Skin pathology

By
Faisal Mehboob

Skin lesions

Skin lesions

Primary lesions

First lesion appear on the skin are

primary lesions

Secondary lesions
when changes occur in primary
lesion it becomes sec

Macules(5mm in diameter, differentiate

from skin by coloration, size greater than
5mm term as PATCH)

Papules (5mm in diameter, size greater

than 5mm term as NODULE)

Plaque(Greater than5mm in diameter)

Nodules

Tumor

Wheal
Vesicle

Scale(dry, result of imperfect

cornification)
Crust
Thickning
Ersosion
Ulcer
Scar
Excoriation(traumatic
lesion,breaking up the
epidermis,cause a red linear mark)

Fissure

atrophy

Sign and symptoms

of skin lesions

Sign and symptoms of skin

lesions

Pruritus (itching)
Urticaria (localized mast cell degenration,
which leads to dermal vascular
hyperpermeability)
Rash
Blisters (vesicle or bulla)

Causes of skin lesions

Hereditory factors
Physical trauma
Systemic origin
Burns
Neoplasm
Reactions to
radiotherapy
Contact with infected
organisms
Reactions to allergens

Aging and
integumentary
system

Aging and integumentary system

Structural changes

Functional changes

In epidermis
Flattening of the dermal-epidermal
junction
Changes in basal cells
Dec number of langerhens cells
Dec number of melanocytes
In dermis
Dec dermal thickness
Dec vascularization
Appendages
Dec number of sweat glands
Dec number of specialized nerve
endings

In epidermis
Altered skin permeability
Dec inflammatory response
Dec immunologic response
Impaired wound healing
In dermis
Dec elasticity
Dec vit D production
Appendages
Altered skin thermoregulation
Impaired skin perception
Changes in hair color and hair loss

Common skin
disorders

Common skin disorders

a topic bht mushkil her bndy sy contact kr

lia ha, examiner sy b kr lia ha , roz he iski tensionki vaja sy incontinence ho jata ha

Atopic dermatitis
*chronic inflammatory skin disease ,most common type of ECZEMA,
frequently present during the first year of life *the exact cause of AD is
unknown ,but is associated with dry , irritable skin with a malfunction of bodys
immune system)
*clinicaly it shows, Red, oozing, crusting rash classified as acute dermatitis.
Xerosis and pruritus are major symptoms of AD. Staphlococcus aureous is most
common bacterial infection in this case.

Contact dermatitis
Acute or chronic skin inflammation caused by exposure to a chemical ,
mechanical, physical or biologic agent.
Common sensitizers include *Nickel *Chromates *wool fats *rubber additives
*topical antibiotics (neomycin)
Clinically it shows , intense pruritis (itching) , erythema (redness) and edema. If
these symptoms persist , then skin becomes Thickenend with prominent
marking.

 Eczema and dermatitis

Superficial inflammation of skin caused by irritant exposure,
allergic sensitizer (delayed hypersensitivity), or genetically
determined idiopathic factors.

Types are *allergic dermatitis *irritant

dermatitis *seborrheich dermatitis *nummular
eczema *AD *stasis dermatitis
Stages are three ( 1. acute dermatitis 2. Subacte 3. chronic
dermatitis)
Etiology (found in older peoples, caused by
hypoproteinemia, venous insufficiency, allergens, irritants or
underlying malignancy)
Stasis dermatitis
Development of areas of very dry, thin skin and sometimes
shollow ulcers of lower legs , primarily as a result of venous
insufficiency.
Environmental dermatoses

 Rosacea
Common chronic facial disorder of middle aged and older people,
although it is related to acne, but it is differentiated by age,in the presence
of erythema.
Incontinence-associated dermatitis
Skin damage results from urine or feces exposure. This condition also
refer as peri rash (affecting the perineum b/w the anus and external
genitalia)

Skin infections

Skin infections
1..Bacterial I m patoki ko goinig, pai o derda ha fail hony sy
a.Impetigo contagiosa
Caused by staphylococci or streptococci.
Found in infants and childrens 2 to 5 years of age.
Clinically it shows small macules(flat spots),
vesicles (blisters), pustular (pus-filled)
b.Pyoderma
c.Folliculitis
d.Cellulitis
Cellulitis is rapidly spreading acute inflammation
with the infection of skin and subcutaneous tissues
that spread widely through tissue spaces.
Streptococcus pyogenes or staphylococcus aureous
is ususal cause in adults and H.influenza in
children.

2..Viral ver ny war ki or ver ny plan bna k her pasy

simple attack kiay

a.Verrucae (warts)
Common, benign viral infections of
skin.
Warts may appear singly or as
multiple lesions with thick white
surfaces.
The most common wart is Verruca
vulgaris which spread to as such and
appear as a rough, elevated round
surface most frequently on the
extremities
Plantar warts are slightly elevated
and reffered to as mosaic warts ,
primarly at the pressure points of the
feet.
b.Verruca plantaris
c. Herpes simplex

3..Fungal teen car, teen cap or teen bed ham Canada sy ly hn

a.Tinea corporis (ringworm)
It has no association with worms but rather is marked by
the formation of ring shaped pigmented patches covered
with vesicles or scales that often become itchy.
b.Tinea capitis (affect scalp)
c.Tinea pedis(athletes foot)
It causes erythema, skin peeling, and pruritus b/w the
toes and may spread from the interdigital spaces to the
plantar surface of foot.
d.Candidiasis (yeast)
A complication of moisture associated skin damage
(MASD) due to chronic wetness from wound exuduates,
urine and stool.
4..Others
a.Scabies (mites)
Higly contagious skin eruption caused by mite,
SARCOPTES SCABIEI.
Clinically symptoms include excoriated skin and burrow,
which is a linear ridge with a vesicle at one end.
b.lice

Skin cancer

Skin cancers
1..Benign sab bore he c, ke rat c o sis, nevi k log b
thy

Seborrheic Keratosis
Hereditary benign proliferation of basal
cells
Occur at middle age
Lesions appear waxy, smooth or raised
lesions that vary in color.
These tumors are left untreated, unless there
is itch or pain
Nevi (moles)
Pigmented or non-pigmented lesions form
from aggregation of melanocytes
Most moles are brown, black or fleshed
color.
They vary in size and thickness

2..Premalignant
Actinic keratosis
Also known as solar keratosis
Caused by many years of exposure to
the suns UV rays.
It shows well defined crusty, or
sandpaper like patch or bump .
It mostly seen on the exposed parts of
the body.
Bowen disease
It can occur on exposed as well as
unexposed parts of the body or mucous
membrane (especially of glans penis)
It presents a perisistant , brown to
reddish brown, scaly plaque with well
defined margins.

3..Non-melanoma
Basal-cell carcinoma
Slow growing surface epithelial skin
tumor originating from undifferentiated
basal cells contained in the epidermis.
It does not invade the blood vessels but
does local destruction.
Etiology is prolong sun exposure,
immunosuppression, genetic
predisposition with defect in DNA
replication and repair, site of vaccination.
Pathogenesis of BCC is unusual. It is
stable growth characterized by
monotonous structure, the absence of
progression to metastasis, and a small
amount of chromosomal damage.
Clinically it has pearly or ivory
appearance , has rolled edges and slightly
elevated above the skin surface with small
blood vessels on the skin
surface(telangiectasia).

Squamous cell carcinoma

2nd most common skin cancer
It is a tumor of epidermal keratinocytes and rarely occurs in dark skinned people.
Invasive squamous cell carcinoma can arise from premalignant lesions of the skin,
including sun-damaged skin, actinic dermatitis scars.

Predisposing factors associated with the SCC are overexposure to the UV

radiation.
PATHOGENSIS. UV rays damage DNA inside the nuclei of the epidermal cells
triggering enzymes to repair the damage.

Basal cell carcinoma

Squamous cell carcinoma

Rarely spread

Spread more commonly than BCCs

Found deep within skin layers of thick skin

Found near body orifices and in the oral cavity

Occupies basement membrane

Occupies outer layer of skin

Most common form of NMSC

Less common but more dangerous

96% victims 40years or over

Almost all victims are 40 years or older

Red pale or pearly in colour

Thickened red, spot, may bleed, crust or

ulcerate

Morphology of squamous cell

carcinoma
Red
Scaly
Actinic keratosis
Nodular lesions
Microscopically highly atypical

4..Melonama superficial nodes bnny ki vja sy L acar gia ha

Superficial spreading melanoma
Occurs in the areas of chronic irritations.
Found in people from 20 to 60 years of age.
Usually asymptomatic.
Nodular melanoma
Can be found in any part of the body
Men 60 years of age affected more than women
Describe as small , darkly pigmented papule.
This type invade the dermis and metastase
quickly.
Lentigo malignant melanoma
Occur on sun exposed areas
This lesion looks like a large flat freckle with
irregular borders containing varied colored of
pigmentations.
Acral lentiginous melanoma
Most common form of melanoma in dark
skinned people.
These lesions have flat, dark brown portions
with raised bumpy areas.

Risk factors for the development of

melanoma
Family history of malignant melanoma
Fair skin , light hair, blue or green eyes
Presence of marked freckling on the upper back
UV rays exposure
Immune suppression
Genetic disorders
Age: older adults or in people younger than 30.

Skin disorders
associated with
immune dysfunction

Skin disorders associated with immune

dysfunction
Psoriasis
Chronic, inherited , recurrent inflammatory
but noninfectious dermatosis characterized
by well defined erythematous plaques
covered with a silvery scale.
Researches has shown higher than noramal
incidence of human leukocyte antigen
(HLAs) in families with psoriasis which
determined it as the autoimmune disorder.
Pathogenesis. It is disorder of
keratinocytes, which form in the lower
epidermis, flatten with age and move
towards the surface as new cells are
generated below. The 2nd component in the
pathogenesis of the psoriasis is immune
system reaction.
The most common form of psoriasis is
psoriasis vulgaris
Clinically: nail beds shows pitting and
discoloration which is term as oncholysis.

 Genetic factors and immunological and environmental factors

Pink plaques, and have silver white scales on it.
Acanthosis

Lupus erythematous
. Chronic inflammatory disorder of
the connective tissues.
It is found in many forms like
Cutaneous lupus erythematous (
which primarly effects the skin)
systemic lupus erythematous
(which effects multiple organs)
It is an autoimmune defect.
Clinically : discoid lesion (chronic
cutaneous LE) can develop from
the rash typically seen in lupus and
become raised, red , smooth
plaques with follicular plugging
and central atrophy. The most
recognized skin manifestationof
SLE is the classic butterfly rash
over the nose, cheeks and forehead
commonly prespitated by exposure
to the sun light

Systemic sclerosis
The disorder which causes fibrosis of
skin, joint, blood vessels and internal
organs by the deposition of collagen.
There are two type 1. systemic
scleroderma(a. limited b. diffuse
c.overlap from with either diffuse r
limited) 2. localized scleroderma (it
mainly effects the skin , without involving
the visceral organs.
Reachers suggest that this disorder is an
acquired disease triggered by
bacteria(mycoplasma)
Pathogenesis : deposition of collagen
produced by activated fibroblasts in the
intima of blood vessels and the
interstitium of the skin distinguish it from
the other autoimmune disorders.

Polymyositis &
dermatomyositis
Diffused Inflammotry
myopathy chiefly in
endomysium(polymyositis)
and in
perimysium(dermatomyosi
tis)
Elevated serum creatine
kinase activity
Progressive weakness
Found proximal to distal
Autoimmune mechanism
appear

Types of inflammatory myopathies

Primary idiopathic polymyositis
Primary idiopathic dermatomyositis
Dermatomyositis and polymyositis associated with malignancy
Juviline polymyositis or dermatomyositis
Polymyositis associated with other connective tissue diseases

Thermal
injuries

Thermal injuries
Cold injuries
Cold injuries occur due to over exposure to the cold environment .e.g
Frostibe (localized injury) & Hypothermia (systemic injuries)
Untreated frostibe can lead to gangrene.
Burns
Injuries that results from direct contact with or exposure to any
thermal, chemical, electrical or radiation source are term as burn

Classification of burn injuries

1..Superficial burn
First degree burn
Involve epidermis
Caused by : sunburn, UV exposure
Appearance : mild to severe erythema
2..Partial thickness burn
2nd degree burn
Involve drmis
3..Full thickness burn
3rd degree burn
Involve subcutaneous tissue

Miscelleneous
inflammatory
disorders

Miscellaneous integumentary disorders

Integumentary ulcers
Pressure ulcers
Also term as bed sore
A lesion caused by unrelieved pressure resulting in damage to
underlying tissue.
Stages.
Stage 1.. intact skin with nonblanchable redness of a localized area
usually over a bony prominence.
Stage 2.. Partial thickness loss of dermis presenting as a shallow open
ulcer
Stage 3.. Full thickness tissue loss
Stage 4 ... Full thickness tissue loss with bone exposure

 Blistering disease
Blisters occurs on skin and mucous
membrane in a condition called
pemphigus, which is uncommon
intraepidermal blistering disease in
which the epidermal cells separate
from one another.
This could be occur by viral or
bacterial infections to the skin
(herpes simplex, impetigo) or local
injury of the skin (burns , ischemia
or dermatitis) or they may be drug
induced (penicillamin, captopril)
Cutaneous sarcoidosis
Mutisystemic disorder
characterized by the formation of
granulomas, inflammatory lesions
containing mononuclear phagocytes
usually surrounded by a rim of
lymphocytes.

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