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My Pathology > Skin > Flashcards

Skin Flashcards

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1
Q

Molluscum contagiosum

A
  • Poxvirus (DNA virus) in children
  • Bowl-shaped lesion filled with keratin, molluscum bodies (viral particles)
  • Disseminates with HIV
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2
Q

Rubeola (measles)

A
  • Paramyxovirus (RNA)
  • Cold Sx, conjunctivitis
  • Koplik spots on buccal mucosa (white spots w/ erythematous base)
  • …followed by maculopapular rash on head —> trunk —> extremities as T cells damage virus-infected endothelial cells
  • Complications: giant cell PNA, acute appy, otitis media, encephalitis
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3
Q

Rubella

A
  • Togavirus (RNA)
  • Forchheimer spots (red spots on posterior palate)
  • Maculopapular rash lasting 3 days beginning at hairline, discrete lesions
  • Painful postauricular lymphadenopathy
  • Polyarthritis in adults
  • Infection in first trimester may lead to congenital anomalies
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4
Q

Erythema infectiosum

A
  • Parvovirus B19 (DNA)
  • Children
  • Net-like erythema starting on cheeks (“slapped face” appearance)
  • Polyarthritis in adults
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5
Q

Roseola infantum

A
  • HHV6 (DNA)
  • Children
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6
Q

Varicella zoster

A
  • Positive Tzanck test (multinucleated giant cells)
  • Children: Reye syndrome w/ ASA (encephalitis); PNA; cerebellitis
  • Adults: PNA, hepatitis, encephalitis
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7
Q

Hand-foot-and-mouth disease

A
  • Coxsackievirus
  • Young children
  • Vesicular rash on hands, feet, mouth
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8
Q

Toxic shock syndrome

A
  • Staph aureus
  • TSST toxin: superantigen
  • Desquamating, sunburn-like rash
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9
Q

Hidradenitis suppurativa

A
  • Staph aureus, chronic
  • Inflamed apocrine glands in axillae and groin
  • Sinus tracts from abscesses
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10
Q

Impetigo

A
  • Often staph aureus
  • Vesiculo-pustular rash begins on face, often with bullae
  • Highly contagious
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11
Q

Scalded skin syndrome

A
  • Staph aureus with exfoliatin toxin
  • Fever, large bullae
  • Skin sloughs off, electrolytes lost
  • Treat with nafcillin
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12
Q

Staph aureus appearance and treatment

A
  • Gram-positive coccus in clusters
  • Bactrim, vancomycin
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13
Q

Scarlet fever

A
  • Strep pyogenes
  • Erythematous sandpapery rash on tongue, face—>neck—>body (spares mouth)
  • White exudate w/ red papillae on tongue later fades, leaving it beefy: strawberry tongue
  • Rash disappears after 6 days, desquamation for up to 10 days after
  • Increased risk of post-strep glomerulonephritis
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14
Q

Strep pyogenes appearance

A

Gram-positive coccus in chains

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15
Q

Erysipelas

A
  • Strep pyogenes
  • Type of cellulitis
  • Orange peel-like surface with raised borders
  • Face, lower extremities
  • Penicillin G for extremities, vanco for face
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16
Q

Leprosy

A
  • Mycobacterium leprae (can’t be cultured)
  • Tuberculoid type w/ intact cellular immunity: granulomas; positive lepromin skin test; localized skin lesions with nerve involvement (digital autoamputation, hypopigmented skin with anesthesia); treat with dapsone and rifampin
  • Lepromatous type w/ impaired cellular immunity: many bacteria in foamy macrophages in subepidermal (Grenz) zone; negative lepromin skin test; leonine facies; dapsone, rifampin, and clofazimine
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17
Q

Acne vulgaris

A
  • Chronic inflammation of pilosebaceous unit
  • Inflammatory type: abnormal keratinization of follicular epithelium, increased sebum production (androgen-dependent), Propionibacterium acnes converts sebum into irritating FAs
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18
Q

Tinea capitis

A
  • Trichophyton tonsurans: most common in black population, negative Wood lamp test (infects inner hair shaft)
  • Microsporum canis and audouinii: most common in whites, positive Wood lamp test
  • Circular areas of alopecia
  • Oral terbinafine, NOT topical azoles
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19
Q

Tinea corporis

A
  • Trichophyton rubrum
  • Raised border w/ central clearing
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20
Q

Tinea pedis

A
  • Trichophyton rubrum
  • Macerated scaling rash b/w toes
  • Diffuse plantar scaling (“moccasin” appearance) in elderly
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21
Q

Tinea cruris

A
  • Trichophyton rubrum
  • Elevated borders WITHOUT central clearing
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22
Q

Tinea unguium (onychomycosis)

A
  • Trichophyton rubrum or mentagrophytes
  • Nail is raised and discolored
  • Nail plate is white, thick, crumbly
  • Oral terbinafine (topical azoles do NOT work)
  • Onychomycosis may also be caused by candida albicans
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23
Q

Tinea versicolor

A
  • Malassezia furfur
  • Hyper- or hypopigmentation
  • Accentuated by Wood lamp
  • “Spaghetti and meatballs” appearance on KOH mount
  • Single dose of oral ketoconazole
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24
Q

Intertrigo

A
  • Candida albicans
  • Erythematous rash in body folds (“diaper rash”)
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25
Seborrheic dermatitis (dandruff)
* Malassezia furfur * Associated w/ Parkinson's, AIDS * Scaly, yellowish, greasy dermatitis * Scalp, eyebrows, nasal creases ("cradle cap" in neonates)
26
Sporotrichosis
* Sporothrix schenckii * Subcutaneous * Thermal dimorph * Traumatic implantation (ex. rose gardening, sphagnum peat moss) * Chain of suppurating lymphocutaneous nodules * Treat with oral itraconazole
27
Cutaneous larva migrans
* Ancylostoma braziliense (nematode) * Dog and cat hookworm; humans are intermediate host * Contracted by children from cat/dog waste in sandboxes * Larvae create serpiginous tunnels in skin * Treat with albendazole
28
Chiggers
* Small red mite * Papular, urticarial, or vesicular rash * Legs and areas of tight-fitting clothes
29
Human itch mite (scabies)
* Sarcoptes scabiei or hominis * Burrows between fingers; also at wrists, nipples, scrotum * Females lay eggs, inducing pruritis * In adults: intertriginous areas * In infants: no burrows; rash on palms, soles, face, or head * Permethrin cream
30
Bedbugs
* Cimex lectularius * Feed on human blood, active before dawn * Allergic rxn to saliva causes wheals
31
Ehrlichiosis
* Ehrlichia chaffeensis * Obligate intraleukocytic parasite * Southeast, south central, mid-Atlantic US * Reservoir in deer * Morula (inclusion) in monocyte cytoplasm; Anaplasma species infects granulocytes * Fever, meningoencephalitis, myalgia, rash, hepatosplenomegaly (children), edema (children) * Treat with doxy
32
Solar lentigo
* Elderly * Brown macules on sun-exposed areas due to increased # of melanocytes
33
Vitiligo
* Black population * Autoimmune destruction of melanocytes * Associated w/ other autoimmune conditions
34
Melasma
* Women * Macular, hyperpigmented lesions lesions on face * Exacerbated by OCPs, pregnancy, sunlight * Treat w/ hydroquinone (bleaching agent)
35
Dysplastic nevus
* May or may not develop into malignant melanoma * \>6mm, erythematous background, irregular borders * Dysplastic nevus syndrome: \>100 nevi on skin, often develop into melanoma
36
Malignant melanoma
* Avg age 53 yrs * Risk factors: UV light exposure, FHx, dysplastic nevus syndrome, xeroderma pigmentosum * Radial growth phase: proliferation within epidermis and papillary dermis, NO metastatic potential * Vertical growth phase: penetration into reticular dermis * Superficial spreading melanoma: 70% of cases * Lentigo maligna: sun-exposed face, good prognosis * Nodular melanoma: sun-exposed area, no radial growth phase, poor prognosis * Acral lentiginous melanoma: NOT related to sun, happens on palm, sole, or nail bed, poor prognosis
37
Seborrheic keratosis
* Adults \>50 yrs * Benign pigmented epidermal tumor * "Stuck-on" appearance * Leser-Trélat sign: rapid increase in keratoses from stomach adenocarcinoma
38
Acanthosis nigricans
* Velvety, pigmented skin * Neck, axilla, groin, under breasts * Excess insulin
39
Keratoacanthoma
* Males * Crateriform tumor w/ central keratin plug grows over 4-6 weeks * Sun-exposed area * ? well-differentiated squamous cell carcinoma
40
Epidermal inclusion cyst (follicular cyst)
* Epidermis of hair follicle * Face, base of ears, trunk * Produces keratin mixed w/ lipid-rich debris
41
Pilar cyst (wen)
* Hair root sheath * Scalp and face * Cyst wall lacks stratum granulosum; keratin has laminated appearance
42
Fibroepithelial polyp
* Elderly * Skin tag on neck, upper chest, upper back
43
Actinic (solar) keratosis
* Prolonged UV exposure * Precursor of SCC * Hyperkeratotic, pearly gray-white appearance of face, neck, dorsum of hands/forearms * Topical 5-FU
44
Basal cell carcinoma
* Chronic UV exposure * Raised papule or nodule with central crater * Inner canthus of eye, upper lip * Locally aggressive, doesn't metastasize * Multifocal in origin * Cords of basophilic-staining basal cells on biopsy
45
Squamous cell carcinoma
* Risk factors: UV light, actinic keratosis, arsenic exposure, 3rd-degree burn, chronically draining sinus tract, immunosuppression * Scaly to nodular ulcerated lesions * Ears, lower lip, dorsal hands * Minimal metastasis risk * Topical 5-FU
46
Ichthyosis vulgaris
* Autosomal dominant * Keratinization defect: absent stratum granulosum, thick stratum corneum * Hyperkeratotic, dry skin on palms, soles, extensor areas
47
Xerosis
* Elderly * Decreased skin lipids
48
Eczema
* Acute: weeping, erythematous, vesicular rash * Chronic: hyperkeratotic skin from scratching * Atopic dermatitis: type I IgE hypersensitivity rxn; children: cheeks etc.; adults: hands, eyelids, elbows, knees * Contact dermatitis: type IV hypersensitivity rxn
49
Chronic cutaneous lupus erythematosus
* DNA-antiDNA immunocomplexes deposit in basement membrane * Positive immunofluorescence * Butterfly rash, alopecia * Treat with antimalarials
50
Pemphigus vulgarus
* IgG vs desmosomes b/w keratinocytes, type II hypersensitivity * Vesicles and bullae on skin and oral mucosa * Basal cells look like tombstones * Nikolsky sign: outer epidermis easily separates from basal layer
51
Bullous pemphigoid
* IgG vs basement membrane, type II hypersensitivity * Subepidermal vesicles on skin and oral mucosa * Negative Nikolsky
52
Dermatitis herpetiformis
* IgA-antiIgA complexes (type III hypersensitivity) deposit in dermal papillae, causing subepidermal vesicles with neutrophils * Strong association w/ celiac * Treat with dapsone or sulfapyridine
53
Lichen planus
* Pruritic, scaly, violaceous, flat-topped papules with Wickham striae; wrists & ankles * Dystrophic nails, oral mucosa involved * Women \> men * Slight SCC risk * Associated with hep C
54
Psoriasis
* HLA association * Adolescents or ~60 yr olds * Keratinocyte hyperplasia * Aggravated by strep pharyngitis, HIV, drugs (lithium, beta blockers, NSAIDs) * Thickened stratum corneum w/ nuclei retention and neutrophils; elongation of rete pegs of basal layer; extension of papillary dermis close to surface epithelium * Auspitz sign: blood vessels in dermis rupture when scales are picked off
55
Pityriasis rosea
* Herald patch: single, large, oval, scaly, rose-colored plaque on trunk (can be misdiagnosed as tinea) * Later, papular eruption on trunk ("Christmas tree" distribution * UV light therapy hastens resolution
56
Erythema multiforme
* Type IV hypersensitivity * Triggered by Mycolplasma pneumoniae, HSV, sulfonamides, penicillin, barbiturates, phenytoin * Targetoid vesicles and bullae on palms, soles, extensor surfaces
57
Stevens-Johnson syndrome
* Type IV hypersensitivity * Erosions of mucous membranes, blistering of skin macules
58
Toxic epidermal necrolysis syndrome
* Commonly drug-induced * Can overlap with Steven-Johnson * Necrosis and bullous detachment of epidermis and mucous membranes —\> GI bleeding, resp failure, GU complications
59
Erythema nodosum
* Inflammation of subQ fat * Raised, erythematous, painful nodules * Associations: coccidiodomycosis, histoplasmosis, TB, leprosy, strep pharyngitis, Yersinia, sarcoidosis, ulcerative colitis, pregnancy, OCPs
60
Granuloma annulare
* Chronic * Children, adult women * Erythematous papules —\> annular plaques * Histiocytes around mucin * Dorsal hands and feet; dissemination may occur with DM
61
Porphyria cutanea tarda
* Uroporphyrinogen decarboxylase deficiency * Wine-red urine with uroporphyrin I * Photosensitive bullous skin lesions (metabolite depositions), hyperpigmentation, fragile skin, hypertrichosis * Sunlight, hep C, alcohol, OCPs, iron
62
Acne rosacea
* Inflammation of facial pilosebaceous units * Demodex folliculorum mite * Alcohol, stress, spicy foods exacerbate * Sebaceous gland hyperplasia w/ enlarged nose * Treat w/ topical metronidazole or systemic isotetrinoin or tetracycline
63
Pyoderma gangrenosum
* Small papule that ulcerates and enlarges; violaceous border overhangs ulcer crater * Often associated w/ systemic disease like Crohns, myeloproliferative disease, autoimmune diseases * Neutrophil dysfunction * May be triggered by trauma * Treat w/ steroids, TNF-alpha inhibitors, cyclosporine
64
Erythema toxicum
* Neonates * Benign eruptions all over EXCEPT palms and soles
65
Sebaceous hyperplasia
* Neonates * Profuse yellow-white papules
66
Milia
* Neonates * Pearly white papules containing laminated keratin material * Face, gingiva
67
Miliaria
* Neonates * Retained sweat in occluded glands * Crystallina: pinpoint clear vesicles in large eruptions; associated w/ warmth or fever * Rubra: small erythematous papulovesicles; also responds to cooling
68
Mongolian spot
* Neonates w/ dark skin * Blue-gray spots on buttocks, back, shoulders, legs
69
Alopecia areata
* Young adults * May have autoimmune or FHx association * Hair loss in well-circumscribed round patches over weeks * Treat w/ clobetasol, triamcinolone

My Pathology (12 decks)

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