Skin Pathology Review (Gomez) Flashcards by Andrea Parsons

papule versus nodule

papule - 5 mm

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vesicle

blister that is <5 mm

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bulla

> 5 mm fluid filled

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acantholysis

Loss of intercellular cohesion between keratinocytes

seen in pemhigus vulgaris

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acanthosis

diffuse epidermal hyperplasia

seen in acanthosis nigricans

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dyskeratosis

Abnormal, premature keratinization within cells below the stratum granulosum

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hydropic swelling

Intracellular edema of keratinocytes, often seen in viral infections

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lentiginous

A linear pattern of melanocyte proliferation within the epidermal basal cell layer

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parakeratosis

where is this normal?

Keratinization with retained nuclei in the stratum corneum. On mucous membranes, parakeratosis is normal

seen in psoriasis

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spongiosis

Intercellular edema of the epidermis

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lamellar/pacinian corpuscle

encapsulated nerve ending

pressure receptors

found in deep dermis or hypodermis

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meissner

touch receptors

confined to dermal papillae

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FGF3
postage stamp
middle age or older
sometimes stimulate malignant melanoma
proliferation of epidermal basal cells

seborrheic keratosis

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what is Leser-Trelat

Sign of Leser-Trélat – acute onset of Seborrheic keratoses with malignancies (GI mostly)

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hyperpigmentation

Epidermal hyperplasia of Stratum Spinosum

acanthosis nigricans

check for malignant adenocarcinoma

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what is cowden syndrome

multiple tircholemmomas (hair follicle adnexal tumor)

dominant inheritance

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what is Muir Torre Syndrome

sebaceous adenomas with association colorectal malignancy (variant of lynch syndrome HNPCC)

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what is a cylindroma

on the forehead and scalp

adnexal tumor involving the eccrine gland (sweat gland)

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what is a Turban tumor

massive confluent cylindromas on the forehead like a turban

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Benign soft tissue neoplasm seen in adults, frequently on the legs of young – middle aged women

Tan-brown papules which are usually small (less than 1.0 cm) and may occasionally be tender

Benign Fibrous Histiocytoma (Dermatofibroma)

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Hypermelanosis characterized by development of sharply demarcated blotchy, brown macules on face
Symmetrical distribution over the cheeks and forehead
Less frequently on upper lip and neck

appears in women

Occurs:
During pregnancy
In women taking oral contraceptives
At menopause

melasma

increase in melanin but not number of melanocytes

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what is solar lentigo

Definition: benign, discrete hyperpigmented macule occurring on chronically sun exposed skin in adults, especially on the back of the hands and the forehead.

Cause: Increased melanin pigment in keratinocytes
Variable increase in number of junctional melanocytes

Note: Term “lentigo or lentiginous” means a proliferation of melanocytes.Lentigines arepigmented macules on skin and mucosa.

Lentigo maligna is the name given to an in situ melanoma arising in sun exposed skin of the face

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what is the cause of acute transient vitiligo

Vitiligo, Acute Transient: Treat people with normally dark pigmented skin with a keratinolytic agents that removes layers of keratinocytes. The results are dramatic

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defect in tyrosinase, an enzyme necessary for melanin production

albinism

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acquired mutations in components of the Ras signaling pathway” NRAS and BRAF

Melanocytic (Nevocellular) Nevi | Benign Neoplasms of Melanocytes

Increased telomerase activity from mutated TERT gene is present in 70%

of skin melanomas.

kit mutations seen in what

non sun exposed melanomas

what mutations are seen in both dysplastic nevus and melanoma familial syndromes?

P16 inhibition is inhibited by CDKN2A mutations CDK4 mutations block p16 inhibition

cutaneous horn premalignant increased risk for SCC

actinic solar keratosis

Rapidly growing (days-weeks) neoplasm; occurs on sun-exposed areas (face, hands) of older adults (men more than women) Often involutes and clears spontaneously within 3 to 4 months

Keratoacanthoma

autosomal dominant disorder multiple basal cell carcinomas before age 20 pits of the palms and soles odontogenic keratocysts medulloblastomas ovarian fibromas

Nevoid basal cell carcinoma syndrome (Gorlin syndrome)

Malignant superficial fibroblastic neoplasm (fibrosarcoma of skin) Locally aggressive but rarely metastasizes Bednar tumor is pigmented variant Translocation of COL1A1 and PDGFB → ↑PDGFB storiform (swirling) of spindled cells

dermatofibrosarcoma protuberans

CD4+ T-cell lymphoma of the skin (CLA, CCR4 & CCR10) Aggressive neoplasm with median survival 8-9 years (M>F) Phases inflammatory erythrodermic pre-mycotic patch plaque tumor

mycosis fungoides

generalized exfoliative erythroderma (red man) lymphadenopathy hepatosplenomegaly T cell lymphoma cerebriform nuclei suvival <3 years

sezary syndrome

``` type IV hypersensitivity epidermal edema lymphocytes in dermis and epidermis pediatrics papuovesicular lesions "boiling over" ``` flexure surfaces

eczema

Hypersensitivity (CD8+ cytotoxic T cells) reaction to drugs, infections, malignancy, collagen vascular disorders Infections: Herpes simplex, deep fungal (Histoplasmosis), Salmonella typii, Leprosy Drugs: Antibiotics, Salicylates, Anti-malarials

erythema multiforme

steven johnson syndrome

extensive symptomatic febrile form of erythema multiforme children erosions and hemorrhagic crusts involving the lips, and oral mucosa

toxic epidermal necrolysis

variant of erythema multiforme diffuse necrosis and sloughing of cutaneous and mucosal epithelilal surface s infection and fluid loss are the major concerns

Involves skin regions with high density of sebaceous glands (oil or sebum production) scalp, forehead, especially glabella (space between upper eyebrow), nasolabial folds, skin of auditory canal, intergluteal folds) Excessive dandruff in scalp common Not due to sebaceous gland abnormality Infection with superficial yeast (Malassezia furfur) may play important role since condition is improved by use of topical antifungal agents

seborrheic dermatitis

Affects skin of elbows, knees, scalp, lumbosacral area, intergluteal cleft, and glans penis Typical lesion: well-demarcated, pink- to salmon plaque Many different clinical presentations HLA-Cw*0602 association – increased CD4+TH1 sensitized cells set off other T-cells causing increased cytokines leading to epidermal proliferation. auspitz sign

psoriasis

``` Fairly common in 30-60 y/o females Stages Pre-rosacea (flushing) Erythematotelengiectatic Papulopustular Phymatous Pathophysiology uncertain Numerous triggers Abnormal cathelicidin may lead to inflammation Perifollicular inflammation with changes similar to acne vulgaris microscopically ```

rosacea

Involves mucosa and scalp, face, axilla, groin and other pressure points; IgG antibodes against desmosomes

``` classic bullous disease Pemphigus vulgaris (80%): ``` In pemphigus vulgaris, autoantibodies against Dsg1 and Dsg3 cause blisters in the deep suprabasal epidermis,

more benign course; involves face, scalp, chest and back and spares mucous membranes Epidemic form occurs in South America (fogo salvagem)

Pemphigus foliaceus in pemphigus foliaceus, the autoantibodies are against Dsg1 alone, leading to superficial, subcorneal blisters.

Common in children and adolescents generally self-limited – present 6 months - 3 years (unless a friendly relative intervenes) Etiology: Human Papillomavirus (HPV) with over 150 subtypes of virus most common cutaneous variety in humans is 2/4 and in anogenital 6/11 Distinct, gray-white to tan 0.1 to 1.0 cm papules firm consistency, “cobble-stone” (roughed surface), firm to palpation.

verruca vulgaris

most common site where melanoma might metastasize

liver | elevated alk phos

the rash that itches atopic eczema - mediated by IgE - AC fossa prone to which infection

staph toll like receptor 2 is the protein that is involved in the innate immune system which is activated in areas where there are blocked sweat ducts in the cases of eczema use steroids to treat

8 year old that has lost none of his teeth high IgE levels history of staph abscesses atopic eczema

has phagocytic dysfunction Job's ! -> hyper IgE and decreased IL-8/NCF IL-8 is needed for white cells to chemotact to the right area recurrent bacterial infections/abscess increased IL-5--> more eo's increased IL-4--> acts on TH2 response pathway

thrombocytopenia and eczema | combinded immunodeficiency

Wiskott Aldrich

what is nummular eczema

lots of spots, worse in the winter and with water? coin shaped treat with steroids

what causes psoriasis to flare up?

stopping steroids certain drugs--> b-blockers, lithium, interferon strep itching sudden flare up may be a marker for HIV

what do psoriatic plaque and atherosclerotic disease have in common

basic problem in ASVD and psoriasis is suppressed T reg cells and hyperactive T helper 1 Thepler 17 cells

oil drop spots | nail pits

psoriasis

where on the nail do fungal infections start?

distal portion so if you see proximal superficial onychomyocosis think of trichophyton rubrum and AIDS!

worsens with cushings, malnutritions, or immunosuppression (steroids- help this grow) dull yellow fluorescence under wood light more prominent in sunlight this is what

malassezia furfur- tinea versicolor on the trunk scrapings show spaghettie and meatballs

coral pink fluorescence under wood's lamp

corynebacterium

green on woodlamp

``` cat ringworm (microsporum canis) tinea ```

urine is wine red and coral red when under woodlamp Woman: BCP's, hep C, elevated ALT Man- increased temporal hair growth and exposure to polychlorinated aromatic hydrocarbons what is the disease

porphyria HUD deficiency pt's with urogen decarboxylase deficiency will have high levels of uroporphyrinogen and it is photosensitive --> deposits supepidermal caterpillar bodies

coLD agglutinins dry cough target lesions - erythema multiforme

atypical pneumonia with mycoplasma

in the west which drugs cause steven johnson/ toxic epidermal necrolysis east?

oxicam NSAID's (peroxicam) sulfas east--> carbamazepine (tegretol) - check for HLA-B1502 allopurinol - HLA- B5801

what pathway does steven johnons work by

death receptor FasR

which organism is associated with lymphoreticular malignancies, colon or gyn malignancies

clostridium septicum combination of aerobic and anaerobic cellulitis and necrotizing fascitis

h0t tub folliculitis

pseudomonal aeruginosa

a child with impetigo may be in danger of devloping what

glomerulonephritis (PSGN) post streptococcal strep pyogenes is the second most common cause

what is a cause of rosacea

demodex mit (bacillus olernius)

borrelia burgdorferi stage I

flu sydnrome with rahs (erythema chronicum migrans)

stage II borrelia burgdorfer

``` heart block joints nerves (bell's palsy) skin rash ```

stage III borrelia burgdoferi

joints and CNS and PNS | oligoarthritis, ecephalitis/memory loss, neuropathies

more common in orientals associated with Hep C sawtooth infiltrate of lymphocytes at dermal epidermal junction

lichen planus | 6' p's

herpes type 8

kaposi sarcoma if associated with HIV/immunosuppression its on head neck region

if a patient has pityriasis and herald patch what else should you check for

syphilis

ssDNA virus glove and stocking purpuritic syndrome slapped cheeks worse after exercise (due to 5th's disease)

parovirus B19 if parents get it they can get endocarditis, arthritis, and hemolytic anemia

rash spread cephalocaudad togavirus +SS RNA forchheimer spots (red dots back of throat) maculopapular rash lymphadenoopahty (postauricular) blueberry muffin rash

German measles (Rubella)

koplik spots fever, conjunctivitis, coryza -runny nose, cough paramyxovirus (- SS RNA) rash on head, spreads to trunk, then extremities becomes confluent on face and trunk

Rubeola (measles)

what is DRESS

drug rash with eosinophilia and systemic syndrome 2-6 weeks after start of new medicine acral edema--> generalized rash--> pinpoint pustules--> desquamation lymphadenopathy, hepatomegaly, abnormal LFT's IL5 disease HHV6 or HHV 7 poisiitve

poison ivy is what type of reaction

type IV a Gell-Combs (TH1 with macrophage activation)

what is the cause of angioedema

ACEinhibitors ARB's acquired C1 esterase deficiency --> sets off bradykinin --> screen with C4 which will be low

how can stress cause hives

b/c CRH increase stimulates mast cells

what type of reaction is bee sting

type I IgE reaction

what causes direct activation of mast cells without IgE

Anaphylactoid- non IgE degranulation ``` C5a CRH thermal and mechanical stimulation radiocontrast dyes opioids shellfish ```

PAS positive staining CD4 T cells in the epidermis patch- plaque- tumor

mycosis fungoides

RO/SSA photosensitive positive band test offspring will have what

heart block this is chronic cutaneous lupus erythematous

causes of erythema nodosum

1st oral contraceptives 2nd streptococcus ``` TB pregnancy coccidioomycosis ulcerative colitis sarcoid ```

Skin Pathology Review (Gomez) Flashcards

(82 cards)