Skin - Naresuan University

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DERMATOPATHOLOGY
(FOR DENTISTRY STUDENT)
Prateep Warnnissorn
Department of Medicine, Naresuan University
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Overview
Definition of terms
Infectious diseases -wart, molluscum contagiousum
Inflammatory diseases -acne, urticaria, eczema, arthropod bites,
psoriasis, seborrheic dermatitis, vesiculobullous disease
Neoplastic diseases -SCC, BCC & MM
Principles of therapy of skin change and pathology
OVERVIEW
Normal skin
Wound healing
NORMAL SKIN
Epidermis
Dermis
Subcutaneous
Adnexal structures
EPIDERMIS
http://headandneckcancerguide.org/wpcontent/uploads/2013/02/61_epidermis2.jpg
http://missinglink.ucsf.edu/lm/dermatologyglossary/img/Derm
atology%20Glossary/Glossary%20Histo%20Images/Epidermi
s_40x-211.jpg
EPIDERMIS -MUCOUS
MEMBRANE
S.spinosum
larger cells
http://www.lab.anhb.uwa.edu.au
/mb140/corepages/oral/oral.htm
pale cytoplasm-more
glycogen
Granular layer -none
Keratinization with
parakeratosis (retain nucleus)
DERMIS
http://kreativestudios.com/Tooltip/05Integume
nt/images/03Dermis.jpg
DERMIS
http://www.lab.anhb.uwa.edu.au/mb140/corepages/connective/Ima
ges/skk040evg.jpg
http://www.google.com/imgres?client=safari&rls=en&biw=1135&bih=669&tbm=isch
&tbnid=n1dYl8VhB3YE1M%3A&imgrefurl=http%3A%2F%2Fwww.studyblue.com%
2Fnotes%2Fnote%2Fn%2Funit-4-histology--connective-tissueproper%2Fdeck%2F1989056&docid=5yd0dxzL1qRYPM&imgurl=http%3A%2F%2
Fclassconnection.s3.amazonaws.com%2F844%2Fflashcards%2F1132844%2Fjpg
%2Fcardimage_1989056_01327949756872.jpg&w=1000&h=688&ei=ab4nU4DdO
4WFrAfghYCgDA&zoom=1&ved=0COABEIQcMC0&iact=rc&dur=509&page=3&st
art=30&ndsp=18
HYPODERMIS & ADNEXAL
STRUCTURES
http://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%
20Physiology/2010/2010%20Exam%20Reviews/Exam
%202%20Review/dermis_diagram.gif
WOUND HEALING
Coagulation
http://img.medscape.com/artic
le/782/469/782469-fig2.jpg
Inflammatory
Proliferative &
migration
Remodeling
DEFINITION OF TERMS
S.corneum/keratin -orthokeratosis, parakeratosis
S.malphigii -atrophy, acanthosis, papillomatosis
S.granular -hypergranulosis, hypogranulosis
S.spinusum -ballooning, spongiosis, acantholysis,
dyskeratosis
Terms in viral infections
Exocytosis -white blood cells in epidermis
ORTHOKERATOSIS
http://escholarship.org/uc/
item/1qg46424/1119023b.jpg
Thickening of the s.corneum
PARAKERATOSIS
http://www.skinpatholog
y.org/psoriasis/
Flattened keratinocyte nuclei in
S.corneum
ATROPHY
http://www.globalskinatlas.co
m/upload/lg259_8.jpg
Thining of epidermis
ACANTHOSIS
http://classconnection.s3.ama
zonaws.com/866/flashcards/8
80334/png/acanthosis.png
hypertrophy of s.spinosum
PAPILLOMATOSIS
http://www.ijdvl.com/articles/2
013/79/3/images/ijdvl_2013_7
9_3_338_110769_f6.jpg
nipplelike growths
HYPERGRANULOSIS
http://www.dermaamin.com/site/ima
ges/histo-pic/h/hypertrophic-lichenplanus/hypertrophic-lichenplanus1.jpg
thickened granular layer
HYPOGRANULOSIS
http://openi.nlm.nih.gov/detail
edresult.php?img=3276782_a
d-23-S303-g002&req=4
decrease thickness of granular
layer
INTRACELLULAR EDEMA
https://web.duke.edu/patholo
gy/Week19/Week19.html#an
swer
ballooning
intracellular clear round spaces
pale, large cells
INTERCELLULAR EDEMA
http://1.bp.blogspot.com/_51yzVOv
ZWEc/SzxAJJVLbiI/AAAAAAAAFjg/
0PpWqE3_Pq0/s400/Eczema%20n
ummular2.jpg
spongiosis
widening of intercellular bridge
ACANTHOLYSIS
http://missinglink.ucsf.edu/lm/de
rmatologyglossary/img/Dermatol
ogy%20Glossary/Glossary%20
Histo%20Images/acantholysis.j
pg
separation and rounding up of
cells
loss of intercellular adhesions
DYSKERATOSIS
necrosis, apoptosis
prematurely keratinised
prominent eosinophilic
cytoplasm
TERMS IN VIRAL INFECTIONS
Coarse clumping keratohyaline granules
Intranuclear inclusion body
Intracytoplasmic inclusion body
multinucleated giant cells
Koilocyte
COARSE CLUMPING
KERATOHYALINE GRANULES
http://forum.mckeedermpat
h.com/uploads/88ca6edbc0
492119d1735034a98b55a8
.jpg
large keratohyaline granules in
s.granular layer
INTRANUCLEAR INCLUSION
BODY
http://upload.wikimedia.org
/wikipedia/commons/d/d3/
Molluscum_contagiosum_1
.jpg
large intranuclear inclusion
body
eccentric, crescent bluish
nucleus
INTRACYTOPLASMIC
INCLUSION BODY
http://cai.md.chula.ac.th/chulapatho/chulapatho/le
cturenote/infection/Pathology%20of%20infection/i
nclusion%20bodies/verruca_vulgaris/verruca4.gif
MULTINUCLEATED GIANT
CELL
http://cai.md.chula.ac.th/chulapatho/chulapatho/le
cturenote/infection/Pathology%20of%20infection/i
nclusion%20bodies/herpesimplex_files/SKIN085.j
pg
VACUOLATED CELL
/KOILOCYTE
http://jcwl.glmc.edu.cn/glblne
t/severbj1/bl/JPEG3/SKIN03
6.JPG
perinuclear halo or clear
cytoplasm
INFECTIOUS DISEASES
Warts
Molluscum contagiosum
WARTS / VERRUCA VULGARIS
http://cai.md.chula.ac.th/chulapath
o/chulapatho/lecturenote/infection
/Pathology%20of%20infection/incl
usion%20bodies/verrusca_vulgari
s.html
acanthosis
“church spire papillomatosis
ortho-and parakeratosis
hypergranulosis
koilocytosis
inward bending of tete
MOLLUSCUM CONTAGIOSUM
http://www.webpathology.co
m/slides/slides/ExtGenitalia_
Molluscum1.jpg
intracytoplasmic inclusion body
crescentric nucleus
INFLAMMATORY DISEASES
acne
urticaria
eczema
arthropod bites
psoriasis
seborrheic dermatitis
vesiculobullous disease -pemphigus, pemphigoid
ACNE VULGARIS
http://accessmedicine.mhmedical.com/co
ntent.aspx?bookid=392&sectionid=41138
785
http://dermaamin.com/site/images/histopic/a/acne-vulgaris/acne-vulgaris1.jpg
URTICARIA
http://www.dermpedia.org/file
s/images/Urticaria_4.jpg
dermal edema
vascular dilatation & endothelial
swelling
scant perivascular infiltration
ECZEMA
spongiosis (acute > subacute)
http://upload.wikimedia.org/wikipe
dia/commons/9/9d/Spongiotic_de
rmatitis_(2)_Dyshidrotic_.JPG
spongiotic vesicle (acute >
subacute)
exocytosis (acute > subacute)
parakeratosis (subacute)
ECZEMA (CHRONIC)
http://missinglink.ucsf.edu/lm/dermatolog
yglossary/img/Dermatology%20Glossary
/Glossary%20Histo%20Images/lichen_si
mplex_chronicus_from_normal_skin_mi
d_power.jpg
vertical collagen streak
compact orthokeratosis
http://missinglink.ucsf.edu/lm/dermatologyglossary/i
mg/Dermatology%20Glossary/Glossary%20Histo%2
0Images/lichen_simplex_chronicus_from_normal_ski
n_mid_power.jpg
acanthosis (chronic >
subacute)
ARTHROPOD BITE
http://classconnection.s3.amazona
ws.com/352/flashcards/717352/png
/untitled1319594530915.png
edema epidermis & dermis
wedge shape inflammation
infiltration superficial & deep
mainly eosinophils
.jpg
PSORIASIS
parakeratosis & orthokeratosis
http://www.dermweb.com/pathol
ogy/graphics/annotations/psorias
is1ann.jpg
http://www.ijdvl.com/articles/20
13/79/3/images/ijdvl_2013_79
_3_338_110769_f4.jpg
neutrophils
in s.corneum (Munro
microabscess)
in upper epidermis (spongioform
pustule of Kogoj)
thin suprapapillary plate (Auspitz
sign)
dilate vessels close to the epidermis
elongation of rete ridge (camel foot)
SEBORRHEIC DERMATITIS
http://dermaamin.com/site/imag
es/histo-pic/s/seborrheicdermatitis/seborrheicdermatitis4.jpg
eczema + psoriasis
spongiosis without spongiotic
vesicle
shoulder parakeratosis
(follicular ostia), neutrophilic
parakeratosis
sebaceous gland -large &
numerous
PEMPHIGUS VULGARIS
http://dermaamin.com/site/images/histopic/p/pemphigushistopathology/pemphigushistopathology25.jpg
http://www.google.com/url?sa=i&source=images&cd=&docid=dur
hjvZDMNVQ8M&tbnid=7F2_20AgcmTcM:&ved=0CAUQjBw4Og&url=http%3A%2F%2Fimg.medsc
ape.com%2Fpi%2Femed%2Fckb%2Fdermatology%2F104888510641873368.jpg&ei=qSctU4XFOMbXrQfVp4CAAg&psig=AFQjCNF5H0f
q_2qRG6pU9RqeDU9pd-Qx7w&ust=1395554602033805
http://www.ijdvl.com/articles/2013/79/3/ima
ges/ijdvl_2013_79_3_338_110769_f27.jpg
suprabasal separation “raw of
tomb stone”
Direct immunoflourescence IgG on surface of keratinocytes
BULLOUS PEMPHIGOID
http://plaza.umin.ac.jp/pathol2/photolibrary/system/data/image_data/1134899951
7711.jpg
subepidermal separation
http://eso-cdn.bestpractice.bmj.com/bestpractice/images/bp/en-gb/4538_default.jpg
eosinophil
DIF -linear C3 & IgG at
basement membrane zone
NEOPLASM
Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma
BASAL CELL CARCINOMA
http://plaza.umin.ac.jp/pathol2/photolibrary/system/data/image_data/1134
9004874921.jpg
large uniform nuclei and scant
cytoplasm
retraction of the stroma around
the tumor islands -clefts
aggregations of basaloid
keratinocytes extend from
epidermis to dermis
peripheral palisading
SQUAMOUS CELL
CARCINOMA
http://missinglink.ucsf.edu/lm/der
matologyglossary/img/Dermatolo
gy%20Glossary/Glossary%20His
to%20Images/squamous_cell_ca
rcinoma_invasive_high_power.jp
g
normal & atypical squamous
cells -nuclear pleomorphism,
apoptosis, mitosis
horn pearls -foci of
keratinization in concentric
rings of squamous cells
extension of atypical
keratinocyte beyond the
basement membrane (invasive
SCC)
MALIGNANT MELANOMA
architectural
http://melanocytepathology.com
/uploads/editor/Malignant_mela
noma_12_a.jpg
asymmetry
poor lateral circumscription
(single, scattered cells)
large size >5 mm)
epidermal nest larger than dermal
nest
pagetoid spreading -spread to
upper epidermis and later to
dermis
MM
https://secure.health.utas.edu.au/i
ntranet/cds/pathprac/Files/Cases/
Skin/Case96/Case96.htm
cytologic atypia
large nuclear & cytoplasm
(with dusty pigment)
nuclear pleomorphism,
hyperchromasia & variability
mitosis & necrotic
PRINCIPLES OF THERAPY OF
SKIN CHANGE AND
PATHOLOGY
Corticosteroids
Retinoids
Immunomodulators
Keratolytics
Antiperspiration
Psoriasis therapies
CORTICOSTEROIDS
Anti-proliferative
inhibit DNA synthesis
reduce keratinocyte size and proliferation
Anti-inflammatory
inhibit phospholiapse A2 release & transcription factors -activator protein-1 & nuclear
factor kappa B
Immunosuppressive
suppress leukocyte migration, mast cells, Langerhans cells & T-cell proliferation
Vasoconstrictive
RETINOIDS
Increase
differential markers -involucrin, loricrin, filaggrin &
transglutaminase
proliferation of basal keratinocytes
IMMUNOMODULATORS
Calcineurin inhibitor
tacrolimus
interact FK-506 binding protein, inhibit nuclear translocation
anti-inflammatory -decrease T-cell proliferation and pro inflammatory cytokines
Imidazoquinoline amine
imiquimod -TLR-7 & TLR-8 agonist
enhances immune response -proinflammatory cytokines
antiviral (wart, molluscum), antitumoral (actinic keratosis, basal cell carcinoma)
KERATOLYTICS
Salicylic acid
loosening corneocytes connections
soften s.corneum
Urea
Lactic acid
ANTIPERSPIRATION
Aluminium chloride
formation of an obstruction of sweat gland
PSORIASIS THERAPIES
Coal tar
inhibit DNA synthesis and mitosis
Calcipotriene
inhibit epidermal proliferation
induce epidermal differentiation
calcipotriol
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