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69 Cards in this Set

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List the 4 diseases classified under Blistering (Bullous) Diseases
1. Pemphigus Vulgaris
2. Bullous Pemphigoid
3. Dermatitis Herpetiformis
4. Epidermolysis Bullosa
Subcorneal = beneath the Stratum Corneum layer
What type of blister is this?
Suprabasal = roof & base of the blister are Keratinocytes
What type of blister is this?
Subepidermal = base is connective tissue, roof is basal layer of keratinocytes
What type of blister is this?
Define Pemphigus Vulgaris
Autoimmune bullous disease mediated by cytotoxic antibody (IgG) to Desmoglein (protein in desmosomes) that results in dyshesion
What type of blister does Pemphigus Vulgaris cause?
Intra-epidermal blister = Suprabasal
What does the DIF look like in Pemphigus Vulgaris?
lace-like pericellular IgG in epidermis
What does the DIF look like in Pemphigus Vulgaris?
lace-like pericellular IgG in epidermis
Pemphigus Vulgaris
-suprabasal acantholytic blister
What blistering disease is this?
Pemphigus Vulgaris
-IgG & complement encircling epidermal cells
What blistering disease is this from?
Pemphigus Vulgaris:
1. most common age?
2. Where do blisters commonly occur
3. Treatment?
1. 30-50 years of age
2. scalp, mucous membrane, periumbilical, intertriginous areas
3. Prednisone + Immunosuppressive agents
Define Bullous Pemphigoid
autoimmune bullous disease mediated by antibodies to 2 basement membrane glycoproteins in the Lamina Lucida (IgG ab's to hemidesmosomes)
What type of blister does Bullous Pemphigoid produce?
Epidermal-dermal interface blister = SUBEPIDERMAL
What does the DIF look like in Bullous Pemphigoid?
Linear deposition of IgG & C3 along the dermal-epidermal jxn
Bullous Pemphigoid
-subepidermal bullae
-perivascular infiltrate of
What blistering disease is this?
Bullous Pemphigoid
-linear band of complement & IgG deposition along BM
What blistering disease is this?
What are the clinical features of Bullous Pemphigoid?
MC affects men > 60 years old

Large & tense blisters

Blisters on medial thighs & flexor aspect of the forearm
A 51-year-old man presents with painful blisters over his entire body. He notes that he currently has several blisters in his mouth as well. A blister appears when you rub his skin with your finger. Skin biopsy demonstrates acantholysis.
Pemphigus Vulgaris
What type of hypersensitivity reaction are Bullous Pemphigoid & Pemphigus Vulgaris
Type II HS = Cytotoxic
What is the treatment for Bullous Pemphigoid?
Corticosteroids
Bullous Pemphigoid
What disease?
Bullous Pemphigoid
-subepidermal bullae
-perivascular infiltrate of eosinophils & lymphocytes
What blistering disease?
Blistering disease strongly associated with Gluten sensitivity (Celiac Disease) in individuals w/ HLA-B8 & HLA-DRw3
Dermatitis Herpetiformis
Blistering disease in which IgA to Gliadin cross-react or these immune complexes deposit at the tips of Dermal Papilla
Dermatitis Herpetiformis
Dermatitis Herpetiformis
-fibrin & neutrophils accumulate selectively at the tips of dermal papillae forming microabscesses
What blistering disease is this?
Dermatitis Herpetiformis
-granular deposits of IgA localized in the tips of Dermal Papillae
What blistering disease is this?
Dermatitis Herpetiformis

Celiac disease
What blistering disease? What is it associated with?
Dermatitis Herpetiformis
Intensely pruritic cutaneous eruption

Urticaria-like plaques & small vesicles over the extensor surfaces of the body
What is the treatment for Dermatitis Herpetiformis?
Gluten-free diet
What is Epidermolytic (simplex) Epidermolysis Bullosa?
Gene mutations in Keratins 5 & 14 in the basal keratinocytes
What is Junctional Epidermolysis Bullosa?
Gene mutation in Laminin in the Basement Membrane (Lamina Lucida)
What is Dermolytic (Dystrophic) Epidermolysis Bullosa due to?
Gene mutation in Collagen Type 7 (beneath the lamina densa)
Epidermolysis Bullosa
1. Where do blisters tend to form?
2. When is this disease usually noted?
1. at sites of minor trauma
2. at birth or shortly thereafter
Epidermolysis Bullosa
What is this?
This disorder of epidermal appendages is a result of phsiologic hormonal variations & alterations in hair follicle maturation
Acne vulgaris
Describe the pathogenesis of Acne Vulgaris
Bacterial lipases of Propionibacterium acnes -> liberating highly irritating fatty acids -> expanding mass of lipid & keratin within the mid portion of the hair follicle -> distended follicle = Comedone
Describe the 2 types of Acne Vulgaris
1. Noninflammatory
-Obstructive-closed comedos = whiteheads
-Open comedos = Blackheads

2. Inflammatory
-follicular rupture -> extensive acute & chronic inflammation -> scarring
Acne vulgaris
What is this?
Acne Vulgaris
What is this?
What skin disease is characterized as a Panniculitis (inflammation of subcutaneous fat)?
Erythema Nodosum
Erythema Nodosum
Self-limited, tender and erythematous nodules usually on the anterior portion of the shins
Inflammation of the fibrous septa of the subcutaneous tissue with Giant cells at the interface between the septa & adipose tissue
Erythema Nodosum
What triggers Erythema Nodosum?
Drugs or Microorganisms = exogenous agents
Erythema Nodosum
-Inflammation in the fibrous septa of the subcutaneous tissue, and giant cells at the interface between the septa and adipose tissue
What is this showing?
What is the cause of Verrucae?
Human Papilloma Virus (HPV)
What is the cause of Verruca Vulgaris?
HPV 1, 2, 3, 4
Verruca vulgaris caused by HPV 1-4
What is this?
Verruca Vulgaris
-papillomatous epidermal hyperplasia
-hyperkeratosis
-parakeratosis
-hypergranulosis
-KOILOCYTES
What is this?
Verruca vulgaris staining for HPV
What is seen here?
Flat wart on the face or dorsal surface of hands, smaller than verruca vulgaris; caused by HPV 3
Verruca Plana
Warts on the soles & palms caused by HPV 2
Verruca Plantaris & Palmaris
Venereal wart caused by HPV 6, 8, 11, 16, 18
Condylomata Acuminatum
Condylomata Acuminatum

HPV 6, 8, 11, 16, 18
What is seen here? What is the cause?
What is Condylomata Acuminatum associated with?
Dysplasia & In-situ Squamous Cell Carcinoma
What is the cause of Molluscum Contagiosum?
Poxvirus
Firm, pruritic, pink to skin-colored umbilicated papules
Molluscum Contagiosum
Molluscum Contagiosum
What is seen here?
Molluscum Contagiousum
-large, eosinophilic cytoplasmic inclusion bodies (molluscum bodies) in the cells of the Stratum Granulosum & Corneum
What is this?
Impetigo:
1. contagious or not?
2. what are most caused by?
1. highly contagious, usually in children, face, & hands
2. S. aureus & Strep pyogenes (happy kendall?)
What is the pathology of Impetigo?
Erythematous macule, multiple small pustules, pustules break -> shallow erosions -> covered with drying serum = Honey-colored crust)
What is the characteristic microscopic feature of Impetigo?
accumulation of neutrophils beneath the stratum corneum (subcorneal pustule)
What is blister formation in Impetigo related to?
a toxin that specifically cleaves the Desmoglein I
-usually due to S. aureus
Impetigo

S. pyogenes
What is seen here? What is the most common cause?
What skin layer are Superficial Fungal Infections confined to? What are they caused by?
Stratum Corneum

Dermatophytes
Superficial Fungal infections
-mild eczematous dermatitis
What is shown here?
Superficial Fungal Infections
What is seen here?
Superficial Fungal Infection
What is seen here?
Human mite that causes pruritic erythematous streaks
Scabies
Scabies
-epidermal tunnels filled with basophilic granular debris and arthropod eggs
What is seen here?