Inflammatory Dermatoses I & II (Swick)

Question 1

what histolopathologic pattern shows inflammation in the subcutaneous adipose tissue?

Answer 1

panniculitis

Question 2

type of psoriasis that is most common in children and young adults, and is associated with Streptococcal pharyngitis; is characterized by small, round papules/plaques with overlying scales

Answer 2

Guttate psoriasis

Question 3

Acanthosis (thickening of the skin) with hypergranulosis, band-like lymphoid infiltrate at the basal layer, and saw-toothing of rete ridges are all features of what condition?

Answer 3

lichen planus

Question 4

clinical category of dermatosis that has palpable or non-palpable bleeding in the skin

Answer 4

purpuric

Question 5

Which of these is NOT routinely recommended for treatment of atopic dermatitis?

A. UV light therapy

B. Narrow spectrum antibiotics

C. Topical corticosteroids

D. Emollients (moisturizers)

E. Systemic immunosuppressants

Answer 5

B.

Antibiotics should only be used if there is an infection present, and the selected antibiotic should cover both S. aureus and S. pyogenes. Systemic immunosuppressants are used for severe atopic dermatitis, and systemic corticosteroids are not indicated in most patients and NOT appropriate for long term use.

Question 6

a rare skin condition that is caused by auto-antibodies (BP Ag II) to components of the basal layer hemi-desmosomes; results in large, fluid-filled blisters on flexure surfaces of the skin

Answer 6

bullous pemphigoid

Question 7

causes cradle cap in infants, and overlying yellow flaky scale lesions in areas of high sebaceous gland concentration in adults

Answer 7

seborrheic dermatitis

*most cases of this are mild but may cause serious infection in patients with HIV infection and certain neural disorders like Parkinson disease

Question 8

life threatening condition that is characterized by widespread cutaneous blistering, mucosal involvement, and is secondary to medications

Answer 8

toxic epidermal necrolysis (steven’s johnson syndrome); SJS may also be secondary to a mycoplasma infection.

Question 9

Type of psoriasis with pink-red plaques that have a sillvery-white scale, are sharply demarcated and commonly have symmetric distribution on the extensor surface of extremities

Answer 9

plaque psoriasis

Question 10

disease that is caused by circulating antibodies to desmosomal proteins and is characterized on histo by intraepidermal blisters and rounding of keratinocytes:

Answer 10

pemphigus vulgaris

Question 11

an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections, namely HSV

Answer 11

erythema multiforme (EM)

Question 12

Which of the following is FALSE regarding a patient presenting with erythema multiforme?

A. Histopathology would show vaculolar degeneration and blistering, as well as parakeratosis

B. Histopathology would show less dense infiltrate than lichen planus and lots of kyskeratotic (apoptotic) keratinocytes

C. This rash most commonly occurs on the hands and feet and is characterized by acral targetoid plaques

D. It is usually secondary to HSV infection away from the site of eruption.

E. It is associated with Stevens Johnson Syndrome when the mucosa is involved

Answer 12

A. There is no parakeratosis with erythema multiforme, therefore no scales. See clinical picture below demonstrating the characteristic 3 zone targetoid plaque:

Question 13

what histolopathologic pattern shows intercellular (between cells) epidermal edema?

Answer 13

spongiotic

Question 14

A _____ is a small molecule that can elicit an immune response only when attached to a large carrier such as a protein

Answer 14

hapten

*upon repeat exposure to an allergen, this is the mechanism by which the T cell mediated immune response occurs during allergic contact dermatitis

Question 15

this disease is usually localized to the head and neck with papulosquamous eruption, scarring, hair loss, and dyspigmentation; ANA is usually negative:

Answer 15

chronic cutaneous (discoid) lupus

Question 16

Which of these is NOT one of the 4 “P’s of lichen planus?

A. Purple

B. Pigmented

C. Pruritic

D. Polygonal

E. Papules

Answer 16

B

Question 17

these dermatoses are sharply defined erythematous papules and plaques with overlying scale (surface change)

Answer 17

papulosquamous

*these dermatoses are most often hostpathologically psoriasiform (elongated rete ridges) but may also demonstrate lichenoid dermatitis

Question 18

type of dermatitis shown below, with elongtated rete ridges, perivascular lympohcytic infiltrate and parakeratosis

Answer 18

psoriasiform dermatitis

Question 19

Which of the following statements about atopic dermatits is FALSE?

A. It is a common, age related excematous eruption that affects 10-20% of US children

B. It is linked to family history and often improves with age

C. It is seen most often in infants on cheeks and extensor surfaces

D. It is associated with a variety of environmental factors including soaps, allergens, and psychological stress

E. All atopic dermatitis is due to a null mutation in a protein that binds to keratin fibers in epithelial cells

Answer 19

E.

While, 14-56% of all patients with atopic dermatitis carry a null mutation in filaggrin (encoded by the FLG gene) not all atopic dermatitis is due to a filaggrin mutation. Some cases are due to the absence of the sphingolipid ceramide normally expressed in the stratum corneum to form a lipid barrier.

Question 20

what histolopathologic pattern shows a band-like lymphocytic inflammation & epidermal degeneration?

Answer 20

lichenoid

Question 21

this disease results in the linear deposition of antibodies to self DNA at the DEJ, resulting in T-cell mediated interface dermatitis

Answer 21

cutaneous lupus (further subdivided into chronic or acute); histopathology shows:

• hyper & parakeratosis
• follicular plugging (see image below - hyperkeratosis filling the follicles)
• band like lymphocyte invasion along the DEJ, especially involving follicles

Question 22

Which of the following statements regarding Psoriasis is TRUE?

A. Men are more affected than women though it is relatively uncommon in the US.

B. Peak incidence in adults is around age 40-50.

C. It clinically demonstrates ill defined rash on flexure surfaces.

D. It is associated with an increased incidence of metabolic syndrome and genetic polymorphisms.

E. It is usually improved by the use of systemic corticosteroids.

Answer 22

D.

Psoriasis is relatively common in the US (2.2%) with men and women affected equally and peak incidence around age 20-30. It is associated with increased risk of obesity, hypertension, diabetes, MI and elevated C-reactive protein. It is clinically demonstrated by erythmatous scaly plaques and papules on extensor surfaces.

Psoriasis tends to worsen with withdrawal of systemic corticosteroids, which is why they are not routinely used in treatment. Use topicals instead.

Question 23

a disease of the skin and/or mucous membranes whose cause is unknown, but it is thought to be the result of an autoimmune process with an unknown initial trigger; in most patients it spontaneously resolves in 1 year.

Answer 23

lichen planus

*lichen planus is most common in ages 30-60, results from cytotoxic T cell attack at the DEJ, most commonly follows trauma (koebnerization), infections, drug use, and contact irritants.

Question 24

any condition in which cytotxic CD8+ T cells attack along the dermoepidermal junction (DEJ) causing lympohcytes to aggregate

Answer 24

lichenoid (or interface, depending on number of lympohcytes present) dermatitis

Question 25

this is due to direct contact with an allergen, may be sharply demarcated, geometric or linear in shape, vesicular, and is often intensely pruritic

Answer 25

allergic contact dermatitis

*note the spongiosis

Question 26

Which of the following is a characteristic of Bullous pemphigoid?

A. It affects young people

B. It is painful

C. It involves mucosal surfaces

D. Histo shows subepidermal blistering with eosinophils

E. It is clinically positive for Nikolsky’s sign

Answer 26

D

Question 27

atopic triad = ?

Answer 27

atopic dermatitis, asthma, allergic rhinitis

Question 28

clinical category of dermatosis that has follicular or non-inflammatory pustules & papules

Answer 28

acneiform

Question 29

a mode of keratinization characterized by the retention of nuclei in the stratum corneum, resulting in the appearance of scale

Answer 29

parakeratosis

*note the parakeratosis and spongiosis in this image, characteristic features of atopic dermatitis

Question 30

clinical category of dermatosis that has erythmatous edematous patches, papulse & plaques with no scales (eg, no surface change)

Answer 30

dermal erythema

Question 31

wickham striae, flot topped with confluent plaques in a lacy, reticulate pattern on flexural surfaces:

Answer 31

lichen planus

*wickham striae may also appear in the oral mucosa as a white tree-like pattern

Question 32

subgroup of lupus characterized by either an annular-polycyclic form or a psoriasiform, both of which involve hyper and hypopigmentation of photodistributed, as well as photo-protected, areas of the skin

Answer 32

subacute cutaneous lupus

*note the papulosquamous (psoriasis-like) form on the left and the ring pattern of annular-polycyclic form on the right, with central clearance (common); hypo and hyperpigmentation not clearly demonstrated in this photo

Question 33

clinical category of dermatosis that has ill defined inflamed macular papular lesions with variable vesiculation, weeping, pruritus, crusting and scale

Answer 33

eczematous

*on histopathology shows spongiosis, variable parakeratosis, and perivascular inflammation

Question 34

Which of the following is NOT a feature of pemphigus vulgaris?

A. Positive Nikolsky sign

B. Self-limiting and generally resolves within a year

C. Onset is mid adult life

D. Blisters rupture easily, leaving erosions

E. Rounded tomb stoning on histo (see below)

Answer 34

B. This infection must be treated or else it is universally fatal from uncontrolled fluid and protein loss or opportunistic infection.

*also note that although the notes are a bit contradictory on this point, for our purposes in this class he said there’s no real mucosal involvement in PV.

Question 35

Which of these is NOT a feature of lichenoid or interface dermatitis?

A. Basal layer vacuolization

B. Apoptotic keratinocytes

C. Saw-toothing of rete ridges

D. Melanin pigment incontinence

E. Squamatization of the basal layer

Answer 35

C.

This is a feature of Lichen planus,

Question 36

this condition is a medical emergency that is often precipitated by withdrawl of systemic corticosteroids; patients present red all over with pustules, fever, malaise, arthralgias, and leukocytosis on CBC

Answer 36

generalized pustular psoriasis

Question 37

_____ occurs when a new area of psoriasis develops in injured skin; it may occur following a non-traumatic skin injury such as a sunburn, or an allergic reaction to a medication.

Answer 37

Koebnerization

*seen in plaque psoriasis

Question 38

clinical category of dermatosis that has sharply demarcated inflammatory pauples & plaques with scales

Answer 38

papulosquamous

Question 39

what histolopathologic pattern shows elongated rete ridges?

Answer 39

psoriasiform

Question 40

Which of the following is FALSE regarding the patient shown below?

A. The best treatment for this patient would involve potent topical corticosteroids and antimalarials

B. Patients with this presentation have a systemic disease

C. This person should be worried about scarring due to the rash

D. An ANA test for this person would be positive

E. This patient should be evalued for internal disease

Answer 40

C. The rash of acute cutaneous lupus is photodistributed and nonscarring.

Question 41

what histolopathologic pattern shows dermal edema and inflammation?

Answer 41

uticarial

Question 42

clinical category of dermatosis that has fluid filled blisters

Answer 42

vesiculobullous