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Flashcards in Skin Pathology Deck (38)
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1

Pruritic eruptions (itchy), MC seen on skin flextures. Also seen in patients with concurrent diseases like asthma or allergic rhinitis. Gets worse in winter time and better in the summer. Also seen in over-bathed babies. What is the diagnosis and treatment of this disease?

Atopic Detmatitis, AKA Eczema

Tx: moisturizing soap or emollient
-calcineurin inhibitors (tacrolimus/pimecrolimus)
-topical steroids
-Antihistamines
-Leukotriene inhibitors
-UV light therapy

-severe cases, systemic steroid

2

Soft tan colored, cauliflower like lesions - Vulgaris form found on hand, condyloma accumulatum found in genital areas caused by HPV. Characterized by hyperkeratosis and koilocytosis. What skin pathology is at hand?

Verrucae

3

Composed of nevus cells (type of melanocyte), usually benign, usually appear within the first 2 decades of the persons life. The congenital form of these are associated with high risk for malignant neoplasms like melanoma.

Melanocytic nevus AKA mole

4

These lesions are clusters of concentrated melanin, but are not composed of melanocytes. More visible on people that are fair skinned, and are very common. What pathology is at hand?

Ephelides —> AKA freckle

5

A patient presents with a pruritic linear rash that shows red raised lesions. History of outdoor activity in a forest, and associated with a type IV hypersensitivity. What pathology is at hand?

Allergic contact dermatitis
Also seen with nickel allergy

6

What are the four causes of acne production?

-Hyperkeratosis
-Sebum overproduction
-Propioninacterium acnes proliferation
-Inflammation

7

If a patient presents with acne, and the cause is hyperkeratosis, what is the treatment of choice?

Vitamin A analogs - aka Retinoids

8

If a patient presents with acne, and the cause is sebum overproduction, what is the treatment of choice?

-Isotretinoin (Accutane)
-Spironolactone
-Estrogens (OCPs)

9

If a patient presents with acne, and the cause is Propioninacterium acnes proliferation, what is the treatment of choice?

-Erythromycin
-Tetracycline (doxycycline, minocycline)
-Clindamycin
-Benzoyl Peroxide

10

If a patient presents with acne, and the cause is Inflammation, what is the treatment of choice?

For a one day thing like a wedding, and injectable steroid.

11

What are the layers of the epidermis to the dermis?

Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale
Dermis

Californians Like Girls in String Bikinis, Duh!

12

This pathology includes the overproduction of new skin cells. The cause isn’t quite known but is associated with immune (activated T-cells) that produces red, dry, itchy papules and plaques with silvery scale. MC found on knees and elbows. Associated with a change called parakaratosis (nuclei retained in the Stratum Corneum). Px also presents with fine dividing on the nails. What changes would you see in the layers of the epidermis? What are the bleeding spots called?

Psoriasis
Increased thickening of the stratum spinosum, and a decrease in the stratum granulosum.
Sign: Auspitz’s sign (bleeding of plaque)

13

What is the treatment for psoriasis and what is the patient at risk for?

At risk for psoriatic arthritis
Topical:
Moisturizers and emollients
Steroids
Tar containing creams
Vitamin D analogs
Retinoids
Phototherapy
Systemic:
Methotrexate
Cyclosporine
Retinoids

14

The following skin lesion is a common benign neoplasm, that is flat or worty, greasy, pigmented like a tortoise shell. Microscopically, you will see squamous epithelial proliferation with keratin filled cysts. Looks like a pasted on lesion. Does not progress to cancer. What pathology is at hand?

Seborrheic keratosis

15

This pathology is due to a lack of tyrosinase enzyme, that may be in the oculo-cutaneous form, with a normal amount of melanocytes, but they have a decrease production of melanin. What is the diagnosis?

Albinism

16

This pathology has a decreased number of melanocytes, causing depigmentation. Thought to be of autoimmune origin.

Vitiligo

17

This skin pigmentation appears on the face, and is more common in pregnant women, women undergoing HRT, or use OCPs as well. What pathology is at hand?

Melasma

18

This skin infection can be caused by S. aureus or S. pyogenes. It is highly infectious, commonly seen with a honey crusted lesion, common around the lips and the nose. It is associated with infection of the epidermis. What pathology is at hand?

Impetigo

19

This disease presents as infection of the dermis, very tender and painful to the touch. It can rapidly spread, usually caused by S. pyogenes or S. aureus. What pathology is at hand?

Cellulitis

20

This skin disease can progress rapidly usually caused by anaerobic bacteria and S. pyogenes. The tender area tends to extend far beyond the visible areas of cellulitis. Crepitus can be felt (produced by methane or CO2). What pathology is at hand?

Necrotizing fasciitis

21

This disease is caused my S. aureus, and the skin lesion is induced by epidermal lytic exotoxin A and B, that destroy keratinocyte attachments in the stratum granulosum. Px will present with fever, general erythematous rash, and sloughing of the upper layers of the epidermis (sloughing of the skin). MC in newborns and children.

Staphylococcal Scalded Skin Syndrome

22

This skin lesion that appear as white patches/plaques that are painless, on the side of the tongue, and they can not be scraped off. They are caused by EBV but often times are seen with immunocompromised or HIV patient. What disease is at hand?

Hairy Leucoplakia

23

This oral cavity lesion is found as a flat white patch that can be confused with oral thrush or lichen planus. 5-25% of these lesions are precancerous. What pathology is at hand?

Leukoplakia

24

This is an autoimmune chronic blistering disease, where antibodies are going against desmosomes or antidesmoglian hold epithelial cells together). Lesions are described as painful flaccid lesions that are wrinkly and droopy. May present in oral mucosa. What pathology is at hand? What is a diagnostic sign that differentiates it from other diseases?

Pemphigus vulgaris

Nikolsky sign - barely touch it, and the layer separates from the dermis (sloughs off) + biopsy to confirm.

D-desmosomes
A-Acantholysis (cells can’t hold things together)
M-Mouth (lesions seen in mouth)
N-Nikolsky’s sign

25

This is an autoimmune chronic blistering disease, where antibodies are going against hemidesmosomes (anchor cells together). Lesions are described as red round lesions filled with eosinophils. Less severe than other blistering lesions. Lesions do not appear in mouth and has a (-)Nikolsky sign.

Bullous pemphigoid

26

This blistering lesion shows pruritic papules and vesicles, with IgA in the tips of the dermal papilla. Associated with Celiac disease. What pathology is at hand?

Dermatitis herpetiformis

27

This blistering skin lesion is more common to a type of drug interaction where there is deposition of immune complexes into the superficial micro-vasculature of the skin or oral
mucosa. Usually follows an infection right a drug exposure —> can vary from a mild rash, to a Stephen-Johnson-like life threatening form. Can present as macules, papules, vesicles, target lesions. What pathology is at hand?

Erythema multiforme

28

Exposure to the following medications can cause fever, bullous formation, necrosis, sloughing of the skin, and considered a dermatologic emergency can arise from:
Seizure medication-ethosuximide, carbamazepine, lamotrigine, phenytoin, phenobarbital.
Sulfa medication
Penicillin
Allopurinol
What pathology is at hand? What is the more extreme version of this disease?

Steven-Johnson Syndrome

Extreme magnitude/version of SJS—> Toxic Epidermal Necrolysis (TEN) Diagnosis is when 30% of the skin is sloughing off!

29

These skin lesions are pruritic, purple, polygonal, papules, plaques, associated with a sawtooth infiltrate of the lymphocytes and associated with HepC.

Lichen planus

30

Sandpaper-like skin lesions that are premalignant to squamous cell carcinoma (20-25%). What pathology is at hand, and what is a drug is used in the treatment?

Actinic keratosis
5-Florouracil
Liquid nitrogen
Krioablation