prodromal: neuritic pain or paresthesia
-acute: vesicular or bullous eruption
-reactivation of varicella zoster virus
-confirm diagnosis by tzanck test
eczema definition
means "to boil out"
stages of eczema
acute: vesicular
subacute:
microvesicular
erythematous
scaling
chronic: lichenified
contact irritant dermatitis
inflammatory reaction caused by chemical irritant or antigen that elicits a delayed hypersensitivity reaction
-Engman's disease: when irritant dermatitis becomes infected
-irritation is dependent on dosage
-reaction is localized to area in contact with irritant
contact allergic dermatitis
-reaction that occurs when sensitized individual is exposed
atopic dermatitis
-"an itch that rashes"
-itch from CNS
-IgE
-tx.: sedating anti-histamines, chemical lobotomy- hydroxyzine
-scratch to cause pain (fast fiber, beat itch (slow fiber))
-deficiency of beta defensins
seborrheic dermatitis
-redness and scaling of skin where oil glands concentrate (nose, mouth, eyes, chest, back, inguinal, armpits)
-dandruff- pityriasis sicca
-cradle cap in infants
Tx: selenium shampoo, ketaconazole, glucocorticoids
nummular eczema
-coin shaped plaques composed of papules and vesicles on erythematous base
-worse in winter/dry weather
-treatment: moisturize, glucocorticoids, coal tar
stasis dermatitis
-"id" (self) reaction
-hypersensitivity reaction due to venous stasis
stasis dermatitis
-classic eczematous dermatitis with inflammatory papules, scaly and crusted erosions
-pigmentation with recent and old hemorrhages
-dermal sclerosis
-ulcerations due to scratching
-most often near medial malleolus
autosensitization id reaction
-pruritic dermatitis directly related to a primary dermatitis elsewhere
-will not disappear until primary dermatitis is controlled
-caused by the release of cytokines
-tx: oral glucocorticoids
asteatotic eczema
-aka eczema craquele (french for "marred with cracks") or xerotic eczema
-usually in older people in winter, low humidity
-can be caused by too frequent bathing with soaps
-superficially fissured skin with slight scaling
-incessant pruritus
-can lead to lichenification due to scratching
treatment and control of eczematous dermatoses
-avoid irritants
-stop scratching
-glucocorticoids
-anti-histamines
-anti-itching medication
-avoid stress
-tx. infections with abx
-rehydrate skin
bacterial infection of the skin most often by staph. aureus or S. pyogenes (group A strep)
pyodermas
impetigo
-superficial infection of epidermis
-characterized by crusted erosions or ulcers
bullous: most often caused by S. aureus which produces exfoliative toxins and causes scalded skin syndrome, vesicles or bulla on normal-appearing skin
non-bullous: vesicles rupture resulting in erosions, become surmounted in crust
ecthyma
-infection of skin that reaches the dermis
-lesion of neglect, develops in excoriations
-ulceration with a thick adherent crust
-most often on distal extremties
eripselas
-superficial cutaneous cellulitis with painful, bright red, raised, edematous, indurated plaque with advancing raised borders, sharply marginated
-usually caused by Group A strep- pyogenes
-bright butterfly shaped rash on bridge of nose an cheeks
-high fever, shaking chills,
-used to be a leading cause of death before antibiotics
-form of cellulitis
erythrasma
-caused by corynebacterium minutissimum
-diagnose with wood's lamp- fluoresce coral red
-intertriginous areas, body folds
pitted keratolysis of the feet
-associated with hyperhydrosis
-tx: treat hyperhydrosis and use benzoyl peroxide to kill bacteria
cellulitis
-extends into subcutaneous skin, not raised, not demarcated from uninvolved skin
-can be caused by vibrio vulnificus- present in brackish water, why immunocompromised (diabetics) should never eat raw seafood, bacteria 1st cause enteritis and then skin
furuncle
-red, hot, tender nodule or abscess that evolves from staph. folliculitis
-extends into deep dermis and subcutaneous tissue
-aka boil
abscess: acute or chronic localized inflammation associated with a collection of pus and tissue destruction
-tx: I and D, abx
carbuncle
-deeper infection than furuncle composed of interconnecting abscesses from several contiguous hair follicles
-a bunch of furuncles (deep folliculitis)
-aka boil
cutaneous tuberculosis: exogenous
-primary inoculation tuberculosis- percutaneous inoculation in nonimmune host
-tuberculosis verrucosa cutis- percutaneous inoculation in host with prior TB infection
endogenous spread TB
lupus vulgaris
scrofuloderma
metastatic tuberculosis abscess
acute miliary tuberculosis
orificial tuberculosis
primary inocculation tuberculosis
-papule at inoculation site
-lesion enlarges to a painless ulcer (tuberculous chancre)
-shallow granular base and multiple tiny abscesses
-limited to skin
-usually resolves on it's own
lupus vulgaris
-initial flat papule (soft and ill defined) becomes well defined irregular plaque
-"apple jelly" appearance with diascopy
-lesion breaks upon probing
-"punched out" often serpiginous ulcers surrounded by brownish infiltrate
-most often on head and neck
scrofuloderma
-firm subcutaneous nodule that intially is freely movable
-lesion becomes doughy and evolves into an irregular deep seated node or plaque that liquifies and perforates
-painless mass in neck
tuberculosis verrucosa cutis
-anatomist/pathologist's wart
-initial papule with violaceous halo
-evolves to hyperkeratotic, warty, firm plaque
-clefts and fissures occur and pus and keratinous material are expressed
-irregular border
-limited to skin
mycobacterium marinum
-follows traumatic inoculation following tropical fish/water exposure
-inflammatory verrucous or crusted lesions at inoculation site and extension to lymphatics (sporotrichoid) and deeper tissues
-papule enlarging to nodule or plaque, may be hyperkeratotic/verrucous, may ulcerate
-Dx: PPD often +, acid fast stain (50% +), isolation of M. Marinum on culture
Tx: minocycline, clarithromycin, rifampin, ethambutol, surgical debridement
leprosy
-hansen's disease
-caused by M. leprae
-tuberculoid: localized skin involvement and/or peripheral nerve involvement (few organisms in biopsy)
-lepromatous: generalized involvement skin, upper resp.,reticuloendothelial, adrenal, testes) many bacilli in culture
borderline or dimorphic form
-epistaxis: nose bleeds
-inverse relationship between darkness of skin color and severity of disease
-infects skin and cutaneous nerves, grows best in ares of body with cooler temperatures (skin, peripheral nerves, testes, Upper resp. tract, ant. chamber of eye)
-reservoir: humans, armadillos, chimpanzes, monkeys
-paresthesia and numbness
-muscle weakness/atrophy, contractures
-severe neruitic pain
-erythematous or purple border and hypopigmented center, often annular
-central area: atrophic, numb
Dx:
skin incision
Ziehl-Neelsen staining
inoculated in mouse foot pad
PCR DNA analysis
Tx: Dapsone, rifampin, clofazimine, manage nerve deficit problems
chancroid
-acute sexually transmitted infection characterized by a painful ulcer at site of inoculation and suppurative regional lymphadenopathy
-increased risk of HIV infection
-Dx: special culture media, painful genital ulcers, no evidence of T. pallidum by darkfield, lymphadenopathy, HSV is negative
-Tx: abx
-caused by H. ducreyi
syphilis
-painless ulcer or chancre at site of inoculation, regional lymphadenopathy
- caused by T. pallidum
-dx by darkfield microscopy, serology
-Tx: penicillin unless allergic
primary syphilis
usually painless ulcer unless superinfected
-button-like papule at site of inoculation
-firm with indurated border
-regional lymphadenopathy
secondary syphilis
-fever, sore throat, weight loss, malaise, anorexia, headache, diffuse hair loss
-relatively faint exanthem always macular and pink, ill defined lesions
-progresses to papular, brownish, more localized
-condylomata lata: soft, flat-topped moist red-to-pale papules, nodules or palques
tertiary syphilis
-15% of untreated syphilis develop
-gumma: nodular or papulosquamous plaques
-neurosyphilis
-cardiovascular syphilis
TB diagnosis
-PPD test (type 4 hypersensitivity reaction)
-culture yields: acid fast bacteria (mycobacterium)
-PCR
cutaneous TB treatment
-primary inoculation tuberculosis and tuberculosis verrucosa cutis are limited to the skin
-primary inoculation tuberulosis- usually resolves on it's own
-tuberculosis verrucosa cutis- excised
-prolonged therapy with at least 2 drugs: isoniazid, rifampin, ethambutol, streptomycin, pyrazinamide
herpes Simplex
-vesicles at site of inoculation
-associated with regional lymphadenopathy
-prodrome: tingling, itching, burning
-virus persists in sensory ganglia
-Dx: Tzanck smear looking for giant multinucleated keratinocytes
-Tx: antiviral drugs (acyclovir)
infectious exanthems
-generalized cutaneous eruption associated with a primary systemic infection
verruca vulgaris
-common wart
-hyperkeratotic papules with clefted surface and vegetations
-red or brown dots due to thrombosed capillary loops
verruca planae
-skin colored or light brown flat papules (1-2mm thick)
verruca plantaris
-small, shiny, sharply marginated papule to plaque with rough hyperkeratotic surface studded with brown-black dots
fungal culture: 3 plate method
KOH
PAS
scabies
-infection by mite sarcoptes scabiei
-mites tunnel and female lays eggs in stratum granulosum or more superficial
-intense itching that prevents sleep
-eczematous lesions
-nocturnal pruritus
pediculosis
-louse infestation
pediculosis captitis
-infestation of the scalp by head louse, deposits eggs in hair
-itching
-lichen simplex chronicus- habit of scratching
pediculosis corporis
-body louse
-live in seams of clothing
-burn clothing
-hygiene
pediculosis pubis
-louse infestation of hair bearing regions: pubic area, chest, axillae, upper eyelashes
-crab lice
-pthirius pubis
tx: physostigmine- paralyze louse
cutanea larva migrans
- in animals enter skin-> blood-> intestine-> picked up by another animal
-in humans the larva cannot get past the basement membrane, migrate to try to find a way out
-often caused by nematode ancylostoma braziliense
-Tx: thiobendazole
papular urticaria
-urticaria: wheals (transient papules and plaques) usually pruritic
-can be caused by arthropod bites
candidiasis
-non-dermatophyte- does not produce keratinase
-polymorphic: yeast forms, budding yeast, pseudohyphae, true hyphae
-KOH prep to see fungus
-chitin made by fungus, not dissolved by KOH
-grows in moist areas
-colonizes GI tract
-treat with antifungal agents: azoles
tinea versicolor
-non-dermatophyte
-caused by melassezia furfur
-azlic acid turns off melanocytes
-hyperemia- red spots
define dermatophyte
produces keratinase
What do you treat psoriasis with?

What do you not treat a person with psoriasis with?
cyclosporine A


NO CORTICOSTEROIDS
calcineurin pathway
1. APC (macrophage) activates T cell
2. T cell wants to kill invader
3. Ca is mobilized from cell membrane
4. binds calmodulin (4 binding sites)
5. calmodulin binds calcineurin (a phosphatase)
6. calcineurin splits NFATc (nuclear factor of activated T cell in cytoplasm) attached to P
7. enters nucleus
8. causes DNA to code for pro-inflammatory cytokines (IL-2,3,4, TNF-alpha)
how does cyclosporine A work
calcineurin inhibitor

immunosuppressant
contact dermatitis that becomes secondarily infected
Engman's disease
primary pyoderma
virulent organism on intact skin
secondary pyoderma
skin integrity altered allowing infection
layers of skin infected by cellulitis vs. eripselas
cellulitis: epidermis-> subcu.

eripselas: epidermis-> superficial dermis
felon
infection of pulp of finger/toe

pyogenic granuloma
difference between folliculitis, a furuncle, and a carbuncle
folliculitis-superficial

furuncle: deep folliculitis

carbuncle: bunch of furuncles connected by sinus tracts
pott's disease
extrapulmonary tuberculosis that affects the spine

causes tuberculous arthritis of intervertebral joints: tuberculosis spondyloarthropathy
mycobacterium marinum treatment
minocycline
Which type of leprosy has antibodies against the lesion?
lepromatous leprosy
condyloma lata

vs

condyloma acuminatum
syphilis



HPV

a lat of syphilis
accumulate warts
Where to scrape for cultures of fungus
and
Herpes
fungus: top

herpes: bottom
scabies
mites
larva migrans caused by:
ancylostoma caninum

or

ancylostoma braziliense
PAS stain
stains neutral polysaccharides in fungal cultures
difference between

tinea unguium

onychomycosis
tinea unguium: dermatophyte infection of nail

onychomycosis: any fungal infection of nail