Acute Eczematous Dermatitis

Poison Ivy

Atopic Derm

Drug Related

Photoecematous Derm

Primary Irritaint derm

Acumulation of fluid with dermatitis -- Sporatic.

Erythema Multiforme

List the causing factors:(3 catagories)

Name a particular type found in Children:

Hypersens to certain drugs or infections

Infections:

Herpes, mycoplasma, histo, coccidio, typhoid, leperacy

Drugs:

Sulfonamides, penicillin, barbituates, salicylates, hydanotoins, antimalarials

Neoplasms

Carcinoma, & lymphomas

-----

Lymph infiltrate at dermo-epidermal junct

-Degenerates keratinocytes

- macules,papules, vesicles, bullae, target lesions

 -----

Steven-Johnson

Children, severe form, marked by crusting of mucosal surfaces

This Dz is a subset of another, found in children, marked by crusting of mucosal surfaces

Caused by cross-reactive ____

Steven-Johnson

Cross reactive CD8

Erythema Multiforme

SLE is detected using Direct Immunoflorescence:

The findings are as follows:

1 Speckled

2 Diffure/Homogeneous

3 Peripheral

4 Nucleolar

1-ABs to Non-DNA nuclear components

2-ABs to DOUBLE STRANDED DNA, chromatin and histones

3-ABs tojust DOUBLE STRANDED DNA

4- ABs to Nucleolar RNA

Perivascular and periadnexal lymhoplasmacytic infiltrate

&

Vacular interface injury

&

Epidermal atrophy

 --

Are microscopic components of what DZ?

CREST(subset of scleroderma)

Skin involvement, rapid progressio and visceral involvement

a chronic autoimmune disease characterized by a hardening^[1] or sclerosis^[2] in the skin or other organs.

Lungs, kidney, heart, intestine

This dz has patches of hardened skin due to excessive collagen deposit

Denser fibrosis of dermis, often encasing sweat glands

Well demarcated, pink plaque with silver white loosely adherent scale

What is another manifestation?

Psoriasis

Nale changes = Pittin, yellowbrown pigmentation, thickening and crumbling

arthritis

Psoriasis is the unregulated proliferation of keratinocytes, microcirculatory changes in superficial papillary dermis

STRONG GENETIC COMPONENT

1) What is the KOEBNER PHENOMONON?

3) What SIGN?

2) What happens to nails?

4)Whatis found in EPIDERMIS?

1)  DEVELOPS IN AREAS OF TRAUMA (ELBOWS, LOWER BACK)

2) pITTING AND YELLOWBROWN COLOR

3) Auspitz sign = blood vessels rupture when scale picked off

4) PMNs (spongiform pustules) in epidermis and STRATUM CORNEUM

This derm DZ is found mainly on Extremities: wrists, elbows, glans penis

Itchy, polygonal papules  (SPONGIFORM PUSTULE)

assoc invlolvement?

 Lichen Planum

lymphocyte infiltrate within superficial epidermis that involves basal epidermis

Necrotic keratinocytes within epidermis

***Oral Involvement***

When do we expect to see toxic epidermal necroslysis?

What changes are expected in the epidermis?

also known as Lyell's syndrome, is a life-threatening dermatological condition that is frequently induced by a reaction to medications.^[1] It is characterized by the detachment of the top layer of skin (the epidermis) from the lower layers of the skin (the dermis) all over the body.

Necrotic keratinocyteswithin epidermis

"Flat topped polygonal papules, the surface of which is marked by white lines and dots (Whickham striae):

WHAT IS PRESENT IN 70% of CASES?

Lichen Planus

ORAL LESIONS

This derm disorder is type II Hypersensitivity?

Cause?

Pemphigus

Caused by IgG ABS to Desmogleins of skin and mucosal memb

Acanthyolysis - loss of intercellular adhesion sites within epithelius

Middle age or older

This Dz is caused by IgG abs to Desmogleins of skin and mucus memb

it occurs in middle age or older

S Aureus and S Pyogenes

Follows bact contamination of skin injury

Bullous Pemphigoid

Subepiderma, nonacanthylytic blister

\

Mostly elderly

Type II hypersens,

IgG, ABS to desmogleins cause Acantholysis

A) A superficial form

B) Intraepidermal with flaccid bullae (Fragile)

Pemphigus

A)  Pemphigus Foliaceous\

B) Pemphigus Vulgaris

Pemphigus is caused by Ig___

2) dermatitis Herpiformis is Ig___

1) IgG (epidermis type II hypersens)

2) IgA( cross reacts withreticulin in papilla tips)

Dermatitis Herptiformis

1) Assoc with ____

2) what forms?

IgA crossreacting with reticulin in tips of DERMAL PAPILLAE-- IgA

1) Celiac DZ

2) fibrin, PMNS form at tips of dermal papillae foring microabsesses.

Classification of EPIDERMOLYSIS BULLOSA:

1) Autosomal Dominant

2) Autosomal Recessive

3) Recessive or dominant, dep on subtype

4) Results in scarring because of Contracutes, like fused fingers

1) Epidermolysis bullosa simplex -- Intra epidermal **Within epidermis -- still see basement memb*** (Blisters form in Keratinocyte)

2) Junctional Epidermolysis bullosa (Prob with hemidesmosome)

3) Dystrophic Epiderm Bullosa

4) Dystrophic Epiderm Bullosa

• Flat, coinlikelesions with velvet, granular surface
• melanin, hyperkeratosis, and horn-like cysts
• EXCISION

___ caused by HPV

name:

• ___ Vulgaris
• ____ Plana
• ____ Plantaris/palmaris

Verrucae (wart)

1fingers/hands (can be raised and bumpy)

2 flat (smaller

3 feet/hands

___ due to chronic sun exposeure & assoc with excess keratin

become?

Actinic Keratosis

Pre-malignangt squamous proliferation from sun ecposure

Can become squamous celled carcinoma

 B

Squamous Cell Cafrcinoma

• difference between 'In situ" and "advanced"
  
  • high risk?

•  Hasnt broken through basement memb (defined plaques)
• advanced= nodular, may ulcerate
• Immunocompromized,xerderma pigmentosum

 Basal cell carcinoma

prediosposition?

Appearance? (micor and macro)

1. Slow growing, UV exposure
2. PEARLY PAPULES, telangiectatic vessels
3. Can ulcerate and invade bone, etc

• Scant cytoplasm and dark nuclei
• Seperation artifact

Nevocellular Nevus

MOLE

Lichen Planus

Polygonal, planar, puritic, purplish, plaques

on wrists, hands, trunk

This skin dz is named so because the vessicles resemble herpes

assoc with?

Dermatitis Herpitiformis

Celiac Dz

Reaction of IgA with Fibrin at papillary tips, makes papillae and blisers

In flexural areas (Axilla, neck, groin)

Velvety texture

Benighn - assoc with insulin insufficiency

Malignant 0-- assoc with GU/GI neoplasms

These derm disorders look "Styuck on' and are described as gresay/velvety

often on oldies

Actinic keratosis

describe

erythematous papules with central scale and sandpaper like texture

sun dmged fibrosis 

*can occur in sun UNEXPOSED areas*

Familial -- Autosonmal DOMINANT

Multiple atypical nevi is the marker

compound nevus components:

more pigmented raised center with less pigmented flat rim at periphery, 

asymetric shoulder

This dermatologiz dz is the result of a germ lin emutation of CDKN2A, cyclin-dependent inhibitor, mutational loss of PTEM gene --

the loss of the P53 gene is uncommon

this dz mostly result  from uv exposure

Xeroderma pigmentosa and immunosuppression are factors

slow growing -- rarely metastasize

____ = Dome chaped nodule with central keratin plug

sun dmged skin

Non- nested proliferaton of melanocytes confined to the basal layer of the epidermis

what is NESTED melanocytes?

Lentigo Simplex

Junctional Melanocytic Nevus

Non Nested proliferation of melanocytes confines to the basal layer of epidermis

This differs from Junctional Melanocytic Nevus, in which the melanocytes are NESTED -- Obviously secluded

Nested Junctional Component

as well as

Intradermal component of Melanocytes

Similar to Compound Nevus, but can be Pedunculated (stalked)

Nested melanocytes without identifyable junctional component

This type of Nevus is frequent in infants and children, and is often non-pigmented

Spitz's Nevus

Most prevalent in infants or young children -- Not uncommon in adults

frequently nonpigmented

Congenital Nevus

More likely to give rise to melanoma than smaller nevi

Often have dnese band-like component which involves the deep reticular dermis and sometimes subcutanis

Appears as blue nodule

Usually in Acral locations (limbs)

Nevus of Ota

similar to Blue Nevus

The Nevus Of Ota

vs

The NEvus of Ito

located where?

along the tract of the TRIGEMINAL NERVE

in the region of the SHOULDER GIRDLE

____= diffure macular pigmented areas on low back / buttocks

Located in the deep reticular dermis

Mongolian Spot

Common in Mongolia, Malayand, chinese, japos, S Americans

Dysplastic Nevus Syndrome

Inherited as Autosomal Dominant Trait

Melanoma in Situ

vs

Invasive Melanoma

Confined to Epidermis

invaded epidermal basement memb

1- Clark's Levels

2 - Myotic Index

3 - Host Resp of Tumor infiltrating Lymphocytes

4  - Presence of Tumore regression

Xeroderma pigmentosa and immunosuppression are factors

slow growing -- rarely metastasize

Yellow - lipid laden histocyte nodules in dermis

suggestive of hyperlipidemia

atopic dermatitis

assoc with?

common in childhood

purulent and weaping papules

ASTHMA AND RHINITIS

Cutaneous lesion commonly found on EYELID that contains lipid-laden macrophages

Indicates -- BILLIARY CIRRHOSIS --> Cholectasis --> Hypocholesterolemia

Bullous Pemphigoid

describe mech how dermititis occurs