Pathology - S2B4 - Skin 1

Front 1

What are the 3 layers of normal Skin?

Back 1

Epidermis

Dermis

Subcutaneous tissue

Front 2

List the layer of Epidermis from inside-out & define each

Back 2

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

Front 3

What are the 4 cells within the Epidermis & explain each

Back 3

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

Front 4

What 2 lamina does the Basement Membrane of the skin contain?

Back 4

Lamina Lucida: with Bullous Pemphigoid antigens

Lamina Densa

Front 5

What are the 2 zones of the Dermis?

Back 5

1. Papillary Dermis = upper, below the Epidermo-dermal jxn; contains loose CT

2. Reticular Dermis = deep, dense collagen, bordering on SubQ tissue

Front 6

What are the Primary Skin lesions that contain NO fluid?

Back 6

Macule

Papule

Plaque

Nodule

Front 7

What are the Primary Skin lesions that contain fluid?

Back 7

Vesicle

Bulla

Blister

Pustule

Front 8

1. Macule

2. Patch

Back 8

Flat area of skin with discoloration
1. < 5 mm
2. > 5 mm

Front 9

Papule

Back 9

Elevated solid area 5 mm or less

Front 10

Plaque

Back 10

Elevated flat-topped area, greater than 5 mm

Front 11

Nodule

Back 11

Solid elevated area, greater than 5 mm

Front 12

Vesicle

Back 12

Fluid-filled raised area, less than 5 mm

Front 13

Bulla

Back 13

Fluid-filled raised area, greater than 5 mm

Front 14

Common term used for Vesicle or Bulla

Back 14

Blister

Front 15

Pustule

Back 15

Discrete, pus-filled, raised area

Front 16

Wheal

Back 16

Transient, irregular pink elevation with surrounding edema

Front 17

Scale

Back 17

Skin debris on the surface of the epidermis

Front 18

Crust

Back 18

Dried exudate over a damaged epithelium

Front 19

Fissure

Back 19

Crack in the epidermis, usually extending into the dermis

Front 20

Ulcer

Back 20

Loss of epidermis, extending into dermis or deeper

Front 21

Hyperkeratosis

Back 21

Stratum Corneum thickening = ?

Front 22

1. Parakeratosis

2. Acanthosis

Back 22

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

2. Epidermal hyperplasia = ?

Front 23

Spongiosis

Back 23

Intercellular Edema of the Epidermis = ?

Front 24

Acantholysis

Back 24

Separation of Epidermal cells from each other = ?

Front 25

What is the pathogenesis of "disorders of Epidermal Maturation"? What disease is characterized by this?

Back 25

Defect in the mechanism of desquamation; increased cohesiveness of the cells in the Stratum Corneum

Ichthyosis

Front 26

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

-Little or no inflammation

Back 26

Ichthyosis

Front 27

Ichthyosis
-Striking thickening of stratum corneum that is disproportionately thick in comparison with the nucleated epidermal layers
-little or no inflammation

Back 27

What is seen here?

Front 28

What is the most common inherited skin disorder?

Back 28

Ichthyosis Vulgaris
-Autosomal Dominant

Front 29

-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)

Back 29

Ichthyosis Vulgaris

Front 30

-Usually mediated by local or systemic immunologic factors
-Last from days to weeks
-Characterized by inflammation and edema

Back 30

Acute Inflammatory Dermatoses
-Urticaria & Angioedema
-Acute Eczematous Dermatitis
-Allergic Contact Dermatitis
-Erythema Multiforme

Front 31

-Type I, IgE-dependent hypersensitivity
-Antigens include pollens, foods, drugs, insect venom
-Degranulation of mast cells -> dermal microvascular permeability -> pruritic edematous plaques (wheals)

Back 31

Urticaria & Angioedema

Front 32

Pruritic papules and plaques that appear and disappear within a few hours

Back 32

Urticaria & Angioedema

Front 33

How is Angioedema different from Urticaria?

Back 33

Deeper edema of both the dermis & subcutaneous fat

Front 34

What is the treatment for Urticaria & Angioedema?

Back 34

Avoid the offending agent

Prompt administration of Antihistamines = b/c its a Type I HS rxn

Front 35

Urticaria or Angioedema = Type I HS rxn

Back 35

What type of Acute Inflammatory Dermatoses is this?

Front 36

Urticaria
-dermal edema
-scattered lymphocytes & mast cells

Back 36

What type of Acute Inflammatory Dermatoses is this?

Front 37

-All are characterized by red, papulovesicular, oozing, and crusted lesions.
-Persistent lesions become less wet, and progressively scaly

Back 37

Acute Eczematous Dermatitis

Front 38

Acute Eczematous Dermatitis

Back 38

These are the stages of what Acute Inflammatory Dermatoses?

Front 39

-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

Back 39

Allergic Contact Dermatitis

Front 40

Allergic Contact Dermatitis

Back 40

What is this picture illustrating?

Front 41

Allergic Contact Dermatitis

Back 41

What is this showing?

Front 42

Allergic Contact Dermatitis
-T-cell mediated reaction to foreign antigens (type IV hypersensitivity)
-spongiosis, vesicles and superficial perivascular lymphocytic infiltrate

Back 42

What is seen here?

Front 43

-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

Back 43

Erythema Multiforme

Front 44

Macules, papules, vesicles, & bullae,characteristic "target lesion"

Symmetric involvement of the extremeties

Back 44

Erythema Multiforme

Front 45

An extensive & life-threatening form of this disease is called Stevens-Johnson Syndrome
-often in children
-erosions & hemorrhagic crusts involve the lips & oral mucosa

Back 45

Erythema Multiforme

Front 46

Erythema Multiforme = target lesions

Back 46

What skin lesion is this?

Front 47

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

Back 47

What skin condition is this?

Front 48

Erythema Multiforme
-vacuolization and necrosis of basal keratinocytes that are being attacked by T-lymphocytes with some necrotic keratinocytes (colloid bodies) in the epidermis

Back 48

What Acute Inflammatory Dermatoses is this?

Front 49

What are 3 examples of Chronic Inflammatory Dermatoses?

Back 49

1. Psoriasis

2. Lichen Planus

3. Lupus Erythematosus

Front 50

Psoriasis:
1. how common?
2. where more common?
3. Etiology?
4. Macroscopic appearance?
5. Where do new lesions occur?

Back 50

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

Front 51

What are 3 examples of Chronic Inflammatory Dermatoses?

Back 51

1. Psoriasis

2. Lichen Planus

3. Lupus Erythematosus

Front 52

Psoriasis
-large plaque with scales
-Acanthosis = epidermal hyperplasia
-Parakeratosis = nuclei retention in Stratum Corneum
-elongation of Rete Ridges

Back 52

What is seen here?

Front 53

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

Back 53

What is this?

Front 54

Psoriasis
-Munro Microabscess

Back 54

What is this picture showing?

Front 55

-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

Back 55

Psoriasis

Front 56

Auspitz sign: multiple minute bleeding points when the scale is lifted from the plaque. Dx?

Back 56

Psoriasis

Front 57

Munro’s microabscesses: collections of neutrophils within the parakeratotic stratum corneum . Dx?

Back 57

Psoriasis

Front 58

-“Pruritic, purple, polygonal papules”

-Self-limiting and resolves within 1-2 years

Flexor surfaces of the wrists

Back 58

Lichen Planus

Front 59

Lichen Planus
-Pruritic, purple, polygonal papules
-usually on wrists

Back 59

What is seen here?

Front 60

Lichen Planus
-band-like epidermal lymphocytic infiltrate
-Hypergranulosis = Stratum Granulosa is thickened

Back 60

What is seen here?

Front 61

What is seen here?

Back 61

Lichen Planus
-Band-like dense infiltrate of lymphocytes at the dermo-epidermal junction
-Hypergranulosis, angulated zig-zag contour of dermoepidermal interface (saw-toothing)

Front 62

Band-like dense infiltrate of lymphocytes at the dermoepidermal junction

Hypergranulosis, angulated zig-zag contour of dermoepidermal interface (saw-toothing)

Back 62

Lichen planus

Front 63

Autoimmune disease mediated by deposition of circulating immune complexes along the dermoepidermal junction

Back 63

Lupus Erythematous

Front 64

T or F: Discoid Lupus Erythematous usually develops into systemic disease

Back 64

False

Front 65

Where does Discoid Lupus Erythematosus usually occur?

Back 65

Above the neck, sun exposed areas, including face (in the malar area), scalp, ears

Front 66

Discoid Lupus Erythematosus
-Epidermal atrophy, band-like lymphocytic infiltrate, vacuolated basal keratinocytes, apoptotic bodies, thickened and reduplicated lamina densa

Back 66

What is seen here?

Front 67

Granular deposits of IgG and C3 along the dermoepidermal junction

Back 67

Discoid Lupus Erythematosus

Front 68

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

Back 68

What is seen here?

Front 69

Discoid Lupus Erythematosus
-DIF: Granular deposits of IgG and C3 along the dermoepidermal junction (lupus band)

Back 69

What is this?