Transcript Derm_Image_Atlas

DERMATOLOGY MINI ATLAS
Dr. M. G. Joseph
Revised November 2011
Dear students:
THIS DERMATOLOGY MINI ATLAS IS DESIGNED TO PRACTICE
YOUR SKILLS IN DESCRIBING THE MORPHOLOGY OF SOME
OF THE COMMON AND CLASSIC DERMATOLOGIC DISORDERS
COVERED DURING THIS COURSE. IN ADDITION THIS MODULE
WILL ALLOW YOU TO ARRIVE AT A DIAGNOSIS OR GENERATE
APPROPRIATE DIFFERENTIAL DIAGNOSIS. YOU MAY REVIEW
YOUR NOTES FOR ADDITIONAL DETAILS ON THESE SKIN
DISEASES.
Mariamma Joseph
PART 1- SKIN RASHES
Case 1
What is your diagnosis ?
Describe this lesion using
SCALDA terminology.
Identify the primary
morphology and
secondary lesional
changes you see
in this picture
Infantile atopic dermatitis acute stage with oozing and
Crusting
Case 2
This patient comes
to you with this rash.
What is the most
likely diagnosis and
cause ?
Case 2
Another example
perhaps too obvious
Case 2, another example.
Nickel allergy from metal
fasteners on jeans
Case 3
Identify the type of
dermatitis
involving
the lower leg and
ankle, medial side
Case 4. Describe this lesion using SCALDA terminology.
W
can give this morphology?
Coin shaped eczematous lesions
Another example of nummular dermatitis, acute stage
Case 5: Describe the morphology of this rash.
This rash is diagnostic of what disease ?
Review the histology of this lesion (next slide) for
clinicopathologic correlation (CPC)
Case 5, histology
A
B
C
D
Psoriasis Vulgaris (plaque psoriasis): Parakeratosis (A), regular acanthosis
(B) dermal dilated capillaries (C) and inflammatory cells (D)
Childhood psoriatic arthritis with nail changes
Generate a differential diagnosis for this
papulosquamous eruption.
What is your most likely diagnosis ?
Clue: this lesion appeared following a streptococcal
throat infection
Case 6
Case 7
Study the classic
location and
morphology of another
papulosquamous lesion
shown in this picture.
What is your diagnosis?
Case 7 another example, study the morphology
Case 8
Study the classic location
and morphology of
another papulosquamous
lesion shown in this
picture.
What is your diagnosis?
What is the clue to your
diagnosis ?
Herald patch
Case 9
Target lesions are shown
In this picture. What is your
Diagnosis? Learn the
causes /associations and
complications
Case 10
ERYTHEMA MULTIFORME, another example
In a child caused by herpes simplex virus
Case 11
This patient is quite unwell and requires hospitalization .
What is this syndrome ?
Case 12
These subcutaneous
nodules on the leg are
quite tender.
What is your diagnosis
What is the pathology ?
Case 13
Red purpuric rash consistent with cutaneous vasculitis.
This patient has HENOCH SCHONLEIN PURPURA on
clinical evaluation. What is vasculitis? What is HSP ? What are the
other causes for vasculitis ?
Another example of vasculitis (palpable purpura)
Study other causes of vasculitis from notes
Septicemia leading to vasculitis can show similar morphology
Case 14
This child presented with
discrete erythematous
macules and
papules
on the trunk
and confluent erythema
on the face.
What is the most likely
cause ?
This is an Immunobullous disorder
Case 15
Describe the morphology using SCALDA ? Review 3
immunobullous disorders you have been taught and recognize
what is the most likely diagnosis in this case?
W
Case 15
Direct IMF test result on case 15
Epidermis
Dermis
Linear band of IGG and C3 at the
basement membrane zone
Another immunobullous disorder
Case 16
Nikolsky sign positive, intra epidermal flaccid bullae (black arrows) and
erosion (white arrow). What is your diagnosis ?
Direct IMF test
Case 16
Epidermis
Dermis
Intercellular desmosomal IGG and C3
Fish net like pattern (black arrow)
Case 17
These grouped blistering
lesions on the
elbow are intensely
pruritic causing
erosions. What
additional investigation
you would consider
for this patient ?
What is your diagnosis ?
Case 18
This leg ulcer is diagnostic of…
What type of ulcer ?
Note the background of
skin hyper pigmentation
and thickening. Review
your notes on skin ulcer
ACNE
A
Open Comedones
C
Case 19
B
Closed Comedones
Inflammed acne
Is this open or closed comedone of acne?
Case 20: Describe the morphology, what is your diagnosis?
What are the common causes ?
Case 21: A case of skin infestation. What is
the most likely cause? What is the clue ?
Case 22: List 4 indicators that determine prognosis
for this partial thickness burn case (review burn lecture)
Part 1 Skin Rashes
Answers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Infantile atopic dermatitis,
subacute stage
Allergic contact dermatitis to
sandals
Stasis dermatitis , medial
malleolus
Nummular dermatitis
Plaque psoriasis
Guttate psoriasis
Lichen planus
Pityriasis rosea
Erythema multiforme
Erythema multiforme, child
11.
12.
13.
14.
15.
16.
17.
18.
19
Steven Johnson syndrome
Erythema nodosum, panniculitis
Vasculitis, HSP
Exanthematous drug eruption
Bullous pemphigoid
Pemphigus vulgaris
Dermatitis Herpetiformis
Venous ulcer
Acne
A. Open comedone
B. Closed comedone
C. Inflammatory acne
20. Urticaria (multiple red wheals)
21. Scabies
22. Partial thickness burn
PART 2 - SKIN GROWWTHS (BUMPS)
Case 1: This benign tumour is present for years
without any change
W
Case 2: Describe the histology of this lesion (Corn or Clavus)
Yellow hyperkeratotic lesion with central depression on the feet
Case 3:
60 year old female
Is this benign
or malignant ?
What is your diagnosis?
Two more examples of seborrheic keratosis. Sebka can have
many faces
Well defined brown soft nodule with
smooth, crumbly texture and stuck
on appearance.
Well defined, flesh-coloured
plaque with a warty surface
and stuck on appearance
Case 4: 70 year old male with actinic keratosis
Describe the morphology of this premalignant skin lesion
Case 5: this lesion is induced by HPV virus
What is your diagnosis ?
Case 6:
Describe the morphology
These lesions are
induced by pox virus.
What is your diagnosis
Case 7:
40 year old male
This painless leg
lesion is present
for years, dimple
sign is positive.
What is your
diagnosis?
DERMATOFIBROMA- dimple sign
Case 8:
Describe the morphology
of this lesion.
What is the histology in the
biopsy specimen?
W
Case 9: Two forms of Basal cell carcinoma
are given below. Name these 2 forms,
describe the morphology of these 2 forms
Case 10: Is this benign or malignant clinically? What is your next
step to make a diagnosis ?
Case 11: This scaly erythematous patch does not respond to
steroid treatment. A skin biopsy shows full thickness atypia of
keratinocytes. What is your diagnosis?
Case 12: This skin coloured
nodule with central crater measures
1.5 cm and rapidly grew during the
last 4 weeks. What is your differentia
Diagnosis? What kind of biopsy
you would perform for diagnosis?
Case 13: Is this pigmented lesion benign or malignant ?
Describe the morphology of this lesion. What is the treatment?
Case 14: Describe this pigmented lesion.
What is your diagnosis?
Case 15: What type of melanoma is this ?
Study various types of melanoma including important
prognostic factors
Case 16: Study the morphology and histology of this benign
compound nevus (CPC)
Benign compound nevus: well circumscribed and symmetrical small
pigmented lesion with regular border and uniform colour, histology shows
symmetry and well defined borders with nests of benign nevus cells at the
dermoepidermal junction and in the dermis (CPC).
Case 17:
This is an example of cutaneous manifestation of systemic disease
ADENOMA SEBACEUM OF TUBEROUS SCLEROSIS
Case 18
Malignant Melanoma, histology: Malignant large cells,
containing brown melanin pigment in cytoplasm, Hematoxylin
and Eosin stain. Hematoxylin stains nuclei purple and eosin stains
cytoplasm pink. Melanin is stained brown
Case 19
B
A
Basal Cell Carcinoma, histology: Basaloid (blue) cells (A) with peripheral
palisading of nuclei (B), Hematoxylin and Eosin stain. Hematoxylin stains
nuclei purple and Eosin stains cytoplasm and stroma pink .
Case 20
B
A
Squamous cell carcinoma, histology: Malignant squamous cells
showing intercellular bridges (A), cytoplasmic keratinization (pink),
and irregular purple nuclei (B) . Hematoxylin and Eosin stain.
Part 2, Skin Growths
Answers
1. Skin tags
2. Corn, hyperkeratosis
3. Benign, Seborrheic keratosis
4. Actinic keratosis
5. Wart (Verruca vulgaris)
6. Molluscum contagiosum
7. Dermatofibroma
8. Pyogenic granuloma, histology shows capillaries in edematous stroma
9. Basal cell carcinoma, nodular and ulcerated types
10. Squamous cell carcinoma, punch biopsy
Part 2, Skin Growths
Answers
11. Bowen’s disease (squamous cell carcinoma insitu)
12. Keratoacanthoma and squamous cell carcinoma, excisional biopsy
13. Malignant melanoma, superficial spreading type, complete excision
with adequate margins
14. Malignant melanoma, superficial spreading type
15. Acral lentiginous melanoma
16. Benign compound nevus
17. Adenoma sebaceum of tuberous sclerosis
18. Malignant melanoma, histology
19. Basal cell carcinoma, histology
20. Squamous cell carcinoma, histology