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Basic Pathological Reactions of the Skin - Dr Zainab Almossalli
1. Basic pathological reactions
of the skin
Basic pathological reactions
of the skin
Done by:
Dr. Zainab Nasser Khalifa Almossalli
Junior dermatology resident
Done by:
Dr. Zainab Nasser Khalifa Almossalli
Junior dermatology resident
2. Skin consist of
Different tissue compartments
Interconnect anatomically and
Interact functionally .
“Reactive units of the
Skin”
Skin consist of
Different tissue compartments
Interconnect anatomically and
Interact functionally .
“Reactive units of the
Skin”
Keep in your mind
3.
4. Keep in your mind
Analysis of the pathological processes
Must
Consider both
The heterogeneity and the interactions
Of the individual cutaneous
Compartments.
22. Keep in your mind
The early mechanism and events responsible
For premature keratinization and apoptosis
Are different
1.Abnormal keratinization : increased eosinophillic
Keratin aggregates in cytoplasm with viable nucleus.
2. Apoptotic cells: shrunken pyknotic fragmented
Nuclei with normal cytoplasm.
24. Under physiological status there is a balance
Between
Forming
intercellular
contacts
Forming
intercellular
contacts
Dissociating
intercellular
contacts
Dissociating
intercellular
contacts
40. The dermal epidermal attachments
Is enforced by
That
Anchors basal cells onto the basal lamina
Which is attached to the dermis by
Anchoring filaments and micro fibrils
Hemidesmosomes
41.
42. Keep in your mind
The basal lamina
is not a ridged or Impermeable structure as:
Langerhans cells, leukocytes and other cells
Can pass without casing a permanent breach
In the junction.
It can be reconstituted these represent an
important phenomenon
In wound healing.
49. Clinical correlation
“dermal epidermal junction is the main target “
scattered lymphocytes and immune complex
deposition leading to broadening of BMZ+
hydropic degeneration + destruction of basal cells
+ progressive atrophy.
Lupus erythematosus
The above reactions will affect the epidermis leading to
Orthokeratosis and parakeratosis.
55. Clinical correlation
Cutaneous drug eruptions
Vascular system itself is the target of inflammatory
process leading to destruction of vascular
components
(clinically : purpura)
Necrotizing vasculitis
60. Reaction patterns in the superfecial part of
Vascular system also occur in deep part
But
there is morphological and functional
Differences due to larger size of vessels in deep
Part
Keep in your mind
61. Superficial and deep vascular network
Connected so closely
That the entire dermal vascular system
represent
a single three dimensional unite
Keep in your mind
66. 1. superficial perivascular infiltrates1. superficial perivascular infiltrates
Its often accompanied by diffuse extension of
Infiltrate to the epidermis revealing focal
“parakeratosis”
1. Erythema anuulare centrifugum
2. Polymorphic light eruption
3. Drug eruptions
4. Insect bites
67. 2. Lymphocytic cuffing of venules without
affecting papillary body or epidermis
2. Lymphocytic cuffing of venules without
affecting papillary body or epidermis
1. Figurate erythemas
2. Drug eruptions
3. CLL
3. perivascular infiltrates with mucinous infiltration
of nonperivascular connective tissues.
3. perivascular infiltrates with mucinous infiltration
of nonperivascular connective tissues.
1. Lupus erythematosus
2. Dermatomyositis
3. Reticular erythematous mucinosis
68. 4. Nodular lymphocytic infiltrate
throughout the dermis
4. Nodular lymphocytic infiltrate
throughout the dermis
Lymphocytoma cutis
5. Nonfollicular lymphocytic infiltrates
sparing the SRU
5. Nonfollicular lymphocytic infiltrates
sparing the SRU
1. Benign lymphoid hyperplasia's
2. Malignant non Hodgkin lymphoma
69. 6. Nodular accumulation of lymphocytes with
plasma cells and eosinophils
6. Nodular accumulation of lymphocytes with
plasma cells and eosinophils
Angiolymphoid hyperplasia
7. Atypical lymphocytic infiltrates7. Atypical lymphocytic infiltrates
Lymphomatoid papulosis
74. Keep in your mind
Skin is an ideal tissue for granuloma formation
In which histiocytes play a key role.
75. Keep in your mind
Granuloma is
Proliferation and focal aggregation of histiocytic cells
Epithelioid cells is
Closely clustered histiocytic cells that resemble
epithelial tissue
76.
77. 1
Naked nodules consisting of epithelioid cells +/-
Langerhans giant cells and lymphocytes
1. Sarcoidal granulomas
2. Foreign body granulomas
78. Palisading granulomas surround necrobiotic areas
Of the connective tissues with histiocytes in radial
Alignment
1. Granuloma annulare
2. Necrobiosis lipoidica
3. Rheumatoid nodules
4. Juxtaarticular nodules of syphilis
These reactions may have significance
As a signs of systemic diseases.
2
79.
80. 3
Infectious granulomas with sarcoidal appearance
1. Tuberculosis 5.Leishmaniasis
2. Leprosy
3. Syphilis
4. Fungal
These reactions are associated with epidermal
Hyperplasia + intraepidermal abscesses
That the etiological organism can be found in
Multinucleated giant cells
In the dermis there is a mixture of cells.
81. 4
Cellular infiltrates consist almost exclusively of
Histiocytes
They have the capacity to store phagocyted material
Like Fat “foam cells” in
xanthomatous reactions
82.
83. Keep in your mind
Its often difficult to classify granulomatus reactions
By histopathology alone for even completely different
Etiological conditions such as vasculitis are associated
With granulomas.
85. Keep in your mind
Sclerosing processes of the skin involve mainly
The connective tissue of the dermis
But usually
Reflect dynamic changes of structure and
Function That involve all compartments.
86. Changes of dermal architecture will become clinically
apparent
Diagnosis
Pathological
Changes
Clinical
Manifestations
Scleroderma
Cutis laxa
Pseudoxanthoma
elasticum
dermatoheliosis
Sclerotic texture and
Homogenization of the
collagen bundles
Fragmentation of elastic
Fibers
Focal aggregation of the
Pathologically altered
Elastic Material
Focal aggregation of
Elastic material
Taut and firm
Connective Tissues
Loose folds
Cobblestone like
Papules
Coarseness of the skin
Lines and surface profile
95. Idiopathic nodular
Primary event is fat necrosis
and inflammation is the secondary.
Accumulation of neutrophils and leukocytoclasia.
necrotic adipocytes will release inflammatory stimulus.
Histiocytes will phagocytes the fat “foam cells”
fibrosis, epithelioid granuloma with giant cells.
Traumatic
lead to necrosis of fat lobules and reactive inflammatory and
Granulomatous tissue response.
oil and silicon inj :cystic cavities
Pentazocine inj: fibrosis and sclerosis.
Animal or vegetable oils: tubercloid or lipophagic granulomas.
