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233 Cards in this Set
- Front
- Back
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list the five layers of the epidermis
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corneum, lucidum, granulosum, spinosum, basal (germinativum)
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horney, keratin layer of the epidermis
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corneum
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epidermal layer seen only in the palms and soles
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lucidum
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what cells fxn as macrophages of the epidermis and process contact antigens
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langerhans cells found in the spinosum
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what is the only cell of the spidermis that is capable of division and where is it found
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the basal cell keratinocyte found in the basal layer, it divides and migrates upward
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what is the purpose of melanin and what produces it
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melanocytes produce melanin and transfer it to keratinocytes, it protects us from UV
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where is melanin found in whites, in blacks?
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-in whites it is found in the basal layer, in blacks it is found throughout the epidermis
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once you pass through the basal layer of the epidermis, what layers do you hit moving deep
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-the dermal-epidermal jxn, then the papillary dermis, then the reticular dermis
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what does the papillary dermis contain
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haphazard collagen fibers, ground substance and delicate elastic fibers
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what does the reticular dermis contain adn where does it extend to
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-it extends to the subcut, coarse elastic fibers and collagen arranged paralell to the skin
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what are the three distinct phases of hair growth from the hiar follicle
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-anagen, catagen, telogen
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anagen
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prolonged growth phase of hair
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catagen
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short lived interphase
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telogen
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final resting stage
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glands that are found in greatest concentration on palms, soles, axilla
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eccrine glands
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where are eccrine glands located and what is their fxn
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-the secretory coil is located in the dermis and transmits sweat directly to the skin surface for cooling of body (sweat)
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where are apocrine glands found
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-Axilla and Anogenital areas
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what is the fxn of apocrine glands
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-they are scent glands that open up into the pilosebaceous follicle rather then skin surface
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glands found on all areas of the body except palms and soles
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sebaceous glands that empty into the hiar follicle
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what is meant by a "primary lesion" and give some examples
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-a lesion caused directly by the disease process (macula, papule, nodule, tumor, vesicle, bulla, wheal)
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what is meant by a "secondary lesion"
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Secondary lesions may evolve from primary lesions, or may be caused by external forces such as scratching, trauma, infection, or the healing process (sclale, crust, excoriation, fissure, erosion, ulcer, scar, eschar)
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flat change in color of the skin
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macule or patch
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flat change in color of the skin less then 1 cm
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macule (freckle)
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flat change in color of skin greater then 1 cm
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patch
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elevated primary skin lesion
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papule, nodule, tumor
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elevated primary skin lesion 1 cm in size
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papule
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elevated primary skin lesion greater then 1 cm
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nodule
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elevated primary skin lesion greater then 2 cm
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tumor
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elevated plateau lesion on the skin
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plaque
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elevated primary skin lesion with fluid
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vesicle, bulla, pustule
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excess of horny material on the skin
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scale
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scab consisting of dried blood, serum or pus
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crust
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erosion
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scooped out, shallow break in the epidermis (no dermis damage)
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linear form of erosion (not into dermis)
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fissure
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deep lesion involving the dermis
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ulcer
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dark colored, hard to remove crust on an ulcer
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eschar
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annular shaped lesion
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round, ring like
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imbricated lesion
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target lesions with normal skin inbetween the abnormal zones
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snake shaped lesions are called,,
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serpiginous
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tufts of protruding lesions that are hyperkeratotic
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verrucous (warts)
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tufts of protruding lesions that are fleshy, uneven and soft
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vegetating
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lesion that conforms to the distribution of a nerve root is called....
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zosteriform
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polycyclic lesions or circinate lesions
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-annular lesions grow together to form larger lesions
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list the 6 morphology characteristics of lesions that should be used in describing them
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-size, color, consistency (soft, medium, firm), configuration (shape, outline), margination (sharp or diffuse), surface char (smooth or rough)
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what do these have in common: impetigo, ecthyma, erysipelas and cellulitis, furnucles and carbuncles, folliculitis, erythrasma, necrotizing fascitis.
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bacterial infections of the skin
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what bacteria cause impetigo
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S.pyogenes, S aureus, alone or together
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what bacteria causes ecthyma
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Group A strept and/or S aureus
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what bacteria causes erysipelas and cellulitis
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Strept
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what bacteria causes erythrasma
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corynebacterium minutissimum
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small thin walled vesicles or pustules that form honey colored crusts
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impetigo
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what antibitoics treat impetigo
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systemic (dicloxicillin, clinda); topical (mupirocin, bacitracin, neomycin)
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superficial skin infection common on the LE, that begins as vesicle or bulla that rupture to form crusts
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ecthyma
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tx for ecthyma
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dicloxacillin (oral)
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what is the diff btwn erysipelas and cellulitis
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-erysipelas has a sharply demarcated and elevated border
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when strept infection spreads into the dermal lymphatics, erysipelas occurs and when it involves the deeper dermis and subcut fat...
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cellulitis occurs
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Strept pyogenes releases enzymes for rapid spread of infection through the tissue planes, what local signs are seen and what systemic signs are seen
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-edema, erythema and heat at the sight and the enzymes produce systemic signs (fever, tachy, confusion, hypotension)
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what are some predisposing factors to erysipelas and cellulitis
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-edema, tinea pedis, previous trauma to skin from burns, surgery or radiation
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usually strept pyogenes causes erysipelas and cellultis, but what are the causes in immunocompromised pts
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P.aeruginosa and other gram negatives
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usually strept pyogenes causes erysipelas and cellultis, but what are the causes around abscess or open wounds
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staph aureus
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severe cellulitis is treated with IV antibiotics, why do signs and symptoms worsen after therapy is initiated
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the antimicrobial therapy rapidly kills the bacteria causing the release of potent enzymes
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infection of the hair follicle that produces inflammatory nodule with a pustule center through which the hair emerges
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furnucle (carbuncle affects several adjacent hair follicles)
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what is the most common cause of furnucles and carbuncles
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staph aureus
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tx for carbuncles and furnucles
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-moist heat to promote drainage, I &D for larger ones
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inflammation of the hiar follicle caused by occlusion of the follicular ostium, usually staph aureus
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folliculitis
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common cause of folliculitis in hot tubs
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p.aeruginosa
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superficial, asymptomatic infection involving the groin, axilla and toe webs
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erythrasma
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organism assoc with erythasma that produces porphyrins so all lesions fluoresce with red or pink coral color under woods lamp
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coreynebacterium minutissimum
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tx for erythasma
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wash with soap and water, whitfields ointment or topical miconazole, topical antibiotics, erythromycin
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fulminating infection of the superficial and deep fascia, thrombosis of subcut vessels occurs when tissues gangrene
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necrotizing fascitis
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early in necrotizing fascitis what are the symptoms
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red, hot, edematous
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later in necrotizing fascitis what are the symptoms
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skin has a blue dusky tinge, cutaneous gangrene with eventual sloughing
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tx for necrotizing fascitis
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-immediate I&D, IV antibiotics
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what are 4 skin signs of bacterial endocarditis
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-petecchiae, splinter hemorrhages on nail beds, oslers nodes (red or purple painful nodules on pads of fgrs/toes), janeways lesions (non tender erythematous macules on palms and soles)
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what are 2 non-skin signs of bacterial endocarditis
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-heart murmur and fever
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bacteria that cause bacterial endocariditis of native or prosthetic heart valves
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-strept and staph
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what are 3 clinical symptoms of disseminated gonococcal infection
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-arthralgias(septic arthritis), tenosynovitis (pain, swelling, redness along tendon sheaths), skin lesions
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describe the skin lesions associated with disseminated gonococcal infections
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-the skin lesions start as tiny petechiaa and become vesicular and pustular with a gray necrotic center on a erythematous base, usually on extremities
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tx for disseminated gonococcal infections
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ceftriaxone
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infection with toxin producing staph aureus which causes the skin to cleave at the granular cell level
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staph scalded skin syndrome
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what age group commonly gets staph scalded skin syndrome
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children less then 5 yo
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what are the clinical symptoms of staph scalding skin syndrome
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-fever, vesicles and bulla that cause skin seperation and skin sloughing (Nikolsky's sign)
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name the 4 viral vesicular derm diseases
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herpes simplex, varicella (cx pox), herpes zoster(shingles), hand-foot-and-mouth disease
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what is the average number of recurrences of Herpes Simplex every year
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twice a year
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when does the viral shedding of herpes simplex end
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-when the lesions crust over (4-5 days)
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what factors can initiate a herpes simplex reactivation
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UV, fever, emotional stress, fatigue, trauma, menstruation and pregnancy
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highly contagious disease caused by the varicella zoster virus
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chicken pox
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what is the progression of the lesions associated with chicken pox
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-they start in crops of macules, and progress thorugh papules, vesicles and pustules that crust and heal w/o scarring
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what is the distinctive feature of cx pox as far as the stages of the lesions go
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-various stages of the lesions (macule,papule,vesicle,pustule,scab) can be seen all in one area of the body
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varicella (cx pox) is a prmary infection, what is the reactivation of the latent virus
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herpes zoster (shingles)
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painful vesicles on an inflamed base usually localized to 1 or 2 dermatomes w/o crossing the midline
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Herpes zoster (shingles)
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what is the lesion progression of Shingles
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-vesicles enlarge and become pustular in 3-4 days then erode and crust in 7-10 days, scarring is common
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tx for chicken pox
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isolation, antipruitics, antipyretics (not aspirin in kids), topical antibiotic
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tx for shingles
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acyclovir and topical Zostrix (capsaicin) for pain
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benign, highly contagious viral vesicular disease seen in infnats and yound children
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hand-foot and mouth disease
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what type of DNA does HSV have
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linear ds DNA
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tx for HSV
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acyclovir
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what virus normally causes hand-foot and mouth disease
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Coxsackie virus A16 or enterovirus 71
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where do hand/foot/mouth lesions occur and what do they look like
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-2-8 mm bright red macules appear on the tongue, hard palate and buccal mucosa; then dvlp into thin walled gray vesicles surrounded by a red halo; after oral lesions, you get cutaneous lesions on the sides and dorsum of the hands, feet, fingers and toes
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what virus are warts caused by
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papillomavirus of the papovavirus group
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what layer of the skin houses warts (verrucae)
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epidermis
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how does the virus in a wart grow and replicate
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-they are slow growing DNA containing viruses that replicate in the nucleus of cells
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upon debridement of warts, why do you have pin point bleeding
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-because the vessels in the dermal papilla are cut (dermal papilla have finger like projections that interlock with the epidermis)
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verruca vulgaris
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most common form of wart that is seen on fingers, hands, and knees; especially in kids
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the black dots on the skin are a pathoneumonic for warts, what are these black dots
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-they are thrombosed capillary loops that supply the blood to the wart
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verruca plantaris
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(plantar wart)- trauma at pressure isghts on the plantar surfae of the foot allows penetration by wart virus
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what does a plantar wart look like
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-hyperkeratotic plaque with thrombosed capillaries that is tender on lateral compression
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mosaic warts
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very large diffuse group of warts with ill defined boundaries (may look like a callous)
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do mosaic warts cause pin point bleeding on debridement
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-no because the dermal papilla are not pushed superficially, mosaic warts have more of a horizontal then vertical arrangement
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histology of a wart; what do the nuclei look like
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-pyknotic (the nucleus is dying and chromatin is compressed)
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histology of a wart; the cells are small and shrunken, pyknotic nuclei, and what inclusion bodies are found
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-basophilic incusion bodies surrounded by a peri-nucelar halo
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what is the best conservative tx for warts
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acid therapy
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what acids can be used for wart tx
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-80% monochloracetic acid and/or 60% salicylic acid paste
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how long does wart tx take
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-6 weeks with a 75% success rate and is often painful
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other then acid therapy, what are 3 other choices for wart tx
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-surgical excision down to superficial fascia, cryotherapy, laser surgery
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molluscum contagiosum
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an epidermal DNA poxvirus that resides in the keratinocytes
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what type of virus is molluscum contagiosum
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DNA poxvirus
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Molluscum Contagiosum virus multiples and forms globules of viral proteins called...
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molluscum or Henderson-Patterson bodies
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how long is the incubation period for Molluscum Contagiosum
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4-8 weeks
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how long does it take for resolution of Molluscum Contagiosum
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2 years
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what is the pathognomonic for molluscum contagiosum
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-central umbilication; but the lesions are flesh colored hemi spherical papules
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superficial fungus that are capable of colonizing keratinized tissue such as hair, nails and stratum corneum
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dermatophytes
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what genera cause dermatophyte fungal infections
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-members of the genera Microsporum, Trichophyton and Epidermophytes
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how are the species idnetified in a dermatophyte infection
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KOH prep
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what are the 3 main causative agents of tinea pedis
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T. mentagrophytes, T.rubrum, E.floccosum
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what are the most common symptoms of tinea pedis
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-foul smell and itching
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what are the 4 classifications of tinea pedis
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-chronic interdigital, chronic papulosquamous hyperkeratotic, vesicular or subacute and acute ulcerative
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tinea pedis characterized by masceration and dermatitis inthe toe webs; skin is white with a foul odor
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chronic interdigital tinea pedis
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tinea pedia characterized by fine, dry white scales that may be patchy or cover the foot in a moccasin distribution
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chronic papulosquamous hyperkeratotic tinea pedis
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what is the causative agent of chronic papulosquamous hyperkeratotic tinea pedis
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T rubrum (usually B/L)
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tinea pedis characterized by tense vesicles and bulla containing a serous fluid
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vesicular or subacute tinea pedis
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causative agent of vesicular or subactute tinea pedis
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T.mentagrophytes
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what form of tinea pedis is most responsible for an id reaction on other parts of the body
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Vesicular or Subacute tinea pedis caused by T.mentagrophytes
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what is an id reaction
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an itchy rash with blisters, or vesicles. It usually occurs on the sides of the fingers. This rash occurs in response to a fungal infection somewhere else on the body, especially athlete's foot. An allergic response to fungi. Treating the fungal infection makes the id reaction rash go away.
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acute ulcerative tinea pedis
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rapid spread of eczematoid vesiculopustular process; secondary bacterial infection can occur and the vesicle fluid turns purulent
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which class of tinea pedis can involve large areas of the foot and appear with cellulitis, lymphangitis, and lymphadenitis
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acute ulcerative
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tx of tinea pedis
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-avoid barefeet, wash and dry feet daily, Clotrimazole, miconazole, econazole, ketoconazole, sulconazole, oxiconazole
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Clotrimazole can tx tinea pedis, what is the name brand
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Lotrimin
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Ketoconazole can tx tinea pedis, what is the name brand
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Nizoral
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multiple scaley lesions and areas of broken hair
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tinea capitis (scalp ring worm)
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cause of tinea capitis
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T.tonsurans
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red, scaling, itchy lesions on the face and neck
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Tinea Faciale caused by T rubrum, T.mentagrophytes, M.canis
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corcular, sharply circumscribed red, dry, scaley patches with central clearing on the trunk and limbs
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Tinea corporis
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Majocchi's granuloma
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occurs on the legs at the ahir follicles as a spongey granuloma caused by T.tonsurans
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Tinea Cruris
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jock itch; well demarcated circular lesions with red raised borders in the groin area
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finely scaling patches on the upper trunk and extending onto the neck and arms
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Tinea versicolor
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causes of Tinea versicolor
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dimorphic yeast (Pityrosporum orbiculare)
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what is another name for Pityrosporum orbiculare that causes Tinea versicolor
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Malasezzia furfur
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superfiical fungus infection caused by T.rubrum that causes scaling plaques/patches or vesiculopustualr plaques of one hand and both feet
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Tinea Manum
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Tinea Nigra
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superficial infection of the stratum coreum caused by Exophiala wernecki found in tropical climates; non scaling dark brown-black lesions on palms, soles, fingers
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Mycetoma (Madura foot)
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- deep fungal infection whose intial implantation forms a tumor like mass that enlarges to form sinus tracts, edema and induration that lead to wooden firmness of the tissue; new nodules form and more sinus tracts dvlp causing destruction of bone and tissue
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what is the triad of Madura foot
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-tumefaction, draining sinuses, and grains (microcolonies of organisms)
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what can cause Madura foot
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a variety of bacterial and fungal agents found in soil and plants
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tx of madura foot
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-I&D of abscess and surgical debridment with antimicrobial therapy
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what is induration
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hardening of an area of the body due to inflammation or other pathology
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Papulosquamous diseases are cahracterized by scaley papules and plaques; list the 5 different types
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-psoriasis, reiters, lichen planus, pityriasis rosea, pityriasis rubra pilaris
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rapid epidermal proliferation resulting in accumulation of stratum corneum
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psoriasis
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describe the classic psoriatic lesion
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-dry silvery scale appearing on the extensor surfaces of the limbs (B/L and symmetrical)
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what is the Koebner phenomonon associated with psoriasis
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replication of skin in an area of pressure due to scratching
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removal of psoriasis scales causes an Auspitz sign...what is that
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-pinpoint bleeding
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what does nail involvement in psoriasis look like
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-nails are pitted with depressions and onycholysis
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what are the diff types of psoriasis
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-plaque, guttate (salmon pink drops), erythrodermic, pustular, arthritic
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what is acanthosis
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-thickening of the corneum layer of the epidermis (present in psoriasis)
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Munroes abscesses are seen in psoriasis..what are they
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-collection of neutrophils in teh stratum corneum
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when psoriasis invades the dermis, what is the histo like
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-capillary proliferation with perivascular infiltration
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tx for psoriasis
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-lubricants, tars, Anthralin(hydrocarbon ointment), topical corticosteroids, phototherapy, systemic therapy (methotrexate,retinoids,cyclosporin,hydroxyurea,D3)
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seronegative asymmetric arthropathy
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reiters
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triad of Reiters
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conjunctivitis, urethritis, arthritis (cant see, cant pee, cant kick your knee)
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haplotype assoc with reiters
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HLA-B27
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classic lesion of Reiters
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-keratoderma blenorrhagicum (pustular psoriasis with a thick layer of keratin overlying the pustules)
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tx for Reiters
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NSAID, immunosupressive
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lace like pattern of white lines on the surface of itchy papules (Wickhams striae)
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Lichen planus
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where do Lichen planus lesions occur
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on the flexor surfaces of wrists, forearms, lumbar, penis, ankles, anterior legs and dorsum of hands
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what membranes are often infected with Lichen planus
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mucous membranes
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tx for lichen planus
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-corticosteroids, antihistamines, phototherapy, retinoid therapy, dapsone (antibac)
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chronic mucocutaneous disease that affects the skin and the oral mucosa
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lichen planus
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acute, self limiting inflammatory disease with an initial "herald patch"
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Pityriasis Rosea
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herald patch
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small plaque usually on a trunk that rapidly produces a larger 2-10 cm patch
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lesions are distributed along lines fo cleavage on the trunk and proximal extremities producing an xmas tree pattern
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Pityriasis rosea
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Pityriasis Rubra pilaris
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-hyperkeratotic follicular papules, slamon colored scaly plaques and palamr-plantar keratoderma
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striking feature is "island sparing" - normal skin with in sheets of erythema
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Pityriasis rubra pilaris
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keratodermic sandal with fissures
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Pityriasis rubra pilaris
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tx for Pityriasis Rubra Pilaris
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topical steroids, emollients, keratolytics, retinoids, methotrexate, Vit A
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the hallmark of all eczematous diseases is itching; list them
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atopic dermatitis, contact dermatitis, seborrheic dermatitis, stasis dermatitis, dyshydrosis (poppholyx)
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Eczematous disease associated with asthma, allergic rhinitis or hay fever
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atopic dermatitis
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what Ig is increased in the serum of atopic dermatitis pts
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IgE
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what type of immunologic rxn is allergic contact dermatitis
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-cell mediated, Type 4, delayed reaction
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what are the two phases of Allergic contact dermatitis
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-first is sensitization to a chemical, then the second occurs with continued or repeat exposure to the antigen
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occurs in hairy areas consisting of erythema covered with a greasy scale
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seborrheic dermatitis(dandruff)
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tx of seborrheic dermatitis
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zinc pyrithione, selenium sulfide, salicylic acid and sulfur
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stasis dermatitis
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-redness, dependent edema, hemosiderin pigmnetation of distal lower legs, mainly medially
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most common cause of stasis dermatitis
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phlebitis or varicose veins that lead to venous insufficiency and eventually stasis dermatitis
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non-inflammatory, idiopathic, recurrent vesicular eruption on the palms and soles
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Dyshydrosis
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cutaneous rash that follows a 1-14 day period of fever, malaise, cough, sore throat, arthralgia and myalgia
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stevens johnson syndrome (erythema multiforme major)
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erythema multiforme
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mild self limiting rash of microvasculature of the skin and oral mucosa usually after a drug reaction
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erythema multiforme major (stevens johnson syndrome)
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inflammatory bullous lesions that appear on the mucous membranes and bilateral purulent conjunctivitis
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what are the complications of stevens johnson syndrome
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blindness, renal failure, pneumonia, scarring of skin, nail loss
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what cutaneous drug reaction is fatal if not treated
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stevens johnson syndrome
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erythema nodosum
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sudden onset of red nodules and plaques over the anterior legs, nodules evolve through color changes of bruise from red to blue to yellow to green
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what are some causes of erythema nodosum
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infectious agents, sarcoidosis, inflammatory bowel disease, drugs such as sulfonamides and oral contraceptives
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Necrobiosis Lipoidica Diabeticorum (NLD)
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several sharply but irregular patches usually on the shin
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what is the histopathology of NLD
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degeneration or necrobiosis of collagen with polymorphic cellular infiltrates composed of lymphoid cells, fibroblasts and histiocytes
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what color do NLD patches appear
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-yellowish in the center and violet at the edges
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granuloma annulare
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rash with reddish bumps arranged in a circle; most commonly on the hands and feet
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what is the histopathology of granuloma annulare
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focal degeneration of collagen with an inflammatory infiltrate and fibrosis with in the dermis
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nail disorder with subungual keratosis, nail pitting, onycholysis, discoloration (oil spots)
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psoriasis
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nail disorder with longitudinal grooving and ridging, shedding of nail plate, atrophy of nail bed, subungual hyperpigmentation
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Lichen planus
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nail disorder with longitudinal subungual red and white streaks, distal wedge shaped subungual keratoses
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dariers disease
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nail disorder with pitted nails
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seen in pts with Alopecia Areata
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seperation of nail plate from nail bed
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onycholysis (assoc with psoriasis, hypothyroidism, hyperthryroidism, pregnancy, tetracyclines, yeast infection
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increase in lovibonds angle greater then 180 degrees
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clubbing
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causes of clubbing
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biliary cirrhosis, chronicc resp illness, congenital heart defects
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Koilonychia
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spoon nails
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causes of Koilonychia
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faulty iron metabolism, familial, inflamm disease, idiopathic
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nail disorder with hypertrophy and curvature
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Onychogryphosis
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causes of Onychogryphosis
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trauma or circulatory disorder
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nail disorder with abscence of nails
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Anonychia
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causes of Anonychia
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stevens johnson syndrome, epidermolysis bullosa
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nail disorder with transverse furrows
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Beau's lines
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causes of beau's lines
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systemic illness, trauma
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onychoschizia
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splitting of distal nail plate into layers (caused by dehydration of the nail plate)
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half and half nails
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distal red, proximal white
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cause of half and half nails
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renal disease
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Muehrcke Lines
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narrow, white, transverse bands occurring in pairs
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causes of Muehrcke lines
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hypoalbuminemia
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Mee's Lines
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white transverse lines
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cause of Mee's lines
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arsenic poisoning
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brightness with breakage of nail
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onychorrhexis
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terry's syndrome
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distal end of nail is normal pink, proximal end has white appearance
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racquet nails
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inherited disorder (wide end of thumb and short distal phalanx)
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white discoloration of nail plate, bed or matrix
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leukonychia
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cause of terrys syndrome
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cirrhosis
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Yellow nail syndrome
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caused by pulmonary disease and lymphedema
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canal formation or splitting in the middle of the nail
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Median nail dystrophy
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