ࡱ> ac`7 $bjbjUU Y@7|7| 4l$000PTY":Y 6 nodules, 95% chance of Neurofibromatosis may also have caf-au-lait spots -light brown macules usually >1cm (coffee colored) Nodules mixture of collagen (fibroblasts) and nerve tissue (Schwann cells) -soft b/c of mucin (GAGs) very large ones = plexiform neurofibroma (bag of worms) button hole sign = push nodules in/out like a button von Recklinghausens Disease (congenital Neurofibromatosis) autosomal dominant Sx -Freckles in armpit (pathognomic) -neurofibromas everywhere (range from >6 to 100s) -can have extremely large plexiform neurofibroma -caf-au-lait spots (>6) -pheochromocytoma -scoliosis -Lisch nodules (pigmented growth in iris, harmless) rarely = ( malignant (neurofibrosarcoma) Dermatofibroma (very common) What does it look/feel like? Indurated (( amnt of collagen forms a nodule) Brown from melanocytic stimulation (reason not known) -not an ( in #melanocytes, just stimulated -so looks like a mole but harder when squeezed, it dimples in the center on arms/legs Cause insect bites trauma folliculitis (inflamed hair follicles) Micro = proliferation of fibroblasts, dense collagen, stimulated melanocytes Keloid More common in African-Americans Begins as scar tissue but w/excessive growth (tumor-like) burns, ear piercing, acne firm Acrochordon (skin tags) Idiopathic 1-3mm pedunculated papules more common in large (overweight) people armpits, groin, neck Tx really this is purely aesthetic this will probably be the only lecture we will ever get (most med-schools dont even get one!) so to treat, you need a pair of scissors (and maybe a piece of ice to numb the area) Hemangioma = blood vessel tumor General Info Color -usually red -can be blue/black if poorly O2d (may resemble a melanoma) Can be macular / plaque / nodular many look just like birthmarks when born, but during puberty they grow Cavernous Hemangioma (if deep in the tissue) Cherry Hemangioma pt are > 30 y/o < 3mm red papules on trunk these do not go away no Tx Strawberry Hemangioma In children Looks strawberry = red, exuberant/roughened surface Severity depends on location: can cause blindness (if in eye) or airway obstruction (if on trachea) when they are deep, may be related to certain syndromes -effects soft tissue with bone and muscle abnormalities Tx: usually goes away on its own, but will scar Flat Hemangioma (Port Wine Stain = Nevus flammeus) Spider Angioma (this is a small hemangioma dermatologists just drop the hem- when small) Common in NL females (rarely males) (d incidence pregnancy Estrogen Tx (birth control pills & hormone replacement therapy) Liver disease (usually HepC or Alcoholism) -b/c ( level of estrogens have central arteriole (spider head) with draining post-capillary venules (spider legs) Pyogenic granuloma what does it all mean? pyo = pus granuloma is really a granulation tissue (there are no macrophages to make it a granuloma) Cause: trauma induced production of too much granulation tissue what does it look like and what is in that thing? red, weeping, fast growing, nodule w/pus -lots of inflammatory cells with proliferation of blood vessels -on a stalk common in pregnancy Clinically patient comes in with band-aid sign -have lots of band-aids all over it b/c it keeps bleeding Tx = surgery Lipoma Sub-Q lump of fat (soft, freely movable) cause = unknown like skin tags, this is only an aesthetic problem to remove, sometimes just cut a slit and it pops out other times, it may be deep and surrounding important tissues (but causing no problems) and to cut it out would be very complicated. Malignant Dermal Tumors Kaposis Sarcoma History: Formerly -mostly in the lower legs of Eastern European descendants -slow growing (low grade) Now: most common in AIDS Appearance start as red papules look like nothing special ( then become red, brown, purple nodules micro: see blood vessel proliferation (endothelial) w/RBCs in slits location = everywhere on AIDS pt (can be in mouth, lungs, etc. which leads to problems if they rupture and bleed) Starting to think this is really not a true sarcoma b/c: Virally induced (HSV-8) may be a reaction to the virus Resolves spontaneously Multi-focal -multiple lesions arise at the same time -true cancer starts one place and then has METS Eczema Eczematous Diseases General features Eczema = Greek for boil over Is epidermal inflammation (so eczema usually presents as scaly red skin) aka dermatitis (not really a good name b/c eczema assumes epidermal while you think dermal w/ dermatitis) Pathogenesis/Pathology -NL epidermis has blood supply from the dermal vessels -layers go: stratum corneum (dead / horny layer w/flakes) ( epidermis ( dermis Spongiosis = intercellular edema that accumulates b/c epidermal cells if bad enough, will get vesicles b/t cells epidermis is deranged then ( scaly ( Parakeratosis (retain nuclei in stratum corneum) leads to more scales Exocytosis of lymphocytes from dermal vessels to epidermis -accompanies spongiosis This all becomes chronic and is itchy ( so we scratch it ( skin gets thicker Acanthosis (thickened spinous layer) Hyperkeratosis (thickened stratum corneum) note: all the above bolded terms are used by pathologists (normal Dr.s use the term lichenified, or lichen simplex chronicus, to describe this thickening) Atopic Dermatitis/Eczema Atopic = out of place = rash is out of place when compared to where the allergen is Epidemiology generally people who hypersensitive (may have excessive asthma/hay fever) allergens are inhaled or ingested usually their skin is not sensitive to allergen (so different than contact dermatitis) manifests in childhood (but 90% outgrow this) familial Clinically (given in order from top to bottom, specific to more general) edema of eyelids w/ double folds under the lower ones (Dennies lines) rhinitis (stuffy nose) hyperlinearity of palms ((d markings on palms) eczema (erythematous scales) -generally in antecubital fossa and popliteal fossa infants = more on face adults = more peripheral (places that are more dry) pruritis (d IgE in blood Pathology (gross) -lesion = bright red and crusty (derm term for scab) usually due to S. aureus infection (may need ABX then) Tx Corticosteroid cream (for almost all eczematous disease) b/c most rashes are inflammatory makes lymphocytes go away and allows pt to heal Seborrheic Eczema (Seborrheic Dermatitis) -another misnomer b/c doesnt have anything to do w/sebaceous glands Clinically (basically = dandruff) erythematous/scaly skin, usually on the scalp can go to forehead and then eyebrows in infants = Cradlecap on eyelids = blephoritis if severe, then on chest, armpits scale is greasy, but not b/c of sebaceous gland can get infected (crusty) w/ S. aureus can see ring pattern (NOT ringworm) a. to differentiate, do scraping, do KOH prep and look under microscope Stasis Dermatitis/Eczema Pathogenesis Failing valves in leg veins ( insufficient venous return ( blood pooling in legs Pooled blood also causes: (d pressure in veins which leads to: -proliferation of vessels -dilate vessels ( varicosities -edema (vessel walls are weakened and leak various stuff including RBCs) poor oxygenation to skin -RBCs breakdown & release hemosiderin ( brown skin Clinically pitting edema brown skin if bad enough, get stasis ulcer (from epidermis all the way to stroma) (d circulation ( skin breakdown difficult to heal b/c of compromise in circulation slide: surrounding skin is extremely discolored b/c it is dead By wisdom a house is built, and through understanding it is established; through knowledge its rooms are filled with rare and beautiful treasures. 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