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Goljan HY Skin
| Question | Answer |
|---|---|
| Ichthyosis vulgaris | ↑ thickness of stratum corneum; absent granular layer |
| Solar lentigo | “liver spot” in elderly; increased melanocytes |
| Senile purpura | trauma to fragile vessels on dorsum of hands; normal finding in elderly |
| Acute eczema | weeping rash with vesicles |
| Chronic eczema | dry, thickened, pruritic skin |
| Atopic dermatitis | dry skin, eczema (type I reaction); children - face, intertriginous areas |
| Allergic contact dermatitis | type IV hypersensitivity; poison ivy, nickel rash |
| Contact photodermatitis | tetracycline; rash in sun exposed areas |
| Superficial dermatophytoses | KOH preparation shows fungi located in stratum corneum |
| Tinea capitis | Trichophyton tonsurans MCC (negative Wood’s lamp) |
| Tinea capitis child with dog | Microsporum canis (positive Wood’s lamp) |
| Tinea versicolor | hypopigmentation; Malassezia furfur; “spaghetti” (hyphae)/”meatball” KOH |
| Seborrheic dermatitis | dandruff; Malassezia furfur |
| Molluscum contagiosum | poxvirus; bowl-shaped with central depression filled with keratin |
| Rubeola | Koplik’s spots; Warthin-Finkeldey giant cells |
| Rubella | teratogenic; rash; postauricular adenopathy; arthritis in adults |
| Parvovirus | “slapped face”; RBC aplasia, aplastic anemia (HbSS), spontaneous abortions, arthritis |
| Roseola | HSV-6; high fever and then rash |
| Toxic shock syndrome | toxin-producing S. aureus; tampon wearing; hypotension, desquamating rash |
| Scarlet fever | group A streptococcus with erythrogenic toxin; strawberry tongue |
| Actinic (solar) keratosis | precursor for squamous cell carcinoma; recur when scrapped off |
| Psoriasis | elevated salmon-colored plaques covered by silver-colored scales; nail pitting |
| Pityriasis rosea | herald patch followed by rash in lines of cleavage |
| Varicella | chickenpox; rash at different stages; Reye syndrome association |
| Herpes zoster | vesicular rash following a sensory dermatome |
| HSV and Varicella-zoster virus | remain latent in sensory ganglia |
| Impetigo | group A streptococcus; honey crusted lesions on face |
| Pemphigus vulgaris | autoimmune disease; IgG antibodies against intercellular attachment sites |
| Pemphigus vulgaris | intraepidermal bullae; acantholytic cells; row of tombstones |
| Bullous pemphigoid | autoimmune disease; IgG antibodies against basement membrane |
| Bullous pemphigoid | subepidermal bullae |
| Pemphigus vulgaris/bullous pemphigoid | type II hypersensitivity |
| Dermatitis herpetiformis | autoimmune disease; IgA ICs; subepidermal bullae with neutrophils |
| Dermatitis herpetiformis | association with celiac disease |
| Erythema multiforme | vesicles and bullae; bullseye appearance |
| Risk factors | drugs, M. pneumoniae infection |
| Stevens Johnson syndrome | erythema multiforme involving mouth |
| Acne vulgaris | androgen dependent (receptor on sebaceous glands) |
| Acne vulgaris | Propionibacterium acnes lipases produce fatty acids causing inflammation |
| Acne rosacea | pustular, erythematous lesion on face resembling malar rash |
| Urticaria | type I and III reactions; type I due to mast cell release of histamine (drugs, fire ant bites) |
| Angioedema | subcutaneous swelling |
| Causes | ACE inhibitor (bradykinin); C1 esterase inhibitor deficiency (C2 and C4 decreased) |
| Sporotrichosis | traumatic implantation of Sporothrix fungus into subcutaneous tissue |
| Causes | rose gardener, lobster fisherman (sphagnum moss) |
| S/S | chain of subcutaneous nodules |
| Tuberculoid leprosy | intact cellular immunity (positive lepromin skin test); granulomas; no organisms |
| S/S | autoamputation of digits; skin depigmentation and anesthesia |
| Lepromatous leprosy | defective cellular immunity (negative lepromin skin test); no granulomas |
| S/S | leonine face, erythema nodosum during treatment |
| Histology | Grenz zone (zone free organisms) foamy macrophages with organisms |
| Rx | dapsone |
| Erythema nodosum | painful nodule on shins; subcutaneous fat inflammation |
| Associations | coccidioidomycosis, TB, leprosy |
| Keratoacanthoma | benign neoplasm; mimics squamous cancer; spontaneously resolves |
| UVB light cancers | basal cell carcinoma, squamous cell carcinoma, malignant melanoma |
| Vitiligo | autoimmune destruction melanocytes producing skin depigmentation |
| Seborrheic keratosis | pigmented, wart-like lesion; “stuck on” appearance |
| Leser-Trelat sign | multiple outcroppings seborrheic keratosis; consider stomach cancer |
| Acanthosis nigricans | verrucoid pigmented lesion usually in axilla; associated with gastric cancer |
| Chloasma | pregnancy mask due to increased melanocytes |
| Nevocellular nevus | benign pigmented tumor modified melanocytes |
| Histology | nevus cells proliferate along basal cell area, dermis, or both |
| Dysplastic nevus | precursor for malignant melanoma |
| Malignant melanoma | malignant tumor of melanocytes; most rapidly increasing cancer worldwide |
| ABCD for melanoma | A, asymmetry; B, irregular border; C, color change; D, increased diameter |
| Risk factors | severe sunburn at early age (MC), dysplastic nevi |
| Radial growth phase | spreads laterally in epidermis/superficial dermis but does not result in metastasis |
| Vertical growth | malignant cells penetrate into dermis; potential for metastasis |
| Lentigo malignant melanoma | face of elderly |
| Superficial spreading melanoma | lower extremities, back |
| Nodular melanoma | aggressive tumor with no radial growth phase |
| Acral lentiginous melanoma | palms, soles, under nails; may occur in blacks |
| Prognosis | depends most on depth of invasion |
| Prevention | sunscreen >15 |
| Porphyria cutanea tarda | photosensitive bullous disease; deficiency uroporphyrinogen decarboxylase |
| S/S | hypertrichosis, fragile skin, port wine colored urine (uroporphyrins) |
| Black widow (Latrodectus) envenomation | neurotoxin; abdominal muscle cramps |
| Brown recluse (Loxosceles) envenomation | necrotoxin; skin ulcer |
Created by:
megankirch
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