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91 Cards in this Set

  • Front
  • Back
stratum basalis contents
regenerative stem cell layer
stratum spinosum contents
desmosomes between keratinocytes
stratum granulosum contents
granules in keratinocytes
stratum corneum contents
keratin in anucleate cells
dermis contents
connective tissue, nerve endings, blood and lymphatic vessels, hair shafts, sweat glands, and sebaceous glands
atopic dermatitis clinical findings
pruritic, erythematous, oozing rash with vesicles and edema involving face and flexor surfaces
atopic dermatitis type of reaction
type I hypersensitivity reaction
atopic dermatitis associations
allergic rhinitis and asthma
contact dermatitis clinical findings
pruritic, erythematous, oozing rash with vesicles and edema

arises upon exposure to allergens
irritants see in contact dermatitis
poison ivy and nickel jewelry (type IV hypersensitivity reacion), detergents, drugs
acne vulgaris lesions
comedone, pustules, nodules (scarring)
cause of acne vulgaris
chronic inflammation of hari follicles and associated sebaceous glands
1. hormone associated increase in sebum production and excess keratin production block follicles, forming comedones
2. propionibacterium acnes infection produces lipases that break down sebum, releasing proinflammatory fatty acids which results in pustule or nodule
treatment of acne
vitamin A derivatives which reduce keratin production and antimicrobial benzoyl peroxide
clinical presentation of psoriasis
well-circumscribed salmon-colored plaques with silvery scale usually on extensor surfaces and scalp; pitting of nails may also be present
cause of psoriasis
due to excessive keratinocyte proliferation

possibly autoimmune, associated with HLA-C, and can arise in areas of trauma
histological findings in psoriasis
1. acanthosis
2. parakeratosis
3. collections of neutros in corneum
4. thinning of epidermis above elongated dermal papillae resulting in pin point bleeding when scale is picked off
acanthosis
epidermal hyperplasia (psoriasis)
parakeratosis
hyperkeratosis with retention of keratinocyte nuclei in the stratum corneum (psoriasis)
munro microabscesses
collections of neutrophils in stratum corneum (psoriasis)
auspitz sign
pin point bleeding when scale is picked off (psoriasis)
treatment of psoriasis
corticosteroids, UVA light with psoralen, immune-modulating therapy
lichen planus P's
pruritic, planar, polygonal, purple papules
wickham striae
reticular white lines on surface in lichen planus
locations in lichen planus
wrists, elbows, oral mucosa
lichen planus associations
hepatitis C
what is pemphigus vulgaris
autoimmune destruction of desmosomes between keratinocytes
what causes pemphigus vulgaris
due to IgG antibody against desmoglein (type II hypersensitivity)
clinical presentation of pemphigus vulgaris
1. acanthosis of spinosum keratinocytes
2. basal layer still attached to basement membrane via hemidesmosomes giving tombstone appearance
3. thin-walled bullae rupture easily leading to shallow erosions with dried crust
4. immunofluorescence highlights IgG surrounding keratinocytes in a fish net pattern
what is bullous pemphigoid
autoimmune destruction of hemidesmosomes due to IgG antibody against basement membrane
presentation of bullous pemphigoid
subepidermal blisters of skin that spares oral mucosa; has tense bullae that does not rupture easily

immunofluorescence highlights IgG along basement membrane in linear pattern
what is dermatitis herpetiformis
autoimmune deposition of IgA at tips of dermal papillae

this IgA are antibodies against gluten that cross react with reticulin fibers connecting epidermis to basement membrane
clinical presentation of dermatitis herpetiformis
pruritic vesicles and bullae that are grouped
dermatitis herpetiformis association
celiac disease
what is erythema multiforme
hypersensitivity reaction characterized by targetoid rash and bullae; targetoid is due to central epidermal necrosis surrounded by erythema
erythema multiforme associations
HSV
also: mycoplasma, drugs, autoimmune, malignancy
clinical presentation of erythema multiforme and oral mucosa and lip involvement with fever
steven-johnson syndrome
toxic epidermal necrolysis
severe form of SJS characterized by diffuse sloughing of skin, resembling large burn and is most often due to adverse drug reaction
what is seborrheic keratosis
benign squamous proliferation that is common in elderly
clinical presentation of seborrheic keratosis
raised, discolored plaques on extremities or face that often has a coin like, waxy, 'stuck on' appearance
characteristic histological sign in seborrheic keratosis
keratin pseudocysts
leser-trelat sign
sudden onset of multiple seborrheic keratoses that suggests underlying carcinoma of the GI tract
what is acanthosis nigricans
epidermal hyperplasia with darkening of the skin (velvet-like skin) that often involved axilla or groin
acanthosis nigricans associations
insulin resistance and malignancy (especially gastric carcinoma)
most common cutaneous malignancy
basal cell carcinoma
risk factors of basal cell carcinoma
prolonged exposure to sunlight, albinism, and xeroderma pigmentosum
xeroderma pigmentosum and its association with basal cell carcinoma
sunlight hits DNA and forms pyrimadine dimers which usually are excised by nucleotide excision repair pathway. in XP, this autosomal recessive dysfunction of enzymes in this pathway can cause basal cell carcinoma
basal cell carcinoma presentation
elevated nodule with a central, ulcerated crater surrounded by dilated blood vessels
(think pink pearl-like papule)
classic location of basal cell carcinoma
upper lip
histological findings of basal cell carcinoma
nodules of basal cells with peripheral palisading
treatment of basal cell carcinoma
surgical excision; metastasis is rare; prognosis is excellent
risk factors of squamous cell carcinoma
sunlight, albinism, xeroderma pigmentosum, immunosuppressive therapy, arsenic exposure, chronic inflammation
clinical presentation of squamous cell carcinoma
ulcerated, nodular mass usually on face
classic location of squamous cell carcinoma
lower lip
actinic keratosis
precursor lesion of squamous cell carcinoma and presents as hyperkeratotic, scaly plaque on face, back, or neck
keratoacanthoma
well-differentiated squamous cell carcinoma that develops rapidly and regresses spontaneously; presents as cup-shaped tumor filled with keratin debris
melanocytes characteristics
in basal layer, derived from neural crest, take tyrosine as precursor molecule and make melanin in melanosomes which pass to keratinocytes
vitiligo
localized loss of skin pigmentation due to autoimmune destruction of melanocytes
albinism cuase
congenital lack of pigment due to enzyme defect (usually tyorsinase) that impairs melanin production
types of albinism
ocular and oculocutaneous forms
freckle
small, tan-brown macule that darkens when exposed to sunlight due to increased numbers of melanosomes
melasma
mask-like hyperpigmentation of cheeks associated with pregnancy and oral contraceptive pills
nevus (mole)
benign neoplasm of melanocytes
characteristic of nevus
hair growing from it
progression of acquired nevus
1. begins as a nest of melanoytes at the dermal-epidermal junction (junctional- most common in children)
2. grows by extension into the dermis (compound)
3. junctional component lost resulting in intradermal (most common in adults)
clinical presentation of nevus
flat macule or raised papule with symmetry, sharp borders, evenly distributed color, and small diameter
most common cause of death from skin cancer
melanoma
dysplastic nevus syndrome
autosomal dominant disorder characterized by formation of dysplastic nevi that may progress to melanoma
ABCDEs of melanoma
Asymmetry, Border, Color, Diameter, Evolution
growth phases of melanoma
1. radial, horizontal along epidermis and superficial dermis (low risk of metastasis)
2. vertical growth into the deep dermis (increased risk of metastasis)
most important prognostic factor in predicting metastasis in melanoma
breslow thickness- depth of extension
variants of melanoma
1. superficial spreading
2. lentigo maligna melanoma
3. nodular
4. acral lentiginous
superficial spreading melanoma
most common subtype; dominant early radial growth results in good prognosis
lentigo maligna melanoma
lentiginous proliferation (radial growth) along junction; good prognosis
nodular melanoma
early vertical growth that pushes epidermis up which causes nodule formation; poor prognosis
acral lentiginous melanoma
arises on palms or soles, often in dark-skinned patients, not related to UV light exposure
impetigo
superficial bacterial skin infection due to staph aureus and strep pyogenes that commonly affects children
presentation of impetigo
erythematous macules that progress to pustules usually on face; ruptures results in erosions and dry, crusted, honey-colored serum
cellulitis
deeper (dermal and subQ) infection, usually due to staph aureus and strep pyogenes
clinical presentation of cellulitis
red, tender, swollen rash with fever
risk factors for cellulitis
trauma, surgery, insect bite
cellulitis can progress to...
necrotizing fascitis with necrosis of subQ tissue due to infection with anaerobic flesh eating bacteria(production of carbon dioxide leads to crepitus)

this is a surgical emergency
clinical presentation of staphylococcal scalded skin syndrome
sloughing of skin with erythematous rash and fever; leads to significant skin loss
what is staphylococcal scalded skin syndrome
due to staph aureus infection producing exfoliative A and B toxins in epidermolysis of the stratum granulosum
verruca
wart
-flesh-colored papules with rough surface
cause of verruca
HPV infection of keratinocytes
location of verruca
hands and feet
molluscum contagiosum
firm, pink umbilicated papules due to poxvirus
hallmark of molluscum contagiosum
molluscum bodies: viral cytoplasmic inclusions
verruca keratinocyte changes
koilocytic change
virus implicated in molluscum contagiosum
poxvirus
people with molluscum contagiosum
children, sexually active adults, and immunocompromised individuals