Lecture 9
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Questions and Answers

What is the appropriate follow-up for evaluating malignancy in patients diagnosed with DM?

  • It should only be done once at the time of diagnosis.
  • It should be repeated monthly for the first year.
  • It should be repeated yearly for the first three years. (correct)
  • It should be repeated biannually for the first five years.

In which demographic is Systemic Sclerosis (SSc) predominantly observed?

  • Individuals over 60.
  • Children under 12.
  • Women aged 30-50. (correct)
  • Men aged 20-40.

What distinguishes the limited form of Systemic Sclerosis from the diffuse form?

  • Diffuse form causes no skin thickening.
  • Confined to patients under 40 years of age.
  • Limited form primarily affects the hands and feet.
  • Limited form spares the skin of the trunk and proximal extremities. (correct)

Which of the following is a characteristic feature of CREST syndrome?

<p>Esophageal dysmotility. (A)</p> Signup and view all the answers

What is a common systemic involvement seen in patients with Systemic Sclerosis?

<p>Pulmonary hypertension. (A)</p> Signup and view all the answers

What is the primary risk factor for developing actinic keratosis (AK)?

<p>Chronic sun exposure (D)</p> Signup and view all the answers

What is the typical appearance of an actinic keratosis lesion?

<p>Rough patches with thick, adherent scale (A)</p> Signup and view all the answers

What is the likely consequence of Raynaud's phenomenon in Systemic Sclerosis?

<p>Cold-induced skin discoloration. (C)</p> Signup and view all the answers

Which mutation is commonly associated with the development of actinic keratosis?

<p>Loss of function of p53 (A)</p> Signup and view all the answers

What is the proposed involvement of TGF-beta in the pathogenesis of Systemic Sclerosis?

<p>It up-regulates collagen production. (D)</p> Signup and view all the answers

What differentiates CREST syndrome from the typical limited form of Systemic Sclerosis?

<p>Increased systemic involvement. (C)</p> Signup and view all the answers

How often should patients with a history of actinic keratosis have skin exams?

<p>Once a year (B)</p> Signup and view all the answers

What is the primary form of treatment for multiple actinic keratosis lesions?

<p>Topical 5-Fluorouracil (D)</p> Signup and view all the answers

What is the most common clinical sign of onychomycosis?

<p>Thickened toenails with separation from the nailbed (A)</p> Signup and view all the answers

Which of the following is NOT a common risk factor for tinea pedis?

<p>Exposure to bright sunlight (B)</p> Signup and view all the answers

What does the presence of actinic keratosis indicate about a patient's risk for other skin cancers?

<p>High risk for developing skin cancer (D)</p> Signup and view all the answers

What characteristic changes in the cuticles are associated with patients who have DM?

<p>Ragged or dystrophic appearance (D)</p> Signup and view all the answers

Which antibodies are most commonly associated with dermatomyositis (DM)?

<p>Anti-synthetase antibodies (C)</p> Signup and view all the answers

What is the significance of checking muscle-derived enzymes in patients with DM?

<p>They confirm muscle disease when elevated (B)</p> Signup and view all the answers

What should patients over age 40 presenting with DM routinely undergo?

<p>Aggressive malignancy work-up (A)</p> Signup and view all the answers

Which of the following treatments is considered systemic for patients with DM exhibiting significant systemic disease?

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

What is commonly seen in the capillaries of patients with DM?

<p>Large, dilated capillaries or disappearance (D)</p> Signup and view all the answers

Which systemic treatments may be used if standard immunosuppressive medications are insufficient in DM?

<p>Intravenous immunoglobulin and cyclophosphamide (B)</p> Signup and view all the answers

What should be expected regarding the presence of anti-nuclear antibodies in patients with DM?

<p>They are found in approximately half of patients with DM (A)</p> Signup and view all the answers

What is the association of anti-centromere antibodies in systemic sclerosis?

<p>They are linked to limited systemic sclerosis. (C)</p> Signup and view all the answers

Which treatment has been shown to dramatically improve the prognosis of systemic sclerosis-related renal disease?

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

What symptom is characteristic of cutaneous dysesthesia syndromes?

<p>Burning without itch (A)</p> Signup and view all the answers

Which of the following treatments may improve skin disease in systemic sclerosis?

<p>D-penicillamine (C)</p> Signup and view all the answers

What is a common trait of the diseases like burning vulva syndrome and burning mouth syndrome?

<p>Their physical examination findings are usually normal. (D)</p> Signup and view all the answers

What is the proposed hypothesis regarding the pathophysiology of cutaneous dysesthesia syndromes?

<p>They represent abnormal function of sensory nerves. (B)</p> Signup and view all the answers

What is the connection between dermatologic symptoms in cutaneous dysesthesia and mental health?

<p>There is a clear cyclic relationship between symptoms and the SAD triad. (C)</p> Signup and view all the answers

What is the primary immunosuppressant associated with the management of systemic sclerosis?

<p>D-penicillamine (C)</p> Signup and view all the answers

Which of the following blood tests is NOT included in the standard workup for generalized pruritus?

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

What should be considered if there is high suspicion for malignancy based on the history and physical exam?

<p>A CT scan of the chest, abdomen, and pelvis (D)</p> Signup and view all the answers

Which of the following topical agents is NOT recommended for relieving pruritus?

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

Which type of contact dermatitis is characterized by a reaction to poison ivy?

<p>Acute allergic contact dermatitis (A)</p> Signup and view all the answers

What is the most common cause of chronic allergic contact dermatitis?

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

What differentiates sedating antihistamines from non-sedating antihistamines?

<p>Sedating antihistamines cause drowsiness (B)</p> Signup and view all the answers

What is a chronic exposure that can cause allergic contact dermatitis?

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

In recalcitrant cases of pruritus, which of the following agents might be useful?

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

What is the primary issue when a patient switches moisturizers without identifying the causative ingredient?

<p>The allergic reaction may persist if the same ingredient is present. (A)</p> Signup and view all the answers

Which agents are most commonly associated with topical medication allergies?

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

What type of dermatitis is caused by any agent that can damage the skin?

<p>Irritant contact dermatitis (ICD) (D)</p> Signup and view all the answers

How do allergens typically interact with proteins in allergic contact dermatitis?

<p>They bind to proteins, forming an antigenic complex. (B)</p> Signup and view all the answers

What is the most challenging aspect of managing allergies to fragrances in cosmetics?

<p>Fragrance-free products often contain hidden fragrances. (D)</p> Signup and view all the answers

What occurs upon first exposure to an allergen in allergic contact dermatitis?

<p>Memory lymphocytes are produced. (D)</p> Signup and view all the answers

Chronic irritant contact dermatitis is most commonly seen in which area of the body?

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

What is the treatment approach for allergic contact dermatitis primarily focused on?

<p>Identifying and avoiding the causative agent (D)</p> Signup and view all the answers

Flashcards

Actinic Keratosis (AK)

A precancerous skin lesion that arises from prolonged sun exposure, characterized by rough patches with thick, adherent scales and erythema. Associated with mutations like loss of p53 function.

Cutaneous Squamous Cell Carcinoma (SCC)

A type of skin cancer that can develop from untreated AKs. It is characterized by a firm, pearly nodule or a flat, scaly lesion with a central depression.

Onychomycosis

A fungal infection affecting the toenails, causing discoloration (usually yellow or white), separation of the nail from the nailbed, and accumulation of scale and powdery material.

Tinea Pedis

A fungal skin infection of the feet, often associated with onychomycosis. It can lead to itching, scaling, and redness between the toes or on the soles of the feet.

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Sunburn

A critical condition causing excessive skin inflammation and redness, occurring as a result of sunburn or prolonged exposure to UV radiation.

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Psoriasis

A common skin condition characterized by raised, red bumps surrounded by white scales, often appearing on the face, scalp, and elbows. It is caused by an overactive immune response to an unknown trigger.

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Keratosis

A condition involving a build-up of dead skin cells on the surface of the skin. It is commonly found on areas with thicker skin, including the elbows, knees, and scalp.

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Melanoma

A type of skin cancer that arises from the pigment-producing cells in the skin (melanocytes). It often appears as a mole with irregular borders, color, or size.

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What is Dermatomyositis (DM)?

A disorder characterized by inflammation of the muscles and often accompanied by skin, lung, and other systemic involvement.

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What is a key characteristic of Dermatomyositis (DM)?

An inflammatory myopathy often associated with "novel" antigens like tumors or drugs.

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What are anti-synthetase antibodies?

Antibodies that attack tRNA synthetases, enzymes involved in protein synthesis.

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What is the best-known anti-synthetase antibody?

The most common type of anti-synthetase antibody, strongly associated with dermatomyositis.

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What is a nail cuticle abnormality often seen in Dermatomyositis?

A common feature of dermatomyositis, characterized by changes in the capillaries around fingernails, often described as 'ragged' or dystrophic.

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What is a major concern when diagnosing Dermatomyositis in older patients?

A significant risk factor associated with dermatomyositis, particularly in patients over 40.

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What is the most frequent cancer found in patients over 40 with Dermatomyositis?

A common malignancy associated with dermatomyositis in older patients, emphasizing the importance of aggressive cancer screening.

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What muscle-derived enzymes are elevated in Dermatomyositis?

Muscle-derived enzymes like aldolase and CPK elevated in the blood, signaling muscle inflammation and damage in dermatomyositis.

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Systemic Sclerosis (SSc)

A rare autoimmune disease primarily affecting women, with onset between 30 and 50. Characterized by thickening of the skin, especially in the hands, face, and distal extremities.

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Limited SSc

A subtype of SSc where skin thickening is limited to the distal extremities and face, sparing the trunk and proximal extremities.

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Diffuse SSc

A subtype of SSc where skin thickening extends to the trunk and proximal extremities in addition to the distal extremities and face.

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CREST Syndrome

A subset of limited SSc characterized by prominent calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia. Other signs of SSc (skin thickening, systemic involvement) are less pronounced.

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Microstomia

Decreased oral aperture (smaller mouth opening) due to sclerosis of facial skin in SSc.

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Telangiectasias

Abnormal dilatation of blood vessels visible on the skin, often prominent in SSc.

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Raynaud's Phenomenon

A common symptom preceding SSc, characterized by episodes of reduced blood flow to the fingers and toes, leading to numbness, tingling, and color changes.

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Scleroderma related to graft-versus-host disease

A theory suggesting a possible link between SSc and immune responses triggered by foreign tissue, similar to those observed after organ transplantation.

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Generalized Pruritus

A common skin condition characterized by intense itching, without any visible rash or skin changes.

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Cutaneous Dysesthesia Syndromes

A group of disorders characterized by burning sensations in the skin, scalp, or mouth, without any identifiable physical cause.

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Complete Blood Count (CBC) with Differential

A blood test that measures several important aspects of red blood cells, white blood cells, and platelets in the blood.

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SAD Triad

A triad of stress, anxiety, and depression that is often associated with cutaneous dysesthesia syndromes.

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Autoimmune Disease

A condition where the body's immune system produces antibodies that attack its own tissues. In SSc, it targets connective tissues, leading to inflammation and fibrosis.

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Blood Urea Nitrogen (BUN) and Creatinine

A blood test used to estimate the level of kidney function.

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Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST)

A blood test that measures the levels of liver enzymes, which indicate liver health.

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Scleroderma (SSc)

A rare autoimmune disease that causes hardening and tightening of the skin, along with potential organ damage. Affected tissues are typically thickened and scarred.

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Thyroid Stimulating Hormone (TSH)

A blood test that measures the level of thyroid stimulating hormone in the blood, which indicates thyroid function.

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Microchimerism

A condition where cells from one individual are found in the tissues of another.

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Total Bilirubin

A blood test that measures the level of total bilirubin, a substance produced by the liver.

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Immune Response

An immune response where the body's defense system reacts to foreign substances (antigens) or altered self-antigens.

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Irritant Contact Dermatitis

Inflammation of the skin caused by direct contact with an irritant substance.

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Anti-Centromere Antibodies

The presence of antibodies in the blood that target the centromere region of chromosomes, associated with CREST syndrome.

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Anti-Scl70 Antibodies

The presence of antibodies in the blood that target topoisomerase I, an enzyme involved in DNA replication and repair. They're associated with diffuse SSc.

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Allergic Contact Dermatitis

Inflammation of the skin caused by an allergic reaction to a substance.

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Sensitization

The initial exposure to an allergen doesn't cause a reaction but primes the immune system. Upon subsequent exposures, the immune system remembers the allergen and reacts intensely.

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Haptens

Small molecules that can trigger allergic reactions when they bind to proteins on the skin. They often cause allergic contact dermatitis.

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Patch Test

It's a skin test used to determine if a person is allergic to a particular substance. Small amounts of various allergens are applied to the back to see which causes a reaction.

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Hands

A common location for chronic irritant dermatitis, often caused by frequent hand washing, exposure to chemicals, or other irritants.

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Topical Antibiotic Allergy

A type of bacterial infection affecting the skin that can be tricky to diagnose because it may look like a wound infection.

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Avoiding Exposure

It's a crucial step in managing allergic contact dermatitis. To prevent further reactions, you must avoid contact with the substance you're allergic to.

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Study Notes

Actinic Keratosis (AK)

  • AKs are common skin lesions, more prevalent in those with lighter skin tones.
  • Chronic sun exposure, particularly in areas with high UV radiation, is a significant risk factor.
  • AKs develop as rough patches, often appearing on sun-exposed areas like the face.
  • As AKs progress, they develop thick, adherent scaling and erythema beneath the scale.
  • Typical AK size ranges from 0.5 to 1.5 cm in diameter.
  • AKs are considered precursors to cutaneous squamous cell carcinoma (SCC).
  • A small percentage (0.1-1%) of AKs progress to SCCs due to UV-induced mutations, most commonly p53 loss-of-function.
  • Treatment methods include freezing (liquid nitrogen), burning (electrocautery), and topical 5-Fluorouracil.
  • Multiple AKs indicate a high risk for developing skin cancers (basal cell carcinoma and melanoma).
  • Annual skin exams and daily sunscreen use are crucial for patients with a history of AKs.

Onychomycosis and Tinea Pedis

  • Onychomycosis is a fungal infection of the toenails, characterized by yellow or white discoloration.
  • Nail separation from the nail bed, along with white, powdery material accumulation under the nail, often occurs.
  • Nail thickening is a common manifestation.
  • Tinea pedis (athlete's foot) is common, particularly in older adults.
  • Risk factors include poor circulation in lower extremities, diabetes, and immunosuppression
  • The 'moccasin' type manifests as redness and dry scaling on soles and sides of feet.
  • Interdigital tinea pedis features soggy, whitish, and fissured skin between toes, often between the 4th and 5th toes.
  • Bullous tinea pedis presents as groups of small blisters on soles of feet.
  • The specific fungal types (e.g., Trichophyton rubrum, Trichophyton mentagrophytes) causing each form can vary.
  • Treatment for onychomycosis typically involves systemic antifungal agents like terbinafine or itraconazole.
  • Treating tinea pedis frequently involves topical antifungals.
  • Concurrent infections of onychomycosis and tinea pedis require simultaneous treatment to prevent reinfection.

Sarcoidosis

  • Sarcoidosis is a multi-system granulomatous disease, primarily affecting the lungs.
  • The condition predominantly affects women between ages 20 and 60, with higher prevalence in African-American women.
  • Cutaneous sarcoidosis often presents as non-inflamed skin colored papules and nodules, typically with "apple-jelly" or "waxy" appearance.
  • Lesions can vary in size (0.2 cm to several centimeters).
  • A wide range of clinical presentations are possible, mimicking other dermatological conditions.
  • Pulmonary involvement is also common.

Dermatomyositis (DM)

  • DM is a rare inflammatory myopathy, most common in women around age 50.
  • Key diagnostic features are heliotrope (edema and violet-red color) on eyelids and Gottron's papules (small red scaly papules) on the dorsal aspects of fingers over knuckles.
  • Other findings include shawl or V-neck erythema.
  • Capillary changes, including enlarged or missing vessels in nail cuticles, can occur.
  • Malignancy assessment is essential in patients over age 40 with DM due to a higher risk.
  • Immunosuppressive medications (e.g., corticosteroids, azathioprine) and other treatments are used for systemic disease, if present.
  • Anti-synthetase antibodies (e.g., anti-Jo-1) are often associated with DM.

Systemic Sclerosis (SSc)

  • SSc is a rare disease, predominantly affecting women between the ages of 30 and 50.
  • Two forms exist: limited and diffuse. The limited form affects primarily the distal extremities and face. The diffuse form affects the trunk and proximal extremities.
  • Key features include skin thickening (fibrosis), microstomia, telangiectasia, and skin ulcerations/calcifications.
  • Pulmonary involvement, pulmonary hypertension, renal crisis are potential complications.

Pruritus (Itching) without a Rash

  • Generalized pruritus is widespread symmetrical itching without a rash.
  • Initial evaluation must rule out underlying medical causes.
  • Systemic causes (i.e., kidney failure, liver disease) can be associated.
  • Topical treatments can include steroids, menthol, camphor, antihistamines.
  • Other systemic interventions may be needed based on the etiology and severity of the itching.

Contact Dermatitis

  • Contact dermatitis represents frequent consultations to dermatologists.
  • Two main forms exist: allergic and irritant.
  • Poison ivy is a frequent cause of allergic contact dermatitis.
  • Common causes such as nickel, or preservatives and fragrances can be causes for irritant contact dermatitis.
  • Diagnosis often relies on a thorough patient history and physical examination, along with potential patch testing.
  • Treatment focuses on avoiding the causative agent and managing symptoms.

Topical Medications

  • Neomycin and bacitracin are commonly implicated in skin allergies from topical medications.
  • Irritant and allergic contact dermatitis can result from topical use of various medications.
  • Avoid exposure to specific allergens, and consider treatment options such as moisturizers and topical corticosteroids.

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Description

Test your knowledge on critical aspects of dermatology, focusing on Systemic Sclerosis and actinic keratosis (AK). This quiz covers demographic information, clinical features, and pathogenesis associated with these conditions. Perfect for medical students and professionals looking to enhance their understanding in this area.

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