Questions and Answers
Which histopathological finding is most commonly associated with erythema nodosum?
In direct immunofluorescence testing for bullous pemphigoid, which of the following findings is expected?
Which clinical feature is least likely to be associated with pemphigus vulgaris?
Which of the following conditions does not typically show a histological presence of neutrophils?
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What is a key histological feature unique to panniculitis?
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What is the main feature of the early lesion in localized chronic cutaneous lupus erythematosus (DLE)?
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Which type of lupus erythematosus is characterized by a highly photosensitive rash typically precipitated by UV exposure?
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Which condition manifests similar features to systemic lupus erythematosus (SLE) but lacks the cutaneous involvement characteristic of drug-induced lupus?
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What is a common characteristic of Raynaud phenomenon?
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Which variant of subacute cutaneous lupus erythematosus is characterized by vitiligo-like leukoderma upon resolution?
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Study Notes
Scleroderma Phases
- Scleroderma progresses through three phases: edematous, indurated, and atrophic (bound-down).
- Atrophic phase features include:
- Matted telangiectasia
- Round finger pad sign
- Sclerodactyly (thickening of skin on fingers)
- Digital pitting scars (depressions in fingertips)
- Salt and pepper appearance (hyperpigmented and hypopigmented skin areas)
- Raynaud phenomenon (cold-induced digital ischemia)
Limited Cutaneous Systemic Sclerosis (SSc)
- Characterized by a long history of Raynaud phenomenon prior to skin symptoms.
- Skin thickening spares proximal joints.
- Commonly includes CREST syndrome: Calcinosis cutis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia.
- High incidence of pulmonary arterial hypertension and pulmonary fibrosis.
- Lower risk of renal crisis and often presents with anti-centromere antibodies.
Diffuse Cutaneous Systemic Sclerosis (SSc)
- Skin sclerosis affects both proximal and distal areas, decreasing the time between Raynaud and skin changes.
- Marked inflammatory response with swelling noted within the first two years.
- Increased likelihood of pulmonary fibrosis, cardiac issues, and renal crisis.
- Presence of anti-Scl-70 or anti-RNAPIII antibodies.
Vasculitis
- Manifestations differentiate based on vessel size:
- Small vessels show palpable purpura, hemorrhagic blisters, necrosis, ulcers, and pyoderma.
- Medium vessels display subcutaneous and ulcerative nodules.
- Histological findings include neutrophils, nuclear debris, extravasated RBCs, and potential granulomatous inflammation.
Specific Vasculitides
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Henoch-Schonlein Purpura:
- Presents with palpable purpura and generally occurs in individuals under 20 years.
- Associated symptoms: arthritis, bowel angina, and renal involvement.
- Diagnosis involves identifying leukocytoclastic vasculitis with IgA deposits.
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Polyarteritis Nodosa:
- Occurs in 30-50% of patients with lichen planus.
Cutaneous Lupus Erythematosus
- Acute cutaneous lupus erythematosus (ACLE) often correlates with internal organ involvement and typically presents as a malar rash.
- Subacute cutaneous lupus erythematosus (SCLE) meets 50% of SLE criteria, highly photosensitive, and can lead to post-inflammatory pigment changes without scarring.
- Chronic cutaneous lupus erythematosus includes localized DLE, which has a lower probability of converting to SLE compared to generalized DLE.
Scleroderma Overview
- Localized forms include morphea and generalized scleroderma.
- Systemic sclerosis encompasses limited, diffuse, and sine scleroderma forms.
- Distinctions among them hinge on skin involvement's extent and associated symptoms.
Raynaud Phenomenon
- Characterized by digital ischemia due to vasospasm, manifesting in three color changes: white, blue, and red.
- Symptoms include numbness and pain, often triggered by cold, stress, or smoking.
- Can be primary or secondary, with systemic scleroderma being a common cause.
Diagnostic Criteria for Scleroderma
- Major diagnostic criterion: symmetric cutaneous sclerosis proximal to the metacarpophalangeal joints.
- Minor criteria include sclerodactyly, digital pitted scars/loss from finger pads, and bibasilar pulmonary fibrosis.
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Description
Test your knowledge on histopathological findings associated with skin disorders such as erythema nodosum and pemphigus vulgaris. This quiz covers various conditions and their clinical features, focusing on histological characteristics and immunofluorescence results related to skin diseases. Ideal for students and professionals in dermatology and pathology.
