Dermatology pathology ... with a lower case p

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jknell
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210892
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Dermatology pathology ... with a lower case p
Updated:
2013-04-02 13:04:57
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Derm pathology
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  1. Macule
    • Flat lesion with well-circumscribed change in skin color
    • <5mm
    • Example: freckle, labial macule

  2. Patch
    • Macule > 5mm
    • Large birthmark (congenital nevus)

  3. Papule
    • Elevated solid skin lesion
    • <5mm
    • Mole (nevus), acne

  4. Plaque
    • Papule > 5mm
    • Psoriasis

  5. Vesicle
    • Small fluid-containing blister
    • <5mm
    • Chickenpox (varicella), shingles (zoster)

  6. Bulla
    • Large fluid-containing blister
    • >5mm
    • Bollous pemphigoid

  7. Pustule
    • Vesicle containing pus
    • Pustular psoriasis

  8. Wheal
    • Transient smooth papule or plaque
    • Hives (urticaria)

  9. Scale
    • Flaking off of stratum corneum
    • Eczema, psoriasis, SCC

  10. Crust
    • Dry exudate
    • Impetigo
  11. Hyperkeratosis
    • ↑ thickness of stratum corneum
    • Psoriasis
  12. Parakeratosis
    • Hyperkeratosis with retention of nuclei in stratum corneum
    • Psoriasis
  13. Acantholysis
    • Separation of epidermal cells
    • Pemphigus vulgaris
  14. Acanthosis
    • Epidermal hyperplasia (↑ spinosum)
    • Acanthosis nigricans
  15. Dermatitis
    • Inflammation of the skin
    • Atopic dermatitis

  16. Albinism
    • Normal melanocyte number
    • ↓ melanin production due to ↓ tyrosinase activity
    • Also caused by failure of neural crest cell migration during development

  17. Melasma (chloasma)
    • Hyperpigmentation associated with pregnancy
    • "mask of pregnancy"
    • or OCP use
  18. Vitiligo
    • Irregular areas of complete depigmentation
    • Caused by ↓ in melanocytes
  19. Verrucae
    • Warts - caused by HPV
    • Soft, tan-colored, cauliflower-like papules
    • Epidermal hyperplasia
    • hyperkeratosis
    • Koilocytosis
    • Condyloma acuminatum on genetals:
  20. Melanocytic nevus
    • Common mole
    • Benign, but melanoma can arise in congenital or atypical moles
    • Intradermal nevi are papular:
    • Junctional nevi are flat macules:
  21. Urticaria
    • Hives
    • Pruritic wheals that form after mast cell degranulation
  22. Ephelis
    • Freckle
    • Normal number of melanocytes
    • ↑ melanin pigment
  23. Atopic dermatitis
    eczema
    • Pruritic eruption, commonly on skin flexures
    • Associations: asthma, allergic rhinitis
    • Starts on the face in infancy;
    • antecubital fossae thereafter
  24. Allergic contact dermatitis
    • Type IV hypersensitivity reaction that follows exposure to allergen
    • Lesions occur at site of contact
    • nickel:
    • poison ivy
    • neomycin:
  25. Psoriasis
    • Papules and plaques with silvery scaling
    • knees and elbows
    • Acanthosis with parakeratotic scaling (nuclei still in stratum corneum)
    • ↑ stratum spinosum
    • ↓ stratum granulosum
    • Auspitz sign: pinpoint bleeding from exposure of dermal papillae when scales are scraped off
    • Associated with nail pitting and psoriatic arthritis
  26. Seborrheic keratosis
    • Flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts)
    • Looks "stuck on":
    • Lesions occur on head, trunk, extremities
    • Common benign neoplasm of older people
    • Leser-Trélat sign: sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (GI, lymphoid)
  27. Blistering skin disorserders
    • Pemphigus vulgaris
    • Bullous pemphigoid
    • Dermatitis herpetiformis
    • Erythema multiforme
    • Stevens-Johnson syndrome

  28. Pemphigus vulgaris
    • Autoimmune skin disorder (potentially fatal)
    • IgG antibody against desmoglein 3 (1 and/or 3) - part of desmosomes (needed for cell adhesion)
    • IF reveals antibodiese around epidermal cells in a reticular or netlike pattern
    • Acantholysis - intraepidermal bullae causing flaccid blisters involving skin and oral mucosa
    • Positive Nikolsky's sign (separation of epidermis upon manual stroking of skin)

  29. Bullo
    us pemphigoid
    • Autoimmune disorder
    • IgG antibody against hemidesmosomes (epidermal basement membrane)
    • **Antibodies are bullow the epidermis
    • IF shows linear depositis of IgG
    • Eosinophils within tense blisters
    • Less severe than pemphigus vulgaris; spares oral mucosa
    • Negative Nikolsky's sign

  30. Dermatitis herpetiformis
    • Pruritic papules, vesicles, and bullae
    • Depositis of IgA at the tips of dermal papillae
    • Associated with celiac disease
  31. Erythema multiforme
    • Presentation: multiple types of lesions
    • -macules
    • -papules
    • -vesicles
    • -target lesions
    • Associated with infections (e.g., Mycoplasma pneumoniae, HSV), drugs (sulfa, β-lactams, phenytoin), cancers, autoimmune disease
  32. Stevens-Johnson syndrome
    • Presentation: fever, bulla formation and necrosis, sloughing of skin, high mortality rate
    • Typically 2 mucus membranes are involved
    • Skin lesions may appear like targets
    • Associated with: adverse drug reaction
    • Toxic epidermal necrolysis: more severe >30% of body surface area involved

  33. Acanthosis nigricans
    • Epidermal hyperplasia causing symmetrical hyperpigmented, velvety thickening of skin
    • neck or in axilla
    • Associated with hyperinsulinemia (diabetes, obesity, cushing's syndrome), visceral malignancy

  34. Actinic keratosis
    • Premalignant lesions caused by sun exposure
    • Small, rough, erythematous or brownish papules or plaques
    • Risk of squamous cell carcinoma is proportional to degree of epthelial dysplasia

  35. Erythema nodosum
    • Inflammatory lesion of subcutaneous fat
    • anterior shins
    • Associated with sarcoidsosis, coccidioidomycosis, histoplasmosis, TB, streptococcal infections, leprosy, Crohn's disease

  36. Lichen Planus
    • Pruritic, Purple, Polygonal, Planar Papules and Plaques
    • Sawtooth infiltrate of lymphocytes at dermal-epidermal junction
    • Associated with hepatitis C

  37. Pityriasis rosea
    • "Herald patch" followed days later by "christmas tree" distribution
    • Multiple plaques with collarette scale
    • Self-resolving in 6-8 weeks
  38. Sunburn
    • UV irradiation causes DNA mutations, inducing apoptosis of keratinocytes
    • UVA is dominant in tanning and photoaging
    • UVB in sunburn
    • Can lead to impetigo and skin cancer (basal, squamous, melanoma)

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