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\author{AlbertEinstein}
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  /Title (skin-diseases.pdf)
  /Creator (Cheatography)
  /Author (AlbertEinstein)
  /Subject (Skin Diseases Cheat Sheet)
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\noindent
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Skin Diseases Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{AlbertEinstein} via \textcolor{DarkBackground}{\uline{cheatography.com/55586/cs/14776/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}AlbertEinstein \\
  \uline{cheatography.com/alberteinstein} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 22nd March, 2018.\\
   Updated 14th March, 2018.\\
   Page {\thepage} of \pageref{LastPage}.
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{4}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Definitions:}}}}  \tn
\SetRowColor{LightBackground}
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Definitions (cont.):}}}}  \tn
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\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Skin Diagram:}}}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/carmilaa_1519382960_image3.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Major Skin Cells:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{1) Keratinocytes} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{2) Melanocytes: anchor to basement membrane and pump out pigment for protection from sunlight damage} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{3) Langerhans' cells: antigen-presenting system} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Normal Skin Structure and Function:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Function: Barrier between the individual and the extrernal environment} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Burn victims:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}loss of barrier leading to loss of fluid and secondary bacterial infections.} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Eczema/Dermatitis:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}damage to the skin resulting in inflammation and spongiosis with edema of the dermis. Hypersensitive reaction to certain chemicals or drugs. Atopic eczema patients are predisposed to allergic rhinitis and asthma.} \tn 
% Row Count 11 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Immersion:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}prolonged immersion in water may overwhelm the barrier (ie. occlusal dressing of burns or under surgical dressings) - can be an advantage in topical therapy.} \tn 
% Row Count 16 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Incidences of Skin Diseases:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Common:}} acne, psoriasis, eczema, seborrheic warts and viral warts, actinic ratosis, basal cell carcinoma, squamous cell carcinoma.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Uncommon:}} pemphigoid, pemphigus, melanoma and scabies.} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Rare:}} xeroderma pigmentosum, mycosis fungoides.} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Age, Sex, Anatomical Site, Rare, Exposure and Geography.}}} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

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\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Disorders: \seqsplit{Inflammatory\&Hematopoietic} cells}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Polymorphonuclear leucocytes (polymorphs)}}– accumulate in the skin due to response to infections e.g Staphylococcus aureus in impetigo.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Psoriasis:}} neutrophilic infiltrate with intra-epithelial migration forming sterile abscesses. Others are Sweet's disease and pyoderma gangrenosum show a heavy dermal neutrophilic infiltrate – 2nd to chronic inflammatory bowel disease.} \tn 
% Row Count 8 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Autoimmune conditions:}} e.g dermatitis herpetiformis show neutrophilic infiltrate where as bullous pemphigoid shows an eosinophilic infiltrate.} \tn 
% Row Count 11 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Lymphocytic infiltrate:}} seen in  most chronic inflammatory skin diseases and comprises mostly T-lymphocytes (CD4/Helper T-cells)} \tn 
% Row Count 14 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Eczema:}} lymphocytic infiltrate and spongiosis} \tn 
% Row Count 15 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Lupus erythematosus and lichen planus}}} \tn 
% Row Count 16 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Cutaneous lymphomas:}} primary (mycosis fungoides) or secondary ( peripheral T-cell lymphoma, anaplastic large cell lymphoma etc.)} \tn 
% Row Count 19 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Mycosis fungoides:}} T-cell lymphoma – Sézary syndrome} \tn 
% Row Count 21 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Histiocytic infiltrates:}} seen in granulomatous skin diseases e.g. bacterial (mycobacteria), fungal (candidiasis) or protozoal infections.} \tn 
% Row Count 24 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Systemic diseases:}}  e.g.  Sarcoidosis.} \tn 
% Row Count 25 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Primary granulomatous skin diseases:}} granuloma annulare or necrobiosis lipoidica.} \tn 
% Row Count 27 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Infections:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Clinical appearance depends on:} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}1. Site} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}2. Nature of organism} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}3. Nature of the body's response to the infection.} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Routes of transmission:}} hematogenous or penetration of the skin barrier}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Viral Infections:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Viruses are obligate intracellular organisms – metabolic basal cells.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Human Papilloma Virus (HPV):}} DNA virus with numerous subtypes.} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Skin and oral mucosa causes squamous papillomas, verrucae vulgaris, verruca plantaris, verruca plana, condyloma acuminatum (genital warts)} \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Molluscum contagiosum:}} DNA pox virus –  umbilicated self-limiting lesion in children.} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Herpes virus:}} HVS1 and HPV2 (blistering vesicles), herpes zoster (chickenpox) and shingles.} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Human herpes virus 8 (HHV8):}} Kaposi's sarcoma (HIV)} \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Bacterial Infections:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Impetigo:}} Staph.aureus in children but Strep. in elderly} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Celluliltis:}} Streptococcus pyogenes} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Tuberculosis of the skin (lupus vulgaris):}}Mycobacterium tuberculosis or Mycobacterium bovis the cause of scrofuloderma.} \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Leprosy (Hansen's disease):}} Mycobacterium leprae (lepromatous and tuberculoid). Lepromatous form fatal  while tuberculoid form destroy tissue and nerves resulting in mutilated leonine facies and auto-amputations of digits.} \tn 
% Row Count 11 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Fungal and Protozoa Infections:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Fungal:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Common ringworm (tinea) Tinea pedis (athletes foot) Candida, Blastomyces and Norcardia} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Protozoal:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Leishmaniasis infections  transmitted by sandflies, organism infiltrates the macrophages} \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Uticaria:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Hives or wheals (reaction pattern), itching and swelling. Sudden marked increase in the permeability of the dermal blood vessels resulting in edema of the dermis – erythematous or edematous lesions.} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Histology:}} shows marked infiltrate of eosinophils and mast cells} \tn 
% Row Count 6 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Causes:}}Plant and animal toxins, physical stimuli e.g. heat, cold or stress, various drugs (aspirin and antibiotics)} \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Histamine is the mediator and increase in IgE.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Lupus erythematosus (SLE or LE)}}}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{-Autoimmune disease affecting connective tissue with antibodies directed against DNA. \newline % Row Count 2 (+ 2)
-Multisystem disease involving almost any organ, most common is skin and kidneys.  \newline % Row Count 4 (+ 2)
-Epidermis and adnexa involved.  \newline % Row Count 5 (+ 1)
-Skin only: Discoid lupus – erythematous, scaly and older lesions show hyperpigmentation. \newline % Row Count 7 (+ 2)
-Often symmetrical on the face with a butterfly rash over nose and cheeks, and on scalp it may cause scarring alopecia. \newline % Row Count 10 (+ 3)
-Immunofluorescence show IgG and IgM at the epidermal basement membrane – "lupus band test"% Row Count 12 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Psoriasis:}}}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Genetically determined – HLA haplotypes (HLA Cw6, B13 and B17). \newline % Row Count 2 (+ 2)
Disease of epidermal proliferation and excess keratin production, driven by cytokines released from activated T-cells in the dermis \newline % Row Count 5 (+ 3)
Silver-grey scales of parakeratosis on extensor surfaces such as knees and elbows. \newline % Row Count 7 (+ 2)
First appearance may be at site of trauma e.g. surgical wound – "Koebner effect". \newline % Row Count 9 (+ 2)
Result in destructive arthropathy (psoriatic arthritis) \newline % Row Count 11 (+ 2)
Small bleeding points – Auspitz's sign. \newline % Row Count 12 (+ 1)
{\bf{Histology:}} rete ridges becomes acanthotic with the dermal papillae covered by thin epidermis two or three layers thick. \newline % Row Count 15 (+ 3)
Loss of the granular cell layer. \newline % Row Count 16 (+ 1)
Erythematous lesions - caused by dilated vessels in upper dermis. \newline % Row Count 18 (+ 2)
Numerous polymorphs that migrate from the vessels into the epidermis forming pustules (micro-abscesses)- pustular psoriasis. \newline % Row Count 21 (+ 3)
May also involves the sole of feet and palms of hands. \newline % Row Count 23 (+ 2)
{\bf{Treatment:}} Coal tar, Methotrexate and arsenic. \newline % Row Count 25 (+ 2)
{\bf{Current therapy:}} Retinoid (Vit A analogues).% Row Count 26 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Panniculitis:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Inflammation of the subcutaneous fat.} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Most common type is {\bf{Erythema nodosum}} which occurs as painful red nodules on the shins.} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Follow a streptococcal infection or in association with inflammatory bowel disease or tuberculosis.} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Lichen Planus:}}}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{- Characterized by destruction of keratinocytes, probably mediated by interferon-gamma and tumour necrosis factor from T-cell in the dermis. \newline % Row Count 3 (+ 3)
- Affects the skin, most commonly the inner surface of the wrist. \newline % Row Count 5 (+ 2)
- Appears as white lacy lesion – presents as itchy, polygonal, violaceous papules that may form blisters. \newline % Row Count 8 (+ 3)
- May be caused by certain drugs or medications. \newline % Row Count 9 (+ 1)
- Mucosal surface white striae – Wickham's striae.% Row Count 11 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{- Histology shows a lymphohistiocytic infiltrate in a band-like fashion at the dermo-epidermal junction- classical lichenoid reaction pattern. \newline - Basal cell vacuolar degeneration, apoptosis, keratinocyte necrosis. \newline - In contrast to psoriasis, LP show an increase in the granular cell layer. \newline - Rete ridges show "sawtooth" morphology. \newline - Treatment: Steroids}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Benign epidermal neoplasms \& tumour-like:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Skin tags or fibro-epithelial polyps:}} seen frequently in the elderly and common in the axilla. Due to friction rather than a true neoplasm.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Seborrheic keratosis (basal cell papillomas):}} common in the elderly, dark greasy looking nodules with an irregular surface. Rarely turn malignant. Stuck-on appearance.} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Histology:}} Convoluted surface with keratin tunnels (horn cysts). The may become inflamed. Often remove for cosmetic purposes and to exclude melanoma.} \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Squamous papilloma:}} Benign neoplasm of squamous epithelium, HPV induced lesion.} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Cyst:}} Epidermal (infundibular) cyst and pilar (tricholemmal) cyst are the most common.} \tn 
% Row Count 15 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Pre-malignant lesions:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Actinic keratosis:}} In sun-exposed areas , show dermal solar elastosis, need to evaluate for keratinocyte intra-epithelial neoplasia (KIN I-III)} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Bowen's disease:}} Squamous cell carcinoma in-situ.} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Basal cell carcinoma (BCC):}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Very common skin malignancy, most commonly on the face of elderly people.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Related to chronic sun exposure.} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Locally very aggressive and destructive, however metastasis are extremely rare.} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Nodular or superficial BCC has a better prognosis while micro-nodular and morphoeic are more aggressive and recurrence is high.} \tn 
% Row Count 8 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Associated with mutations in the Drosophila gene patched- PTCH1 (tumour suppressor gene)which is a member of the sonic hedge-hog pathway.} \tn 
% Row Count 11 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Clinically:}} ulcerated irregular lesions – rodent ulcers with raised pearly borders and blood vessels visible on the border.} \tn 
% Row Count 14 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Histology:}}cells look like normal basal epithelial  cells, islands of basaloid cells with peripheral palisading.} \tn 
% Row Count 17 (+ 3)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{May develop from the basal cell layer or hair follicles.} \tn 
% Row Count 19 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Squamous cell carcinoma (SCC):}}}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{3.833cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/carmilaa_1520788377_image42.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{-Are common and usually caused by chronic UV exposure. \newline -Other: immunosuppression, irradiation, chemical carcinogens, HPV infections and chronic infections. \newline -More common in the elderly . \newline -Rarely SCC arises at the edge of a chronic skin ulcer (Majolin's ulcer). \newline -Very aggressive and invasive however metastasize late. \newline -Excision can be curative and SCC are more sensitive to radiation than BCC's.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Keratoacanthoma:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Rapidly growing, cup-shaped squamous epidermal lesion} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Involves sun-exposed skin of elderly - face} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Regresses spontaneously if left untreated} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Histology:}} \newline -Endophytic-endophytic squamous proliferation,  \newline -Cup-shaped lesion \newline -Crater-like center filled with laminated keratotic material \newline -Resembles a well differentiated squamous cell carcinoma}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Melanocyte Derived Lesions:}}}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{\textgreater{} Melanocytes are pigmented cells \newline % Row Count 1 (+ 1)
\textgreater{} Found in basal layer of epidermis \newline % Row Count 2 (+ 1)
\textgreater{} Melanin is synthesized by melanosomes \newline % Row Count 3 (+ 1)
\textgreater{} Found on skin and mucosal surfaces – oral cavity, vagina, conjunctiva etc.% Row Count 5 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Types of Benign Lesions:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Lentigos:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Increase in single melanocytes in basal areas. Small, pigmented macule.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Naevi:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Increase in groups of melanocytes. Melanocytes form nests.} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Freckle:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Increase in melanin production by normal melanocytes which are taken up by adjacent keratinocytes. UV stimulation.} \tn 
% Row Count 10 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Naevis:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Common in light-skinned individuals. Absent at birth and appear in early childhood. Increase in number through early adulthood. Found mainly on sun-exposed areas. Different stages} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{STAGE 1 - JUNCTIONAL:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}At dermo-epidermal junction –intraepidermal nests. Tan or brown pin-point macules (1-2mm). Gradually enlarge. Increase in number of individual melanocytes at dermo-epidermal junction.} \tn 
% Row Count 9 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{STAGE 2 – COMPOUND:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Nevus is elevated above skin surface. Childhood \textbackslash{} adolescence.Slightly raised due to nests of melanocytes} \tn 
% Row Count 13 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{STAGE 3- INTRADERMAL:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}Middle to old age. Nevus cells detach from dermo-epidermal junction. Smaller, more mature and less metabolically active. Cannot divide. Two components Junctional and intradermal. Pink due to lack loss of melanin} \tn 
% Row Count 19 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Histology of Stage 2:}} \newline - Nests of melanocytes at dermo-epidermal junction and infiltrating dermis \newline - Pigmented \newline - Dendrites lost \newline - Nuclei become round, inconspicious nucleoli}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Blue Naevis:}}}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{- Occurs in deep dermis \newline % Row Count 1 (+ 1)
- Bluish tinge \newline % Row Count 2 (+ 1)
- Any area of skin \newline % Row Count 3 (+ 1)
- Less than 5mm in diameter \newline % Row Count 4 (+ 1)
- Solitary \newline % Row Count 5 (+ 1)
- Malignant transformation is rare% Row Count 6 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{MALIGNANT LESIONS: Melanoma}}}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{- Common skin cancer \newline % Row Count 1 (+ 1)
- Can arise from any melanocyte, composed of malignant melanocytes. \newline % Row Count 3 (+ 2)
- Usually pigmented but may be unpigmented. \newline % Row Count 4 (+ 1)
- Etiology associated with fair skin and sunburn \newline % Row Count 5 (+ 1)
- Asymmetrical (ABCDE) \newline % Row Count 6 (+ 1)
- Irregular borders \newline % Row Count 7 (+ 1)
- Varying colours: blue, black-brown, ulcerated \newline % Row Count 8 (+ 1)
- \textgreater{}6mm \newline % Row Count 9 (+ 1)
- Evolution \newline % Row Count 10 (+ 1)
- Prognosis depends on thickness of lesion and presence of surface ulceration – Breslow thickness \newline % Row Count 12 (+ 2)
- \textgreater{} 1 mm depth  indicates significant risk for metastasis \newline % Row Count 14 (+ 2)
- Cure rate for completely excised non-ulcerated melanomas below 1mm is 100\%% Row Count 16 (+ 2)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Main Variants:}} \newline {\bf{1. Lentigo maligna melanoma:}} - sun damaged skin of the elderly, develops from a pre-existing in situ lesion termed a lentigo maligna (Hutchinson's melanotic freckle). \newline  \newline {\bf{2. Acral lentiginous melanoma:}} – palms and soles, most common type in Non-Caucasians. \newline  \newline {\bf{3. Superficial spreading melanoma:}}- most common type in people from European descent \newline  \newline {\bf{4, Nodular melanoma:}} -retain no features to identify a pre-existing in situ lesion}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Vesiculo-Bullous Conditions:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Fluid –filled cavities} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Within the skin} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Caused by the separation of two layers of tissue and leakage of plasma into the space} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Bullae: 	\textgreater{} 5mm} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Vesicles:	\textless{} 5mm} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{DISTINCT MECHANISMS OF BLISTER FORMATION:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Direct destruction of bonds between epithelium e.g. pemphigus} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Cells forced apart by edematous fluid e.g. eczema} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Cellular destruction leaving gaps e.g. herpes infection} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Basement membrane or its attachments to epidermis or dermis altered e.g. bullous pemphigoid} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Pemphigus:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{BONDS BETWEEN EPITHELIUM IS BROKEN} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Common in middle-aged to elderly} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Mortality rate of approximately 40\%} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Autoantibodies directed against desmosomes} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Bridges lysed and epidermis falls apart} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{- Blister formed containing epithelial cells within cavity (acantholysis) \newline  \newline - Various forms: \newline Pemphigus vulgaris \newline Pemphigus foliaceus \newline Pemphigus vegetans \newline  \newline - Skin very fragile \newline - Firm pressure on normal-looking skin will cause blister formation (Nikolsky's sign)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Bullous Pemphigoid (BP):}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{More common than pemphigus} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Usually over 60 years of age} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Self-limiting} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Associated with periods of pruritis} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Blister forms at dermo-epidermal junction} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Etiology:}} \newline \textgreater{} Circulating antibodies against lamina lucida of the BM. \newline \textgreater{} Linear deposition of antibodies along basement membrane (IgG) \newline \textgreater{} Causes antigen-antibody complexes and release of complement factors as well as degranulation of mast cells \newline \textgreater{} Blisters are more persistent}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{DERMATITIS HERPETIFORME:}}}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{- Characterized by small, itchy blisters \newline % Row Count 1 (+ 1)
- On extensor surfaces of knees and elbows  \newline % Row Count 2 (+ 1)
- Young adults \newline % Row Count 3 (+ 1)
- May be associated with Coeliac disease \newline % Row Count 4 (+ 1)
- Pruritic lesions \newline % Row Count 5 (+ 1)
- Bullous forms at dermo-epidermal junction \newline % Row Count 6 (+ 1)
- {\bf{Immunofluorescence:}} Granular deposits of IgA \newline % Row Count 8 (+ 2)
- Therapy: Response to dapsone% Row Count 9 (+ 1)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{{\bf{Bullous and Acantholytic Dermatosis:}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Intra-epidermal/Suprabasal Cleft:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}1. Pemphigus Vulgaris: IgG (intercellular) 2.Pemphigus Foliaceus: IgG (subcorneal) 3. Pemphigus Erythematous: IgG} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{{\bf{Sub-epidermal Cleft:}}} \tn 
\mymulticolumn{1}{x{3.833cm}}{\hspace*{6 px}\rule{2px}{6px}\hspace*{6 px}1. Bullous Pemphigoid: linear IgG and C3 at basement membrane. 2. Dermatitis Herpetiformis: granular IgA papillary dermis. 3. bullous Systemic Lupus Erythematosus:IgG, IgA and C3.} \tn 
% Row Count 9 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}