pathology of skin - introduction
TRANSCRIPT
![Page 1: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/1.jpg)
Man is the maker of himself….
You are the stone, You are the chisel, and You are the sculpture….!
www.akshardham.com
![Page 2: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/2.jpg)
““The The investment you make in yourselfinvestment you make in yourself must receive ‘Top Priority’. When you must receive ‘Top Priority’. When you ‘GROW’ your entire world Expands... ‘GROW’ your entire world Expands...
when you do not grow your whole when you do not grow your whole world starts to become ‘Very world starts to become ‘Very
Small’...that smallness reflects in all Small’...that smallness reflects in all areas of life including your income."areas of life including your income."
Bob ProctorAuthor and Personal Coach
![Page 3: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/3.jpg)
Pathology of Skin(SSS MD3020)
Dr. Shashidhar Venkatesh MurthyAssociate Professor & Head of Pathology
![Page 4: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/4.jpg)
DERMATOLOGYDERMATOLOGY
![Page 5: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/5.jpg)
Learning Objectives:• Knowledge:
• Anatomy, Histology, Physiology• Pathology of Major disorders *• Etiology, pathogenesis, Morphology.
• Skills:• Recognise common diseases* • Clinical/Gross & Microscopy.
Pathology of Pathology of Common Skin DiseasesCommon Skin Diseases
![Page 6: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/6.jpg)
Sessions & Details:
Pathology:• Inflammatory, Blistering
& Neoplastic diseases.• Clinical, Gross &
Microscopy
Synthesis: • Review• Quiz• Q & A
Session 3
Introduction:• Review – Histology.• Histopathology• Diseases - Overview &
Classification.
Session 2Session 1
![Page 7: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/7.jpg)
Dermatopathology:• Pathology is “Scientific Study of Disease”
• What, when, who, how… etc of a disease.• “Understanding disease”
• Study of Pathology:• What caused disease? EtiologyEtiology• How it caused? PathogenesisPathogenesis• What changes? – MorphologyMorphology
• Gross & Microscopy
• Clinical significance – PathologicPathologic basisbasis.
• Laboratory tests:• Biopsy, Cytology, “Markers”, Molecular, genetic…
![Page 8: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/8.jpg)
Exam Question: 2006 MB3• 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.
![Page 9: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/9.jpg)
Exam Question: 2006 MB3• Describe the appearance of the lesion shown
in the image? [2] • Bilateral large Pinkish plaques covered with
white silvery scales.• What is the most likely diagnosis? [1]• Psoriasis• Briefly describe “Koebner Phenomenon” ?
[2]• “Koebner phenomenon” means the development
of isomorphic psoriatic lesions immediately subsequent to, and at the site of, a cutaneous injury;
• What is Auspitz sign what is its significance?[2]
• 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.
![Page 10: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/10.jpg)
Exam Question: 2006 MB31. Look at the Microscopy picture from her
lesion (Image-2). Identify any 4 histopathological features shown. [2]
• Hyperkeratosis• Parakeratosis• Regular elongation of the rete ridges• Diminished granular layer• Tortuous papillary dermal blood vessels• Inflammatory cells in the superficial
dermis.2. You are prescribing a medication for her,
what type of base would be suitable for her and why? [2]
• Water soluble Cream base with keratolytic agent such as urea, for hydration and good penetration as the lesion is dry & scaly.
![Page 11: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/11.jpg)
"The will to win is important, but the will to prepare is vitalvital."
- Joe Paterno
![Page 12: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/12.jpg)
Quick ReviewQuick Review
Skin Under MicroscopeSkin Under MicroscopeAnatomy, Histology &
Physiology
![Page 13: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/13.jpg)
Normal Skin:
![Page 14: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/14.jpg)
Normal skin:
![Page 15: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/15.jpg)
Hairy skin – Pubic Hair
![Page 16: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/16.jpg)
Prominent granular layer
Thick Skin:
![Page 17: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/17.jpg)
Melanocytes:
![Page 18: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/18.jpg)
1 2 3 4 5
6% 4%10%
73%
7%
What is the function of this organ?What is the function of this organ?
??
1. Fine touch sensation2. Pressure sensation3. Pain sensation4. Sweat production5. Temperature control
![Page 19: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/19.jpg)
1 2 3 4 5
89%
1% 0%1%
9%
What is the function of this cell?What is the function of this cell?
??
1. Antigen Processing2. Multiplication3. Melanin production4. Melanin storage5. Osmotic barrier
![Page 20: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/20.jpg)
What is the function of this cell?What is the function of this cell?
??1. Antigen Processing2. Temperature control3. Melanin production4. Immune Defence5. Wound Healing
1 2 3 4 5
31%
0%
17%
43%
9%
![Page 21: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/21.jpg)
1 2 3 4 5 6 7 8 9
95%
0%4%
1% 0%0%0%0%0%
What is the type of lesion?What is the type of lesion?1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer
??
![Page 22: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/22.jpg)
1 2 3 4 5
53%
46%
1%0%0%
What is the function of this?What is the function of this?
??
1. Fine touch sensation2. Pressure sensation3. Lubrication4. Sweat production5. Temperature control
![Page 23: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/23.jpg)
1 2 3 4 5
0%
50%
0%
50%
0%
What is the function of this?What is the function of this?
??
1. Fine touch sensation2. Pressure sensation3. Lubrication4. Immunity & defence5. Temperature control
![Page 24: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/24.jpg)
What is the type of lesion? What is the type of lesion?
1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer
1 2 3 4 5 6 7 8 9
0%
5%
0% 0% 0%0%0%1%
94%
![Page 25: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/25.jpg)
1 2 3 4 5 6 7 8 9
47%
3%
26%
0% 0%0%
19%
6%
0%
What is the type of lesion?What is the type of lesion?
1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer
??
![Page 26: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/26.jpg)
1 2 3 4 5 6 7 8 9
1%
16%
13%
46%
1%
19%
1%0%0%
What is the type of lesion?What is the type of lesion?
1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer
![Page 27: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/27.jpg)
1 2 3 4 5
2% 4%0%
5%
89%
What is the function of this cell?What is the function of this cell?
1. Antigen Processing2. Multiplication3. Melanin production4. Melanin storage5. Protection
??
![Page 28: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/28.jpg)
1 2 3 4 5 6 7 8 9
0% 0%
15%
0%
6%
9%
69%
0%0%
What is the type of lesion?What is the type of lesion?
1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer
![Page 29: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/29.jpg)
1 2 3 4 5
5%
93%
0%0%2%
What is the function of this?What is the function of this?
??
1. Fine touch sensation2. Pressure sensation3. Pain sensation4. Sweat production5. Temperature control
![Page 30: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/30.jpg)
1 2 3 4 5 6 7 8 9
0%
14%
5%
69%
6%
1%0%0%
4%
What is the type of lesion?What is the type of lesion?
1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer
![Page 31: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/31.jpg)
1 2 3 4 5 6 7 8 9
0% 0%
51%
0% 0%
29%
16%
4%
0%
What is the type of lesion?What is the type of lesion?
1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer
![Page 32: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/32.jpg)
1 2 3 4 5 6 7 8 9
0%
5% 4%1%
73%
5%
0%0%
12%
What is the type of lesion? What is the type of lesion? * Multiple correct answers* Multiple correct answers
1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer
![Page 33: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/33.jpg)
If you fail to If you fail to planplan,,you plan to you plan to failfail..
![Page 34: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/34.jpg)
Skin Pathology Skin Pathology Part 1 - IntroductionPart 1 - Introduction
(SSS - MD3020)(SSS - MD3020)
Dr. Shashidhar Venkatesh MurthyAssociate Professor & Head of Pathology
![Page 35: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/35.jpg)
Common Histopathological Terms:
Complex…!! but we will discuss common & important ones…
![Page 36: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/36.jpg)
Hyperkeratosis• hyperplasia of the stratum corneum• Psoariasis, eczema.
![Page 37: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/37.jpg)
PARAKERATOSIS• Keratinization pattern characterized by
retention of nuclei in the stratum corneum (this is normal on mucous membranes)
![Page 38: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/38.jpg)
ACANTHOSIS• epidermal hyperplasia• Eczema, psoriasis
![Page 39: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/39.jpg)
Acanthosis:•Psoriasiform (regular)
•Irregular
•Papillated
•Pseudoepitheliomatous
/pseudocarcinomatous
![Page 40: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/40.jpg)
Acanthosis +hyperkeratosis:
Viral wart: Molluscum contagiosum
![Page 41: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/41.jpg)
Papillomatosis• hyperplasia of the papillary dermis• Neoplastic-verrucous ca, venous stasis,
viral infections etc..
![Page 42: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/42.jpg)
Dyskeratosis• Abnormal keratinization – carcinoma.
![Page 43: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/43.jpg)
Acantholysis• loss of intercellular connections• Pemphigus
![Page 44: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/44.jpg)
Spongiosis• Intercellular edema in the epidermis• Eczema, pempigus, seborrheic dermatitis.
![Page 45: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/45.jpg)
““Fascination is one step beyond interest. Fascination is one step beyond interest. Interested people want to know Interested people want to know if it worksif it works. .
Fascinated people, Fascinated people, want to learn want to learn how it workshow it works””
-- Jim Rohn-- Jim Rohn
![Page 46: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/46.jpg)
Incidence of Skin Diseases:
• Common: nevi/moles, acne, infections (Fungal, Bacterial, viral), urticaria, eczema (wet/dry), actinic keratoses, psoriasis, carcinoma (BCC, SCC, MM)
• Uncommon: pemphigoid, pemphigus, scabies* Leprosy*
• Rare: xeroderma pigmentosum, dermatitis artefacta, mycosis fungoides (cancer-lymphoma).
![Page 47: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/47.jpg)
Classification: (Morphologic).
Epidermis:• Epithelium: Psoriasis, pemphigus, Neoplasms.• Pigment disorders: hyper, hypo,
• Dermis:• Blood vessels - urticaria, contact dermatitis.
• Dermal connective tissue - systemic sclerosis
• Panniculus / Sub cut tissue: erythema nodosum,
• Neoplasms – fibroma, lipoma, sarcoma ..etc.• Ultimately both Epidermis & Dermis involved *
![Page 48: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/48.jpg)
Classification (Pathologic):• Congenital: nevi
• Acquired:• Traumatic: chemical, physical
• Infections: Bacterial, fungal, Viral, etc.
• Immune: Urticaria, Eczema.
• Neoplastic: Nevi…carcinoma
• Idiopathic diseases : Psoriasis
![Page 49: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/49.jpg)
Skin injury - Pathogenesis
Normal Urticaria Wet Eczema Dry Eczyma
Normal Infl: Spongiosis Infl: Ulcer/Blist/Oozing Hyperkeratosis
Acute Chronic
![Page 50: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/50.jpg)
Dermatopathology: MD3020 curriculum1. Acute Inflammations:
• Urticaria, • Acute Eczema, • Erythema Multiforme.
2. Chronic Inflammations:
• Psoriasis,
• Chronic Eczema, • Lichen planus.
3. Infections• Bacterial (Impetigo), • Fungal(tinea) &
• Viral(warts).
1. Blistering Diseases• Pemphigus, • Pemphigoid, • Dermatitis herpetiformis.
5. Neoplastic:
• Benign:
• Nevi, • Actinic Keratosis, • Seborrheic Keratosis.
• Malignant:• BCC, SCC, Melanoma.
![Page 51: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/51.jpg)
Study Tips:• Preparation:
• Read Lecture notes, attend lecture*.• Read Robbins Pathology (Basic).• Study Images Gross & Microscopic.
• Make short notes for each condition,• Etiology, Pathogenesis• List 3* clinical features.• List 3* gross features.• List 3* microscopic features.
• Self Assessment:• Case studies. (http://www.dermnetnz.org) • Questions & Answers.
![Page 52: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/52.jpg)
Psychodermatosis..?
![Page 53: Pathology of Skin - Introduction](https://reader034.vdocuments.us/reader034/viewer/2022050613/587eda701a28abdb198b6eb9/html5/thumbnails/53.jpg)
“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?