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
- Leukotriene inhibitors
- UV light therapy
-severe cases, systemic steroid
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?
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
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
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
What are the four causes of acne production?
- Sebum overproduction
- Propioninacterium acnes proliferation
If a patient presents with acne, and the cause is hyperkeratosis, what is the treatment of choice?
Vitamin A analogs - aka Retinoids
If a patient presents with acne, and the cause is sebum overproduction, what is the treatment of choice?
- Isotretinoin (Accutane)
- Estrogens (OCPs)
If a patient presents with acne, and the cause is Propioninacterium acnes proliferation, what is the treatment of choice?
- Tetracycline (doxycycline, minocycline)
- Benzoyl Peroxide
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.
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!
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?
Increased thickening of the stratum spinosum, and a decrease in the stratum granulosum.
Sign: Auspitz’s sign (bleeding of plaque)
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
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?
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?
This pathology has a decreased number of melanocytes, causing depigmentation. Thought to be of autoimmune origin.
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?
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?
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?
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?
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
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?
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?
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?
Nikolsky sign - barely touch it, and the layer separates from the dermis (sloughs off) + biopsy to confirm.
A-Acantholysis (cells can’t hold things together)
M-Mouth (lesions seen in mouth)
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.
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?
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?
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.
What pathology is at hand? What is the more extreme version of this disease?
Extreme magnitude/version of SJS—> Toxic Epidermal Necrolysis (TEN) Diagnosis is when 30% of the skin is sloughing off!
These skin lesions are pruritic, purple, polygonal, papules, plaques, associated with a sawtooth infiltrate of the lymphocytes and associated with HepC.
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?
This skin lesion is due to hyperplasia of the stratum spinosum. Seen in Px with hyperinsulinemia/diabetes, also with visceral malignancy (rule out malignancy in Px over 40 with new onset of skin alteration). What pathology is at hand?
This is an inflammatory lesion of subcutaneous fat. Closely related to sarcoidosis, coccidiomycosis, histopladmosis, tuberculosis, leprosy, or Group A Strep. Seen a red/purple bruise-like skin lesions, seen as multiple lesions. What pathology is at hand?
This skin lesion begins with a large oval and scaly patch (Harold lesion) found on the trunk or the back, and days later presents as a Christmas tree distribution that lasts about 4-6 weeks and remits spontaneously. Sunlight tends to help these lesions resolve. What pathology is at hand?
What is the order of MC cancer to least common cancer?
What is the order of metastatic potential?
MC cancer order: Basal cell —> Squamous cell—> Melanoma
MC metastatic order: Melanoma —> Squamous cell —> Basal cell Carcinoma
This cancer occurs MC in sun exposed skin like the hands and the face, locally invasive with low metastatic risk. Described as an ulcerative red lesion, with keratin pearls seen histologically.
Squamous cell carcinoma
This lesion is MC found in sun exposed areas. The lesion is described as a rolled edge appearance with a central ulceration. May present with a pearly papule and telangiectasias. Microscopically presents with palisading nuclei. What pathology is at hand?
Basal cell carcinoma
This skin malignancy appears in sun exposed areas, and the depth of the tumor correlated with the risk metastasis. Best tool for diagnosis is a deep punch biopsy or an excisional biopsy. What pathology is at hand?
Tumor market is: S-100
What are the ABCDs of melanoma?
D-Diameter (bigger than head of a pencil)