The Motherload Flashcards
What is the innermost layer of the Epidermis?
Stratum basale
What connects the cells together int he stratum spinosum?
Desmosomes
What 3 types of connective titsue are within the dermis?
Collagen
Elastic tissue
Reticular fibers
What later of the dermis is composed of thin, haphazardly arranged collagen fibers?
Papillary layer
What is the arrangement of the collagen in the reticular layer of the dermis?
parallel to the surface of the skin
What are the cells in the dermis that are macrophages that accumulate hemosiderin, melanin, and inflammatory debris?
Histiocytes
What cells in the dermis are arround blood vessels, anad release histamine and heparin?
Mast cells
What types of nerves innvervate the papillary dermis?
Unmyelinated nerve endings
What amplitude of stimulation will cause an itch sensation by inflammation?
Low intensity
A high intensity of stimulation of nerve endings by inflammation will give what sensation?
Pain
This is the type of lesion that most skin diseases begin with, and provides the initial orientation and aloows the formulation of a differnetial diagnosis?
Primary lesion
When do secondayr lesions develop?
During the evolutionary process of skin disease or are created by scrating or infection
What is the type of lesion characterized by a circumscribed flat discoloration that may be brown, blue, red, or hyperpigmented, and is a primary lesion?
Macule
What is the type of lesion characterized by an elevated solid lesion up to 0.5cm, may become confluent?
Papule
What is the type of lesion characterized by an circumscribed, elevated, superficial, solid lesion more than 0.5cm is diameter, and formed by the confluence of papules?
Plaque
What is the type of lesion characterized by a circumscribed, elevated, solid lesion more than 0.5 cm and resides within the dermis?
Nodule
What is the type of lesion characterized by a circumscribed collection of leukocytes and free fluid that varies in size?
Pustule
What is the type of lesion characterized by a circumscribed collection of free fluid up to 0.5cm and involves the superficial epidermis?
Vesicle
What is the type of lesion characterized by a circumscribed collection of free fluid more than 0.5 cm in diameter?
Bullae
What is the type of lesion characterized by a firm, edematous plauqe from infiltration of the dermis with fluid, are tranient and may last only a few hours?
Wheal
aka a hive
What is the type of lesion characterized by excess dead epidermial cells that are produced by abnormal keratinization and shedding?
Scale
What is the type of lesion characterized by a collection of dried serum and cellular debris, aka a scab?
Crust
What is the type of lesion characterized by a focal loss of epidermis, does not penetrate below the dermo-epidermial jxn, and heals without scarring?
Erosion
What is the type of lesion characterized by a focal loss of epidermis and dermis, and heals with scarring?
Ulcer
What is the type of lesion characterized by a LINEAR loss of epidermis and dermis with a sharply defined, nearly vertical walls?
Fissue
What is the type of lesion characterized by a depression in the skin from the thinning of the epidermis or dermis?
Atrophy
What is the type of lesion characterized by an abnormal formation of CT implying dermal damage?
Scar
What is the type of lesion characterized by a circumscribed lesion with a wall and a lumen, and the lumen may contain solid or fluid matter?
Cyst
What are the 2 vehicles for dry disease?
Emollient creams
Lotions
This is an exudative inflammatory disease that pours out serum that leaches the complex lipids and proteins from the epidermis?
Wet disease
In addition to debridement and antibacterials, what also must you do in the managmenet of a wet disease?
Wet compresses to suppress inflammation
You do repeated cycles of wetting and drying for a wet disease because you eventually want a wet lesion to turn into what other kind of lesion?
a DRY lesion
DERMATOLOGY. IS. AMAZING.
This is the vehicle that is a mixture of several different organic chemicals, and water, highly versitile, and has a possible drying effect?
Creams
This is the vehicle that is a limited # of organic compounds consisting primarily of greases (KY jelly) with little to no water.
Ointments
This is the vehicle that is a greaseless mixture of popylene glycol and water and is used for acute exudative inflammation (poison ivy) and on your scalp.
Gels
This is the vehicle that may contain water and other chemicals, used for the scalp.
Solutions/lotions
This is the vehicle that is used between strands of hair until they reach the scalp and then the foam melts and delivers the active drug.
Foams
What does coticosteroids do the small blood vessels in the upper dermis to induce an antiinflammatory response?
Vasoconstriction.
Rate the following cotricosteroids from weakest to strongest activity.
Hydrocortisone Triamcinolone Fluticasone Betamethasone diproprionate Clobestasol Prednisone
Hydrocortisone (weakest) Prednisolone Triamcinolone Betamethasone diproprionate Fluticasone Clobetasol (strongest, group 1)
“Hi Peter, Try Bringing Fucking Cream”
This is the effective method for enhancing absorption of topical steroids by using a plastic dressing or a vinyl body suit.
Occlusion
Why do we always crave the moistness of the skin when delivering topical medication?
It can penetrate the stratum corneum (10-100x) more effectively than dry
If you use a vinyl body suit for the occlusion method, what inevitably happens?
I will laugh at you.
This is the condition where fair-skinned females complain of erythema with or without pustules after the application of topical steroids.
Steroid rosacea
If you get steroid rosacea, what inevitably happens?
I will discontinue the steroid
What did u think I was gonna say? IM NOT A MONSTER
This is when there is pustules, erythema, and scaling around the nose, mouth, and chin because of the application of topical steroids.
Perioral dermatitis
What happens to the dermis and epidermis with long term steroid use?
Thinning of the epidermis
Regression of CT in dermis
(Atrophy)
The atrophy of the skin from long term steroid use may reveal what 3 conditions?
Telangienctasia
Prominence of underlying veins
Hypopigmentation
What may cortisone creams to do the clinical prsentation of diseases?
Alter them and produce unusual atypical eruptions
This is when tinea of the groin spreads to involve a wider area after applying a group II corticosteroid.
Tinea incognito
What is the main Sx in the acute stage of eczematous inflammation?
SUPER ITCH
What are the lesions seen in acute exzemous inflammation?
Vesicles, blisters, intense redness
What causes acute eczematous inflammation?
Poison ivy, irridation, ID reaction, other stuff
This is the form of eczema where there is redness, scaling, fissuring, parchednessingableyed, and a scalded appearance.
Subacute eczematous inflammation
What are the main Sx to Subacute eczematous inflammation?
moderate itching, pain, stinging, burning
What causes Subacute eczematous inflammation?
Contact allergy, irritation, atopic dermititis, stasis dermatitis, other crap
What is the Tx for Subacute eczematous inflammation?
topical steroids with or without occlusion, lube, antihistamines, antibiotics, tar
Does Subacute eczematous inflammation resolve spontaneousy?
Yes, if irritative agent is withdrawn
This is the form of eczema where there is thickened skin, skin lines attenuated, excoriations, and fissuring.
Chronic eczematous inflammation
What is the main Sx in Chronic eczematous inflammation?
Moderate-intense itch
What are the main etiologies for Chronic eczematous inflammation?
Atopic dermatitis, habitual scratiching, lichen simplex chronicus, chapped feet, other eczema stuff.
What is the Tx for Chronic eczematous inflammation?
Topical steroids and other stuff
What are the initial changes to cause irritant contact dermatitis?
Dryness and chapping
What occurs over the creases in irritant contact dermatitis?
Painful cracks and fissues, especially at the fingertips
This is the form of dermatitis on the backs of the hands, where there is erythema, edema, vesiculation, crusting, excoriation, scaling, and lichenification.
Atopic hand dermatitis
What main worsen the Sx in Atopic hand dermatitis?
Scratching
This is the form of dermatitis where there is an area of inflammaton that corresponds exactly to the area covered by the allergen.
Allergic contact dermatitis
This is the form of eczema where there there is red plaques with thin, long, horizontal superficial fissues that appear with excess drying, especially in the winter months.
Asteatoic eczema
This is the form of eczema where there is several coin-shaped plaques on the back of the hands
Nummular eczema
This is the form of self-inflicted dermatoses where there is focal erosions and scars, being crazy and thinking there are parasites, and being a woman over 50.
Psychogenic parasitosis
This is the form of self-inflicted dermatoses where there is random lesions, the pt denies that they did it, from PTSD/depresison/abuse with a “hollow history”
Factitial dermatitis
This is the form of self-inflicted dermatoses where there is repetitive self excoiation, pt knows they do it, OCD/depression/stressors.
Neurotic excoriations and acne excoriee
This is the form of self-inflicted dermatoses where there is constant scratching, plaques, severe itch, triggered by sress, and lasts forever.
Lichen simplex chronicus
This is the form of self-inflicted dermatoses where there is 0.5-1cm itchy noduels on arms or legs, severe pruritis, interferes with sleep, and has a thick epidermis.
Prurigo nodularis
This is an eczematous eruption that occurs on the lower legs in some pts with venous insufficiency.
Stasis dermatitis
What type of hypersensitivity is contact dermatitis?
IV
What cells are the main APCs to cause sensitization to a Ag in contact dermatitis?
Langerhans cells
What is the stage of contact dermatitis where there is re-exposure of the Ag, causing dermatitis within 12-48 hours and persistance for 3-4 weeks?
Elicitation phase
True or False: the pattern of inflammation usually corresponds exactly to the shape of the offending substance in contact dermatitis.
True
This is the form of dermatitis which is an allergic dermatitis caused by poison ivy, poison oak, or poison sumac.
Rhus dermatitis
What is the Tx for Rhus dermatitis?
Wet compresses, topical steroids, and prednisone
True or False: latex allergies can manifest as a irritant contact dermatitis, type I and type IV HS rreactions.
true
What metal causes metal allergies and baboon syndrome?
Nickel
What type of HS is metal allergy?
IV
This is the method to determine if a specific substance causes allergic inflammation to the skin by production of a local allergic rxn.
Patch testing
This is the condition where there is chronic, pruritic, eczematous disease that always begins in childhood and follows a remitting/flaring course that may continue throughout life.
Atopic dermatitis
What causes atopic dermatitis?
Combo of environmental, immunologic, genetic, and drugs.
What happens to the cheeks in the infant phase of atopic dermatitis?
Dry, red, scaling areas to the cheeks
What happens to the lips in the infant phase of atopic dermatitis?
habitual licking –> oozing, crusting, and scaling
What area of the body is spared in infant phase of atopic dermatitis?
Diaper area
Where are the eczema in the childhood phase of atopic dermatitis?
Flexural areas
What is the most common pattern to the inflammation in the adult phase of atopic dermatitis?
Localized inflammation with lichenfication
This is the associated feature of atopic dermatitis where there is a disorder of ketatinization characterized by the development of dry, rectangular scales.
Ichythyosis vulgaris
“Ichthys” from the ancient greek root meaning “fish” because this has scales.
This is the associated feature of atopic dermatitis where there is small rough follicular papules or pustules that appear at any age and are common in young kids.
Keratosis pilaris
This is the associated feature of atopic dermatitis where there is accentuation of the major skin creases of the palms.
Hyperlinear palmar creases
This is the associated feature of atopic dermatitis where there is asymptomatic, hypopigmented, slightly elevated, fine scaling plaques with distinct borders.
Pityriasis alba
This is the associated feature of atopic dermatitis where there is an extra line on the lower eyelid.
Atopic pleats
What eye problem occurs in 10% of atopic dermatitis pts?
Cataracts
In 1 word, what sums up the triggers for atopic dermatitis?
Irritation
What drugs are used to treat atopic dermatitis by controlling inflammation?
Steroids like hydrocotisone, Nonsteroidals like Creams and Tacrolimus
What antibiotics are given for the treatment of atopic dermatitis?
Cephalexin and cefadroxil
What class of drugs are Doxepin HCl cream and Zonalon cream, which are used for the treatment of atopic dermatitis?
Antihistamines
What type of light therapy can be used for the treatment of atopic dermatitis?
UVA and UVB
These are hives or wheals; circumscribed, erythematous or white, nonpitting, edematous, usually pruritic plaque that changes in size and shape by peripheral extension or regression during the few hours or days that the individual lesion exists
Urticaria
What is the main mediator for Urticaria, where it causes vascular fluid leaks and tissue edema and wheal formation?
Histamine from mast cells
What are the 3 things that histamine produces to cause a Urticaria?
Local erythema (vasodilation)
Flare (erythema)
Wheal (fluid)
What R does histamine act on to cause vasodilation, axon reflex, and wheal?
H1
What is the effect from histamine binding to H2 to cause Urticaria?
Vasodilation
What type of HS rxn causes mose Urticaria?
Type I
This is the hivelike swelling caused by increased vascular permeability in the subQ tissue of the skin and mucosa.
Angioedema
True or False: angioedema and hives often occur together and have the same etiology.
True
What are the 3 main differences between hives and angioedema?
Angioedema has more diffuse swelling, no itching, and affects the lips, palms, soles, limbs, trunk, and genitalia.
This is the disease produced by exposure to drugs, monoclonal Ab therapy (rituximab), blood products, or animal-derived vaccines.
Serum sickness
What gets trapped in the walls of organs and activates the complement in serum sickness?
Ag-Ab complexes
What type of HS reaction is serum sickness?
III
In addition to systemic signs, what SKIN signs occur from serum sickness?
Morbilliform rash or urticaria limited to the trunk (or generalized)
What type of acne is simple and is divided into open or closed comedones (clogged hait follicles)?
Noninflammatory
What are the 2 lesions that are seen in inflammatory acne?
Nodules
Papules
What is the MOA for tretinoin and isotretinoin?
Normalization of the pattern of follicular keratinization
What is the MOA for benzoyl peroxide, topical antibiotics, oral antibiotics, and isotretinoin (indirectly)?
Antibacterial
What is the MOA for esterogens, oral corticosteroids at very low dose, isotretinoin, and anti-androgens?
Inhibit sebaceous gland fxn
What is the MOA for intralesional corticosteroids, oral corticosteroids, NSAIDs, and antibiotics?
Antiinflammatory effect
What causes the transition from a closed comedo –> open comedo?
Pore dilation
What causes the transition from a closed comedo –> papule?
follicle wall thins and accumulates P. acnes
What is the main treatment for comedonal acne?
Benzoyl peroxide
and retinoids at bedtime
What is the main treatment for mild inflammatory acne?
Topical antibiotics
+ BP and a retnoid
What is the main treatment for moderate acne?
Systemic antibiotics (tetracycline, doxycycline)
What is the main treatment for severe acne?
Accutane (isotretinoin)
I took this stuff and dear jezus it drys the shit outta your skin.
What is the newer retinoid which is more effective than tretinoin, but can only be used for short contact so u gotta wash it off right away?
Tazarotene
What is the drug that has tretinoin like activity in terminal differentiation processes of hair follicle, and is for mild-moderate acne?
Adapalene
What is the the drug that is antikeratinizing, antibacteria, antiinflammatory, and used for noninflamm and inflamm acne and used with other antibiotics?
Azelaoic acid
What is the antibiotics that produces a drying effect and releases radical oxygent hat oxidizes bacterial proteins, and is used for inflammatory acne?
Benzoyl Peroxide
This is the condition where there is a Distinctive eruption in young women, resembles acne, erythematous papules and pustules around the mouth but spares the skin immediately around the mouth
Perioral dermatitis
What is teh treatment for perioral dermatitis?
Tetracycline or erythromycin
This is where there are clusters of papules and pustules on red, swollen, telangiectatic skin of cheeks and forehead.
Rosacea
Is rosacea related to alcohol use?
Nah
This is where there is Eccrine sweat duct occlusion causes rupture and leakage into surrounding tissue, which induces an inflammatory response in response to heat.
Miliaria rubra
Heat rash
What form of miliaria rubra has sweat accumulates under the stratum corneum, looks like a clear dew drop?
Crystallina
What form of miliaria rubra is deeper in the intraepidermal section, and causes an erythema from inflammatory response?
Rubra
What form of miliaria rubra occurs after several bouts of rubra, occlusion of the dermal section?
Profunda
What is the inheritance pattern for psoriasis?
AD
What are the lesions like in psoriasis?
red scaling plaque, silvery scale, bleeding when removed (auspitz sign)
What is it called when there are psoriasis between ur butt cheeks?
Gluteal pinking (no scales)
This is when there is brand new psoriasis after trauma.
Koebner phenomenon
What 4 drugs exasterbate psoriasis?
Li
Beta blockers
Anti-malarials
Systemic steroids
This is the form of psoriasis where there is a chronic, noninflammatory plaque anywhere on the skin, and they can enlarge,
Chronic plaque
This is the form of psoriasis where there is deep pustules on the mid portion of the palms and soles, can be local or spread, dont rupture but are brown in scaly, in smokers.
Palm and sole
This is the form of psoriasis where there is crusting of 1 therapy.
Acordermatitis continua
This is the form of psoriasis where there is psoriasis in the flexural or intertriginous areas, cracking or fissuring?
Inverse