Bullous & Pigmented Skin Lesions – Flashcards
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Bullous Pemphigoid -Epidemiology -typically disease of the ___ , onset after __ years old -approx __-__new cases per million population -very ___ in children -risk increases ___ -fold in pts>__ yrs old -significant association in Caucasians with DQB1*0301 alleles -no geographic predilection of disease
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Bullous Pemphigoid -Epidemiology -typically disease of the elderly, onset after 60 years old -approx 6-7 new cases per million population -very rare in children -risk increases 300-fold in pts>90 yrs old -significant association in Caucasians with DQB1*0301 alleles -no geographic predilection of disease
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Bullous Pemphigoid Pathophysiology -this immune mediated disease is associated with a humoral and cellular response directed against 2 antigens: BP antigen 180 and BP antigen 230 -these are adhesion complexes promoting epithelial-stromal adhesion in skin and mucous membranes
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Bullous Pemphigoid Pathophysiology -this immune mediated disease is associated with a humoral and cellular response directed against 2 antigens: BP antigen 180 and BP antigen 230 -these are adhesion complexes promoting epithelial-stromal adhesion in skin and mucous membranes
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BP Clinical features -Non bullous: can be extremely polymorphic, non specific with mild to severe pruritis alone or with excoriated eczematous papular and/or urticarial lesions which persist for weeks to months -Bullous: Tense vesicles and bullae on normal or erythematous skin with urticarial and infiltrated papules and plaques
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BP Clinical features -Non bullous: can be extremely polymorphic, non specific with mild to severe pruritis alone or with excoriated eczematous papular and/or urticarial lesions which persist for weeks to months -Bullous: Tense vesicles and bullae on normal or erythematous skin with urticarial and infiltrated papules and plaques
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BP Associated Disease -In some cases, association of malignancy is reported (digestive tract, bladder and lung cancer) -tumor screening is suggested in atypical presentations such as in a middle aged patient -other autoimmune diseases: RA, Hashimoto's thyroiditis, dermatomyositits, SLE (lupus)
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BP Associated Disease -In some cases, association of malignancy is reported (digestive tract, bladder and lung cancer) -tumor screening is suggested in atypical presentations such as in a middle aged patient -other autoimmune diseases: RA, Hashimoto's thyroiditis, dermatomyositits, SLE (lupus)
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BP Differential Diagnosis -Lots! Non bullous (non specific presentation): drug reactions, contact dermatitis, urticaria, vasculitis, scabies Bullous: porphyria cutanea tarda, pompholyx, bullous impetigo
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BP Differential Diagnosis -Lots! Non bullous (non specific presentation): drug reactions, contact dermatitis, urticaria, vasculitis, scabies Bullous: porphyria cutanea tarda, pompholyx, bullous impetigo
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BP Diagnosis -based on clinical presentation, histological features, and most importantly, positive findings of direct and indirect immunofuorescence (IF) microscopy studies -Direct IF of perilesional skin reveals: linear continuous deposits of IgG at epidermal basement membrane zone
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BP Diagnosis -based on clinical presentation, histological features, and most importantly, positive findings of direct and indirect immunofuorescence (IF) microscopy studies -Direct IF of perilesional skin reveals: linear continuous deposits of IgG at epidermal basement membrane zone
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BP Treatment -Grounded more on clinical experience than controlled studies -Systemic corticosteroids is best validated treatment: oral prednisone 0.5mg/kg/day usually controls disease within 1-2 weeks, dose is tapered over 6-9 months -Topical Steroids (Clobetasol): for localize/mild forms, fewer systemic SEs -Immunosuppresants: debatable (Azathioprine, cyclophosphamide, methotrexate) all quite toxic -Tetracyclines (minocycline, doxycycline) have been used
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BP Treatment -Grounded more on clinical experience than controlled studies -Systemic corticosteroids is best validated treatment: oral prednisone 0.5mg/kg/day usually controls disease within 1-2 weeks, dose is tapered over 6-9 months -Topical Steroids (Clobetasol): for localize/mild forms, fewer systemic SEs -Immunosuppresants: debatable (Azathioprine, cyclophosphamide, methotrexate) all quite toxic -Tetracyclines (minocycline, doxycycline) have been used
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Epidermoid Cysts -Epidermoid/Infundibular/Inclusion cysts -common cutaneous lesions -can be classified by anatomic location (as they occur in virtually any organ, or histologically) -true cysts have epithelial lining or casing which if not removed almost always recur -only true sebaceous cyst is the steatocystoma (from sebaceous duct)
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Epidermoid Cysts -Epidermoid/Infundibular/Inclusion cysts -common cutaneous lesions -can be classified by anatomic location (as they occur in virtually any organ, or histologically) -true cysts have epithelial lining or casing which if not removed almost always recur -only true sebaceous cyst is the steatocystoma (from sebaceous duct)
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Epidermoid Cysts -Histologic examination shows a cystic cavity filled with laminated keratin lined by a stratified squamous epithelium -surrounding inflammatory response with both acute and chronic granulomatous inflammation is seen in previous ruptures -Tell patients not to squeeze their cysts! (Can lead to infection and sets up inflammatory reaction)
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Epidermoid Cysts -Histologic examination shows a cystic cavity filled with laminated keratin lined by a stratified squamous epithelium -surrounding inflammatory response with both acute and chronic granulomatous inflammation is seen in previous ruptures -Tell patients not to squeeze their cysts! (Can lead to infection and sets up inflammatory reaction)
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Signs and Symptoms and PE of Epidermoid Cysts -Well demarcated dermal nodules and may have visible central punctum from follicle where cyst is derived -multiple cysts may occur in setting of Gardern's syndrome (familial adenomatous polyposis) -if ruptured, the sebum (cholesterol, fat, and sometimes infection) smells
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Signs and Symptoms and PE of Epidermoid Cysts -Well demarcated dermal nodules and may have visible central punctum from follicle where cyst is derived -multiple cysts may occur in setting of Gardern's syndrome (familial adenomatous polyposis) -if ruptured, the sebum (cholesterol, fat, and sometimes infection) smells
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Treatment of Cysts -If treatment is desired, excision is curative -if entire cyst wall is not removed, the cyst may recur -inflamed epidermoid cysts may require I&D, and occasionally antibiotic therapy -Intralesional triamcinolone (steroid) may be helpful in speeding resolution
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Treatment of Cysts -If treatment is desired, excision is curative -if entire cyst wall is not removed, the cyst may recur -inflamed epidermoid cysts may require I&D, and occasionally antibiotic therapy -Intralesional triamcinolone (steroid) may be helpful in speeding resolution
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Milia -small epidermoid cysts and are quite common, occuring at all ages of life -presenting Signs and Symptoms: 1-2 mm white to yellow subepidermal papules -40-50% of infants will have milia, most commonly on face -most resolves spontaneously in newborns in first 4 weeks -can also occur in areas of topical corticosteroid induced atrophy
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Milia -small epidermoid cysts and are quite common, occuring at all ages of life -presenting Signs and Symptoms: 1-2 mm white to yellow subepidermal papules -40-50% of infants will have milia, most commonly on face -most resolves spontaneously in newborns in first 4 weeks -can also occur in areas of topical corticosteroid induced atrophy
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Milia Pathology -Small epidermoid cysts with stratified squamous epithelial lining including a granular layer and laminated keratin content
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Milia Pathology -Small epidermoid cysts with stratified squamous epithelial lining including a granular layer and laminated keratin content
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Milia Treatment -incising epidermis over millum with a needle, scalpel, or lance (can be aided by comedone extractor) -for adult pts, topical retinoids are quite helpful in reducing number of milla
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Milia Treatment -incising epidermis over millum with a needle, scalpel, or lance (can be aided by comedone extractor) -for adult pts, topical retinoids are quite helpful in reducing number of milla
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Lipomas -benign tumors of mature fat -most common neoplasms in humans -more often solitary than multiple, size from 1cm to several inches
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Lipomas -benign tumors of mature fat -most common neoplasms in humans -more often solitary than multiple, size from 1cm to several inches
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Epidemiology of Lipomas -occur at any age, most commonly beyond 4th decade -most studies report higher incidence in males, but equal in all races
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Epidemiology of Lipomas -occur at any age, most commonly beyond 4th decade -most studies report higher incidence in males, but equal in all races
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Pathogenesis of Lipomas -vast majority are incidental, and little is known how they occur -Occassionally there is a hereditary component -incident is increased in overweight individuals, diabetics, and pts with hypercholesterolemia
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Pathogenesis of Lipomas -vast majority are incidental, and little is known how they occur -Occassionally there is a hereditary component -incident is increased in overweight individuals, diabetics, and pts with hypercholesterolemia
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Differential of Lipomas -often mistaken for epidermoid cysts or other benign fatty tumors (hibernomas)
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Differential of Lipomas -often mistaken for epidermoid cysts or other benign fatty tumors (hibernomas)
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Treatment of Lipomas -solitary lipomas are easily excised as they are sharply circumscribed and can be shelled out -Larger lesions or systemic lipomatoses may be amenable to liposuction
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Treatment of Lipomas -solitary lipomas are easily excised as they are sharply circumscribed and can be shelled out -Larger lesions or systemic lipomatoses may be amenable to liposuction
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What is the Synonym for Neurofibromatosis?
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Von Recklinghausen's disease
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Neurofibromatosis (NF1) -Epidemiology -reported around the world -autosomal dominant disorder that affects approx 1 in 3000 individuals -as many as 50% of cases of NF1 may represent spontaneous mutations rather than inherited germline mutations
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Neurofibromatosis (NF1) -Epidemiology -reported around the world -autosomal dominant disorder that affects approx 1 in 3000 individuals -as many as 50% of cases of NF1 may represent spontaneous mutations rather than inherited germline mutations
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NF1 Pathophysiology -although autosomal dominant, there is variable expressivity among families -specific mutation that is inherited is not predictive of phenotype -recent work in mice suggests that a complex genetic interaction exists between neoplastic Schwann cells and non-neoplastic stromal tissue
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NF1 Pathophysiology -although autosomal dominant, there is variable expressivity among families -specific mutation that is inherited is not predictive of phenotype -recent work in mice suggests that a complex genetic interaction exists between neoplastic Schwann cells and non-neoplastic stromal tissue
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NF1 Clinical Featuers -Characterized by cafe-au-lait macules, neurofibromas, freckling in the axillae and groin, and bony defects -can develop various interal tumors, optic gliomas, malignant peripheral nerve sheath tumors, pheochromocytomas and juvenline CML
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NF1 Clinical Featuers -Characterized by cafe-au-lait macules, neurofibromas, freckling in the axillae and groin, and bony defects -can develop various interal tumors, optic gliomas, malignant peripheral nerve sheath tumors, pheochromocytomas and juvenline CML
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Diagnosis of Neurofibromatosis Two or more of the following: -6 or more cafe au lait spots 1.5 cm or larger in post-pubertal individuals, 0.5cm in pre-pubertal individuals -2 or more neurofibromas of any type or one or more plexiform neurofibroma -freckling in the axilla or groin -optic glioma (tumor of the optic pathway) -two or more Lisch nodules (benign iris hamartomas) -a distinctive bony lesion: dysplasia of sphenoid bone or dysplasia or thinning of long bone cortex -first degree relative with NF1
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Diagnosis of Neurofibromatosis Two or more of the following: -6 or more cafe au lait spots 1.5 cm or larger in post-pubertal individuals, 0.5cm in pre-pubertal individuals -2 or more neurofibromas of any type or one or more plexiform neurofibroma -freckling in the axilla or groin -optic glioma (tumor of the optic pathway) -two or more Lisch nodules (benign iris hamartomas) -a distinctive bony lesion: dysplasia of sphenoid bone or dysplasia or thinning of long bone cortex -first degree relative with NF1
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Treatment of Neurofibromatosis -Requires a multidisciplinary approach -physical exam should include a complete assessment of skin and eyes -lab tests, including radiological tests should be directed towards symptoms -surgical excision, laser ablation are used to remove CNF (cutaneous neurofibromas) and CALMS (cafe au lait macules)
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Treatment of Neurofibromatosis -Requires a multidisciplinary approach -physical exam should include a complete assessment of skin and eyes -lab tests, including radiological tests should be directed towards symptoms -surgical excision, laser ablation are used to remove CNF (cutaneous neurofibromas) and CALMS (cafe au lait macules)
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Hidradenitis Suppuritiva -poral occlusion of pilosebaceous units with intertriginous zones (where skin rubs together), especially axillary and anogenital regions -secondary inflammation of apocrine glands -inflamed nodules and sterile abscesses are followed by sinus tracts, fistulas, and hypertrophic scars
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Hidradenitis Suppuritiva -poral occlusion of pilosebaceous units with intertriginous zones (where skin rubs together), especially axillary and anogenital regions -secondary inflammation of apocrine glands -inflamed nodules and sterile abscesses are followed by sinus tracts, fistulas, and hypertrophic scars
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What are the 4 parts of the Follicular Occlusion Tetrad
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Acne conglobata, hidradenitis suppuritiva, dissecting cellulitis of scalp, and pilonidal sinus
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Epidemiology of Hidradenitis Suppuritiva -HS starts soon after puberty; children nver affected unless precocious puberty -women 3x more often affected than men -people of African descent have a higher incidence than those of European -autosomal dominant inheritance has been proposed but not proven
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Epidemiology of Hidradenitis Suppuritiva -HS starts soon after puberty; children nver affected unless precocious puberty -women 3x more often affected than men -people of African descent have a higher incidence than those of European -autosomal dominant inheritance has been proposed but not proven
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Pathology of HS -heavy mixed inflammatory cells infiltrate lower half of dermis -abscesses are present in active cases and may connect with sinus tracts leading to skin surface -chronic cases there may be extensive fibrosis with destruction of pilosebaceous follicles and sweat glands
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Pathology of HS -heavy mixed inflammatory cells infiltrate lower half of dermis -abscesses are present in active cases and may connect with sinus tracts leading to skin surface -chronic cases there may be extensive fibrosis with destruction of pilosebaceous follicles and sweat glands
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Differential Diagnosis of HS -Initially may resemble a staphylococcal furunculosis, but the latter usually has central pointing or ulceration and usually does not form sinus tracts
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Differential Diagnosis of HS -Initially may resemble a staphylococcal furunculosis, but the latter usually has central pointing or ulceration and usually does not form sinus tracts
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Clinical Features of HS -initially inflammatory nodules and sterile abscesses develop in axillae, groin, perianal and inframammary areas -can be very tender and painful -chronic drainage, marked frustration, embarrassment, self consciousness -discharged fluid is oftex a mixture of serous, exudate, blood and pus in varying proportions
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Clinical Features of HS -initially inflammatory nodules and sterile abscesses develop in axillae, groin, perianal and inframammary areas -can be very tender and painful -chronic drainage, marked frustration, embarrassment, self consciousness -discharged fluid is oftex a mixture of serous, exudate, blood and pus in varying proportions
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HS Treatment -many are successful some of the time, but none successful all the time -Weight reduction if pt is overweight (reduces friction and moisture) -Absorbent powder (Ammens, Gold Bond) -Antiseptic soaps (Gold Dial Bar Soap) -Topical AlCl (keeps things dry) -Triamcinolone 5mg/ml intralesionally -topical clindamycin (evoclin foam)-works very well -systemic corticosteroids often lead to dramatic improvement, but flares occur when stopped
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HS Treatment -many are successful some of the time, but none successful all the time -Weight reduction if pt is overweight (reduces friction and moisture) -Absorbent powder (Ammens, Gold Bond) -Antiseptic soaps (Gold Dial Bar Soap) -Topical AlCl (keeps things dry) -Triamcinolone 5mg/ml intralesionally -topical clindamycin (evoclin foam)-works very well -systemic corticosteroids often lead to dramatic improvement, but flares occur when stopped
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Albinism=group of genetic alterations of melanin pigment system that affects skin, hair, follicles, and eyes
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Albinism=group of genetic alterations of melanin pigment system that affects skin, hair, follicles, and eyes
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Epidemiology of Albinism -present at birth, 1:20,000 -Race: Hispanics from Puerto Rico, Dutch origin, East Indians from Madras -several different classifications: OCA1, OCA1G, OCA2-based on different genetic pathways
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Epidemiology of Albinism -present at birth, 1:20,000 -Race: Hispanics from Puerto Rico, Dutch origin, East Indians from Madras -several different classifications: OCA1, OCA1G, OCA2-based on different genetic pathways
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Pathology of Albinism -Defect in melanin synthesis resulting from absence of activity of tyrosinase -Tyrosinase is a copper containing enzyme that catalyzes oxidation of tyrosine to dopa, then deyhdrogenation of dopa to dopa-quinione
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Pathology of Albinism -Defect in melanin synthesis resulting from absence of activity of tyrosinase -Tyrosinase is a copper containing enzyme that catalyzes oxidation of tyrosine to dopa, then deyhdrogenation of dopa to dopa-quinione
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Signs/Symptoms of Albinism -"Poring" eyes half closed, squinting in sunlight -Skin: snow white to creamy white, tan -Hair: white (tyrosinase-negative), yellow, cream or light brown (tyrosinase-positive) -Eyes: findings that permit diagnosis: nystagmus (twitching of eye at extreme position) is always present, with iris translucency
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Signs/Symptoms of Albinism -"Poring" eyes half closed, squinting in sunlight -Skin: snow white to creamy white, tan -Hair: white (tyrosinase-negative), yellow, cream or light brown (tyrosinase-positive) -Eyes: findings that permit diagnosis: nystagmus (twitching of eye at extreme position) is always present, with iris translucency
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Albinism Diagnostics: Not necessarily needed to diagnose Management: Eye- under care of ophthalmologist Skin- yearly exams by dermatologist to detect solar kerastoses, skin cancer, and dermatoheliosis -Potent broad spectrum SPF>30 and lip blocks -avoidance of sun exposure in high intensity season -use of topical tretinoin for dermatoheliosis (photoaging)
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Albinism Diagnostics: Not necessarily needed to diagnose Management: Eye- under care of ophthalmologist Skin- yearly exams by dermatologist to detect solar kerastoses, skin cancer, and dermatoheliosis -Potent broad spectrum SPF>30 and lip blocks -avoidance of sun exposure in high intensity season -use of topical tretinoin for dermatoheliosis (photoaging)
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Treatment of Albinism -Systemic: Beta-carotene 30-60mg tid imparts a more normal color to skin and provides some protection in skin cancer development (only proven in mice)
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Treatment of Albinism -Systemic: Beta-carotene 30-60mg tid imparts a more normal color to skin and provides some protection in skin cancer development (only proven in mice)
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Epidemiology of Vitilgo -can be at any age, 50% of cases begins between 10-30 yrs old -occurs equally in both sexes -races: all races, more prominent in darker skinned person -Incidence: common, up to 1% of population -Appears to be an inherited disease, >30% reported disease in parent, sibling or child
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Epidemiology of Vitilgo -can be at any age, 50% of cases begins between 10-30 yrs old -occurs equally in both sexes -races: all races, more prominent in darker skinned person -Incidence: common, up to 1% of population -Appears to be an inherited disease, >30% reported disease in parent, sibling or child
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Pathophysiology of Vitiligo -Autoimmune theory holds that selected melanocytes are destroyed by certain lymphocytes that are activated internally -neuogenic hypothesis: interaction between melanocytes and nerve cells -Self destruct hypothesis: melanocytes are destroyed by toxic substances in melanin biosynthesis
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Pathophysiology of Vitiligo -Autoimmune theory holds that selected melanocytes are destroyed by certain lymphocytes that are activated internally -neuogenic hypothesis: interaction between melanocytes and nerve cells -Self destruct hypothesis: melanocytes are destroyed by toxic substances in melanin biosynthesis
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Signs/Symptoms -Chalky, pale white macules from several mm to several cm -round, oval, elongated lesions, -Koebner phenomenon: induction of depigmentation by physical trauma (occurs along lines of trauma) -lesions can occur anywhere -Associated findings: white hair and premature gray hair, alopecia areata, and halo nevi
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Signs/Symptoms -Chalky, pale white macules from several mm to several cm -round, oval, elongated lesions, -Koebner phenomenon: induction of depigmentation by physical trauma (occurs along lines of trauma) -lesions can occur anywhere -Associated findings: white hair and premature gray hair, alopecia areata, and halo nevi
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Vitiligo -not uncommonly associated with thyroid disease (up to 30% in all cases) Differential: Pityriasis alba (slight scaling, fuzzy margins, off white color), pityriasis versicolor, chemical leukoderma, idiopathic guttate hypomelanosis Diagnosis: based on clinical exam, but can do biopsy to prove
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Vitiligo -not uncommonly associated with thyroid disease (up to 30% in all cases) Differential: Pityriasis alba (slight scaling, fuzzy margins, off white color), pityriasis versicolor, chemical leukoderma, idiopathic guttate hypomelanosis Diagnosis: based on clinical exam, but can do biopsy to prove
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Vitiligo -Chronic disease that has no cure -Treatment: sunscreens, cosmetic coverups -topical glucoocorticoids (4 weeks on, 2 weeks off) -oral PUVA: for widespread disease, 5-methoxysporalen and sunlight -Bleaching agents: hydroquinone 20% cream
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Vitiligo -Chronic disease that has no cure -Treatment: sunscreens, cosmetic coverups -topical glucoocorticoids (4 weeks on, 2 weeks off) -oral PUVA: for widespread disease, 5-methoxysporalen and sunlight -Bleaching agents: hydroquinone 20% cream
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Seborrheic Keratosis (SK) Key Features: -very common brown macules, papules, plaques typically affecting individuals over 30 yo -often appear verrucous or "stuck on" -predilection for face, neck, and trunk -rare sign of Leser-Trelat, striking proliferation or incresae in size and # of SKs may be a marker for internal malignancy
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Seborrheic Keratosis (SK) Key Features: -very common brown macules, papules, plaques typically affecting individuals over 30 yo -often appear verrucous or "stuck on" -predilection for face, neck, and trunk -rare sign of Leser-Trelat, striking proliferation or incresae in size and # of SKs may be a marker for internal malignancy
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Epidemiology of SKs -appears to be a familial predisposition -probable autosomal dominant -few stats on prevalance, sexual predilection, race or geographic distrivution -some sources state a risk factor is sunligh and higher prevalance in sun exposed areas
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Epidemiology of SKs -appears to be a familial predisposition -probable autosomal dominant -few stats on prevalance, sexual predilection, race or geographic distrivution -some sources state a risk factor is sunligh and higher prevalance in sun exposed areas
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Pathophysiology of SKs -Six histologic types (acanthotic, hyperkeratotic, reticulated, clonal, irritated, and melanoacathoma (only for dermpath or insurance purposes)) -base of lesion lies on a flat horizontal plane flanked by normal epidermis on other side
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Pathophysiology of SKs -Six histologic types (acanthotic, hyperkeratotic, reticulated, clonal, irritated, and melanoacathoma (only for dermpath or insurance purposes)) -base of lesion lies on a flat horizontal plane flanked by normal epidermis on other side
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Differential Diagnosis of SKs -Although quite easily identified, different diagnoses include: acrochrodn, verruca vulgaris, condyloma acuminatum, Bowen's disease, solar lentigo, and melanoma
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Differential Diagnosis of SKs -Although quite easily identified, different diagnoses include: acrochrodn, verruca vulgaris, condyloma acuminatum, Bowen's disease, solar lentigo, and melanoma
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Treatment of SKs 0largely done for cosmesis -when associated with bleeding, pruritis or inflammation, removal is appropriate -cryosurgery, electrodessication, CO2 laser ablation -shave excision when much larger than 1-2 cm and thick
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Treatment of SKs 0largely done for cosmesis -when associated with bleeding, pruritis or inflammation, removal is appropriate -cryosurgery, electrodessication, CO2 laser ablation -shave excision when much larger than 1-2 cm and thick
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Skin Tags -Synonyms: Acrochordon, fibroepithelial poly, soft fibroma
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Skin Tags -Synonyms: Acrochordon, fibroepithelial poly, soft fibroma
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Skin Tags 0most common fibrous lesion of skin; men and women equally affected -close to 50% of people have at least 1 -presents as soft, skin colored to slightly hyperpigmented pedunculated papule (like a little stalk) -very common on neck, axilla, groin -single to multiple, from 1-2 mm to 1-2 cm baggy polpys which can become irritated or infarct
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Skin Tags 0most common fibrous lesion of skin; men and women equally affected -close to 50% of people have at least 1 -presents as soft, skin colored to slightly hyperpigmented pedunculated papule (like a little stalk) -very common on neck, axilla, groin -single to multiple, from 1-2 mm to 1-2 cm baggy polpys which can become irritated or infarct
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Pathology of Skin Tags -polpoid growth or variably loose to dense collagenous stroma with thin walled dilated blood vessels in center
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Pathology of Skin Tags -polpoid growth or variably loose to dense collagenous stroma with thin walled dilated blood vessels in center
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Treatment for Skin Tags -unless irritated or infarcted, more of a cosmetic issue -simple scissor excision, electrodessication, or cryosurgery
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Treatment for Skin Tags -unless irritated or infarcted, more of a cosmetic issue -simple scissor excision, electrodessication, or cryosurgery
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Capillary Hemangioams -Most common soft tissue tumor of infancy -benign endothelial cell neoplasms -demonstrate a typical growth pattern characterized by early proliferation followed by gradual, spontaneous involution -Treatment, if any, depends on multiple factors and must be tailored to each individual patient
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Capillary Hemangioams -Most common soft tissue tumor of infancy -benign endothelial cell neoplasms -demonstrate a typical growth pattern characterized by early proliferation followed by gradual, spontaneous involution -Treatment, if any, depends on multiple factors and must be tailored to each individual patient
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Infantile Hemangiomas -Clinical: usually absent at birth (often precursor lesion present), rapid proliferation -Epidemiology: more common in girls 3-5:1, premature infants, infants of mother post chorionic villus sampling
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Infantile Hemangiomas -Clinical: usually absent at birth (often precursor lesion present), rapid proliferation -Epidemiology: more common in girls 3-5:1, premature infants, infants of mother post chorionic villus sampling
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Pathology of Hemangiomas -Proliferating: endothelial cell hyperplasia, lobule formation, mast cells, prominent basement membrane -Involuting: fibrofatty tissue replacement, decreased mast cells
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Pathology of Hemangiomas -Proliferating: endothelial cell hyperplasia, lobule formation, mast cells, prominent basement membrane -Involuting: fibrofatty tissue replacement, decreased mast cells
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Hemangiomas -Vascular birthmarks are divided into 2 broad categories: vascular tumors and vascular malformations -Vascular malformations are usually evident at birth, have slow expansion, proportionate to growth and persis to adulthood; no gender or gestation predilection
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Hemangiomas -Vascular birthmarks are divided into 2 broad categories: vascular tumors and vascular malformations -Vascular malformations are usually evident at birth, have slow expansion, proportionate to growth and persis to adulthood; no gender or gestation predilection
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Treatment of Hemangiomas -Major goals of treatment: -preventing or reversing life or function-threatening complications -treating ulcerations (loss of blood supply) -preventing permanent disfigurement -minimizing psychosocial distress to pts and family -avoiding overly aggressive potentially scarring procedures -some treatments have been early surgery, extensive cryosrugery, corticosteroids, intralesional corticosteroids and benign neglect -Propanolol used for treatment since 2008
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Treatment of Hemangiomas -Major goals of treatment: -preventing or reversing life or function-threatening complications -treating ulcerations (loss of blood supply) -preventing permanent disfigurement -minimizing psychosocial distress to pts and family -avoiding overly aggressive potentially scarring procedures -some treatments have been early surgery, extensive cryosrugery, corticosteroids, intralesional corticosteroids and benign neglect -Propanolol used for treatment since 2008
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Keloids Key features: normal scares are preced by injury, immediate at onset, flat and asymptomatic -hypertrophic scars are raised and confined to wound margin. They have a good response to treatment -Keloids extend beyond wound margin and are delayed in onset. They seldom resolve spontaneously, and their response to treatment is often poor. -hypertrophic scar formation
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Keloids Key features: normal scares are preced by injury, immediate at onset, flat and asymptomatic -hypertrophic scars are raised and confined to wound margin. They have a good response to treatment -Keloids extend beyond wound margin and are delayed in onset. They seldom resolve spontaneously, and their response to treatment is often poor. -hypertrophic scar formation
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Epidemiology of Keloids -Occur worldwide in all skin types -higher risk in darker pigmented people -incidence as high as 16% in african american population -women=men although women get more earlobe keloids -Pathogenesis: unknown -complex hierarchy of events, give rise to wound healing misadventure
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Epidemiology of Keloids -Occur worldwide in all skin types -higher risk in darker pigmented people -incidence as high as 16% in african american population -women=men although women get more earlobe keloids -Pathogenesis: unknown -complex hierarchy of events, give rise to wound healing misadventure
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Keloids -Injury occurs, hemostasis is achieved and inflammation is present -neutrophils and macrophages enter synthesis and remodel via fibrin and platelet deposition along with degranulation -at some point, inflammation and remodeling are hyperactive leading to Keloids
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Keloids -Injury occurs, hemostasis is achieved and inflammation is present -neutrophils and macrophages enter synthesis and remodel via fibrin and platelet deposition along with degranulation -at some point, inflammation and remodeling are hyperactive leading to Keloids
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Treatment of Keloids -Clinical Pictures is distinctive -Treatment is often ineffective -Intralesional corticosteroids are most commonly used: Triamcinolone 0.1% 20-40mg, injected over 4 sessions for scars 1-2cm -Pulsed dye laser therapy (PDL): decreases redness and flattens lesions -Surgery (recurrence is in excess of 80%) -Flurouracil (5-FU)
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Treatment of Keloids -Clinical Pictures is distinctive -Treatment is often ineffective -Intralesional corticosteroids are most commonly used: Triamcinolone 0.1% 20-40mg, injected over 4 sessions for scars 1-2cm -Pulsed dye laser therapy (PDL): decreases redness and flattens lesions -Surgery (recurrence is in excess of 80%) -Flurouracil (5-FU)
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Pigmented Lesions -In persons of color (hyperpigmentation related to chronic conditions such as psoriasis or eczema) -sometimes difficult to diagnose -can get melanoma, actually more likely to die from it since many people don't realize they have it -venous lakes (blood moles) often are mistaken for melanoma -Dermoscopy significantly reduces examination of skin lesions in black people
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Pigmented Lesions -In persons of color (hyperpigmentation related to chronic conditions such as psoriasis or eczema) -sometimes difficult to diagnose -can get melanoma, actually more likely to die from it since many people don't realize they have it -venous lakes (blood moles) often are mistaken for melanoma -Dermoscopy significantly reduces examination of skin lesions in black people
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Pigmented Lesions in Dark Skin -Although primary plantar melanoma makes up only 5% of all malignant melanomas, its incidence rises to approx 2/3 of all melanomas in black, native american and asian populations
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Pigmented Lesions in Dark Skin -Although primary plantar melanoma makes up only 5% of all malignant melanomas, its incidence rises to approx 2/3 of all melanomas in black, native american and asian populations
