Derm Lecture 2

What is the name of the structure that connects keratinocytes together throughout the epidermis?

Desmosomes

What is the name of the structure that anchors the basal keratinocytes of the epidermis to the basement membrane?

Hemidesmosomes

What the 3 major mechanism steps for SJS/TEN?

1. Massive keratinocyte apoptosis

2. Epidermal necrosis

3. Epidermal detachment & shedding

What is the target protein of pemphigus vulgaris

Desmogleins

What is the target protein of Bullous Pemphigoid

Hemidesmosomes

What kind of biopsy is useful for bullous or desquamating disorders?

Punch biopsy for full thickness

Why would direct immunofluroescence be an important diagnostic in bullous disease?

To detect autoantibody deposition

e.g. bullous pemphigoid and pemphigus vulgaris

What viruses cause erythema multiforme?

HSV

EBV

Mycoplasma pneumoniae

S. pneumoniae

Cytomegalovirus

What medications can cause Erythema Multiforme?

Sulfornamides

NSAIDS

Beta lactams

Anticonvulsants

What areas of the body are commonly affected by Erythema Multiforme?

Hands feet elbows knees and mucus membranes

What differentiates minor vs major erythema multiforme?

Mucosal involvement

Treatement for Erythema Multiforme?

Do nothing! Spontaneous remission in 2 weeks

Treat underlying vause

Oral and topical corticosteroids and include lidocaine + diphenhydramine for oral lesions

Systemic corticosteroids if severe

SJS/TEN Drug inducers (ANALS)

Allopurionol

NSAIDS

Anticonvulsants

Sulfonamide

What are the prodromal symptoms assoc with SJS/TEN?

1-3 days prior to lesions

Headache

Fever

Malaise

Rhinorrhea

Odynophagia

Dysuria

What kind of burn has no initial blisters

Superficial thickness

What kind of burn bleeds upon touch?

Deep partial burn

Describe a full thickness burn

White-yellow or black in color

Loss of adnexal structures

Vessels and nerves destroyes

Loss of sensation

What is Parklands Formula for Burns?

(4mL)(body wt in kg)(%BSA burned)

Healing for superficial burn

5-10 days w no scar

Healing of Superficial partial thickness burn

10-21 days w minimum scarring

Healing of Deep partial burn

25-60 days w significant scar and contractures

Skin grafting often needed

What are common secondary bacterial infections after a burn?

Negative Staph

MRSA

P. aeruginosa