Major Skin Lesions Lecture 2 Pathology II

Eczema
1. Epidermis
  1. Inflammation
    1. ACUTE
  2. Flexor surfaces
2. Gross Morphology
  1. red
  2. oozing
  3. crusting
  4. papules
  5. vesicles
3. Histopathology
  1. spongiosis
    1. edema
      1. btw
      2. keratinocytes
      3. of epidermis
  2. epidermal microvesicles
  3. parakeratosis
    1. nucleated stratum corneum
  4. acanthosis
    1. epidermal hyperplasia
  5. Dermal edema
  6. Dermal infiltrates
4. Types
  1. Contact Dermatitis
    1. reaction to allergen
    2. cell mediated hypersensitivity
      1. type IV
  2. Atopic Dermatitis
    1. eczema
    2. too much histamine response
  3. Photosensitivity
5. Etiology
  1. Allergy
    1. IgE - Type I Hypersensitivity
      1. Food
      2. Drugs
      3. UV exposure
      4. Insect bites
    2. Concomitants
      1. hayfever & asthma
  2. Repeated chemical irritation
6. Course
  1. with time, lesions stop oozing
  2. lesions become elevated, scaly plaques
  3. scratching may lead to lichen simplex chronicus
7. Progresion
  1. Early Stages
    1. Papulocesicular
      1. oozing, weeping and crusting
  2. Later
    1. scaling plaques
Erythema multiforme
1. Etiology
  1. Herpes simplex
  2. ANY serious infection
    1. fungi/mycoplasma
  3. Drug rashes
    1. antibiotics
    2. antimalarials
    3. salicylates
    4. barbiturates
    5. anticonvulsants
  4. Paraneoplastic syndromes
    1. sign of cancer on skin
  5. Lupus
2. Gross Morphology
  1. TARGET LESIONS
    1. AKA
      1. iris lesions
    2. pale center
      1. necrotic
  2. MAC/PAP/VES/BULLAE
3. Histopathology
  1. dermal edema
  2. early
    1. perivascular lymphocytic infiltrate
  3. vesicles along dermis/epidermis junction
4. Course
  1. minor
    1. most
  2. severe
    1. Stevens-Johnson Syndrome
      1. Toxic epidermal necrolysis
      2. near total loss of epidermis
      3. dt drugs
      4. Cipro
Psoriasis
1. Etiology
  1. Drugs
    1. Beta-blockers
    2. Ca-channel blockers
    3. Anti-malarials
  2. Alcohol
    1. trigger
  3. HLA-C
    1. genetic marker
      1. HLA B13, 27 and Cw6
    2. Th-1 rxn (cytokine soup)
      1. IFN-G
      2. TNF
      3. IL-12
    3. Antigen Unknown
2. Histopathology
  1. acanthosis
    1. epidermal hyperplasia
      1. increase in # of cells
      2. rete pegs
      3. parakeratotic scales
  2. parakeratotis scale
  3. rete ridges
    1. elongated
  4. mitotic figures
  5. mb neutrophilic aggregates
3. Auspitz sign
  1. epidermal layer over papillae
    1. thinned
  2. twisted blood vessels in papillae
  3. results in
    1. multiple, minute bleeding points when scale is lifted from plaque
4. Gross Morphology
  1. elbows, scalp, knees, back, nails, intergluteal, glans penis
  2. silvery scales
  3. salmon or violaceous plaques
5. Pathophysiology
  1. cAMP
    1. decreases
      1. leads to inc. histamines
  2. cGMP
    1. increases
      1. leads to increased proliferation
6. Systemic Effects
  1. arthritis
  2. AIDS
    1. get psoriasis
  3. nail changes
  4. myopathy
    1. prob w. skeletal muscle
  5. ankylosing spondylitis
    1. type of arthritis
7. Tx
  1. 10 day live-in program
    1. Alt Med Rev.2004;9(3):297-307
    2. fresh f+V
    3. moderate protein
      1. fowl
      2. fish
    4. fiber supplements
    5. olive oil
    6. Avoid
      1. CHOS
    7. Saffron tea
    8. Slippery elm bark
    9. Results
      1. Area, severity and intestinal permeability were all significantly reduced
Lichen planis
1. Etiology
  1. cell turnover
    1. SLOW
  2. Idiopathic
  3. self-limiting
2. Gross Morphology
  1. purple
  2. pruritic
  3. polygonal
  4. papules
    1. planar
  5. plaques
  6. Wickha striae
    1. web of white lines
3. Histopathology
  1. dermal-epidermal junction
    1. lymphocytic infiltrate
      1. dense
    2. zig-zag
  2. basal keratinocytes
    1. necrosis
      1. incorporated into dermis
    2. degeneration
4. Location
  1. penis
  2. flexor wrist
  3. mouth
Pemphigus vulgaris
1. Etiology
  1. VERY RARE
    1. VERY SERIOUS
      1. Blistering
      2. mb lethal
  2. Ab attack desmosomes of sq. epithelium
    1. Acantholysis
      1. epid. cells cease to adhere to each other
2. Gross Morphology
3. Clinical
  1. Nicolsky sign
    1. skin is irritated
      1. blister forms w/in minutes
  2. Vesicles
    1. skin
    2. mucus membranes
  3. Erosion & Infection
Bullous pemphigoid
1. Older Pts
2. Subepidermal
  1. non-acantholytic vesicles
3. Histopathology
  1. basal cells to basement is damaged
Seborrheic keratosis
1. Etiology
  1. very very very common
  2. basal cells
    1. hyperplasia
2. Gross Morphology
  1. pigmented
  2. verrucous
  3. can be scraped off
  4. appear pasted-on/superficial
3. Histopathology
  1. hyperkeratosis
    1. sheets of basal-like cells
  2. keratin filled cysts
4. Clinical
  1. problem
    1. if many erupt at the same time
      1. mb
      2. Leser-Trelat
      3. sign of
      4. Adecocarcinoma
Acanthosis Nigricans
1. acanthosis causing hyperpigmented areas
  1. velvet-like texture
  2. skin folds
    1. neck
    2. axillae
    3. groin
    4. anogenital
2. Benign
  1. 80%
  2. onset
    1. childhood
    2. obesxity, DM, PCOS
3. Malignant
  1. onset
    1. middle age or older
    2. THINK
      1. adenocarcinomas
4. Etiology
  1. Medications
    1. glucocorticoids
    2. niacin
    3. insulin
    4. oral contraceptives
    5. protease inhibitors
    6. promote hyperinsulinemia
5. Incidence
  1. African America
    1. 25 fold vs caucasians
6. Pathology
  1. Elevated insulin
    1. activates IGF-1 receptors on
      1. keratinocytes
      2. fibroblasts
      3. causes proliferation
7. Histopathology
  1. thickened stratum corneum