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What is a Macule?

Flat discoloration less than 1 cm

What is an example of a disease that causes macules?

Tinea Versicolor

What is a patch?

A macule greater than 1 cm

What is a papule?

A raised lesion less that 1 cm

What is an example of a disease that causes papules?

Acne vulgaris

What is a plaque?

A papule greater than 1 cm

What is an example of a disease that has plaques?

Psoriasis

What is a Vesicle?

A fluid filled blister

What is an example of a disease that has vesicles?

Chickenpox

What is a Wheal?

A transient vesicle

What is a condition that illustrates wheals?

Hives

What is a Bulla?

A Large fluid filled blister

What is a disease that illustrates Bullae?

Bullous pemphigoid

What is a Keloid

An irregular raised lesion resulting from scar tissue hypertrophy (commonly seen in African Americans)

What is a Pustule?

A blister containing pus?

What is an example of a disease that has pustules?

Impetigo

What is a Crust?

Dried exudates from a vesicle, bulla or pustule

What is Hyperkeratosis?

Increased thickness of the stratum corneum.

What is Parakeratosis?

Hyperkeratosis with retention of nuclei in the stratum corneum

What is a disease that illustrates both hyperkeratosis and parakeratosis?

Psoriasis

What is Acantholysis?

Separation of epidermal cells

What is a disease that illustrates acantholysis?

Pemphigus Vulgaris

What is Acanthosis?

Epidermal hyperplasia of Spinous layer

What is Dermatitis?

An inflammation of the skin

What are Verrucae?

Warts

What skin lesions to Verrucae illustrate?

Acanthosis
Hyperkeratosis
Koilocytosis (HPV)

What are warts called on the hands?

Verrucae vulgaris

What are warts called on the genitals?

Condyloma acuminata

What is a nevocellular nevus?

A common mole, benign

What is Urticaria and what are its characteristics?

Hives: Intensely prurtic wheals that form after mast cell degranulation...( Wheals have a clearing center with red surrounding it)

What is Ephelis?

A freckle....Normal number of melanocytes but increased melanin production

What is Atopic dermatitis AKA?

Eczema

What is common of atopic dermatitis?

Pruritic eruption, common on skin flexures---associated with other atopic diseases like asthma and allergic rhinitis (Type I)

What is Allergic Contact dermatitis?

Type IV hypersensitivity following antigen exposure

What are characteristic lesions seen in Psoriasis?

Salmon pink or silver scaly papules and plaques, esp on knees and elbows.

What are two associated findings in psoriasis patients?

Nail pittting and Psoriatic arthritis

What is Auspitz sign?

Bleeding in spots where the scales of Psoriasis are scraped off.

What histological changes are seen in Psoriasis?

Increased stratum spinosum and decreased stratum granulosum
AND
Parakeratosis

What is Seborrheic keratosis?

Flat greasy pigmented squamous epithelial proliferation with keratin filled cysts...Common benign neoplasm of elderly.

What is Albinism?

Normal melanocyte number with decreased melanin production due to decreased tyrosinase activity.
OR
Failure of NCCells to migrate

What is Vitiligo?

Irregular areas of complete depigmentation caused by a decreased number of melanocytes

What is melasma?

Hyperpigmentation associated with pregnancy or OCP use

What Usually causes Impetigo?

S. aureus or S. pyogenes...highly contagious

What is characteristic of Impetigo?

Honey-colored crusts esp around the mouth

What is the typical cause of cellulitis?

S. aureus or S. pyogenes....

What IS cellulitis?

Acute and painful spreading infection of dermis and SQ tissues

What is Necrotizing Fasciitis?

Deeper tissue injury than cellulitis, usually caused by anaerobic bacteria or S. pyogenes.

What is characteristic of Necrotizing Fasciitis?

Crepitus due to increased methane or CO2 production from anaerobes---seen in 'flesh-eating bacteria

What is Staphylococcal Scalded Skin Syndrome?

Exotoxic damage from S. aureus that destroys KERATINOCYTE attachments in the stratum GRANULOSUM

What is characteristic of SSSS?

Fever, generalized rash and sloughing of the upper layers of the epidermis due to destroyed keratinocyte attachments.

What is characteristic of Hairy Leukoplakia?

White painless patches on the tongue that CANNOT be scraped off---

What is usually responsible for Hairy Leukoplakia?

EBV reactivation associated with HIV patients

What type of antibodies are seen in Pemphigus vulgaris?

Anti-epithelial cell antibodies (IgG) against DESMOSOMES---potentially fatal.

What is a characteristic skin lesion illustrated in Pemphigus vulgaris?

Acantholysis--intraepidermal bullae form esp on skin AND mouth

What is a positive Nikolsky's sign and where is it seen?

Separation of the epidermis upon manual stroking--seen in pemphigus vulgaris

What are antibodies directed against in bullous pemphigoid?

Hemidesmosomes of the epidermal basement membrane (Antibodies are 'BULLOW' the BM)

What is the difference in immunofluorescent staining pattern between pemphigus vulgaris and bullous pemphigoid?

Vulgaris has IM staining positive throughout but Bullous pemphigoid has a linear staining only along the BM

What is seen within the blisters of bullous pemphigoid?

Eosinophils

What is are two clinical differences between Pemphigus vulgaris and Bullous pemphigoid?

Pemphigoid SPARES the oral mucosa and has a negative Nikolsky's sign... the patient is also otherwise healthy. Vulgaris can be life threatening.

What is Dermatitis Herpetiformis associated with?

Celiac disease

What is characteristic of dermatitis herpetiformis?

Pruritic papules and vesicles... Deposits of IgA are seen at the tips of dermal papillae

What are the two main infections associated with Erythema multiforme?

Mycoplasma pneumonia and HSV

What types of lesions are commonly seen in Erythema multiforme?

TARGET lesions, red papules with a clear ring around them.
Also macules, papules and vesicles

What is the next step up from Erythema multiforme that is in addition characterized by fever, bulla and necrosis, sloughing of skin and high mortality rate?

Stevens Johnson syndrome

What is Toxic Epidermal necrolysis?

Like SJS but with more severity and greater epidermal involvement.

What are drug commonly known to cause SJS?

Allopurinol
Lamotrogine
Carbamazepine, phenytoin and phenobarbitol
Sulfa drugs
Penicillin

What is the characteristic finding of Lichen Planus?

Pruritic purple polygonal papules

What disease is Lichen Planus associated with?

Hep C

What is seen on histology of Lichen Planus?

Sawtooth infiltration of lymphocytes at dermal-epidermal junction.

What is Actinic Keratosis?

Premalignant lesions to SCC caused by sun exposure.
Small, rough and erythematous or browning papules

What is the risk of developing SCC proportional to in Actinic Keratosis?

Level of epithelial dysplasia

What is Acanthosis nigricans?

Hyperplasia of the SPINOSUM layer

What are the associated findings in pts with acanthosis nigricans?

Hyperlipidemia, esp in Cushings or DM
and
Visceral Malignancy

What are several diseases associated with Erythema nodosum?

Sarcoid!
TB
Leprosy
Histoplasmosis
Coccidioidomycosis

What IS erythema nodosum?

Inflammatory lesions of subcutaneous fat, usually on anterior shins (can resemble bruising.)

What Described as having a Herald patch followed by a Christmas tree distribution?

Pityriasis rosea

What is the precursor to SCC?

Actinic Keratosis

What are associated causes of SCC?

Sun exposure and arsenic exposure

What is seen on histology of SCC?

Keratin Pearls

What is characteristic of the lesions on SCC?

Usually on hands or face, they are ulcerative red lesions...
Invade but rarely metastasize

What type of histological feature is common in Basal cell carcinoma, BCC?

Palisading Nuclei

What is seen on gross in BCC?

Rolled edges with central ulceration and appear as 'pearly papules.'

What is characteristic of the spreading pattern of BCC?

Locally invasive but rarely metastasizes

What is the precursor to Melanoma?

A dysplastic nevus

What is the tumor marker found to be positive in Melanoma?

S-100

Why is melanoma so feared?

METASTASIZES like a mofo

What are the associated causes of melanoma?

Sunlight exposure, esp intermittent burning
and
Fair skinned persons are at higher risk

What correlates best with risk of melanoma for metastasis?

DEPTH
of invasion

What are the ABCDs of melanoma?

Asymmetry
Borders (irregular)
Color
Diameter (>6mm is suspicious)
Any of these changes in a mole should be investigated.

What is the cause of a palpable purpura until proven otherwise?

Vasculitis

---****---What is the cause of the redness if a lesion blanches on diascopy?

Dilated capillaries... Pressing of the glass slide pushes the blood out of the capillaries and causes the blanching (Telangiectasia)

What is the cause of redness if a lesions does NOT blanch on diascopy?

Damage to the capillaries or post-capillary venues, which has caused leakage of blood that will not disappear

What is Ballooning degeneration?

Swelling of spinous cells due to intracellular edema (herpes)

What is a granuloma?

Collection of histiocytes with or without epitheliod cells and multinucleated giant cells.

What are granulomas called if they are surrounded by lymphocytes?

Tuberculoid granulomas

What is leukocytoclasis?

Fragmentation of leukocytes commonly seen in vasculitis---does not blanch on diascopy

What is the gold standard for diagnosis of Allergic Contact dermatitis?

A patch test, where a patch of the suspected substance is applied to the skin to look for the resulting dermatitis.

What type of hypersensitivity is cutaneous leukocytoclastic Vasculitis?

Type III---immune complexes deposit in the skin 7-10 days after inciting agent

What type of hypersensitivity is Pemphigus vulgaris?

Type II hypersensitivity

What condition is angioedema an exacerbation of?

Hives or Urticaria---can lead to swelling of lips, eyes

Difference between Urticaria and Erythema multiforme?

Urticaria: lesions are less than 24 hours, and new lesions show up daily... associated w/ edema
EM: Lesions are fixed and all show up at once usually after 7 days. No edema

What condition are anti-desmoglein-3 antibodies found in?

PVulgaris... ONLY the basal layer of skin and below remains intact.

In what condition are anti-desmoglein-1 antibodies found?

P-Folaceus---only the corneum is sloughed off

What is the characteristic lesion seen in LYME disease patients?

Bulls-eye lesion, with an expanding red region from which B-Burgdorferi can be isolated. (Erythema chronicum migrans)

What is the vector for B. Burgdorferi?

Ixodes ticks, carried on white-footed deermice or deer.

What immune substance does the spirochete in LYME disease induce?

TNF--leads to fever and inflammation

What is the acronym for remembering associated features of LYME disease?

BAKE a key LYME pie!
Bell's palsy
Arthritis
Kardiac block
Erythema migrans

What is the treatment for LYME disease?

Doxycycline

What is a typical presentation of a Scabies infected patient?

Erythematous papules and burrows esp in the finger webs of a patient in a massive cluster of people, esp homeless or prisoners.

How is scabies diagnosed?

With the scabies prep or scraping skin using a scalpel with mineral oil and inspecting it for mites or eggs.

What is Roseola Infantum AKA?

Sixth disease--
Maculo-papulo rash with high fever but otherwise the child feels fine.

What is the causative agent of Roseola Infantum?

HHV6 or HHv7

What is characteristic of Rubella infection?

Cranial-caudal development of macular-papular rash (rapidly) with tender cervical lymph nodes and low-grade fever

What disease is associated with 'Blueberrry Muffin Boys?'

Rubella, the German measles.

What is the real danger with Rubella infections?

It is a TORCHeS infection associated with congenital problems

What are the 3 C's of Measles?

Cough, Coryza and Conjunctivitis

What disease are Koplick-s spots associated?

Measles or Rubeola

What disease is Measles associated with years after the rash occurred?

Subacute sclerosing Panencephalitis

What is Asboe-Hansen's sign?

When bullae move laterally in the skin with pressure...
Seen in pemphigus vulgaris

What type of antibodies are present in Pemphigus Vulgaris?

Antibodies against the desmosomes
Specifically antidesmoglein 1 and 3

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