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115 Cards in this Set
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interface dermatitis
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pattern of inflammation DEJ and PAPILLARY DERMIS
l@ apoptosis of basal k@ and occ melanocytes |
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normal k@ ICAM levels
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low
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k@ exposed to cytokines or UV exposure ICAM levels
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cytokines (TNFalpha) and UV exposure upregulate ICAM on k@ attracting l@ to come kill them
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ICAM
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intracellular adhesion molecule k@s
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2 types of interface dermatitis
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1. cell poor
2. cell rich |
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cell poor interface dermatitis
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vaculoar or liquefaction degeneration
focal intracellular edema vacule formation basal k@ small bubbles DEJ CIVATTE BODIES COLLOID BODIES |
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Civatte and Colloid bodies immunofluorescence?
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yes
ENTRAPMENT of IgM deposited on TONOFILAMENTS in CONDENSED CYTOPLASM |
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vacuolar degeneration immune rxn?
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type 2 or 4 immune rxn resulting in CELLULAR TOXICITY
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cell poor interface dermatitis
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1. EM
2. autoimmune 3. graft-versus-host 4. fixed drug 5. erythema dyschromicum perstans 6. poikiloderma |
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EM
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cell poor interface dermatitis
1. infection mediated: brisk ANGIOCENTRIC SUP AND DEEP L@ 2. drug medicated: EPI NECROSIS, E@, ACROSYRINGEAL inflammation |
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autoimmune CT disorders
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cell-poor interface dermatitis
SUP AND DEEP PERIVAS and PERIADNEXAL VARIABLE MUCIN deposition SLE, dermatomyositis, MCTD |
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graft-versus-host
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cell poor interface dermaitis
acute findings FOCAL VACULOAR DEGENERATION TIPS OF RETE RIDGES and FOLLICULAR INVOLVEMENT |
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Fixed drug
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cell poor interface dermatitis
SUP AND DEEP PIG INCONTINENCE |
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Erythema dyschromicum perstans
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cell poor interface dermatitis
MINIMAL VACUOLAR DEGENERATION |
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Poikiloderma
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cell poor interface dermatitis
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EM
mc assoc? less common assoc? other causes? |
cell poor interface dermatitis
HSV >EBV mycoplasma, drugs, contact w nickel, poison ivy |
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HSV in EM leads to release of?
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IFN gamma especially if recurrent
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HAEM
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herpes assoc EM
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EM HLA types more predisposed?
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HLA-B35, B62, B12, DR3
for herpes EM? |
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EM rxn mediated by cells?
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cytotoxic t-cells cause apoptosis k@ via interaction w SOULUBLE FAS and its receptor FASL via POL GENE EXPRESSION (herpes DNA polymerase gene)
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POL gene expression
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EM
herpes DNA polymerase gene cytotoxic t-cells cause apoptosis of k@ via interaction w SOLUBLE FAS and its receptor FASL via POL GENE expression |
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FAS and FASL
where? |
on k@
cytotoxic t- cells interact with receptor FASL causing k@ to be targeted by t-cells or abs against desmoplakin 1 and 2 |
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streak dyskeratosis
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basilar k@ in EM elongated cigar morph w condensed eosinophilic cytoplasm and pyknotic elongated nuclei
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TEN release of?
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TNF alpha
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TEN assoc HLA type
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HLA B12
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TEN histo
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subepi clefting
basket weave less infiltrate than EM few E@ durgs NECROSIS OF SWEAT GLANDS |
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Erythema dyschromicum Perstans
other names? clinical? histo? |
Ashy dermatitis, LP Pigmentosa
macular pig TRUNK LATIN AMERICANS, INDIANS cell poor interface dermatitis SPARSE VACUOLAR change w FEW CIVATTE BODIES PIG INCONTINENCE |
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Graft-versus-host disease
similar to ? on histo |
1. eruption of l@ recover (ELR)
2. acute radiation dermatitis |
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GVHD
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donor cytotoxic l@ attack recipients' cells
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ELR
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eruption of l@ recover (ELR)
hosts' l@ attack body |
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assoc sx with GVHD and ELR?
labs? |
n/v/d, elevated LFTs
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Acute GVHD
Grades? |
within 30 days of BMT
Grade 0: normal skin Grade 1: basal vacuolation rete ridges,apoptosis, satellite-apoptosis Grade 2: acrosyringium or follicle and mild dermal l@ Grade 3: fusion of basal vacuoles creating subpepi clefts Grade 4: sep epi from dermis |
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Chronic GVHD
2 phases |
1. early lichenoid
2. late sclerodermoid |
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Early Lichenoid GVHD
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Chronic GVHD
band like infiltrate w apopototic k@ epi and FOLLICLE +/- focal column of epi necrosis related to ECCRINE DUCT |
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Late Sclerodermoid GVHD
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Chronic GVHD
mild vacuolar change w scattered apoptotic k@ epi and dermis THICK BUNDLES OF COLLAGEN increased FIBROBLAST ACTIVITY UPPER DERMIS ADNEXA REDUCTION |
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LE and Dermatomyositis like histo
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DLE
Rowell's SCLE Neonatal Lupus Bullous Lupus SLE perniosis Tumid lupus DM Poilkiloderma |
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acute SLE and neonatal lupus
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can see more n@ and n@ debris
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DM vs SLE
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DM more sup and less intense SUP and DEPP PERIVASCULAR AND PERIADNEXAL INFILTRATE
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hemoatoxyphil bodies
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Can be seen in DM
rare Hematoxyphil bodies tissue equivalent to LE Cell mature n@ w inclusion of homogenous staning degnerated nucleoprotein and abs against nucleoprotein (PMNs with engulfed nuclear debris) |
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DM
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can see n@ and n@ debris
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LE and DM histo
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1. vacuolar dengeration w scattered apoptotic cells
2. sup and deep l@ PERIVAS and PERIADNEXAL (more sup and less intense in DM), m@, plasma cells acute lesions and DM n@ and n@ dust, hematoxyphil bodies (tissue equivalent to LE cell) 3. chronic REDUNDANCY and THICK BMZ, REDUPLICATION OF CAP and VENULAR basement membranes VASCULAR ECTASIA 4. epi normal (acute), atrophic (chronic), or acanthotic (chronic verrucous) 5. stratum corneum hyperkeratotic FOLLICULAR PLUGGING of FOLLICLES AND ACROSYRNGIAL OSTIA 6. DERMAL MUCIN DEPOSITS (excessive tumid lupus) |
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anti-ro abs histo
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vascular dilation
endothelial cell necrosis luminal fibrin |
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Immunoflourescence
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DIF IgG and IgM +/- compliment DEJ just below the basal lamina
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Lupus panniculitus
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can occur without assoc interface dermatitis and a sup and deep infiltrate
LOBULAR PANNICULITIS LOTS OF L@ around indiv adipocytes fat necrosis and lipophages secondary germinal centers (collections of l@) plasma cells and e@ hyalinized fat and CALCIUM DEPOSITS |
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Chilblain Lupus
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similar to pernio
l@ vasculopathy SMUDGY VESSELS SUP AND DEEP AND ECCRINE FOCAL VACUOLAR DEGENERATION |
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DM histo
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epi atrophy
sparce vacuolar degeneration variable mucin endothelial cell necrosis, intraluminal fibrin, reduced vascular density with ECTASIA kids: NEC VAS and ECTOPIC CALCIUM DEPOSITS supepi vaculoization assoc w internal mal 33% MAC(C5-9) vasculature of DM |
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DM vasculature deposits
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MAC (C5 - 9)
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MCTD
high? |
high ENP (nRNP)
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Similar histo to acute SLE?
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parovirus 19
Lyme disease |
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drug induced SCLE
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anti-ro abs
THIAZIDES TERBINAFINE CA CHANNEL BLOCKERS GRISEOFULVIN |
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Drug Induced SLE
assoc w? drugs? clinical? |
anti-histone abs
HIP MAC G HCTZ,Hyrdralazine INH PROCAINAMIDE * Penicllamine Phenobarbitone Phenytoin Piroxicam Minocycline Methlydopa Allopurinol Captorpril Clonodine Griseofulvin arthralgias, serositis, occ photo rash, RARE RENAL or NEURO |
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SLE, SCLE, or DLE
1. thick adherent scale? 2. follicular atrophy? 3. photo? 4. scarring? 5. atrophy? 6. pig? 7. telaniectasia? |
1. DLE
2. DLE 3. SCLE 4. DLE 5. DLE 6. DLE 7. all |
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lupus band test
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intense IgM dpostion sun exposed skin 50% + width of bx
interrupted IgG with IgA increase specificity sun protected moderate intensity IgM band, reduced sensitivity more specific; assoc w sx disease |
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C5b-9
correlates with which abs? |
membrane attack complex florescence of k@ in BMZ lupus
correlates with abs to extractable nuclear proteins (SM, RO/SSA, La/SSB or RNP) can be seen in vasculature of DM, MCTD, SLE and anticoagulant abs or vasculitis |
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+ La
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SICCA syndrome
SCLE predictive of pulmonary |
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+ Ro
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SLE pts increase photo, interstitial pneumonitis, myositis, myocarditis, and complete heart block in neonatal lupus
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vitiligo interface dermatitis?
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yes at leading edge
cell poor pig incontinence loss of melanocytes centrally |
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poikiloderma
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congenital (Rothmund Thompson Syndrome, Dyskeratosis Congenital, Kindler Syndrome, heridtary sclerosing poikiloderma, mild changes in bloom syndrome)
early MF DM radiation injury histo hyperkeratosis over epi atrophic vaculoar degen w scattered melanophages and telangiectasis w radiation dermatitis atypical fibroblasts, kissing telangiectasias, and dermal sclerosis |
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Lichen Sclerosis et Atrophicans
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early interface dermatitis
hyperkeratotic with epi atrophy follicular plugging ddx: late radiation dermatitis |
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MF
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rare vacuolar pattern assoc with worse prog
line up of l@ with halos not vacoular change at DEJ one variant with true lichenoid destructive interface dermatitis |
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LP
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focal destruction and raggedness of basal layer
SAW TOOTH PATTERN CASPARI-JOSEPH or MAX-JOSEPH spaces HYPERKERATOTIC with WEDGE-SHAPED HYPERGRANULOSIS (orifices of ADNEXA) no parakeratosis (except LP drug or lichenoid keratosis) CIVATTE BODIES LOWER 1/3 OF EPI pig incontinence papillary dermis |
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Hypertrophic LP
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SHINS
BETA BLOCKERS HIV TIPS OF RETE RIDGES l@ infiltration scattered plasma cells and E@ |
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Atrophic LP
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attenuation of rete ridges
SCANT infiltrate |
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Mucosal LP
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e@
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LP Pilaris
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focal areas hair loss (scarring alopecia)
hyperkeratotic follicular plugs k@ follicle infundibulum and isthmus 30% changes in epi between follicles FIBROSIS and NARROWING of FOLLICLE HOUR GLASS CONFIGURATION follicle repalced with FIBROUS STREAMERS 50% have classic LP skin |
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Graham-Little-Piccardi-Lassuer Syndrome
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scarring alopecia
KP variable alopecia axillae and groin |
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LP-like keratosis
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benign lichenoid keratosis
erythematous brown scaly paques on trunk clinicall dx bcc lichenoid rxn to soalr lentigo or sk initally epi hyperkeratotic and acnathotic Sk or lentigo edge of lesion lots of collooid bodeis attenuatio of epi DDx: r/o regression inmealnom in situ |
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Lichenoid drug
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mc BETA BLOCKERS, GOLD, HCTZ and ANTIMALARIAL
clinically like psoriasis (B-Blockers) like LP or photodistributed LP (HCTZ and COLOR FILM DEVELOPERS) deeper less dense infiltrate focal parakeratosis (mild spongiosis) e@ pig incontinenece |
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LP pemphigoides Ag? DIF?
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NC16A region of BP ag II (180 KD) molecule
linear IgG, C3, C9 IIF with salt split skin abs to roof |
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LP overlap w which lupus?
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DLE
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Keratosis Lichenoides Chronica
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genodermatosis
linear or reticulated LP on extremities seb derm face oral lesions and nail changes extensive apoptotic cells deeper perivas and periadnexal infiltrate eccrine duct and gland with hypergranulosis and keratin plug |
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Lichen Nitidus
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extremities, genitlia, abdomen of kids young men
variant assoc with atitinic damage BALL AND CLAW PATTERN MULTINUCLEATED GIANT CELLS colloid bodies |
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Lichen Striatus
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female kids resovle 1 - 2 yrs
extremity spogiotic and lichenoid FOCAL AND LIMITED TO 3 - 4 ADJACENT PAPILLAE aopototic k@ ALL LAYERS OF DERMIS PERI-ECCRINE |
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Pityriasis Lichenoies et Varioliformis Acuta
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PLEVA
Mucha-Habermann Disease recurrent CROPS of HEMORRHAGIC papules resolve with SCARS 20 to 30 yr old MALES TRUNK FLEXURAL PROXIMAL EXTREMITIES |
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Pityriasis Lichenoides Chronica
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PLC
younger patients MALES TRUNK FLEXURAL PROXIMAL EXTREMITIES small red-brown papules with central adherent scale |
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primary process in PLEVA and PLC
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l@ vasculitis with assoc lichenoid dermatitis
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DM subepidermal vesiculation?
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assoc with internal mal 33% adult cases
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Deposits vasculature of DM?
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MAC(C5-()
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MCTD high titers?
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ENP(nRNP)
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acute SLE similar to?
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parvovirus 19
Lyme |
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Drug induced SCLE
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assoc with anti-Ro abs
THIAZIDES TERFINAFINE CA CHANNEL BLOCKERS GRISEOFULVIN |
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DRUG INDUCED SLE
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ANTI-HISTONE ABS
HIP MAC G HCTZ HYDRALAZINE INH PROCAINAMIDE PENICILLAMINE PHENOARBITONE PHENYTOIN PIROXICAM MINOCYCLINE METHYLDOPA ALLOPURINOL CAPTOPRIL CLONIDINE GRISEOFULIN NO RENAL OR NEURO SX |
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CIVATTE BODIES
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EIDERMIS
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COLLOID BODIES
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DERMIS
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HYPERTROPHIC LP
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B-BLOCKERS
HIV SHINS RETE RIDGES |
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GRAHAM-LITTLE-PICCARDI-LASSUER
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LLP
KP ALOPECIA AXILLAE AND GROIN |
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LLP
LEVEL OF INFILTRATE |
INFUNDIBULUM AND ISTHMUS
HOUR GLASS |
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LICHEN PLANUS-LIKE KERATOSIS
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BENIGN LICHENOID KERATOSIS
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LICHENOID DRUG
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B-BLOCKERS (PSORIASIS)
GOLD HCTZ ANTIMALARIAL HCTZ AND COLOR FILM DEVELOPERS PHOTODISTRIBUTED |
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lp PEMPHIGOIDES
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NC16A REGION OF BP AG II (180 KD)
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KERATOSIS LICHENOIDES CHRONICA
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GENODER
LINEAR OR RETICULATED LP LESION ON EXTREMITIESS SEB DERM FACE ORAL EROSIONS NAIL CHANGES |
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LICHEN STRIATUS
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ECCRINE GLAND
LICHENOID |
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PITYRIASIS LICHENOIDES ET VARIOLIFORMIS ACUTA
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MUCHA-HABERMANN DISEASE
TRUNK AND FLEXURAL PROXIMAL EXREMITIES 20 TO 30 MALES YOUNGER PTS WITH PLC LICHENOID DERMATITIS PARAKERATOSIS PMNS SC APOPTOTIC KERATINOCYTES IN SUP EPI ALL LAYERS EXTRAVACATED RBCS |
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SECONDARY SYPHILIUS
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LICHENOID
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FIXED DRUG
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HLA B22
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FIXED DRUG LIPS
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PYRAZOLONE
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NON-PIGMENTED FIXED DRUG
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PSUEDOEPEDRINE
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LICHENOID PIGMENTED PURPURA OF GOUGEROT AND BLUM
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LICHENOID DERMATITIS
EXTRAVASATED RBC HEMOSIDERIN |
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LICHEN AUREUS
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LICHENOID DERMAITITS
EXRAVASATED RBC HEMOSIDERIN |
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SYPHILIS
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PLASMA CELLS
LICHENOID |
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SUPRABASAL KERATINOCYES
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K 1 AND K 10
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PSORIASIS KERATINES
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K 6, 16, 17
NORMAL K1 AND K10 |
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PSORIASIS EARLY ONSET HLA?
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HLA-CW6
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PSORIASIS HLA?
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HLA-CW6 (EARLY ONSET, FAMILY HX)
HLA-B13 HLA B17 (SPONDYLOARTHRITIS) |
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PSORIASIS INCREASED INCIDENCE OF?
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LYMPHOMA
LARYNX CA |
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KIDS WITH PUSTULAR PSORIASIS BONES?
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LYTIC BONE LESIONS
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IMPETIGO HERPETIFORMIS
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PUSTULAR PSORIASIS OF PREG
3RD FLEXURAL INVOLVEMENT PLACENTAL INSUFFICIENCY HYPOPARATHROIDISM HYPCALCEMIA |
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PRP
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PLANTOPALMER KERATODERMA
NO PMNS IN EPI ADULTS FACE/SCALP TO BODY JUVENILES LEGS TO BODY FOLLICULAR BX ERYTHEMATOUS |
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ILVEN
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PRURITIC LINEAR
EXTREMITIES OF KIDS ALTERNATING PARAKERATOISSI WITH ORTHOKEARTOSIS |
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SPONGIOSIS
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VASE LIKE
PARAKERATOSIS |
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N@ SPONGIOSIS
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PAIRS GC
PSORIASIS PALMOPLANTAR PUSTULOSIS IGA PEMPHIGUS INFANTILE ACROPUSTULOSIS ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS SSSS NEISSERIAL PUSTULAR LESIONS SEONDARY SYPHILIS BEETLE DERMATITIS PUSTULAR CONTACT CEMENT IRRITANT CONACT ALLERGIC IMPETIGO REITER'S GON CANIDIA |
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E@ SPONGIOSIS
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A HAPPIE FD
PEMPHIGUS HERPTIFORM PEMPHIGUS PEMPHIGUS VEGETANS BULLOSUP PEMPHIGOID HERPES GESTATIONIS ARTHROBOD INCONTINENTIA PIGMENTI DRUG EOSINOPHILIC FOLLICULITIS GROVERS ALLERGIC CONTACT |
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SULZERGER-GARBE SYNDROME
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NUMMULAR ECZEMA FACE AND PENIS
MALE JEWS L@ SPONGIOSIS PV EDEMA |
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SEB DERM
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PARKINSONS
EPILEPSY CHG ETOH ZINC DEFICIENCY LEINER'S DISEASE GOLD ARSENIC CLORPROMAZINE CIETIDINE METHYLDOPA PMNS FOLLICLE PARAKERTATOIS SPONGIOSIS |
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INTRACORNEAL AND SUBCORNEAL BLISTERS
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BULLOUS IMPETIGO
SSS FUNGUS CANDIDA PSUTUAL PSORIASIS REITERS GEOGRAPHIC TONGUE PEMPHIGUS FOLIACEUS HERPEIFORM PEPHIGUS SUBCORNEAL PUSTUAL DRMATOSIS IGA PEMPHIGUS INFANTILE ACROPUSTULOSIS TRANSIETN NEONTALA PUSTULAR MELANOSIS ERYTHEMA TOXICUM NEONATORUM MILIARIA CRYSTALLINA OR RURA ACUTE GENERALIZE EXANTHEMATOUS PUSTULOSIS |
