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365 Cards in this Set

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4 layers of epidermis from in to out
1) Basal cell layer (basal cells)
2) Stratum spinosum (keratinocytes)
3) Stratum granulosum
4) Stratum corneum (sheds)
Dermis
Support structure
is a matrix of (3x)?
1) Lamina lucida
2) Basal lamina
3) Anchoring fibrils - anchors epidermis to dermis
which sweat glands go to the surface - NOT attached to hair follicles
regulate temperature
eccrine
which dermis glands:

Special - groin / axilla
not important physiological
this sweat mixes w/bacteria = odors
Apocrine sweat glands
which dermis glands:
Make sebum
Face / back / neck
empties into hair follicle
skin moisturizer
Sebaceous glands
name for:

Circumscribed color change of skin
Flat

< 10mm
name for:

Circumscribed color change of skin
Flat

< 10mm
Macule
name for:

Circumscribed RAISED bump
- solid (not liquid)
name for:

Circumscribed RAISED bump
- solid (not liquid)
Papule
name for:

Raised> 10mm
name for:

Raised> 10mm
Plaque
name for:

 flat
> 10 mm
depigmented patches
name for:

flat
> 10 mm
depigmented patches
patch
name for:

circumscribed
raised
Filled w/FLUID

- white / thick / purulent
- bacteria
- neutrophils
name for:

circumscribed
raised
Filled w/FLUID

- white / thick / purulent
- bacteria
- neutrophils
Pustule
name for:

Circumscribed
Raised
< 10mm
Fluid filled
- CLEAR (sirous)/ foggy - NOT purulent
name for:

Circumscribed
Raised
< 10mm
Fluid filled
- CLEAR (sirous)/ foggy - NOT purulent
Vesicle
name for:

 circumscribed
Raised
> 10mm
Clear fluid filled
name for:

circumscribed
Raised
> 10mm
Clear fluid filled
Bulla
name for:

Red (errythematous)
Edemadous
Papule/plaque
Slightly raised
name for:

Red (errythematous)
Edemadous
Papule/plaque
Slightly raised
Wheal
name for:

Circumscribed
Feels in dermis
Can be hard or soft
< 10mm
name for:

Circumscribed
Feels in dermis
Can be hard or soft
< 10mm
Nodule
a bulla is a larger (> 10mm) version of __________
a bulla is a larger (> 10mm) version of a vesicle
name for:

Nodule > 10mm
name for:

Nodule > 10mm
Tumor
name for:


superimposed on surface or primary lesion
Can be thick or thin
Abnormally retained stratum corneum

Here - primary is red, but then white scaling over it
name for:


superimposed on surface or primary lesion
Can be thick or thin
Abnormally retained stratum corneum

Here - primary is red, but then white scaling over it
Scale
name for:

AKA - scab

Dried serous debris (neutrophils / bacteria)
dark / raised
name for:

AKA - scab

Dried serous debris (neutrophils / bacteria)
dark / raised
Crust
name for:

Circumscribed loss of epidermis
shallow
name for:

Circumscribed loss of epidermis
shallow
Erosion
name for:

Circumscribed loss of epidermis and dermis
name for:

Circumscribed loss of epidermis and dermis
Ulceration
name for:

Circumscribed loss of epidermis and dermis
linear
name for:

Circumscribed loss of epidermis and dermis
linear
Fissure
name for:

Thinning of the skin (epidermis or dermis)

any circumbscribed loss of epidermis or dermis - a scar is a type
name for:

Thinning of the skin (epidermis or dermis)

any circumbscribed loss of epidermis or dermis - a scar is a type
Atrophy
name for:
name for:
scar
name for:

circumscribed loss of epidermis
self induced - scratched
name for:

circumscribed loss of epidermis
self induced - scratched
Excoriation
name for:

Dark dots - open comedo
Primary lesion here is acne vulgaris

Trapped cebum
name for:

Dark dots - open comedo
Primary lesion here is acne vulgaris

Trapped cebum
Comedo


white - closed
black - open
Comedo


white - closed
black - open
name for:

Tiny white dots
Cystic structure / tumor
name for:

Tiny white dots
Cystic structure / tumor
Milium
name for:

Like a nodule
Firm or soft (fluctuent)
name for:

Like a nodule
Firm or soft (fluctuent)
Cyst
name for:

Thick texture
from rubbing skin

hallmark lesion of ectopic dermatitis
(*exam question)
name for:

Thick texture
from rubbing skin

hallmark lesion of ectopic dermatitis
(*exam question)
Lichenification
physical exam finding that is the hallmark lesion of ectopic dermatitis
lichenification




Thick texture
from rubbing skin
lichenification




Thick texture
from rubbing skin
name for:

Feels rock hard - not soft
name for:

Feels rock hard - not soft
Induration
name for:

Scale lines

from scabies - from human mite 

Burrows into top layer of epidermis (stratum corneum)
name for:

Scale lines

from scabies - from human mite

Burrows into top layer of epidermis (stratum corneum)
Burrow
name for:

Circumscribed macules
blanch when pressed


Blood vessels - just more pronounced
name for:

Circumscribed macules
blanch when pressed


Blood vessels - just more pronounced
Telangiectasia
Telangiectasia
name for:

Extravagated blood
- blood left blood vessels

3 names depending on size:
< 10mm
> 10mm
Large purpura
name for:

Extravagated blood
- blood left blood vessels

3 names depending on size:
< 10mm
> 10mm
Large purpura
petchiae (< 10mm)
purpura (> 10mm)
ecchymosis (Large purpura)
5 ways/MOA that the skin acts as a protective barrier
what is impetigo?
- layer?
- 3 types?
infection in the epidermis only
infection in the epidermis only
what is this:

(general - name of general type)

1) Superficial infection
2) Extends to dermal lymphatics
3) Erysipelas = cellulitis (by some people)
a) This has sharper defined edges
Erysipelas
what is:
infection in dermis and subcutaneous fat layer
2) Red / swelling / heat / tenderness
3) Rapidly spreading
4) Inflammation of the lymph nodes
Cellulitis
Purulent
hair follicle infection
Folliculitis
what are
Furuncles (boils)
Localized purulent inflammatory lesions
name for

Several furuncles
connected subcutaneously by sinus tracts
Carbuncles
bacteria:

hot tub
burn wounds
ecthyma
gangranosum
pseudomonas aeruginosa
gram negative rod
obligate aerobe

burn wounds
pseudomonas aeruginosa
gram negative rod
cellulitis - scratches from dogs/cats
pasteurella multicoda
mold that causes ringworm - dermatophytes
tinea
what are exanthems?

who gets them?
widespread rash usually in children
widespread rash usually in children
what viruses can cause exanthems in children
ALL VIRUSES - except Scarlet fever
virus that causes
infectious mononucleosis
epstein-barr virus
virus that causes
rocky mountain spotted fever
rickettsia rickettsii
virus that causes
streo toxic shock syndrome
strep pyogenes
virus that causes
staph toxic shock syndrome
staph aureus
type of plaque

Brown to red
patches
in the groin
from - Corynebacterium minutissimum (normal skin flora)

Predisposing factors
	- ↑ sweating
	- Obesity
	- DM
type of plaque

Brown to red
patches
in the groin
from - Corynebacterium minutissimum (normal skin flora)

Predisposing factors
- ↑ sweating
- Obesity
- DM
Erythrasma
what are
Annular plaques
distinguishing characteristic
clearing int he center
bacteria of lyme
borrelia burgdorferi
Verrucous papules
means that the papules feel?
rough

warts
Erythema nodosum
- what/cause/pathophys
- who
Hypersensitivity reaction
		b. Inflammatory response of dermis - fat
		c. Not painful
			i. Hot / red then bluish/yellow
		d. Discrete nodules
		e. 1-2 wks - then desquamate
		f. Usually
			i. Lower legs
			ii. Can be on arms / face
		g. ...
Hypersensitivity reaction
b. Inflammatory response of dermis - fat
c. Not painful
i. Hot / red then bluish/yellow
d. Discrete nodules
e. 1-2 wks - then desquamate
f. Usually
i. Lower legs
ii. Can be on arms / face
g. Young 18-34
h. F > M
how diff
Staphylococcus vs streptococcus
catalase
staph is catalase+
how diff staph aureus from other staph?
coagulase
staph aureus is the only coagulase+ staph
i. Normal skin flora
1) Opportunistic
Staphylococcus epidermidis
name the bacteria

i. Group A (GAS)
ii. Beta hemolytic
iii. Bacitracin sensitive
iv. Primary infection
1) Strep throat
streptococcus pyogens
Toxic shock syndrome
toxin?
TSST-1
what are ETA and ETB

disease?
exfoliative toxin A & B

Scalded skin syndrome (SSS) - staph aureus
what causes Scalded skin syndrome (SSS)
staph aureus
MOA of ETA & ETB?
a) Are serine proteases
					b) Break part of desmosomes
						i) Which are cell adhesion structures

THIS is why vesicles form - cells not holding down to other layers correctly
a) Are serine proteases
b) Break part of desmosomes
i) Which are cell adhesion structures

THIS is why vesicles form - cells not holding down to other layers correctly
Dx?

			ii. Small vessicles → crust
			iii. Face / extremities
			iv. Painless - may itch

Regional lymphadenopathy - common
Dx?

ii. Small vessicles → crust
iii. Face / extremities
iv. Painless - may itch

Regional lymphadenopathy - common
Nonbullous impetigo
Dx?


				1) Fluid filled vesicles
					a) HAS ORGANISM = infectious
				2) From
					a) Staph aureus - expressing exfoliative toxin A & B
				3) Face / extremities
				4) Sx
					a) Painless
					b) Fever
					c) Diarrhea
					d) Weak...
Dx?


1) Fluid filled vesicles
a) HAS ORGANISM = infectious
2) From
a) Staph aureus - expressing exfoliative toxin A & B
3) Face / extremities
4) Sx
a) Painless
b) Fever
c) Diarrhea
d) Weakness
e) Lymphadenopathy - UNCOMMON
Bullous impetigo
Dx?

			ii. More severe form of impetigo
			iii. Starts as pustule over inflamed skin
				1) → ulcer w/crust
			iv. From
				1) Strep pyogenes
				2) Staph aureus
			v. 
				1) MRSA
				2) Didn’t respond to cephalexin - switched to c...
Dx?

ii. More severe form of impetigo
iii. Starts as pustule over inflamed skin
1) → ulcer w/crust
iv. From
1) Strep pyogenes
2) Staph aureus
v.
1) MRSA
2) Didn’t respond to cephalexin - switched to clindamycin - fine
Ecthyma
1 word to describe infection around hair follicles
folliculitis
- enlarged infected follicle
- also called a boil
furnuncle
what general type of skin lesion

1) Pus - ↑ PMNs
2) Fibrin deposition → sequestration of bacteria
3) Coagulase helps keep the bacteria around too
abscess
Dx?

				2) Infection of subcutaneous tissue
				3) Sx
					a) Redness
					b) Swelling
					c) Heat
					d) Tenderness
				4) Rapid spread via lymphatics - RED STREAKING
				5) Can dev → severe septicemia in 1-2d
				6) Legs - most co...
Dx?

2) Infection of subcutaneous tissue
3) Sx
a) Redness
b) Swelling
c) Heat
d) Tenderness
4) Rapid spread via lymphatics - RED STREAKING
5) Can dev → severe septicemia in 1-2d
6) Legs - most common
7) Burn pts / wounds / skin abrasions
8) 90% from
a) Staph aureus
b) Strep pyogenes
9) Pasteurella multicoda
a) Can cause after bite /scratch from cat/dog
Cellulitis
Dx?

sandpaper rash
			i. From exotoxin (Spe A & C)
				1) Erythrogenic
				2) Or pyogenic
			ii. Sx
				1) Rash preceded by
					a) Pharyngitis
					b) Fever
					c) Headache
				2) Rash in 10% pts w/strep throat
				3) Neck → trunk...
Dx?

sandpaper rash
i. From exotoxin (Spe A & C)
1) Erythrogenic
2) Or pyogenic
ii. Sx
1) Rash preceded by
a) Pharyngitis
b) Fever
c) Headache
2) Rash in 10% pts w/strep throat
3) Neck → trunk → extremities
4) 3-4 days → desquamation
Scarlet fever
Scarlet fever
Dx?

i. From
1) Strep or
2) Staph
ii. Sx
1) Hypotension
2) Tachycardia
3) Multiorgan dysfunction

1) Temp > 38.9 C
2) Hypotension (systolic < 90mmHg)
3) Sunburn like rash
4) Rash w/ desquamation (esp palms / soles)
Toxic shock syndrome
Dx?

Rickettsia rickettsii = obligate intracellular pathogen

			ii. Rash
				1) 5-10 days post
				2) Starts wrists / ankles
Dx?

Rickettsia rickettsii = obligate intracellular pathogen

ii. Rash
1) 5-10 days post
2) Starts wrists / ankles
Rocky mountain spotted fever
Rocky mountain spotted fever
Rocky mountain spotted fever
bacterial cause?
Rocky mountain spotted fever
bacterial cause?
Rickettsia rickettsii
Rickettsia rickettsii
Dx?

			i. From
				1) Pseudomonas aeruginosa septicemia
			ii. Septicemia
				1) 1-13% cases
				2) Immunocompromised - oportunistic
			iii. Bacteria infects blood vessels in dermis / subcutaneous layers
				1) Necrotizing vasculitis
			...
Dx?

i. From
1) Pseudomonas aeruginosa septicemia
ii. Septicemia
1) 1-13% cases
2) Immunocompromised - oportunistic
iii. Bacteria infects blood vessels in dermis / subcutaneous layers
1) Necrotizing vasculitis
2) → ↓ blood supply to skin
3) → necrotic lesions in skin
iv. Red macule / papule
1) → becomes hemorrhagic w/ necrosis at the center
2) Eschar - ulcers that develop hemorrhagic crust
a) Black necrotic center in the middle
Ecthyma gangrenosum
Ecthyma gangrenosum
a. Erythema infectiosum
i. AKA Fifth disease
ii. From ?
1) Human parvirus B19
2) Droplets - winter and spring
Dx?
4) "gloves and shock" syndrome
a) Young adults
b) Swelling
c) Pain
d) Purpuric papules - hands / feet
i. AKA Fifth disease
ii. From
1) Human parvirus B19
2) Droplets - winter and spring
Erythema infectiosum
Dx?

1) Coxsackie A16, A5, A10, B1, B3
a) REMEMBER COXSACKIE A16
2) RNA virus, pcomavirus famile
3) Enteroviruses
ii. Summer - early fall
iii. Sx
1) Sore mouth
2) Fever
3) Malaise
4) Diarrhea
5) Joint pain
6) Lymphadenopathy
7) Skin
a) Red football shaped or oval papules on acral sites
b) +- exanthem / red papules - on proximal extremities
8) Mucosa
a) Papules and vesicales → erosions
iv. Dx
1) Lesions on hands / feet / mouth
2) Serum for coxsackie virus
a) Don’t really do this
3) Viral cultures from throat or stool
v. Tx
1) Supportive
2) Self-limited - lasts 1 week
Hand foot & mouth syndrome
*** main cause of Hand foot & mouth syndrome
COXSACKIE A16
Dx?

i. AKA Exanthem subitum
ii. AKA Sixth disease
iii. From
1) Human herpesvirus 6 (HHV 6)
2) Respiratory spread *
Roseola infantum
i. A herpes virus
Incubation
3-7 wks
iii. Infectious mononucleosis
1) EBV is primary cause of mono
Epstein-Barr virus
HSV1 (oral/genital?)
1 = oral
HSV2 (oral/genital?)
2 = genital
Dx?

1) Hypersensitivity reaction
a) → causes targetoid red plaques
i) On palms / soles / maybe mucosal surfaces
Erythema multiforme from herpes simplex
Dx - cause?

v. Dewdrop on a rose petal
1) Vesicle on a erythematous base
2) Clear / translucent
3) Pink hue at base
4) Several at various stages
a) Helps DDx from other diseases - such as small pox (large and monomorphous)
i. Varicella=zoster virus (VZV)
what trimester is Congenital varicella syndrome
1st trimester
what is
Ramsay Hunt syndrome?
herpes zoster infection
i) Facial / auditory nerves (geniculate ganglion)
ii) External ear / tympanic involvement
iii) Facial paralysis
iv) Auditory probs - tinnitus / deafness / vertigo / nausea / vomiting / nystagmus
d) Delayed contralateral hemiparesis
i) Simulates stroke
Dx?

1) From East Africa
ii. US in 1999
iii. Primary complications - neurologic
1) Seizures
2) Ascending flaccid paralysis
3) Ataxia
4) Meningitis
5) Encphalitis
6) Myelitis
7) Cranial neuropathies
8) ↓ LOC (level of consciousness)
iv. Cutaneous signs
1) Nonspecific
2) Non-pruritic
3) Erythematous macules / patches (5mm-1cm)
v. Dx
1) Serum or CSF for IgM for WNV (ELISA)
West Nile virus
what specifically causes:

1) Neonates / young children
2) Adults - in renal and immunocompromised pts
3) Staph infection in
a) Pharynx
b) Nose
c) Ear
d) Conjunctiva
4) Erythema skin folds
a) Palms / soles
b) Mucous membranes - SPARED
SSSS - exfoliative exotoxins types A & B
which bacteria causes TSS
staph aureus
strep A or B
what are
Janeway spots
a) NOT painful
b) Septic emboli
c) Non-tender hemorrhagic lesions on palms
Most frequently reported and most severe rickettsial disease
Rocky mountain spotted fever
Dx?


i. From
1) Neisseria meningitidis
a) Gram (-)
b) Diplococcus
ii. Human nasopharynx - reservoir - 10% carrier rate
iii. Can cause life threatening acute meningitis w/septicemia
iv. Cutaneous
1) Petechial eruption → ecchymosis / hemorrhagic bullae / ischemic necrosis
2) Angular infarcted lesions - "gun-metal" gray interior
3) Purpura fulminans - diffuse
4) Exanthum like pustules less common
v. Looks like rocky mountain spotted fever
vi. Dx
1) Gram stain of skin lesion
2) Blood or CSF culture
vii. Tx
1) Cefotaxime
2) PCN G
3) Cefotaxime
4) Chloramphenicol
5) Trimethroprim-sulfamthoxazole (TMP-SMX)
viii. Vaccine
1) Who gets
a) Children 11-12 yo
b) High school
c) College freshmen
d) Military recruits
e) Terminal compliment deficiencies
f) Splenectomy pts
g) Travelers to endemic regions - Africa, India, middle east , nepal
Meningoccemia
Tinea capitis are what type of infection? where
fungal infections on the scalp
Onychomycosis are what type of infection? where?
fungal infections in the nails
how Dx fungal infections
i. KOH prepe
1) Scrape - add KOH - put on slide
2) Will see hyphae
ii. Wood's lamp
1) 365nm UV light
2) Some fungi will have yellow-green fluorescence
Woods lamp - UV
365nm
to Dx fungal infections
what color is positive? negative
yellow - positive

negative - doesnt fluoresce
Treponemal - a spirochete bacterium that is parasitic or pathogenic in humans and warm-blooded animals, including the causal agents of ?
Syphilis
1st line Tx for Syphilis
Benzathine penicillin
Dx?

					b) Hutchinson's triad
						i) Hutchinson's teeth
						ii) Interstitial keratitis
						iii) 8th nerve deafness
						iv) 
							A. Conical shaped teeth
Dx?

b) Hutchinson's triad
i) Hutchinson's teeth
ii) Interstitial keratitis
iii) 8th nerve deafness
iv)
A. Conical shaped teeth
Prenatal (congenital syphilis)
Dx?


a) Gram (-)
b) Diplococcus
c) Intracellular
Incubation
2-10 days
iii. Males
1) Urethritis
2) 15% asymptomatic
3) Complications
a) Epididimytis
b) Seminal vesiculitis
c) Prostatitis
iv. Females
1) Acute cervicitis
2) Salpingitis
3) Pelvic inflammatory disease
4) 50% asymptomatic
v. Sx - other
1) Proctitis
2) Pharyngeal
3) Conjunctival
4) Disseminated
vi. Tx
1) Ceftriaxone
a) + azithromycin or doxycycline
Gonorrhea
what bacteria causes Gonorrhea?
Neisseria gonorrhoeae


a) Gram (-)
b) Diplococcus
c) Intracellular
Dx?

i. From
1) Haemophilus ducreyi
a) Gram (-)
b) Bacillus
c) "school of fish"
Incubation
3-5 days
ii. Painful ulcer
1) Bubo
2) From lots of inflammation
iii. Tx
1) Azithromycin
2) Ceftriaxacin
3) Ciprofloxacin
4) Erythromycin base
Chancroid


(bacteria) (STD)
what bacteria
a) Gram (-)
b) Rod
c) "Donovan bodies"
Calymmatobacterium granulomatis



(STD)
Tx for Calymmatobacterium granulomatis

(STD)
Doxycycline
Pediculosis pubis - Phthirus pubis

is commonly known as _________, because ___________.
crabs - Claws specifically for hanging onto pubic hair
Dx?

i. Poxvirus
Incubation
2-7 wks
iii. Small shiny umbilicated papules
1) Little volcanoes
2) In skin folds
3) Little kids get all the time
iv. Tx
1) Destruction
a) Liquid nitrogen
b) Topical blistering agent
2) Imiquimod - off label use
3) Retinoids
4) Tape - very superficial
Molluscum contagiosum
Condyloma acuminata

is caused by what virus
Human papilloma virus
in HIV, 87% of pts have cutaneous signs if CD4 < ?
100
Exanthem = ?
Exanthem = widespread rash
5th disease or erythema infectiosum is what virus
parovirus B19
6th disease or exanthema subitum is what virus?
Human herpesvirus 6(7)
Molluscum contagiosum virus (DNA pox virus) - makes what kind of lesion
Smooth plaques
Warts (common / flat / plantar)

Genital warts (condyloma acuminatum)

caused by what virus?
what type of lesion?
Human papillomavirus (HPV)
Verrucouc papules
Herpetic whitlow
- infection of what and where
- who get it
herpes simplex infection of finger
- enter through break in skin
- nurses / docs/ dentists/ child who sucks thumb
Herpetic gladiatorum
- what
- who
herpes simplex on skin
- wrestlers
what is
Eczema herpeticum
what is
Eczema herpeticum
Children w/eczema -
Makes it easier for HSV to spread to skin
Dx?

			ii. Dome shaped papules
			iii. Central depression (umbilicated)
Dx?

ii. Dome shaped papules
iii. Central depression (umbilicated)
Molluscum contagiosum



a. DNA pox virus
b. Transmission
i. Skin-skin contact
ii. Exposure to infected fomites
c. Children < 5 y/o
d. Adults - STD
what 2 types of HPV cause:

Anogenital warts (condyloma acuminatum)
Pink/brown nodules
Cauliflower like lesions
HPV
6
11
what is the mechanism that causes viral exanthems in children?
rash is from immune response to virus
Dx?

Sx
- Respiratory tract
- Rash
- Koplik's spots
Dx?

Sx
- Respiratory tract
- Rash
- Koplik's spots
Measles
Rubella is called by what virus
togavirus
Congenital rubella syndrome (CRS) manigests when
1st trimester
primary Varicella-Zoster is called?
chicken pox
Dx?

Incubation
14-21 days
			iii. Sx
				1) Fever
				2) Headache
				3) Rash
					a) Pustules / vesicles / crusts
					b) Trunk / face/ limbs / buccal / pharyngeal mucosa
					c) Crops of pocks over 2-4 days
				4) Contagious during t...
Dx?

Incubation
14-21 days
iii. Sx
1) Fever
2) Headache
3) Rash
a) Pustules / vesicles / crusts
b) Trunk / face/ limbs / buccal / pharyngeal mucosa
c) Crops of pocks over 2-4 days
4) Contagious during the incubation period - before Sx
a) Until pox crust over
chicken pox - varicella-zoster
60x ↑ of infection of _____________ post chicken pox
- THIS IS WHY YOU SHOULD GET THE VACCINE
- causes Necrotizing fasciitis
Invasive group B strep (GAS)
zoster lays latent in what before it reactivates in shingles?
results in what Sx?
zoster lays latent in what before it reactivates in shingles?
results in what Sx?
neurons

Postherpetic neuralgia (persistent pain)
__________________ = exanthema subitum = 6th disease = roseola
Ubiquitous
i. 100% seropositivity by age 2
b. Replicates in salivary glands
i. Spread via oral secretions

Latent infection in T cells and monocytes
Human herpesvirus type 6 (HHV-6)
Erythema infectiosum = 5th disease
- what virus
- what does it like to infect?
parovirus B19

erythroid progenitor cells (precursors to RBCs)

daycare common
most common viral cause of Hand foot and mouth disease
most common viral cause of Hand foot and mouth disease
coxsackie A16
common name for dermatophytes?
3 genera - DDx by micro
ringworm

1) Microsorum
2) Trichophyton
3) Epidermophyton floccosum
Anthropophilic

is a fungal infection which came from?
people
Zoophilic

is a fungal infection which came from?
animals
Geophilic

is a fungal infection which came from?
Soil
Tinea = ?
ringworm
Onychomycosis - fungal infection of ?
Onychomycosis - fungal infection of the nails
Trichophyton rubrum
is the main fungus that causes?
tinea pedis
athletes foot
Most common cause of athletes foot / nail infection (onychomycosis)?
Trichophyton rubrum
the bacterial infection is called?

bacterial infection that came in from cracks formed between toes of tinea pedis infectio
the bacterial infection is called?

bacterial infection that came in from cracks formed between toes of tinea pedis infectio
Cellulitis
most common cause of tinea in the US?
what does it cause?
Tinea tonsurans


iii. Endothrix
1) Arthroconidia - IN hair shaft
2) Hair cuticle remains intact
3) Does NOT fluoresce
2x methods to Dx fungal infections
- KOH skin scrapping
- culture w/ Woods lamp (UV)
Terbinafine is used to Tx fungal infections. It is an allylamine - what is its MOA?
inhibits ergosterol synthesis - part of the cell membrane
azoles MOA?
inhibits ergosterol synthesis - part of the cell membrane
inhibits ergosterol synthesis - part of the cell membrane
Griseofulvin MOA?
Disruption of microtubules / inhibition of mitosis
Disruption of microtubules / inhibition of mitosis
Ciclopirox
MOA unknown
what is it used to Tx?
2) Used for dermatophytes / candidiasis / malassezia furfur
3) Cream / lotion / shampoo / nail lacquer
most common Candidiasis?
Candida albicans
this is what most likely caused by what
this is what most likely caused by what
oral thrush

candida albicans
Dx / cause?


				1) Budding yeast cells / pseudohyphae
				2) Yeast cells alone are not significant
Dx / cause?


1) Budding yeast cells / pseudohyphae
2) Yeast cells alone are not significant
Cutaneous candidiasis

probably albicans
most common superficial mycoses



Oily areas - *this is what grows if you put lotion on your feet maybe
Malassezia furfur
Dx?

				1) Light (hypopigmented) / coppery brown lesions
				2) On
					a) Trunk
					b) Shoulders
					c) Arms
					d) Rarely neck / face
				3) Sx
					a) Mild itching
					b) Summer - lesions don’t tan
				4) Dx
					a) Clinical ...
Dx?

1) Light (hypopigmented) / coppery brown lesions
2) On
a) Trunk
b) Shoulders
c) Arms
d) Rarely neck / face
3) Sx
a) Mild itching
b) Summer - lesions don’t tan
4) Dx
a) Clinical appearance
i)
b) Fluoresce under Woods light
c) Skin scrappings reveal yeast & pseudohyphae (spaghetti & meatballs)
Tinea versicolor
Dx?
- Pityriasis folliculitis - Papules / pustules - at hair follicules

- Seborrhoeic dermatitis & danruff = Flaky white-yellowish scales
Malassezia furfur
Hortiaea werneckii
is a
Dematiaceous fungus - soil / compost / wood
that causes?
Hortiaea werneckii
is a
Dematiaceous fungus - soil / compost / wood
that causes?
Tinea nigra
what are these:

i. Sporotrichosis
ii. Phaeohyphomycosis
iii. Chromoblastomycosis
iv. Mycetoma
Subcutaneous mycoses
most common Subcutaneous mycoses in US
Sporotrichosis
Tx of choice for Sporotrichosis - a subcutaneous mycoses
Itraconazole
seen in what fungal infection?

Sclerotic bodies
				1) In lesions
				2) Thick-walled cells w/horizontal or vertical septa
seen in what fungal infection?

Sclerotic bodies
1) In lesions
2) Thick-walled cells w/horizontal or vertical septa
Chromoblastomycosis



in soil from plant debris
Chromoblastomycosis



in soil from plant debris
Dx?

From bacteria OR fungus
Fungal cause - Eumycetoma (called)
Bacterial cause - Actinomycetoma (called)

			ii. Traumatic inoculation - soil
			iii. Chronic suppurative infection
			iv. Abscess formation (NOT DRY - like cauliflower which...
Dx?

From bacteria OR fungus
Fungal cause - Eumycetoma (called)
Bacterial cause - Actinomycetoma (called)

ii. Traumatic inoculation - soil
iii. Chronic suppurative infection
iv. Abscess formation (NOT DRY - like cauliflower which is dry)
Mycetoma
5x blistering diseases of the skin
a. Pemphigus
b. Bullous pemphigoid
c. Dermatitis herpetiformis
d. Epidermolysis bullosa
e. Porphyria
Outer most layer of epidermis - no nuclei
Stratum corneum
Stratum corneum
layer of epidermis Has desmosomes - connects kerotinocytes to each other
Stratum spinosum
Stratum spinosum
which layer of the epidermis does not have nuclei?
stratum corneum
stratum corneum
Dx?

Autoantibodes → attachments break → fluid accumulation → bullae forms
Pemphigus
most common type of Pemphigus
Pemphigus vulgaris



a) Superficial vesicles
b) Rupture - leaving shallow erosions covered w/ dried serum and crust
c) Acantholysis
i) ↓ intercellular adhesions - connect squamous cells
Dx?


					a) Superficial vesicles
					b) Rupture - leaving shallow erosions covered w/ dried serum and crust
					c) Acantholysis
						i) ↓ intercellular adhesions - connect squamous cells
Dx?


a) Superficial vesicles
b) Rupture - leaving shallow erosions covered w/ dried serum and crust
c) Acantholysis
i) ↓ intercellular adhesions - connect squamous cells
Pemphigus vulgaris
1) Localized
2) Less severe form of Pemphigus foliaceus
3) Like butterfly rash of lupus - malar area
Pemphigus erythematosus
Dx?

old people
			v. Linear deposition of IgG & complement in basement membrane
				1) In basal cell-basement membrane attachment plaques
				2) BPAG2 (bullous pemphigoid antigen 2)
Dx?

old people
v. Linear deposition of IgG & complement in basement membrane
1) In basal cell-basement membrane attachment plaques
2) BPAG2 (bullous pemphigoid antigen 2)
Bullous pemphigoid
Bullous pemphigoid
Dx?

			i. 20-30s
			ii. M > F
			iii. Urticaria & vesicles
			iv. Associated w/celiac disease
			v. On
				1) Elbows
				2) Knees
				3) Back
			vi. Subepidermal blisters
				1) w/granular deposition of IgA
				2) Tips of dermal papil...
Dx?

i. 20-30s
ii. M > F
iii. Urticaria & vesicles
iv. Associated w/celiac disease
v. On
1) Elbows
2) Knees
3) Back
vi. Subepidermal blisters
1) w/granular deposition of IgA
2) Tips of dermal papillae
a) Small microabscesses instead of large/broad
b) Looks like herpes (but no relationship)
3) Some dermatoepidermal separation
Dermatitis herpetiformis
- associated w/Celiac
- subepidermal blisters - IgA deposition
- looks like herpes but no association
Dermatitis herpetiformis
Vampires - people think this is what vampires had - went out into sun and scarred up
Porphyria
what is 
Porphyria
3x
what is
Porphyria
3x
- scars from sun
- Urticaria (itchiness / dryness)
- subepidermal vesicle - w/thickening of the walls of the superficial dermal vessels
Dx?

Early - Papulovesicular oozing crusted lesion
Later - Raised scaling plaques

			ii. Histopathology
				1) Spongiosis (squamous cells separate from each other looking like a sponge)
				2) Lymphocytic infiltrate
				3) Mast cell degra...
Dx?

Early - Papulovesicular oozing crusted lesion
Later - Raised scaling plaques

ii. Histopathology
1) Spongiosis (squamous cells separate from each other looking like a sponge)
2) Lymphocytic infiltrate
3) Mast cell degranulation
Sharply demarkated
Acute eczematous dermatitis
what is/causes:

2) TEN (toxic epidermal necrolysis)
a) Very severe form of Stevens-Johnson syndrome

Medical emergency - one of the only derm emergencies
erythema multimorme

From
1) Hypersensitivity to infection / drugs
2) Malignancies - carcinomas

Collagen vascular diseases - lupus
Dx?

			iv. Acanthosis - epidermal thickening
			v. Auspitz sign
				1) Parts of the epidermis thin - blood vessels prone to bleeding
			vi. Munro's abscesses
			vii. Usually painless - more of a cosmetic issue
Dx?

iv. Acanthosis - epidermal thickening
v. Auspitz sign
1) Parts of the epidermis thin - blood vessels prone to bleeding
vi. Munro's abscesses
vii. Usually painless - more of a cosmetic issue
Psoriasis
Psoriasis
Dx?
Dx?
Psoriasis
Dx?

			i. What (4 P's)
				1) Pruritic
				2) Purple
				3) Polygonal
				4) Planar papules and plaques
			ii. Wrists - symmetric
			iii. Lymphocytes at dermalepidermal junction
			iv. Necrosis of keratinocytes
			v. Wickham's striae
	...
Dx?

i. What (4 P's)
1) Pruritic
2) Purple
3) Polygonal
4) Planar papules and plaques
ii. Wrists - symmetric
iii. Lymphocytes at dermalepidermal junction
iv. Necrosis of keratinocytes
v. Wickham's striae
1) White dots on papules caused by hypergranulosis
Lichen planus
Lichen planus
what are the 4 Ps of Lichen planus?
what are the 4 Ps of Lichen planus?
1) Pruritic
2) Purple
3) Polygonal
4) Planar papules and plaques
what is the type of lesion pictured called?
what is the type of lesion pictured called?
exophytic nodule
what is the type of lesion pictured called?
what is the type of lesion pictured called?
endophytic nodule
what is the type of lesion pictured called?
what is the type of lesion pictured called?
macule
what is the type of lesion pictured called?
what is the type of lesion pictured called?
papule
what is the type of lesion pictured called?
what is the type of lesion pictured called?
patch
what is the type of lesion pictured called?
what is the type of lesion pictured called?
plaque
what is the type of lesion pictured called?
what is the type of lesion pictured called?
vesicles
what is the type of lesion pictured called?
what is the type of lesion pictured called?
bulla
what is the type of lesion pictured called?
what is the type of lesion pictured called?
fissure
what is the type of lesion pictured called?
what is the type of lesion pictured called?
erosion
what is the type of lesion pictured called?
what is the type of lesion pictured called?
ulcer
what is an ephelis
freckle
what is the medical name for freckle

and are of what type of lesion
ephelis

macule
Most common pigmented lesion of childhood
Freckle (ephelis)
Dx?
Dx?
Lentigo
common name for
Melanocytic nevi
mole
general Dx?
general Dx?
Melanocytic nevi (mole)
describe each of the 3 stages of changes a melanocytic nevi goes through
- junctional nevi
- compound nevi
- intradermal nevi
how DDx melanocytic nevi from cancer
maturation

melanomas have no differentiation
name each
name each
A - Nondysplastic nevi
B - junctional nevus
C - compound nevus (dermis and epidermis)
D - dermal only
Dx - specific kind of nevus?
Dx - specific kind of nevus?
Spitz nevus
Dx?

- Heavy infiltration of the nevus by lymphocttes and histocytes
- Can be confused w/melanoma / lymphoma / dermatitis
Dx?

- Heavy infiltration of the nevus by lymphocttes and histocytes
- Can be confused w/melanoma / lymphoma / dermatitis
Halo nevus
Dx?
Dx?
Dysplastic nevi
Dysplastic nevi
Dx?
Dx?
Malignant melanoma
how do you know it is Malignant melanoma?
> 10mm (most) (> 6mm is concern)
- Melanoma cells > nevus cells
- Asymmetric
- Irregular border (notched)
* most important sign of Malignant melanoma is
change in color / size/ shape of a pigmented lesion

ABCD
• Asymmetry (1 side looks different than the other)
• Border (irregular border - looks like someone bit something out of it) - notched
• Color (dark - but variable - some dark, some blue or red or white)
• Diameter (> 6mm)
what are the ABCDs of Malignant melanoma
ABCD
• Asymmetry (1 side looks different than the other)
• Border (irregular border - looks like someone bit something out of it) - notched
• Color (dark - but variable - some dark, some blue or red or white)
• Diameter (> 6mm)
what are the 2 general tumor suppressor gene mutations in malignant melanoma?
- RB (retinoblastoma)
- PTEN
- RB (retinoblastoma)
- PTEN
___________- encodes tumor suppressors:
□ P15 / INK4b
□ P16 / INK4a
□ P14 / ARF
® P53 tumor suppressor - inhibits MDM2 oncoprotein


→ ↑ melanocytic proliferation - escape oncogene induced senescence
CDKN2A
Familial melanoma syndrome has a mutation in chromosome 9pq21 which encodes _____________
which when deleted → unrestricted phosphorylation of RB → uncontrolled cell growth
CDNK2
Dx?


	- Asymmetric
	- Borders - notched
	- Color - variable - dark and depigmented
	- Diameter > 6mm (like 20)
Dx?


- Asymmetric
- Borders - notched
- Color - variable - dark and depigmented
- Diameter > 6mm (like 20)
malignant melanoma
Dx?
Dx?
malignant melanoma
what staining - seen here - brings out malignant melanocytes
what staining - seen here - brings out malignant melanocytes
S-100
- Most common intraocular malignancy in adults
Ocular melanoma
Dx?


- Looks like a dried out cornflake
- BENIGN but:
- Explosive onset = internal malignancy (GI - adenocarcinoma)
	• Syndrome of Leser Trelet
Dx?


- Looks like a dried out cornflake
- BENIGN but:
- Explosive onset = internal malignancy (GI - adenocarcinoma)
• Syndrome of Leser Trelet
Seborrheic keratosis (SKs)
Dx?


- Mimics squamous cell carcinoma
	• Can be considered a well differentiated carcinoma
- Heals spontaneously (unlike squamous cell ca)
M > F
50+
Dx?


- Mimics squamous cell carcinoma
• Can be considered a well differentiated carcinoma
- Heals spontaneously (unlike squamous cell ca)
M > F
50+
Keratoacanthoma
what causes Verrucae (warts)?
HPV (human papillomaviruses)
Pebble like lesion on hands from HPV
verruca vulagaris
HPV on soles of feet called?
Verruca plantaris
what is
Actinic keratosis (AK)
- Dysplasia of squamous cells

Precursor of squamous cell carcinoma
Dx?

- Dysplasia of squamous cells

Precursor of squamous cell carcinoma
Dx?

- Dysplasia of squamous cells

Precursor of squamous cell carcinoma
Actinic keratosis (AK)
Dx?

sunlight
arsenic
chewing tobacco

lips - lower lips
scaling plaques
invasive
atypia at all levels
squamous cell carcinoma
Dx?
Dx?
squamous cell carcinoma
Dx?

pearly papules

UPPER LIPS
basal cell carcinoma
cancer on the upper lips
basal cell carcinoma
Dx?


 upper lips
Dx?


upper lips
basal cell carcinoma
********

which of the following is least like to mets
pick basal cell carcinoma
********

which of the following is least like to mets
pick basal cell carcinoma
Dx?

		a. "Creeping eruption"
		b. Etiology/causes
			i. A. braziliense
			ii. A. caninum
		c. Transmitted by skin penetration
		d. Sx
			i. Raised erythematous / serpiginous / pruritic lesions
		e. Dx
			i. Clinical
		f. Rx
			i. Topi...
Dx?

a. "Creeping eruption"
b. Etiology/causes
i. A. braziliense
ii. A. caninum
c. Transmitted by skin penetration
d. Sx
i. Raised erythematous / serpiginous / pruritic lesions
e. Dx
i. Clinical
f. Rx
i. Topical / oral thiabendazole
ii. Albendazole
g. Risk
i. Sandboxes
ii. Warm sandy soil
Cutaneous larva migrans (CLM)
Dx?
Dx?
Cutaneous myasis
Dx?
Dx?
Cutaneous Leishmaniasis
most severe form of leishmaniasis
- 100% mortality
- potential AIDS indicator
Visceral leishmaniasis (VL)
Volcano sign
is a sign of what?
Volcano sign
is a sign of what?
Cutaneous leishmaniasis
Potential AIDS INDICATOR
Visceral leishmaniasis
Hansen's disease (HD)
is better known as?
why is it named after him?
Leprosy

i. 1841-1912

1st to say it is a microbe and NOT HEREDITARY
2x bacteria that cause leprosy
Mycobacterium leprae

Mycobacterium lepromatosis
Dx?

ACID FAST

Mycobacterium leprae

Mycobacterium lepromatosis
Leprosy
2x how Dx Leprosy
Pin prick
Punch biopsy
transmission of leprosy is mainly via?
Respiratory - through broken skin
NASAL DROPLETS
armadillos (this was also in a Uworld question)
where do the bacteria live in leprosy
macrophages
Dx?

- Macular hypopigmented / copper skin lesions
- scaly plaques
- Nerve damage
leprosy
how does pin prick Dx of leprosy work?
if they dont feel pin prick - could be leprosy

from schwann cell infection -> demyleniation
what is the only animal that can harbor the bacteria leprosy infection
armadillo
how much does skin weigh
6 pounds
Dx?

Most common benign cutaneous neoplasm
Dx?

Most common benign cutaneous neoplasm
Seborrheic keratosis
Seborrheic keratosis
what is
Dermatosis papulosa nigra
a) Black / asians
					b) Female
					c) Family predisposition
					d) Young / middle aged
					e) Tx
						i) Light
						ii) Avoid liquid nitrogen - hypopigmentation
a) Black / asians
b) Female
c) Family predisposition
d) Young / middle aged
e) Tx
i) Light
ii) Avoid liquid nitrogen - hypopigmentation
Lines of Blaschko
represent/from?
Lines of Blaschko
represent/from?
of BlaschkoRepresents pathways of epidermal cell migration / proliferation during fetal dev
medical name for
Any congenital skin lesion (birthmark)

which is ii. A type of hamartoma
1) Circumscribed stable malformation of the skin / oral mucosa
2) Not from external causes

Epidermal / CT / adnexal / nervous / vascular
nevus
name for
1) Tumor-like nodule
2) OVERGROWTH of mature cells - of a type that is normally there
a) But one element of that type of cell predominating
haratoma
name for/Dx?
name for/Dx?
Nevus sebaceus
Dx?
Dx?
Infundibular cyst
Infundibular cyst
Dx?

epidermal cyst on the scalp
F
60+
Pilar cyst - isthmus-catagen cyst
Pilar cyst - isthmus-catagen cyst
Fibrous reaction to trauma / ingrown hair
Fibrous reaction to trauma / ingrown hair
Dermatofibroma
Dx?

subcutaneous far tissue
trunk
Dx?

subcutaneous far tissue
trunk
lipoma
- Most common benign tumor of childhood
- Present at birth in 1/3 of cases
- Grows over the 1st year or so
- Stabilize then involute
- Most common benign tumor of childhood
- Present at birth in 1/3 of cases
- Grows over the 1st year or so
- Stabilize then involute
Hemangioma
what is PHACE syndrome?
PHACE syndrome
- Posterior fossa brain malformations
- Hemangiomas
- Coarctation of the aorta (narrowing at where ductus arteriosus connected)
- Cardiac defects
- Eye abnormalities
___% of UV radiation GOES THROUGH CLOUDS!
90% of UV radiation GOES THROUGH CLOUDS!
which is worse - UVA or UVB
why
UVB


damages DNA
what are
Lentigines
what is this called
what is this called
Cutis nuchae
what is
Actinic chelitis
Erythema and scale of lower lip
Erythema and scale of lower lip
half of all cancers in the US are?
non pigmented skin tumors
- Most common malignancy in humans
- 80% of all skin cancers
Basal cell carcinoma
- Most common malignancy in humans
- 80% of all skin cancers
Basal cell carcinoma
Dx?


- Arise from basal keratinocytes of epidermis and adnexal structures
- UVB radiation damages
• the DNA and
• repair system and
• Immune system
- Can also form at trauma sites - scars / burns / radiation Tx
Basal cell carcinoma
Most common form of basal cell carcinoma

telangiectasias
Most common form of basal cell carcinoma

telangiectasias
nodular BCC
a type of BCC
				1) Insidious
				2) Waxy / firm / pale white or yellow
					a) Looks like localized scleroderma
				3) Average subclinical extension 7.2mm
a type of BCC
1) Insidious
2) Waxy / firm / pale white or yellow
a) Looks like localized scleroderma
3) Average subclinical extension 7.2mm
Sclerosing or morpheadorm BCC
1) Least aggressive BCC
				2) Trunk / extremities
				3) Spreads peripherally for a long time - then becomes invasive
				4) Aldara - Tx
1) Least aggressive BCC
2) Trunk / extremities
3) Spreads peripherally for a long time - then becomes invasive
4) Aldara - Tx
Superficial BCC
Superficial BCC
Dx?

			i. 20% nonmelanoma skin cancers
			ii. Some mets risk
			iii. Etiology
				1) Low mets
					a) Actinic damage
				2) High mets
					a) Prior radiation
					b) Thermal injury
					c) Draining sinus
			iv. Organ transplants (253x ...
Dx?

i. 20% nonmelanoma skin cancers
ii. Some mets risk
iii. Etiology
1) Low mets
a) Actinic damage
2) High mets
a) Prior radiation
b) Thermal injury
c) Draining sinus
iv. Organ transplants (253x risk for renal transplants)
v.
vi. Risk factors
1) UVB exposure
a) P53 mutation
2) Southern climates
3) HPV 6 and 11 - genital tumors
4) HPV 16 - periungal tumors
5) Arsenic exposure
6) Transplant - major problem
vii. Gross
1) Rougher and scalier than basal cell
Squamous cell carcinoma
Squamous cell carcinoma
Merkel cell carcinoma

what does a Merkel cell do
Slow acting mechanoreceptor
Slow acting mechanoreceptor
Highest rate of mets of skin cancer
Merkel cell carcinoma
skin carcinoma
			- 80% from virus
			- < 20% 5 yr survival
skin carcinoma
- 80% from virus
- < 20% 5 yr survival
Merkel cell carcinoma
what is
Ephelis
Freckle

		b. Pigmented basilar keratinocytes
		c. Mild ↑ in # of melanocytes
		d. ↑ by sun
Freckle

b. Pigmented basilar keratinocytes
c. Mild ↑ in # of melanocytes
d. ↑ by sun
a. Liver spots
		b. Sun exposed areas
		c. .2 - 2cm diameter
		d. ↑ w/age
		e. Any lesion w/highly irregular border / thickening / asymmetry
			i. Should biopsied
		f. Rete ridge hyperplasia
a. Liver spots
b. Sun exposed areas
c. .2 - 2cm diameter
d. ↑ w/age
e. Any lesion w/highly irregular border / thickening / asymmetry
i. Should biopsied
f. Rete ridge hyperplasia
Lentingines
what is
Peutz-Jeghers syndrome
a type of lentingines - liver spots

a) Autosomal dominant
b) Pigmented macules on
i) Lips
ii) Oral mucosa
iii) Perioral
iv) Sacral
c) GI polyps - small intestine
d) 15x ↑ cancer
e) GI most frequent
what is
LEOPARD syndrome
a type of lentingines - liver spots

a) Lentigines
b) EKG abnormalities
c) Ocular hypertelorism
d) Pulm stenosis
e) Abnormalities of genitalia
f) Retardation of growth
g) Deafness
Acquired nevi - show up after __ months old
Acquired nevi - show up after 6 months old
Dx - junctional or compound or dermal nevi?
Dx - junctional or compound or dermal nevi?
dermal
dermal
*** if a derm lesion is blue - what layer is it in?
blue = in dermis
*** if a derm lesion is blue - what layer is it in?
blue = in dermis
Dx?

				1) Blue grey macule
				2) In 80-90% of them are in
					a) Asian
					b) Southern European
					c) American black
					d) Native american
				3) 100% of pure mayan indians
				4) Disappears during childhood
				5) Can look like...
Dx?

1) Blue grey macule
2) In 80-90% of them are in
a) Asian
b) Southern European
c) American black
d) Native american
3) 100% of pure mayan indians
4) Disappears during childhood
5) Can look like child abuse
Mongolian spot
Dx?

				1) Oculodermal melanosis
				2) May not show until teens
					a) Most that have eye involvement have it at birth (2/3)
				3) Grows slowly - then persists
				4) 80% F -asians
				5) Mostly a cosmetic problem
				6) Rare malignant...
Dx?

1) Oculodermal melanosis
2) May not show until teens
a) Most that have eye involvement have it at birth (2/3)
3) Grows slowly - then persists
4) 80% F -asians
5) Mostly a cosmetic problem
6) Rare malignant transformation
a) choroid
Nevus of Ota
Dx?

 types					a) Common
						i) Young
						ii) Steel blue papule or nodule
						iii) 2-10mm
						iv) On
							A. Dorsal hands
							B. Feet
							C. Face
						v) Malignant potential
					b) Cellular
						i) Large
						ii) ...
Dx?

types a) Common
i) Young
ii) Steel blue papule or nodule
iii) 2-10mm
iv) On
A. Dorsal hands
B. Feet
C. Face
v) Malignant potential
b) Cellular
i) Large
ii) Firm
iii) Blue / black nodule
iv) 40+ y/o
v) 10-20mm
vi) Malignant potential
Blue nevus
what is a
spitz nevus?
what is a
spitz nevus?
a type of dermal pigmented nevus


1) AKA Benign juvenile melanoma
2) Pink
3) Smooth - surfaced / raised / round / firm papule
4) Before 20s
5) Often no pigment
6) Tx
a) Too hard to DDx from melanoma
b) So biopsy all
which spitz nevus lesions should you Bx?
all of them - b/c hard to DDx from melanoma
all of them - b/c hard to DDx from melanoma
Most common cancer in young adults 25-29 y/o
Malignant melanoma (MM)
Malignant melanoma (MM)
Dx?
Dx?
Malignant melanoma (MM)
Dx?
Dx?
Malignant melanoma (MM)
Malignant melanoma (MM)
Dx?
Dx?
Malignant melanoma (MM)
Malignant melanoma (MM)
how wide would this have to be to be a concern
how wide would this have to be to be a concern
> 2mm
> 2mm
what is used to determine prognosis of melanoma
depth of tumor

< 1 mm = good prognosis (epidermis only)
depth of tumor

< 1 mm = good prognosis (epidermis only)
melanoma is most often found where
- M
- F
M - upper back
F - lower legs and upper back
50% of melanomas have _______ gene
50% of melanomas have BRAF gene
which category of agents is the highest priority?
category A
what bioterrorism category are these:

i. Plague
ii. Tularemia

Hemorrhagic fever virus
category A
name this virus and its disease:

			i. Large
			ii. DNA virus
			iii. Brick shaped

* Centrifugal rash

Pearls of pus
name this virus and its disease:

i. Large
ii. DNA virus
iii. Brick shaped

* Centrifugal rash

Pearls of pus
Variola virus

smallpox
Dx?

Single case = international emergency
- staining
- viral culture
- FBI transports specimen
Variola virus

smallpox
Dx?
Dx?
Variola virus

smallpox
smallpox - variola virus

Once scabs separate - pt is no longer infectious

Takes ___ days
smallpox - variola virus

Once scabs separate - pt is no longer infectious

Takes 21 days
how DDx chickenpox from smallpox
chickenpox is
- all over the place
- superficial
- in different phases of evolution [small pox is consistent - all in same phase]
what is the animal vector of cowpox
what is the animal vector of cowpox
rodents
who gave the first vaccination
Used cowpox to vaccinate against smallpox
Edward Jenner
Wait __ weeks between chickenpox or TB vaccine and smallpox
Wait 4 weeks between chickenpox or TB vaccine and smallpox
what is a philtrum
indent above upper lip
- dandruff

-  scaly, flaky, itchy, and red skin
- particularly affects the sebaceous-gland-rich areas of skin
- yellow/waxy
- dandruff

- scaly, flaky, itchy, and red skin
- particularly affects the sebaceous-gland-rich areas of skin
- yellow/waxy
Seborrheic dermatitis
Seborrheic dermatitis
***
- Scaly
- Prediliction for eyebrows / scalp / labial folds
= seborrhea
***
- Scaly
- Prediliction for eyebrows / scalp / labial folds
= seborrhea
Dx?

- Itch (pruritus) that rashes
- itch/scratch/open-> infection cycle
- a type of eczema, an inflammatory, relapsing, non-contagious and pruritic (itchy) skin disorder
Dx?

- Itch (pruritus) that rashes
- itch/scratch/open-> infection cycle
- a type of eczema, an inflammatory, relapsing, non-contagious and pruritic (itchy) skin disorder
Atopic dermatitis
Atopic dermatitis
Trichophyton tonsurans
is the main cause of what in the US
Trichophyton tonsurans
is the main cause of what in the US
tinea infection
how DDx tinea from lupus or psoriasis
how DDx tinea from lupus or psoriasis
annular (ring) - CENTRAL CLEARING
annular (ring) - CENTRAL CLEARING
is this tinea?

- no scale but annular
is this tinea?

- no scale but annular
NO - it is indurated (firm) - so NOT tinea
dystrophic nails are the tell tail factor of what
likes between toes
tinea infection
caused by pityrosporum
worse in summer

dull red/brown
fine dust like scale
caused by pityrosporum
worse in summer

dull red/brown
fine dust like scale
tinea versicolor
Dx?
Dx?
Psoriasis
Red plaques
thick silvery scale
inflammatory disease
Red plaques
thick silvery scale
inflammatory disease
Psoriasis
Dx?
Dx?
psoriasis
2x causes of
Lichen planus
2x causes of
Lichen planus
- drugs (diuretics)
- hepatitis
central collarette
salmon colored

Dx?
central collarette
salmon colored

Dx?
Pityriasis rosea
red/scaly lupus

which type - discoid or systemic
discoid
red / SMOOTH lupus

which type - discoid or systemic
systemic
3 listed causes of contact dermatitis
which is #1?
3 listed causes of contact dermatitis
which is #1?
plants
nickel
fragrence - #1
why would you think you are dealing with Cutaneous T-cell lymphoma (CTCL)?

How Dx to confirm your suspicion?
why would you think you are dealing with Cutaneous T-cell lymphoma (CTCL)?

How Dx to confirm your suspicion?
looks liek psoriasis - but no responding
Dx - punch Bx
match - open/closed comedone with
black/white head
open - white
closed - black
4 steps to pathogenesis of acne
1 - open comedone (white head) - sticky from sebacous gland
2 - shed keratin & sebum build up
3 - inflammatory pustule forms
4 - nodule / cyst - lots of inflammation -> scarring
1 - open comedone (white head) - sticky from sebacous gland
2 - shed keratin & sebum build up
3 - inflammatory pustule forms
4 - nodule / cyst - lots of inflammation -> scarring
these drugs can cause what?

2) Phenytoin
3) Iodide / Isoniazide
4) Methotrexate (folate)
5) Phenobarbital
6) Lithium
7) Ethambutol
8) Steroids
PIMPLES (acne)
MOA
Benzoyl peroxide
Tx acne vulgaris
Unblocks follicular plugging
what acne Tx is safe for pregnancy (topical)
azelaic acid
what acne Tx is used for 8-12yo pts (topical)
salicylic acid
match skin type and ointment type

oily/dry skin
cream or lotion / gel
oily - gel

dry - cream/lotion
when using topical retinoids - which are good for Tx ALL forms of acne, what do you need to be careful of?
sun sensitivity

use sunscreen
what topical retinoid should you NOT use during pregnancy?

which is the only pregnancy catagory x
tretinoin


Tazarotene
acne Tx that is
Antimicrobial and keratolytic
benzoyl peroxide
Azelaic acid is used mostly to Tx?
rosacea
what antibiotic can cause
Steven's Johnson syndrome

what is that?
TMP-SMX (bactrim)

Serious rash-TEN (Steven's Johnson syndrome) - rare but really bad - toxic epidermal necrolysis (TEN)
hives / photosensitivity
how much or for how long do you take Accutane for?
isotretinoin
NOT BASED ON TIME - BASED ON WEIGHT - NEED TO GET 120-150MG / KG INTO YOU
drug (real and trade name)?

NOT BASED ON TIME - BASED ON WEIGHT - NEED TO GET 120-150MG / KG INTO YOU
isotretinoin (accutane)
if you are female on isotretinoin, what else must you take?
bith control
what is Pseudotumor cerebri?
what drug can cause it?
what are 2x possible Sx
↑ intracranial pressure

Unsteady gate
Visual disturbance
what 2x acne drugs have this MOA:
Keratinocytes - sluff more normally
Accutane

Tretinoin
what 4x acne drugs have this MOA:

Sebaceous gland - block
Estrogen (oral contraceptives)
steroids (prednisone)
isotretinoin (accutane)
Anti-androgens (spironolactone)
what is
Rosacea
a. Chronic inflammatory skin condition
i. Erythema
ii. Telangiectasias
iii. Papules
iv. NO COMEDONES (clogged hair follicle)
v. 25 y/o+
vi. Rhinophyma
1) Large nose
2) Skin hypertrophy of nose
a) 2ndary to chronic deep inflammation
NEVER use topical _________ for acne / rosacea / perioral dermatitis - will get rebound
NEVER use topical steroid for acne / rosacea / perioral dermatitis - will get rebound
Hidrandenitis suppurativa is a form of?
acne
****** Follicular occlusion triad
- what
- HS (hidrosis suppurativa) - abscesses
- Acne conglobata
- Dissecting cellulitis of the scalp
what is this triad:
- HS (hidrosis suppurativa) - abscesses
- Acne conglobata
- Dissecting cellulitis of the scalp
Follicular occlusion triad
how Tx Perioral dermatitis
low dose doxy
what is
Hematoxylin and Eosin
used for?
H & E staining
for ALL routine Bx
what is DIF?
used for
i. Direct immunofluorescence
ii. Evaluates immune deposits
1) IgG / IgM / IgA / C3 / fibrin
2) In frozen skin tissue samples

Taken from adjacent UNAFFECTED skin
where is skin taken from for DIF
adjacent UNAFFECTED skin - checking for immune deposits
name the layers
name the layers
what are the 4 layers
what are the 4 layers
what are the 4 layers
what are the 4 layers
what disease is associated w/BPAG1 mutation
bullous pemphigoid
match the salt-split skin type (roof or floor)

BPAG1
roof - lsmins lucida (up)
roof - lsmins lucida (up)
match the salt-split skin type (roof or floor)

laminin 5
floor - lamin densa (down)
floor - lamin densa (down)
match the salt-split skin type (roof or floor)

Type IV collagen
floor - lamin densa (down)
floor - lamin densa (down)
match the salt-split skin type (roof or floor)

Type VII collagen
floor - lamin densa (down)
floor - lamin densa (down)
match the salt-split skin type (roof or floor)

BPAG2
roof - lsmins lucida (up)
roof - lsmins lucida (up)
Bullous pemphigoid

roof or floor?
what protein is mutated?
layer?
Bullous pemphigoid

roof or floor?
what protein is mutated?
layer?
roof

BPAG2

lamina lucida
what class of drugs is likely to cause bullous pemphigoid?
diuretics



1) Furosemide
2) Bumetanide

Spironolactone
Dx?

- BP180 (BPAg2)
- DIF - Linear C3 along BMZ
- Salt split skin - C3 on epidermal side (roof)
Dx?

- BP180 (BPAg2)
- DIF - Linear C3 along BMZ
- Salt split skin - C3 on epidermal side (roof)
Gestational pemphigoid

AKA herpes gestationis
Gestational pemphigoid

AKA herpes gestationis
Dx?

Children
- Annular erythema
- blisters
- where - flexural areas / lower trunk / thighs / groin
- "crown of jewels" - the annular blisters

Adult
- looks like BP (bullous pemphigoid)

BP180 (BPAg2) = roof
DIF - Linear deposition of...
Dx?

Children
- Annular erythema
- blisters
- where - flexural areas / lower trunk / thighs / groin
- "crown of jewels" - the annular blisters

Adult
- looks like BP (bullous pemphigoid)

BP180 (BPAg2) = roof
DIF - Linear deposition of IgA along BMZ
Salt split skin - Epidermal side (roof)
Linear IgA bullous dermatosis
Linear IgA bullous dermatosis
genetic bullae of External mucosal surfaces
cicatricial pemphigoid (CP)
Mucosal Cicatricial pemphigoid (CP)
has IgG against?
BP230 (BPAg1)

roof
Dx?

DIF - IgG to type VII collagen (anchoring fibrils)

Salt split - Floor (dermal side)

Type VII collagen

DORSAL HANDS

		a. Sx similar to BP and rarely CP
		b. Mechanobullous disorder
			i. Trauma induced
Dx?

DIF - IgG to type VII collagen (anchoring fibrils)

Salt split - Floor (dermal side)

Type VII collagen

DORSAL HANDS

a. Sx similar to BP and rarely CP
b. Mechanobullous disorder
i. Trauma induced
Epidermolysis bullosa aquisita (EPA)



Really need to look for underlying malignancy
how DDx
Epidermolysis bullosa aquisita (EPA)
and
Bullous SLE
ANA is the way to differentiate
Dx?
Dx?
Bullous SLE
***
Biopsy site for DIF in workup of bullous (blistering) disorder is
NORMAL skin adjacent to a lesion
***
Sodium chloride (1 mol / L) induces a split in human skin at he level of the (what is the top layer of the split)
lamina lucida