Path Spring 13 Skin Ii

Front 1

whats ichthyosis

Back 1

its when you cant desquamate so keratin build up and you get scale like lesions

Front 2

what is the epidermal thickineing that looks like fish scales called

Back 2

ichthyosis

Front 3

how is ichthyosis vulgaris inherited

Back 3

AD

**scales on skin bc of defective profilaggrin synthesis. this is the most common form of ichthyosis

**poor desquamation

Front 4

cause and course of urticaria, wahts the macro morphology

Back 4

Cause: type I HS rxn --> mast cell degranulation. can be IgE dependent or independent. IgE independent is when mast cells are degranulated by drugs. Hereditary angioedema will cause urticaria bc there is a deficit in the C1 inhibitor

Clinical: wheels (dermal edema),

Front 5

what is eczema? what are the types

Back 5

red, papulovesicular oozing, crust.

**THE itch that rashes. things that itch and then --> eczema

Types:
allergic contact dermatitis, atopic dermatitis, primary irritant

Front 6

whats the itch that rashes

Back 6

eczema- its red papulovesicular, it crusts over and is all nasty

many types:
1. allergic contact dermatitis
2. atopic dermatitis
3. primary irritant

Front 7

the types of eczema are:

Back 7

1. Allergic contact dermatitis:
2. Atopic dermatitis: drug related, AG or haptens
3. Primary irritiant

Front 8

atopic dermatitis is often seen with what 2 other things

Back 8

1. eczema
2. asthma
3. atopy- atopic dermatitic

Front 9

what is the micro and macro of poision ivy. this skin lesion is classified as what

Back 9

Macro: linerar vesicles, if infected with stapf crust is yellow

Front 10

whats the pathogenesis of an allergic contact dermatitis

Back 10

its a type 4 HS reaction, like poision ivy

1. langerhan present AG and make IL1 to stim lymph proliforation

2. memory T release cytokines and recruit inflammatory cells. this is the spongiotic (epidermal edema) phase

Front 11

whats spongiosis

Back 11

its the epidermal edema seen in allergic atopic dermatitis

Front 12

erythema multiforme

Back 12

CLA + CT8 T mediated apoptosis of basal cells makes the lesions that are symettrical and have central necrosis

Front 13

what has targetoid lesions, and how do the lesions present

Back 13

its a macule/papule that has central necrosis

symmetrical involvement

**CLA+ CD8 cells mediate apoptosis of the basal cells

Front 14

erythema miltiforme is what? whats it associated with

Back 14

self limited, HS reactions

associated with:
infection, drugs (drugs can be SJS)
HSV
cocci
mycoplasma

Front 15

your pt has symmetrical red lesions on the hands, feet etc etc. whats the deal. some you notice have a central clearing. what is this associate with

Back 15

erythema multiforme

*drugs, infection, HSV, cocci, mycoplasma

Front 16

55 yo male with painful rash on palms of both hands, spread symmetrically over body. Rash is red with scattered bullea. 10 day hx of cough/fever. Mycoplasma pneumonia was ID and AB were started. Rash responded to corticosteroids. what what the rash

Back 16

erythema multiforme- associated with infections like cocci.

Front 17

what are 2 severe forms of erythema multiforme

Back 17

SJS- steven johnson syndrome. drug association and seen in mucosa- continium, hard to draw the line
toxic epidermal necrolysis

Front 18

there is a targetoid symmetrical lesion of CLA+ CD8 cells. its seen in the mucosa and appeared after used a sulfa drug. whats the deal

Back 18

its SJS, this is a continum of erythrma nodosum*

*can be mucosa anywhere (vagina)
*skin sloughs off (can be esophagous that then the slough settles in teh lungs)

Front 19

profilaggrin synthesis defect is seen in what disease

Back 19

ichthyosis vulgaris

Front 20

if you see a spongiotic vesicle at micro, what dsiease

Back 20

eczema

Front 21

tell me about steven joshnson

Back 21

1. severe form of erythema multiforme seen in ppls mucosa adn skin after using a drug (carbamazapine)

2/ the lesions then slough off

3. common to see fever and systemic sx

Front 22

whats toxic epidermal necrosis/necrolysis

Back 22

1. severe form of erythema multiforme
2. seen after drugs like SJS.
3. this one is clinically simliar to a burn bc as the name implies there is HUGE amts of sloughing

Front 23

the 3 chronic inflammatory derm diseases are...

Back 23

1/ psorisasis
2. seborrheic dermatitis
3. lichen planus

Front 24

what does psoriasis look like micro and macro

whats the pathogenesis

Back 24

Macro: large pink plaques with silver scale that bleed when picked off- auspitz sign. lesions develop at places of truama (koebner phenomenon)

Micro: munro microabcess, thin stratum granulosum with parakeratotic scale

Pathogenesis: T cell response to AG in HLA predisposed ppl. TNFa and other cytokines stim keratinocyte proliformation, inflammation, adn angiogenesis

Front 25

what is psoriasis associated with

Back 25

nail lesions- discoloration, pitthin, oncholysis

psoriatic arthritis

increased cardiovascular disease risk

Front 26

whats aupitz sign
what is the growth distribution of this lesion

Back 26

its associated with psoriasis- when plaque is picked it bleeds

psoriasis grows at sites of truama- koebner (same distribution as vitelligo)

Front 27

what disease is associated with this pathogensis

T cells respond to AG
TNFa and other cytokines stim keratinocyte proliforation, inflammation, and angiogenesis

Back 27

psoriasis

hone in on the angiogenesis, recall the auptzis sign-- bleed when picked

Front 28

munros microabcess and thin stratum granulosum is seen in what disease

Back 28

psoriasis, this is the micro

Front 29

whats seborrheic dermatitis
whats hte cause

Back 29

dandruff, cradle cap
malassezia furfur

Front 30

lichen planus

morph

pathogenesis

clinical

Back 30

the P's
purple, puritic, polygonal, planar, palpule.
Micro: interface dermatitis angulated saw tooth dermoepidermal junction with civatte bodies which are necrotic basal bodies

path: self limited, cell mediated HS rxn

clinical: itchy, purple papule with white streak- wickmans striae

Front 31

so psoriasisi is a pink plaque with a silver scale

wht is a purple lesion with a white streak, what is the white streak called

Back 31

lichen planus- wickmans striae

like psoriasis lichen planus exhibits koebner phenomoino

Front 32

civatte bodies are what, what disease are they seen with, what other micro of this disease

Back 32

lichen planus

civatte body- necrotic basal body

interface dermatitis- angulated saw tooth

Front 33

what is pemphigus vulgaris

Back 33

PV- its when you have type II HS reaction where IgG AB attack desmosomes, cells cant hold together so you get flaccid bullea. this can lead to life threatening fluid loss

Micro shows acantholytic fishnet
suprabasal lesion

Front 34

when is there an acantholytic IgG + fishnet on immunoflourscence

Back 34

pemphigous vulgaris

**most common there is IgG that attacks desmoglian, this holds cells together so the bullea are flaccid. life threatening fluid loss

suprabasal lesion

Front 35

what disease:

there is a type II HS reaction where IgG attacks desmoglian, cells can no longer hold together and there are flaccid bullea. There is an acantholytic fishnet like pattern to the IgG when seen on immuno. The condition can be life threatening bc of fluid loss

Back 35

pehphigous vulgaris- common

suprabasal lesion

Front 36

what is bullous pemphigoid

Back 36

its an autoimmune type II HS reaction against BM. The bullea can move bc BM isnt in tact- tense bullea. Heals w/o scar. Its a subepidermal lesion that stains IgG on the BM lamina lucida on immuno

Front 37

what is the bullous lesion that heals w/o scars and leaves a linear immuno stain?

whats the pathogenesisi

Back 37

bullous pemphigoid

its BPAG that is attacked by AB on the BM. see tense bullea. See subepidermal lesion

Front 38

tense bullea are seen...

flaccid bullea are seen...

Back 38

tenst- bulleous pemphigoid

flaccid- pemphigoid vulgaris

Front 39

what is dermatitis herpetiformis

Back 39

its a type II HS reaction against reticulin and gluten. you get IgA abcesses in the tips papillea. The lesions are in small clusters adn are itchy. seen in celiacs

Front 40

whats the skin lesion that responds to gluten and is common in celiac

Back 40

dermatitis herpetiformis, its an IgA microabcess. small clusters. AB against reticulin and gluten. PURITIC

Front 41

what is teh IgA mediated microabcess forming lesion in the tips papilla. Vesicles are in small clusters and are super itchy!! Its AB agaisnt gluten and reticulin so is commonly associated with celiacs disease

Back 41

DERMATITIS HERPETIFORMIS

lesions seen on back of arms, back, butt, thighs, and knees. CLUSTERS

Front 42

what is the non immune blister that is seen at birth

Back 42

epidermolysis bullosa

Front 43

what is the most serious form of epidermolysis bullosa (the non immune mediated herditary bulla seen at birth)

Back 43

dystrophic type

**its abnormal collagen VII, this is seen everywhere. this type scars

the other 2 types (EB simplex, and junctional EB) dont scar

Front 44

whats acne vulgaris

pathogensis and lesions

Back 44

inflamm, hormone variation and hair follicle maturation. its hormonally induced sebum excess and cornification of hair follicle

proprinibacterium acnes anerobically proliforates in the follcile and release FFA --> inflammation

**the inflammatory type can have such big lesions/nodules it erodes bone

Front 45

what disease in older adults resembles acne

Back 45

rosacea

get red face with sun, hot foods, etoh, and a big nose

Front 46

rhinophyma is what, what is it seen in

Back 46

large nose, seen in rosacea, adn in EtOH

Front 47

erythema nodosum

Back 47

its a type of panniculiits, inflammation of the subcu fat. most common type

self limited, immune mediated HS reaction. involved legs. tender nodules

NODOSUM
NO known cause
Drugs
Organisms (strep, TB, cocci)
Sarcoidosis
Ulcerative colitis/chrons
Malignancy

Front 48

tender nodules on the legs caused by strep, cocci, TB, drugs, sarcoid, UC, malignancy is called what, what is the pathogensis

Back 48

erythema nodosum

**self limited, immune mediated, seen in legs

Front 49

Patient with fever and skin nodules
• 26 y/o male African American high school
teacher c/o fever up to 38.9oC (102oF), myalgia
and painful, raised erythematous nodules on
his legs for 10 days. He has a dry cough, mild
exertional dyspnea and has lost 4 pounds.
• Does not drink, smoke, use drugs or take
medications. Stable relationship with one
sexual partner for 8 years. He has not traveled
outside of the US.
• Physical exam: erythema nodosum of legs
Serum angiotensin converting enzyme:
132 u/l (reference range >20 y/o: 6.1‐21.1)
• Interpretation: Increased ACE levels are seen
in patient with active sarcoidosis, systemic
amyloidosis, histoplasmosis, Gaucher’s dis., leprosy
• Mediastinoscopy with biopsy demonstrated
noncaseating granulomas. No microbes were
 isolated on TB and fungal cultures
 Dx?

Back 49

sarcoidosis, potato nodes

Front 50

we know erythema nodosum is a common form of panniculitis, what is erythema induratum

Back 50

uncommon form of panniculitis that involves dermal BV

Front 51

micro of verrucae

Back 51

koilocytes with bumpy hyperkeratosis

benign papilloma with vacuolated cells in granular layer (koilocytes) and prominent cytoplasmic keratohyaline granules