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365 Cards in this Set
- Front
- Back
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4 layers of epidermis from in to out
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1) Basal cell layer (basal cells)
2) Stratum spinosum (keratinocytes) 3) Stratum granulosum 4) Stratum corneum (sheds) |
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Dermis
Support structure is a matrix of (3x)? |
1) Lamina lucida
2) Basal lamina 3) Anchoring fibrils - anchors epidermis to dermis |
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which sweat glands go to the surface - NOT attached to hair follicles
regulate temperature |
eccrine
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which dermis glands:
Special - groin / axilla not important physiological this sweat mixes w/bacteria = odors |
Apocrine sweat glands
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which dermis glands:
Make sebum Face / back / neck empties into hair follicle skin moisturizer |
Sebaceous glands
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name for:
Circumscribed color change of skin Flat < 10mm |
Macule
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name for:
Circumscribed RAISED bump - solid (not liquid) |
Papule
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name for:
Raised> 10mm |
Plaque
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name for:
flat > 10 mm depigmented patches |
patch
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name for:
circumscribed raised Filled w/FLUID - white / thick / purulent - bacteria - neutrophils |
Pustule
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name for:
Circumscribed Raised < 10mm Fluid filled - CLEAR (sirous)/ foggy - NOT purulent |
Vesicle
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name for:
circumscribed Raised > 10mm Clear fluid filled |
Bulla
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name for:
Red (errythematous) Edemadous Papule/plaque Slightly raised |
Wheal
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name for:
Circumscribed Feels in dermis Can be hard or soft < 10mm |
Nodule
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a bulla is a larger (> 10mm) version of __________
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a bulla is a larger (> 10mm) version of a vesicle
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name for:
Nodule > 10mm |
Tumor
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name for:
superimposed on surface or primary lesion Can be thick or thin Abnormally retained stratum corneum Here - primary is red, but then white scaling over it |
Scale
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name for:
AKA - scab Dried serous debris (neutrophils / bacteria) dark / raised |
Crust
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name for:
Circumscribed loss of epidermis shallow |
Erosion
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name for:
Circumscribed loss of epidermis and dermis |
Ulceration
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name for:
Circumscribed loss of epidermis and dermis linear |
Fissure
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name for:
Thinning of the skin (epidermis or dermis) any circumbscribed loss of epidermis or dermis - a scar is a type |
Atrophy
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name for:
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scar
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name for:
circumscribed loss of epidermis self induced - scratched |
Excoriation
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name for:
Dark dots - open comedo Primary lesion here is acne vulgaris Trapped cebum |
Comedo
white - closed black - open |
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name for:
Tiny white dots Cystic structure / tumor |
Milium
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name for:
Like a nodule Firm or soft (fluctuent) |
Cyst
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name for:
Thick texture from rubbing skin hallmark lesion of ectopic dermatitis (*exam question) |
Lichenification
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physical exam finding that is the hallmark lesion of ectopic dermatitis
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lichenification
Thick texture from rubbing skin |
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name for:
Feels rock hard - not soft |
Induration
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name for:
Scale lines from scabies - from human mite Burrows into top layer of epidermis (stratum corneum) |
Burrow
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name for:
Circumscribed macules blanch when pressed Blood vessels - just more pronounced |
Telangiectasia
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name for:
Extravagated blood - blood left blood vessels 3 names depending on size: < 10mm > 10mm Large purpura |
petchiae (< 10mm)
purpura (> 10mm) ecchymosis (Large purpura) |
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5 ways/MOA that the skin acts as a protective barrier
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what is impetigo?
- layer? - 3 types? |
infection in the epidermis only
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what is this:
(general - name of general type) 1) Superficial infection 2) Extends to dermal lymphatics 3) Erysipelas = cellulitis (by some people) a) This has sharper defined edges |
Erysipelas
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what is:
infection in dermis and subcutaneous fat layer 2) Red / swelling / heat / tenderness 3) Rapidly spreading 4) Inflammation of the lymph nodes |
Cellulitis
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Purulent
hair follicle infection |
Folliculitis
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what are
Furuncles (boils) |
Localized purulent inflammatory lesions
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name for
Several furuncles connected subcutaneously by sinus tracts |
Carbuncles
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bacteria:
hot tub burn wounds ecthyma gangranosum |
pseudomonas aeruginosa
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gram negative rod
obligate aerobe burn wounds |
pseudomonas aeruginosa
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gram negative rod
cellulitis - scratches from dogs/cats |
pasteurella multicoda
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mold that causes ringworm - dermatophytes
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tinea
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what are exanthems?
who gets them? |
widespread rash usually in children
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what viruses can cause exanthems in children
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ALL VIRUSES - except Scarlet fever
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virus that causes
infectious mononucleosis |
epstein-barr virus
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virus that causes
rocky mountain spotted fever |
rickettsia rickettsii
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virus that causes
streo toxic shock syndrome |
strep pyogenes
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virus that causes
staph toxic shock syndrome |
staph aureus
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type of plaque
Brown to red patches in the groin from - Corynebacterium minutissimum (normal skin flora) Predisposing factors - ↑ sweating - Obesity - DM |
Erythrasma
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what are
Annular plaques distinguishing characteristic |
clearing int he center
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bacteria of lyme
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borrelia burgdorferi
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Verrucous papules
means that the papules feel? |
rough
warts |
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Erythema nodosum
- what/cause/pathophys - who |
Hypersensitivity reaction
b. Inflammatory response of dermis - fat c. Not painful i. Hot / red then bluish/yellow d. Discrete nodules e. 1-2 wks - then desquamate f. Usually i. Lower legs ii. Can be on arms / face g. Young 18-34 h. F > M |
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how diff
Staphylococcus vs streptococcus |
catalase
staph is catalase+ |
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how diff staph aureus from other staph?
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coagulase
staph aureus is the only coagulase+ staph |
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i. Normal skin flora
1) Opportunistic |
Staphylococcus epidermidis
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name the bacteria
i. Group A (GAS) ii. Beta hemolytic iii. Bacitracin sensitive iv. Primary infection 1) Strep throat |
streptococcus pyogens
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Toxic shock syndrome
toxin? |
TSST-1
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what are ETA and ETB
disease? |
exfoliative toxin A & B
Scalded skin syndrome (SSS) - staph aureus |
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what causes Scalded skin syndrome (SSS)
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staph aureus
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MOA of ETA & ETB?
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a) Are serine proteases
b) Break part of desmosomes i) Which are cell adhesion structures THIS is why vesicles form - cells not holding down to other layers correctly |
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Dx?
ii. Small vessicles → crust iii. Face / extremities iv. Painless - may itch Regional lymphadenopathy - common |
Nonbullous impetigo
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Dx?
1) Fluid filled vesicles a) HAS ORGANISM = infectious 2) From a) Staph aureus - expressing exfoliative toxin A & B 3) Face / extremities 4) Sx a) Painless b) Fever c) Diarrhea d) Weakness e) Lymphadenopathy - UNCOMMON |
Bullous impetigo
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Dx?
ii. More severe form of impetigo iii. Starts as pustule over inflamed skin 1) → ulcer w/crust iv. From 1) Strep pyogenes 2) Staph aureus v. 1) MRSA 2) Didn’t respond to cephalexin - switched to clindamycin - fine |
Ecthyma
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1 word to describe infection around hair follicles
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folliculitis
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- enlarged infected follicle
- also called a boil |
furnuncle
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what general type of skin lesion
1) Pus - ↑ PMNs 2) Fibrin deposition → sequestration of bacteria 3) Coagulase helps keep the bacteria around too |
abscess
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Dx?
2) Infection of subcutaneous tissue 3) Sx a) Redness b) Swelling c) Heat d) Tenderness 4) Rapid spread via lymphatics - RED STREAKING 5) Can dev → severe septicemia in 1-2d 6) Legs - most common 7) Burn pts / wounds / skin abrasions 8) 90% from a) Staph aureus b) Strep pyogenes 9) Pasteurella multicoda a) Can cause after bite /scratch from cat/dog |
Cellulitis
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Dx?
sandpaper rash i. From exotoxin (Spe A & C) 1) Erythrogenic 2) Or pyogenic ii. Sx 1) Rash preceded by a) Pharyngitis b) Fever c) Headache 2) Rash in 10% pts w/strep throat 3) Neck → trunk → extremities 4) 3-4 days → desquamation |
Scarlet fever
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Dx?
i. From 1) Strep or 2) Staph ii. Sx 1) Hypotension 2) Tachycardia 3) Multiorgan dysfunction 1) Temp > 38.9 C 2) Hypotension (systolic < 90mmHg) 3) Sunburn like rash 4) Rash w/ desquamation (esp palms / soles) |
Toxic shock syndrome
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Dx?
Rickettsia rickettsii = obligate intracellular pathogen ii. Rash 1) 5-10 days post 2) Starts wrists / ankles |
Rocky mountain spotted fever
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Rocky mountain spotted fever
bacterial cause? |
Rickettsia rickettsii
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Dx?
i. From 1) Pseudomonas aeruginosa septicemia ii. Septicemia 1) 1-13% cases 2) Immunocompromised - oportunistic iii. Bacteria infects blood vessels in dermis / subcutaneous layers 1) Necrotizing vasculitis 2) → ↓ blood supply to skin 3) → necrotic lesions in skin iv. Red macule / papule 1) → becomes hemorrhagic w/ necrosis at the center 2) Eschar - ulcers that develop hemorrhagic crust a) Black necrotic center in the middle |
Ecthyma gangrenosum
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a. Erythema infectiosum
i. AKA Fifth disease ii. From ? |
1) Human parvirus B19
2) Droplets - winter and spring |
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Dx?
4) "gloves and shock" syndrome a) Young adults b) Swelling c) Pain d) Purpuric papules - hands / feet i. AKA Fifth disease ii. From 1) Human parvirus B19 2) Droplets - winter and spring |
Erythema infectiosum
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Dx?
1) Coxsackie A16, A5, A10, B1, B3 a) REMEMBER COXSACKIE A16 2) RNA virus, pcomavirus famile 3) Enteroviruses ii. Summer - early fall iii. Sx 1) Sore mouth 2) Fever 3) Malaise 4) Diarrhea 5) Joint pain 6) Lymphadenopathy 7) Skin a) Red football shaped or oval papules on acral sites b) +- exanthem / red papules - on proximal extremities 8) Mucosa a) Papules and vesicales → erosions iv. Dx 1) Lesions on hands / feet / mouth 2) Serum for coxsackie virus a) Don’t really do this 3) Viral cultures from throat or stool v. Tx 1) Supportive 2) Self-limited - lasts 1 week |
Hand foot & mouth syndrome
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*** main cause of Hand foot & mouth syndrome
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COXSACKIE A16
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Dx?
i. AKA Exanthem subitum ii. AKA Sixth disease iii. From 1) Human herpesvirus 6 (HHV 6) 2) Respiratory spread * |
Roseola infantum
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i. A herpes virus
Incubation 3-7 wks iii. Infectious mononucleosis 1) EBV is primary cause of mono |
Epstein-Barr virus
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HSV1 (oral/genital?)
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1 = oral
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HSV2 (oral/genital?)
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2 = genital
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Dx?
1) Hypersensitivity reaction a) → causes targetoid red plaques i) On palms / soles / maybe mucosal surfaces |
Erythema multiforme from herpes simplex
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Dx - cause?
v. Dewdrop on a rose petal 1) Vesicle on a erythematous base 2) Clear / translucent 3) Pink hue at base 4) Several at various stages a) Helps DDx from other diseases - such as small pox (large and monomorphous) |
i. Varicella=zoster virus (VZV)
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what trimester is Congenital varicella syndrome
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1st trimester
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what is
Ramsay Hunt syndrome? |
herpes zoster infection
i) Facial / auditory nerves (geniculate ganglion) ii) External ear / tympanic involvement iii) Facial paralysis iv) Auditory probs - tinnitus / deafness / vertigo / nausea / vomiting / nystagmus d) Delayed contralateral hemiparesis i) Simulates stroke |
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Dx?
1) From East Africa ii. US in 1999 iii. Primary complications - neurologic 1) Seizures 2) Ascending flaccid paralysis 3) Ataxia 4) Meningitis 5) Encphalitis 6) Myelitis 7) Cranial neuropathies 8) ↓ LOC (level of consciousness) iv. Cutaneous signs 1) Nonspecific 2) Non-pruritic 3) Erythematous macules / patches (5mm-1cm) v. Dx 1) Serum or CSF for IgM for WNV (ELISA) |
West Nile virus
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what specifically causes:
1) Neonates / young children 2) Adults - in renal and immunocompromised pts 3) Staph infection in a) Pharynx b) Nose c) Ear d) Conjunctiva 4) Erythema skin folds a) Palms / soles b) Mucous membranes - SPARED |
SSSS - exfoliative exotoxins types A & B
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which bacteria causes TSS
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staph aureus
strep A or B |
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what are
Janeway spots |
a) NOT painful
b) Septic emboli c) Non-tender hemorrhagic lesions on palms |
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Most frequently reported and most severe rickettsial disease
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Rocky mountain spotted fever
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Dx?
i. From 1) Neisseria meningitidis a) Gram (-) b) Diplococcus ii. Human nasopharynx - reservoir - 10% carrier rate iii. Can cause life threatening acute meningitis w/septicemia iv. Cutaneous 1) Petechial eruption → ecchymosis / hemorrhagic bullae / ischemic necrosis 2) Angular infarcted lesions - "gun-metal" gray interior 3) Purpura fulminans - diffuse 4) Exanthum like pustules less common v. Looks like rocky mountain spotted fever vi. Dx 1) Gram stain of skin lesion 2) Blood or CSF culture vii. Tx 1) Cefotaxime 2) PCN G 3) Cefotaxime 4) Chloramphenicol 5) Trimethroprim-sulfamthoxazole (TMP-SMX) viii. Vaccine 1) Who gets a) Children 11-12 yo b) High school c) College freshmen d) Military recruits e) Terminal compliment deficiencies f) Splenectomy pts g) Travelers to endemic regions - Africa, India, middle east , nepal |
Meningoccemia
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Tinea capitis are what type of infection? where
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fungal infections on the scalp
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Onychomycosis are what type of infection? where?
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fungal infections in the nails
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how Dx fungal infections
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i. KOH prepe
1) Scrape - add KOH - put on slide 2) Will see hyphae ii. Wood's lamp 1) 365nm UV light 2) Some fungi will have yellow-green fluorescence |
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Woods lamp - UV
365nm to Dx fungal infections what color is positive? negative |
yellow - positive
negative - doesnt fluoresce |
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Treponemal - a spirochete bacterium that is parasitic or pathogenic in humans and warm-blooded animals, including the causal agents of ?
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Syphilis
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1st line Tx for Syphilis
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Benzathine penicillin
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Dx?
b) Hutchinson's triad i) Hutchinson's teeth ii) Interstitial keratitis iii) 8th nerve deafness iv) A. Conical shaped teeth |
Prenatal (congenital syphilis)
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Dx?
a) Gram (-) b) Diplococcus c) Intracellular Incubation 2-10 days iii. Males 1) Urethritis 2) 15% asymptomatic 3) Complications a) Epididimytis b) Seminal vesiculitis c) Prostatitis iv. Females 1) Acute cervicitis 2) Salpingitis 3) Pelvic inflammatory disease 4) 50% asymptomatic v. Sx - other 1) Proctitis 2) Pharyngeal 3) Conjunctival 4) Disseminated vi. Tx 1) Ceftriaxone a) + azithromycin or doxycycline |
Gonorrhea
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what bacteria causes Gonorrhea?
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Neisseria gonorrhoeae
a) Gram (-) b) Diplococcus c) Intracellular |
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Dx?
i. From 1) Haemophilus ducreyi a) Gram (-) b) Bacillus c) "school of fish" Incubation 3-5 days ii. Painful ulcer 1) Bubo 2) From lots of inflammation iii. Tx 1) Azithromycin 2) Ceftriaxacin 3) Ciprofloxacin 4) Erythromycin base |
Chancroid
(bacteria) (STD) |
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what bacteria
a) Gram (-) b) Rod c) "Donovan bodies" |
Calymmatobacterium granulomatis
(STD) |
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Tx for Calymmatobacterium granulomatis
(STD) |
Doxycycline
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Pediculosis pubis - Phthirus pubis
is commonly known as _________, because ___________. |
crabs - Claws specifically for hanging onto pubic hair
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Dx?
i. Poxvirus Incubation 2-7 wks iii. Small shiny umbilicated papules 1) Little volcanoes 2) In skin folds 3) Little kids get all the time iv. Tx 1) Destruction a) Liquid nitrogen b) Topical blistering agent 2) Imiquimod - off label use 3) Retinoids 4) Tape - very superficial |
Molluscum contagiosum
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Condyloma acuminata
is caused by what virus |
Human papilloma virus
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in HIV, 87% of pts have cutaneous signs if CD4 < ?
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100
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Exanthem = ?
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Exanthem = widespread rash
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5th disease or erythema infectiosum is what virus
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parovirus B19
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6th disease or exanthema subitum is what virus?
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Human herpesvirus 6(7)
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Molluscum contagiosum virus (DNA pox virus) - makes what kind of lesion
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Smooth plaques
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Warts (common / flat / plantar)
Genital warts (condyloma acuminatum) caused by what virus? what type of lesion? |
Human papillomavirus (HPV)
Verrucouc papules |
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Herpetic whitlow
- infection of what and where - who get it |
herpes simplex infection of finger
- enter through break in skin - nurses / docs/ dentists/ child who sucks thumb |
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Herpetic gladiatorum
- what - who |
herpes simplex on skin
- wrestlers |
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what is
Eczema herpeticum |
Children w/eczema -
Makes it easier for HSV to spread to skin |
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Dx?
ii. Dome shaped papules iii. Central depression (umbilicated) |
Molluscum contagiosum
a. DNA pox virus b. Transmission i. Skin-skin contact ii. Exposure to infected fomites c. Children < 5 y/o d. Adults - STD |
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what 2 types of HPV cause:
Anogenital warts (condyloma acuminatum) Pink/brown nodules Cauliflower like lesions |
HPV
6 11 |
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what is the mechanism that causes viral exanthems in children?
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rash is from immune response to virus
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Dx?
Sx - Respiratory tract - Rash - Koplik's spots |
Measles
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Rubella is called by what virus
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togavirus
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Congenital rubella syndrome (CRS) manigests when
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1st trimester
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primary Varicella-Zoster is called?
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chicken pox
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Dx?
Incubation 14-21 days iii. Sx 1) Fever 2) Headache 3) Rash a) Pustules / vesicles / crusts b) Trunk / face/ limbs / buccal / pharyngeal mucosa c) Crops of pocks over 2-4 days 4) Contagious during the incubation period - before Sx a) Until pox crust over |
chicken pox - varicella-zoster
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60x ↑ of infection of _____________ post chicken pox
- THIS IS WHY YOU SHOULD GET THE VACCINE - causes Necrotizing fasciitis |
Invasive group B strep (GAS)
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zoster lays latent in what before it reactivates in shingles?
results in what Sx? |
neurons
Postherpetic neuralgia (persistent pain) |
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__________________ = exanthema subitum = 6th disease = roseola
Ubiquitous i. 100% seropositivity by age 2 b. Replicates in salivary glands i. Spread via oral secretions Latent infection in T cells and monocytes |
Human herpesvirus type 6 (HHV-6)
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Erythema infectiosum = 5th disease
- what virus - what does it like to infect? |
parovirus B19
erythroid progenitor cells (precursors to RBCs) daycare common |
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most common viral cause of Hand foot and mouth disease
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coxsackie A16
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common name for dermatophytes?
3 genera - DDx by micro |
ringworm
1) Microsorum 2) Trichophyton 3) Epidermophyton floccosum |
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Anthropophilic
is a fungal infection which came from? |
people
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Zoophilic
is a fungal infection which came from? |
animals
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Geophilic
is a fungal infection which came from? |
Soil
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Tinea = ?
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ringworm
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Onychomycosis - fungal infection of ?
|
Onychomycosis - fungal infection of the nails
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Trichophyton rubrum
is the main fungus that causes? |
tinea pedis
athletes foot |
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Most common cause of athletes foot / nail infection (onychomycosis)?
|
Trichophyton rubrum
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the bacterial infection is called?
bacterial infection that came in from cracks formed between toes of tinea pedis infectio |
Cellulitis
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most common cause of tinea in the US?
what does it cause? |
Tinea tonsurans
iii. Endothrix 1) Arthroconidia - IN hair shaft 2) Hair cuticle remains intact 3) Does NOT fluoresce |
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2x methods to Dx fungal infections
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- KOH skin scrapping
- culture w/ Woods lamp (UV) |
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Terbinafine is used to Tx fungal infections. It is an allylamine - what is its MOA?
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inhibits ergosterol synthesis - part of the cell membrane
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azoles MOA?
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inhibits ergosterol synthesis - part of the cell membrane
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Griseofulvin MOA?
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Disruption of microtubules / inhibition of mitosis
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Ciclopirox
MOA unknown what is it used to Tx? |
2) Used for dermatophytes / candidiasis / malassezia furfur
3) Cream / lotion / shampoo / nail lacquer |
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most common Candidiasis?
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Candida albicans
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this is what most likely caused by what
|
oral thrush
candida albicans |
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Dx / cause?
1) Budding yeast cells / pseudohyphae 2) Yeast cells alone are not significant |
Cutaneous candidiasis
probably albicans |
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most common superficial mycoses
Oily areas - *this is what grows if you put lotion on your feet maybe |
Malassezia furfur
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Dx?
1) Light (hypopigmented) / coppery brown lesions 2) On a) Trunk b) Shoulders c) Arms d) Rarely neck / face 3) Sx a) Mild itching b) Summer - lesions don’t tan 4) Dx a) Clinical appearance i) b) Fluoresce under Woods light c) Skin scrappings reveal yeast & pseudohyphae (spaghetti & meatballs) |
Tinea versicolor
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Dx?
- Pityriasis folliculitis - Papules / pustules - at hair follicules - Seborrhoeic dermatitis & danruff = Flaky white-yellowish scales |
Malassezia furfur
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Hortiaea werneckii
is a Dematiaceous fungus - soil / compost / wood that causes? |
Tinea nigra
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what are these:
i. Sporotrichosis ii. Phaeohyphomycosis iii. Chromoblastomycosis iv. Mycetoma |
Subcutaneous mycoses
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most common Subcutaneous mycoses in US
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Sporotrichosis
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Tx of choice for Sporotrichosis - a subcutaneous mycoses
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Itraconazole
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seen in what fungal infection?
Sclerotic bodies 1) In lesions 2) Thick-walled cells w/horizontal or vertical septa |
Chromoblastomycosis
in soil from plant debris |
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Dx?
From bacteria OR fungus Fungal cause - Eumycetoma (called) Bacterial cause - Actinomycetoma (called) ii. Traumatic inoculation - soil iii. Chronic suppurative infection iv. Abscess formation (NOT DRY - like cauliflower which is dry) |
Mycetoma
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5x blistering diseases of the skin
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a. Pemphigus
b. Bullous pemphigoid c. Dermatitis herpetiformis d. Epidermolysis bullosa e. Porphyria |
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Outer most layer of epidermis - no nuclei
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Stratum corneum
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layer of epidermis Has desmosomes - connects kerotinocytes to each other
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Stratum spinosum
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which layer of the epidermis does not have nuclei?
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stratum corneum
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Dx?
Autoantibodes → attachments break → fluid accumulation → bullae forms |
Pemphigus
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most common type of Pemphigus
|
Pemphigus vulgaris
a) Superficial vesicles b) Rupture - leaving shallow erosions covered w/ dried serum and crust c) Acantholysis i) ↓ intercellular adhesions - connect squamous cells |
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Dx?
a) Superficial vesicles b) Rupture - leaving shallow erosions covered w/ dried serum and crust c) Acantholysis i) ↓ intercellular adhesions - connect squamous cells |
Pemphigus vulgaris
|
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1) Localized
2) Less severe form of Pemphigus foliaceus 3) Like butterfly rash of lupus - malar area |
Pemphigus erythematosus
|
|
Dx?
old people v. Linear deposition of IgG & complement in basement membrane 1) In basal cell-basement membrane attachment plaques 2) BPAG2 (bullous pemphigoid antigen 2) |
Bullous pemphigoid
|
|
Dx?
i. 20-30s ii. M > F iii. Urticaria & vesicles iv. Associated w/celiac disease v. On 1) Elbows 2) Knees 3) Back vi. Subepidermal blisters 1) w/granular deposition of IgA 2) Tips of dermal papillae a) Small microabscesses instead of large/broad b) Looks like herpes (but no relationship) 3) Some dermatoepidermal separation |
Dermatitis herpetiformis
|
|
|
- associated w/Celiac
- subepidermal blisters - IgA deposition - looks like herpes but no association |
Dermatitis herpetiformis
|
|
|
Vampires - people think this is what vampires had - went out into sun and scarred up
|
Porphyria
|
|
what is
Porphyria 3x |
- scars from sun
- Urticaria (itchiness / dryness) - subepidermal vesicle - w/thickening of the walls of the superficial dermal vessels |
|
Dx?
Early - Papulovesicular oozing crusted lesion Later - Raised scaling plaques ii. Histopathology 1) Spongiosis (squamous cells separate from each other looking like a sponge) 2) Lymphocytic infiltrate 3) Mast cell degranulation Sharply demarkated |
Acute eczematous dermatitis
|
|
|
what is/causes:
2) TEN (toxic epidermal necrolysis) a) Very severe form of Stevens-Johnson syndrome Medical emergency - one of the only derm emergencies |
erythema multimorme
From 1) Hypersensitivity to infection / drugs 2) Malignancies - carcinomas Collagen vascular diseases - lupus |
|
Dx?
iv. Acanthosis - epidermal thickening v. Auspitz sign 1) Parts of the epidermis thin - blood vessels prone to bleeding vi. Munro's abscesses vii. Usually painless - more of a cosmetic issue |
Psoriasis
|
|
Dx?
|
Psoriasis
|
|
Dx?
i. What (4 P's) 1) Pruritic 2) Purple 3) Polygonal 4) Planar papules and plaques ii. Wrists - symmetric iii. Lymphocytes at dermalepidermal junction iv. Necrosis of keratinocytes v. Wickham's striae 1) White dots on papules caused by hypergranulosis |
Lichen planus
|
|
what are the 4 Ps of Lichen planus?
|
1) Pruritic
2) Purple 3) Polygonal 4) Planar papules and plaques |
|
what is the type of lesion pictured called?
|
exophytic nodule
|
|
what is the type of lesion pictured called?
|
endophytic nodule
|
|
what is the type of lesion pictured called?
|
macule
|
|
what is the type of lesion pictured called?
|
papule
|
|
what is the type of lesion pictured called?
|
patch
|
|
what is the type of lesion pictured called?
|
plaque
|
|
what is the type of lesion pictured called?
|
vesicles
|
|
what is the type of lesion pictured called?
|
bulla
|
|
what is the type of lesion pictured called?
|
fissure
|
|
what is the type of lesion pictured called?
|
erosion
|
|
what is the type of lesion pictured called?
|
ulcer
|
|
|
what is an ephelis
|
freckle
|
|
|
what is the medical name for freckle
and are of what type of lesion |
ephelis
macule |
|
|
Most common pigmented lesion of childhood
|
Freckle (ephelis)
|
|
Dx?
|
Lentigo
|
|
|
common name for
Melanocytic nevi |
mole
|
|
general Dx?
|
Melanocytic nevi (mole)
|
|
|
describe each of the 3 stages of changes a melanocytic nevi goes through
- junctional nevi - compound nevi - intradermal nevi |
|
|
|
how DDx melanocytic nevi from cancer
|
maturation
melanomas have no differentiation |
|
name each
|
A - Nondysplastic nevi
B - junctional nevus C - compound nevus (dermis and epidermis) D - dermal only |
|
Dx - specific kind of nevus?
|
Spitz nevus
|
|
Dx?
- Heavy infiltration of the nevus by lymphocttes and histocytes - Can be confused w/melanoma / lymphoma / dermatitis |
Halo nevus
|
|
Dx?
|
Dysplastic nevi
|
|
Dx?
|
Malignant melanoma
|
|
|
how do you know it is Malignant melanoma?
|
> 10mm (most) (> 6mm is concern)
- Melanoma cells > nevus cells - Asymmetric - Irregular border (notched) |
|
|
* most important sign of Malignant melanoma is
|
change in color / size/ shape of a pigmented lesion
ABCD • Asymmetry (1 side looks different than the other) • Border (irregular border - looks like someone bit something out of it) - notched • Color (dark - but variable - some dark, some blue or red or white) • Diameter (> 6mm) |
|
|
what are the ABCDs of Malignant melanoma
|
ABCD
• Asymmetry (1 side looks different than the other) • Border (irregular border - looks like someone bit something out of it) - notched • Color (dark - but variable - some dark, some blue or red or white) • Diameter (> 6mm) |
|
|
what are the 2 general tumor suppressor gene mutations in malignant melanoma?
|
- RB (retinoblastoma)
- PTEN |
|
|
___________- encodes tumor suppressors:
□ P15 / INK4b □ P16 / INK4a □ P14 / ARF ® P53 tumor suppressor - inhibits MDM2 oncoprotein → ↑ melanocytic proliferation - escape oncogene induced senescence |
CDKN2A
|
|
|
Familial melanoma syndrome has a mutation in chromosome 9pq21 which encodes _____________
which when deleted → unrestricted phosphorylation of RB → uncontrolled cell growth |
CDNK2
|
|
Dx?
- Asymmetric - Borders - notched - Color - variable - dark and depigmented - Diameter > 6mm (like 20) |
malignant melanoma
|
|
Dx?
|
malignant melanoma
|
|
what staining - seen here - brings out malignant melanocytes
|
S-100
|
|
|
- Most common intraocular malignancy in adults
|
Ocular melanoma
|
|
Dx?
- Looks like a dried out cornflake - BENIGN but: - Explosive onset = internal malignancy (GI - adenocarcinoma) • Syndrome of Leser Trelet |
Seborrheic keratosis (SKs)
|
|
Dx?
- Mimics squamous cell carcinoma • Can be considered a well differentiated carcinoma - Heals spontaneously (unlike squamous cell ca) M > F 50+ |
Keratoacanthoma
|
|
|
what causes Verrucae (warts)?
|
HPV (human papillomaviruses)
|
|
|
Pebble like lesion on hands from HPV
|
verruca vulagaris
|
|
|
HPV on soles of feet called?
|
Verruca plantaris
|
|
|
what is
Actinic keratosis (AK) |
- Dysplasia of squamous cells
Precursor of squamous cell carcinoma |
|
Dx?
- Dysplasia of squamous cells Precursor of squamous cell carcinoma |
Actinic keratosis (AK)
|
|
|
Dx?
sunlight arsenic chewing tobacco lips - lower lips scaling plaques invasive atypia at all levels |
squamous cell carcinoma
|
|
Dx?
|
squamous cell carcinoma
|
|
|
Dx?
pearly papules UPPER LIPS |
basal cell carcinoma
|
|
|
cancer on the upper lips
|
basal cell carcinoma
|
|
Dx?
upper lips |
basal cell carcinoma
|
|
|
********
which of the following is least like to mets |
pick basal cell carcinoma
|
|
|
********
which of the following is least like to mets |
pick basal cell carcinoma
|
|
Dx?
a. "Creeping eruption" b. Etiology/causes i. A. braziliense ii. A. caninum c. Transmitted by skin penetration d. Sx i. Raised erythematous / serpiginous / pruritic lesions e. Dx i. Clinical f. Rx i. Topical / oral thiabendazole ii. Albendazole g. Risk i. Sandboxes ii. Warm sandy soil |
Cutaneous larva migrans (CLM)
|
|
Dx?
|
Cutaneous myasis
|
|
Dx?
|
Cutaneous Leishmaniasis
|
|
|
most severe form of leishmaniasis
- 100% mortality - potential AIDS indicator |
Visceral leishmaniasis (VL)
|
|
Volcano sign
is a sign of what? |
Cutaneous leishmaniasis
|
|
|
Potential AIDS INDICATOR
|
Visceral leishmaniasis
|
|
|
Hansen's disease (HD)
is better known as? why is it named after him? |
Leprosy
i. 1841-1912 1st to say it is a microbe and NOT HEREDITARY |
|
|
2x bacteria that cause leprosy
|
Mycobacterium leprae
Mycobacterium lepromatosis |
|
|
Dx?
ACID FAST Mycobacterium leprae Mycobacterium lepromatosis |
Leprosy
|
|
|
2x how Dx Leprosy
|
Pin prick
Punch biopsy |
|
|
transmission of leprosy is mainly via?
|
Respiratory - through broken skin
NASAL DROPLETS armadillos (this was also in a Uworld question) |
|
|
where do the bacteria live in leprosy
|
macrophages
|
|
|
Dx?
- Macular hypopigmented / copper skin lesions - scaly plaques - Nerve damage |
leprosy
|
|
|
how does pin prick Dx of leprosy work?
|
if they dont feel pin prick - could be leprosy
from schwann cell infection -> demyleniation |
|
|
what is the only animal that can harbor the bacteria leprosy infection
|
armadillo
|
|
|
how much does skin weigh
|
6 pounds
|
|
Dx?
Most common benign cutaneous neoplasm |
Seborrheic keratosis
|
|
|
what is
Dermatosis papulosa nigra |
a) Black / asians
b) Female c) Family predisposition d) Young / middle aged e) Tx i) Light ii) Avoid liquid nitrogen - hypopigmentation |
|
Lines of Blaschko
represent/from? |
of BlaschkoRepresents pathways of epidermal cell migration / proliferation during fetal dev
|
|
|
medical name for
Any congenital skin lesion (birthmark) which is ii. A type of hamartoma 1) Circumscribed stable malformation of the skin / oral mucosa 2) Not from external causes Epidermal / CT / adnexal / nervous / vascular |
nevus
|
|
|
name for
1) Tumor-like nodule 2) OVERGROWTH of mature cells - of a type that is normally there a) But one element of that type of cell predominating |
haratoma
|
|
name for/Dx?
|
Nevus sebaceus
|
|
Dx?
|
Infundibular cyst
|
|
|
Dx?
epidermal cyst on the scalp F 60+ |
Pilar cyst - isthmus-catagen cyst
|
|
Fibrous reaction to trauma / ingrown hair
|
Dermatofibroma
|
|
Dx?
subcutaneous far tissue trunk |
lipoma
|
|
- Most common benign tumor of childhood
- Present at birth in 1/3 of cases - Grows over the 1st year or so - Stabilize then involute |
Hemangioma
|
|
|
what is PHACE syndrome?
|
PHACE syndrome
- Posterior fossa brain malformations - Hemangiomas - Coarctation of the aorta (narrowing at where ductus arteriosus connected) - Cardiac defects - Eye abnormalities |
|
|
___% of UV radiation GOES THROUGH CLOUDS!
|
90% of UV radiation GOES THROUGH CLOUDS!
|
|
|
which is worse - UVA or UVB
why |
UVB
damages DNA |
|
|
what are
Lentigines |
|
|
what is this called
|
Cutis nuchae
|
|
|
what is
Actinic chelitis |
Erythema and scale of lower lip
|
|
|
half of all cancers in the US are?
|
non pigmented skin tumors
|
|
|
- Most common malignancy in humans
- 80% of all skin cancers |
Basal cell carcinoma
|
|
|
- Most common malignancy in humans
- 80% of all skin cancers |
Basal cell carcinoma
|
|
|
Dx?
- Arise from basal keratinocytes of epidermis and adnexal structures - UVB radiation damages • the DNA and • repair system and • Immune system - Can also form at trauma sites - scars / burns / radiation Tx |
Basal cell carcinoma
|
|
Most common form of basal cell carcinoma
telangiectasias |
nodular BCC
|
|
a type of BCC
1) Insidious 2) Waxy / firm / pale white or yellow a) Looks like localized scleroderma 3) Average subclinical extension 7.2mm |
Sclerosing or morpheadorm BCC
|
|
1) Least aggressive BCC
2) Trunk / extremities 3) Spreads peripherally for a long time - then becomes invasive 4) Aldara - Tx |
Superficial BCC
|
|
Dx?
i. 20% nonmelanoma skin cancers ii. Some mets risk iii. Etiology 1) Low mets a) Actinic damage 2) High mets a) Prior radiation b) Thermal injury c) Draining sinus iv. Organ transplants (253x risk for renal transplants) v. vi. Risk factors 1) UVB exposure a) P53 mutation 2) Southern climates 3) HPV 6 and 11 - genital tumors 4) HPV 16 - periungal tumors 5) Arsenic exposure 6) Transplant - major problem vii. Gross 1) Rougher and scalier than basal cell |
Squamous cell carcinoma
|
|
|
Merkel cell carcinoma
what does a Merkel cell do |
Slow acting mechanoreceptor
|
|
|
Highest rate of mets of skin cancer
|
Merkel cell carcinoma
|
|
skin carcinoma
- 80% from virus - < 20% 5 yr survival |
Merkel cell carcinoma
|
|
|
what is
Ephelis |
Freckle
b. Pigmented basilar keratinocytes c. Mild ↑ in # of melanocytes d. ↑ by sun |
|
a. Liver spots
b. Sun exposed areas c. .2 - 2cm diameter d. ↑ w/age e. Any lesion w/highly irregular border / thickening / asymmetry i. Should biopsied f. Rete ridge hyperplasia |
Lentingines
|
|
|
what is
Peutz-Jeghers syndrome |
a type of lentingines - liver spots
a) Autosomal dominant b) Pigmented macules on i) Lips ii) Oral mucosa iii) Perioral iv) Sacral c) GI polyps - small intestine d) 15x ↑ cancer e) GI most frequent |
|
|
what is
LEOPARD syndrome |
a type of lentingines - liver spots
a) Lentigines b) EKG abnormalities c) Ocular hypertelorism d) Pulm stenosis e) Abnormalities of genitalia f) Retardation of growth g) Deafness |
|
|
Acquired nevi - show up after __ months old
|
Acquired nevi - show up after 6 months old
|
|
Dx - junctional or compound or dermal nevi?
|
dermal
|
|
|
*** if a derm lesion is blue - what layer is it in?
|
blue = in dermis
|
|
|
*** if a derm lesion is blue - what layer is it in?
|
blue = in dermis
|
|
Dx?
1) Blue grey macule 2) In 80-90% of them are in a) Asian b) Southern European c) American black d) Native american 3) 100% of pure mayan indians 4) Disappears during childhood 5) Can look like child abuse |
Mongolian spot
|
|
Dx?
1) Oculodermal melanosis 2) May not show until teens a) Most that have eye involvement have it at birth (2/3) 3) Grows slowly - then persists 4) 80% F -asians 5) Mostly a cosmetic problem 6) Rare malignant transformation a) choroid |
Nevus of Ota
|
|
Dx?
types a) Common i) Young ii) Steel blue papule or nodule iii) 2-10mm iv) On A. Dorsal hands B. Feet C. Face v) Malignant potential b) Cellular i) Large ii) Firm iii) Blue / black nodule iv) 40+ y/o v) 10-20mm vi) Malignant potential |
Blue nevus
|
|
what is a
spitz nevus? |
a type of dermal pigmented nevus
1) AKA Benign juvenile melanoma 2) Pink 3) Smooth - surfaced / raised / round / firm papule 4) Before 20s 5) Often no pigment 6) Tx a) Too hard to DDx from melanoma b) So biopsy all |
|
|
which spitz nevus lesions should you Bx?
|
all of them - b/c hard to DDx from melanoma
|
|
|
Most common cancer in young adults 25-29 y/o
|
Malignant melanoma (MM)
|
|
Dx?
|
Malignant melanoma (MM)
|
|
Dx?
|
Malignant melanoma (MM)
|
|
Dx?
|
Malignant melanoma (MM)
|
|
how wide would this have to be to be a concern
|
> 2mm
|
|
|
what is used to determine prognosis of melanoma
|
depth of tumor
< 1 mm = good prognosis (epidermis only) |
|
|
melanoma is most often found where
- M - F |
M - upper back
F - lower legs and upper back |
|
|
50% of melanomas have _______ gene
|
50% of melanomas have BRAF gene
|
|
|
which category of agents is the highest priority?
|
category A
|
|
|
what bioterrorism category are these:
i. Plague ii. Tularemia Hemorrhagic fever virus |
category A
|
|
name this virus and its disease:
i. Large ii. DNA virus iii. Brick shaped * Centrifugal rash Pearls of pus |
Variola virus
smallpox |
|
|
Dx?
Single case = international emergency - staining - viral culture - FBI transports specimen |
Variola virus
smallpox |
|
Dx?
|
Variola virus
smallpox |
|
|
smallpox - variola virus
Once scabs separate - pt is no longer infectious Takes ___ days |
smallpox - variola virus
Once scabs separate - pt is no longer infectious Takes 21 days |
|
|
how DDx chickenpox from smallpox
|
chickenpox is
- all over the place - superficial - in different phases of evolution [small pox is consistent - all in same phase] |
|
what is the animal vector of cowpox
|
rodents
|
|
|
who gave the first vaccination
Used cowpox to vaccinate against smallpox |
Edward Jenner
|
|
|
Wait __ weeks between chickenpox or TB vaccine and smallpox
|
Wait 4 weeks between chickenpox or TB vaccine and smallpox
|
|
|
what is a philtrum
|
indent above upper lip
|
|
- dandruff
- scaly, flaky, itchy, and red skin - particularly affects the sebaceous-gland-rich areas of skin - yellow/waxy |
Seborrheic dermatitis
|
|
|
***
- Scaly - Prediliction for eyebrows / scalp / labial folds |
= seborrhea
|
|
|
***
- Scaly - Prediliction for eyebrows / scalp / labial folds |
= seborrhea
|
|
Dx?
- Itch (pruritus) that rashes - itch/scratch/open-> infection cycle - a type of eczema, an inflammatory, relapsing, non-contagious and pruritic (itchy) skin disorder |
Atopic dermatitis
|
|
Trichophyton tonsurans
is the main cause of what in the US |
tinea infection
|
|
how DDx tinea from lupus or psoriasis
|
annular (ring) - CENTRAL CLEARING
|
|
is this tinea?
- no scale but annular |
NO - it is indurated (firm) - so NOT tinea
|
|
|
dystrophic nails are the tell tail factor of what
likes between toes |
tinea infection
|
|
caused by pityrosporum
worse in summer dull red/brown fine dust like scale |
tinea versicolor
|
|
Dx?
|
Psoriasis
|
|
Red plaques
thick silvery scale inflammatory disease |
Psoriasis
|
|
Dx?
|
psoriasis
|
|
2x causes of
Lichen planus |
- drugs (diuretics)
- hepatitis |
|
central collarette
salmon colored Dx? |
Pityriasis rosea
|
|
|
red/scaly lupus
which type - discoid or systemic |
discoid
|
|
|
red / SMOOTH lupus
which type - discoid or systemic |
systemic
|
|
3 listed causes of contact dermatitis
which is #1? |
plants
nickel fragrence - #1 |
|
why would you think you are dealing with Cutaneous T-cell lymphoma (CTCL)?
How Dx to confirm your suspicion? |
looks liek psoriasis - but no responding
Dx - punch Bx |
|
|
match - open/closed comedone with
black/white head |
open - white
closed - black |
|
|
4 steps to pathogenesis of acne
|
1 - open comedone (white head) - sticky from sebacous gland
2 - shed keratin & sebum build up 3 - inflammatory pustule forms 4 - nodule / cyst - lots of inflammation -> scarring |
|
|
these drugs can cause what?
2) Phenytoin 3) Iodide / Isoniazide 4) Methotrexate (folate) 5) Phenobarbital 6) Lithium 7) Ethambutol 8) Steroids |
PIMPLES (acne)
|
|
|
MOA
Benzoyl peroxide Tx acne vulgaris |
Unblocks follicular plugging
|
|
|
what acne Tx is safe for pregnancy (topical)
|
azelaic acid
|
|
|
what acne Tx is used for 8-12yo pts (topical)
|
salicylic acid
|
|
|
match skin type and ointment type
oily/dry skin cream or lotion / gel |
oily - gel
dry - cream/lotion |
|
|
when using topical retinoids - which are good for Tx ALL forms of acne, what do you need to be careful of?
|
sun sensitivity
use sunscreen |
|
|
what topical retinoid should you NOT use during pregnancy?
which is the only pregnancy catagory x |
tretinoin
Tazarotene |
|
|
acne Tx that is
Antimicrobial and keratolytic |
benzoyl peroxide
|
|
|
Azelaic acid is used mostly to Tx?
|
rosacea
|
|
|
what antibiotic can cause
Steven's Johnson syndrome what is that? |
TMP-SMX (bactrim)
Serious rash-TEN (Steven's Johnson syndrome) - rare but really bad - toxic epidermal necrolysis (TEN) hives / photosensitivity |
|
|
how much or for how long do you take Accutane for?
isotretinoin |
NOT BASED ON TIME - BASED ON WEIGHT - NEED TO GET 120-150MG / KG INTO YOU
|
|
|
drug (real and trade name)?
NOT BASED ON TIME - BASED ON WEIGHT - NEED TO GET 120-150MG / KG INTO YOU |
isotretinoin (accutane)
|
|
|
if you are female on isotretinoin, what else must you take?
|
bith control
|
|
|
what is Pseudotumor cerebri?
what drug can cause it? what are 2x possible Sx |
↑ intracranial pressure
Unsteady gate Visual disturbance |
|
|
what 2x acne drugs have this MOA:
Keratinocytes - sluff more normally |
Accutane
Tretinoin |
|
|
what 4x acne drugs have this MOA:
Sebaceous gland - block |
Estrogen (oral contraceptives)
steroids (prednisone) isotretinoin (accutane) Anti-androgens (spironolactone) |
|
|
what is
Rosacea |
a. Chronic inflammatory skin condition
i. Erythema ii. Telangiectasias iii. Papules iv. NO COMEDONES (clogged hair follicle) v. 25 y/o+ vi. Rhinophyma 1) Large nose 2) Skin hypertrophy of nose a) 2ndary to chronic deep inflammation |
|
|
NEVER use topical _________ for acne / rosacea / perioral dermatitis - will get rebound
|
NEVER use topical steroid for acne / rosacea / perioral dermatitis - will get rebound
|
|
|
Hidrandenitis suppurativa is a form of?
|
acne
|
|
|
****** Follicular occlusion triad
- what |
- HS (hidrosis suppurativa) - abscesses
- Acne conglobata - Dissecting cellulitis of the scalp |
|
|
what is this triad:
- HS (hidrosis suppurativa) - abscesses - Acne conglobata - Dissecting cellulitis of the scalp |
Follicular occlusion triad
|
|
|
how Tx Perioral dermatitis
|
low dose doxy
|
|
|
what is
Hematoxylin and Eosin used for? |
H & E staining
for ALL routine Bx |
|
|
what is DIF?
used for |
i. Direct immunofluorescence
ii. Evaluates immune deposits 1) IgG / IgM / IgA / C3 / fibrin 2) In frozen skin tissue samples Taken from adjacent UNAFFECTED skin |
|
|
where is skin taken from for DIF
|
adjacent UNAFFECTED skin - checking for immune deposits
|
|
name the layers
|
|
|
what are the 4 layers
|
|
|
what are the 4 layers
|
|
|
|
what disease is associated w/BPAG1 mutation
|
bullous pemphigoid
|
|
|
match the salt-split skin type (roof or floor)
BPAG1 |
roof - lsmins lucida (up)
|
|
|
match the salt-split skin type (roof or floor)
laminin 5 |
floor - lamin densa (down)
|
|
|
match the salt-split skin type (roof or floor)
Type IV collagen |
floor - lamin densa (down)
|
|
|
match the salt-split skin type (roof or floor)
Type VII collagen |
floor - lamin densa (down)
|
|
|
match the salt-split skin type (roof or floor)
BPAG2 |
roof - lsmins lucida (up)
|
|
Bullous pemphigoid
roof or floor? what protein is mutated? layer? |
roof
BPAG2 lamina lucida |
|
|
what class of drugs is likely to cause bullous pemphigoid?
|
diuretics
1) Furosemide 2) Bumetanide Spironolactone |
|
Dx?
- BP180 (BPAg2) - DIF - Linear C3 along BMZ - Salt split skin - C3 on epidermal side (roof) |
Gestational pemphigoid
AKA herpes gestationis |
|
Dx?
Children - Annular erythema - blisters - where - flexural areas / lower trunk / thighs / groin - "crown of jewels" - the annular blisters Adult - looks like BP (bullous pemphigoid) BP180 (BPAg2) = roof DIF - Linear deposition of IgA along BMZ Salt split skin - Epidermal side (roof) |
Linear IgA bullous dermatosis
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genetic bullae of External mucosal surfaces
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cicatricial pemphigoid (CP)
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Mucosal Cicatricial pemphigoid (CP)
has IgG against? |
BP230 (BPAg1)
roof |
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Dx?
DIF - IgG to type VII collagen (anchoring fibrils) Salt split - Floor (dermal side) Type VII collagen DORSAL HANDS a. Sx similar to BP and rarely CP b. Mechanobullous disorder i. Trauma induced |
Epidermolysis bullosa aquisita (EPA)
Really need to look for underlying malignancy |
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how DDx
Epidermolysis bullosa aquisita (EPA) and Bullous SLE |
ANA is the way to differentiate
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Dx?
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Bullous SLE
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Biopsy site for DIF in workup of bullous (blistering) disorder is |
NORMAL skin adjacent to a lesion
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***
Sodium chloride (1 mol / L) induces a split in human skin at he level of the (what is the top layer of the split) |
lamina lucida
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