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Pathology II > Dermatopathology (Part 1) > Flashcards

Dermatopathology (Part 1) Flashcards

1
Q

Skin functions

A
  • Protection
  • Thermoregulation
  • Vitamin D synthesis
  • Excretion
  • Monitor
  • Immune function
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2
Q

Squamous epithelial cells (keratinocytes)

A
  • Secrete soluble molecules influence cutaneous immune responses (cytokines, defensins)
  • “Glued” tightly together by desmosomes
  • Produce abundant amounts of keratin protein
  • Keratin and desmosomes create a tough, durable physical barrier
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3
Q

Melanocytes

A
  • Found within the epidermis

- Responsible for the production of melanin

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4
Q

Melanin

A
  • Absorbs and protects against injurious ultraviolet (UV) radiation
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5
Q

Dendritic cells (Langerhans cells) functions

A
  • First line of defense against microorganisms
  • Process microbial cell antigens
  • Augment innate immune responses
  • Present antigens to T lymphocytes
  • Stim­ulate the adaptive immune system
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6
Q

Afferent nerve fibers

A
  • Responsible for physical sensations
  • Pain
  • Touch
  • Vibration
  • Itchiness
  • Cold
  • Heat
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7
Q

Receptive fields

A
  • Meissner – pressure – fast adaptation
  • Merkel – pressure – slow adaptation
  • Pacinian – fast changing stimuli - respond to vibration
  • Ruffini – slow adapting
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8
Q

Efferent nerve fibers

A
  • Regulate adnexal components
  • Sweat glands
  • Erector pili muscles
  • Influence immune response
  • Merkel cell (basal location, neuroendocrine or mechanoreceptor function)
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9
Q

Adnexal components

A
  • Sweat Glands = regulate body temperature
  • Hair Follicles = harbor epithelial stem cells
  • Sebaceous Glands = lubricate and waterproof the skin and hair
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10
Q

Skin histology

A
  • Epidermis
  • Dermis
  • Subcutaneous tissue
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11
Q

Excoriation

A
  • Traumatic lesion breaking the epidermis and causing a raw linear area (i.e., deep scratch)
  • Often self-induced
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12
Q

Lichenification

A
  • Thickened, rough skin (similar to a lichen on a rock); usually the result of repeated rubbing
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13
Q

Macule, patch

A
  • Circumscribed, flat lesion distinguished from surrounding skin by color
  • Macules are 5 mm in diameter or less, patches are greater than 5 mm
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14
Q

Onycholysis

A
  • Separation of nail plate from nail bed
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15
Q

Papule, nodule

A
  • Elevated dome-shaped or flat-topped lesion

- Papules are 5 mm or less across, while nodules are greater than 5 mm in size

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16
Q

Plaque

A
  • Elevated flat-topped lesion, usually greater than 5 mm across (may be caused by coalescent papules)
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17
Q

Pustule

A
  • Discrete, pus-filled, raised lesion
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18
Q

Scale

A
  • Dry, horny, platelike excrescence

- Usually the result of imperfect cornification

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19
Q

Vesicle, bulla, blister

A
  • Fluid-filled raised lesion 5 mm or less across (vesicle) or greater than 5 mm across (bulla)
  • Blister is the common term for either
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20
Q

Wheal

A
  • Itchy, transient, elevated lesion with variable blanching and erythema formed as the result of dermal edema
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21
Q

Hyperleratosis

A
  • Thickening of the stratum corneum

- Often associated with a qualitative abnormality of the keratin

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22
Q

Letiginous

A
  • A linear pattern of melanocyte proliferation within the epidermal basal cell layer
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23
Q

Papillomatosis

A
  • Surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae
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24
Q

Parakeratosis

A
  • Keratinization with retained nuclei in the stratum corneum

- On mucous membranes, parakeratosis is normal

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25
Q

Spongiosis

A
  • Intercellular edema of the epidermis
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26
Q

Ulceration

A
  • Discontinuity of the skin showing complete loss of the epidermis revealing dermis or subcutis
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27
Q

Vacuolization

A
  • Formation of vacuoles within or adjacent to cells

- Often refers to basal cell-basement membrane zone area

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28
Q

Acanthosis

A
  • Diffuse epidermal hyperplasia

- Increased thickness of the Malpighian layer (stratum basale and stratum spinosum)

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29
Q

Dyskeratosis

A
  • Abnormal, premature keratinization within cells below the stratum granulosum
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30
Q

Erosion

A
  • Discontinuity of the skin showing incomplete loss of the epidermis
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31
Q

Exocytosis

A
  • Infiltration of the epidermis by inflammatory cells
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32
Q

Hydropic swelling (ballooning)

A
  • Intracellular edema of keratinocytes

- Often seen in viral infections

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33
Q

Hypergranulosis

A
  • Hyperplasia of the stratum granulosum

- Often due to intense rubbing

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34
Q

Acantholysis

A
  • Loss of intercellular cohesion between keratinocytes
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35
Q

Acute inflammatory dermatoses

A
  • Urticaria
  • Acute eczematous dermatitis
  • Erythema multiforme
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36
Q

Acute lesions (acute dermatoses)

A
  • Last from days to weeks

- Inflammatory Infiltrates

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37
Q

Inflammatory infiltrates in acute dermatoses

A
  • Lymphocytes
  • Macrophages
  • Edema
  • Variable degrees of epidermal, vascular, or subQ injury
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38
Q

Chronic lesions in actue dermatoses

A
  • Persist for months to years

- Associated atrophy or hyperplasia or dermal fibrosis

39
Q

Urticaria (hives) characteristics (1)

A
  • Localized mast cell degranulation
  • Dermal microvascular hyperpermeability
  • Pruritic edematous plaques called wheals
40
Q

Angioedema (related to urticaria)

A
  • Edema of the deeper dermis and the subQ fat
41
Q

Urticaria (hives) characteristics (2)

A
  • Condition usually resolves in less than 24 hours
  • Episodes may last for days or persist for months
  • Sites of predilection –> areas exposed to pressure
  • Persistent episodes (underlying disease, underlying cause not identified)
42
Q

Urticaria pathogenesis

A
  • Antigen-induced release of vasoactive mediators from mast cells
  • Mast cell-dependent, IgE-dependent (exposure to pollens, foods, drugs, insect venom)
  • Localized immediate hypersensitivity (type I) reaction
43
Q

Urticaria morphology

A
  • Small pruritic papules –> large edematous plaques
  • Individual lesions may coalesce
  • Sparse superficial peri-venular infiltrate (Mononuclear)
  • Dilated Superficial lymphatic channels
  • Epidermis (No change)
44
Q

Urticaria clinical presentation

A
  • Isolated event without systemic reaction
  • Prelude to an anaphylactic reaction
  • Features of Anaphylaxis
45
Q

Features of anapylaxis

A
  • Hypotension
  • Respiratory distress
  • Stridor
  • Gastrointestinal distress
  • Swallowing problems
  • Joint swelling, joint pain (immediate medical intervention necessary)
46
Q

Acute eczematous dermatitis categories

A
  • Allergic contact dermatitis
  • Atopic dermatitis
  • Drug-related eczematous dermatitis
  • Photoeczematous dermatitis
  • Primary irritant dermatitis
47
Q

Acute eczematous dermatitis causes

A
  • Reaction from external application of an antigen (e.g., poison ivy)
  • Reaction to an internal circulating antigen (derived from ingested food or drug)
48
Q

Acute eczematous dermatitis

pathogenesis

A
  • T cell-mediated inflammatory reaction (Type IV hypersensitivity)
  • Reactive chemical induction of neo-antigens
  • Neoantigens are processed in lymph nodes
49
Q

Acute eczematous dermatitis morphology (1)

A
  • Red, papulovesicular, oozing, crusted lesions
  • Small and large blisters (vesicles and bullae)
  • Spongiosis
  • Raised scaling plaques (produced by reactive acanthosis and hyperkeratosis)
50
Q

Stages of eczema development

A

A) Initial dermal edema and perivascular infiltration by inflammatory cells
B) Epidermal spongiosis and microvesicle formation
C) Abnormal scale, including parakeratosis, along with progressive acanthosis
D ,E) Progressive acanthosis and hyperkeratosis as lesion becomes chronic

51
Q

Acute eczematous dermatitis morphology (2)

A
  • Edema seeps to level of the stratum spinosum (result in the formation of intraepidermal vesicles)
  • Lesion are pruritic
52
Q

Erythema multiforme

A
  • Hypersensitivity reaction to infections and drugs
53
Q

Erythema multiforme associations

A
  • Infections
  • Exposure to certain drugs
  • Cancer
  • Collagen vascular disease
54
Q

Infections associated with erythema multiforme

A
  • Herpes simplex
  • Mycoplasma
  • Histoplasmosis
  • Coccidioidomycosis
55
Q

Drugs associated with erythema multiforme

A
  • Sulfonamides
  • Penicillin
  • Barbiturates
  • Salicylates
  • Hydantoins
  • Antimalarials
56
Q

Cancers associated with erythema multiforme

A
  • Carcinomas

- Lymphomas

57
Q

Collagen vascular disease associated with erythema multiforme

A
  • Lupus erythematosus
  • Dermatomyositis
  • Polyarteritis nodosa
58
Q

Erythema multiforme pathogenesis

A
  • Keratinocyte injury mediated by CD8+ T cells
  • Lesions (CD8+ T cells in the central portion, CD4+ helper T cell and Langerhans cells in the peripheral portions)
  • Epidermal antigens recognized by the infiltrating T cells remain unknown
59
Q

Erythema multiforme morphology/presentation

A
  • Macules
  • Papules
  • Vesicles
  • Bullae
  • Targetoid (target-like) lesions
  • The lesions may occur in a variety of distributions
  • Limited cases show symmetry
  • Often involve the extremities
60
Q

Stevens-Johnson Syndrome (SJS) consensus definiton (variant of erythema multiforme)

A
  • SJS separated from EM spectrum and added to toxic epidermal necrolysis
  • SJS and toxic epidermal necrolysis (TEN) are considered severity variants of a single entity
  • A febrile form of EM with extensive involvement of the skin (also considered a minor form of toxic epidermal necrolysis)
61
Q

Steven-Johnson Syndrome lesions (seen most often in children)

A
  • Skin
  • Lips
  • Oral mucosa
  • Conjunctiva
  • Urethra
  • Genital and perianal areas
  • Secondary Infection: life-threatening sepsis
62
Q

Toxic Epidermal Necrolysis (TEN)

A
  • Potentially life-threatening dermatologic disorder
  • Widespread erythema
  • Necrosis
  • Bullous detachment of epidermis and mucous membranes
  • Exfoliation (secondary to bullous detachment)
  • Sepsis and/or death
  • Mucous membrane involvement
63
Q

Mucous membrane involvement in TEN

A
  • GI hemorrhage
  • Respiratory failure
  • Ocular abnormalities
  • Genitourinary complications
64
Q

Immunopathologic pathways leading to keratinocyte apoptosis

A
  • Fas ligand activation on keratinocytes leading to apoptosis
  • Release of destructive proteins (perforin and granzyme B) from cytotoxic T cells
  • Cytokine overproduction
  • Drug-induced secretion of granulysin from CTLs natural killer cells, and natural killer T cells
  • How inciting agent trigger pathways is unclear
65
Q

Chronic inflammatory dematoses

A
  • Psoriasis
  • Seborrheic Dermatitis
  • Lichen Planus
  • Inflammatory skin disorders persist for many months to years
66
Q

Psoriasis

A
  • Chronic inflammatory dermatosis
  • Autoimmune basis
  • Affects 1% to 2% of people in US
  • All ages may develop the disease
  • Approximately 15% of the patients have arthritis
67
Q

Psoriasis associations

A
  • Myopathy
  • Enteropathy
  • AIDS
68
Q

Psoriasis pathogenesis

A
  • Association with HLA-C
  • Culprit antigens remain elusive
  • Sensitization of CD4+ TH1 and TH17 cells
  • Activated CD8+ accumulate in the epidermis
  • Stimulate secretion of cytokines and growth factors
  • Induction of keratinocyte proliferation
  • Lymphocytes also produce growth factors
  • Epidermal thickening
69
Q

Psoriasis areas frequently affected (morphology)

A
  • Elbows
  • Knees
  • Scalp
  • Lumbosacral areas
  • Intergluteal cleft
  • Glans penis
70
Q

Psoriasis lesions

A
  • Well-demarcated
  • Pink to salmon-colored plaque
  • Covered by loosely adherent silver-white scale
71
Q

Koebner phenomenon (psoriasis)

A
  • Formation of psoriatic lesions in uninvolved skin of psoriatic patients after cutaneous trauma
72
Q

Psoriasis morpholoy variations/configurations

A
  • Annular, linear, gyrate, or serpiginous configurations
73
Q

Changes seen in psoriasis

A
  • Cause of total body erythema and scaling (erythroderma)

- Nail changes

74
Q

Nail changes seen in psoriasis

A
  • Yellow-brown discoloration
  • Pitting, dimpling
  • Onycholysis
  • Thickening
  • Crumbling
75
Q

Auspitz sign (psoriasis histology)

A
  • Abnormal proximity of vessels in dermal papillae overlying parakeratotic scale
  • Bleeding points occur when scale is lifted from the plaque
  • Spongiform pustules
  • Munro microabscesses
76
Q

Psoriatic arthritis

A
  • Seronegative oligoarthritis
  • Found in patients with psoriasis
  • 1/5 patients with psoriasis has psoriatic arthritis
77
Q

Psoriatic arthritis differentiating features

A
  • Distal joint involvement

- Arthritis mutilans

78
Q

Psoriatic arthritis classifications

A
  • Mild
  • Severe (deformities resembling RA)
  • Any joint affected
  • Symmetrical or asymmetrical
79
Q

Seborrheic dermatitis

A
  • More common than psoriasis
  • Affecting up to 5 % of the general population
  • Classically involves regions with a high density of sebaceous glands
80
Q

Seborrheic dermatitis typical locations

A
  • Scalp
  • Head
  • External auditory canal
  • Retroauricular area
  • Nasolabial folds
  • Presternal area
81
Q

Seborrheic dermatitis pathogenesis

A
  • Etiology unknown
  • Related with increased sebum production (androgenic response)
  • Parkinson Disease
82
Q

Parkinson disease in seborrheic dermatitis

A
  • Increased sebum production
    secondary to dopamine deficiency
  • Increased incidence of seborrheic dermatitis
83
Q

Seborrheic dermatitis in parkinsons Tx

A
  • Levodopa treatment
  • Oiliness of the skin decreases
  • Seborrheic dermatitis improves
84
Q

Seborrheic dermatitis morphology

A
  • Lesions are macules and papules
  • Erythematous-yellow, greasy base
  • Extensive scaling and crusting
  • Fissures
  • Dandruff (scalp involvement)
85
Q

Seborrheic dermatitis histology

A
  • Early lesions are spongiotic
  • Later lesions acanthotic (follicular lipping)
  • Mounds of Parakeratosis
  • Superficial perivascular inflammatory infiltrate
86
Q

Follicular lipping (seborrheic dermatitis histology)

A
  • Neutrophils and serum present at the ostia of hair follicles
87
Q

Lichen planus

A
  • Disorder of skin and mucosa
  • Self-limited (resolves spontaneously 1 to 2 yrs after onset)
  • Post-inflammatory hyperpigmentation (Residual)
  • Oral lesions can persist for years
  • Squamous cell carcinoma can occur in chronic mucosal and paramucosal
  • Koebner phenomenon seen
88
Q

Lichen planus pathogenesis

A
  • Unknown
  • Altered antigen expression
  • Basal epidermal cells
  • Dermoepidermal junction
  • Elicit CD8+ T cell responses
  • T-lymphocyte infiltrates
  • Hyperplasia of Langerhans cells
89
Q

6 P’s of lichen planus (morphology)

A
  • Pruritic
  • Purple
  • Polygonal
  • Planar
  • Papules
  • Plaques
90
Q

Lichen planus cutaneous lesions (morphology)

A
  • Violaceous
  • Flat-topped papules
  • Coalesce to form plaques
  • Wickham striae
  • Areas of hypergranulosis
91
Q

Lichen planus histology

A
  • Dense dermoepidermal continuous infiltrate of lymphocytes
  • Basal keratinocytes destruction
  • Dermoepidermal interface (angulated / zigzag contour (sawtoothing))
  • Civatte bodies
  • Chronic
92
Q

Lichen planus civatte bodies (histology)

A
  • Anucleate, necrotic basal cells may become incorporated into inflamed papillary dermis
93
Q

Chronic Lichen planus (histology)

A
  • Epidermal hyperplasia

- Thickening of the granular cell layer and stratum corneum (hypergranulosis and hyperkeratosis, respectively)

Pathology II (7 decks)

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