Dermatopathology part 6

Question 1

Panniculitis

Answer 1

inflammation of fat lobules or the connective tissue septa separating fat lobules

Question 2

Erythema nodosum: Etiology, SX

Answer 2

inflammatory reaction of hte connective tissue septa separating fat lobules

most common in females 20-30

not a disease but a reaction to various etiologies

self limited resolution in 6 weeks

fever malaise and joint pain may precede the rash

Question 3

ERythema nodosum: gross

Answer 3

painful, red, subcutaneous, elevated nodules

nodules are indurated and poorly circumscribed

usually located on the anterior aspect of the tibia

bilateral but not symmeteric

Question 4

Erythema nodosum causes

Answer 4

idiopathic

strep infection

sarcoidosis

inflammatory bowel disease

fungal infection

pregnancy

meds: OCP, sulfa, amiodarone, antibiotics

syphillis

TB

Question 5

Erythema nodosum: TX

Answer 5

bed rest, lega elevation, NSAIDS, and heat for SX. Steroids only when infection excluded

Question 6

Erythema nodosum histo

Answer 6

septal panniculitis (little to no necrosis of lobule)

Early: widening of septa from fibrin edema and neutrophilic infiltrate

chronic: mononuclear cells and granulomatous inflammation of septum with fibrosis

Question 7

Warts

Answer 7

benign growths caused by infection of epidermal cells with human papilloma virus

generally occur in children and yougn adults

transmitted by skin to skin contact

lesions disrupt skin lines

intralesional brown black dots are pathogenomic and reprsent thrombosed vesels

Question 8

Wart gross: the common wart (verruca vulgaris)

Answer 8

the common wart (verruca vulgaris)

flesh colored papule with hyperkeratotic surface

most common on elbows, knees, fingers, palms

Question 9

Wart gross; Flat wart (verruca plana)

Answer 9

flesh colored, slightly raised papules and flat surface

usually on chin, dorsum of hands, and legs

Question 10

Wart gross: Plantar wart (verruca plantaris)

Answer 10

HPV 1

fleshed colored papule with hyperkeratotic surface

warts found on underside of foot. may cause pain if on pressure areas.

Question 11

Warts: Anogenital wart (condyloma acuminatum)

Answer 11

Most common STD, types HPV 6 and 11

HPV 16 and 18 can lead to cervical cancer

appearnce: soft, fleshy pink papillomas on the genitalia, perineum , and anus.

Question 12

Verruca vulgaris histo

Answer 12

exophytic

chruch spire of verrucous acanthosis

koilocytes (cells with vacuolated cytoplasm- clearing around the nucleus)

infected cells may show prominent keratohyline granules

Question 13

Warts sx

Answer 13

most warts are asymptomatic

may bleed

most disappear in 1-2 years but may mutiply or recur despite treatment

Question 14

Warts TX

Answer 14

cryotherapy may need > 1 treatment, 60-75%

duct tape: more effective than cryo in some studies

salicyclic acid

5 fu

imiquimod

pdophyllin for genital warts

pare lesion down or soak to allow better penetration of topical medication

Question 15

Molluscum contagiosum

Answer 15

common, self limited viral infection in kids and sexually active adults

caused by poxvirus

transmitted via skin to skin contact and is highly contagious

Question 16

Molluscum contagiosum: SX

Answer 16

asymptomatci smooth, dome shaped papules with central umbilication

lesions are flesh colored and translucent

papules ahve a cheesy core that can be expressed

may occur singly or in groups

occur anywhere on kids and genitals of sexually active adults

Question 17

Molluscum contagiosum TX

Answer 17

spontaneously remit in a few months

In HIV patients, lesions can be extesnive, grow very large and be refaractory to treatment

TX: cryotherapy, curettage, salicyclic acid

Question 18

Molluscum contagiosum: Histo

Answer 18

cup shaped lesion with scallped border

verrucous acanthosis (epidermal hyperplasia)

molluscum bodies in cells of stratum corneum and stratum granulosum (ovid, homogeneous, cytoplasmic inclusion bodies)

Question 19

Impetigo

Answer 19

Common, highly contagious superficial bacterial infection of the skin

children, adults

painful lesions distinguishes from contact dermatitis

two forms nonbullous and bullous

Staph a. is most common cause of either kind

Question 20

Impetigo: Nonbullous

Answer 20

most common

face and extremities

papules progress to vesicles on erythematous base

when vescicles rupture causes typically “hone colored rust”

Question 21

Impetigo: Bullous

Answer 21

young children

vesicles enlarge to form flaccid bullae with clear yellow fluid contents, later becomes darker and more turbid; ruptured bullae leave a thin brown crust

trunk is more frequently affected

Question 22

Impetigo Histo

Answer 22

accumulation of neutrophils beneath stratum corneum

Question 23

Impetigo TX

Answer 23

topical: Mupirocin or hydrogen peroxide cream for limited number of lesions

oral antibiotics for bullous type

Question 24

Scabies

Answer 24

infection with sarcoptes scabiei

common in school age children, nursing home patients, and less developed countries

patients present with the worst itch they;ve ever had

incubation time is about 1 month so contacts may not be symptomatic

Question 25

Scabies sx

Answer 25

predilection for finger webs, wrists, and penis spares head, neck, palms, and soles linear burrows with a drak dot at one end representing apth of female mite in skin small inflammatory papules and excoriations predominate

Question 26

Scabies (sarcoptes scabiei)

Answer 26

highly contagious: skin contact, towels, linens mites tunnel in epidermis, lay eggs, and deposit feces. Very few mites present eggs and feces cause delayed type IV hypersensitivity reaction causing intense itching usually at night

Question 27

Scabies diagnosis

Answer 27

look for burrows on hands, wrists, etc suspect in anyone with persistent generalized, severe pruritis confirm diagnosis by scraping burrow with a scalpel. Look under microscope to detect mites, ova, or feces

Question 28

Scabies oil preparation

Answer 28

put a few drops of mineral oil on glass slide put mineral oil on scalpel blade scrape burrow with blade put scrapings on slide look under microscope

Question 29

Sccabies TX

Answer 29

topical: 5% permethrin cream, 1% lindande lotion oral ivermectin treat all close contact and wash all linens and underwear not contagious after 1 treatment. itching may alst for weeks as mites are shed. use topical steroids and oral antihistamines

Question 30

Xanthelasma (xanthoma

Answer 30

collection of macrophages containing lipid droplets assocaited with familial hyperlipidemias, nephrotic syndrome, myeloma, pnacreatitis, thryoid disease, primary biliary cirrhosis may be isolated findings. Always check lipids

Question 31

mongolian spot

Answer 31

single gray-blue lesion over lumbosacral area more common in asian and native americans pts melanocytes lcoated in the dermis instead of epidermis that may be neural crests cells interrupted in migration most disappear during childhood. no melanomas occur in this lesion

Question 32

cherry angioma

Answer 32

bright red , domed, vascular lesions on trunk benign and increase with age TX not indicated

Question 33

Hemangioma of infancy

Answer 33

most common tumor of infancy most common in premature, caucasian girls benign tumor of hyperplastic blood vessels blachable bright red to deep purple lesions arise in the first few weeks of life and grows for the first year then regresses normally by 10.

Question 34

Hemangioma of infancy

Answer 34

do not treat unless it ulcerates or blocks ears, eyes, larynx can use propranolol, steroids, or laser parents need a lot of reassurance

Question 35

Alopecia

Answer 35

3 phases of hair development: anagen (grwoing) catagen (involution), telogen (resting and hair shed at end)

Question 36

Alopecia androgentic alopecia

Answer 36

polygenic inheritance involves scalp 5 alpha reductase activity and androgenic effects of dihydrotestosterone produced men and women equally affected men: loss at temporal areas and mid scalp women: diffuse loss, rarely complete, front hairline maintained

Question 37

Alopecia: tinea capitis (ringworm)

Answer 37

isolated pruritic lesion on scalp with central clearing

Question 38

Alopecia Telogen effluvium

Answer 38

diffuse decrease in ahir density due to rapid conversion of anagen to telogen hair precipitate by stressful events, illness, fever, pregnancy

Question 39

Aloipecia areata

Answer 39

autoimmune disorder causing patchy or diffuse hair loss

Question 40

alopecia TX

Answer 40

alopecia areata: high potency topical steroids androgentic alopcia: minoxidil and finasteride (inhibits syntehsis of dihydrotesterone.) spirnolactone in women.

Question 41

Xeroderma pigmentosum

Answer 41

autosomal recessive condition decreased ability to repair DNA followed damage by UV light due to defects in excision of abnormal nucleotides or defects in replacement of nucleotides following excision first year of life with erythema, scaling, subsequent hyperpigmentation and lentigo on lgiht exposed area skin later shows atrophy, teleangiectasia and intermingling areas of hypo and hyperpigmentation squamous cell cancer, basal cell cancer and melanoma develop as early as 50-60 years of life

Question 42

Chediak higash syndrome

Answer 42

autosomal recessive immunodeficiency due to defect in neutrophil phagosome lysosome fusion causing abnormal giant lysosomal inclusions visible on peripheral blood smear. Pyogenic infection due to staph and strep. Albinism: abnormal melanin sotrage in melanocytes causes aprtial oculocutaneous albinism nystagmus, peripheral and cranial neuropathies most commonly diagnosied in childhood.

Question 43

Wiskott aldrich syndrome

Answer 43

x linked disorder immunodeficiency eczema thrombocytopenia combined B and t lymphcyte disorder

Question 44

albinism

Answer 44

melanocytes normal in number and location but production of melanin defective due to complete absence of tyrosinase complete albinism manifest by white hair, blue eyes and pink or white skin.