Transcript Integumentary Diseases, Disorders, and Conditions Part I PPT

Integumentary Diseases,
Disorders, and Conditions
Part I of II
As presented November 2014
H. Biology II
Definitions
• Disease- an abnormal condition of the
body or the mind that causes dysfunction
or discomfort.
• Disorder- a functional abnormality, or
disturbance.
• Condition- a state of being, in health, a
disease, such as a heart condition.
Top Skin Diseases
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Scaly Red Rashes (5) • Benign Growths (3)
Pigment Changes (2) • Premalignant
Growths (2)
Nodules (2)
• Malignant Growths
Purpura (1)
(3)
Blisters (4)
Systemic (3)
Scaly Red Rash 1: Seborrhea
Greasy yellow scaly plaques are
characteristically distributed in the scalp,
Tzone of face, hairy areas of face
(eyebrows, eyelashes, beard), behind the
ears, on the forehead, trunk, body folds,
and genitalia.Unknown etiology.
"cradle cap"
focal parakeratosis, moderate acanthosis, slight
spongiosis and a mild, mixed inflammatory infiltrate.
Scaly Red Rash 2: Psoriasis
Red or pink papule/plaque with silvery
or micaceous scaling. The fingernails
may show dystrophy, depressions known
as "pits" and subungual debis
presence of a thickened epidermis and
stratum corneum containing neutrophils and
neutophilic debris; no granular layer,
elongation of the rete ridges; T cell
involvement in etiology
Psoriasis
• It can appear anywhere on the body, but it is
most commonly found on the elbows, knees,
scalp, and lower back.
• Skin typically becomes red and inflamed and
may form white scaly patches.
• It can be quite painful and may itch, crack,
and bleed.
• While psoriasis may look like just a skin
disease, it is in fact a disease of the immune
system.
Centrifugally spreading, reddish or pink
plaques or patches with slightly raised
advancing edge. Annular. Itchy rash
caused by fungus Tricophytum rubrum
in most cases.
Tinea corporis
Scaly Red Rash 3: Tinea
Tinea corporis
Tinea capitis
Tinea versicolor
Tinea capitis KOH prep on hair
“spaghetti and meatballs”
thick stratum
corneum
Tinea versicolor
Tinea unguium
Parakeratosis
Tinea pedis
PAS stain showing fungi
Tinea Pedis- Athletes’ Foot
• Athlete's foot is a very common skin infection of the
foot caused by fungus.
• . When the feet or other areas of the body stay moist,
warm, and irritated, this fungus can thrive and infect
the upper layer of the skin..
• Athlete's foot is caused by the ringworm fungus
("tinea" in medical jargon). Athlete's foot is also called
tinea pedis. The fungus that causes athlete's foot can
be found on many locations, including floors in gyms,
locker rooms, swimming pools, nail salons, and in
socks and clothing.
• The fungus can also be spread directly from person
to person or by contact with these objects.
Scaly Red Rash 4: Eczema
Eczema is very itchy. There are variants
of eczema, the so-called "messy" rash,
for example, "irritant" eczema, atopic
eczema, and contact eczema, all of which
are characterized by rashes that are quite
itchy and appear "messy" because they
are often scratched.TH2 mediated DTH
Flexural distribution
Lichenification from scratching
crusting in the stratum corneum (making one
think of a "messy rash") and the "spongiosis"
or epidermal edema, as evidenced by the
relative pallor around the keratinocytes.
Eczema
• Eczema most commonly causes dry,
reddened skin that itches or burns, although
the appearance of eczema varies from
person to person and varies according to the
specific type of eczema.
• Intense itching is generally the first symptom
in most people with eczema.
• Sometimes, eczema may lead to blisters and
oozing lesions, but eczema can also result in
dry and scaly skin.
• Repeated scratching may lead to thickened,
crusty skin.
Scaly Red Rash 5: Scabies
Scabies (or infestation with the
Sarcopetes mite), especially when
untreated, can lead to a widespread
eczema rash with a few additional
distintive features such as heavy
involvement in the groin or skin folds
and, in particular, involvement of the
interdigital web spaces with crusting.
one finds a lot going on in the
stratum corneum. Here one
can see traces of the mite.
Pigment Changes 1: Vitiligo
With Fontana Masson stain, lesions of
long standing vitiligo (right hand panel)
show no melanocytes. In normal skin (left
panel) darkly stain melanocytes are
visible along the dermoepidermal
junction.
Vitiligo
• Vitiligo (vit-ill-EYE-go) is a pigmentation
disorder in which melanocytes (the cells that
make pigment) in the skin are destroyed. As a
result, white patches appear on the skin in
different parts of the body.
• Similar patches also appear on both the
mucous membranes (tissues that line the
inside of the mouth and nose), and the retina
(inner layer of the eyeball).
• The hair that grows on areas affected by
vitiligo sometimes turns white.
Pigment Changes 2: Melasma
large amount of melanin in the basal layer
HPV mediated. Here shown is common wart
Papules/Plaques 1: Warts
Flat wart
Genital wart
Aka condyloma
acuminatum
Plantar wart
The hallmarks of warts are hyperkeratosis, papillomatosis
(outward expansion of the spinous layer) and acanthosis.
The epidermis contains foci of vacuolated cells (koilocytes),
clumped keratohyaline granules, and vertical tiers of
parakeratotic cells (stratum corneum with retained nuclei).
Warts
• Common warts are local growths in the skin
that are caused by human papillomavirus
(HPV) infection.
• Although they are considered to be
contagious, it is very common for just one
family member to have them.
• They often affect just one part of the body
(such as the hands or the feet) without
spreading over time to other areas.
Papules/Plaques 2: Molluscum
dome-shaped pink-brown papules with
secondary umbilication noted in mnay of the
well-developed lesions
ballooning-like changes in the keratinocytes as
they approach the granular layer. There are
intracellular inclusion bodies known as molluscum
bodies.
Papules/Plaques 3: Acne Vulgaris
Acne Vulgaris
• Acne vulgaris is a common skin disease that
affects 85-100% of people at some time
during their lives.
• It is characterized by non-inflammatory
pustules or comedones, and by inflammatory
pustules, and nodules in its more severe
forms.
• Acne vulgaris affects the areas of skin with
the densest population of sebaceous follicles;
these areas include the face, the upper part
of the chest, and the back.
• Treatment is a regimine of topical creams,
and oral antibiotics, and or steroids.
Papules/Plaques 4: Urticaria (Hives)
There is little that appears wrong in this histology except for
the fact that there is a separation of the collagen bundles,
more so than one would usually see in normal skin. There is
also a sparse infiltrate in which an occasional lymphocyte
may be seen
Urticaria
• Hives (medically known as urticaria) are red,
itchy, raised areas of skin that appear in
varying shapes and sizes.
• They range in size from a few millimeters to
several inches in diameter.
• Hives can be round, or they can form rings or
large patches.
• Wheals (welts), red lesions with a red "flare"
at the borders, are another manifestation of
hives.
• Hives can occur anywhere on the body, such
as the trunk, arms, and legs.
Papules/Plaques 5: Erythema
Multiforme
The pathologic features of erythema multiforme include a perivascular,
lymphocytic infiltrate of variable intensity, vacuolization of the dermalepidermal junction, extravasation of red blood cells without vasculitis,
papillary dermal edema, and variable eosinophilic necrosis of the
epidermis.
Nodules 1: Erythema Nodosum
histologic findings associated with erythema nodosum are
largely localized to the deep dermis and the subcutaneous
tissue. There is an accumulaton of lymphocytes,
neutrophils, histiocytes, and giant cells accumulate in the
fibrous septae between fat lobules and perivascular
infiltration of lymphocytes in the dermis.
Nodules 2: Keloids
change in the diameter of the collagen bundles
and a kind of bluish background, the latter
indicating that there is some mucin there.
Keloid
• A keloid is a scar that doesn't know when to
stop. When the cells keep on reproducing,
the result is an overgrown (hypertrophic) scar
or a keloid.
• A keloid looks shiny and is often domeshaped, ranging in color from slightly pink to
red.
• It feels hard and thick and is always raised
above the surrounding skin.
Purpura 1: Vasculitis
larger vessel is involved in an inflammatory porcess
vasculitis of the
superficial
vascular plexus.
One sees
extravation of red
blood cells,
indicating that
the vessels must
have been
damaged. There
is a lot of
neutrophilic
debris.
Blisters 1: Herpes
Note: these images are kind of weak, also,
not sure if they are only referring to HSV 1
or HSV 1 and HSV 2.
cells in the epidermis are undergoing degenerative changes. There is
acantholysis (epidermal cells falling apart) and enlarging of the nuclei. In
some specimens, one might be lucky enough to see the diagnostic mltinucleated giant cells
Blisters 2: Bullous Pemphigoid
sub-epidermal blister and an infiltrate with
plenty of eosinophils
Blisters 3: Pemphigus Vulgaris
INTRAEPIDERMAL split! (above
basal layer)
Mucosal involvement
Blisters 4: Acute Contact Dermatitis
Contact Dermatitis
• The word "dermatitis" means inflammation of
the skin.
• In contact dermatitis, the skin becomes
extremely itchy and inflamed, causing
redness, swelling, cracking, weeping,
crusting, and scaling.
• Dry skin is a very common complaint and an
underlying cause of some of the typical rash
symptoms.
• This is usually occupationally related: hair
stylists, medical personnel, photographers,
etc.
Systemic 1: Lupus
discoid lupus. There is a
perivascular and
periappendageal lymphocytic
infiltrate that also tends to hug
the dermo-epidermal junction,
the latter type of infiltrate
being referred to as "lichenoid
Systemic 2: Scleroderma
The collagen bundles are thickened and homogenized.
Systemic 3: Drug Eruption
Benign Growths 1: Lentigo
two features here: the excess pigment in the basal layer and the
peculiar elongation of the epidermis itself, sometimes likened to a
"hockey stick".
LentiginesThese brown macules are sometimes
inappropriately referred to as "liver spots" by
lay people.
Benign Growths 2: Seborrheic
Keratosis
epidermal growth whose borders can almost be distinguished by a
pencil line drawing. The cells are banal and basophilic. There are often
"pseudo-horn cysts" or keratinaceous intra-epidermal inclusions.