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Flashcards in Derm Deck (69):
1

Layers of the Epidermis

"Californians Like Girls in String Bikinis"
Stratum Corneum (keratin)
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum (spines = desmosomes)
Stratum Basale (stem cell site)

2

Sebaceous gland
What kind of gland?
What does it secrete?
What is it associated with?

Holocrine (cell rupture) secretion of sebum associated with hair follicle

3

Eccrine gland
What does it secrete?
Where are they located?

Secret sweat
Found Everywhere

4

Apocrine gland
What does it secrete?
Where are they located?
When does it begin functioning?
How are they different from eccrine glands sensory-wise? Why?

Secretes milky viscous fluid
Found in axillae, genitalia, and areolae
Does not become functional until puberty
Malodorous because of bacterial action

5

Tight Junctions
Name
Function
Composition

Zona Occludens
Prevents paracellular movement of solutes
Claudins and Occludins

6

Adherens Junctions
Name
Location
What does it form?
Composition
Association with disease?

Zona Adherens
Below tight junctions
Forms belt connection actin cytoskeletons of adjacent cells
CADherins (Ca dependent ADhesion proteins)
Loss of E cadherin promotes metastasis

7

Desmosomes
Name
Function
Composition
Disease involving them?

Macula Adherens
Structural support
Desmoplakin and Keratin
Autoantibodies --> pemphigus vulgaris

8

Gap Junctions
Composition
Function

Connexons (channel proteins)
Permit electrical and chemical communication

9

Hemidesmosomes
Function
Composition
Disease involving them?

Connect keratin in basal cells to underlying basement membrane
Integrins in cell bind Laminin in BM
Autoantibodies --> Bullous Pemphigoid

10

SLE
Epidemiology
Presentation
Common cause of death?

90% are female 14-45. Most common and severe in blacks
Fever, Fatigue, Wt Loss, Libman-Sacks Endocarditis, Hilar adenopathy, Raynaud Phenomenon
Nephritis is common cause of death
Nephritic: DPGN, Nephrotic: Membranous

11

Libman-Sacks Endocarditis

Verrucous wart-like sterile vegetations on both sides of valve

12

Lab results in SLE

False + on Syphilis test (RPR/VDRL) due to antiphospholipid Abs which cross react with cardiolipin used in test
ANA (sensitive but not specific)
Anti dsDNA (specific, poor prognosis)
Anti Smith Ab (specific, not prognostic)
Anti Histone Ab (sensitive for drug induced lupus)

13

Presentation of SLE

"I'm DAMN SHARP"
Immunoglobins (dsDNA, Smith, Phospholipids)
Malar Rash
Discoid Rash, ANA, Mucositis (oropharyngeal ulcers), Neurological disorder
Serositis (pleuritis, pericarditis), Hematologic disorders, Arthritis, Renal disorders, Photosensitivity

14

Sarcoidosis
Epidemiology
Findings
Labs
Histo

Black females
Enlarged bilateral hilar adenopathy or reticular opacities on CXR
↑ ACE levels, ↑ Ca (elevated 1α hydroxylase mediated VitD activation in epithelioid Macs)
Noncaseating Granulomas

15

Sarcoidosis
Symptoms
Associated with what disease?
Treatment

"A Red BUG"
Often asymptomatic. Erythema Nodosum, Bell's Palsey, Epithelial Granulomas containing microscopic Schaumann and Asteroid Bodies, Uveitis
Associated with Restrictive Lung disease (interstitial fibrosis)
Steroids

16

Scleroderma
Characterization
Presentation
Other organ systems involved?
Epidemiology
Types

Excessive fibrosis and collagen deposition throughout body
Commonly sclerosis of skin manifesting as puffy and taut skin w/o wrinkles
Sclerosis of Renal, Pulmonary (most common cause of death), CV, GI systems
75% females
Diffuse vs CREST

17

Diffuse Scleroderma
Presentation
Progressive
Labs

Widespread skin involvement
Rapid progression with early visceral involvement
Anti Scl70 Ab (anti DNA topoisomerase I)

18

CREST Syndrome
Name
Areas involved
Prognosis
Labs

Calcinosis, Raynaud's phenomenon, Esophageal dismotility (b/c of fibrous replacement of muscularis), Sclerodactyly, Telangiectasia
Limited skin involvement (Fingers and Face)
Benign clinical course
Anti Centromere Ab

19

Macule

Flat lesion w/ well circumscribed change in skin color
<5mm

20

Patch

Macule >5mm

21

Papule

Elevated solid skin lesion <5mm

22

Plaque

Papule >5mm

23

Vesicle

Small fluid containing blister <5mm

24

Bulla

Large fluid containing blister >5mm

25

Pustule

Vesicle containing pus

26

Wheal

Transient smooth papule or plaque (Hives)

27

Scale

Flaking off of stratum corneum

28

Crust

Dry exudate

29

Hyperkeratosis

Thickening of stratum corneum

30

Parakeratosis

Hyperkeratosis with retention of nuclei in stratum corneum

31

Acantholysis

Separation of epidermal cells

32

Acanthosis

Epidermal hyperplasia (↑ spinosum)

33

Dermatitis

Inflammation of the skin

34

Albinism
What is it?
Causes

Normal melanocyte # with ↓ melanin production
↓ Tyrosinase activity or failure of neural crest cell migration during development

35

Melasma (Chloasma)

Hyperpigmentation associated with pregnancy or OCP use

36

Vitiligo

irregular areas of complete depigmentation caused by ↓ in melanocytes

37

Verrucae
What is it?
Causes by
Description
PathoPhys
If on genitals

Warts
HPV
Soft, tan colored, cauliflower-like papules
Epidermal hyperplasia, Hyperkeratosis, Koilocytosis
Condyloma Acuminatum on genitals

38

Melanocytic nevus
What is it?
Malignant?
Location and description?

Common mole
Benign but melanoma can arise in congenital or atypical moles
Intradermal nevi are papular. Junctional nevi are flat macules

39

Urticaria
What is it?
PathoPhys

Hive
Pruritic wheal that forms after mast cell degranulation

40

Ephelis
What is it?
Physiology

Freckle
Normal # of melanocytes with ↑ melanin pigment

41

Atopic Dermatitis
What is it?
Common location
Associated with what other diseases
Course

Eczema. Pruritic eruptions
Commonly on skin flexures
Associated with other atopic disease (asthma, allergic rhinitis)
Usually starts on the face during infancy and often appears in the antecubital fossae thereafter

42

Allergic Contact Dermatitis
Type of Rxn
Location

Type IV hypersensitivity reaction following exposure to allergen
Lesions occur at site of contact

43

Psoriasis
What is it?
Where is it?
Histo
Physical Exam findings
Associations

Papules and Plaques with silvery scaling
Knees and Elbows
Acanthosis with parakeratotic scaling (nuclei still in stratum corneum).
↑ Stratum spinosum, ↓ Stratum granulosum
Auspitz sign (pinpoint bleeding spots from exposed dermal papillae when sclaes are scraped off)
Associated with nail pitting and psoriatic arthritis

44

Seborrheic Keratosis
What is it?
Appearance
Location
Malignant
Age of pt?

Flat, Greasy, Pigmented Squamous Epithelial Proliferation with keratin filled cysts (horn cysts)
Looks stuck on
Head, trunk, extremities
Benign neoplasm
Older persons

45

Leser Trelat Sign

Sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy (GI, lymphoid)

46

Pemphigus Vulgaris
PathoPhys
If
Presentation

IgG Abs against desmoglein 1 +/or 3 (part of desmosome)
If reveals Abs around epidermal cells in reticular or netlike pattern
Acantholysis - Intraepidermal bullae causing flaccid blister involving skin and oral mucosa. + Nikolsky Sign

47

Nikolsky Sign

Separating of epidermis upon manual stroking of skin
Means that the lesion is intraepidermal

48

Bullous Pemphigoid
PathoPhys
If
Histo
Presentation

IgG Abs against hemidesmosomes
Linear If
Eosinophils within tense border
Affects skin but not oral mucosa
- Nikolsky sign

49

Dermatitis Herpetiformis
What is it?
PathoPhys
Associated with what disease?

Pruritic papules, vesicles, and bullae
Deposits of IgA at tips of dermal papillae
Associated w/ celiac disease

50

Erythema Multiforme
What causes it
Presentation

Infections (Mycoplasma pneumoniae, HSV), Drugs (sulfa, β lactams, phenytoin), Cancer, Autoimmune
Presents with macules, papules, vesicles, target lesions (targets with multiple rings and dusky center showing multiple epithelial disruption)

51

Stevens-Johnson Syndrome
Presentation
Danger
Description of lesions
Caused by
Severe form

Fever, Bulla, Necrosis, Sloughing off of skin
High mortality rate
Typically 2 mucus membranes are involved. Lesions may appear like targets as seen in erythema multiforme
Adverse drug reaction
More severe form is toxic epidermal necrolysis

52

Acanthosis Nigricans
PathoPhys
Description
Location
Diseases associated with it?

Epidermal hyperplasia causing symmetrical hyperpigmented, velvety thickening of skin
Neck and axilla
Hyperinsulinemia (diabetes, obesity, Cushing's) and visceral cancer

53

Actinic Keratosis
Malignant?
What causes it?
Description
Risk of...

Premalignant lesion caused by sun exposure
Small, rough, scaley erythematous or brownish papules or plaques
Risk of squamous cell carcinoma proportional to degree of epithelial dysplasia

54

Erythema Nodosum
PathoPhys
Location
Associated with what disorders?

Inflammatory lesions of subcutaneous fat
Anterior shins
Sarcoidosis, Coccidioidomycosis, Histoplasmosis, TB, Streptococcal infection, Leprosy, Crohn's Disease

55

Lichen Planus
Description
Histo
Associated with what other diseases?

Pruritic, Purple, Polygonal, Planar, Papules and Plaques
Sawtooth infiltrate of lymphocytes at dermal-epidermal junction
HCV

56

Pityriasis Rosea
Course
Description

Herald Patch followed days later by Christmas tree distribution. Self-resolving in 6-8 weeks
Multiple plaques with collarette scales

57

Sunburn
PathoPhys
Kind of UV light
What can in lead to?

UV irradiation causes DNA mutations inducing apoptosis of keratinocytes
UVA is dominant in tanning and photoaging
UVB is dominant in sunburn
Can lead to impetigo and skin cancers (basal cell carcinoma, squamous cell carcinoma, and melanoma)

58

Impetigo
What is it?
What causes it?
Epidemiology
Presentation

Very superficial skin infection
S aureus or S pyogenes
Highly contagious
Honey colored crusting

59

Bullous Impetigo

Bullae caused by S aureus

60

Cellulitis
What is it?
Presentation
Caused by?
Course

Spreading infection of dermis and subcutaneous tissues
Acute and painful
S pyogenes or S aureus
Often starts with break in skin from trauma or another infection

61

Necrotizing fasciitis
What is it?
What causes it?
Presentation

Deeper tissue injury
Anaerobic bacteria or S pyogenes. "Flesh eating bacteria"
Crepitus from methane and CO2 production
Bullae and purple colored skin

62

Staphylococcal scalded skin syndrome (SSSS)
PathoPhys
Presentation
Classic Pt?

Exotoxin destroys keratinocyte attachment in the stratum granulosum only
Fever and generalized erythematous rash with sloughing of the upper layers of the epidermis that heals completely
Newborns and children

63

Toxic Epidermal Necrolysis

Exotoxin destroys epidermal-dermal junction

64

Hairy Leukoplakia
What is it?
What causes it?
What kind of pt gets it?

White, painless, plaques on the tongue that cannot be scraped off
EBV
HIV+ pt

65

Basal Cell Carcinoma
Frequency
Location
Invasion? Metastatic?
Presentation
Secondary presentation?
Histo

Most common skin cancer
Sun exposed areas
Locally invasive but almost never metastasizes
Pink, Pearly nodules commonly w/ telangiectasias, rolled border, central crusting or ulceration
Also appears as nonhealing ulcer with infiltrating growth or a scaling plaque
Palisading nuclei

66

Squamous Cell Carcinoma
Frequency
What causes it?
Location
Invasion? Metastatic?
Presentation
Associated w/
Histo

2nd most common skin cancer
Sun exposure, immunosuppression, arsenic exposure
Face, lower lip, ears, hands
Locally invasive but may spread to lymph nodes and will rarely metastasize
Ulcerative red lesions with frequent scales
Associated with chronic draining sinuses
Keratin pearls

67

Keratoacanthoma

Variant of Actinic Keratosis that grows rapidly (4-6 weeks) and may regress spontaneously over months

68

Melanoma
Metastatic?
Marker?
Risk factors?
Presentation

Depth of tumor correlates with metastasis
S-100
Sunlight exposure. Fair skinned persons
Asymmetry, Border irregularity, Color variation, Diameter > 6mm, Evolution over time

69

Melanoma
Genetics
Treatment

BRAF kinase mutation. BRAF V600E is metastatic and unresectable.
Excision with appropriately wide margins. BRAF V600E: use Vemurafenib or BRAF kinase inhibitors