Pathology - Integumentary Diseases 2

Front 1

Human Papilloma Virus Infection
(Warts)

Back 1

Epi: 1/10 mostly in children and whites
Eti: Papoviridae virus
RF: Positive FMHx, Direct contact with infected person, Raw meat handling, Immunodeficiency
Path: Infection of squamous epithelial cells of the skin and mucous membranes causing cells to multiply and form hyperkeratic papule
Sx: Distribution is usually on the hands, fingers, palms, and soles. Well demarcated, rough, hard nodules with an irregular surface
Px: Resolution by cell-mediated immunity
Tx:
Notes:

Front 2

Molluscum Contagiosum

Back 2

Epi: General population- 1/100, HIV population- 1/5
Eti: Poxviridae virus
RF: Contact with infected person, Atopic Dermatitis
Path: Viral infection of epidermal cells leading to squamous cells proliferation
Sx: Face, Trunk, Extremities, Genitals, Lesion is pearly flesh colored surface vesicle with umbilication at center
Px: Progressive spread due to autoinnoculation, spontaneous resolution
Tx:
Notes:

Front 3

Impetigo

Back 3

Epi: usually younger children
Eti: Staph aureus or Strep pyogenes
RF:
Path: Infection gets in through skin disruption, satellite lesions develop from contiguous spread
Sx: Erythematous erosion manifesting an adherent yellow-orange crust
Px: Majority of patients resolve spontaneously in weeks
Tx:
Notes: Many types- Bullous, Non-Bullous, Gladiatorum

Front 4

Bacterial Folliculitis

Back 4

Epi:
Eti:
RF:
Path: Obstruction of the orifice of a hair follicle leads to bacterial infection manifested as folliculocentric erythema and purulent drainage
Sx: Face, Buttocks, Scalp, Extremities, Lesion is a hair follicle-centered pustule with surrounding erythema
Px: usually abates w/o Rx, may progress to a larger or deeper area
Tx:
Notes: Can be caused by hot tubs and P. arugenosis

Front 5

Acute Meningococcemia

Back 5

Epi: 1/100000
Eti: Aerosal Inhalation of Gram (-) diplococcus
RF: Chronic Liver Disease, Agammaglobulinemia, IgG subclass deficiency, Asplenia, Hereditary compliment component deficiency, Acquired compliment deficiency
Path: Meningococci attach to nasopharyngeal epithelial cells w/ pili, Enter bloodstream and invade endothelial cells or cause systemic inflammatory response
Sx: Kids- Fever, Nausea, Vomiting, hemorrhagic skin rash, Adults- headache, myalgia, arthralgia, Hemorrhagic skin rash
Px: Usually fatal w/o therapy
Tx:
Note: Human respiratory tract is ONLY reservoir

Front 6

Chronic Meningococcemia

Back 6

Epi: Very uncommon, mainly in adults
Eti: Aerosal Inhalation of Gram (-) diplococcus
RF: Chronic Liver Disease, Agammaglobulinemia, IgG subclass deficiency, Asplenia, Hereditary compliment component deficiency, Acquired compliment deficiency
Path: Meningococci attach to nasopharyngeal epithelial cells w/ pili, Enter bloodstream and invade endothelial cells or cause systemic inflammatory response, Probably repeatedly gains access to bloodstream from throat
Sx: Recurrent attacks of fever, chills, hemorrhagic rash, and leukocytosis, Splenomegaly
Px: Majority resolve spontaneously, 1 in 5 get systemic infection
Tx:
Note: Human respiratory tract is ONLY reservoir

Front 7

Oral Candidiasis

Back 7

Epi:
Eti:
RF: Diabetes Mellitus, Antibiotic Rx, Immune Deficiency state
Path: Caused by immune defect or disruption of normal bacteria flora
Sx: Erythematous plaques with adherent white material located in the mouth and tongue (THRUSH)
Px:
Tx:
Note: Most common form of Candidiasis

Front 8

Candidal Vulvovaginitis

Back 8

Epi:
Eti:
RF: Pregnancy, Oral contraceptives, Diabetes, Antibiotic Rx, Immune deficiency state
Path: Caused by immune defect or disruption of normal bacteria flora
Sx: White, "cottage cheese-like" vaginal discharge or erythematous plaques with white adherent
Px:
Tx:
Note:

Front 9

Candidal Balanitis

Back 9

Epi:
Eti:
RF: Uncircumscised Penis, Diabetes, Antibiotic Rx, Immune deficiency state
Path: Caused by ummune defect or disruption of normal bacteria flora
Sx: Erythematous macules that manifest either a vesicle or a shallow erosion usually located on the glans penis
Px:
Tx:
Note:

Front 10

Acute Meningococcemia

Back 10

Epi: 1/100000
Eti: Aerosal Inhalation of Gram (-) diplococcus
RF: Chronic Liver Disease, Agammaglobulinemia, IgG subclass deficiency, Asplenia, Hereditary compliment component deficiency, Acquired compliment deficiency
Path: Meningococci attach to nasopharyngeal epithelial cells w/ pili, Enter bloodstream and invade endothelial cells or cause systemic inflammatory response
Sx: Kids- Fever, Nausea, Vomiting, hemorrhagic skin rash, Adults- headache, myalgia, arthralgia, Hemorrhagic skin rash
Px: Usually fatal w/o therapy
Tx:
Note: Human respiratory tract is ONLY reservoir

Front 11

Chronic Meningococcemia

Back 11

Epi: Very uncommon, mainly in adults
Eti: Aerosal Inhalation of Gram (-) diplococcus
RF: Chronic Liver Disease, Agammaglobulinemia, IgG subclass deficiency, Asplenia, Hereditary compliment component deficiency, Acquired compliment deficiency
Path: Meningococci attach to nasopharyngeal epithelial cells w/ pili, Enter bloodstream and invade endothelial cells or cause systemic inflammatory response, Probably repeatedly gains access to bloodstream from throat
Sx: Recurrent attacks of fever, chills, hemorrhagic rash, and leukocytosis, Splenomegaly
Px: Majority resolve spontaneously, 1 in 5 get systemic infection
Tx:
Note: Human respiratory tract is ONLY reservoir

Front 12

Candidal Balanitis

Back 12

Epi:
Eti:
RF:
Path: Caused by ummune defect or disruption of normal bacteria flora
Sx: Erythematous macules that manifest either a vesicle or a shallow erosion usually located on the glans penis
Px:
Tx:
Note:

Front 13

Cutaneous Cadidiasis

Back 13

Epi:
Eti:
RF: Obesity, Diabetes, Antibiotic Rx, Immune deficiency state
Path: Caused by Immune Deficiency state or disruption in the bacterial flora
Sx: Diffuse rash located in areas of the skin where heat, moisture, and irritation commonly occur
Px:
Tx:
Note:

Front 14

Candidal Paronychia

Back 14

Epi:
Eti:
RF: Chronic immersion in water (dishwashers, bartenders, food handlers)
Path: Caused by Immune Deficiency state or disruption in bacterial flora
Sx: Erythematous and Edematous nail fold area
Px:
Tx:
Note:

Front 15

Chronic Mucocutaneous Cadidiasis

Back 15

Epi: very rare, usually inherited, onset usually in childhood
Eti:
RF:
Path: Due to defect in cell mediated immunity
Sx: Chronic and recurrent Candidal Infections of mouth, genitals, nails and skin
Px: Immune competent- Infection stays localized, Immunodeficient- infection disseminates
Tx:
Note:

Front 16

Cutaneous Mycoses

Back 16

Eti: Direct contact from humans or animals
Path: Remained confined to keratinous zone of the skin
Sx: Tinea Capitus- Kerion is raised, edematous lesion of scalp w/ granulomatous inflammation
Tinea Barbae- Fungal infection of hair follicles
Tinea Corporis- "Ringworm", only involves glabrous skin, annular lesion
Tinea Cruris- "Jock Itch", located in groin
Tinea Pedis- dry, cracked, hyperkeratotic, vesicles,
Tinea Manus- Hand infection with manifestations like the foot
Tinea Corporis Gladiatorum- epidemics among team, direct skin to skin contact, located on extremities, annular lesion

Front 17

Scabies

Back 17

Epi: very common, affects all ages,
Eti: Sarcoptes scabei infection through direct contact
RF:
Path: Hypersensitive Rxn to burrowing of parasite in the keratinized layer of the skin
Sx: Pruritis, Linear erythematous lesion w/ inflammation
Px: Self-limiting in weeks to months
Tx:
Note:

Front 18

Chiggers

Back 18

Epi:
Eti: Trombiculidae trombicula
RF:
Path: Hypersensitivity reaction to burrowing of parasite as they feast on the lymph areas around follicles
Sx: Pruritic inflammation around the waist and sock lines
Px: Self-limiting
Tx:
Note:

Front 19

Oral Hairy Leukoplakia

Back 19

Epi: 1/3 HIV patients, increased incidence in healthy homosexual men
Eti:
RF:
Path: Unknown, majority manifest Epstein Bar virus within lesion
Sx: White plaque that usually manifests a verrucous appearance, located on tongue and buccal mucosa
Px: No risk of malignant transformation
Tx:
Note:

Front 20

Bacillary Angiomatosis

Back 20

Epi: only small minority of AIDS patients
Eti: Bartonella sp.
RF: exposures to cats
Path: Subcutaneous nodules composed of proliferating blood vessels and a/w gram (-) bacillary bacteria
Sx: Fever, Malaise, Anorexia, Cachexia, Lymphadenopathy
Px:readily responds to antibiotics, can become disseminated,
Tx:
Note: Lesion looks identical to Kaposi's Sarcoma

Front 21

Kaposi's Sarcoma

Back 21

Epi: 1/6 AIDS patients
Eti:
RF:
Path: Arises from endothelial cells and cytokines that work with HIV to induce neoplastic proliferation of endothelium
Sx: Brownish macule that gets larger and coalesce into nodules and dome-shaped tumors, ulceration may occur, located on head/neck and lower extremities
Px:
Tx:
Note:

Front 22

Xanthoma

Back 22

Epi: 1/1000
Eti:
RF: Hereditary Lipid disorder, Diabetes, Hypothyroidism, Nephrotic Syndrome
Path: Composed of Foam cells, usually a/w Systemic Hyperlipidemia
Sx: Skin manifests a discrete oval or polygonal yellow plaque, located around knees, elbows, buttocks
Px: Chronic persistent as long as lipids remain high
Tx:
Note:

Front 23

Seborrheic Keratosis

Back 23

Epi: Commonly found on elderly
Eti:
RF:
Path: Benign epithelial neoplasmic proliferation that begins as a macule and thickens to verrucous plaque
Sx: Usually located on sun-exposed area, appear "stuck on", may or may not be pigmented
Px: Remain stable after appearance for many years, possibility of SCC or BCC
Tx:
Note: Lesser-Trelat sign- Multiple eruptive SKs a/w internal malignancy

Front 24

Dysplastic Nevus

Back 24

Epi: Usually on whites, onset usually in childhood, but can develop as adults
Eti:
RF:
Path: Melanocytes present at Dermo-epidermal junction, Cytologic atypia of melanocytes with enlarged hyperchromatic nuclei, nest located within the epidermis
Sx: Pigmented macule that manifests irregular borders, irregular pigmentation, and an irregular surface, majority are >5mm
Px: Numerous dysplastic nevi is a risk for developing Melanoma
Tx:
Note:

Front 25

Actinic Keratosis

Back 25

Epi: 1/300, usually whites, usually elderly
Eti:
RF: Sun exposure
Path: Neoplastic transformation of epidermal keratinocytes into a carcinoma in situ, Epidermis demonstrates features similar to SCC
Sx: History of light skin and significant sun exposure, Usually >1cm, Flat erythematous lesion on sun-exposed areas, May be verrucous
Px: Increased incidence of transformation into a SCC
Tx:
Note:

Front 26

Basal Cell Carcinoma

Back 26

Epi: 1/300, usually whites, usually males, usually adults
Eti:
RF: Sun exposure
Path: Arises from pluripotential cells within the basal layer of the epidermis, Neoplasmic proliferation of basaloid cells in nests and nodules
Sx: Erythematous plaque or nodule that commonly grows slowly but finally manifests ulceration, Located on face, neck, other sun-exposed areas
Px: Very slow growing, Vanishingly rare metastasis
Tx:
Note: Most COMMON skin malignancy

Front 27

Cutaneous Squamous Cell Carcinoma

Back 27

Epi: 1/1000, Usually elderly, Usually male, Usually white
Eti:
RF: Sun-Exposure, Positive Hx of skin cancer, Fair skin,
Path: Arises from epidermal cells, Majority arise from precancerous lesions (Actinic Keratosis), Majority manifest a p53 mutation, Cytogenetic abnormalities are common
Sx: Erythematous plaque which usually evolves into a nodule, May also manifest a scaling keratotic plaque, Usually less than 1.5cm
Px: SCC on the lips and ears has highest risk of metastasis
Tx:
Note:

Front 28

Paget Disease of the Breast

Back 28

Epi: 1/35 females with breast carcinoma, Usually elderly female
Eti:
RF:
Path: Invading Paget cells enter along ductal epithelium to the nipple and spread to adjacent areola is induced by a mobility factor that acts through the HER2/NEU receptor
Sx: Begins as a very small plaque that progressively enlarges to involve first the nipple and subsequently the areola, Sharply demarcated eczemantoid plaque that manifests scaling and crusting, Nipple discharge, Nipple deformity
Px: 5yrs 60%
Tx:
Note: