Pathoma skin Flashcards by Caitriona McGovern

Name the layers of the epidermis

Stratum basalis (stem cell layer)
Stratum spinosum (desmosomes connect)
Stratum granulosum (granules in keratinocytes)
Stratum corneum (anucleate cells)

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Are there blood vessels in the epidermis?

NO! They are all in the dermis!

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pruritic, erythematous, oozing rash with vesicles and edema,
often involves face and flexor surfaces
type 1 HSR associated with asthma and allergic rhinitis

Atopic dermatitis (eczema) (treat with topical steroids)

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pruritic, erythematous, oozing rash with vesicles and edema after exposure to an irritant

contact dermatitis (treat with topical steroids if needed)

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Name lesions associated with acne vulgaris

comedones, pustules, nodules

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what is the difference between a whitehead and blackhead?

Closed vs. open comedone

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What causes acne?

Chronic inflammation of hair follicles and sebaceous glands; P acnes infection leads to inflammation (pustules or nodules)

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Why do vitamin A derivates help with acne?

Reduce keratin production

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Well-circumscribed, SALMON-colored plaques with silvery scales usually on extensor surfaces and scalp (may also have pitting of the nails)

Psoriasis

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How would you describe the lesions associated with psoriasis and where do they generally occur?

Well-circumscribed, SALMON-colored plaques with silvery scales usually on extensor surfaces and scalp (may also have pitting of the nails)

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What causes psoriasis?

excessive keratinocyte proliferation, possible autoimmune etiology, associated with HLA-C, often occurs in areas of trauma

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What histologic features are associated with psoriasis

Hyperplasia with increased thickness of epidermis (akanthosis); parakaretosis; monroe micro abscesses, elongated dermal papillae, thinned dermis (–> pinpoint bleed = Auspitz sign)

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Pinpoint bleeds make you think?

Psoriasis

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Treatment for psoriasis

corticosteroids
UV light with psoralen (PUVA)
immune modulating therapy

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Pruritic, planar, polygonal, purple papules

Lichen planus

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Which what 5 Ps is lichen planus associated?

Pruritic, planar, polygonal, purple papules

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What disease is associated with reticular white lines on surface (Wickham striae)?

Lichen planus

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Where does lichen planus usually show up?

wrists, elbows, oral mucosa

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Key histo finding with lichen planus?

inflammation (lots of neutrophils) at dermal-epidermal junction –> saw-tooth appearance

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With what disease is lichen planus associated?

Chronic hepatitis C virus infection

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autoimmune destruction of desmosomes

- due to IgG antibody against desmoglein

Pemphigous vulgaris

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IF highlights IgG surrounding keratinocytes (“fish net”)

Pemphigous vulgaris

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Fancy name for scale

hyperkeratosis

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“Too much stratum corneum because it is being made too quickly”

Hyperproliferative hyperkeratosis

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“Too much stratum corneum because it is being made improperly (leading to clumping/poor sloughing,etc.)”

Retention Hyperkeratosis

congenital lack of pigmentation due to an enzyme defect, usually tyrosinase, that impairs melanin production; may involve eyes (ocular form) or both eyes and skin (oculocutaneous form); increased risk of skin cancer

albinism

Are there increased melanocytes in a freckle?

Are there increased melanosomes in a freckle?

YES

Why are freckles darker than surrounding skin?

INcreased number of melanosomes

Hair growing from a dark spot?

NOT A MELANOMA!!! (most likely a nevus); means cells are "respecting the follicle"

What are the types of nevi?

Junctional (along the DE jxn) Compound (DE jxn and dermis) Dermal (dermis only)

Risk factors for melanoma?

Prolonged exposure to sunlight (UVB light) albinism XP Dysplastic nevus syndrome

What are the ABCDEs of melanoma?

``` Asymmetry Borders irregular Color not uniform Diameter > 6 mm Evolution ```

What are the growth phases of melanoma?

Radial growth phase (epidermus and superfical dermis) | Vertical growth phase

What are the four subtypes of melanoma?

Lentigomaligno melanoma (junction) Superficial spreading Nodular (early vertical growth phase, poor prognosis) Acral lentiginous (arises on palms or soles, often in dark-skinned individuals; not related to UV light exposure)

Superficial bacterial skin infection usually Staph aureus or strep progenies

Impetigo

Tender rash with fever

Cellulitis

Necrosis of subcutaneous tissue due to infection with anaerobic bacteria; production of CO2 leads to crepitus

Necrotizing fasciitis

Sloughing of skin with erythematous rash and fever?

Staph aureas infxn --> exfoliative A and B toxins --> separation of at layer of stratum granulosum Staph scalded skin

Mechanism of

Exfoliative A and B toxins result in epidermolysis of stratum granulosum

TEN = ?

Toxic epidermal necrolysis; separation at dermal-epidermal junction

flesh-colored papule with rough surface due to HPV

Verruca

Firm, pink umbilicated papule due to poxvirus; most often arises in children; also in sexually active or immunocompromised adults

Molluscum contagiosum

Histological finding in molloscum contagiosum?

mollosucum bodies within keratinocytes

From what embryonic structure are melanocytes derived?

Neural crest

At what level in the epidermis are melanocytes found?

Basal

Melanocytes synthesize melanin from WHAT?

tyrosine

Autoimmune destruction of melanocytes --> localized loss of skin pigmentation

vitiligo

Patient goes to tan and certain areas don't become dark?

Vitiligo

Benign squamous proliferation; often in elderly; classic "stuck on" appearance

Seborrheic Keratosis

Histologic presentation of SK

Pseudocytes (circular spaces with abundant pink collagen)

Sudden onset of multiple SKs

suggests underlying GI carcinoma - Leser -Trelat sign

Epidermal hyperplasia with darkening of skin that feels like velvet (usually groin or axilla0

associated with insulin resistance or malignancy

Malignant proliferation of basal cells; risk factors all based on UVB exposure (sun exposure; albinism; xeroderma pigmentosum (autosomal recessive defect in enzymes related to nucleotide excision repair pathway))

Basal cell carcinoma

Elevated nodule with central area of necrosis and telangectasias; arises on upper lip

basal cell carcinoma

peripheral palisading

basal cell carcinoma

Ulcerated, nodular mass on lower lip

Squamous cell carcinoma

Risk factors for SCC

immunosuppressive therapy; arsenic poisoning chronic inflammation (e.g. scar from burn or draining sinus tract); UVB light

Precursor to SCC; presents as a hyperkeratotic, scaly plaque on face, back, or neck

Actinic Keratosis

Well-differentiated SCC; develops rapidly and regresses spontaneously

Keratoacanthoma

Cup shaped tumor filled with keratin debris

Keratoacanthoma

Autoimmune destruction of desmosomes due to IgG antibody against desmoglein

Pemphigous vulgaris

Pathoma skin Flashcards

(62 cards)