Dermatology Lecture Review

Flashcards for dermatology exam review, covering papulosquamous disorders, immunobullous disorders, systemic diseases, pigmentary disorders, eczemas, skin tumors, genodermatoses, gland disorders, hair and nail disorders, and pediatric dermatoses.

What are Papulosquamous Disorders?

Disorders with scaly papules and plaques.

What is Psoriasis?

Chronic, relapsing-remitting, immune-mediated disorder.

What are the Etiological factors leading to systemic chronic inflammation in Psoriasis?

Genetic, immune, and environmental factors.

What are the Genetic Factors associated with Psoriasis?

HLA Cw6, HLA B27, PSORS1

What are the key Pathogenic features of Psoriasis?

Epidermal and dermal inflammatory cells, dilated blood vessels.

What are the Triggers for Psoriasis?

UV, infection, smoking, drinking, stress.

What are the Pathophysiological changes in Psoriasis?

Reduced epidermal turnover time to 4 days, hyperproliferation of keratinocytes, angiogenesis/vasodilation, TH-1 predominant immune response.

What are the key inflammatory mediators in Psoriasis?

INF-γ, TNF-α, TH-17 (IL-17), TH-22 (IL-22).

In the histopathology of Psoriasis, which occurs first, dermal or epidermal changes?

Dermal changes precede epidermal changes.

What are the features of the Stratum corneum in Psoriasis histopathology?

Hyperkeratosis, parakeratosis, Munro's microabscess.

What occurs in the Stratum Granulosum in Psoriasis histopathology?

Agranulocytosis/Agranulosis (absent granular layer).

What are the features of the Malpighian layer (Stratum Spinosum and Basale) in Psoriasis histopathology?

Acanthosis, Kogoj's Spongiform pustules.

What changes occur to the Rete ridges in Psoriasis histopathology?

Elongated and club-shaped (Camel foot appearance).

What are the key features of the Dermis in Psoriasis histopathology?

Dilated tortuous blood vessels and inflammation.

What is the common site for Psoriasis lesions?

Extensors of the body.

What are the characteristics of Psoriasis lesions?

Salmon colored, well-defined plaques and papules, erythematous, silvery-white scale, indurated.

What is Woronoff's Ring?

Zone of pallor around the psoriatic plaque due to the inability to synthesize PGE2.

What is the Candle sign in Psoriasis?

Accentuation of scaling.

What is Berkley's membrane in Psoriasis?

Thin translucent membrane.

What is Auspitz sign in Psoriasis?

Pinpoint bleeding points.

What is Koebner's Phenomenon?

Psoriatic lesions develop along the lines of trauma.

Give examples of Category 1 Koebnerization (True koebnerization)

Psoriasis, Lichens planus, Vitiligo.

Give examples of Category 2 Koebnerization (Pseudo koebnerization)

Warts, Molluscum.

Give examples of Category 3 Koebnerization (Occasional koebnerization)

Darier disease, Erythema multiforme.

Give examples of Category 4 Koebnerization (Dubious association with trauma)

Pemphigus vulgaris, Lupus erythematosus.

What are the characteristics of Scalp psoriasis?

Erythematous scaly plaques, cross hair line, not itchy, no alopecia, extends up to the forehead.

What are the characteristics of Inverse/flexural psoriasis?

No scaling, little induration, bilaterally symmetrical, not itchy.

What are the characteristics of Palmo-plantar psoriasis?

Hyperkeratosis, fissuring.

What is the most common nail finding in Nail psoriasis?

Pitting (shallow depressions).

What are the major findings in Nail psoriasis, POLISH?

Pits, Onycholysis, Leukonychia, Salmon patch, Subungual Hyperkeratosis.

What is the most common clinical pattern of presentation in Psoriatic arthritis?

Asymmetrical oligoarthritis.

What are the characteristics of Guttate Psoriasis?

Raindrop like appearance, commonly seen in children, preceded by streptococcal infection, small erythematous scaly plaques on the trunk.

What are the two types of Unstable Psoriasis?

Erythrodermic psoriasis and Pustular psoriasis.

What are the Aggravating factors for Psoriasis?

Withdrawal of steroids, coal tar, pregnancy, stress, infections, hypocalcemia.

What are the features of Erythrodermic psoriasis?

Erythema, scaling of >90% of the BSA, red scaly skin.

What is the defining characteristic of Pustular psoriasis?

Presence of visible Sterile pustules (collection of neutrophils).

What is Impetigo Herpetiformis?

Pustular psoriasis of pregnancy, seen in the last trimester, associated with adverse fetal outcomes.

What are Treatment Options for Psoriasis?

Topical Treatment, Phototherapy/Light Therapy, Systemic Treatment.

What are the key components of Topical Treatment for Psoriasis?

Emollients, moisturization, topical corticosteroids, topical retinoids, vitamin D analogues, coal tar, anthralin, salicylic acid, calcineurin inhibitors.

What type of light is used in phototherapy for the treatment of psoriasis?

UV-A and UV-B.

What are the Main Systemic Drugs for Psoriasis Treatment?

Methotrexate (MTX), Acitretin, Cyclosporin.

Give examples of Biologicals used for systemic treatment of Psoriasis.

Anti-TNF alpha drugs, IL 12/23 Inhibitor, LFA-1 (Lymphocyte Function Associated antigen), IL 17A inhibitor.

What are the key clinical features of Pityriasis Rubra Pilaris (PRP)?

Scaly red follicular papules or plaques.

What are the key characteristics of Lichen Planus?

Autoimmune disorder mediated by T cells, affects the Basement Membrane Zone, skin, nails, mucosa, and hair.

What are the characteristic lesion of Lichen Planus (5 p's)?

Purplish, Plane topped, Pruritic, Polygonal, Papules and Plaque (5 P's).

What are Wickham's Striae?

Whitish streaks on a lesion of Lichen Planus seen on hand lens, due to hypergranulosis.

What nail findings occur in Lichen planus?

Longitudinal ridging of nails.

What is Pterygium regarding Lichen Planus?

wing-shaped extension of the proximal nail fold on the nail plate.

What term is used to describe basal cell degeneration and infiltrate in the dermis?

Interface dermatitis.

What are the two broad categories of Immunobullous Disorders?

Pemphigus group (Intraepidermal) and Pemphigoid group (Subepidermal).

What are the Target proteins in Intraepidermal Immunobullous Disorders (Pemphigus group)?

Desmosomes.

What is the Target Antigen in Pemphigus foliaceus?

Desmoglein-1 (DSG-1).

What is the Target Antigen in Pemphigus vulgaris?

Desmoglein-3 (DSG-3).

If DSG-1 and DSG-3 are Both Targets, what occurs?

Both skin and mucosa are affected.

Where is the Split / Layer located in Pemphigus Vulgaris?

Stratum spinosum.

Where is the Split / Layer located in Pemphigus Foliaceus?

Sub corneal layer (Stratum Granulosum).

What is Nikolsky's sign?

Development of bulla or erosion when a shearing force is applied on the skin surrounding a vesicle or bulla.

What is Bulla spread sign?

Bulla spreads over its margin when pressure is applied laterally.

What are Acantholytic Cell Characteristics?

Round to oval shape, large nuclei (½ of cell surface), peripheral condensation of cytoplasm.

What patterns of fluorescence occur in Direct immunofluorescence for Pemphigus disorders?

Fluorescence passes between keratinocytes: Fishnet pattern.

What is another name for Endemic PF?

Fogo Selvageum.

In Endemic PF, where is the common location?

Brazilian Pemphigus.

What Antigens are present in Paraneoplastic Pemphigus?

DSG 1 and DSG 3, Desmoplakin 1 and 2, Envoplakin, Periplakin, 230 kDa bullous pemphigoid (BP) antigen 1.

What are the key features of Systemic Connective Tissue Disorders?

Autoimmune inflammation, skin manifestations, internal organ manifestations, autoantibodies on laboratory investigations.

List features of LE Spectrum

Acute cutaneous LE, Subacute cutaneous LE, Chronic cutaneous LE/DLE.

What is ACLE associated with?

Systemic Lupus Erythematosus (SLE).

What is another name for Chronic Cutaneous LE/DLE?

Discoid Lupus Erythematosus.

What are Signs of DLE?

Photosensitivity, Cat's Tongue/Carpet Tack/Tin Tack sign.

What causes Neonatal LE?

It is caused by Transplacental passage of maternal antibodies.

What are Gottron's Papule?

Erythematous to violaceous raised papules on interphalangeal joint, distal interphalangeal joint and Metacarpophalangeal joint.

What are Gottron's signs?

Confluent macular violaceous erythema (bilateral) present in Interphalangeal spaces and Dorsum of hands.

What other features are present in Dermatomyositis?

Heliotrope rash, V-sign, Shawl sign, Holster sign, Calcinosis, Mechanic's hand.

What autoantibody is positive in Limited cutaneous Systemic sclerosis?

Anticentromere antibody.

What clinical features are present in Systemic Sclerosis/Scleroderma?

Loss of wrinkling, Mask-like appearance, skin appears shiny, restricted mouth opening, Telangiectasias, furrowing along the oral commissure.

What is the Earliest sign of Vitamin A Deficiency?

Night blindness.

In Vitamin B3 (Nicotinic Acid, Nicotinamide, Niacin) deficiency, what is Dermatitis present on neck, appearing like a necklace known as?

Cassal's necklace.

What is the defective protein in Acrodermatitis Enteropathica (congenital)?

ZIP4 transporter protein is defective.

What are the clinical features of Acrodermatitis Enteropathica?

Dermatitis, Diarrhoea, Alopecia.

Clinical Features of Granuloma Annulare?

Annular lesions with normal clear centre, no scaling/crusting, smooth overlying surface, periphery is raised due to granulomas.

What organs are affected in Sarcoidosis?

Pulmonary, Peripheral lymph nodes, Skin, Eyes: Uveitis.

What are the characteristics of Specific Cutaneous Sarcoidosis lesions?

Red-brown papule with normal surface.

What is Lupus pernio?

Red papules with normal surface present on nose and cheeks along with Telangiectasias

What causes the Pathogenesis of Acanthosis Nigricans?

Increased production of IGF-1 (Insulin like growth factor 1).

What malignancy is Sudden eruption of seborrheic keratosis on the trunk/face of the patient (Sign of Leser-Trelat) associated with?

Adenocarcinoma of GIT and Carcinoma of breast.

What illness is Migratory Erythema associated with?

Lung cancer.

What illness is Necrolytic Migratory Erythema associated with?

Glucagon-secreting alpha-cell tumour of the pancreas.

What are the key Skin features of Henoch Schonlein Purpura (HSP)?

Palpable purpura on lower legs and buttocks which are usually painful.

What conditions are associated with Pyoderma Gangrenosum?

IBD, Rheumatoid arthritis, haematological malignancy or monoclonal gammopathy.

What are the key clinical findings in Behcet's Disease?

Relapsing uveitis, Recurring genital ulcers, Recurring oral ulcers.

What are the most common triggers for Erythema Nodosum?

Tuberculosis, Sarcoidosis, Crohn's disease.

How does Erythema induratum of bazin differ from Erythema Nodosum?

Is present in posterior calves, associated with overlying ulceration and crusting, a form of Tuberculid.

What is another name for Reactive Arthritis?

Reiter's disease.

What is the difference between Hyperpigmented disorder and Hypopigmentary disorder?

Hyperpigmented disorder: Increase in pigmentation and Hypopigmentary disorder: Decrease in pigmentation or little loss of pigmentation.

How many different types of skin are there in Fitzpatrick classification of the skin type?

Six (I-Very Fair to VI-Black).

No Tyrosinase is synthesized in the body, what albinism is this?

Tyrosinase negative type OCA (TNA).

What mutations occur in Piebaldism?

KIT gene on chromosome 14.

What phenomenon occurs in Vitiligo?

Koebner's phenomenon.

What genetic factors in the Vitiligo?

Catalase gene.

What may cause Chemical Leukoderma?

Rubber chappals.

What are Bindi dermatitis caused by?

Adhesive used in Bindi (Para Tertiary Butyl phenol (PTBP)).