Non-neoplastic skin

Question 1

acute inflammatory dermatosis with spongiosis and formation of intraepidermal vesicles

Answer 1

Acute Eczematous Dermatosis (Eczema)

Question 2

oozing/ crusted erythematous papulovesicular lesion with pruritic scaling plaques

Answer 2

Eczema

Question 3

Self limiting Type 4 hypersensitive acute inflammatory dermatosis with keratinocyte injury mediated by CD8+ T cells

Answer 3

Erythema Multiforme

Question 4

Causes of erythema multiforme

Answer 4

Infection

• HSV
• Histoplasma
• Coccidiomycosis
• Typhoid
• Leprosy

Drugs

• Sulfa
• Penicillins
• Barbiturates
• Salicylates
• Hydantoins
• Anti-malarials

SLE

Polyarteritis nodosa

Dermatomyositis

Immunizations

Question 5

• Erythematous maculopapular rash, progressing into target lesions
• Pruritic or burning sensations
• symmetrical distribution to dorsal hands and feet, followed by proximal spread
• can include palms and soles
• only in major case will mucocutaneous surfaces be affected

Answer 5

Clinical Presentation of Erythema Multiforme

Question 6

What is the difference between Stevens-Johnson Syndrome and TEN?

Answer 6

SJS is less than 10% of total body surface

TEN includes > 30% of the body’s surface

Question 7

Leukopenia

increased BUN

Increased transaminases

Hyperglycemia

subepidermal splitting at dermo-epidermal junction

Answer 7

Diagnostics of SJS/ TEN

Question 8

Infections

• CMV
• Herpes
• Mycoplasma

Drugs

• Sulfa
• Aminopenicillins
• Rifampin
• Corticosteroids
• Nevirapine
• Antiepileptics
• Piroxicam
• Allopurinol

Vaccinations

Graft vs Host Disease

Answer 8

Triggers of SJS/ TEN

Question 9

Prodromal Phase

ALWAYS has Mucocutaneous Manifestations

Positive Nikolsky sign

Necrosis and sloughing of full epidermal thickness

Involves face and trunk

Lesions form bullae/ vesicles

Answer 9

Clinical Presentation of SJS/ TEN

Question 10

Chronic inflammatory dermatosis with sensitized CD4+ T cells causing keratinocyte death by CD8+ T cells

Leads to hyperkeratosis

Answer 10

Psoriasis Pathology

Question 11

Associations of Psoriasis

Answer 11

arthritis

myopathy

enteropathy

staph/ strep infections

mechanical irritation

Drugs (beta-blockers, chloroquine, lithium, interferon)

HLA-Cw

Question 12

Diagnostics of Psoriasis

Answer 12

positive Auspitz sign

increased inflammatory markers

stratum corneum cells still have nuclei

increased stratum corneum

decreased stratum granulosum

Question 13

What is an Auspitz sign

Answer 13

small pinpoint bleeding that occurs when scaled skin is scraped off

Question 14

Acanthosis

Parakeratosis

Munro microabscesses

Answer 14

Psoriasis Morphology

Question 15

Well demarcated pink plaques covered by loosely adherent silver scales

primarily appears in extensor surfaces

pruritis

Koebner phenomenon

Positive Auspitz sign

Answer 15

Psoriasis

Question 16

acanthosis

Answer 16

epidermal hyperplasia

Question 17

Wickham’s striae

Answer 17

pattern of white lines on lesion surface

Question 18

Koebner Phenomenon

Answer 18

physical stimuli leading to skin lesions typical of underlying condition on previously healthy skin

Question 19

oily skin

stress

androgenic alopecia

immunodeficiency

familial history

increased sebum production

Malassezia furfur

Answer 19

Associations of seborrheic dermatitis

Question 20

Erythematous plaques with patchy scaling and greasy yellow crusting

usually distributed along areas of hair and oily skin

dandruff

pruritis/ burning sensations

originates in the dermis

Answer 20

Clinical presentation of seborrheic dermatitis

Question 21

Pathology of seborrheic dermatitis

Answer 21

increased sebum production and colonization of yeasts in sebaceous areas or exposure to irritants

Question 22

Chronic, but Self-limited CD8+ immune response associated with Hep C

Answer 22

Lichen Planus

Question 23

Diagnostics of Lichen Planus

Answer 23

Wickham’s striae

Band-like lymphocytes at dermo-epidermal junction

irregular saw tooth acanthosis

hyperkeratosis

wedge-shaped hypergranulosis

Question 24

Purple, pruritic, planar, polygonal, papules and plaques of the skin and mucosa

involves stratum corneum and granulosum

Answer 24

Lichen planus

Question 25

Antibody-mediated attack against **desmogleins** 1&3 causing the disruption of **intercellular adhesions**

Answer 25

Pathology of Pemphigus Vulgaris

Question 26

Drugs * ACE Inhibitors * Penicillamine * Phenobarbitol * Penicillins Viruses UV radiation Diet changes Paraneoplastic syndromes

Answer 26

Associations of Pemphigus Vulgaris

Question 27

**Easily rupturable thin roofed bullae** spontaneous flaccid intraepidermal blisters on the oral mucosa and skin shallow erosions covered with dried serum and crust **Re-epithelialization with hyperpigmentation** No Scarring

Answer 27

Clinical presentation of Pemphigus Vulgaris

Question 28

**Positive Nikolsky sign** **Positive Tzank smear** Deposition of IgG in a fishnet pattern in intracellular epidermal spaces **Suprabasal acantholysis,** forming intraepidermal blisters Single layer of intact basal cells that form **tombstone blister**

Answer 28

Diagnostics and Morphology of Pemphigus Vulgaris

Question 29

Most common bullous autoimmune disease

Answer 29

Bullous Pemphigoid

Question 30

Antibodies against **hemidesmosomes** cause **separation of basal keratinocytes** from the basement membrane, forming bullae

Answer 30

Pathogenesis of Bullous Pemphigoid

Question 31

Antibodies against BPAg1 &2 **Subepidermal** vesicle formation **eosinophil rich infiltrates underlying the dermis** **Linear deposition of complement** and Ig/ C3 along the dermo-epidermal junction

Answer 31

Diagnostics and morphology of Bullous Pemphigoid

Question 32

**Tense subepidermal blisters** that are hard to rupture ulcers form in the place of ruptured blisters intensely pruritic lesions that **heal without scar formation**

Answer 32

Clinical presentation of Bullous Pemphigoid

Question 33

HLA-DR3 HLA-DQ2 Sensitivity to potassium iodide Celiac Disease

Answer 33

Associations of Dermatitis Herpetiformis

Question 34

**Antibodies against tissue transglutaminases and endomysium** Subepidermal vesicle formation **Neutrophilic papillary microabscesses** Deposition of granular IgA in dermal papillae

Answer 34

Diagnostics and Morphology of Dermatitis Herpetiformis

Question 35

urticaria pruritic plaques and groups of vesicles distributed symmetrically usually on extensor surfaces

Answer 35

Clinical presentation of Dermatitis Herpetiformis

Question 36

Nikolsy sign

Answer 36

upper epidermal layer is easily removed by rubing separates dermis and forms a blister

Question 37

Tzank test relevance in Pemphigus Vulgaris

Answer 37

shows presence of multinucleated giant cells

Question 38

Acantholysis

Answer 38

separation of epidermal cells due to dissolution of intercellular bridges

Question 39

What is the purpose of Reticulin

Answer 39

component of anchoring fibrils that **tether epidermal basement membranes to the superficial dermis** * composed of collagen III, causing limited elasticity by **good tensile strength**