Skin Patho Day 1

Question 1

Macule

Answer 1

Primary Lesion

Flat, non-palpable

<1 cm in diameter

Question 2

Patch

Answer 2

Primary lesion

Flat, non-palpable, >1 cm in diameter

Question 3

Papule

Answer 3

Primary lesion

Elevated or depressed, palpable

<1 cm

Question 4

Plaque

Answer 4

Primary lesion

elevated or depressed, palpable, >1 cm

Question 5

Nodule

Answer 5

Primary lesion

Palpable, >1 cm in diameter and round

Question 6

Vesicle

Answer 6

Primary lesion

Fluid-filled blister, <1 cm in diameter

Question 7

Bulla

Answer 7

Primary lesion

Fluid filled lesion, >1 cm

Question 8

Pustule

Answer 8

Primary lesion

Pus-filled blister

Question 9

Wheal

Answer 9

Primary lesion

Edematous papules and plaques characteristic of hives

Question 10

Telangiectasia

Answer 10

Primary lesion

dilated blood vessels

Question 11

Purpura

Answer 11

Primary lesion

Area of hemorrhage, flat or elevated

Question 12

Petechiae

Answer 12

Primary lesion

Pinpoint purpura

Question 13

Scale

Answer 13

Secondary Change

Accumulation of stratum corneum

Question 14

Crust

Answer 14

Secondary Change

Dried serum, pus

Question 15

Lichenification

Answer 15

Secondary Change

Epidermal thickening with accentuation of skin markings

Question 16

Induration

Answer 16

Secondary Change

Dermal thickening causing firm feeling

Question 17

Excoriation

Answer 17

Secondary Change

Linear erosion caused by scratching

Question 18

Erosion

Answer 18

Secondary Change

Open area with partial or full loss epidermis

Question 19

Ulcer

Answer 19

Secondary Change

Open area with loss of part of dermis

(fissure=linear ulcer)

Question 20

Nummular

Answer 20

Coin shaped

Question 21

Geographic

Answer 21

irreg bordered

Question 22

Polycyclic

Answer 22

Multiple round lesions coalesced together

Question 23

Serpinginous

Answer 23

Wavy lines

Question 24

Annular

Answer 24

Ring-like with central clearing

Question 25

Arcuate

Answer 25

curved

Question 26

Linear

Answer 26

Straight line

Question 27

Targetoid

Answer 27

Like bull's eye

Question 28

Intertriginous

Answer 28

Within body folds

Question 29

Keratohyalin granules

Answer 29

Filaggrin, involucrin, loricrin

Question 30

Lamellar granules

Answer 30

Ceramides, cholesterol, fatty acids, hydrolyic enzymes (top lipid barrier of stratum corneum)

Question 31

Pemphigus Vulgaris

Answer 31

**Autoimmune IgG against desmoglein 1+3 in stratum spinosum** --\> intraepidermal erosions * Oral and mucosal lesions * Pos Nikolsky's sign--\> separation epidermis with stroke * Can be fatal -- tx prednisone, azathioprine, mycophenolate mofetil, ritixmab

Question 32

Ichthyosis Vulgaris

Answer 32

**Autosomal Dom. mutation in profilaggrin gene**--defect in conified envelope "Fish scales", dry skin, hyperlinear palms (associated with atopic dermititis, allergies, asthma)

Question 33

Physical blockers of UVB

Answer 33

Reflect and scatter UV | (zinc oxide, titanium dioxide)

Question 34

Chemical blockers of UVB

Answer 34

Absorb UV | (PABA, oxybenzone, avobenzone)

Question 35

Difference between papillary dermis and reticular dermis

Answer 35

**Papillary dermis:** rete ridges, more cellular, fine/loose collagen **Reticular dermis:** more coarse/packed collagen

Question 36

Marfan Sx

Answer 36

**Autosomal Dominant--Fibrillin defect** * tall/thin body type * long limbs/scoliosis * flexible joints * nearsightedness/dislocation eyes * aortic dilation/mitral valve prolapse

Question 37

Ehlers-Danlos Sx

Answer 37

**Abnormalities in collagen production** * Fragile skin, scar prone * flexible joints * scoliosis of spine --\> breathing affected * rupture of organs

Question 38

Morphea (Localized scleroderma)

Answer 38

**Autoimmune aquired w/ sclerosis** **(thickening of collagen)** * erythematous/indurated plaques * fibrotic/atrophic scars * neuro * limb issues

Question 39

Systemic Sclerosis (CREST)

Answer 39

**Aquired autoimmune characterized by sclerosis; puffy taut skin and pitting** (middle aged women) *CREST [anti centrome antibody]* Calcinosis cutis Raynaud phenomena Esophageal dysmotility Sclerodactyl Telangiectasia

Question 40

Systemic Sclerosis (Diffuse)

Answer 40

Aquired autoimmune characterized by sclerosis; puffy taut skin and pitting (middle aged women) *Diffuse--anti DNA topiosmerase I ab* sclerosis pulmonary fibrosis renal failure GI disease heart disease

Question 41

Erythema Nodosum

Answer 41

**Acquired disorder in women** Triggers=upper resp. strep, oral contraceptives, sarcoidosis, IBD, malignancy Tender red nodules ON SHINS

Question 42

BP230

Answer 42

Plakin responsible for cytoskeleton organization

Question 43

BP 180

Answer 43

Type XVII collagen, basal keratinocyte to dermis

Question 44

Bullous Pemphigoid

Answer 44

**Autoimmune against BP230 and BP180 (hemidesmosomes**) * Nikolsky sign negative; less severe than Pemphis Vulgaris * Antibodies BULL-OW the epidermis * Pruritic uriticaria w/out blistering --\> tense stable blisters DIF=IgG and C3 along BMZ; IIF=staining at epidermal side TX: steroids or immunosuppressants in elderly

Question 45

Generalized Atrophic Benign Epidermolysis Bullosa

Answer 45

**Genetic--\>** mutated BMZ protein (i.e. BP180) * blisters, skin fragile, hair problems, minimum trauma causes blisters * immunofluroscence shows less protein/none in BMZ

Question 46

Mucous Membrane Pemphigoid

Answer 46

**Autoimmune:** **antibodies against BP 180 or BP 230, IB4, laminin 332** * erosions/lesions in eye=blindness * in older people; 70% association with other malignancies * Blistering of mucous membranes; scars, strictures, synechiae, etc. DIF=deposits along BMZ IIF: staining epidermal/dermal and epidermal/dermal based on specific issue **Anti-Laminin 332--\>** also cancer, dermal split

Question 47

Herlitz Junctional Eb

Answer 47

**Inherited laminin 332 malfunction** * prevalent in kids, no cure, will die * mucosal linings poor, can't eat * fingers/joints fuse * too much granulation tissue --\> difficulty breathing

Question 48

Epidermolysis Bullosa Acquisita

Answer 48

**Autoimmunity type VII collagen** * Slight trauma=blistering/erosions * healing leaves atrophy, scars, pigmentation issues * fibrosis hands and feet * sometimes oral mucosa hemorrhages * nail dystrophy DIF=IgG and C3 on BMZ IIF=on dermal side

Question 49

Inherited Epidermolysis Bullosa

Answer 49

Erosions/blisters after light trauma **EB Simplex:** Keratin 5, 14 (autosomal dom) **Junctional EB:** laminin 332, BP 180, integrins (autosomal rec) **Dystrophic Eb:** type VII collagen (children can live to adulthood but hard life) (both patterns inheritance) **Kindler Sx:** Kindlin 1