Pathology of Skin - Introduction

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Pathology of Skin (SSS MD3020) Dr. Shashi dhar Venkatesh Murthy Associate Professor & Head of Pathology Pathology of Skin (SSS MD3020) Dr. Shashi dhar Venkatesh Murthy Associate Professor & Head of Pathology

DERMATOLOGY

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 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

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 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

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> 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>

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> 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>

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> 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>

. 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>

. "The will to win is important, but the will to prepare is vital ." - Joe Paterno

. Quick Review Skin Under Microscope Anatomy, Histology & Physiology

. Normal Skin:

. Normal skin:

. Hairy skin – Pubic Hair

. Thick Skin: Prominent granular layer

. Melanocytes:

. 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>?

. 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>?

. 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>?

. 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>?

. 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>?

. 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>?

. 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>

. 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>?

. 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>?

. 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>?

. 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>

. If you fail to plan , you plan to fail .

. Skin Pathology Part 1 - Introduction (SSS - MD3020) Dr. Shashidhar Venkatesh Murthy Associate Professor & Head of Pathology

. Common Histopathological Terms: Complex…!! but we will discuss common & important ones…

. Hyperkeratosis <ul><li>hyperplasia of the stratum corneum </li></ul><ul><li>Psoariasis, eczema. </li></ul>

. PARAKERATOSIS <ul><li>Keratinization pattern characterized by retention of nuclei in the stratum corneum (this is normal on mucous membranes) </li></ul>

. ACANTHOSIS <ul><li>epidermal hyperplasia </li></ul><ul><li>Eczema, psoriasis </li></ul>

. Acanthosis: <ul><li>Psoriasiform (regular) </li></ul><ul><li>Irregular </li></ul><ul><li>Papillated </li></ul><ul><li>Pseudoepitheliomatous/pseudocarcinomatous </li></ul>

. Acanthosis +hyperkeratosis: Viral wart: Molluscum contagiosum

. Papillomatosis <ul><li>hyperplasia of the papillary dermis </li></ul><ul><li>Neoplastic-verrucous ca, venous stasis, viral infections etc.. </li></ul>

. Dyskeratosis <ul><li>Abnormal keratinization – carcinoma. </li></ul>

. Acantholysis <ul><li>loss of intercellular connections </li></ul><ul><li>Pemphigus </li></ul>

. Spongiosis <ul><li>Intercellular edema in the epidermis </li></ul><ul><li>Eczema, pempigus, seborrheic dermatitis. </li></ul>

. “ Fascination is one step beyond interest. Interested people want to know if it works . Fascinated people, want to learn how it works ” -- Jim Rohn

. 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>

. 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>

. 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>

. Skin injury - Pathogenesis Normal Urticaria Wet Eczema Dry Eczyma Normal Infl: Spongiosis Infl: Ulcer/Blist/Oozing Hyperkeratosis Acute Chronic

. 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>

Pathology of Skin - Introduction