Acanthosis Nigricans and PIH Overview
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Questions and Answers

What is the estimated prevalence of acanthosis nigricans in Latinos?

  • 5.5% (correct)
  • 1.5%
  • 13.3%
  • 34.2%

    • What is the link between acanthosis nigricans and insulin resistance?

  • Acanthosis nigricans is a direct cause of insulin resistance.
  • Insulin resistance is a commonly associated factor with acanthosis nigricans. (correct)
  • There is no known link between acanthosis nigricans and insulin resistance.
  • Insulin resistance is a direct cause of acanthosis nigricans.

    • What is the role of insulin in the development of acanthosis nigricans?

  • Insulin inhibits the growth of keratinocytes, leading to acanthosis nigricans.
  • Insulin plays no role in the development of acanthosis nigricans.
  • Insulin binds to receptors in the keratinocytes, potentially promoting growth and contributing to acanthosis nigricans. (correct)
  • Insulin directly damages keratinocytes, leading to acanthosis nigricans.

    • What age group is typically more affected by acanthosis nigricans?

    <p>People under 40 years old (D)</p> Signup and view all the answers

    In what cases is acanthosis nigricans potentially linked to an internal malignancy?

    <p>When lesions develop abruptly in middle-aged individuals who are not obese. (D)</p> Signup and view all the answers

    Which of the following is NOT a possible symptom of lichen sclerosis?

    <p>Swelling (C)</p> Signup and view all the answers

    What percentage of women with lichen sclerosis experience the condition spreading to the anal and perianal skin?

    <p>50% (B)</p> Signup and view all the answers

    What is a possible consequence of scratching or minimal friction caused by tight clothing or sitting?

    <p>Blood blisters (D)</p> Signup and view all the answers

    Which of the following areas is NOT specifically mentioned as a location where lichen sclerosis can be localized?

    <p>Vulva (C)</p> Signup and view all the answers

    What can be a consequence of lichen sclerosis for sexual intercourse?

    <p>Pain and fissures (B)</p> Signup and view all the answers

    What is a common symptom associated with lichen sclerosis?

    <p>Discomfort or bleeding during bowel movements (C)</p> Signup and view all the answers

    At what age can lichen sclerosis typically manifest?

    <p>At any age (C)</p> Signup and view all the answers

    What is a potential complication associated with lichen sclerosis?

    <p>Increased risk of vulval, penile or anal cancer (C)</p> Signup and view all the answers

    What is the role of a biopsy in the diagnosis of lichen sclerosis?

    <p>Biopsy helps to confirm the diagnosis in early cases (A)</p> Signup and view all the answers

    What is the estimated percentage of patients with lichen sclerosis who may develop cancer?

    <p>5% (D)</p> Signup and view all the answers

    What factor increases the likelihood of cancer development in patients with lichen sclerosis?

    <p>Uncontrolled inflammation of the disease (A)</p> Signup and view all the answers

    What percentage of patients with lichen sclerosis have a family member with the condition?

    <p>15% (A)</p> Signup and view all the answers

    Which of the following is a potential physical change associated with lichen sclerosis?

    <p>Resorption of the labia minora (B)</p> Signup and view all the answers

    Which of the following treatment options for vitiligo is considered a second-line therapy?

    <p>Ruxolitinib cream (A)</p> Signup and view all the answers

    What is the typical timeframe for whole-body UVB phototherapy treatment for vitiligo?

    <p>6-12 months (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of vitiligo?

    <p>Increased risk of fungal infections in affected areas (B)</p> Signup and view all the answers

    What is the estimated percentage of the population affected by vitiligo?

    <p>1% (A)</p> Signup and view all the answers

    Which of the following treatments is considered a systemic therapy for vitiligo?

    <p>Systemic steroids (C)</p> Signup and view all the answers

    Which of the following conditions is most strongly associated with vitiligo?

    <p>Thyroid disease (A)</p> Signup and view all the answers

    What is the typical progression of vitiligo over time?

    <p>Slow and variable (B)</p> Signup and view all the answers

    What is the primary diagnostic tool used to identify vitiligo?

    <p>Wood's lamp (B)</p> Signup and view all the answers

    What is the underlying cause of vitiligo?

    <p>Autoimmune destruction of melanocytes (A)</p> Signup and view all the answers

    What is the primary concern related to depigmented areas in patients with vitiligo?

    <p>Increased risk of skin cancer (C)</p> Signup and view all the answers

    Which of the following skin types is most prone to post-inflammatory hyperpigmentation (PIH)?

    <p>Fitzpatrick skin types 4-6 (B)</p> Signup and view all the answers

    What is the primary treatment for PIH?

    <p>Identifying and treating the source of inflammation and sunscreen (C)</p> Signup and view all the answers

    What is the typical timeframe for PIH lesions to resolve spontaneously?

    <p>6-12 months (C)</p> Signup and view all the answers

    Which of the following is NOT a common treatment option to accelerate the resolution of PIH?

    <p>Antibiotics (A)</p> Signup and view all the answers

    What is the key characteristic that differentiates melasma from PIH?

    <p>The absence of inflammation (A)</p> Signup and view all the answers

    Which of the following is a common pattern of melasma?

    <p>Centrofacial (B)</p> Signup and view all the answers

    What is the usual onset of melasma?

    <p>Gradual and slow (D)</p> Signup and view all the answers

    Which of the following is NOT a common treatment approach for melasma?

    <p>Pulsed dye laser treatment (B)</p> Signup and view all the answers

    Which risk factor is NOT associated with melasma?

    <p>Genetic predisposition (D)</p> Signup and view all the answers

    At what age range does melasma typically onset?

    <p>20 to 40 years (A)</p> Signup and view all the answers

    What is an effective treatment for melasma?

    <p>Hydroquinone (D)</p> Signup and view all the answers

    Which Fitzpatrick skin type is less likely to develop melasma?

    <p>Fitzpatrick type I (B)</p> Signup and view all the answers

    What is a common prognosis for melasma after pregnancy?

    <p>Gradual fading (C)</p> Signup and view all the answers

    What is the typical treatment difficulty for longstanding melasma?

    <p>It is challenging and may be frustrating (C)</p> Signup and view all the answers

    Which treatment method is used in melasma management?

    <p>Microdermabrasion (C)</p> Signup and view all the answers

    What condition primarily involves the non-hair bearing inner areas of the vulva?

    <p>Lichen sclerosis (B)</p> Signup and view all the answers

    Study Notes

    Acanthosis Nigricans

    • Characterized by velvety, papillomatous, brown or hyperpigmented patches/plaques.
    • Also shows darkening and thickening (hyperkeratosis) or leathery skin.
    • Most commonly found on the neck, axilla, groin, and inframammary region.
    • Prevalence varies across ethnic groups (13.3% African American, 5.5% Latino, 34.2% Native American).
    • Primarily linked to insulin resistance (obesity, diabetes, etc.).
    • Can rarely be associated with internal malignancy (malignant AN: middle-aged, non-obese, abrupt onset).
    • Prevention: Unknown, but often associated with lifestyle changes.
    • Treatment: topical retinoids, microdermabrasion, keratolytics (e.g., lactic, glycolic, salicylic or trichloroacetic acid).

    Post Inflammatory Hyperpigmentation (PIH)

    • Hyperpigmented macular patches or plaques, a temporary pigmentation following skin injury/inflammation.
    • Most common in darker skin tones (Fitzpatrick 4-6).
    • Diagnosis: usually clinical, potentially biopsy.
    • Treatment: addressing the inflammatory source, sunscreen. Lesions usually resolve spontaneously (6-12 months).
    • Speeding resolution: Skin lighteners (hydroquinone 4-8% qhs, 1-2 months), retinoids, topical steroids, microdermabrasion, chemical peels (salicylic or glycolic acid).

    Melasma

    • Hyperpigmented macular patches/plaques on sun-exposed areas (face, neck, arms).
    • Gradual onset, no inflammation present.
    • Bilateral, asymptomatic, light-to-dark brown macules/patches with irregular borders.
    • Common patterns: centrofacial (forehead, cheeks, nose, upper lip), malar (cheeks), mandibular (jawline, chin), extrafacial (forearms/shoulders).
    • More common in women (20-40 years old, Fitzpatrick skin types III-IV).
    • Risk factors: pregnancy, estrogen (oral contraceptives, HRT), sun exposure.
    • Prognosis: gradually fades after pregnancy/contraceptive discontinuation.
    • Treatment: sun protection (broad-spectrum sunscreen), antioxidants (omega-3/6, vitamin E), topical skin lighteners (kojic acid, ascorbic acid, azelaic acid, hydroquinone), hormone modification, microdermabrasion, lasers, chemical peels.

    Lichen Sclerosus

    • Ivory white, atrophic papules with faint pink rims.
    • Flat-roofed, slightly raised papules coalescing into oval plaques with dull/glistening white, atrophic surfaces (wrinkled).
    • Mucosal surfaces exhibit atrophic, white, glistening, wrinkled lesions.
    • Etiology: unclear but potentially genetic, hormonal, irritant, traumatic, infectious.
    • Autoimmune component suspected (ECM-1 antibodies in 60-80% of women).
    • Primarily affects non-hair-bearing areas of the vulva (can extend to perineum, labia, clitoris, surrounding skin, anal/perianal areas, 50% of women).
    • Increased risk of anogenital cancer (squamous cell carcinoma, SCC), up to 5% (risk highest with uncontrolled inflammation).
    • Diagnosis: often from biopsy (early cases)
    • Treatment: emollients, avoidance of tight clothing/friction, topical steroids (high-potency), other treatments such as Cyclosporine and surgery if necessary.

    Vitiligo

    • Acquired depigmentation of the skin, well-circumscribed white macules/patches.
    • Hairs in affected areas can be normal or white.
    • Etiology: autoimmune destruction of melanocytes; 1% of population is affected, often onset before 20 years old, equal genders, and family history (30%) is present. Strongly associated with thyroid disease (15% adults, 5-10% children).
    • Diagnosis: Wood's lamp (accentuates hypopigmentation), skin biopsy (melanocyte absence, sparse lymphocytic inflammation).
    • Prognosis: variable and potentially progressive, increased skin cancer risk in depigmented areas due to sunburns.
    • Treatment: topical corticosteroids, calcineurin inhibitors (pimecrolimus, tacrolimus), topical vitamin D derivatives (calcipotriol, tacalcitol), ruxolitinib, Jak1 and 2 inhibitors, PD-1 inhibitors, phototherapy (UVB), lasers.
    • Older Systemic Treatments: systemic steroids, methotrexate, cyclosporine, mycophenolate mofetil, or oral minocycline.

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    Description

    This quiz explores the characteristics, causes, and treatments of Acanthosis Nigricans and Post Inflammatory Hyperpigmentation (PIH). Learn about the prevalence among different ethnic groups and the link to conditions like insulin resistance. Discover the diagnostic methods and common treatments associated with these skin conditions.

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