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Block 7; Week 2-Michelle > Dermatopathology-Fung > Flashcards

Dermatopathology-Fung Flashcards

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1
Q

What are the 3 layers of the skin?

A

Epidermis
Dermis
Subcu

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2
Q

What is found in the epidermis?

A 
mainly keratinocytes--produce keratin, a water soluble barrier for the skin.
stratified squamous cells
melanocytes-UV protection.
inflammatory cells
langerhans cells
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3
Q

What is found in the dermis?

A

layer filled with collagen

adnexal structures: hair follicles, glands

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4
Q

What is found in the subcutaneous layer? What is its function?

A

lots of fat!
provides shock absorption
thermal insulation for the skin

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5
Q

What are the layers of the epidermis–from nearest the basement membrane up? Note: this is the same order of keratinocyte maturation.

A

Stratum Basale.
Stratum Spinosum
Stratum Granulosum
Stratum Corneum

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6
Q

What is the main function of the stratum basale?

A

responsible for regenerating keratinocytes

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7
Q

What is the main function of the stratum spinosum?

A

polyhedral keratinocytes

produce cytokeratins–these form tonofibrils & desmosomes.

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8
Q

What is the function of desmosomes? Note: these are partially formed in the stratum spinosum.

A

function: intercellular bridges

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9
Q

What is the appearance of the stratum granulosum? What is found there? What is its function?

A

It appears blue
keratohyalin granules are there!
keratohyalin granules combine with tonofibrils=keratin made!

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10
Q

What is found in the stratum corneum?

A

mature keratin

these keratinocytes don’t have nuclei or cytoplasm. It was spit out!

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11
Q

Which structure separates the epidermis & dermis?

A

the basement membrane

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12
Q

The epidermis has ridges that connect with the _____ layer of the dermis. What is the function of these ridges?

A

these ridges help the skin to withstand sheering forces

connects with the papillary layer of the dermis

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13
Q

Which layer is found beneath the papillary layer?

A

the reticular layer

has collagen bundles!

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14
Q

What are the 2 types of glands that are found in the dermis?

A

apocrine-non fcnl

secretory/eccrine-secrete sweat!

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15
Q

What is the main function of eccrine sweat glands?

A

thermoregulation!

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16
Q

Where are the apocrine glands found?

A

axilla & groin

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17
Q

What is different & special about the skin that is found on the soles of feet & palms of hands?

A

they have modified skin!
no adnexal structures in the dermis
bunches of thick keratin in the epidermis
can withstand more trauma

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18
Q

What is the macule’s larger buddy?

A

the patch.

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19
Q

What is the def & distinguishing features of a macule?

A 
Well circumscribed.
flat lesion.
Less than 5 mm
Sharply demarcated from the skin.
Noted b/c of pigmentation compared to rest of skin.
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20
Q

What is the definition of a patch?

A

well circumscribed
flat
>5 mm
different color

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21
Q

What is the definition of a papule?

A

well circumscribed
elevated dome-shaped or flat-topped lesion
<5 mm

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22
Q

What is the definition of a nodule?

A

well circumscribed
elevated dome-shaped or flat-topped
>5 mm

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23
Q

What is the papule’s larger buddy?

A

nodule!

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24
Q

What is the definition of a plaque?

A 
elevated
flat-topped lesion
>5 mm
ex: psoriasis
something seen in chronic inflammatory dermatosis
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25
What is the definition of a pustule?
these are pus filled raised lesions no size criteria seen in acne & abscesses
26
What is the definition of a scale?
dry, horny, platelike excrescence | b/c of imperfect cornification
27
What is the definition of a vesicle?
fluid-filled raised lesion less than 5 mm blister
28
What is the definition of a bulla?
fluid-filled raised lesion greater than 5 mm blister
29
What is the vesicle's larger buddy?
bulla
30
What is the definition of an excoriation?
traumatic lesion breaking the epidermis | causes a raw linear area (deep scratch)
31
What is the definition of a wheal?
itchy transient elevated lesion variable blanching some blistering erythema--dermal edema present
32
What is lichenification?
thickened rough skin usu result of repeated rubbing
33
What is acanthosis?
microscopic lesion diffuse epidermal hyperplasia, thickened seen in chronic inflammatory dermatosis
34
What is acanthosis' friend?
papillomatosis
35
What is the definition of papillomatosis?
microscopic lesion thickened epidermis, hyperplasia distinct papillary fragment enlarged contiguous dermal papillae
36
What is hyperkeratosis?
thickened keratin layer stratum corneum is thickened no nuclei, like normal
37
What is the friend of hyperkeratosis?
parakeratosis
38
What's the deal with parakeratosis?
microscopic lesion also a thickened keratin layer abnormal in that it retains the nuclei in the keratinocytes. see blue dots in the stratum corneum.
39
What is hypergranulosis?
thickened stratum granulosum
40
what is spongiosis?
this is when you don't see much space b/w the keratinocytes, edema has pushed them apart! basically: intercellular edema of the epidermis
41
What is lentiginous, a microscopic lesion?
melanin is produced in the epidermal basal layer linearly
42
What is dyskeratosis?
abnormal premature keratinization due to malignant change happens below the stratum granulosum, which is abnormal when you see a bunch of pink in the epidermis
43
What happens in an acute inflammatory dermatosis?
it lasts from days-weeks | there are lymphocytic & macrophage inflammatory infiltrate & edema.
44
What happens in chronic inflammatory dermatosis?
months-years changes in epidermal growth (atrophy or hyperplasia) or changes in dermis, maybe fibrosis skin is roughened due to excess or abnormal scale formation & shedding
45
What is urticaria, hives?
common disorders caused by local mast cell degranulation & dermal microvascular hyper permeability get pruritic edematous plaques (wheals) can be acute or chronic acute if less than 6 weeks
46
What is angioedema?
condition that is related to urticaria | edema of a deeper dermis & subcutaneous fat
47
Which is fairly normal in urticaria: epidermis, dermis?
epidermis is fairly normal papillary dermis exhibits edema inflammation
48
What are some possible causes of urticaria?
``` Causes include Immunologic mechanisms Non-immunologic mechanisms Physical stimuli Skin contact Small vessel vasculitis ```
49
What are some treatment options for urticaria?
avoidance of allergen oral h1 antagonists epi
50
What is acute eczematous dermatitis?
common skin disorder results from t cell mediated inflammatory reactions type IV DTH
51
What are the 5 categories of acute eczematous dermatitis?
``` Allergic contact dermatitis Atopic dermatitis Drug-related eczematous dermatitis Photoeczematous dermatitis Primary irritant dermatitis ```
52
What are some microscopic features of acute eczematous dermatitis?
spongiosis: space b/w keratinocytes parakeratosis: nuclei present in the stratum corneum sometimes you get intaepidermal vesicles
53
What are the 2 broad categories of causes of acute eczematous dermatitis?
Inside Cause: internal circulating antigen | Outside Cause: external application of an antigen
54
What is the treatment of acute eczematous dermatitis?
removal of antigen | topical steroids
55
What is erythema multiform?
self limited hypersensitivity reaction associated with certain infections from viruses, bacteria, fungi associated with exposure to some drugs associated with cancer & collagen vascular disease
56
What are some viral infections & bacterial infections associated with erythema multiform?
viral: herpes simplex bacterial: mycoplasma, leprosy, typhoid
57
What are some fungal infections associated with erythema multiform?
histoplasma | coccidioides
58
What are some drugs that a pt can be exposed to and then develop erythema multiform?
``` sulfonamides penicillin barbiturates salicylates antimalarials ```
59
Stevens Johnson Syndrome is a febrile form of ________. with extensive skin involvement.
a form of erythema multiforme can lead to sepsis often seen in children
60
Which additional areas of skin does stevens johnson syndrome include?
oral mucosa conjunctiva urethra genital & perianal regions
61
Toxic Epidermal Necrolysis is a form of _________. What is it characterized by?
form of erythema multiform diffuse necrosis, sloughing of cutaneous & mucosal epithelial surfaces similar clinical case to a burn pt
62
What is the treatment for erythema multiform? For acute & chronic cases?
``` Treatment Acute -- Observation Oral antihistamines Topical steroids Acyclovir-in treatment of recurrent herpes. Prednisone Chronic-- Antivirals (acyclovir) Dapsone Azathioprine Cyclosporine ```
63
What % of the pop. does psoriasis affect?
1-2%
64
What is psoriasis?
Chronic inflammatory dermatosis that results from interactions of genetic and environmental factors Associated with HLA-C **Results from activated T cells in the skin stimulating the secretion of cytokines and growth factors that induce keratinocyte proliferation
65
15% of psoriasis patients also have what?
associated arthritis
66
What is the auspitz sign? Which condition is it associated with?
this is associated with psoriasis. It is when you get micro hemorrhages after scraping off plaques. this is when the b.v. of the papillary dermis reach the epidermis.
67
Where can you sometimes see monroe abscesses in psoriasis?
within the parakeratosis
68
What is the treatment for psoriasis?
``` Treatment Topical steroids Intralesional steroid injection UVB and tar Methotrexate Cyclosporine Soriatane ```
69
What is seborrheic dermatitis?
common chronic inflammatory dermatosis affects up to 5% of general pop. involves regions of high density sebaceous glands
70
What are some common areas to see seborrheic dermatitis?
remember: areas with sebaceous glands! ``` Scalp Forehead External auditory canal Retroauricular area Nasolabial folds Presternal area ```
71
What are the causes of sebhorreic dermatitis?
increased sebum production colonization of the skin by Malassezia can get a more severe form if you are HIV+ & have low CD4 counts
72
What is the treatment for sebhorreic dermatitis?
``` Treatment Frequent washing of the affected area with antisebhorreic soaps Topical steroids Anti-yeast medications Oral antifungals ```
73
Lichen has 6 letters. So...lichen planus has 6 important Ps. What are they?
1. pruritic 2. purple 3. polygonal 4. planar 5. papules 6. plaques
74
Describe the resolution process of lichen planus.
it is a self limited condition & resolves spontaneously 1-2 years after onset resolution of lesions may leave post inflammatory hyper pigmentation
75
What may develop in oral lesions of lichen planus?
squamous cell carcinoma
76
What is wickham's striae? Which condition is it associated with?
these are white lines that are seen within a purple plaque | sign of lichen planus
77
What causes wickham's striae?
hypergranulosis
78
What is the treatment for lichen planus?
``` Treatment Topical steroids Intralesional steroids Systemic steroids Azathioprine Cyclosporine Light therapy (PUVA & UVB) ```
79
Give some examples of conditions that include blisters.
Herpes virus Spongiotic dermatitis Erythema multiforme Thermal burns
80
What are the characteristics of bullous blistering disorders?
group of diseases with blisters that are primary & distinctive features inflammatory or not!
81
Which layer of the skin are the pemphigus foliaceus blisters located?
subcorneal | right underneath the stratum corneum
82
Which type of blistering disorder has blisters located above the basal layer?
pemphigus vulgaris
83
Which type of blistering disorder has blisters located below the epidermal layer?
bullous pemphigoid | **occurs below the stratum basal...at the level of the basement membrane
84
Pemphigus foliaceus which makes sub_____ blisters is directed against which desmoglein?
subcorneal blisters | directed against desmoglein 3
85
Bullous pemphigoid is directed against what?
BPAG2 at the hemidesmosome level
86
What is pemphigus?
inflammatory blistering disorder | caused by autoantibodies that result in dissolution of intercellular attachments w/i epidermis & mucosal epithelium.
87
Which antibodies does pemphigus involve? What do they target?
involves IgG autoantibodies to desmoglein 1 & 3 **affects desmosomes
88
What are the 5 variants of pemphigus?
``` pemphigus vulgaris pemphigus vegetans pemphigus foliaceus pemphigus erythematosus paraneoplastic pemphigus ```
89
Which type of pemphigus is associated with cancer?
paraneoplastic pemphigus
90
Which type of pemphigus is the most common, seen 80% of the time?
pemphigus vulgaris
91
Which type of pemphigus is seen as plaques around the groin?
pemphigus vegetans
92
Which type of pemphigus forms sub corneal blisters?
pemphigus foliaceus
93
Which type of pemphigus forms less severe sub corneal blisters?
pemphigus erythematosus
94
What would you see on histo of pemphigus vulgaris?
you would still see the basal layer, b/c the blisters are supra basal see intraepithelial vesicles being formed
95
What is the proper treatment of pemphigus?
immunosuppressive agents--decrease titers of pathogenic autoantibodies
96
What is bullous pemphigoid?
blistering disorder (inflammatory) caused by autoantibodies against proteins that bind basal keratinocytes to the basement membrane
97
What are the proteins that link the basal keratinocytes to the basement membrane?
BPAGs are the proteins that are a critical part of the hemidesmosomes
98
What is the pattern of antibody deposition in bullous pemphigoid?
linear pattern at the dermoepidermal junction
99
What happens when you touch the blister of a pt w/ bullous pemphigoid?
they don't break when touched | they can even heal without scarring
100
What is the treatment for bullous pemphigoid?
topical steroids systemic steroids methotrexate azathioprine
101
What is dermatitis herpetiformis?
``` urticaria & grouped vesicles strong association with HLA-B8, HLA-DR3, HLA-DQw2 develop IgA antibodies to dietary gluten antibodies cross react w/ reticulin injury results in sub epidermal blisters ```
102
Why is it that antibodies to reticulin could lead to sub epidermal blisters in dermatitis herpetiformis?
reticulin is a component of anchoring fibrils that attach the epidermal basement membrane to the superficial papillary dermis
103
What is the treatment for dermatitis herpetiformis?
dapsone sulfapyridine **immunomodulatory agents
104
What is an example of a non-inflammatory blistering disorder?
epidermolysis bullosa
105
What is epidermolysis bullosa?
inherited defect in structural proteins that cause mechanical instability for the skin soon after birth see blister formation at sites of pressure, rubbing, or trauma
106
What are the 4 types of epidermolysis bullosa?
simplex junctional dystrophic mixed
107
How is the simplex type of epidermolysis bullosa inherited? What does it target?
aut dom inheritance affects keratin 14 & 5 defects in the basal cell layer of the epidermis gives sub epidermal blisters!!
108
What are the 2 components of the basement membrane?
lamina densa | lamina lucida
109
How is the junctional type of epidermolysis bullosa inherited? What does it target?
aut rec inheritance born w/ defects in laminin laminin deficiency-->makes lamina lucida of basement membrane defective. blisters seen @ the level of the lamina lucida
110
What does the lamina lucida bind to?
binds to hemidesmosomes | binds to anchoring filaments (bind basal keratinocytes to basement membrane)
111
How is the dystrophic type of epidermolysis bullosa inherited? What defects are present?
aut dom inheritance or aut rec defects in type VII collagen causes blisters at the level of the lamina densa (in the basement membrane) scarring disorder
112
What is type VII collagen a major component of?
basement membrane anchoring fibrils

Block 7; Week 2-Michelle (4 decks)

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