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SBL Exam 2 > 1.2 Pathology of Skin (pt 2) > Flashcards

1.2 Pathology of Skin (pt 2) Flashcards

(50 cards)

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1
Q

how does seborrheic dermatitis present microscopically

A

spongiotic dermatits & acanthosis w/ parakeratotic mounds around the hair follicles (“follicular lipping”) & mixed inflam population

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2
Q

what is pemphigus vulgaris

A

most common

-mucosa & skin (esp scalp); may present in oral ulcers

lesion = superficial vesicle & bullae rupture easily = suprabasalar blister - part of epidermis (including stratum corneum)

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3
Q

what is hereditary angioneurotic edema?

A

inherited deficiency of C1 inhibitor –> excess activation of early components of complement & produce vasoactive mediators

worry about this when angioedema present (which is related to utricaria but has edema in deeper dermine & subQ fat)

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4
Q

what is an example of disorders of epidermal maturation

A

ichthyosis

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5
Q

What is erythema multiforme associated with?

(=the self-limited hypersensitivity rxn)

A
  1. infxns (viral, bacterial and fungal) *HSV & mycoplasma & histoplasma & coccidiomycosis*
  2. drugs (sulfa, penicillin, barbiturates, salicylates, antimalarial, hydantoins)
  3. cancer
  4. collagen vascular dz (SLE, dermatomytosis & polyarteritis nodosa)
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6
Q

what is epidermolysis bullosa

A

=non-inflam

= group of disorders due to inherited defects in structural protein that provide mechanical stability (keratin)

commonly: form blistes at sides of pressure, rubbing or trauma or at/soon after birth

so subtle that electron microscopy may be required to differentiate btn types

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7
Q

What are examples of panniculitis

(define panniculitis)

A

erythema nodosum

erythema induratum

=inflam of subQ layer of fat (deep & nodular)

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8
Q

What is seborrheic dermatitis? what is it correlated w/?

A

= chronic inflam, more common than psoriasis

involves regions w/ high density of sebaceous glands (scalp, forehead, external auditory canal, retroauricular area, nasolabial folds and presternal areas)

BUT** rmr **NOT a dz of glands it self

correlations = HIV w/ low CD4 count & parkinsons

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9
Q

what are examples of epidermal appendages

A

acne vulgaris

rosacea

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10
Q

describe ichthyosis & its morphology

A

inherited disorder - seen at or soon after birth

=disorder of epidermal maturation ==> hyperkeratosis –> fishlike scales

morphology: build up of compacted stratum cornem ; defective desquamation –> retention of abnormal formed scale

some variants = paraneoplastic of lymphoid or visceral malignancy (esp GI tract)

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11
Q

how long do acute inflam lesions last?

what are they characterized by?

A

days - weeks

=characterize by inflam inflitrates (lymphocytes, macrophages), edema, degree of epidermal, vascular or subcutaneous injury

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12
Q

what are characterisics of the bacteria is causing proprionibacterium acne

what has it been recently associated with?

A

“Acutibacterium” - proprionibacterium (gram +) - prefer anaerobic

= actinobacteria

associated w/ chronic blepharitis & endophthalmitis (after intraocular surgery) & prosthetic related infxn, & chronic nerve root inflam

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13
Q

What is pemphigus foliaceus

A

blister found in superficial epidermis at level of stratum granulosum

subcorneal blister - stratum corneum forms roof of bulla

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14
Q

what is verruca vulgaris?

what is the pathogenesis/morphology

A

common warts (esp kids)

pathogenesis: HPV
morphology: verrucous/papillomatous epidermal hyperplasia ; koilocytosis (cytoplasmic alterations) = (pic C)

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15
Q

treatment with _____ & ____ have shown efficacy for psoriaris w/ auspitz sign

A

anti-TNF & anti- IL 17

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16
Q

how does erythema multiforme present?

A

macules, papules, vesicles & bullae

cutaneous & mucucutaneous “target” lesion - face & extremities

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17
Q

what is lichen planus?

How does it present (acute & chronic)

A

6 P’s: Pruritis, Purple, Polygonal, Planar, Plaque, Papules

disorder of the skin & mucosa

=self limited (resolve w/i 1-2 yrs) - resolution will leave residuum of post-inflam hyperpigmentation & oral lesions may persist for years

SCC occur in chronic mucosal & paramucosal lesions

Koebner phenomenon (like psoriasis)

Wickham striae: white dots/lines that highlight the papule

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18
Q

How does dematitis herpetiformis present?

whats the pathogenesis/morphology behind it?

A

= urticaria & grouped vesicles; plaques and vesicles are extremely pruritic

M>F, 30s-40s

pathogenesis: *association w/ intestinal celiac dz* - responds to gluten free diet

Ab cross react w/ reticulin –> subepidermal blister

morphology: IgA granular deposits - localize in the tips of dermal papillae

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19
Q

what is the difference in action of mast cells in acute vs chronic response

A

acute: IgE Ab bind to Fc receptor –> cell degranulate and release mediators (histamine and prostoglandins)
chronic: secrete cytokines and promote inflam rxn

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20
Q

What are examples of chronic inflam dermatoses

A

psoriasis

seborrheic dermatitis

lechin planus

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21
Q

what are causes for acne

*rmr: Whitehead = open & blackhead = closed*

Study These Flashcards
A

hormonal fluctuation, androgens

obstructive effects

chronic inflam

proprionibacterium (reason why antibiotics can be use to treat acne!)

22
Q

What are the different levels w/i the skin that blisters can develop

Study These Flashcards
A
  1. Subcorneal: stratum corneum from roof of bulla (under stratum corneum) pemphigus foliaceus
  2. Suprabasal: portion of epidermis, including stratum corneum, form roof (right above basalar layer) pemphigus vulgaris
  3. Subepidermal : entire epidermis and dermis separate bullous pephigoid
23
Q

what are examples of derm infections

Study These Flashcards
A

verracae

molluscum contagiosum

impetigo

superficial fungal infxn

24
Q

what are examples of acute inflam dermatoses

Study These Flashcards
A

urticaria

acute eczematous dermatitis

erythema multiform

25
what is the pathogenesis and morphology for acute eczematous dermatitis?
pathogenesis: _Type IV hypersensitivity_ morphology: **red, papulovesicular (blister), oozing** --\> if persistent - reactive acanthosis and **hyperkeratosis** make raised plaques (lesions are prone to bacterial superinfxn --\> yellow crust (impetiginization)) =characterized by **_"epidermal spongiosis"_** -edema in intercel space - prominent seperation btn keratinocytes (esp stratus spinosum)
26
What type of panniculitis tends to affect teen & menopausal women describe the disorder
erythema induratum -possible _primary vasculitis_ of deep vessels supplying fat _lobules of subQ_ skin erythematous nodules --\> ulcerate
27
what is acantholysis
splaying apart keratinocytes due to spongiosis
28
what derm disorder is associated w/ increased/abnormal endogenous anti-microbial proteins & activation certain mediates like toll-like receptors?
Rosacea (i. e catheliciden peptide) - face (cheek, nasolabial fold) chronic inflam Spectrum = persistent erythema \<--\> pustules \<--\> development of rhinophyma (_ENLARGED NOSE)_
29
What is the morphology of Lichen Planus?
wickham stria = pink-purple, polygonal papule w/ white lacelike pattern - has bandlike infiltrate of lymphocytes at dermoepidermal jxn, hyperkeratosis and pointed rete (sawtooth)
30
what is psoriasis and what other conditions is it associated w/
**= chronic inflam dermatosis that appears to have autimmune basis** (see in all ages) -associated w/ 1. arthritis (15%)- may be mild or produce deformities resembling RA (one side or symmetric) 2. myopathy 3. enteropathy 4. AIDS
31
What is the pathogenesis & morphology for psoriasis
pathogenesis: sensitized CD4, Th17 and activated CD8; driven by Th1 & Th17 (IL 12, IL 17, INF-gamma & TNF) ; 2/3 pt = HLA-C gene **Koebner phenomenon:** _areas w/ trauma have psoriatic lesions bc motion for local inflam which becomes self-perpetuating_ morphology: 1. nail changes 2. stratum granulosum thinned/absent 3. **biopsy show: change in papilary dermis, acanthosis, scaling, microabsess in stratum corneum** 4. **Auspitz Sign** - dilated vessels of underlying dermal papillae - multiple, minue and bleeding point
32
What is pemphigus vegetans
large, moist, wart-like vegetating plaque studded w/ pustules _cells immediately above basal layer_ _overlying epidermal hyperplasia_
33
what are the 5 types of pemphigus
vulgaris vegetans foliaceous erythematosus paraneoplastic
34
What is the pathogenesis and morphology of impetigo
= common superficial bacterial infxn (usually due to **Staph aureus**) pathogenesis: innate immune response --\> epidermal injury --\> local serous exudate & form scab & blister formation = bacterial production that cleaves _desmoglein 1_ (responsible for cell-cell adhesion in upper most epidermal layers) morphology: erythematous macules that progress to small pustules --\> to shallow erosions covered w/ drying serum as pustules (**honey colored crust)** _accumulation of neutrophils beneath stratum corneum_
35
What is bullous pemphigoid
**_subepidermal, nonacantholytic blister_** elderly pts -inner thigh, flexor surfaces - forearm, axillae, groin and lower abdomen oral lesion (10-15%) possible utricarial plaques w/ severe pruritus **auto-ab IgG - bind to proteins required for adherence of basal keratinocytes to BM (hemidesmosomes)**
36
**What are toxic epidermal necrolysis & steven johnson syndrome**
=severe _epidermolytic_ adverse cutaneous drug rxns (skin & mucous membrane) - rare; medical emergencies! **=mucocutaneous tenderness & hemorrhagic erosions, erythema and more/less severe epidermal detachment - presenting as blisters & ares of denuded skins** _differ by extend of skin detachment_
37
what is pemphigus erythematosus
localized may have selective malar presentation like SLE
38
what are characterisitics and examples of superficial fungal infxns
confined in _stratum corneum_ caused by **_dermatophytes_** from soil or animal = bright pink/red w/ PAS & are found in anucleated cornified layers of lesional skin, hair or nails
39
What is Molluscum Contagiousm
- self limited viral skin dz (children & young adults) morphology: umbilicated pink papules; molluscum bodies - large ellipsoid, homogenous, cytoplasmic inclusions in cells of stratum granulosum & corneum
40
what are the subdivisions of acute aczematous dermatitis?
1. allergic contact 2. atropic 3. drug-related 4. photoeczematous 5. primary irritant
41
What is the NODOSUM mneumonic for erythemal nodosum
**NO** cause found in 60% cases = _idopathic_ **D**rugs (sulfa, antibiotics, etc) **O**ral contraceptives **S**arcoidosis or Lofgren's syndrome **U**C, crohns, bechets **M**icro: (infxns - TB, EBV, HSV, camplobacter, syphilis, etc) = nodular & painful = **septal panniculitis**
42
**what is paraneoplastic pemphigus**
associated w/ malignancies (**most common NHL**) Auto-Ab that recognize _desmogleins or other proteins of intercellular adhesion_
43
what is the immune mechanism, histopathologic lesions of type I (immediate) hypersensitivity (when do these rxns occur?)
=make IgE Ab -\> release vasoactive amines from mast cells & later recruit inflam cells histopath lesions: vascular dilation, edema, Sm M contraction, mucous production, tissue injury & inflam (anaphylaxis, allergies, bronchial asthma)
44
what is pemphigus caused by
**IgG auto-Abs against desmogleins**- result in dissolution of intercellular attachment w/i epidermis & mucosal epithelium 5 types
45
What is Weber-Christian Dz
relapsing febrile nodular panniculitis
46
how does psoriasis present?
on elbows, knees, scalp, lumbosacral areas, intergluteal cleft & glans penis =**pink to salmon colored plaque covered by loosely adherent silver-white scale** possible _nail changes_- yellow-brown discoloration w/ pitting, dimpling, separation of nail plate (onycholysis) , thickening, crumbling
47
what are examples of blistering (bullous) dzs
inflam 1. pemphigus 2. bullous pemphigoid 3. dermatitis herpetiforms Noninflam * epidermolysis bullous and porphyria
48
What are porphyrias
= noninflam =group of uncommon inborn/acquired distrubances of porphyrin metabolism _\*porphyrin - pigments in Hb, myoglobin and cytochromes_ **bone and skin involvement** - urticaria & vesicles associated w/ scarring (worse w/ sunlight)
49
if a pt presents w/ firm edematous plaques that last only a few hrs.. what do they have? describe the morphology
**Utricaria (wheals - hives)** firm edematous plaque resulting from infiltration of dermis w/ fluid **_type I hypersensitivity ==\> localized mast cell degranulation --\> dermal microvascular hyperpermeability_** compare w/ **angioedema** - which is edema of deeper dermis & subQ fat morphology: sparse mononuclear infiltrate & occasional dermal eosinophils
50
what are chronic inflam lesions characterized as
month- years = _epidermal changes_ (atrophy/hyperplasia) &/or _dermal fibrosis_

SBL Exam 2 (8 decks)

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