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Pathology of Rashes Flashcards

1
Q

What cells does the epidermis mainly consist of?

A

Maturing squamous cells

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2
Q

Where is the mitotic pool of the epidermis?

A

Basal Layer

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3
Q

Where are melanocytes found in normal skin?

A

dermo-epidermal junction

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4
Q

Ratio of melanocytes: basal cells?

A

1:10

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5
Q

What kind of epithelium is the normal epidermis?

A

Stratified squamous epithelium

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6
Q

What is prominent in the prickle cell layer?

A

Desmosomes

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7
Q

What is the granular layer rich in?

A

Keratohyalin granules

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8
Q

What is the corneal layer rich in?

A

Differentiated keratinised cells

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9
Q

What do corneocytes turn into?

A

House dust

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10
Q

Where are melanocytes found in normal epidermis?

A

Basal layer

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11
Q

How do melanocytes transfer pigment?

A

Transfer pigment to keratinocytes via dendritic processes

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12
Q

Where are langerhans cells found?

A

Upper and mid-epidermis

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13
Q

What is the role of langerhans cells?

A

Sentinels monitoring environment for antigens, important in initiating inflammation

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14
Q

Describe the structure of the dermis

A
  • Matrix of type 1 and 111 collagen
  • Elastic fibres
  • ground substances; hyaluronic acid + chondroitin sulphate
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15
Q

Describe the structure and location of the papillary dermis

A

Thin, lies just beneath the epidermis

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16
Q

Describe the structure and location of the reticular dermis

A
  • Thicker bundles of type 1 collagen

- reticular dermis contains appendage structures

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17
Q

What does the epidermal BM consist of?

A

Laminin and collagen IV

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18
Q

Define hyperkeratosis?

A

Increased thickness of keratin layer

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19
Q

Define parakeratosis?

A

Persistence of nuclei in the keratin layer

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20
Q

Define acanthosis?

A

Increased thickness of epithelium

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21
Q

Define papillomatosis?

A

Irregular epithelial thickening

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22
Q

Define spongiosis?

A

Oedema fluid between squames appears to increase prominence of intercellular prickles.

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23
Q

What are the four patterns of inflammatory skin disease?

A
  1. Spongiotic
  2. Psoriasform
  3. Lichenoid
  4. Vesiculobullous
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24
Q

Describe a spongiotic condition?

A

Intraepidermal oedema e.g. eczema

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25
Describe a psoriasform condition?
Elongation of the rete ridges e.g. psoriasis
26
Describe a lichenoid condition?
Basal layer damage e.g. lichen plants and lupus
27
Describe a vesiculobullous condition?
Blistering e.g. pemphigoid, pemphigus and dermatitis herpetiformis
28
Describe the pathogenesis of psoriasis?
- Epidermal hyperplasia - Increased epidermal turnover - Hereditary factors - Associated specific HLA types - New lesions at sites of trauma (koebner) - Complement mediated attack on keratin layer
29
What is the prototypic lichenoid disorder?
Lichen planus
30
Describe the lesions in lichen planus
Itchy flat topped violaceous papule
31
Describe the histology of lichen planus
- Irregular sawtooth acanthosis - Hypergranulosis and orthohyperkeratosis - Band-like upper dermal infiltrate of lymphocytes - Basal damage with formation of cytoid bodies
32
What other lichenoid disorders resemble lichen planus?
Discoid Lupus | Drug rashes
33
What lichenoid disorders have a more marked vacuolar interface change?
Erythema multiforme, TEN
34
When do vesicles and bullae occur?
Vesicles and bullae occur as a secondary phenomenon in many skin diseases e.g. eczema
35
Name three examples of immunobullous diseases?
Pemphigus Bullus pemphigoid Dermatitis herpetiformis
36
What is the cause of pemphigus?
Rare autoimmune disease with four subtypes Loss of integrity of epidermal cell adhesion
37
What does pemphigus respond to?
Steroids
38
What is the most common form of pemphigus?
80% of cases are pemphigus vulgaris
39
What is the cause of pemphigus vulgaris?
IgG auto-antibodies made against desmoglein 3
40
What is the function of desmoglein 3?
Maintains desmosomal attachments
41
Describe the pathogenesis of pemphigus vulgaris?
Immune complexes form on cell surface Complement activation and protease release Disruption of desmosomes End result is acantholysis
42
Where does pemphigus vulgaris affect?
Skin esp scalp, face, axillae, groin, trunk | May affect mucosal in mouth, resp tract
43
What happens to the blisters in pemphigus vulgaris?
Rupture to form shallow erosions
44
What is common to all variants of pemphigus?
Acantholysis= lysis of intercellular adhesion sites
45
What is bullous pemphigoid?
Subepidermal blister formation
46
Describe the pathogenesis of bullous pemphigoid?
Circulating antibodies (IgG) react with a major and/or minor antigen of the hemidesmosomes anchoring basal cells to the basement membrane. The result is local complement activation and tissue damage
47
What is there no evidence of in bullous pemphigoid?
Acantholysis
48
What is seen in immunofluorescence of bulgur pemphigoid?
Linear IgG + complement deposited about the BM
49
What do old lesions of pemphigoid show?
Re-epithelialisation of their floor, mimicking pemphigus vulgarisms
50
What is dermatitis herpetiformis?
Autoimmune bullous disease
51
What is dermatitis herpetiformis associated with?
Coeliac disease (HLA-DQ2 haplotype)
52
What is seen in dermatitis herpetiformis?
Intensely itchy lesions-symmetrical Elbows, knees and buttocks often excoriated Hallmark= papillary derma micro abscesses
53
What is seen in DIF or dermatitis herpetiformis?
IgA in dermal papillae
54
Describe the pathophysiology of dermatitis herpetiformis?
IgA antibodies target gliadin component of gluten but cross react with connective tissue matrix proteins Immune complexes form in dermal papillae and activate complement and generate neutrophil chemotaxins
55
Describe the aetiology of acne?
Increased androgens at puberty Increased androgen sensitivity of sebaceous gland Keratin plugging of pilosebaceous units Infection with anaerobic bacterium corynebacterium acnes
56
What does rupture of pilosebaceous unit cause?
Acute inflammation and foreign body granulomas
57
What is seen in rosacea?
Recurrent facial flushing Visible blood vessels Pustules Thickening of the skin-rhinophyma
58
What trigger aggravate acne rosacea?
Sunlight Alcohol Spicy foods Stress
59
What does rosacea respond to?
Tetracyclines
60
Describe the pathology of rosacea?
- Vascular ectasia - Patchy inflammation with plasma cells - Pustules - Periofollicular granulomas - Follicular demodex mites often notes Is it an allergic reaction to mites
61
What is nikolsky's sign?
The top layer of skin slips away from lower layer when slightly rubbed Suggests plane of cleavage is within the epidermis

Dermatology (15 decks)

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