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69 Cards in this Set

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What are the 3 layers of normal Skin?
Epidermis

Dermis

Subcutaneous tissue
List the layer of Epidermis from inside-out & define each
Stratum Basale = proliferative basal layer of columnar-like cells; actively dividind stem cells along the BM

Stratum Spinosum = contains prominent Desomosome attachments of Keratinocytes

Stratum Granulosum = cells contain Keratohyaline granules

Stratum Corueum = flattened, anucleated cells containing keratin
What are the 4 cells within the Epidermis & explain each
Keratinocytes = form the multilayered epidermis; produce keratin proteins

Melanocytes = provide color & protection from UV radiation; derived from Neural Crest ectoderm; located in Stratum Basalis; transfers Melanosomes by dendritic processes to Keratinocytes

Langerhans cells = APC cells

Merkel Cells = tactile function of the skin
What 2 lamina does the Basement Membrane of the skin contain?
Lamina Lucida: with Bullous Pemphigoid antigens

Lamina Densa
What are the 2 zones of the Dermis?
1. Papillary Dermis = upper, below the Epidermo-dermal jxn; contains loose CT

2. Reticular Dermis = deep, dense collagen, bordering on SubQ tissue
What are the Primary Skin lesions that contain NO fluid?
Macule

Papule

Plaque

Nodule
What are the Primary Skin lesions that contain fluid?
Vesicle

Bulla

Blister

Pustule
1. Macule

2. Patch
Flat area of skin with discoloration
1. < 5 mm
2. > 5 mm
Papule
Elevated solid area 5 mm or less
Plaque
Elevated flat-topped area, greater than 5 mm
Nodule
Solid elevated area, greater than 5 mm
Vesicle
Fluid-filled raised area, less than 5 mm
Bulla
Fluid-filled raised area, greater than 5 mm
Common term used for Vesicle or Bulla
Blister
Pustule
Discrete, pus-filled, raised area
Wheal
Transient, irregular pink elevation with surrounding edema
Scale
Skin debris on the surface of the epidermis
Crust
Dried exudate over a damaged epithelium
Fissure
Crack in the epidermis, usually extending into the dermis
Ulcer
Loss of epidermis, extending into dermis or deeper
Hyperkeratosis
Stratum Corneum thickening = ?
1. Parakeratosis

2. Acanthosis
1. nuclei retention in the keratinocytes of the Stratum Corneum = ?

2. Epidermal hyperplasia = ?
Spongiosis
Intercellular Edema of the Epidermis = ?
Acantholysis
Separation of Epidermal cells from each other = ?
What is the pathogenesis of "disorders of Epidermal Maturation"? What disease is characterized by this?
Defect in the mechanism of desquamation; increased cohesiveness of the cells in the Stratum Corneum

Ichthyosis
-Striking thickening of stratum corneum that is disproportionately thick in comparison with the nucleated epidermal layers

-Little or no inflammation
Ichthyosis
Ichthyosis
-Striking thickening of stratum corneum that is disproportionately thick in comparison with the nucleated epidermal layers
-little or no inflammation
What is seen here?
What is the most common inherited skin disorder?
Ichthyosis Vulgaris
-Autosomal Dominant
-Autosomal dominant or acquired
-Onset in childhood
-Small white scales on extensor surfaces of the extremities and on the trunk and face (fish-like scales)
Ichthyosis Vulgaris
-Usually mediated by local or systemic immunologic factors
-Last from days to weeks
-Characterized by inflammation and edema
Acute Inflammatory Dermatoses
-Urticaria & Angioedema
-Acute Eczematous Dermatitis
-Allergic Contact Dermatitis
-Erythema Multiforme
-Type I, IgE-dependent hypersensitivity
-Antigens include pollens, foods, drugs, insect venom
-Degranulation of mast cells -> dermal microvascular permeability -> pruritic edematous plaques (wheals)
Urticaria & Angioedema
Pruritic papules and plaques that appear and disappear within a few hours
Urticaria & Angioedema
How is Angioedema different from Urticaria?
Deeper edema of both the dermis & subcutaneous fat
What is the treatment for Urticaria & Angioedema?
Avoid the offending agent

Prompt administration of Antihistamines = b/c its a Type I HS rxn
Urticaria or Angioedema = Type I HS rxn
What type of Acute Inflammatory Dermatoses is this?
Urticaria
-dermal edema
-scattered lymphocytes & mast cells
What type of Acute Inflammatory Dermatoses is this?
-All are characterized by red, papulovesicular, oozing, and crusted lesions.
-Persistent lesions become less wet, and progressively scaly
Acute Eczematous Dermatitis
Acute Eczematous Dermatitis
These are the stages of what Acute Inflammatory Dermatoses?
-T-cell mediated reaction to foreign antigens (Type IV HS)

-possible antigens: Poison ivy, rubber glove, dyes, cosmetic, minerals (gold ring, nickel)

-intensely pruritic erythema & vesicles

-Histology shows spongiosis, vesicles, & superficial perivascular lymphocytic infiltrate
Allergic Contact Dermatitis
Allergic Contact Dermatitis
What is this picture illustrating?
Allergic Contact Dermatitis
What is this showing?
Allergic Contact Dermatitis
-T-cell mediated reaction to foreign antigens (type IV hypersensitivity)
-spongiosis, vesicles and superficial perivascular lymphocytic infiltrate
What is seen here?
-Usually a reaction to a drug (sulfonamides), or an infectious agent (herpes simplex)

-A sparse infiltrate of lymphocytes in the upper dermis and small individually necrotic keratinocytes

-Both humoral and delayed type hypersensitivity contribute to the pathogenesis of EM -> epithelial cells killed by CD8+ cytotoxic T lymphocytes
Erythema Multiforme
Macules, papules, vesicles, & bullae,characteristic "target lesion"

Symmetric involvement of the extremeties
Erythema Multiforme
An extensive & life-threatening form of this disease is called Stevens-Johnson Syndrome
-often in children
-erosions & hemorrhagic crusts involve the lips & oral mucosa
Erythema Multiforme
Erythema Multiforme = target lesions
What skin lesion is this?
Erythema Multiforme
-A sparse infiltrate of lymphocytes in the upper dermis and small individually necrotic keratinocytes
What skin condition is this?
Erythema Multiforme
-vacuolization and necrosis of basal keratinocytes that are being attacked by T-lymphocytes with some necrotic keratinocytes (colloid bodies) in the epidermis
What Acute Inflammatory Dermatoses is this?
What are 3 examples of Chronic Inflammatory Dermatoses?
1. Psoriasis

2. Lichen Planus

3. Lupus Erythematosus
Psoriasis:
1. how common?
2. where more common?
3. Etiology?
4. Macroscopic appearance?
5. Where do new lesions occur?
1. common = 1-2% of all people
2. Scandanavia, less common in Africa & China, nonexistent in Native American Indians
3. Genetic predisposition, multifactorial
4. Large, erythematous, scaly, plaques on the extensor dorsal surfaces
5. At the site of minor skin trauma = Koebner's Phenomenon
What are 3 examples of Chronic Inflammatory Dermatoses?
1. Psoriasis

2. Lichen Planus

3. Lupus Erythematosus
Psoriasis
-large plaque with scales
-Acanthosis = epidermal hyperplasia
-Parakeratosis = nuclei retention in Stratum Corneum
-elongation of Rete Ridges
What is seen here?
Psoriasis
-Acanthosis = epidermal hyperplasia
-elongation of Rete ridges
-Parakeratosis = nuclei retention in Stratum Corneum
-extension of the Papillary Dermis close to the surface epithelium = blood vessels in the dermis rupture when scales are picked off = Auspitz sign
What is this?
Psoriasis
-Munro Microabscess
What is this picture showing?
-Marked acanthosis with regular downward elongation of the rete ridges
-Extensive overlying parakeratotic scale with thinned or absent stratum granulosum
-Supra-papillary thinning with dilated and tortuous blood vessels within these papillae
Psoriasis
Auspitz sign: multiple minute bleeding points when the scale is lifted from the plaque. Dx?
Psoriasis
Munro’s microabscesses: collections of neutrophils within the parakeratotic stratum corneum . Dx?
Psoriasis
-“Pruritic, purple, polygonal papules”

-Self-limiting and resolves within 1-2 years

Flexor surfaces of the wrists
Lichen Planus
Lichen Planus
-Pruritic, purple, polygonal papules
-usually on wrists
What is seen here?
Lichen Planus
-band-like epidermal lymphocytic infiltrate
-Hypergranulosis = Stratum Granulosa is thickened
What is seen here?
What is seen here?
Lichen Planus
-Band-like dense infiltrate of lymphocytes at the dermo-epidermal junction
-Hypergranulosis, angulated zig-zag contour of dermoepidermal interface (saw-toothing)
Band-like dense infiltrate of lymphocytes at the dermoepidermal junction

Hypergranulosis, angulated zig-zag contour of dermoepidermal interface (saw-toothing)
Lichen planus
Autoimmune disease mediated by deposition of circulating immune complexes along the dermoepidermal junction
Lupus Erythematous
T or F: Discoid Lupus Erythematous usually develops into systemic disease
False
Where does Discoid Lupus Erythematosus usually occur?
Above the neck, sun exposed areas, including face (in the malar area), scalp, ears
Discoid Lupus Erythematosus
-Epidermal atrophy, band-like lymphocytic infiltrate, vacuolated basal keratinocytes, apoptotic bodies, thickened and reduplicated lamina densa
What is seen here?
Granular deposits of IgG and C3 along the dermoepidermal junction
Discoid Lupus Erythematosus
Discoid Lupus Erythematosus
-atrophy of the epidermis with an interface type of inflammation (affecting the basal layer of the epidermis causing vacuolization of the basal keratinocytes) with a superficial and deep inflammatory infiltrate
What is seen here?
Discoid Lupus Erythematosus
-DIF: Granular deposits of IgG and C3 along the dermoepidermal junction (lupus band)
What is this?