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| Where is a large cornified layer of skin normal? |
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| elevated lesion <5mm in diameter |
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| elevated lesion >5mm in diameter (big papule) |
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| flat-topped area with different feel than surrounding skin, usually >5mm across |
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| fluid-filled cavity <5mm in diameter |
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| pus-filled vesicle or bulla |
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| dry, flaky area on skin surface |
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| thickening due to trauma (such as scratching) |
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| scratch with causes ulceration |
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| nail place separation from nail bed |
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| retention of keratinocytes nuclei into stratum corneum |
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| abnormal keratinization (premature) |
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| loss of intercellular desmosomes leads to separation of keratinocytes |
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| intercellular edema in epidermis |
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| linear pattern of melanocytic proliferation at the DEJ |
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| Pigment-producing melanocytes are lost (complete or partial). Affects all ages. Histology = normal skin, EM shows loss of melanocytes & no rxn to tyrosinase, Melan-A or S-100. Pathogenesis is probably autoimmune, but the exact cause is unknown. |
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| normal melanocytes; lack of or defective tyrosinase |
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| Common in children. Seasonal variability (in contrast to lentigo). Increased melanin w/in basal keratinocytes. Melanocytes are not increased, just pigment is increased due to effect of the UV light. |
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| Benign (can be suspicious for melanomas). Localized dark brown pigmentation of the mucosa. Lip, oral mucosa & male/female genitalia. Oral macules in adults caused by smoking, drugs, hormones. Increased melanin pigmentation at the basal layer. |
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| Mask-like tan-brown macule, petechia on face. Mask of pregnancy (hormones). Increased melanin pigment in basal layer of epidermis & w/in macrophages of the dermis. |
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| Linear localized hyperplasia of melanocytes that affects all ages. Located on mucous membranes. Not affected by sun exposure. |
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| Hives. Most common trunk and distal extremities. Histology is subtle with minimal increase in inflammatory cells around superficial vascular plexus. No epidermal changes. |
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| Acute eczematous (spongiotic) dermatitis |
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Definition
| Erythematous, oozing, scaly vesicles & bullae that develop into scaly plaques over time (ex. poison ivy). There is intraepidermal edema, prominent intercellular bridges b/w keratinocytes |
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| Characterisitic lesion is targetoid lesion or "iris-like". Common on acral surfaces. Minor form is self-limited, associated with drugs and herpes infections. The major forms have a STRONG ASSOCIATION WITH DRUG INGESTION, but none with herpes (unlike minor). Stevens-Johnson & Toxic Epidermal Necrolysis (TEN) are the two major forms. Histo = superficial perivascular lymphocytic infiltrate with some lymphocytes extending into overlying epidermis. Can also see lines between the squamous cells. |
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| Erythematous, well-demarcated, silvery-white scaly plaques. Common on elbow, knees, lumbosacral regions, intergluteal folds. Affects the scalp and RARELY leads to alopecia. Histology = confluent parakeratosis, hypogranulosis, suprapapillary thinning, DILATED TORTUOUS BLOOD VESSELS (Auspitz's sign) & NEUTROPHILIC ABSCESSES IN STRATUM CORNEUM (Munro) or EPIDERMIS |
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| Chronic inflammation with histo like psoriasis, but not same gross appearance. More prevalent in high density sebaceous glands. Dandruff is SD of the scalp. Macules/papules on erythmatous-yellow greasy base. |
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| Common. Purple, polygonal, pruritic papules that can be anywhere (often on flexor surfaces of extremities). Affects that scalp and CAN cause scarring alopecia. Histology = hyperkeratosis & hypergranulosis; acanthosis with saw tooth appearance |
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| Systemic or localized (discoid). SLE and DLE have identical morphology with malar erythema (butterfly rash). Morphology - EPIDERMAL ATROPHY; thickened basement membrane; DIF has granular deposit at DEJ, IgG and Complement (BAND TEST) |
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| Pemphigus (vulgaris, vegetans, foliaceus, erythematosus) |
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| Inflammatory blistering (bullous) disorder. Vulgaris is most common and foliaceus is the most benign. Flaccid blisters most common on mouth. Shallow erosions with overlying crusts. Foliaceus has more of a tissue paper scale instead of blisters. In pemphigus vulgaris if you put pressure on a non-blistered area, get damage (skin sloughs off with some bleeding, known as Nickolsky sign). Histology = acantholysis due to dissolution of intercellular bridges; autoimmune disease. DIF shows "CHICKEN WIRE" pattern of intercellular deposits of IgG and C3 around keratinocytes. |
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| Inflammatory blistering (bullous) disorder. Much more common than pemphigus & affects elderly. Tense bullae occurring on erythematous base. Common in flexor surfaces, groin, axillae, trunk. Histology = subepidermal blister with abundant eosinophils in the blister cavity. NO necrosis of keratinocytes or acantholysis. DIF = LINEAR STAINING (not band, different from lupus) with IgG and C3 along DEJ. Basically hemidesmosomes lose fxn; autoimmune. |
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| Inflammatory blistering (bullous) disorder. Intensely itchy vesicles on extensor surfaces of extremities, buttocks, & upper back. Affects young adults. Grouping of vesicles ("herpes like"). Associated with gluten-sensitive enteropathy. Histology = subepidermal split; smaller blister; neutrophils present w/in papillary dermal tips & base of blisters; no overlying epidermal necrosis or acantholysis. DIF = GRANULAR DEPOSITS OF IgA & C3 in papillary dermal tips. |
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| Epidermolysis bullosa (aquisita, & congenita) |
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| Non-inflammatory blistering (bullous) disorder. Blisters at site of pressure, trauma, rubbing, sometimes soon after birth. Dystrophic form = BLISTERS DEVELOP BENEATH LAMINA DENSA, defective ANCHORING FILAMENTS & gene for VII COLLAGEN, SKIN SPLIT TEST to differentiate from BP |
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| Non-inflammatory blistering (bullous) disorder. Five major forms. PCT = porphyria cutanea tarda. Urticaria, vesicles. Leaves scars. Aggravated by sunlight. Marked dermal vessel thickening. CATERPILLAR BODIES in epidermis. |
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| Non-inflammatory blistering (bullous) disorder. |
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| Dialysis-induced dermatosis |
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| Non-inflammatory blistering (bullous) disorder. |
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| Due to hormonal variations or hair maturational alterations. Non-inflammatory and inflammatory types. |
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| Panniculitis - septal form is drythema nodosum |
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| Most common form; acute; associated with bacterial infections, TB, fungus, leprosy, drugs, INFLAMMATORY BOWEL DISEASE, sarcoidosis. Idiopathic. Lower legs of young females. Takes wks to resolve w/o scar. Septal inflammation, perivascular inflammation, neutrophils, lymphocytes & giant cells |
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| Panniculitis - lobular form is erythema induratum |
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| Uncommon. Mostly adolescence. Lower limbs. Vasculitis, lobular necrosis & inflammation. Ulceration. |
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| Useful in dx herpes & varicella -- detects multinucleated giant cells |
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| Useful for dx dermatophytoses (fungus of skin) |
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| Benign keratinocytic tumors |
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Definition
| Seborrheic keratosis, verrucae (wart), and keratoacanthoma (borderline) |
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| Most common benign keratinocytic tumor. Very common after middle age. Round, flat papules, nodules that are mm-cm in diameter. May be pigmented. Always waxy & scaly. Appear "stuck on" with a greasy texture. These have smooth and uniform borders. HISTOLOGY = proliferation of basaloid keratinocytes; horn cysts present; few mitoses & no cytologic atypia; overlying hyperkeratosis (not parakeratosis). Whole process is LIMITED TO THE EPIDERMIS. |
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