Derm In-Review

From the ODAC experts: Board Review Pearls

Compiled by Dr. Sheila Jalalat

Highlights: key word associations for boards

Neal Bhatia, MD

Read CME in JAAD every Month

55% of the Boards is Kodachrome based

Minocycline hyperpigmentation- Type 1 is most common and involves areas of previous inflammation and scarring

Minocycline hypersensitivity reaction – hepatitis and facial edema

Minocycline causing Lupus-like drug reaction – +ANA and can have positive P-ANCA

Erythema Dyschromicum Perstans – associated with HLA-DR4 – 65%

Imiquimod may cause apoptosis

Diclofenac – induction of apoptosis by inhibiting Cox-2 expression and thereby indirectly inhibiting PGE2 which normally causes hyperproliferation and angiogenesis

Actinic Keratosis – HPV 21, 23, 28 may be associated which causes resistance of apoptosis

Photodynamic therapy requires oxygen

Soret Band is 417 nm (Blu-Light)

Cao Gio is coin rubbing

Pustular pyogenic granuloma is most associated with IBD

Adam Friedman, MD

10% of the Boards is connected with questions about drugs -usually side effects

DH- associated with DQw2; endomysium antibodies

Dapsone can cause many side effects – HELPPMA (hemolysis, elevated liver enzymes, leukopenia, G6PD, peripheral neuropathy, methemoglobinemia, aplastic anemia)

Cimetidine helps counteract methemoglobinemia

Histoplasmosis – treat with amphotericin B

Milium on the hard palate – Bohn’s nodules

Milium on the gums – Epstein pearls

Sebaceous hyperplasia occurs in 10-15% of patient on cyclosporine

Rombo syndrome- trichoepitheliomas, vermiculate atrophoderma, BCC, hyptrichosis, milia

Treat Gram negative folliculitis with Accutane

Pityrosporum folliculitis – inflammation caused by free fatty acids formed from Pityrosporum

Vitamin A deficiency – poor night vision, Bitot spots

Focal dermal hypoplasia (Goltz) – coloboma, raspberry papillomas, osteopathia striata

Brushfield spots – Down syndrome

Gardner’s syndrome – osteomas, supernumerary teeth, CHRPE

Pinguecula – does not cross pigmented areas, seen in Gaucher’s syndrome

Osler’s sign – Alkaptonuria

SAPHO syndrome- synovitis, acne, pustulosis, hyperostosis, osteomyelitis

Hep B in 7-8% of patients with PAN

Hep C – associated with oral erosive type of LP

Hep C- necrolytic acral erythema

Dermatomyositis – pulmonary disease in 15-30% of patients (synthetase syndrome); anti-p155 associated with malignancy

Scleroderma- ventral pterygium

Gonococcemia – treatment ceftriaxone IV

Malignant reticular histiocystosis – xanthelasma in 1/3; 60% arthritis which usually is the first symptom, coral bead lesions along periungual region

Erythromelalgia- distal lower extremities most common site

Scleroderma – dilated vessel – periungual

Nail Patella Syndrome – nephropathy in 40%

Kraurosis Vulvae – Lichen sclerosis et atrophicus- associated with antibodies to ECM-1

Sarcoidosis has an annular subtype

Darier-Roussy type – subcutaneous nodules of sarcoidosis

Heerfordts – sarcoid with uveoparotid involvement

EAC – trailing scale seen in superficial type; can be due to reaction to dermatophyte infection

Annular elastolytic giant cell granuloma

DRESS- culprit drugs include allopurinol, aromatic anticonsulvants- phenobarbital, carbamazepine, Dilantin)

DRESS- eosinophilia, increased transaminases

Allopurinol hypersensitivity syndrome – 7 weeks after

Linear IgA – autoantibody 97 kD

Sweet’s syndrome – gCSF can cause this

PCT- urine uroporphyrin/coproporphyrin; stool isocoproporphyrin

PCT – increase in Hep C, hemochromatosis C282Y gene

Bullous impetigo- Phage 2 group 71, exfoliative toxin A&B

Trichothiodystrophy – PIBIDS

Melorheostosis- seen in linear morphea

Sima Jain, MD

Carney Complex (LAMB syndrome)- lentigines, adrenocortical disease, myxomas, blue nevi, increase in cortisol level, primary pigmented nodular adrenocortical disease; psammomatous melanotic schwannoma; AD, PRKAR1A

Peutz-Jeghers- usually involves lower lip, increase in GI adenocarcinoma

Leopard syndrome- lentigines, deafness 25%, MR 30%

Clumped tonofilaments on EM (only in Dowling Meara type EBS); most severe subtype of EBS

JEB- Laminin 5 (332); Herlitz subtype has exuberant granulation tissue

DEB- Cockayne-Torraine subtype with acral involvement

Monsel’s solution – 20% ferric subsulfate

Blastomycosis- conidia resemble lollipops

Histo- skin lesions <10% of patients

Coccidio- <1% skin involvement; barrel shaped arthroconidia

Paracoccidio – perioral, painful lesions

Papillon Lefevre- cathepsin C (lysosomal protease), transgrediens, calcification of falx and tentorium

Polygonal vessels on dermoscopy – Rosacea

Dermatomyositis- enlarged capillaries

Maffucci syndrome- enchondromas (malignant transition to chondrosarcoma (30%), venous malformations

Blue Rubber Bleb Nevus- TIE2 gene (tyrosine kinase activating mutation)

Monilethrix – K81,86

Cowden’s disease – thyroid follicular carcinoma, breast cancer

Anti-Ro Ab mother 3% chance of baby with neonatal lupus

Hair collar sign- look for ectopic neural tissue – do imaging

EDS- type 1 collagen, large joint dislocation- arthroclasia type

EDS- kyphoscoliosis- PLOD defect

Justin Finch, MD

Yaws- T pallidum pertenue

Pinta- T pallidum carateum; skin limited, central and south America, depigmented lesions

Ulcerative colitis on azathioprine- if put on Humira then increase chance of gamma delta T cell lymphoma

EN- trt SSKI (saturated solution of potassium iodide) but can get se of Wolff-Chaikoff effect and get decreased TSH

Blue lunulae- Wilson dz, AZT (Zidovudine), Argyria

Yellow Nail Syndrome- bronchiectasis (40%)

Blue pigmentation – clofazimine which is a trt for leprosy

Angiokeratoma corporis diffusum – Fabry dz, acral pain crises, XLR, alpha galactosidase A, maltese cross in urine, whorl like corneal opacities

Erythrasma – coproporphin 3 produced by C. minutissium – coral red fluorescence

Phorbol ester- Poinsetta

Capsacin – activates TRP receptor

Garlic- thiocyanates

Pineapple – Bromelin

Calcium oxalate- Dumb cane

Ingenol mebutate- from Euphorbia peplus

Dz= disease

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