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180 Cards in this Set
- Front
- Back
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Dennie-Morgan folds
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associated with Irritant Contact Derm (asthma, eczema, allergies)
itchy rashy folds of the arms or legs |
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Pityriasis Alba
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post inflammatory hypopigmentation (melanocytes are injured)
associated with Irritant Contact Derm (asthma, eczema, allergies) |
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Keratosis pilaris
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sandpaper like rash on arms
sometimes red base use buff puff and lotion to tx associated with irritant contact derm |
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Hertoghe sign
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thinning of the lateral eyebrow
associated with Irritant Contact Derm (asthma, eczema, allergies) |
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Keratosis punctata palmaris et plantaris
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hyperkeratotic lesion
associated with Irritant Contact Derm (asthma, eczema, allergies) |
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xerosis
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dry winter skin
associated with Irritant Contact Derm (asthma, eczema, allergies) |
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icthyosis vulgaris
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dry skin
looks like fish scales white/clear comes off easily autosomal dominant 50% of irritant contact derm pts have this |
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palmarplantar hyperliniarity
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pleats on skin are hyper linear -exagerated
associated with Irritant Contact Derm (asthma, eczema, allergies) |
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prurigo nodularis
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ongoing LSC scratching that leads to bumps on skin
associated with Irritant Contact Derm (asthma, eczema, allergies) |
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LSC
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lichen symplex complex
itching of scratching that leads to leichenification (raised skin) associated with Irritant Contact Derm (asthma, eczema, allergies) |
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verrucae
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flat wart
frequency increases as a result of atopic dermatitis (irritant contact derm) |
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pomphylx
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dyshydrosis, tapioca vesicles on sides of hands in atopic dermatitis (irritant contact derm)
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Macule
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change in color
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Papule
Plaque |
papule <1 cm within the epidermis
plaque >1 cm " ie lichen planus (lace-like itchy on hands and feet) |
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nodule
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deep seated mass (in dermis)
ie basal cell CA (red) telangectagia, pearly |
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tumor
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greater area than nodule or plaque
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wheal
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fluid with peripheral redness
ie dermatographism |
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vesicle
bulla |
<1cm intradermal, thin walled ie herpies
>1cm ie bollus pemphigoid (#1 blistering disease of elderly) |
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scale
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epidermal cells that peel
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crust
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dry/moist material on surface
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maceration
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water logged look on hands
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telogen
catagen anagen |
telogen - hair being pushed out
catagen - resting stage (ie after pregnancy) anagen - 85% of hair, actively growing |
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areata
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A. areata – sudden loss of hair from immunologic T cell response
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erosion
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loss of epidermis (partial or full)
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What are the features of Pemphigus Vulgaris
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intraepidermal tombstoning blister with a positive Nikolsky sign and Asboe-Hansen, comorbid with autoimmune dz’s, myasthenia gravis
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What age group is most vulnerable to have pemphigus vulgaris.
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50-60 y-o
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What causes pemphigus vulgaris?
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IgG mediated antibody against Desmogein-3
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What is a Nikolski sign?
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sloughing, degloving when a bollous/blister/vesicle is pressed on
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What is a positive Asboe-Hansen sign?
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When a bollous/vesicle is pressed, it spreads, to involve more skin.
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Where and how does Pemphigus Foliaceus occur?
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Desmoglein-1 therefore superficial epidermis
skin not mucosa |
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What disease is associated with Desmoglein-1 antibodies?
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Pemphigus Foliaceus
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What autoimmune disease is associated with desmoglein-3 antibodies?
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pemphigus vulgaris
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Where do pemphigus vulgaris, paraneoplastic pemphigus, pemphigus vegitans, and Cicatricial Pemphigoid first appear?
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mucosa
p. vulgaris usually later involves other areas paraneo. pemph. is mucosa only p. vegitans is a type of p. vulgaris, it is often in the body folds Cicatricial pemphigoid is mouth and eye |
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What does Bollous Pemphigoid look like?
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subepidermal, large, pruritic
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What age group is commonly afflicted with bollous pemphigoid?
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65-75 yo
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What do the IF and biopsy look like for bollous pemphigoid?
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attacks basement membrane (BPAg-1 and 2), cell rich biopsy with subepidermal blister full of eosinophils
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What bollous disease is HLA-B8 positive?
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dermatitis herpetiformis
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What bollous disease is associated with gluten sensitivity?
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dermatitis herpetiformis
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What symmetrical bollous disease is very very prurutic and has IgA in skin to tissue transglutaminase and endomysium?
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dermatitis herpetiformis
granular lesions with PMN's responding to IgA |
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What symmetrical pruritic bollous disease is associated with with lymphoma and thyroid disease?
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dermatitis herpetiformis
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What disease has epidermal and or dermal necrosis, subepidermal blister beneith basal lamina), and inflammation only when lesions are older?
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Epidermolysis Bullosa Acquisita
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What bollous disease is due to antibodies to the basement membrane? Specifically type VII collagen on the dermal side?
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Epidermolysis Bullosa Acquisita
This causes necrosis of the dermis and epidermis and is associated with IBD |
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What bollous disease is associated with milling, hirsutism, and vesicles/scaring in sun exposed areas?
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Porphyria Cutanea Tarda
Remember, this is going to be associated with Hep C or alcoholism because porphyria proteins are made in the liver. |
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What is a nevi and from where is it derived?
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benign mole of melanocytes
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Where is a junctional nevi located? Examples include: Halo, Becker
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In the lower epidermis where melanocytes are normally located.
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From where is a nevus derived?
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Melanocyte derived cells
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Where is a compound nevi located?
Example includes: Spitz |
Elevation and pigmentation from the dermal side of the epidermal junction
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Where is a Dermal Nevi located?
An example is a blue nevi. |
Dermas
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What is a Spitz nevi?
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compound, pink, potentially warty, hairless nevi usually found in kids
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What is the histologic finding of a Spitz Nevi?
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very malignant looking with pleomorphic, spindle-fusiform or polygonal-epitheliod shaped cells raining into dermis
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What is the treatment for a Spitz Nevi?
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remove
They appear suddenly and need to be removed suddenly |
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Becker nevi are almost the opposite of Spitz Nevi. What are they?
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usually found on the chest/back/shoulders of grown men, with hair coming from them, junctional,
no malignancy association |
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Which of these nevi are associated with malignancy: spitz, blue, Becker, halo, and Nevus Spilus?
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Spits is highly associated
Blue occasionally Halo is associated with melanoma elsewhere. |
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What are Blue Nevi?
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dermal nevi found more often in women. Darkly pigmented and really little (<.5 cm).
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What are the histological findings of a Blue Nevi?
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Histology – epi undisturbed, brown symmetric spindle cell proliferation in the dermal zone, deep infiltrate of melanocytes in a 5ml nodule
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A women presents with a blue nevi. What changes on PE would indicate malignancy?
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ulceration of the epidermis (usually undisturbed)
sudden changes |
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What histological findings would you expect to find on an ulcerated blue nevi?
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mitotic figures, pleomorphism, clusters of malignant cells into deep dermis and fat
normal has undisturbed epi, brown symmetric spindle cell proliferation in the dermal zone |
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Where would you usually find a nevus spilus and what would it look like?
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tan with darker spots on it.
usually on lower extremity or trunk almost 2% of the population has these. |
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What nevi has a speckled appearance?
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Nevus spilus
no association with melanoma |
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Which of the following are often found in children? halo, Beckers, Nevus Spilus, Spitz, blue
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halo
blue spitz |
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Which of the following is more common in women? halo, spitz, blue, nevus spilus, Becke'rs
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blue
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Which of the following is more common in men? Blue, Becker's, Nevus spilus, spitz, halo
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Becker's
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Congenital (of different sizes), giant hairy, and atypical melanocytic (dysplastic) nevi are pre-malignant. Which usually involves the axial region? Which involves the trunk? how are these different from Nevus Spilus, which is often found on the trunk too?
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Giant hairy often involve the axial region.
dysplastic/atypcial melanocytic nevi usually involve the trunk Nevus Spilus is brown with darker spots. Atypical nevi have color change throughout, are large, and irregular. They are autosomal dominant. |
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What are the histological findings of a atypical melanocytic/dysplastic nevi?
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basilar melanocytic hyperplasia with elongated bridged rete-ridges, fibroplagia, sparse lymphocytes
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What is the presentation of a Café au-lait lesions?
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non-uniform, light brown, well circumscribed, macule, onset in childhood
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How is a Café au-lait lesion different from a nevi?
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Nevus spilus has dark macules on it but is also found in childhood
Becker's nevus has hair and is found in adult men spitz nevi are pinkish, warty or just domed, and appear suddenly Blue Nevi are often in kids too but very dark congenital nevi are irregular and present at birth like Café au-lait lesions but not macular and irregular in color throughout |
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What does a Café au-lait lesion look like on histology?
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macromelanosomes
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What is a Ephilide?
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a freckle is a normal number of melanocytes hyperpigmenting a spot of skin when exposed to the sun
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What is hyperpigmentation with a normal number of melanocytes?
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Ephilide
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What is Seborrheic keratosis?
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well demarcated, dark, waxy, epidermal lesion with a stuck-on look, with papule cyst
middle age or later |
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When in life does seborrheic keratosis appear?
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middle age or later
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What lesion is a dark epidermal papule with a cyst and has a stuck on look?
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Seborrheic keratosis
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The following are all present at either birth or appear during childhood. Differentiate lentigo simplex, mongolian lesions, ephilides, and Café au-lait lesions.
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lentigo simplex - onset at birth or in childhood, well demarcated, dark, round lesions anywhere on body (more melanocytes and melanin)
mongolian lesions are melanocytes that never made it to the surface. they are steel-blue and usually on the spine or lumbo-sacral region ephildes appear with sun exposure (normal number of melanocytes just excessive melanin) Café au-lait lesions are non-uniform, but well circumscribed light brown macules. (macromelanosomes) |
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Differentiate lentigo simplex from solar lentigo.
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lentigo simplex is apparent at birth, anywhere on the body and well defined.
Solar lentigo appear with age in sun exposed areas and are poorly defined. |
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What might solar lentigo transform to become?
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lentigo meligna and 30% to lentigo meligna melanoma
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What cancers are associated with CDKN2A?
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pancreatic and familial atypical multiple mole melanoma
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What percentage of patients have at least 1 dysplastic nevus (atypical melanocytic nevus)?
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5-20%
irregular, color varies throughout, large diamerter macule, often on trunk |
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What are the criteria for familial atypical multiple mole melanmoa?
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fmhx
>50 melanocytic nevi (some AN) MND on histology |
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What is the diagnosis if you biopsy a growth and see elongated bridging rete ridges, lymphocytes, nests of spindle or epitheliod melanocytes arranged horizontally, lamellar and concentric dermal infiltrate
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Atypical Melanocytic Nevi
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What is the protocol for treating atypical nevi?
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+ personal or fmhx examine every 3-6 months
excise challenging nevi photogrphs, self monitoring, protection from sun |
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What percentage of melanomas come from novi?
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50%
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What melanoma is associated with sun exposure?
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Lentigo maligna or lentigo meligna melanoma
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What is the most common melanoma?
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Superficially Spreading Melanoma
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What did Bob Marley die from?
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Superficially Spreading Melanoma
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What melanoma is found commonly on the nail beds, feet, or palms?
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Acral-lentiginous Melanoma
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Which of these are flat? Superficial Spreading, Lentigo Maligna, nodular, and acral-lentiginous melanoma.
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Superficial spreading, Lentigo Maligna, and acral-lentiginous are all flat lesons.
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What are the 4 most common melanomas?
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Supficially spreading, Lentigo maligna, acral-lentiginous, nodular
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UVA is responsible for?
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aging appearance
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UVB is responsible for?
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for burning, tan, and inflammation
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If a lesion is <1, <4, or >4 mm thick and suspected of being a melanoma, how much margin do you take?
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<1 take 1cm margins
<4 mm take <2 cm >4 mm take 2-3 cm |
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Sunscreen that blocks UVA and B
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Ultrashear touch by Nutragena
zink oxide and titanium |
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onycholysis is?
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separation from nail bed
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causes of vitiligo
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depigmentation of the skin is cause by the death of melanocytes for 1 of 3 reasons: toxic metabolites of melanocytes, neurohumeral, and the most common reason, autoimmune
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With what systemic problems are vitiligo associated?
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B12/folate deficiency, Addisons(adrenal insufficiency), thyroid autimmune, T cell leukemia
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What is the histologic finding of lentigo?
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thin epidermis, elongated and club shaped rete ridges lined with increased melanocyte numbers, increased melanine, and increased dermal melanophages
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What are the histological findings of a dysplastic nevus?
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atypical hyperplastic melanocytes (spindle or epitheliod shaped and horizontally arranged in nests) with atypical architecture (bridged rete ridges), lamellar and concentric superficial dermal infiltrate, fibroplagia, sparse lymphocytes
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acanthosis
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epidermal hyperplagia
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papillomatosis
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hyperplagia with widening and lengthening of dermal papilla
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4 squamous cell lesion stages
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actinic change --> actinic keratosis --> squamous cell CA in situ --> invasive
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describe actinic change histology
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parakeratosis
jumbling atypia of at least basal layer (can be full thickness) |
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What is Bowen's disease?
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squamous cell Ca in Situ (full thickness atypia)
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What are the histological findings of invasive SSCa?
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cell bridging
keratin pearls invasion |
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What disease is identified by buttresses?
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keratoacanthoma
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what are the histological findings in keratoacanthoma?
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SCCa with a better clinical outcome
well-differentiated SCCa but within the center of buttresses of a cup shaped lesions |
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What papule does this describe?
Well differentiated SCCa with features consistent with... |
keratoacanthoma
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what lesions have stinky cheesy discharge?
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either pilar (debris is eosinophilic and calcified) or keratinous (debris is deratin) epidermal inclusion cysts
epidermal |
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what is acrochordon?
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skin tag
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what virus causes verrica vulgaris/warts?
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HPV
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Describe the histology of verruca
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papilloma on fan-shaped base
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what is poikiloderma
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patches of different colored skin associated with sun damaged skin
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With what is parakeratosis associated?
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actinic keratosis in the progression of SCCa
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What is acrochordon?
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papillary folds of epidermis with soft vascular center...skin tag
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what lesion has red/salmon base, scales, Auspitz's sign, and Koebner phenomena?
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psoriasis
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What disease is associated with nail changes,uniform rete elongation, stratum corneum microabscesses, and T cell infiltration?
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psoriasis
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What are the histologic findings of lichen planus?
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activated T-cell hugs DE junction (same way lichen hugs rock), Civatte bodies (apoptitic keratinocytes) at DE junction, sawtoothing of rete; must match clinical features
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What disease does the following describe? activated T-cell hugs DE junction (same way lichen hugs rock), Civatte bodies (apoptitic keratinocytes) at DE junction, sawtoothing of rete
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lichen planus
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Pautrier microabscesses are found in what disease?
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mycoises fungoides (T cell lymphoma)
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Monroe microabscesses are associated with what disease?
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psoriasis (T cells infiltrate --> cytokine release causes damage --> rete elongate --> Monroe microabscesses)
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What is the name?
lots of dermal edema, epidermal increase IgE and eosinophils → spongiosis (acute inflammatory rxn causes separation of ED junction keratinocytes) |
contact dermatitis
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What disease is associated with spaghetti and meatballs on histology?
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tinea versicolor is caused by yeast m. furfur
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what disease is associated with tombstoning of the basal layer/basement membrane on histo and fishnetting on IF?
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Pemphigus vulgaris
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What disease is associated wtih the following?
subepidermal bulla with intact roof, edematous papillae often jet into bulla, eosinophils in superficial dermis and bulla (therefore cell rich bulla), IF = linear IgG deposits |
bullous pemphigoid
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What is the disease associated with granular lesions (fibrin and PMN's responding to IgA action) at the tips of dermal papillae?
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herpetic dermatitis
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what disease of young (20-40 yo people) causes very pruritic symmetrical excoriated subepidermal papules/lesions? Hint: ciliac dz association
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dermatitis herpatiformis
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What causes a filliform (papilloma on fan shaped base)?
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HPV in warts verruca
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what is a pygenic granuloma?
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fast growing lump
collarette surrounding small benign vascular channels |
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what is a dermatofibroma?
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pink/tan dermal bump that dimples when pressed (unlike melanoma)
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what are the histological findings of a dermatofibroma (pink/tan dermal bump that dimples when pressed (unlike melanoma))?
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dermal collagen every which way with long deep rete ridges and sometimes hyperpigmentation
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these drugs might cause what reaction?
sulfonamides, penicillin, barbiturates, salicylates, hydantoins, and antimalarials |
target lesion of erythema multiform
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what is erythema multiform
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self-limiting reaction, target lesion with central necrosis due to edema and lymphocytes at the DE jxn
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Discoid, Subacute cutaneous, and systemic are subtypes of what disease?
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Lupus erathematous
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Patient presents with anemia, leukopenia, and elevated ESR. The patient also has sharply demarcate scaly plaques with telangiectasias that heal with scarring. On histology the lesion has spongiosis, IgG banding at DE juncti, epidermal atrophy, and follicular plugging. What do they have?
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Discoid lupus erathematous-DLE
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Patient presents with sun exposed areas, polycyclic, erythemetous, scaly, atrophy, annular dyspigmentation → heals with scars and deformity. The patient has systemic signs such as ANA, ESR, leukopenia, and anemia too. On histologic examination you see spongiosis. On IF you see banding at the DE junction. There is epidermal atrophy and follicular plugging. What does this patient have?
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Subacute cutaneous lupus erathematous
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Patient presents with malar rash, discoid rash, photosensitivity, oral ulcers, +ANA, serositis (inflammation of pericardium, plura, or peritoneum). What other symptoms might the patient have if they have SLE?
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kidney problems, arthritis, seizures or psychosis, hemolytic anemia with reticulocytosis, leucopenia, lymphopenia, thrombocytopenia, immunologic disorder (ds-DNA - anti-DNA, anti-Sm, antiphospholipid ab),
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What is the name of the disease that causes vascular insufficiency to the fingers in cold or stressful situations?
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Raynaud's phenomena
If idiopathic it is raynauds dz |
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>50% of patients with Raynaud's phenomena also have what disease?
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Scleroderma
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What is the presentation of scleroderma?
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raynauds, renal fibrosis, esophogeal dysmotility, and cutaneous findings
en coupe de sabre poikiloderma acrosclerosis and a hard, white, atrophic scar |
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What is heliotrope?
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(violacious discoloration round eyes
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What is en coupe de sabre?
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big atrophic line down the middle of the forehead
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what is poikiloderma?
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telangectasias
atrophic scar dyspigmentation |
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What is the cause of scleroderma?
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anti-dsDNA (anti-Scl or anti-centromere) or over production of collagen
otherwise cause is u/k |
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What disease may this patient have?
heliotrope, gottrons papules, raynauds, telangiectasia, poikiloderma, proximal muscle weakness, associated with malignancy 10-50% of the time (often lymphoma). You run an EMG, blood work for muscle enzymes, and an MRI etc for malignancy. |
dermatomyositis
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Raynauds is associated with ...?
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CT disease, dermatomyositis, and scleroderma
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What is calcinosis?
In what diseases is it found? |
the deposit of calcium in soft tissue. More often in kids.
found in dermatomyositis |
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Sarcoidosis is usually found where in the body?
Advanced/worse cases will have granulomas elsewhere. |
lungs
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What disease of either 25 or 50 y-o black women has Erythema nodosum, arthritis, potato nodes in lungs, fatigue, fever?
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Lofgren’s syndrome-early sarcoidosis
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What granulomatous disease is associated with remissions?
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sarcoidosis and Lofgren's syndrome
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What are the signs and symptoms of sarcoidosis
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granulomas, lupus pernio, and Lofgren's syndrome (EN, arthritis, fever, fatigue, potato nodes in lungs)
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what is lupus pernio?
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violacious plaques of face
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A 25 year old black woman presents with arthritis, tiredness, lupus pernio, granulomas, potato nodes in the lungs, and fever. You suspect she has sarcoidosis. What tests will you run?
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high Calcium, ACE, hyperglobulinemia
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Autosomal dominant casued epidermal cysts, osteomas, lipomas, fibromas → malignancy high, GI polyps → death by age 50. What disease is this?
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Gardner's syndrome
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Describe Gardner's syndrome.
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autosomal dominant fibromas, lipomas, and epidermal cysts, GI polyps and malignancy that leads to death by age 50.
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What do Gardner's, Peutz-Jegher’s, Muir-Torre Syndrome, Lesser-Trelat,
and Osler-Weber-Rendu Syndromes have in common? |
GI polyps --> malignancy
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How is Peutz-Jegher's syndrome different from Gardner's, Muir-Torre Syndrome, Lesser-Trelat, and Osler-Weber-Rendu syndrome?
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perioral melanotic freckles
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what diseases are associated with perioral melanotic freckles?
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Peutz-Jegher’s syndrome and GI malignancy
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What skin presenting disease is associated with AV malformations, telangectasias, and bleeds?
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Osler-Weber-Rendu
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5% of the time Inflammatory Bowel syndrome is associated with what skin presentations?
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EN or pyoderma gangrenosum
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multiple keratoacanthomas are associated with what syndrome?
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Muir-Torre
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Match the unique quality with the syndrome:
keratocanthomas perioral melanocyte freckles AV malformations increased # seborrheic keratosis’s lipomas/fibromas Lesser Trelat Gardner's Osler-Weber-Rendu Muir-Torre Peutz-Jegher |
keratocanthomas - Muir-Torre
perioral melanocyte freckles - Peutz-Jegher AV malformations - Osler-Weber-Rendu increased # seborrheic keratosis’s - Lesser Trelat lipomas/fibromas - Gardners |
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What can cause anemia and millia, vesicles/bullae of sun exposed area’s, facial hyperkeratosis?
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Hep C or alcoholism causing porphoria's
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What is trichodiscoma?
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a tumor of the hair disc
Found in Birt-Hogg-Dube along with fibrofolliculomas and acrochordons |
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What is an acrochordon?
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skin tag
excessive numbers are associated with Birt-Hogg-Dube allong with fibrofolliculomas and trichodiscoma. |
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Numerous firm fleshy nodules/papules of head, neck, trunk and many acrochordons might lead you to look for Ca where?
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kidney
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Which are more potent? Class I or VII steroids?
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I
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Herald patches are associated with what disease?
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Pityariasis Rosea
pink/salmon colored, oval, crinkled epithelium, collarette scale, + pruritic, plaques (if patches they are called Herald patches) in 15-25 y-o women 2.pathology – mild perivascular lymphocytic infiltration, RBC’s migrate all the way to the epidermis → disturbance causes acanthosis (epidermal hyperplasia) and parakeratosis (retention of nuclei in stratum corneum) 3.cause – probably viral |
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What disease has pink oval crinkled patches/plaques of acantholosis and parakeratosis in young women?
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These are herald patches found in pityariasis Rosea
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What disease is described as having a mycocious T cell mediated scale and pencil-in-cup arthritis on x-ray?
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psoriasis
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lichen planus can be in the mouth, what do the lesions look like?
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symmetrical puzzling, persistent, papules, purple, polygonal, >>>pruritic, peripheral/penis/plantar; self-limiting
T cell mediated eruption at the DE junction, Civatte bodies, and sawtoothed rette |
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What disease may be in the mouth or anywhere and is described by this histology? T cell mediated eruption at the DE junction, Civatte bodies, and sawtoothed rette
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lichen planus
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Pityriasis Rubra Pilaris is treated with what medicine?
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retinol
It is due to a retinol binding protein deficiency descends, follicular papules on red base especially on fingers (involves nail bed), may coalesce to a red-orange plaque, orange waxy keratoderma on palms |
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describe the difference between pityriasis Rubra and Rosea.
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rubra descends and can get waxy orange keratoderma on hands or if it patches up.
Rosea is a crankled salmon oval scaley lesion of young women |
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What IgA mediated bullous lesion ruptures easily in middle aged women and leaves a scar?
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Cicatricial pemphigoid
versus bollous pemphigoid with an intact bullous on an uticarial base |
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What pruritic bullous is intact on a uticarial base?
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bullous pemphigoid
versus cicatricial pemphigoid which is IgA usually in the mucosa, and ruptures |
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The time span of contact dermatitis presentation is...
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weapy and slightly scaly, crusted
scaly and disfiguring with a little weaping and crusting scaly |
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dyshidriasis is
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really pruritic and vescicular eczema
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describe psoriasis on histology
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T cell infiltrate → uniform rete elongation → hyperplasia with stratum corneum micro abscesses (Monroe microabscesses)
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describe psoriasis on PE
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pitting nails, lesions with white scales on knees/elbows, head, groin Auspitz’ sign
Koebner phenomena |
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What disease has a nutmeg grinder look, salmon coloration, and descends?
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Pityriasis rubra
Vit A metab deficiency |
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What is the cause of neutrophils at the horn of the dermal papillae
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Herpies Zoster
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what are the 4 different types of onchymycosis?
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Proximal can indicate HIV
Distal and lateral subungal is most common Superficial white can occur Mucocutaneous candidal disease |
