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54 Cards in this Set

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1) What are the two types of tumors of cellular migrants to the skin?

2)What are the cellular migrants in each?
1)Mycosis Fungoides & Mastocytosis

2) mycosis fungoide= cutaneous t-cell lymphoma (CTCL) typically CD4+
mastocytosis=mast cells
1) What are some epidemiological characteristics of Mycosis Fungoides?
1) onset after 40 y/o, slowly progressive, a minority have rapid systemic dissemination.
presents as side of the trunk rash
1)What are the three stages of Mycosis Fungoides?

2)What is the associated Sezary Syndrome?
1) 1-the red brown scaly patches
2-scaling plaques (psoriasis like)
3-fungating nodules (tumor stage)
2) Sezary Syndrome= leukemic presentation with diffuse erythema and scaling of entire body surface (erythroderma)
What are the histological features of Mycosis Fungoides?
T helper lymphocytes (CD4+ typically) and Pautrier's Microabcesses (aggregation of CD4+ cells that form aggregates and enter and invade the epidermis as single cell)
What are some epidemiological characteristics of Mastoctosis?
-It's a rare spectrum of disorders with increased mast cells in the skin.
-predominates in children
-uticaria pigmentosa (itching subtype) accounts for more than 50% of cases and is localized to the skin
-systemic mastocytosis accounts for 10% of cases in adults with poor prognosis
What are the signs and symptoms of mastocytosis (darier's sign? dermatographism? triggers?)?
-signs and symptoms due to release of histamine, heparin, and other mast cells contents
-produce pruritis and flushing
-produces darier's sign= a wheal from rubbing (localized edema)
-produces dermatographism= dermal edema and erythema from stroking
-may be triggered by food, medication, temperature
Describe the characteristics of ichthyosis?
-Gross appearance=prominent fishlike scales
-rare
-numerous genetic variations most common being ichtyosis vulgaris
What is the etiology of ichthyosis?
excess keratin production that is compacted and thick
What are the characteristics of uticaria?
-hives and wheal (pruritic edematous plaques)
-Caused by localized mast cell degranulation, thus IgE mediated
-common in 20-40 y/o
-variable duration from hours to months
-triggered by pollens, food, drugs, insect venom, underlying disease (lymphoma, collogen vascular diseases)
mit Kohlensäure
con gas (m)
What differentiates acute and chronic Eczemtous Dermititis?
Eczema=greek for boiling over triggered by contact antigens

Acute= red papulovesicular oozing crusted lesions plus spongiosis (epidermal edema between keratinocytes)

Chronic=evolves into raised plaques due to acanthosis and hypereratosis (thickened keratin layer)
bringen, mitbringen
traer (yo traigo)
What are some causes of erythema multiforme?

Signs/Symptoms of erythema multiforme?
-uncommon, self limiting
-hypersensitivity reaction to infections or drugs
- maybe associated with underlying neoplasia or collegen vascular disease


-Contains a multiforme array of various lesions. With a characterisitic target lesion=a red macule or papule with a pale, vesicular, or eroded center
What is Stevens-Johnson Syndrome?

What is toxic epidermal necrolysis?
=febrile form of erythema multiforme with mucosal involvement

=a form of erythema multiforme with diffuse necrosis and sloughing of cutaneous and mucosal epithelial surfaces producing a situation analagous to the situation seen with extensive burns (infection/fluid loss)
What is psoriasis and what are some etiological considerations of psoriasis?
-common chronic inflammatory dermatosis. Cytokines and gowth factors stimulate epidermal proliferation
-1-2% of US popualtion seen in all ages
-pathogenesis is multifactorial with environmental and genetic factors
-Associated with myopathy, arthritis, AIDS, spondylitis
What are the clinical features of psoriasis?
-pink to salmon colored plaques
-loosely adherent silver-white scale
-Auspitz sign=bleeding under scales
-May involve total body with erythema and scaling=erythroderma
-lesions seen commonly on elbows, knees, lumbrosacral, gluteal clefts, and glans penis
What are some histological features of psoriasis?
-suprapapillary thinning
-neutrophils in keratin,
-uniform acanthosis except above papules
-Munro's microabcess=neutrophils in parakeratotic stratum corneum.
What are some characteristics of seborrheic dermatitis?
-common chronic inflammatory dermatosis
-1-3% of population affected
-occurs in skin with prominent sebaceous glands (scalp, forehead, ear canal, nasolabial folds)
-macules/papules on ereythematous, yellow, greasy, base with scaling/crusting (dandruff)
-severe form in HIV-positive pts.
What are the 6 p's of Lichen Planus?
pruritic, purple, polygonal, planar, papules, and plaques.
What are some characteristics of Lichen Planus?
-involves skin and mucosa
-self limiting resolving in one-two years
-papular lesions may have white dots termed Wickham striae due to hypergranulosis.
-Koebner phenomena=Wickham striae on scrotum
-Pathogenesis unknown
What are some histologic features of lichen planus?
-sawtooth epidermal acanthosis with lymphocytes at interface of dermal/epidermal layers and civatte bodies (Immunoflourescent properties=light up as green circular bodies).
-hypergranulation common
1) What are the three inflammatory types of blistering (bullous disease)?

2) What are the two noninflammatory blistering (bullous) diseases?
1) Pemphius, Bullous pemphigoid, and Dermatitis Herpetiformis.

2) Epidermmolysis, Porphoria
1) What are the three histologic locations for blisters that are useful in determing diagnosis and pathogenesis? Name the associated inflammatory blistering disease associated with each layer?
-subcorneal (Pemphigus foliaceus)
-suprabasilar (pemphigus vulgaris) -subepidermal (bullous pemphigoid & dermatitis herpetiformis)
1) What are some epidemiological charactereistics of pemphigus?

2)What are some common signs/symptoms of pemphigus?
1)- rare incidence
- life threatening if untreated
-onset 4th-6th decade
-equal gender incidence

2)
-Acantholysis= dissolution of intercellular adhesion proteins that connect squamous epithelial cells
-Antibodies to intracellular attachments within epidermis and mucousa
-flaccid, fragile bulla with extensions
-60-75%oral involvement at onset. Eventual 100% oral mucosal involvement
How is pemphigus vulgaris distinguished from pemphigus follaceus using DIF (direct immunofluorescence?
vulgaris= deposition of immunoglobulin along plasma membranes of epidermal keritinocytes leading to a fishnet like pattern. (suprabasilar)

foliaceus= immunoglobulin deposits are more superficial (intraepidermal)
What are some clinical features of bullous pemphigoid?
-older patients 60+ y/o
-tense bullae filled with clear fluid and minimal extension
-2 cm bullea typically can get as big as 8 cm
-can be local, generalized
-oral involvement in 10-15% of cases (0-5% at onset)
-involves inner thighs, flexor forearm, axillae, groin, lower abdomin
-low mortality
What is the DIF (direct 1)immunofluorescence pattern in bullous pempgigoid?

2) Where is the bullaw located histologically?

3) name the protein that antibodies attack in bullous pemphigoid?
-linear deposition of immunoglobulin and complement in the basement membrane zone

2)subepidermal cleft w/eosionophilia

3) hemidesmosomes=BPAG 2
What are some characteristics of dermatitis herpetiformis?

What are the signs of Dermitis Herpediformis?
-rare disorder
-onset 3rd and 4th decade
-males more affected
-associated with intestinal celiac disease responding to gluten free diet

2) grouped extremely pruritic vesicles involving extensor surfaces, elbows, knees, upper back, and buttocks
What are the histological feature of Dermatits herpetiformis?
-micro neutrophils at tips of dermal papilla
-DIF=granular IgA depositions at dermal papilla.
What are the two noninflammatory blistering (bulla) disorders?
epidermolyisis bullosa and porphyria
What are some characteristics of epidermolysis bullosa?
-noninflammatory, subepidermal vesicles and bullae
-genetic disorder with defect in structural proteins
-tendency for blister formation increased with pressure/trauma
-muliple subtypes
-erosin in flexural junctions common
What are some characteristics on Porphoria?
-uncommon
-subepidermal blisters
-genetic or acquired disorder of porphyrin metabolism
-lesions made worse by sunlight
-multiple subtypes
-subtype prophyria tarda most common with alcoholism
-results in urticaria and vessicles that heal with scarring
-hand lesions common
What are the histologic characteristics of porphyria?
subepidermal blisters and thickened dermal blood vessels
What are the two types of epidermal appendage disorders?
Acne Vulgaris and Rosacea
1) What are teh characteristics of acne vulgaris?

2) What is the difference between open and closed comedones?
1)-common teenage disorder
-more common in males than in females
-can have genetic links

2)
open comedones=non inflammatory, small foolicular papules with a cenral black keratin plug
closed comedones= follicular papules without a visible plug because keratin is trapped beneath the surface. inflammatory.
1)What are the characteristics of rosacea?

2)What are the four stages in rosacea?
1)
-common condition 3% of middle age and beyond
-more common in females
-occurs in alcoholics

2)-flushing (pre-rosacea)
-persistent erythema/ telangiectasia
-pustules and papules
-rhinophyma(thickening nasal skin)
1)What is panniculitis?

2) What are two examples of panniculitis?
1)-inflammatory rxn in the subcutaneous adipose tissue

2) erythema nodosum & erythema induratum
What are some characteristics of erythema nodosum?
-most common
-typically pretibial
- usually an acute presentation
- triggered by infection, medication, inflammatory bowel disease, and neoplasm
-can become septic
- no ulcerations associated
What is histologically unique in panniculitis?
connective tissue septal inflammation
What are some characteristics of erythema induratum?
-uncommon
-affects adolescent and menopausal women
-Primary vasculitis affecting deep vessels supplying lobules with subsequent necrosis and inflammation
-ulceration common
What is histologically unique with erythema induratum?
-granulomatous inflammation
-caseous necrosis involving fat lobules
What are verracus?

What virus is associated with verracus?
1) warts

2) HPV
What are five types of verracus and what part of the body do they affect?
-multiple types based on location
-verruca vulgaris (anywhere)
-verruca plana (flat warts anywhere)
-verruca plantaris (foot)
-verucca palmeris (hand)
-condyloma accuminatum (venereal warts: mucosal layers of penis, vagina, anus, mouth) ask Saba she knows more about this than i do.
What are the unique histologic features of verracus?
-papillomatous epidermal hyperplasia
-prominent keratohyaline granules
-in situ hybridization shows viral DNA in epidermal cells
What virus causes molluscum contagiosum?
pox virus
What are some characterisitics of molluscum contagiosum?
-common
-self limited
-direct contact spread
-lesions are firm, umbilicated papules
What is the characteristic feature both grossly and histologically?
cupcake lesions: look like cupcakes (or mushrooms) both grossly and microscopically
-also molluscum bodies= large, ellipsoid, homogeneous, cytoplasmic incusions in cells of the stratum granulosum and corneum. bodies contain many virions.
1) what bacteria causes impetigo?

2) What are some features of impetigo?
1) staph or strep

2) highly contagious
-seen in healthy children or less frequently in sick adults
-lesion: honey colored crusted pustules.
What is the most common cause of superficial fungal infections?

Name 6 types of tinea and where they are locates?
-Tinea
-tinea capitis-scalp
-tinea barbes-beard
-tinea corporis- body
-tinea cruris- inguinal
-tinea pedis-foot(athletes foot)
-tinea versicolor-upper trunk
How is tinea confirmed as a diagnoses?

What is unique histologically about tinea vesicolor?
1)KOH prep looking for dermatophytes

2) Malassezia furfur= the fungal grow in a spaghetti and meatballs kind of pattern
What is onychomycosis?
fungal infections of the nail causing nail opacities
What is scabies cause by?
What are some features of scabies?
1) caused by the scabies mite

2) commonly found in the web spaces of the hand, armpit, feet, and penis
-the mite can be visible microscopically
1) Where does herpes simplex 1 cause infection?

2) Where does herpes simplex virus 2 cause infecion?

3) Where does varicella zoster cause infection?
1) Above the abdomien

2)below abdomen

3)anywhere with chicken pox.
dermatomes with shingles
What is the Tzanck prep used for?
The Tzanck preparation is done by smearing cells taken from a fresh blister or ulcer onto a microscope slide. The cells are stained with a special stain, such as Wright's stain, and then examined under a microscope for characteristic changes caused by herpes virus. Herpes causes giant cells (syncitial cells) with multiple nuclei. The shape of each nucleus appears molded to fit together with those adjacent. The background of the cell looks like ground glass and contains small dark spots called inclusion bodies (Cowdry Type A).