Emerging and established academic leaders from all of the various fields within dermatology have come together to redesign and update the most comprehensive study guide and online image companion in dermatology board review. Derm In-Review’s 2019/2020 study guide and online image companion match the new and pending changes to examinations that lay ahead for dermatology residents. Changes include clinical guidelines, high-def, high-quality digital images and delineation of information appropriate for the Basic, Core and Applied exams as outlined in the Exam of the Future.
Study Guide Updates
The Derm In-Review study guide is over 400 pages and formatted for quick study and easy reference. It includes call-out text, tip boxes, highlighted text, mnemonic boxes and 300+ full-color images. The study guide is comprised of five chapters:
Chapter 1: Basic Science (including Immunodermatology)
Chapter 2: Medical Dermatology
Chapter 3: Pediatric Dermatology
Chapter 4: Surgical Dermatology
Chapter 5: Dermatopathology
Request or Download the Study Guide
2019/2020 Derm In-Review study guides will be provided to all US dermatology residents in print. A free electronic version of the study will also be available for download on the Derm In-Review website. Log in or create a complimentary account and then go to Study Guide Request in your dashboard. Special thanks goes to the Derm In-Review advertisers and corporate sponsors: Aurora Diagnostics, Celgene, Lilly, and Novartis.
In addition, all of the study guide clinical images as well as additional clinical images will be available in the Online Image Companion. This companion includes nearly 400 original images and will allow users to log on to the website to enlarge the images for enhanced viewing. Over 100 images are dedicated to dermatopathology board review.
Exam of the Future
The American Board of Dermatology (ABD) is restructuring the In-Training and Certification exams—moving from our current approach of emphasizing knowledge retention and visual diagnosis to exams that better emphasize the application of knowledge using clinically relevant case scenarios. The Exam of the Future will be a staged evaluation with a BASIC exam designed for first-year residents, covering dermatology fundaments; CORE exam modules testing more advanced knowledge of senior residents about dermatology’s major clinical areas; and an APPLIED exam given after residency, which tests the ability to apply knowledge in clinical situations.
Author(s): Adam Friedman
Edition: 1
Publisher: SanovaWorks
Year: 2019
Language: English
Tags: Dermatology
CHAPTER 1 BASIC SCIENCE
1.1 Basic Science....................................................3
Epidermis...................................................................................3
Dermis..................................................................................... 11
Antigens Implicated in Autoimmune Diseases.................... 14
Immunofluorescence Patterns.............................................. 15
Hair Follicle Biology................................................................ 17
Sebaceous Glands.................................................................20
Eccrine Glands........................................................................ 21
Apocrine Glands..................................................................... 21
Nails......................................................................................... 21
Nerves and Receptors of the Skin........................................22
1.2 Immunodermatology......................................23
The Innate Immune System (Overview)...............................23
The Adaptive Immune System (Overview)..........................25
Major Histocompatibility Complex and HLA
Disease Associations............................................................. 27
Antibodies...............................................................................28
Complement............................................................................29
Cytokines.................................................................................30
Wound Healing.......................................................................33
Skin Reorganization Following Injury...................................35
CHAPTER 2 MEDICAL DERMATOLOGY
2.1 General Dermatology.....................................39
Adnexal Disorders..................................................................39
Papulosquamous Disorders..................................................43
Eczematous Disorders...........................................................50
Pigmentary Disorders............................................................ 54
Connective Tissue Diseases..................................................55
Vascular Disorders................................................................. 67
Deposition Disorders............................................................. 73
Neutrophilic Disorders........................................................... 77
Panniculitis..............................................................................80
Granulomatous Disorders.....................................................83
Hematopoietic Disorders....................................................... 84
Perforating Disorders............................................................89
Erythemas...............................................................................90
2.2 Infectious Diseases of the Skin......................93
Bacterial Infections................................................................93
Mycobacterial Infections.......................................................99
Viral Infections...................................................................... 101
Sexually Transmitted Infections..........................................105
Nonvenereal Treponematoses............................................ 107
Parasitic Infections...............................................................108
Rickettsial Diseases..............................................................110
Opportunistic Organisms.....................................................111
Fungal Infections...................................................................113
2.3 Bullous and Vesicular Dermatosis............... 121
Overview and Workup..........................................................121
Basement Membrane and Molecules................................. 122
intraepidermal Autoimmune Diseases............................... 125
Subepidermal Autoimmune Diseases................................ 128
Hereditary Bullous Diseases............................................... 131
Inflammation-Mediated Bullous Diseases......................... 134
Infectious Blistering Disorders............................................ 135
Other Disorders That Can Present with a Blister.............. 135
2.4 Cutaneous Manifestations of
Systemic Disease............................................... 137
Vitamin Deficiencies and Excess........................................ 137
Acanthosis Nigricans........................................................... 139
Flushing Disorders and Carcinoid Syndrome.................... 139
Pruritus.................................................................................. 140
Cutaneous Features and Disorders of Pregnancy.............141
Paraneoplastic Dermatoses................................................ 143
Cutaneous Manifestations of Hepatitis C Virus................ 146
Cutaneous Manifestations of Endocrine Disorders.......... 146
Cutaneous Manifestations of Diabetes Mellitus............... 147
2.5 Disorders of Hair and Nails.......................... 148
Hair Disorders....................................................................... 148
Nail Disorders....................................................................... 154
2.6 Plants and Creatures.................................... 157
Plant Dermatoses..................................................................157
Irritant Contact Dermatitis.................................................. 158
Allergic Contact Dermatitis................................................. 159
Spiders...................................................................................161
Ticks....................................................................................... 163
Mites...................................................................................... 164
Lice........................................................................................ 165
Other Infestations................................................................ 166
Other Bites............................................................................ 166
Medicinal Plants and Creatures.......................................... 169
Marine Injuries...................................................................... 169
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CHAPTER 3 PEDIATRIC DERMATOLOGY
3.1 Cutaneous Disorders of the Newborn..........183
Neonatal Skin.......................................................................183
Cutis Marmorata...................................................................183
Harlequin Color Change......................................................183
Bronze Baby Syndrome.......................................................183
Cephalohematoma...............................................................183
Caput Succedaneum............................................................183
Neonatal Lupus Erythematosus.........................................183
Sclerema Neonatorum.........................................................184
Subcutaneous Fat Necrosis of the Newborn.....................184
Pedal Papules of Infancy.....................................................188
Aplasia Cutis Congenita......................................................188
3.2 Eczematous Eruptions in Childhood............191
Atopic Dermatitis.................................................................191
Hyper-IgE Syndrome ...........................................................191
Wiskott-Aldrich Syndrome .................................................191
3.3 Papulosquamous and Related Disorders.....193
Pityriasis Rubra Pilaris........................................................193
Pityriasis Lichenoides.........................................................193
3.4 Disorders of the Hair and Nails:
Nonsyndromic....................................................194
3.5 Cutaneous Tumors and
Tumor Syndromes..............................................194
Pigmented Lesions...............................................................194
Tumors of the Epidermis......................................................196
Tumors of the Epidermal Appendages...............................197
Fibromatoses........................................................................198
Tumors of Fat, Muscle, and Bone.......................................198
3.6 Histiocytosis and Malignant
Skin Disorders....................................................200
Langerhans Cell Histiocytoses............................................200
Juvenile Xanthogranulomas................................................200
Benign Cephalic Histiocytosis.............................................200
3.7 Disorders of Pigmentation Except
Hypopigmentation.............................................201
Disorders of Abnormal Pigmentation................................201
Waardenburg and Piebaldism ............................................201
Disorders of Hyperpigmentation........................................201
3.8 Vascular Disorders of Infancy
and Childhood....................................................202
Infantile Hemangiomas........................................................202
Noninvoluting Congenital Hemangioma............................203
Rapidly involuting Congenital Hemangioma......................203
Kasabach-Merritt Phenomenon..........................................203
Vascular Malformations.......................................................203
Venous Malformations.........................................................204
Arteriovenous Malformations.............................................205
Lymphatic Malformations....................................................205
Angiokeratomas...................................................................206
Disorders Associated with Vascular Dilatation.................206
Telangiectases......................................................................206
3.9 Bullous Disorders of Childhood...................207
3.10 Exanthematous Diseases of Childhood......207
3.11 Photosensitivity and Photoreactions:
Nonsyndromic Photosensitivity Disorders.........209
Polymorphous Light Eruption.............................................209
Actinic Prurigo......................................................................209
Hydroa Vacciniforme...........................................................210
Photosensitivity From Exogenous Agents ........................210
3.12 Skin Signs of Other Systemic Diseases......210
Chronic Granulomatous Disease........................................210
3.13 X-Linked Recessive Syndromes..................210
3.14 X-Linked Dominant Syndromes..................210
3.15 Hereditary Blistering Disorders..................211
3.16 Ichthyoses and Keratinopathies.................213
Ichthyosis Vulgaris................................................................213
X-Linked Ichthyosis...............................................................213
Collodion Baby......................................................................213
Autosomal Recessive Congenital Ichthyosis......................214
Congenital Ichthyosiform Erythroderma (Nonbullous
Congenital Ichthyosiform Erythroderma)...........................214
Harlequin Ichthyosis..............................................................214
Nonsyndromic Ichthyosis.....................................................214
Syndromic Ichthyoses...........................................................215
Keratinopathies.....................................................................217
xiii
3.17 Palmoplantar Keratodermas......................218
Diffuse Palmoplantar Keratodermas..................................219
Focal PPKS............................................................................220
3.18 Disorders with Hypopigmentation.............220
Silvery Hair Syndromes.......................................................221
Waardenburg and Piebaldism.............................................221
3.19 Disorders with Pigmented Lesions.............223
Freckles (Ephelides).............................................................223
Lentigines..............................................................................223
Peutz-Jeghers Syndrome....................................................223
Noonan Syndrome with Multiple Lentigines
(Formerly LEOPARD Syndrome)........................................224
Carney Complex (NAME and LAMB Syndromes)............224
Café Au Lait Macules...........................................................224
Mccune-Albright Syndrome
(Polyostotic Fibrous Dysplasia)..........................................226
Neurofibromatosis...............................................................226
Watson Syndrome................................................................226
Legius Syndrome..................................................................226
Russell-Silver Syndrome......................................................226
Congenital Dermal Melanocytosis (Mongolian Spot).......226
Nevus of Ota (Oculodermal Melanocytosis/
Nevus Fuscoceruleus Ophthalmaxillaris)...........................226
Nevus of Ito (Nevus Fuscoceruleus
Acromiodeltoideus)..............................................................226
Blue Nevus............................................................................226
Dowling-Degos Disease......................................................226
3.20 Vascular Disorders.....................................227
Acute Hemorrhagic Edema of infancy
(Finkelstein Disease)............................................................228
Henoch-Schonlein Purpura.................................................228
3.21 Connective Tissue Disorders......................228
Ehlers-Danlos Syndrome.....................................................228
Marfan Syndrome.................................................................228
Congenital Contractural Arachnodactyly..........................229
Cutis Laxa.............................................................................229
Pseudoxanthoma Elasticum................................................229
Buschke-Ollendorff Syndrome...........................................229
Focal Dermal Hypoplasia (Goltz Syndrome).....................229
Lipoid Proteinosis.................................................................229
Restrictive Dermopathy.......................................................229
Stiff Skin Syndrome.............................................................229
Hyaline Fibromatosis Syndrome (Infantile Systemic
Hyalinosis and Juvenile Hyaline Fibromatosis)..................230
Beare-Stevenson Cutis Gyrata Syndrome........................230
Apert Syndrome...................................................................230
Pachydermoperiostosis.......................................................230
Osteogenesis Imperfecta....................................................230
3.22 Diseases with Malignant Potential
and Related Conditions......................................230
Basal Cell Nevus Syndrome (Gorlin Syndrome)................230
Bazex Syndrome..................................................................230
Rombo Syndrome.................................................................230
Nicolau-Balus Syndrome.....................................................230
Braun-Falco-Marghescu Syndrome...................................230
Tüzün Syndrome...................................................................231
Rasmussen Syndrome.........................................................231
Familial Cylindromatosis......................................................231
Brooke-Spiegler Syndrome.................................................231
Birt-Hogg-Dubé Syndrome.................................................231
Myotonic Dystrophy with Multiple Pilomatricomas...........231
Gardner Syndrome...............................................................231
Cronkhite-Canada Syndrome.............................................231
Peutz-Jeghers Syndrome....................................................231
PTEN Hamartoma Tumor Syndrome..................................231
Multiple Endocrine Neoplasia Type I
(Wermer Syndrome)............................................................231
Multiple Endocrine Neoplasia Type 2A
(Sipple Syndrome)................................................................231
Multiple Endocrine Neoplasia Type 2B
(Multiple Mucosal Neuromas).............................................232
Dyskeratosis Congenita.......................................................232
Familial Dysplastic Nevi/Melanoma...................................232
Familial Multiple Cutaneous Leiomyomatosis
(Reed Syndrome).................................................................232
Li-Fraumeni Syndrome.........................................................232
xiv 2019/2020 Derm In-Review
3.23 Disorders with Immunodeficiency.............232
Wiskott-Aldrich Syndrome..................................................232
Chronic Granulomatous Disease........................................232
Hyper-IgE Syndrome (Job Syndrome)................................233
Severe Combined Immunodeficiency.................................233
Omenn Syndrome................................................................233
Chronic Mucocutaneous Candidiasis.................................233
GATA2 Deficiency................................................................233
PLAID (PLCG2-Associated Antibody Deficiency
and Immune Dysregulation)................................................233
DOCK8 Deficiency...............................................................233
PGM3 Deficiency..................................................................233
APECED................................................................................233
X-Linked Agammaglobulinemia (Bruton)..........................233
Common Variable Immunodeficiency.................................234
X-Linked Hyper-IgM Syndrome..........................................234
IPEX.......................................................................................234
3.24 DNA Repair Disorders and
Chromosomal Disorders.....................................234
Xeroderma Pigmentosum...................................................234
Cockayne Syndrome............................................................235
Rothmund-Thomson Syndrome
(Poikiloderma Congenitale).................................................235
Bloom Syndrome..................................................................236
Werner Syndrome................................................................236
Progeria (Hutchinson-Gilford Syndrome)..........................236
Muir-Torre Syndrome...........................................................236
Down Syndrome...................................................................236
Klinefelter Syndrome............................................................236
Turner Syndrome..................................................................236
3.25 Disorders of Metabolism............................237
Alkaptonuria.........................................................................237
Fabry Disease (Angiokeratoma Corporis Diffusum).........237
Gaucher Disease..................................................................237
Mucopolysaccharidoses......................................................237
Biotinidase Deficiency or Holocarboxylase
Synthetase Deficiency.........................................................237
Phenylketonuria....................................................................237
Homocystinuria.....................................................................237
Acrodermatitis Enteropathica.............................................238
Wilson Disease.....................................................................238
Hemochromatosis................................................................238
3.26 Lipodystrophy............................................239
Congenital Generalized Lipodystrophy
(Berardinelli-Seip)................................................................239
Acquired Generalized Lipodystrophy
(Lawrence Syndrome)..........................................................239
Familial Partial Lipodystrophy (Dunnigan).........................239
Acquired Partial Lipodystrophy
(Barraquer-Simons Syndrome)..........................................239
Leprechaunism (Donohue Syndrome)...............................240
Familial Multiple Lipomatosis..............................................240
3.27 Hyperlipoproteinemias..............................240
Type I.....................................................................................240
Type IIA..................................................................................240
Type IIB..................................................................................240
Type III...................................................................................240
Type IV...................................................................................240
Type V....................................................................................240
3.28 Disorders of the Hair and Nails..................241
Hair Shaft Abnormalities with Fragility..............................241
Hair Shaft Abnormalities without Fragility.........................241
Nonscarring Alopecias without Hair Shaft
Abnormalities.......................................................................241
Ectodermal Dysplasias.........................................................242
p63 Ectodermal Dysplasias.................................................242
Disorders of Follicular Plugging..........................................242
Nails.......................................................................................242
3.29 Porphyrias..................................................243
Porphyrinogens....................................................................243
Porphyria Cutanea Tarda ...................................................243
Pseudoporphyria..................................................................244
Congenital Erythropoietic Porphyria..................................244
Hepatoerythropoietic Porphyria.........................................244
Acute intermittent Porphyria..............................................244
Variegate Porphyria and Hereditary
Coproporphyria ...................................................................245
Variegate Porphyria.............................................................246
Erythropoietic Protoporphyria............................................246
Transient Erythroporphyria of Infancy................................246
The Basic Heme Synthesis Pathway (Distilled Down)......246
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CHAPTER 4 SURGICAL DERMATOLOGY
4.1 Procedural Dermatology..............................253
Anatomy................................................................................253
Instruments...........................................................................258
Preoperative Considerations...............................................263
Wound Healing.....................................................................266
Flaps and Grafts...................................................................267
Surgical Complications.........................................................274
Electrosurgery and Cryosurgery........................................275
Cosmetic Dermatology........................................................276
Light, Lasers, and Energy Devices.....................................279
4.2 Cutaneous Oncology....................................284
Cutaneous Oncology...........................................................284
Surgical Techniques and Therapy.......................................309
CHAPTER 5 DERMATOPATHOLOGY
5.1 Introduction.................................................319
Tissue Media.........................................................................319
Direct Immunofluorescence................................................319
Normal Histology..................................................................319
Regional Differences in Microanatomy .............................320
Normal Skin Differential Diagnosis.....................................321
5.2 Stains...........................................................322
Special Stains.......................................................................322
Immunohistochemistry........................................................324
5.3 Tissue Reaction Patterns.............................326
Spongiotic Pattern...............................................................326
Psoriasiform Pattern............................................................327
Interface Pattern..................................................................328
Miscellaneous.......................................................................331
5.4 Granulomatous Infiltrates...........................331
Palisaded...............................................................................331
Interstitial..............................................................................332
Sarcoidal/Nodular/Tuberculoid........................................333
Suppurative and Granulomatous Inflammation ...............333
5.5 Bullous Disorders.........................................334
Intraepidermal.......................................................................334
Subepidermal and Pauci-Inflammatory.............................335
Subepidermal and Inflammatory........................................336
Subcorneal Pustular Dermatoses......................................336
Acantholysis with Corps Ronds and Grains......................337
5.6 Vasculitis/Vasculopathy..............................337
Small-Vessel Vasculitis........................................................337
Medium-Vessel Vasculitis....................................................337
Large-Vessel Vasculitis........................................................338
Vasculopathy........................................................................338
Miscellaneous.......................................................................339
Lymphocytic Infiltrates.........................................................339
5.7 Panniculitis..................................................340
Septal....................................................................................340
Lobular..................................................................................341
5.8 Infections/Infestation.................................342
Bacterial................................................................................342
Spirochetal............................................................................344
Protozoan..............................................................................344
Fungal....................................................................................344
Viral........................................................................................347
Infestations...........................................................................348
5.9 Disorders of Collagen and Elastic Tissue.....349
Sclerotic................................................................................349
Fibrotic...................................................................................350
Elastic....................................................................................351
5.10 Alopecia......................................................352
Biopsy Techniques...............................................................352
Approach to Diagnosis........................................................352
Clues to Diagnosis...............................................................352
Nonscarring..........................................................................353
Scarring.................................................................................354
5.11 Cysts and Deposits......................................356
Cysts......................................................................................356
Deposits................................................................................357
5.12 Melanocytic Neoplasms..............................359
Benign...................................................................................359
Malignant...............................................................................363
Synoptic Reporting For Melanoma.....................................363
Immunohistochemistry........................................................364
Molecular/Genomic Aberrations.......................................364
Clues......................................................................................365
5.13 Epidermal Neoplasms.................................366
Benign...................................................................................366
Premalignant and Malignant...............................................367
xvi 2019/2020 Derm In-Review
5.14 Adnexal Neoplasms....................................368
Follicular................................................................................368
Ductal....................................................................................370
Sebaceous.............................................................................371
5.15 Fibrohistiocytic Neoplasms........................373
Benign...................................................................................373
Malignant...............................................................................376
5.16 Lipomatous/Smooth Muscle/
Neural Tumors....................................................377
Lipomatous Tumors.............................................................377
Smooth Muscle Tumors.......................................................379
Neural Tumors.......................................................................380
5.17 Vascular Neoplasms....................................381
5.18 Lymphoid and Leukemic Infiltrates............384
Basic Staining Patterns.......................................................384
Pseudolymphoma.................................................................384
T-Cell Infiltrates....................................................................384
B-Cell Infiltrates....................................................................388
Myeloid/Precursor Infiltrates.............................................389
5.19 Nonlymphoid Infiltrates.............................390
Neutrophilic Infiltrates..........................................................390
Eosinophilic Infiltrates..........................................................391
Mast Cell Infiltrates..............................................................392
Plasma Cell Infiltrates..........................................................392
Histiocytic Infiltrates............................................................393
5.20 Miscellaneous Entities...............................395
Disorders of Epidermal Maturation....................................395
Metastatic Tumors to the Skin............................................395
Artifacts and Foreign Bodies..............................................396
Ectopic Phenomena.............................................................397
5.21 Board Fodder..............................................397
Histopathologic Clues..........................................................397
Histopathologic Bodies.......................................................399
CHAPTER 6 DERMATOPHARMACOLOGY
6.1 Drug Vehicles and Absorption
Mechanisms of Action........................................403
Vehicles.................................................................................403
Volume...................................................................................403
6.2 Topical and Systemic Corticosteroids..........405
Topical Corticosteroids........................................................405
Systemic Corticosteroids....................................................405
Topical Corticosteroids in Pregnancy................................405
6.3 Other Immune-Modulatory Drugs...............405
Crisaborole (Eucrisa)...........................................................405
Apremilast (Otezla)..............................................................405
Tofacitinib (Xeljanz)..............................................................405
Ruxolitinib (Jakafi)................................................................405
6.4 Sunscreens...................................................406
Summary of Sunscreens.....................................................406
6.5 Retinoids......................................................406
6.6 Antibiotics....................................................408
Penicillins...............................................................................408
Cephalosporins.....................................................................408
Tetracyclines.........................................................................409
Macrolides.............................................................................409
Sulfonamides and Co-Trimoxazole.....................................409
Fluoroquinolones..................................................................410
Rifampin................................................................................410
Clindamycin...........................................................................410
6.7 Antivirals......................................................410
Acyclovir...............................................................................410
Valacyclovir...........................................................................410
Famciclovir and Penciclovir..................................................411
Ganciclovir.............................................................................411
Foscarnet...............................................................................411
Cidofovir.................................................................................411
Treatment of HIV-1 Infection...............................................411
Other Agents.........................................................................412
xvii
6.8 Antifungals..................................................412
Terbinafine.............................................................................412
Itraconazole...........................................................................412
Ketoconazole.........................................................................412
Fluconazole...........................................................................413
Voriconazole.........................................................................413
Posaconazole.......................................................................413
Griseofulvin...........................................................................413
Amphotericin........................................................................413
6.9 Antiparasitics...............................................413
Permethrin............................................................................413
Lindane..................................................................................413
Malathion................................................................................414
Ivermectin...............................................................................414
Benzimidazoles......................................................................414
6.10 Antihistamines...........................................414
6.11 Antimalarials..............................................414
6.12 Cytotoxic Agents........................................415
Cyclophosphamide................................................................415
Chlorambucil..........................................................................415
Methotrexate.........................................................................415
Azathioprine..........................................................................416
Mycophenolate Mofetil........................................................416
Hydroxyurea.........................................................................416
Fluorouracil (5-FU)................................................................417
Bleomycin...............................................................................417
Kaposi’s Sarcoma Treatment...............................................417
6.13 Immunosuppressants..................................417
Cyclosporin A........................................................................417
6.14 Dapsone and Sulfapyridine........................418
6.15 Hormone-Related Drugs............................418
Spironolactone.....................................................................418
Finasteride.............................................................................418
Stanozolol and Danazol.......................................................419
6.16 Miscellaneous Drugs..................................419
Colchicine..............................................................................419
Potassium Iodide..................................................................419
Thalidomide...........................................................................419
6.17 Biologic Therapy.........................................420
Psoriasis Therapy.................................................................420
Atopic Dermatitis Therapy...................................................420
Other Biologics.....................................................................420
6.18 Drugs in Pregnancy....................................421
6.19 Drug Interactions.......................................421
Specific Drug Eruptions.......................................................421
Hypersensitivity Syndromes................................................422
Drug-Related Pigmentation Side Effects..........................422
Chemotherapy-Induced Cutaneous Effects......................422
