Skin Test Christina P

SKINTEST Skin Test Christina P. Linton

1. What are the two most important prognostic c. Piezogenic papules indicators when predicting melanoma survival for d. Eruptive xanthomas tumors less than or equal to 1 mm in thickness? 6. Which of the following nail conditions results in a. Clark’s level and Breslow depth the appearance of multiple longitudinal hollows b. Mitotic rate and Breslow depth within a thickened nail plate? c. Ulceration and Breslow depth a. Onychomatricoma d. Mitotic rate and Clark’s level b. Keratoacanthoma c. Glomus tumor 2. Which of the following is not an expected d. Subungual exostosis manifestation of Bazex syndrome? a. Palmoplantar keratoderma 7. The development of a pilomatricoma is most b. Acral psoriasiform lesions common among which age group? c. Alopecia a. Infants d. Enlargement of distal phalanges b. Children c. Middle-aged adults 3. When evaluating prepubertal children for d. Elderly adults Neurofibromatosis type 1, one of the diagnostic 8. In which of the following conditions would spongiosis criteria is the presence of ______cafe´-au-lait not be an expected histopathologic finding? macules of more than 5 mm in greatest diameter. a. Pityriasis alba a. Three or more b. Contact dermatitis b. Four or more c. Tinea pedis c. Five or more d. Keratosis pilaris d. Six or more 9. How long does it take for the first incidence of a 4. In the United States, which dermatophyte is the fixed drug eruption to appear after exposure to most common cause of onychomycosis? the responsible medication? a. Trichophyton tonsurans a. 12Y24 hours b. Trichophyton rubrum b. 48Y72 hours c. Microsporum canis c. 1Y2 weeks d. Microsporum audouinii d. 3Y5 days 5. Ayoung woman presents with multiple, asymptomatic, 10. Which of the following autoantibodies has the highest yellowish outpouchings on the lateral aspect of disease specificity for systemic lupus erythematosus? her heels. Which diagnosis best fits her a. Double-stranded DNA clinical presentation? b. SjPgren-syndrome-related antigen A a. Papular acrodermatitis c. Single-stranded DNA b. Necrobiosis lipoidica d. SjPgren-syndrome-related antigen B

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ANSWERS in postpubertal individuals, (b) two or more neuro- fibromas of any type or one plexiform neurofibroma, 1. b. Mitotic rate and Breslow depth. Since the last (c) freckling in the axillary or inguinal regions, (d) publication of the guidelines of care for primary optic glioma, (e) two or more Lisch nodules, (f) a cutaneous melanoma by the American Academy distinctive osseous lesion, and (g) a first-degree rel- of Dermatology in 2001, the most significant changes in the management of primary melanoma are a result ative with the disease. of the acknowledgment of the dermal mitotic rate as James, W. D., Berger, T. G., & Elston, D. M. (2011). Andrews’ diseases of the skin: Clinical dermatology (11th ed.). Philadelphia, PA: Saunders/ an important prognostic parameter. This change is Elsevier. reflected in the seventh edition of the American Joint Committee on Cancer staging system for melanoma, 4. b. Trichophyton rubrum. Most onychomycosis effective January 1, 2010. In the new staging system, cases in the United States are caused by dermato- mitotic rate has replaced Clark’s level of invasion as phytes, most commonly Trichophyton rubrum, the second factor predicting melanoma survival in which is also the most common cause of tinea addition to tumor thickness (Breslow depth) for pedis. Trichophyton mentagrophytes is less com- tumors less than or equal to 1 mm in thickness. monly identified as the causative organism, followed by Trichophyton tonsurans, Microsporum canis, Bichakjian, C. K., Halpern, A. C., Johnson, T. M., Foote Hood, A., Grichnik, J. M., Swetter, S. M., I American Academy of Dermatology. (2011). Guidelines and Epidermophyton floccosum.Whenyeastisthe of care for the management of primary cutaneous melanoma. American Academy of Dermatology. Journal of the American Academy of Dermatology, cause of onychomycosis, Candida parapsilosis is 65(5), 1032Y1047. the most commonly identified organism, followed by Candida albicans. Among the nondermatophyte 2. c. Alopecia. Bazex syndrome (also known as acro- molds that are responsible for onychomycosis in keratosis paraneoplastica) is a rare, acral psoriasi- the United States, Acremonium and Fusarium spe- form dermatosis that is associated with internal cies are most commonly responsible, followed by malignancy. Classic dermatologic findings include Scopulariopsis species. well-defined erythematous to violaceous plaques covered by a fine-to-thick adherent psoriasiform- Jellinek,N.J.,Rich,P.,&Pariser,D.M.(2015).Understanding onychomycosis treatment: Mechanisms of action and formulation. Retrieved from http:// like scales that are symmetrically distributed on www.globalacademycme.com/fileadmin/pdf/supplement_pdf/DERM_ the acral areas, ear helices, and nasal and malar 3S_6-15_OnychoSppl_Final.pdf surfaces. In later stages, the limbs and trunk be- 5. c. Piezogenic papules. Piezogenic papules are come involved. Other cutaneous findings include yellowish outpouchings on the heel that represent hyperpigmentation, palmoplantar keratoderma, herniation of subcutaneous fat through small and paronychia. Involved nails show ridging, tears in the plantar fascia. This condition may be thickening, yellowish discoloration, and onycholy- asymptomatic or tender and is often associated sis. Bulbous enlargement of distal phalanges with with distance running or high-impact sports. nail dystrophy is another characteristic finding. Papular acrodermatitis (also referred to as papular The appearance of psoriasiform lesions precedes acrodermatitis of childhood or GianottiYCrosti the diagnosis of the associated malignancy in syndrome) is a self-limited cutaneous eruption that 65%Y70% of patients. Treatment is aimed at manifests with skin-colored to pinkYred, edema- eradication of the underlying malignancy, and in tous papules that are symmetrically distributed on 90%Y95% of patients, the cutaneous manifesta- the face, buttocks, and extensor surfaces of the tions improve with successful treatment of the extremities. Necrobiosis lipoidica presents with underlying malignancy. Systemic retinoid therapy yellow-brown, atrophic, telangiectatic plaques in should be considered if the tumor is unresectable or treatment resistant. the pretibial region that are surrounded by raised, violaceous rims. Eruptive xanthomas are erythem- Shah, K. R., Boland, C. R., Patel, M., Thrash, B., & Menter, A. (2013). Y Cutaneous manifestations of gastrointestinal disease: Part I. Journal of atous to yellowish papules that are usually 1 4mm the American Academy of Dermatology, 68(2), 189.e1Y189.21. and distributed on the extensor surfaces of the 3. d. Six or more. Neurofibromatosis is an extremities, buttocks, and hands. They are often autosomal-dominantly inherited syndrome mani- associated with hypertriglyceridemia. fested by developmental changes in the nervous Bolognia, J. L., Jorizzo, J. L., & Rapini, R. P. (2012). Dermatology (2nd ed.). St. Louis, MO: Elsevier/Mosby. system, bones, and skin. The diagnosis of Neurofi- bromatosis type 1 (which encompasses more than 6. a. Onychomatricoma. Onychomatricoma is a rare 85% of cases) requires two or more of the following neoplasm that produces localized or diffuse thick- criteria: (a) six or more cafe´-au-lait macules of more ening of the nail plate with perforations consisting than5mmingreatestdiameterinprepubertalin- of multiple longitudinal hollows that contain the dividuals or more than 15 mm in greatest diameter digitating tumor. A frontal view of the nail typically

398 Journal of the Dermatology Nurses’ Association

reveals multiple holes in the thickened free margin, 9. c. 1Y2 weeks. The first incidence of fixed drug and there is usually transverse overcurvature. The eruption (FDE) generally develops 1Y2 weeks affected nail is yellowYwhite in color with multiple after exposure to the responsible medication. With splinter hemorrhages. Keratoacanthoma presents subsequent exposures, the eruption occurs in the as a painful, subungual keratotic nodule; glomus same site within 24 hours. Classic FDE appears in tumor is a painful, red-bluish nail bed macule; the form of one or a few round, sharply demarcated subungual exostosis is a tender, benign bony erythematous and edematous plaques, sometimes proliferation. with a dusky violaceous hue, central blister, or de- Bolognia, J. L., Jorizzo, J. L., & Rapini, R. P. (2012). Dermatology (2nd ed.). tached epidermis. The lesions can arise anywhere on St. Louis, MO: Elsevier/Mosby. the body but favor the lips, face, hands, feet, and 7. b. Children. Pilomatricoma is a benign adnexal neo- genitalia. The lesions fade over several days and plasm typified by cornification of follicular material often leave a postinflammatory brown pigmenta- that usually presents as a solitary, firm, skin-colored tion. In the nonpigmenting variant of FDE, erythem- to faint-blue nodule. These lesions most commonly atous and edematous plaques appear, often in the develop on the head or upper trunk and usually girdle region, that are characteristically quite large in occur during childhood or adolescence. Treatment diameter (910 cm) and heal with no residual. There is generally accomplished with simple enucleation, is also a rare linear variant of FDE that may be con- although if multiple recurrences are observed, com- fused with linear lichen planus. plete excision is advised to exclude the possibility of Bolognia, J. L., Jorizzo, J. L., & Schaffer, J. V. (2012). Dermatology (3rd ed.). pilomatrical carcinoma. St. Louis, MO: Elsevier/Mosby. Bolognia, J. L., Jorizzo, J. L., & Rapini, R. P. (2012). Dermatology (2nd ed.). 10. a. Double-stranded DNA. Double-stranded DNA St. Louis, MO: Elsevier/Mosby. is frequently (60%) detected in patients with 8. d. Keratosis pilaris. Spongiosis is not an expected systemic lupus erythematosus (SLE) and also has histologic finding in keratosis pilaris. Spongiosis is a high disease specificity for this condition. Smith mainly an extracellular edema between keratinocytes antibodies, ribosomal ribonucleoprotein, and pro- in the epidermis. The edema may cause the kerati- liferating cell nuclear antigen also have high disease nocytes to become elongated and stretched, eventu- specificity for SLE but are not as commonly ele- ally producing spongiotic intraepidermal vesicles. vated. Single-stranded DNA, histones, and SjPgren- Spongiosis is the hallmark of eczema, although it syndrome-related antigen A are commonly found in may not be present in all stages. It also commonly patients with SLE (50%Y60%) but have a low dis- appears nonspecifically in many rashes and irritated ease specificity for SLE. Other less frequently de- neoplasms, including pityriasis rosea, erythema multi- tected autoantibodies with a low specificity for SLE forme, candidiasis, tinea, contact dermatitis, lichen include U1 ribonucleoprotein, SjPgren-syndrome- Y striatus, pityriasis alba, Gianotti Crosti syndrome, related antigen B, and Ku. pityriasis lichenoides acuta, and arthropod bites. Goldsmith, L. A., Katz, S. I., Gilchrest, B. A., Paller, A. S., Leffell, D. J., & Bolognia, J. L., Jorizzo, J. L., & Rapini, R. P. (2012). Dermatology (2nd ed.). Wolff, K. (2012). Fitzpatrick’s dermatology in general medicine (8th ed.). St. Louis, MO: Elsevier/Mosby. New York, NY: McGraw-Hill Medical.

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