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138 Cards in this Set
- Front
- Back
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What is a Macule?
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Flat Lesion
differs from surrounding skin by only color <5mm |
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What is a Patch?
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flat lesion
differs from surrounding skin by only color >5mm |
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What is a Papule?
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Solid, Elevated Lesion
<5mm |
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What is a Plaque?
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Elevated, Flat-Topped Lesion
>5mm |
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What is a Wheat?
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Firm, Edematous, Flat-Topped Papule or Plaque
Infiltrates Dermis w/ fluid lasting <24hrs |
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What is a Vesicle?
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Circumscribed, Elevated collection of fluid
<5mm |
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What is a Bulla?
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Circumscribed, Elevated collection of fluid
>5mm |
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Where are vesicles and bullae located?
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Intraepidermal
Subepidermal |
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What is a Pustule?
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Elevated Collection of Purulent Fluid
Varies in Size |
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What is a Nodule?
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Solid, Palpable Lesion
Located Under Epidermis |
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When might you see plaques?
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Psoriasis
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When might you see Vesicles or pustules?
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Herpes Simplex
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When might you see Bulla?
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Contact Dermatitis
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When might you see nodules?
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Neurofibromatosis
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What are all the previous terms called?
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PRIMARY Lesions
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What are all the secondary lesions?
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Scales
Crusts Excoriation Erosion Ulcers Lichenification |
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What are scales?
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Abnormal shedding or accumulations of stratum corneum
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What are Crusts?
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Dried Serum, blood, or purulent exudate on skin
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What is an Excoriation?
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Linear or Punctate Erosion of epidermis secondary to scratching
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What about Erosion?
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Focal loss of epidermis
Does not penetrate dermoepidermal junction Heals w/o scarring |
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What is an Ulcer?
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Depressed Lesion w/ focal loss of epidermis and dermis
Heals w/ scarring |
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What is a Lichenification?
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Thickened skin
Accentuated skin lines secondary to chronic rubbing |
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What is Hyperkeratosis?
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Increased thickness or hyperplasia of cornified layer
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Parakeratosis?
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hyperkeratosis w/ pyknotic nuclei retained in cornified
layer usually has decreased granular layer |
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When is parakeratosis seen?
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Rapid Cell Turnover precluding normal maturation
i.e. psoriasis |
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What is the Malpighian Layer?
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Stratum Granulosum and Spinosum
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what is hypergranulosis?
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increased number of cells in granular layer
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What is Acanthosis?
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epidermal hyperplasia (specifically in spinous layer)
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what is Papillomatosis?
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Form of acanthosis
Dilated projections above skin surface |
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What is Spongiosis?
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Edema between the spinous cells-->widened intercellular spaces
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What is Dyskeratosis?
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Premature Abnormal Keratinization of cells
Eosinophilic Cytoplasm Small, Dark Staining Nuclei |
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What is Acantholysis?
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loss of epidermal cell cohesion leads to intraepidermal clefts and vesicles
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What is Eczematous Dermatitis?
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Most common inflammatory rxn of skin w/ multiple etiologies?
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Eczematous Dermatitis
Stages/ |
Acute
Subacute Chronic |
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Eczematous Dermatitis
Clinical Characteristics? |
**Marked Pruritis**
Lesions |
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Eczematous Dermatitis
acute lesions? |
Vesicles and oozing papules
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Eczematous Dermatitis
chronic lesions? |
lichenified papules and plaques with indistinct borders
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Eczematous Dermatitis
what are 5 types? |
Allergic Contact Dermatitis
Irritant Contact Dermatitis Atopic Dermatitis Photodermatitis Drug-related Eczematous Dermatitis |
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What is the etiology of Allergic Contact Dermatitis?
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Type IV delayed hypersensitivity rxn
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Allergic Contact Dermatitis
so what does delayed hypersensitivity mean? |
It means ACD occurs in people who have been previously sensitized who are RE-EXPOSED to the Ag
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How does Irritant Contact Dermatitis differ from Allergic?
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ICD is non-allerginic w/ no prior sensitization
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What type of skin reacts least to irritants?
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Dry and Thick
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What is up with Atopic Dermatitis?
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Common, Chronic, Pruritic Disease
Personal/Family History Genetic Predisposition Presentation is age dependent |
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How does Infantile Atopic Dermatitis present?
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acute/subacute eczema
oozing/crusted papules on head, neck, extensor surfaces |
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How does older folks' Atopic Dermatitis present?
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Chronic eczema
Scaling and Lichenification in flexural areas |
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What's up with Photodermatitis?
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Eczema in sun-exposed areas
Commonly seen w/ drugs (nsaids, hctz) |
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What's up with Drug-Related Eczematous Dermatitis?
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Spongiotic Rxns coinciding with use of meds (systemic)
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How do you Dx eczematous dermatitis?
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Patch test for Allergic
Photopatch for photoallergic Punch Biopsy of lesions |
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What are the histopathological features of Acute Spongiotic Dermatitis?
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Normal Corneum
No acanthosis Epidermal Spongiosis Papillary Dermal Edema Intraepidermal vesicles secondary to spongiosis Mixed perivascular inflammatory infiltrate of lymphocytes and some eosinophils |
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Histopath of Chronic Eczematous Dermatitis?
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Hyperkeratosis
Acanthosis Mild Spongiosis (no vesicles) Infl infiltrate of lymphocytes |
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Rx of allergic/irritant contact dermatitis?
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Topical Steroids
Avoid Allergen |
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Rx for Atopic Dermatitis?
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Topical Steroids
Topical Tacrolimus Topical Pimecrolimus Sedating Antihistamines |
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Rx for Photodermatitis?
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Remove photosensitizing agent
Avoid Sunlight Topical Steroids |
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Rx for Drug-Related Dermatitis?
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Discontinue Meds
Topical Steroids |
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Difference between Acute and Chronic Urticaria?
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Acute <6 weeks
Chronic > 6 weeks |
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Most common cause of urticaria?
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Drugs: PCN, aspirin
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Pathogenesis of Urticaria?
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IgE mediated (type I rxn)
Mast Cell Degranulation-->histamine and heparin release-->inc cap perm-->fluid extravasation |
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How do you Dx urticaria?
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circle the wheals, tell them to come back
Punch Biopsy Labs |
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Histopath of Urticaria?
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May look normal
Epidermis normal Dermal Edema (collagen bundles separated by edema) Infl Infiltrate: lymphocytes, neutrophils, eosinophils |
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Rx for Urticaria?
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ID and avoid the trigger
Antihistamines |
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What is Erythema Multiforme?
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Self-limited, recurrent
Spectrum of diseases Triggered by drugs or infections or 50% idiopathic |
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Spectrum of Erythema Multiforme?
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Erythema Multiforme
Stevens-Johnson Syndrome Toxic Epidermal Necrolysis |
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As far as triggers go, who triggers each subtype?
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EM-infections (HSV, mycoplasma)
SJS/TEN- Drugs (AB's, Antiepileptics, NSAIDs) |
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What's up w/ Erythema Multiforme
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No or mild prodrome
Target or Iris Lesions Symmetric distribution on hands and feet (other areas involved too like mild oral) |
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What is up with a target/iris lesion?
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They have 3 zones:
1. central dusky purpura/vesicle 2. elevated, edematous pale ring 3. Peripheral rim of macular erythema |
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SJS and TEN
prodrome? |
Frequent Febrile Prodrome
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SJS & TEN
involvement? |
Mucous Membrane (oral, ocular, genital)
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SJS & TEN
Lesions? |
Atypical target lesion
More diffuse Become Confluent |
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SJS & TEN
controversy? |
Controversy about classification
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SJS & TEN
classification |
SJS - 10% Surface area
Overlap syndrome - 10-30% TEN >30% surface area of body` |
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Dx of Erythema Multiforme
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Punch Biopsy
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Histopath of EM/SJS/TEN
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Vacuolar Interface Pattern
Vacuolization--> subepidermal blister Infl Infiltrate at dermal-epidermal jxn Necrotic Keratinocytes start in basal layer and move up |
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What is the vacuolar interface pattern?
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damage to basal cells w/ intracytoplasmic vacuole formation
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Rx of EM?
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Usually Self-limited
Avoid meds If related to HSV...suppress it |
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Rx for SJS/TEN
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Hospitalize
Treat like burn pt Maybe Oral Steroids early IVIG for TEN |
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PSORIASIS
gender and onset |
males=females
~27 |
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PSORIASIS
what is up with Koebner's Phenomenon? |
appearance of lesions at sites of trauma
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PSORIASIS
etiology |
unknown
but T-cells and cytokines play a role |
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PSORIASIS
pathogenesis |
abnormal diff
Keratinocyte hyperprolif and infl |
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PSORIASIS
clinical course |
usually chronic
unpredictable (could just be knees and elbows...or scalp?) |
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What's up with Plaque Psoriasis?
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Well Demarcated
Erythematous Plaques + white scale Scalp, Nails, Extensor extremities, Elbows, and Knees Asymptomatic-->burning or pruritis |
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What's up with Guttate Psoriasis?
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2-5mm erythematous scaly papules
Diffuse Abrupt Onset after acute infection |
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Avg age of Guttate pts?
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<30
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Typical infection triggering Guttate?
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Streptococcal pharyngitis
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PSORIASIS
Nail findings? |
maybe initial sign for years
Pitting Oil Spots (oncholysis) Subungal debris |
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What is oncholysis?
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AKA oil spots
Separation of nail from bed |
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What do 25% of psoriasis pts also have?
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Arthritis
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What's the most common arthritis pattern seen in psoriasis?
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Asymmetric
Oligo 1+ hand joints (DIPs and PIPs) |
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Dx for Psoriasis?
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Auspitz's Sign
Punch Biopsy Antistreptolysin |
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What is Auspitz's Sign?
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pinpoint bleeding when scale forcibly removed secondary to thinning of epidermis over dermal papillae
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Which type of Psoriasis is the antistreptolysin test for?
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Guttate
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Histopath of Psoriasis?
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Hyper and para-keratosis
Munro Microabscesses Acanthosis Epidermal thinning over dermal papillae Perivascular Lymphocytic infiltrate |
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What is a Munro Microabscess?
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Neutrophils in the Stratum Corneum
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Rx for Psoriasis?
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Depends on Type
Topical (steroids) Light Therapy-uva, uvb (more diffuse cases) Oral Therapy Antibiotics (guttate) |
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Who are the new Rx's?
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"biological" therapies
-mab's -cept's |
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What are they from:
-ximab -zumab -umab -cept |
-ximab = chimeric monoclonal AB
-zumab = humanized mAB -umab = human mAB -cept = receptor-AB fusion protein |
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ETANERCEPT
binds? SE's? |
Binds TNF-alpha
SE: TB reactivation, Demyelination, Lupus-like syndrome |
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ALEFACEPT
binds? SE? |
CD2 on T's
Lymphopenia |
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EFALIZUMAB
mech SE |
Inhibits T-->Endothelial Adhesion
Thrombocytopenia Rebound Psoriasis |
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ADALIMUMAB
binds? SE? |
TNF-alpha
TB-reactivation |
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INFLIXIMAB
binds? SE? |
TNF-alpha
TB-reactivation Lupus-like syndrome |
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LICHEN PLANUS
Typical Sx's |
The 5 P's
Wickham's Striae |
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What are the 5 P's?
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Pruritic
Planar Purple Polygonal Papules |
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What is Wickham's Striae
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Lacy, reticulated pattern of criss-crossed whitish lines
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LICHEN PLANUS
Kickers |
Inc incidence in Hep C
Unpredictable Course Koebnerization 50% mucous membrane involvement Heals w/ dark hyperpigmentation |
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what is koebnerization?
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skin lesions appear in lines of trauma
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Dx of Lichen Planus?
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Clinical
skin - Punch Biopsy serum - hep panel |
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Histopath of Lichen Planus?
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Hyperkeratosis
Focal wedge-shaped hypergranulosis Saw-tooth pattern of irregular acanthosis Lichenoid Infiltrate Pigment Incontinence Civatte Bodies |
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what is Lichenoid Infiltrate?
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dense band-like dermal infiltrate
mainly lymphocytes hugging the underside of epidermis |
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how do you get Pigment Incontinence?
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Basal Cell Layer damage (vacuolization
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what are Civatte Bodies?
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necrotic keratinocytes
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Rx for Lichen Planus?
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Potent Topical Steroids
Rarely systemic steroids or other immunosuppressors Topical for oral |
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Difference between Direct and Indirect Immunofluorescence?
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Direct IF=finds Ag in skin
Indirect IF= AB's in serum |
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Pemphigus Vulgaris
General stuff to know |
Rare Autoimmune blistering disorder
Loss of Intercellular cohesion IgG directed at desmoglein Ag's Old, Jews, maybe drug induced |
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Pemphigus Vulgaris
Clinical Characteristics |
Flaccid Blisters, erosion on skin and mucous membranes
Heals w/ Hyperpigmentation, no scarring Death from sepsis 5-10% |
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Pemphigus Vulgaris
Dx Signs |
Nikolsky Sign
Asboe-Hansen Sign |
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what is Nikolsky sign?
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slight pressure or rubbing near blister causes epidermis to slough
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What is the Asboe-Hansen sign?
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Gentle pressure on intact blister forces fluid under adjacent skin
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What does a positive DIF test for Pemphigus Vulgaris look like?
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chicken wire
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Histopath of Pemphigus Vulgaris?
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Intraepidermal Blister (suprabasal with tombstoning)
Acantholysis Inflammatory Infiltrate |
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Rx for Pemphigus Vulgaris
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Immunosuppressives
High dose Prednisone |
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Bullous Pemphigoid
general characteristics |
Chronic
Autoimmune Supepidermal Blisters Older people |
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Bullous Pemphigoid
autoimmunity?? |
IgG to basement membrane Ag's (hemidesmosomal)
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Bullous Pemphigoid
Clinical Characteristics |
Large, tense bullae
Erythematous Patches Urticarial Plaques Pruritis Bullae Rupture and heal spontaneously |
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Bullous Pemphigoid
Dx |
Skin: Biopsy w/ DIF
Serum: IIF |
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DIF w/ Bullous Pemphigoid?
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Linear Staining
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Bullous Pemphigoid
Histopath? |
Subepidermal Blistering
No Acantholysis Eosinophils in infiltrate |
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Bullous Pemphigoid
Rx |
Lower dose steroids
Tetracyclines Topical corticosteroids |
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Dermatitis Herpetiformis
General stuff |
Chronic
Relapsing Severely Pruritic Blistering |
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Dermatitis Herpetiformis
gender |
males>females
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Dermatitis Herpetiformis
genetics? |
HLA B8
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Dermatitis Herpetiformis
association? |
gluten-sensitive enteropathy
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Dermatitis Herpetiformis
increased risk for? |
thyroid disorders
lymphoma (stomach/GI) |
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Dermatitis Herpetiformis
Clinical Characteristics |
Grouped, bilateral, symmetrical papulo-vesicular lesions
Erythematous base Maybe tense bullae Spontaneous remissions then new crops Hyperpigmented Scars |
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Dermatitis Herpetiformis
Dx? |
Skin Biopsy w/ DIF
Serum: IIF negative |
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Dermatitis Herpetiformis
Histopath? |
Accumulation of NEUTROPHILS, eosinophils, fibrin at tip of dermal papillae (microabscess)
-->subepidermal blister |
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Dermatitis Herpetiformis
What does DIF show? |
granular deposits of IgA at tips of dermal papillae
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Dermatitis Herpetiformis
Rx? |
Dapsone (monitor G6PD)
Gluten-free diet Sulfapyridine |
