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Terms in this set (176)
localized loss of skin pigmentation
What causes vitiligo?
autoimmune, neurohormonal, and toxic destruction of melanocytes
How are the lesions in vitiligo?
aSx, flat, well-dermarcated zones
congenital lack of pigmentation
What causes albinism?
enzyme defect (tyrosinase) that impairs melanin production
small, tan to brown macules; darkens when exposed to sunlight
What causes freckles?
increased number of melanosomes
mask-like hyperpigmentation of the cheeks
What can cause melasma?
pregnancy or oral contraceptives
increased melanin deposition along basal layer of epidermis
macrophages w/ melanin pigment in cytoplasm
How can you Tx epidermal melasma?
topical bleaching (hydroquinone)
proliferation of benign melanocytes; don't darken when exposed to sunlight
What is seen histologically in lentigo?
benign linear melanocyte hyperplasia of individual melanocytes
Benign melanocytic nevus
benign nested proliferation of melanocytes at the dermal-epidermal junction, dermis only, or both
dysplastic melanocytic nevi with variability in pigmentation and irregular borders
malignant melanocytes which are positive for S-100 and HMB-45
What are clinical warning signs of malignant melanoma?
enlargement, itching or pain, new pigmented skin lesion, irregularity of borders, and variation of color
What is radial growth of malignant melanoma?
grows horizontlly within epidermis and superficial dermis
radial growth of malignant melanoma on face of sun-damaged skin
What is vertical growth of malignant melanoma?
grows downward into the deep reticular dermis and even into the adipose tissue
What if the depth of invasion of malignant melanoma <0.76 nm?
Clark's Level I
tumor limited to epidermis
Clark's Level 2
tumor invading into but not filling papillary dermis
Clark's Level 3
tumor invading into and filling papillary dermis
Clark's Level 4
tumor invading into reticular dermis
Clark's Level 5
tumor invading into adipose tissue of subcutis
benign squamous proliferation (elderly)
What does seborrheic keratosis look like?
raised, discolored plaques on extremities or face; coin-like, waxy, stuck-on appearance
What is seen histologically in seborrheic keratosis?
sudden onset of multiple seborrheic keratoses which suggests carcinoma of GI tract
epidermal hyperplasia w/ darkening of skin (velvet-like)
Where do you see acanthosis nigricans?
axilla or groin
What is acanthosis nigricans associated with?
insulin resistance, autosomal dominant, obesity, or malignancy (gastric CA)
skin tag on neck, trunk, face; flesh-colored bag like tumor attached to skin by a stalk
What seen histologically with fibroepithelial polyp?
fibrovascular cores covered by benign squamous epithelium of the epidermis
Epithelial cyst (Wen)
down growth and cystic expansion of epidermis or keratinizing epithelium forming the hair follicle
What do epithelial cysts look like?
dermal or subcutaneous, well-circumscribed, firm, moveable, dome-shaped, and painful
What is seen histologically with an epidermal inclusion cyst?
lined w/ benign epithelium (looks like normal dermis)
What is seen histologically with a pilar or trichilemmal cyst?
lined by epithelium resembling the follicular epithelium w/o granular layer but filled with eosinophils
What is seen histologically with dermoid cysts/
shows epidermal appendages
cyst lined by epithlium resembling sebaceous gland duct
rapidly developing neoplasm of epidermic which mimics squamous cell CA but regresses quickly
What do keratoacanthomas look like?
flesh-colored, dome-shaped nodules w/ central, keratin-filled plug which resemble a crater
What is characteristic of keratoacanthomas histologically?
glassy eosinophilic cytoplasm and produce keratin
Adnexal (appendage) tumors
benign and malignant neoplasms from epidermal appendages (hair, sebaceous glands, eccrine sweat glandts, and apocrine sweat glands
sun-exposed skin w/ a series of progressively dysplastic changes that resemble atypia
What does actinic keratosis look like?
tan-brown, red, or skin-colored; rough-sandpaper-like; lots of keratin
How do you Tx actinic keratosis?
gentle curettage, freezing or topical application of chemotherapeutic agent
Squamous cell carcinoma
malignant proliferation of squamous cells with keratin pearls
What does squamous cell CA look like?
ulcerated, nodular mass (face)
Basal cell CA
malignant proliferation of basal cells of the epidermis
What does basal cell CA look like?
elevated nodule w/ central, ulcerated crater surrounded by dilated (telangiectatic) vessels
What does histology show w/ basal cell CA?
nodules of basal cells w/ peripheral palisading
Merkel Cell CA
malignant neoplasm from Merkel cell of epidermis (tactile sensation)
What do Merkel cell CA look like?
small, round, malignant cells w/ neurosecretory-type cytoplasmic granules
Benign fibrous histiocytoma
benign dermal neoplasms of fibroblasts and histiocytes
What is the MC type of benign fibrous histiocytoma?
What do benign fibrous histiocytomas look like?
tan to brown firm papules, slightly tender, can grow or regress
proliferation of fibroblasts w/ deposition of dense collagen
well-differentiated primary fibrosarcoma of the skin
How is the growth of dermatofibrosarcoma protuberans?
slow, locally aggressive
What do dermatofibrosarcoma protuberans look like?
firm, solid nodules (trunk)
What is seen histologically with dermatofibrosarcoma protuberans?
atypical fibroblasts arranged in a basket-weave pattern
tumor-like collection of foamy histiocytes w/in dermis
sudden showers of yellow papules which increase and decrease secondary to variations in plasma triglyceride and lipid content
Tuberous and tendinous xanthomas
yellow nodules on Achilles tendor and extensor tendons of fingers
linear yellow lesions in skin folds
soft yellow plaques on the eyelids
Dermal vascular tumors
benign vascular neoplasms (capillary and cavernous hemangiomas), malformations (nevus flammeus or port-wine-stain), multifocal angioproliferative (Kaposi's), and malignant vascular tumors (angiosarcomas)
Langerhans cell histiocytosis: solitary or multiple lesions which range from papules tonodules to scaling erythematous plaques
What is seen histologically in histiocytosis X?
marked infiltration of the skin by histiocytes which show Birbeck granules with variable eosinophils
cutaneous T-cell malignant lymphoma
What does mycosis fungoides look like?
scaly, red-brown patches
What is seen histologically in mycosis fungoides?
malignant T-lymphoid cells (Sezary cells): cerebriform
How do you Tx mycosis fungoides?
glucocorticosteroids or UV light, chemo, PUVA-therapy, UV A irradiation
skin d/o characterized by infiltration of mast cells in skin
multiple and widely distributed red-brown non-scaling papules and small plaques
one or several tan-brown nodules which may be pruritic or show blister formation
Darier's sign (mastocytosis)
localized area of dermal edema and erythema (wheal) when lesional skin is rubbed
What is seen histologically in mastocytosis?
subtle increase in mast cells around superificial dermal blood vessels
localized mast cell degranulation causing dermal microvascular hyperpermability --> pruritic edematous plques (wheals)
edema of deeper dermis and subcuanous adipose tissue
What is seen histologically in uticaria?
sparse, superficial, peri-vascular infiltrate of lymphocytes, histiocytes, eosinophils, and neutrophils
What causes uticaria?
antigen-induced release of vasoactive mediators from mast cell granules after sensitization of specific IgE Abs
Hereditary angioneurotic edema
inherited deficiency of C1 activator --> uncontrolled activation of early complement system
Eczematous (atopic) dermatitis
pruritic, erythematous, oozing rash w/ vesicles and edema
Where do you seen eczematous dermatitis?
face and flexor surfaces
What is seen histologically in eczematous dermatitis?
mild or greater peri-vascular infiltrate of lymphocytes, histiocytes, and eosinophils
hypersensitivity reaction w/ targetoid rash and bullae
Targetoid appearance of erythema multiforme?
central epidermal necrosis surrounded by erythema
What causes erythema multiforme?
HSV but also mycoplasma, drugs, autoimmune disease, and malignancy
What is erythema multiforme of the lip/mucosa associated with?
Toxic epidermal necrolysis
severe Stevens-Johnson syndrome w/ diffuse sloughing of skin due to an adverse drug reaction
What is seen histiologically in erythema multiforme?
mild superficial peri-vascular infiltrate of lymphocytes and histiocytes
inflammatory reaction of the subcutaneous adipose tissue
MC panniculitis which is acute
Where does panniculitis typically show?
lower legs with poorly defined tender erythematous nodules
primary vascultiis in deep blood vessel supplying the lobules of the adipose tissue of the subcutis with necrosis and inflammation
lobular, nonvasculitic panniculitis seen in children and adults; erythematous plaques or nodules
What is seen histologically in Weber-Chrisitan disease?
aggregates of foamy histiocytes w/ lymphocytes, neutrophils, and giant epithelioid phistiocytes
self-inflicted trauma or injection of foreign or toxic substances
well-circumscribed salmon-colored plaques with silvery scale
What causes psoriasis vulgaris?
excessive keratinocyte proliferation
What are possible causes of psoriasis vulgaris?
autoimmune (HLA-C) and in areas of trauma
What is psoriasis vulgaris associated with?
arthritis, myopathy, enteropathy, spondylitic heart disease, and AIDS
What does psoriasis vulgaris look like histologically?
acanthosis (epidermal hyperplasia), parakeratosis (hyperkeratosis w/ retention of keratinocyte nuclei in stratum corneum), collections of neutrophils in stratum corneum, Auspitz sign
thinning of epidermis above elongated dermal papillae --> bleeding when scaled picked off
How do you Tx psoriasis vulgaris?
corticosteroids, UV light, or immune-modulating therapy
multiple small pustules form on erythematous plaques
pruritic, planar, polygonal, purple papules
Where do you see lichen planus?
wrists, elbows, and oral mucosa
What does lichen planus look like histologically?
inflammation at dermal-epidermal junction w/ saw-tooth appearance; irregular acanthosis, hypergranulosis, hyperkeratosis in stratum corneum
What is lichen planus associated with?
chronic hepatitis C
Wickham striae (lichen planus)
reticular white lines on oral surface
lichen planus affecting the epithelium of the hair follicles
poorly defined malar erythema on the face or large, sharply demarcated erythematous scaling plaques
Does lupus erythematosus get better or worse when exposed to the sun?
What does lupus erythematosus look like histologically?
vacuolar degernation with mild superficial and deep peri-vascular and peri-appendageal chronical inflammatory infiltrate; epidermic may be thin or atrophic; hyperkeratosis and hair follicles dilated and plugged w/ keratin
chronic inflammation of hair follicles associated w/ the sebaceous glands
What are the different types of acne vulgaris?
comedones (whiteheads and blackheads), pustules (pimples), and nodules
What are causes of acne vulgaris?
hormone-associated increase in sebum production and excess keratin that block follicles (comedones); Propionibacterium acnes infection
What is the noninflammatory type of acne vulgaris?
comedones: open and closed
small follicular papule w/ central black keratin plug due to the oxidation of melanin
small follicular papule w/o visible central plug
What is the inflammatory type of acne vulgaris?
papule, nodules, and pustules
How do you Tx acne vulgaris?
benzoyl peroxide and vitamin A deriatives
autoimmune destruction of desmosome between keratinocytes (separate layers of skin); IgG Ab against desmoglyan
What are the 4 types of pemphigus?
vulgaris, vegetans, foliaceus, and erythematosus
Where do you see pemphigus vulgaris?
scalp, face, axilla, groin, trunk, and points of pressure
What does pemphigus vulgaris look like?
superficial vesicles and bullae which rupture easily
moist verrucous plaques on groin, axilla, and flexor surfaces
benign with bullae w/ zones of erythema and crusting on scalp, face, chest, back
localized foliaceus which involves the malar area of the face
What does pemphigus look like histologically?
acantholysis (separation) of stratum spinosum keratinocytes --> suprabasal blisters; basal layer cells attached to basement membrane via hemidesmosomes; thin-walled ballae rupture easily (Nikolsky sign) --> shallow erosions w/ dried crust; IgG around keratinocytes in fish net appearance
autoimmune destruction of hemidesmosomes between basal cells and underlying basement membrane
What is IgG Ab against in bullous pemphigoid?
basement membrane collagen
What does bullous pemphigoid look like?
blisters of the skin except oral mucosa and these don't rupture easily
autoimmune deposition of IgA at the tips of the dermal papillae
What does dermatitis herpetiformis look like?
pruritic vesicles and bullae
What is associated with dermatitis herpetiformis?
celiac disease which resolves with a gluten-free diet
Where do you see dermatitis herpetiformis?
bilateral and symmetrical of back, elbows, knees, and buttocks
Porphyria and pidermolysis Bullosa Porphyria
disease caused by heme production
What do porphyrias look like?
uticaraia and vesicles which heal with scarring and exacerbated by exposure to sunlight
common blisters at sites of pressure, rubbing or trauma
Jucntion noninflammatory blistering disease
blisters in lamina lucida
Scarring dystrophic noninflammatory blistering disease
beneath lamina dense w/ defective anchoring fibrils to the dermis
Simplex noninflammatory blistering disease
degeneration of basal cell layer of epidermis
warts: caused by human papillomaviruses due to direct contact; flesh colored that have rough surfaces
anywhere but most frequently the hands
flat wart on face or sorsal surfaces of hands
sole of the foot
palms of hands
What do verrucae look like histologically?
koilocytosis which involves superficial keratinocytes and peri-nuclear vacuolization
firm, pink, umbilicated papules due to poxvirus with cytoplasmic inclusions
Who do you see with molluscum contagiosum?
children, sexually active adults, and immunocompromised
superficial bacterial infection due to S. aureus or S. pyogenes
Who does impetigo affect?
What does impetigo look like?
erythematous macules that progress to pustules --> honey crusted lesions
fungi on scalp with hairless patches of skin having erythema, crust, and scale
ringworm of the body
Tinea cruris (jock itch)
Tinea pedis (athlete's foot)
fungal infection of cutaneous nails
upper trunk where macules can be lighter or darker than normal skin with a fine scale
How can you ID tinea?
PAS or methenamine silver
What are included in arthropod bites?
arachnia (spiders, scorpions, ticks, mites); insect (lice, bedbugs, bees, wasps, fleas, flies, mosquitos); chilopods (centipedes)
What can cause athropod lesiosn?
direct irritant (parts or secretions), immediate or delayed hypersensitivity (retained or injected parts), venoms, and vectors
What do arthropod bites look like?
uticaria or inflammed papules or nodules
tick bite by Ixodes dammini with erythema migrans
Brown recluse spider bite
contagious, pruritis dermatosis caused by Sarcoptes scabiei; female mite burrows under stratum corneum and produces cutaneous burrows
Where do you see scabies?
interdigital skin, palms, wrists, peri-areolar skin, and genital skin
head louse, crab louse, body louse; pruritic; see louse or eggs in hair shafts
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