Dermatology

Front 1

-silvery scales, plaques
-often on palms, soles, scalp, nails, extensor surfaces
-Koebner's phenomenon- physical trauma elicits lesions
-Auspitz sign: removal of scales-> appearance of minute blood droplets
-can be caused by glucocorticoids
-28x the normal production of epidermal cells
-T cell driven disease (TH1 response)

Back 1

psoriasis

Front 2

-redness and scaling in regions where sebaceous glands are most active (face,scalp, presternal, body folds)
-orange-red or gray-white skin, with greasy or white dry scaling macules and papules
-pityriasis sicca- dandruff
-infants: cradle cap
- malassezia furfur- role in pathogenesis
-pruritus is increased by perspiration
-butterfly rash on forehead
-Tx: selenium or ketoconzole shampoo, topical glucocorticoids

Back 2

seborrheic dermatitis

Front 3

-1st a single plaque (herald)
-then generalized secondary eruption
-oval, scattered papules and plaques with characteristic distribution with the long axes of the oval lesions following the lines of cleavage in a christmas tree pattern
-lesions mostly on trunk and proximal arms and legs (rare on face)

Back 3

pityriasis rosea

Front 4

-flat topped pink to violaceous shiny, pruritic polygonal papules on the skin and milky white reticulated papules in the mouth
-4Ps: papule, purple, polygonal, pruritic
-Wickham's stia: white lines

Back 4

lichen planus (plane-flat)

Front 5

-chronic, pruritic, inflammatory dermatitis in the form of coin-shaped plaques composed of groups of small papules and vesicles on an erythematous base
-usually in atopic individuals
-worse in winter
-S. aureus often present

Back 5

nummular eczema

Front 6

- vesicular type of dermatitis
-sudden onset of deep-seated pruritic, clear "tapioca like" vesicles
-later scaling fissures and lichenification
- caused by hyperhydrosis
- inhibit cholinergic eccrine sweat glands with botox

Back 6

dyshidrosis: dyshidrotic eczematous dermatitis

Front 7

-"an itch that rashes"
-lines under eyelid, denny lines, morgan folds or denny morgan lines
-itching from CNS
-treat with sedating anti-histamines
-chemical lobotomy: hydroxyzine
-deficiency of beta defensins and kaptulociden
-aka eczema, IgE dermatitis, atopic eczema
-langerhans cells involved with allergen
-TH2 helper cells get B cells involved- produce antibodies
-IgE elevated
-in chronic phase TH2 becomes TH1

Back 7

atopic dermatitis

Front 8

-result of sensitization to an antigen
-langerhans cell takes up antigen and presents with MHC 2 to T cells
- "spongiosus"
- cell mediated hypersensitivity

Back 8

allergic contact dermatitis

Front 9

-inflammation of the pilosebaceous unit
-manifests itself as comodones (keratin plugs)
-open comedones- blackheads
-closed comedones- whiteheads

Back 9

acne

Front 10

-chronic inflammatory acneform disorder of facial pilosebaceous unit coupled with increased reactivity of capillaries leading to flushing and telangiectasia
-aggrevated by hot,spicy food, sunlight, stress, alcohol
-risk of developing lymphoma in men
-tx. antiinflammatories

Back 10

rosacea

Front 11

-autoimmune disease of hair follicle
-exclamation point hair (distal ends are broader)
ophiasis pattern- snake surrounding head
-"going gray overnight"
-pitting of nails

Back 11

alopecia areata

Front 12

-hypertrophic scar that extends beyond site of original injury
-can become inflamed and ulcerate
-common in black or blood group A

Back 12

keloids

Front 13

-most commonly caused by T. rubrum, M. canis, T. tonsurans
-infect trunk, legs, arms, and/or neck
-plaques + or- vesicles
-sharply marginated
-peripheral enlargement and central clearing, arcuate lesions

Back 13

tinea corporis

Front 14

-T. rubrum
-dermatophyte infection of feet
-characterized by erythema, scaling, maceration, and/or bulla formation
-associated with hyperhydrosis
-moccasin type: well demarcated erythema, minute papules on margin, fine white scaling, hyperkeratosis
-can be secondarily infected, often with S. aureus

Back 14

tinea pedis

Front 15

-dermatophyte infection of toenails
-common in immunosuppressed and diabetics
-most often caused by Trichophyton mentagrophytes, T. rubrum
-always associated with tinea pedis
- superficial: invades dorsal surface of nail
-proximal subungual: enters by cuticle nail area, always associated with immunocompromised (HIV)

Back 15

tinea unguium

Front 16

-dermatophytosis of glabrous facial skin
-well circumscribed erythematous patch
-most common in children

Back 16

tinea faciale

Front 17

-caused by melassezia
-aka pityriasis versicolor
-does not produce keratinase- NON-DERMATOPHYTE
-fungus makes azoleic acid turns off melanocyte

Back 17

tinea versicolor

Front 18

-means vulnerable
-superficial infection of epidermis
-characterized by crusted erosions or ulcers
-often infected by S. aureus or group A strep (s.pyogenes)

Back 18

impetigo

Front 19

-superficial inflammation of hair follicle

Back 19

folliculitis

Front 20

-bacterial infection of DERMIS and epidermis
-ulceration with thick adherent crust
-associated with HTN

Back 20

ecthyma

Front 21

-bunch of furuncles (deep folliculitis)

Back 21

carbuncle

Front 22

CD4

Back 22

-glycoprotein on surface of T cells, regulatory T cells, monocytes, macrophages, dendritic cells,
-TH2

Front 23

CD8

Back 23

-coreceptor for T cell receptor,
-expressed on cytotoxic T cells and NK cells
-TH1 response

Front 24

verruca vulgaris

Back 24

-caused by papilloma virus
-less malignancy with lower numbered strains
-black dots- thrombi in capillaries
-causes angiogenesis factor-capillaries in papillary dermis

Front 25

verruca plana

Back 25

-flat warts on face, hands, feet

Front 26

molluscus contagiosum

Back 26

-DNA pox virus in waxy coat
-humans only known reservoir
-looks like pearl-flesh colored, dome shaped, dimpled center
-spread by direct contact
- if more than 100 check for AIDS

Front 27

herpes simplex

Back 27

- herpes means: to creep
-stay in dorsal root ganglion of nerve
-vesicle, pustules
- no cure
-lesions usually do not cross midline
-tzank smear: multinucleated

Front 28

herpes zoster

Back 28

-shingles
-usually does not cross midline
-follows dermatomes
-prodromal: neuritic pain or paresthesia
-acute: vesicular or bullous eruption
-reactivation of varicella zoster virus
-confirm diagnosis by tzanck test

Front 29

eczema definition

Back 29

means "to boil out"

Front 30

stages of eczema

Back 30

acute: vesicular
subacute:
microvesicular
erythematous
scaling
chronic: lichenified

Front 31

contact irritant dermatitis

Back 31

inflammatory reaction caused by chemical irritant or antigen that elicits a delayed hypersensitivity reaction
-Engman's disease: when irritant dermatitis becomes infected
-irritation is dependent on dosage
-reaction is localized to area in contact with irritant

Front 32

contact allergic dermatitis

Back 32

-reaction that occurs when sensitized individual is exposed

Front 33

atopic dermatitis

Back 33

-"an itch that rashes"
-itch from CNS
-IgE
-tx.: sedating anti-histamines, chemical lobotomy- hydroxyzine
-scratch to cause pain (fast fiber, beat itch (slow fiber))
-deficiency of beta defensins

Front 34

seborrheic dermatitis

Back 34

-redness and scaling of skin where oil glands concentrate (nose, mouth, eyes, chest, back, inguinal, armpits)
-dandruff- pityriasis sicca
-cradle cap in infants
Tx: selenium shampoo, ketaconazole, glucocorticoids

Front 35

nummular eczema

Back 35

-coin shaped plaques composed of papules and vesicles on erythematous base
-worse in winter/dry weather
-treatment: moisturize, glucocorticoids, coal tar

Front 36

stasis dermatitis

Back 36

-"id" (self) reaction
-hypersensitivity reaction due to venous stasis

Front 37

stasis dermatitis

Back 37

-classic eczematous dermatitis with inflammatory papules, scaly and crusted erosions
-pigmentation with recent and old hemorrhages
-dermal sclerosis
-ulcerations due to scratching
-most often near medial malleolus

Front 38

autosensitization id reaction

Back 38

-pruritic dermatitis directly related to a primary dermatitis elsewhere
-will not disappear until primary dermatitis is controlled
-caused by the release of cytokines
-tx: oral glucocorticoids

Front 39

asteatotic eczema

Back 39

-aka eczema craquele (french for "marred with cracks") or xerotic eczema
-usually in older people in winter, low humidity
-can be caused by too frequent bathing with soaps
-superficially fissured skin with slight scaling
-incessant pruritus
-can lead to lichenification due to scratching

Front 40

treatment and control of eczematous dermatoses

Back 40

-avoid irritants
-stop scratching
-glucocorticoids
-anti-histamines
-anti-itching medication
-avoid stress
-tx. infections with abx
-rehydrate skin

Front 41

bacterial infection of the skin most often by staph. aureus or S. pyogenes (group A strep)

Back 41

pyodermas

Front 42

impetigo

Back 42

-superficial infection of epidermis
-characterized by crusted erosions or ulcers
bullous: most often caused by S. aureus which produces exfoliative toxins and causes scalded skin syndrome, vesicles or bulla on normal-appearing skin
non-bullous: vesicles rupture resulting in erosions, become surmounted in crust

Front 43

ecthyma

Back 43

-infection of skin that reaches the dermis
-lesion of neglect, develops in excoriations
-ulceration with a thick adherent crust
-most often on distal extremties

Front 44

eripselas

Back 44

-superficial cutaneous cellulitis with painful, bright red, raised, edematous, indurated plaque with advancing raised borders, sharply marginated
-usually caused by Group A strep- pyogenes
-bright butterfly shaped rash on bridge of nose an cheeks
-high fever, shaking chills,
-used to be a leading cause of death before antibiotics
-form of cellulitis

Front 45

erythrasma

Back 45

-caused by corynebacterium minutissimum
-diagnose with wood's lamp- fluoresce coral red
-intertriginous areas, body folds

Front 46

pitted keratolysis of the feet

Back 46

-associated with hyperhydrosis
-tx: treat hyperhydrosis and use benzoyl peroxide to kill bacteria

Front 47

cellulitis

Back 47

-extends into subcutaneous skin, not raised, not demarcated from uninvolved skin
-can be caused by vibrio vulnificus- present in brackish water, why immunocompromised (diabetics) should never eat raw seafood, bacteria 1st cause enteritis and then skin

Front 48

furuncle

Back 48

-red, hot, tender nodule or abscess that evolves from staph. folliculitis
-extends into deep dermis and subcutaneous tissue
-aka boil
abscess: acute or chronic localized inflammation associated with a collection of pus and tissue destruction
-tx: I and D, abx

Front 49

carbuncle

Back 49

-deeper infection than furuncle composed of interconnecting abscesses from several contiguous hair follicles
-a bunch of furuncles (deep folliculitis)
-aka boil

Front 50

cutaneous tuberculosis: exogenous

Back 50

-primary inoculation tuberculosis- percutaneous inoculation in nonimmune host
-tuberculosis verrucosa cutis- percutaneous inoculation in host with prior TB infection

Front 51

endogenous spread TB

Back 51

lupus vulgaris
scrofuloderma
metastatic tuberculosis abscess
acute miliary tuberculosis
orificial tuberculosis

Front 52

primary inocculation tuberculosis

Back 52

-papule at inoculation site
-lesion enlarges to a painless ulcer (tuberculous chancre)
-shallow granular base and multiple tiny abscesses
-limited to skin
-usually resolves on it's own

Front 53

lupus vulgaris

Back 53

-initial flat papule (soft and ill defined) becomes well defined irregular plaque
-"apple jelly" appearance with diascopy
-lesion breaks upon probing
-"punched out" often serpiginous ulcers surrounded by brownish infiltrate
-most often on head and neck

Front 54

scrofuloderma

Back 54

-firm subcutaneous nodule that intially is freely movable
-lesion becomes doughy and evolves into an irregular deep seated node or plaque that liquifies and perforates
-painless mass in neck

Front 55

tuberculosis verrucosa cutis

Back 55

-anatomist/pathologist's wart
-initial papule with violaceous halo
-evolves to hyperkeratotic, warty, firm plaque
-clefts and fissures occur and pus and keratinous material are expressed
-irregular border
-limited to skin

Front 56

mycobacterium marinum

Back 56

-follows traumatic inoculation following tropical fish/water exposure
-inflammatory verrucous or crusted lesions at inoculation site and extension to lymphatics (sporotrichoid) and deeper tissues
-papule enlarging to nodule or plaque, may be hyperkeratotic/verrucous, may ulcerate
-Dx: PPD often +, acid fast stain (50% +), isolation of M. Marinum on culture
Tx: minocycline, clarithromycin, rifampin, ethambutol, surgical debridement

Front 57

leprosy

Back 57

-hansen's disease
-caused by M. leprae
-tuberculoid: localized skin involvement and/or peripheral nerve involvement (few organisms in biopsy)
-lepromatous: generalized involvement skin, upper resp.,reticuloendothelial, adrenal, testes) many bacilli in culture
borderline or dimorphic form
-epistaxis: nose bleeds
-inverse relationship between darkness of skin color and severity of disease
-infects skin and cutaneous nerves, grows best in ares of body with cooler temperatures (skin, peripheral nerves, testes, Upper resp. tract, ant. chamber of eye)
-reservoir: humans, armadillos, chimpanzes, monkeys
-paresthesia and numbness
-muscle weakness/atrophy, contractures
-severe neruitic pain
-erythematous or purple border and hypopigmented center, often annular
-central area: atrophic, numb
Dx:
skin incision
Ziehl-Neelsen staining
inoculated in mouse foot pad
PCR DNA analysis
Tx: Dapsone, rifampin, clofazimine, manage nerve deficit problems

Front 58

chancroid

Back 58

-acute sexually transmitted infection characterized by a painful ulcer at site of inoculation and suppurative regional lymphadenopathy
-increased risk of HIV infection
-Dx: special culture media, painful genital ulcers, no evidence of T. pallidum by darkfield, lymphadenopathy, HSV is negative
-Tx: abx
-caused by H. ducreyi

Front 59

syphilis

Back 59

-painless ulcer or chancre at site of inoculation, regional lymphadenopathy
- caused by T. pallidum
-dx by darkfield microscopy, serology
-Tx: penicillin unless allergic

Front 60

primary syphilis

Back 60

usually painless ulcer unless superinfected
-button-like papule at site of inoculation
-firm with indurated border
-regional lymphadenopathy

Front 61

secondary syphilis

Back 61

-fever, sore throat, weight loss, malaise, anorexia, headache, diffuse hair loss
-relatively faint exanthem always macular and pink, ill defined lesions
-progresses to papular, brownish, more localized
-condylomata lata: soft, flat-topped moist red-to-pale papules, nodules or palques

Front 62

tertiary syphilis

Back 62

-15% of untreated syphilis develop
-gumma: nodular or papulosquamous plaques
-neurosyphilis
-cardiovascular syphilis

Front 63

TB diagnosis

Back 63

-PPD test (type 4 hypersensitivity reaction)
-culture yields: acid fast bacteria (mycobacterium)
-PCR

Front 64

cutaneous TB treatment

Back 64

-primary inoculation tuberculosis and tuberculosis verrucosa cutis are limited to the skin
-primary inoculation tuberulosis- usually resolves on it's own
-tuberculosis verrucosa cutis- excised
-prolonged therapy with at least 2 drugs: isoniazid, rifampin, ethambutol, streptomycin, pyrazinamide

Front 65

herpes Simplex

Back 65

-vesicles at site of inoculation
-associated with regional lymphadenopathy
-prodrome: tingling, itching, burning
-virus persists in sensory ganglia
-Dx: Tzanck smear looking for giant multinucleated keratinocytes
-Tx: antiviral drugs (acyclovir)

Front 66

infectious exanthems

Back 66

-generalized cutaneous eruption associated with a primary systemic infection

Front 67

verruca vulgaris

Back 67

-common wart
-hyperkeratotic papules with clefted surface and vegetations
-red or brown dots due to thrombosed capillary loops

Front 68

verruca planae

Back 68

-skin colored or light brown flat papules (1-2mm thick)

Front 69

verruca plantaris

Back 69

-small, shiny, sharply marginated papule to plaque with rough hyperkeratotic surface studded with brown-black dots

Front 70

fungal culture: 3 plate method

Back 70

KOH
PAS

Front 71

scabies

Back 71

-infection by mite sarcoptes scabiei
-mites tunnel and female lays eggs in stratum granulosum or more superficial
-intense itching that prevents sleep
-eczematous lesions
-nocturnal pruritus

Front 72

pediculosis

Back 72

-louse infestation

Front 73

pediculosis captitis

Back 73

-infestation of the scalp by head louse, deposits eggs in hair
-itching
-lichen simplex chronicus- habit of scratching

Front 74

pediculosis corporis

Back 74

-body louse
-live in seams of clothing
-burn clothing
-hygiene

Front 75

pediculosis pubis

Back 75

-louse infestation of hair bearing regions: pubic area, chest, axillae, upper eyelashes
-crab lice
-pthirius pubis
tx: physostigmine- paralyze louse

Front 76

cutanea larva migrans

Back 76

- in animals enter skin-> blood-> intestine-> picked up by another animal
-in humans the larva cannot get past the basement membrane, migrate to try to find a way out
-often caused by nematode ancylostoma braziliense
-Tx: thiobendazole

Front 77

papular urticaria

Back 77

-urticaria: wheals (transient papules and plaques) usually pruritic
-can be caused by arthropod bites

Front 78

candidiasis

Back 78

-non-dermatophyte- does not produce keratinase
-polymorphic: yeast forms, budding yeast, pseudohyphae, true hyphae
-KOH prep to see fungus
-chitin made by fungus, not dissolved by KOH
-grows in moist areas
-colonizes GI tract
-treat with antifungal agents: azoles

Front 79

tinea versicolor

Back 79

-non-dermatophyte
-caused by melassezia furfur
-azlic acid turns off melanocytes
-hyperemia- red spots

Front 80

define dermatophyte

Back 80

produces keratinase

Front 81

What do you treat psoriasis with?

What do you not treat a person with psoriasis with?

Back 81

cyclosporine A


NO CORTICOSTEROIDS

Front 82

calcineurin pathway

Back 82

1. APC (macrophage) activates T cell
2. T cell wants to kill invader
3. Ca is mobilized from cell membrane
4. binds calmodulin (4 binding sites)
5. calmodulin binds calcineurin (a phosphatase)
6. calcineurin splits NFATc (nuclear factor of activated T cell in cytoplasm) attached to P
7. enters nucleus
8. causes DNA to code for pro-inflammatory cytokines (IL-2,3,4, TNF-alpha)

Front 83

how does cyclosporine A work

Back 83

calcineurin inhibitor

immunosuppressant

Front 84

contact dermatitis that becomes secondarily infected

Back 84

Engman's disease

Front 85

primary pyoderma

Back 85

virulent organism on intact skin

Front 86

secondary pyoderma

Back 86

skin integrity altered allowing infection

Front 87

layers of skin infected by cellulitis vs. eripselas

Back 87

cellulitis: epidermis-> subcu.

eripselas: epidermis-> superficial dermis

Front 88

felon

Back 88

infection of pulp of finger/toe

pyogenic granuloma

Front 89

difference between folliculitis, a furuncle, and a carbuncle

Back 89

folliculitis-superficial

furuncle: deep folliculitis

carbuncle: bunch of furuncles connected by sinus tracts

Front 90

pott's disease

Back 90

extrapulmonary tuberculosis that affects the spine

causes tuberculous arthritis of intervertebral joints: tuberculosis spondyloarthropathy

Front 91

mycobacterium marinum treatment

Back 91

minocycline

Front 92

Which type of leprosy has antibodies against the lesion?

Back 92

lepromatous leprosy

Front 93

condyloma lata

vs

condyloma acuminatum

Back 93

syphilis



HPV

a lat of syphilis
accumulate warts

Front 94

Where to scrape for cultures of fungus
and
Herpes

Back 94

fungus: top

herpes: bottom

Front 95

scabies

Back 95

mites

Front 96

larva migrans caused by:

Back 96

ancylostoma caninum

or

ancylostoma braziliense

Front 97

PAS stain

Back 97

stains neutral polysaccharides in fungal cultures

Front 98

difference between

tinea unguium

onychomycosis

Back 98

tinea unguium: dermatophyte infection of nail

onychomycosis: any fungal infection of nail