Pathology of Skin - Introduction

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Introduction to Dermatopathology of common skin disorders for undergraduate medical students.

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Pathology of Skin - Introduction

  1. 1. Man is the maker of himself…. You are the stone, You are the chisel, and You are the sculpture….! www.akshardham.com
  2. 2. “ The investment you make in yourself must receive ‘Top Priority’. When you ‘GROW’ your entire world Expands... when you do not grow your whole world starts to become ‘Very Small’...that smallness reflects in all areas of life including your income." Bob Proctor Author and Personal Coach
  3. 3. Pathology of Skin (SSS MD3020) Dr. Shashi dhar Venkatesh Murthy Associate Professor & Head of Pathology
  4. 4. DERMATOLOGY
  5. 5. Learning Objectives: <ul><li>Knowledge: </li></ul><ul><ul><li>Anatomy, Histology, Physiology </li></ul></ul><ul><ul><li>Pathology of Major disorders * </li></ul></ul><ul><ul><li>Etiology, pathogenesis, Morphology. </li></ul></ul><ul><li>Skills: </li></ul><ul><ul><li>Recognise common diseases* </li></ul></ul><ul><ul><li>Clinical/Gross & Microscopy. </li></ul></ul>Pathology of Common Skin Diseases
  6. 6. Sessions & Details: <ul><li>Pathology: </li></ul><ul><li>Inflammatory, Blistering & Neoplastic diseases. </li></ul><ul><li>Clinical, Gross & Microscopy </li></ul><ul><li>Synthesis: </li></ul><ul><li>Review </li></ul><ul><li>Quiz </li></ul><ul><li>Q & A </li></ul>Session 3 <ul><li>Introduction: </li></ul><ul><li>Review – Histology. </li></ul><ul><li>Histopathology </li></ul><ul><li>Diseases - Overview & Classification. </li></ul>Session 2 Session 1
  7. 7. Dermatopathology: <ul><li>Pathology is “Scientific Study of Disease” </li></ul><ul><ul><li>What, when, who, how… etc of a disease. </li></ul></ul><ul><ul><li>“ Understanding disease” </li></ul></ul><ul><li>Study of Pathology: </li></ul><ul><ul><li>What caused disease? Etiology </li></ul></ul><ul><ul><li>How it caused? Pathogenesis </li></ul></ul><ul><ul><li>What changes? – Morphology </li></ul></ul><ul><ul><ul><li>Gross & Microscopy </li></ul></ul></ul><ul><ul><li>Clinical significance – Pathologic basis . </li></ul></ul><ul><li>Laboratory tests: </li></ul><ul><ul><li>Biopsy, Cytology, “Markers”, Molecular, genetic… </li></ul></ul>
  8. 8. Exam Question: 2006 MB3 <ul><li>19 year old female presented with recurrent lesions since 6 years(Image-1). The lesions seems to flare up during winter months and responds partially to topical steroid ointment. </li></ul>
  9. 9. Exam Question: 2006 MB3 <ul><li>Describe the appearance of the lesion shown in the image? [2] </li></ul><ul><li>Bilateral large Pinkish plaques covered with white silvery scales. </li></ul><ul><li>What is the most likely diagnosis? [1] </li></ul><ul><li>Psoriasis </li></ul><ul><li>Briefly describe “Koebner Phenomenon” ? [2] </li></ul><ul><li>“ Koebner phenomenon” means the development of isomorphic psoriatic lesions immediately subsequent to, and at the site of, a cutaneous injury; </li></ul><ul><li>What is Auspitz sign what is its significance? [2] </li></ul><ul><li>Removal of the scales results in small pinpoint bleeding because of increased vascularity under focal areas of epidermal thinning. This feature occurs only in psoriasis and is known as Auspitz’s sign. </li></ul>
  10. 10. Exam Question: 2006 MB3 <ul><li>Look at the Microscopy picture from her lesion (Image-2). Identify any 4 histopathological features shown. [2] </li></ul><ul><ul><li>Hyperkeratosis </li></ul></ul><ul><ul><li>Parakeratosis </li></ul></ul><ul><ul><li>Regular elongation of the rete ridges </li></ul></ul><ul><ul><li>Diminished granular layer </li></ul></ul><ul><ul><li>Tortuous papillary dermal blood vessels </li></ul></ul><ul><ul><li>Inflammatory cells in the superficial dermis. </li></ul></ul><ul><li>You are prescribing a medication for her, what type of base would be suitable for her and why? [2] </li></ul><ul><ul><li>Water soluble Cream base with keratolytic agent such as urea, for hydration and good penetration as the lesion is dry & scaly. </li></ul></ul>
  11. 11. &quot;The will to win is important, but the will to prepare is vital .&quot; - Joe Paterno
  12. 12. Quick Review Skin Under Microscope Anatomy, Histology & Physiology
  13. 13. Normal Skin:
  14. 14. Normal skin:
  15. 15. Hairy skin – Pubic Hair
  16. 16. Thick Skin: Prominent granular layer
  17. 17. Melanocytes:
  18. 18. What is the function of this organ? <ul><li>Fine touch sensation </li></ul><ul><li>Pressure sensation </li></ul><ul><li>Pain sensation </li></ul><ul><li>Sweat production </li></ul><ul><li>Temperature control </li></ul>?
  19. 19. What is the function of this cell? <ul><li>Antigen Processing </li></ul><ul><li>Multiplication </li></ul><ul><li>Melanin production </li></ul><ul><li>Melanin storage </li></ul><ul><li>Osmotic barrier </li></ul>?
  20. 20. What is the function of this cell? <ul><li>Antigen Processing </li></ul><ul><li>Temperature control </li></ul><ul><li>Melanin production </li></ul><ul><li>Immune Defence </li></ul><ul><li>Wound Healing </li></ul>?
  21. 21. What is the type of lesion? <ul><li>Macule </li></ul><ul><li>Papule </li></ul><ul><li>Plaque </li></ul><ul><li>Nodule </li></ul><ul><li>Pustule </li></ul><ul><li>Wheal (hive) </li></ul><ul><li>Scales </li></ul><ul><li>Crust </li></ul><ul><li>Erosion/Ulcer </li></ul>?
  22. 22. What is the function of this? <ul><li>Fine touch sensation </li></ul><ul><li>Pressure sensation </li></ul><ul><li>Lubrication </li></ul><ul><li>Sweat production </li></ul><ul><li>Temperature control </li></ul>?
  23. 23. What is the function of this? <ul><li>Fine touch sensation </li></ul><ul><li>Pressure sensation </li></ul><ul><li>Lubrication </li></ul><ul><li>Immunity & defence </li></ul><ul><li>Temperature control </li></ul>?
  24. 24. What is the type of lesion? <ul><li>Macule </li></ul><ul><li>Papule </li></ul><ul><li>Plaque </li></ul><ul><li>Nodule </li></ul><ul><li>Pustule </li></ul><ul><li>Wheal (hive) </li></ul><ul><li>Scales </li></ul><ul><li>Crust </li></ul><ul><li>Erosion/Ulcer </li></ul>
  25. 25. What is the type of lesion? <ul><li>Macule </li></ul><ul><li>Papule </li></ul><ul><li>Plaque </li></ul><ul><li>Nodule </li></ul><ul><li>Pustule </li></ul><ul><li>Wheal (hive) </li></ul><ul><li>Scales </li></ul><ul><li>Crust </li></ul><ul><li>Erosion/Ulcer </li></ul>?
  26. 26. What is the type of lesion? <ul><li>Macule </li></ul><ul><li>Papule </li></ul><ul><li>Plaque </li></ul><ul><li>Nodule </li></ul><ul><li>Pustule </li></ul><ul><li>Wheal (hive) </li></ul><ul><li>Scales </li></ul><ul><li>Crust </li></ul><ul><li>Erosion/Ulcer </li></ul>
  27. 27. What is the function of this cell? <ul><li>Antigen Processing </li></ul><ul><li>Multiplication </li></ul><ul><li>Melanin production </li></ul><ul><li>Melanin storage </li></ul><ul><li>Protection </li></ul>?
  28. 28. What is the type of lesion? <ul><li>Macule </li></ul><ul><li>Papule </li></ul><ul><li>Plaque </li></ul><ul><li>Nodule </li></ul><ul><li>Pustule </li></ul><ul><li>Wheal (hive) </li></ul><ul><li>Scales </li></ul><ul><li>Crust </li></ul><ul><li>Erosion/Ulcer </li></ul>
  29. 29. What is the function of this? <ul><li>Fine touch sensation </li></ul><ul><li>Pressure sensation </li></ul><ul><li>Pain sensation </li></ul><ul><li>Sweat production </li></ul><ul><li>Temperature control </li></ul>?
  30. 30. What is the type of lesion? <ul><li>Macule </li></ul><ul><li>Papule </li></ul><ul><li>Plaque </li></ul><ul><li>Nodule </li></ul><ul><li>Pustule </li></ul><ul><li>Wheal (hive) </li></ul><ul><li>Scales </li></ul><ul><li>Crust </li></ul><ul><li>Erosion/Ulcer </li></ul>
  31. 31. What is the type of lesion? <ul><li>Macule </li></ul><ul><li>Papule </li></ul><ul><li>Plaque </li></ul><ul><li>Nodule </li></ul><ul><li>Pustule </li></ul><ul><li>Wheal (hive) </li></ul><ul><li>Scales </li></ul><ul><li>Crust </li></ul><ul><li>Erosion/Ulcer </li></ul>
  32. 32. What is the type of lesion? * Multiple correct answers <ul><li>Macule </li></ul><ul><li>Papule </li></ul><ul><li>Plaque </li></ul><ul><li>Nodule </li></ul><ul><li>Pustule </li></ul><ul><li>Wheal (hive) </li></ul><ul><li>Scales </li></ul><ul><li>Crust </li></ul><ul><li>Erosion/Ulcer </li></ul>
  33. 33. If you fail to plan , you plan to fail .
  34. 34. Skin Pathology Part 1 - Introduction (SSS - MD3020) Dr. Shashidhar Venkatesh Murthy Associate Professor & Head of Pathology
  35. 35. Common Histopathological Terms: Complex…!! but we will discuss common & important ones…
  36. 36. Hyperkeratosis <ul><li>hyperplasia of the stratum corneum </li></ul><ul><li>Psoariasis, eczema. </li></ul>
  37. 37. PARAKERATOSIS <ul><li>Keratinization pattern characterized by retention of nuclei in the stratum corneum (this is normal on mucous membranes) </li></ul>
  38. 38. ACANTHOSIS <ul><li>epidermal hyperplasia </li></ul><ul><li>Eczema, psoriasis </li></ul>
  39. 39. Acanthosis: <ul><li>Psoriasiform (regular) </li></ul><ul><li>Irregular </li></ul><ul><li>Papillated </li></ul><ul><li>Pseudoepitheliomatous/pseudocarcinomatous </li></ul>
  40. 40. Acanthosis +hyperkeratosis: Viral wart: Molluscum contagiosum
  41. 41. Papillomatosis <ul><li>hyperplasia of the papillary dermis </li></ul><ul><li>Neoplastic-verrucous ca, venous stasis, viral infections etc.. </li></ul>
  42. 42. Dyskeratosis <ul><li>Abnormal keratinization – carcinoma. </li></ul>
  43. 43. Acantholysis <ul><li>loss of intercellular connections </li></ul><ul><li>Pemphigus </li></ul>
  44. 44. Spongiosis <ul><li>Intercellular edema in the epidermis </li></ul><ul><li>Eczema, pempigus, seborrheic dermatitis. </li></ul>
  45. 45. “ Fascination is one step beyond interest. Interested people want to know if it works . Fascinated people, want to learn how it works ” -- Jim Rohn
  46. 46. Incidence of Skin Diseases: <ul><li>Common: nevi/moles, acne, infections (Fungal, Bacterial, viral), urticaria, eczema (wet/dry), actinic keratoses , psoriasis , carcinoma (BCC, SCC, MM) </li></ul><ul><li>Uncommon: pemphigoid, pemphigus, scabies* Leprosy* </li></ul><ul><li>Rare: xeroderma pigmentosum, dermatitis artefacta, mycosis fungoides (cancer-lymphoma). </li></ul>
  47. 47. Classification: (Morphologic). <ul><li>Epidermis: </li></ul><ul><ul><li>Epithelium : Psoriasis, pemphigus, Neoplasms. </li></ul></ul><ul><ul><li>Pigment disorders: hyper, hypo, </li></ul></ul><ul><li>Dermis: </li></ul><ul><ul><li>Blood vessels - urticaria, contact dermatitis. </li></ul></ul><ul><ul><li>Dermal connective tissue - systemic sclerosis </li></ul></ul><ul><ul><li>Panniculus / Sub cut tissue : erythema nodosum, </li></ul></ul><ul><ul><li>Neoplasms – fibroma, lipoma, sarcoma ..etc. </li></ul></ul><ul><ul><li>Ultimately both Epidermis & Dermis involved * </li></ul></ul>
  48. 48. Classification (Pathologic): <ul><li>Congenital : nevi </li></ul><ul><li>Acquired: </li></ul><ul><ul><li>Traumatic: chemical, physical </li></ul></ul><ul><ul><li>Infections: Bacterial, fungal, Viral, etc. </li></ul></ul><ul><ul><li>Immune: Urticaria , Eczema. </li></ul></ul><ul><ul><li>Neoplastic: Nevi… carcinoma </li></ul></ul><ul><li>Idiopathic diseases : Psoriasis </li></ul>
  49. 49. Skin injury - Pathogenesis Normal Urticaria Wet Eczema Dry Eczyma Normal Infl: Spongiosis Infl: Ulcer/Blist/Oozing Hyperkeratosis Acute Chronic
  50. 50. Dermatopathology: MD3020 curriculum <ul><li>Acute Inflammations: </li></ul><ul><ul><li>Urticaria, </li></ul></ul><ul><ul><li>Acute Eczema, </li></ul></ul><ul><ul><li>Erythema Multiforme. </li></ul></ul><ul><li>Chronic Inflammations: </li></ul><ul><ul><li>Psoriasis, </li></ul></ul><ul><ul><li>Chronic Eczema, </li></ul></ul><ul><ul><li>Lichen planus. </li></ul></ul><ul><li>Infections </li></ul><ul><ul><li>Bacterial (Impetigo), </li></ul></ul><ul><ul><li>Fungal(tinea) & </li></ul></ul><ul><ul><li>Viral(warts). </li></ul></ul><ul><li>Blistering Diseases </li></ul><ul><ul><li>Pemphigus, </li></ul></ul><ul><ul><li>Pemphigoid, </li></ul></ul><ul><ul><li>Dermatitis herpetiformis. </li></ul></ul><ul><li>5. Neoplastic: </li></ul><ul><li>Benign: </li></ul><ul><ul><li>Nevi, </li></ul></ul><ul><ul><li>Actinic Keratosis, </li></ul></ul><ul><ul><li>Seborrheic Keratosis. </li></ul></ul><ul><li>Malignant: </li></ul><ul><ul><li>BCC, SCC, Melanoma. </li></ul></ul>
  51. 51. Study Tips: <ul><li>Preparation: </li></ul><ul><ul><li>Read Lecture notes, attend lecture * . </li></ul></ul><ul><ul><li>Read Robbins Pathology ( Basic ). </li></ul></ul><ul><ul><li>Study Images Gross & Microscopic. </li></ul></ul><ul><li>Make short notes for each condition, </li></ul><ul><ul><li>Etiology, Pathogenesis </li></ul></ul><ul><ul><li>List 3* clinical features. </li></ul></ul><ul><ul><li>List 3* gross features. </li></ul></ul><ul><ul><li>List 3* microscopic features. </li></ul></ul><ul><li>Self Assessment: </li></ul><ul><ul><li>Case studies. ( http://www.dermnetnz.org ) </li></ul></ul><ul><ul><li>Questions & Answers. </li></ul></ul>
  52. 52. Psychodermatosis..?
  53. 53. “ Identifying your Goal is like identifying the North Star--you fix your compass on it and then use it as the means of getting back on track when you tend to stray” -- Marshall Dimock What am I doing? Where am I going? Where I want to be in 5 years time?

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