13 - Skin diseases Flashcards

Question

Treatment of erythema multiforme?

Answer 1

Self limiting disorder

Answer 2

a. This is an extensive and symptomatic febrile form of EM. b. Skin and mucosal surfaces of mouth, nose, eyes and genitalia are typically involved. c. Although self-limited, can be life-threatening

Answer 3

- Affects 1-2% of population. - The cause of psoriasis is unknown but recent studies suggest there are genetic predisposing factors and autoimmune mechanisms at play. - It could be a type of complement-mediated reaction that is localized to the stratum corneum. - Occurs at all ages; mean age of onset is 27 years

Answer 4

a. May be associated with arthritis, myopathy, enteropathy and AIDS. b. Sites – elbows, knees, scalp c. Typical appearance is a well-demarcated, pink and salmon-colored plaque covered by loosely adherent silver-white scales. d. Erythroderma – total body erythema and scaling

Answer 5

a. Rete ridges are elongated. b. The granular cell layer is thin or absent, thus dermal papillae are close to the surface. c. Parakeratosis d. Munro’s microabscesses –

Answer 6

Chronic inflammatory disease involves the skin and mucous membranes. a. Exact etiology is unknown. b. Recent studies suggest that release of antigens in the basal cell layer and at the dermal-epidermal junction may elicit a cell-mediated cytotoxic immune response. c. Early studies indicated that there was an association between lichen planus and nervous, worrying type personalities. More recent studies do NOT support this association.

Answer 7

a. Presenting signs are the “four Ps” – pruritic, purple, polygonal papules b. Striae of Wickham – c. Locations – symmetric distribution particularly on the extremities d. Oral lesions –

Answer 8

a. Irregular acanthosis with rete ridges having a “saw tooth” appearance b. Parakeratosis c. Liquefactive degeneration of basal cell layer with infiltration of lymphocytes d. Dense, narrow band of lymphocytes (T cells) in superficial dermis

Answer 9

a. Skin lesions are usually self-limited and spontaneously resolve after one to two years. Nonetheless, skin lesions often require treatment. b. Oral lesions tend to persist for years (forever!). c. If treatment is necessary, topical corticosteroids are used.

Answer 10

a. Type II hypersensitivity reaction – antibody dependent cytotoxic reaction b. IgG antibodies are produced that are directed against proteins of desmosomes, the intercellular cementing substance of epithelial cells of skin and mucous membrane. Autoantibodies targets are: 1. Desmoglein 3 2. Desmoglein 1 c. When autoantibodies bind to antigen, it causes activation of the complement cascade. d. This causes the epithelial cells to become discohesive, thus vesicles and bullae are formed.

Answer 11

This rare disease is characterized by blistering lesions of the skin and mucous membranes. a. Both sexes are equally affected. b. Onset of the disease is usually between 30 and 50 years of age. c. Any area of skin or mucous membranes may be involved but more common sites are scalp, face, axilla, groin, trunk and points of pressure. d. Superficial vesicles and bullae rupture easily leaving shallow erosion covered by dried serum and crust.

Answer 12

a. Routine staining shows intraepithelial (suprabasal cleft) vesicle and acantholysis. b. Infiltration of the dermis by lymphocytes, histiocytes and eosinophils is typical. c. Immunofluorescent studies show lattice-like deposits of IgG and complement in the intercellular areas.

Answer 13

a. This can be a life-threatening disease because of secondary infection and possible dehydration. b. It cannot be cured but blister formation can be controlled by systemic corticosteroids.

Answer 14

a. Type II hypersensitivity reaction – antibody dependent cytotoxic reaction b. IgG autoantibodies are formed against hemidesmosomal antigens in the lamina lucida of the basement membrane of skin and mucosal basement membranes. These are autoantibodies against BP antigens are: 1. Anti-BP230 (BPAg1) 2. Anti-BP180 (BPAg2) c. Complement activation → dissolution of the basement membrane. d. The epithelium then detaches from the supporting connective tissue producing a vesicle.

Answer 15

a. This disease is generally seen in the elderly. b. It shows a wide range of clinical presentations. 1. Localized skin involvement only 2. Generalized skin involvement w/wo mucosal involvement c. Bullae may reach 4 to 8 cm. Bullae are tense and filled with clear fluid. d. Bullae heal without scarring. e. Sites of predilection – inner aspect of the thighs, flexor surfaces of the forearms, axilla, groin, and lower abdomen. f. Oral involvement is seen in up to one third of patients.

Answer 16

a. Routine staining shows clefting of the epithelium from the dermis at the basement membrane leading to formation of a subepidermal vesicle. b. Dermis shows infiltration by lymphocytes, some eosinophils and occasional neutrophils. c. Immunofluorescent stains show linear deposits of IgG and compliment along the basement membrane.

Answer 17

a. This disease is treated by topical or systemic corticosteroids. b. Since it is often localized, it does not often lead to life-threatening secondary infections.

Answer 18

This disease is common in the oral cavity and only rarely involves the skin. MMP is caused by activity of autoantibodies against basement membrane epitopes and may involve the same autoantibodies as bullous pemphigoid. Common autoantibody targets are: 1) BP180 (BPAg2) 2) BP230 (BPAg1) 3) Laminin 5 4) Beta 4 integrin

Answer 19

Usually heals with scarring and is sometimes called cicatricial pemphigoid (cicatrix = scar).

Answer 20

Skin lesion of unknown origin and common. Occur most often in middle-aged or older individuals. They arise spontaneously and may be numerous. Locations – trunk, extremities, head and neck NOT related to skin cancer, BENIGN EPITHELIAL LESION

Answer 21

1) Round, flat, coin-like plaques 2) Tan to dark brown 3) Velvety to granular surfaces 4) Size – mm to several cm 5) May peel off but then return

Answer 22

No tx. | Aesthetic tx: liquid nitrogen/laser tx

Answer 23

Warts Caused by various strains of the human papilloma virus (HPV) which are transmitted by direct contact. Verruca vulgaris is the common skin wart. Condyloma accuminata is the venereal wart Replicates in basal cell layer

Answer 24

Lesions are grey-white to tan. They may be flat or convex. The surface is often rough or pebbly. Sessile elevated skin lesion - Normal color to whitish - Translucent to opaque - Rough surface - Cauliflower-like

Answer 25

Self limiting, heals spontaneously. May take 6 months-2 years Cryo, laser, surgical removal

Answer 26

A dysplastic process (premalignant) in the skin. | Has a natural tendency to progress to BCC

Answer 27

1) Chronic sun exposure in light pigmented people most commonly 2) Other causes – ionizing radiation, hydrocarbons and arsenic

Answer 28

1) Tan brown, red or skin colored lesions, usually less than 1 cm 2) Rough or sandpaper consistency Macular, plaque or cratered shape Flesh colored to brown to pink to red Bigger than seborrheic keratosis

Answer 29

1) Hyperkeratosis 2) Epithelial dysplasia of varying degrees, may/may not be present 3) Elastosis of underlying fibrous connective tissue (due to sun exposure, solar elastosis)

Answer 30

Treated by curettage or cryosurgery. Protection from predisposing factors may help Can progress to carcinoma over time.

Answer 31

It is the most common cancer arising on sun-exposed sites (skin + mucosa of vermillion lip) of older individuals. It affects skin and mucosa

Answer 32

1) Exposure to sunlight and other ionizing radiation 2) Industrial carcinogens – tars and oils 3) Chronic ulcers and draining osteomyelitis 4) Old thermal burn scars 5) Arsenic 6) Immunosuppression

Answer 33

1) Carcinoma-in-situ – sharply defined plaque 2) Invasive stage a) May be flat, nodular or cratered. b) Red scaly surface c) May ulcerate and bleed. d) Margins often indurated

Answer 34

1) Nests, strands and individual cells invade the dermis. 2) Keratin pearls and dyskeratotic cells may be present. 3) Differentiation a) Well differentiated b) Moderately differentiated c) Poorly differentiated

Answer 35

1) Usually are identified and treated while small. 2) Less than 5% have metastasis to regional lymph nodes at the time of diagnosis. 3) Treated by excision, sometimes by radiation. Lip is most curable. > 90% cure rate Prognosis depends on stage and site

Answer 36

It is a slowly growing skin tumor that rarely metastasizes. Basal cell carcinoma is the most common malignant skin tumor. It does NOT affect the mucosa but is INVASIVE.

Answer 37

1) Fair skin 2) Sun exposure 3) Immunosuppression 4) Nevoid basal cell carcinoma syndrome – -Autosomal dominant Mendelian disorder -Multiple basal cell carcinoma -Multiple odontogenic keratocysts -Bifid ribs and other rib malformations -Can get BCC in teens Middle + upper face: cheeks, nose, temple, forehead

Answer 38

1) Flat or plaque-like, but may be nodular. 2) Surface may be smooth or crusty. 3) May ulcerate and bleed, or mimic non-healing pimple. 4) Size – 5) Often multiple 6. Central crater common, w/ rolled edge/border

Answer 39

1) This is one of the most indolent malignant tumors. 2) It is usually cured by local excision. 3) Although it rarely metastasizes, it may become very large and locally destructive if not treated. Can be lethal. 4. Invasive

Answer 40

1. This disease features well-demarcated areas of pigment loss. 2. It is caused by complete or partial loss of pigment-producing melanocytes within the epidermis. 3. It is a common disorder that affects all races but is more noticeable in darkly pigmented people. Idiopathic - may be familial Must R/O infection, autoimmune ds, etc., make sure it is not secondary to something else.

Answer 41

Freckles. 1. Ephilides are the most common pigmented lesions of childhood. 2. Freckles are predominantly seen in Caucasians.

Answer 42

Hyperpigmentation follows sun exposure and is due to increased amounts of melanin pigment within basal keratinocytes.

Answer 43

Clinical: Small flat tan to brown macules. Always flat, symmetric, small. Usually multiple and numerous. More common on face, can be anywhere Histo: Normal # and distribution of melanocytes Excess production of melanin.

Answer 44

A mole. | Tumor-like lesions are congenital or acquired hamartomas of melanocytes.

Answer 45

a. Well-defined flat or elevated lesion b. Uniformly pigmented, tan to brown c. Small – usually < 1 cm d. Most develop during childhood or early adulthood. Round, oval.

Answer 46

a. Junctional nevus – round to oval nevus cells grow along dermal-epidermal junction and contain varying amounts of melanin pigment. b. Compound nevus – nests of pigmented nevus cells are present in the upper dermis and at the dermal-epidermal junction. (Both dermal and junctional). c. Dermal (intradermal) nevus – nests of pigmented nevus cells are present in the upper dermis only.

Answer 47

Usually, no treatment. Only for esthetics. Removal can cause scarring! Be suspicious of moles developing in ADULTHOOD! May be MALIGNANT MELANOMA!

Answer 48

1. Until recently, the dysplastic nevus was considered to be a distinct histologic form of nevocellular nevus and was thought to be a precursor of malignant melanoma. 2. It is now recognized that dysplastic nevus is NOT a histologic diagnosis. A more appropriate usage of the term is as “Dysplastic Nevus Syndrome,” a diagnosis of which can be made only on the basis of clinical findings.

Answer 49

a. Multiple, possibly hundreds, of nevi which may be larger than other acquired nevi. b. Nevi may be flat or slightly raised. c. Nevi usually show variation in pigmentation. d. Nevi often show borders that are irregular in contour. e. Nevi may occur on sun-exposed or non-sun-exposed surfaces. f. Often seen in persons with family history of dysplastic nevus syndrome

Answer 50

a. Due to the sheer numbers of pigmented nevi, there is a risk of malignant transformation to malignant melanoma for any given nevus. b. Patients with the syndrome need careful monitoring by a dermatologist to provide early diagnosis and treatment of a melanoma, should it arise.

Answer 51

A malignant neoplasm of melanocytes. It may or may not actually be pigmented

Answer 52

1) Exposure to sunlight, especially during infancy and childhood a) Men – upper back b) Women – back and legs 2) Light normal pigmentation 3) Other factors include dysplastic nevus syndrome, hereditary factors and exposure to carcinogens.

Answer 53

a. A – Asymmetry b. B – Border that is irregular or notched c. C – Color that is variegated d. D – Diameter that is greater than 6 mm or the diameter of a pencil eraser e. E – Evolution of lesion, i.e., there has been change in an existing pigmented lesion

Answer 54

a. Nevus cells may proliferate in nests or solid sheets. b. Individual cells are enlarged and often bizarre. c. Histologic Growth Patterns 1) Radial growth phase – the melanoma has a tendency to grow horizontally within the epidermal and superficial dermal layers. This stage may last for a prolonged period of time. Melanoma does NOT have the capacity to metastasize in this stage. 2) Vertical growth phase – the melanoma now grows downward into the deeper dermal layers as an expansile mass. Clinically, the melanoma develops a nodule within the previously flat lesion. This stage features metastatic potential

Answer 55

Tx: a. Complete surgical excision. b. Depending on depth of invasion at the primary site, local lymph nodes may also be surgically removed. Prognosis: a. In 1945 the 5-year survival rate was about 40%. b. In 1983 the 5-year survival rate was 83%. c. Factors that affect prognosis 1) Early detection and treatment in the lateral growth phase (< 2 cm diameter). 5-year disease-free survival is 100%. 2) Tumor thickness and presence (or absence) of ulceration have prognostic significance independent of clinical stage. 3) Depth of invasion in the vertical growth phase 4) < 0.76 mm invasion yields best survival → 5-year disease-free survival 98% 5) < 1.7 mm tumor thickness is still considered favorable.

13 - Skin diseases Flashcards

(80 cards)