Man is the maker of himself….

You are the stone, You are the chisel, and You are the sculpture….!

www.akshardham.com

““The The investment you make in yourselfinvestment you make in yourself must receive ‘Top Priority’. When you must receive ‘Top Priority’. When you ‘GROW’ your entire world Expands... ‘GROW’ your entire world Expands...

when you do not grow your whole when you do not grow your whole world starts to become ‘Very world starts to become ‘Very

Small’...that smallness reflects in all Small’...that smallness reflects in all areas of life including your income."areas of life including your income."

Bob ProctorAuthor and Personal Coach

Pathology of Skin(SSS MD3020)

Dr. Shashidhar Venkatesh MurthyAssociate Professor & Head of Pathology

DERMATOLOGYDERMATOLOGY

Learning Objectives:• Knowledge:

• Anatomy, Histology, Physiology• Pathology of Major disorders *• Etiology, pathogenesis, Morphology.

• Skills:• Recognise common diseases* • Clinical/Gross & Microscopy.

Pathology of Pathology of Common Skin DiseasesCommon Skin Diseases

Sessions & Details:

Pathology:• Inflammatory, Blistering

& Neoplastic diseases.• Clinical, Gross &

Microscopy

Synthesis: • Review• Quiz• Q & A

Session 3

Introduction:• Review – Histology.• Histopathology• Diseases - Overview &

Classification.

Session 2Session 1

Dermatopathology:• Pathology is “Scientific Study of Disease”

• What, when, who, how… etc of a disease.• “Understanding disease”

• Study of Pathology:• What caused disease? EtiologyEtiology• How it caused? PathogenesisPathogenesis• What changes? – MorphologyMorphology

• Gross & Microscopy

• Clinical significance – PathologicPathologic basisbasis.

• Laboratory tests:• Biopsy, Cytology, “Markers”, Molecular, genetic…

Exam Question: 2006 MB3• 19 year old female presented with recurrent

lesions since 6 years(Image-1). The lesions seems to flare up during winter months and responds partially to topical steroid ointment.

Exam Question: 2006 MB3• Describe the appearance of the lesion shown

in the image? [2] • Bilateral large Pinkish plaques covered with

white silvery scales.• What is the most likely diagnosis? [1]• Psoriasis• Briefly describe “Koebner Phenomenon” ?

[2]• “Koebner phenomenon” means the development

of isomorphic psoriatic lesions immediately subsequent to, and at the site of, a cutaneous injury;

• What is Auspitz sign what is its significance?[2]

• Removal of the scales results in small pinpoint bleeding because of increased vascularity under focal areas of epidermal thinning. This feature occurs only in psoriasis and is known as Auspitz’s sign.

Exam Question: 2006 MB31. Look at the Microscopy picture from her

lesion (Image-2). Identify any 4 histopathological features shown. [2]

• Hyperkeratosis• Parakeratosis• Regular elongation of the rete ridges• Diminished granular layer• Tortuous papillary dermal blood vessels• Inflammatory cells in the superficial

dermis.2. You are prescribing a medication for her,

what type of base would be suitable for her and why? [2]

• Water soluble Cream base with keratolytic agent such as urea, for hydration and good penetration as the lesion is dry & scaly.

"The will to win is important, but the will to prepare is vitalvital."

- Joe Paterno

Quick ReviewQuick Review

Skin Under MicroscopeSkin Under MicroscopeAnatomy, Histology &

Physiology

Normal Skin:

Normal skin:

Hairy skin – Pubic Hair

Prominent granular layer

Thick Skin:

Melanocytes:

1 2 3 4 5

6% 4%10%

73%

7%

What is the function of this organ?What is the function of this organ?

??

1. Fine touch sensation2. Pressure sensation3. Pain sensation4. Sweat production5. Temperature control

1 2 3 4 5

89%

1% 0%1%

9%

What is the function of this cell?What is the function of this cell?

??

1. Antigen Processing2. Multiplication3. Melanin production4. Melanin storage5. Osmotic barrier

What is the function of this cell?What is the function of this cell?

??1. Antigen Processing2. Temperature control3. Melanin production4. Immune Defence5. Wound Healing

1 2 3 4 5

31%

0%

17%

43%

9%

1 2 3 4 5 6 7 8 9

95%

0%4%

1% 0%0%0%0%0%

What is the type of lesion?What is the type of lesion?1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer

??

1 2 3 4 5

53%

46%

1%0%0%

What is the function of this?What is the function of this?

??

1. Fine touch sensation2. Pressure sensation3. Lubrication4. Sweat production5. Temperature control

1 2 3 4 5

0%

50%

0%

50%

0%

What is the function of this?What is the function of this?

??

1. Fine touch sensation2. Pressure sensation3. Lubrication4. Immunity & defence5. Temperature control

What is the type of lesion? What is the type of lesion?

1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer

1 2 3 4 5 6 7 8 9

0%

5%

0% 0% 0%0%0%1%

94%

1 2 3 4 5 6 7 8 9

47%

3%

26%

0% 0%0%

19%

6%

0%

What is the type of lesion?What is the type of lesion?

1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer

??

1 2 3 4 5 6 7 8 9

1%

16%

13%

46%

1%

19%

1%0%0%

What is the type of lesion?What is the type of lesion?

1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer

1 2 3 4 5

2% 4%0%

5%

89%

What is the function of this cell?What is the function of this cell?

1. Antigen Processing2. Multiplication3. Melanin production4. Melanin storage5. Protection

??

1 2 3 4 5 6 7 8 9

0% 0%

15%

0%

6%

9%

69%

0%0%

What is the type of lesion?What is the type of lesion?

1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer

1 2 3 4 5

5%

93%

0%0%2%

What is the function of this?What is the function of this?

??

1. Fine touch sensation2. Pressure sensation3. Pain sensation4. Sweat production5. Temperature control

1 2 3 4 5 6 7 8 9

0%

14%

5%

69%

6%

1%0%0%

4%

What is the type of lesion?What is the type of lesion?

1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer

1 2 3 4 5 6 7 8 9

0% 0%

51%

0% 0%

29%

16%

4%

0%

What is the type of lesion?What is the type of lesion?

1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer

1 2 3 4 5 6 7 8 9

0%

5% 4%1%

73%

5%

0%0%

12%

What is the type of lesion? What is the type of lesion? * Multiple correct answers* Multiple correct answers

1. Macule2. Papule3. Plaque4. Nodule5. Pustule6. Wheal (hive)7. Scales8. Crust9. Erosion/Ulcer

If you fail to If you fail to planplan,,you plan to you plan to failfail..

Skin Pathology Skin Pathology Part 1 - IntroductionPart 1 - Introduction

(SSS - MD3020)(SSS - MD3020)

Dr. Shashidhar Venkatesh MurthyAssociate Professor & Head of Pathology

Common Histopathological Terms:

Complex…!! but we will discuss common & important ones…

Hyperkeratosis• hyperplasia of the stratum corneum• Psoariasis, eczema.

PARAKERATOSIS• Keratinization pattern characterized by

retention of nuclei in the stratum corneum (this is normal on mucous membranes)

ACANTHOSIS• epidermal hyperplasia• Eczema, psoriasis

Acanthosis:•Psoriasiform (regular)

•Irregular

•Papillated

•Pseudoepitheliomatous

/pseudocarcinomatous

Acanthosis +hyperkeratosis:

Viral wart: Molluscum contagiosum

Papillomatosis• hyperplasia of the papillary dermis• Neoplastic-verrucous ca, venous stasis,

viral infections etc..

Dyskeratosis• Abnormal keratinization – carcinoma.

Acantholysis• loss of intercellular connections• Pemphigus

Spongiosis• Intercellular edema in the epidermis• Eczema, pempigus, seborrheic dermatitis.

““Fascination is one step beyond interest. Fascination is one step beyond interest. Interested people want to know Interested people want to know if it worksif it works. .

Fascinated people, Fascinated people, want to learn want to learn how it workshow it works””

-- Jim Rohn-- Jim Rohn

Incidence of Skin Diseases:

• Common: nevi/moles, acne, infections (Fungal, Bacterial, viral), urticaria, eczema (wet/dry), actinic keratoses, psoriasis, carcinoma (BCC, SCC, MM)

• Uncommon: pemphigoid, pemphigus, scabies* Leprosy*

• Rare: xeroderma pigmentosum, dermatitis artefacta, mycosis fungoides (cancer-lymphoma).

Classification: (Morphologic).

Epidermis:• Epithelium: Psoriasis, pemphigus, Neoplasms.• Pigment disorders: hyper, hypo,

• Dermis:• Blood vessels - urticaria, contact dermatitis.

• Dermal connective tissue - systemic sclerosis

• Panniculus / Sub cut tissue: erythema nodosum,

• Neoplasms – fibroma, lipoma, sarcoma ..etc.• Ultimately both Epidermis & Dermis involved *

Classification (Pathologic):• Congenital: nevi

• Acquired:• Traumatic: chemical, physical

• Infections: Bacterial, fungal, Viral, etc.

• Immune: Urticaria, Eczema.

• Neoplastic: Nevi…carcinoma

• Idiopathic diseases : Psoriasis

Skin injury - Pathogenesis

Normal Urticaria Wet Eczema Dry Eczyma

Normal Infl: Spongiosis Infl: Ulcer/Blist/Oozing Hyperkeratosis

Acute Chronic

Dermatopathology: MD3020 curriculum1. Acute Inflammations:

• Urticaria, • Acute Eczema, • Erythema Multiforme.

2. Chronic Inflammations:

• Psoriasis,

• Chronic Eczema, • Lichen planus.

3. Infections• Bacterial (Impetigo), • Fungal(tinea) &

• Viral(warts).

1. Blistering Diseases• Pemphigus, • Pemphigoid, • Dermatitis herpetiformis.

5. Neoplastic:

• Benign:

• Nevi, • Actinic Keratosis, • Seborrheic Keratosis.

• Malignant:• BCC, SCC, Melanoma.

Study Tips:• Preparation:

• Read Lecture notes, attend lecture*.• Read Robbins Pathology (Basic).• Study Images Gross & Microscopic.

• Make short notes for each condition,• Etiology, Pathogenesis• List 3* clinical features.• List 3* gross features.• List 3* microscopic features.

• Self Assessment:• Case studies. (http://www.dermnetnz.org) • Questions & Answers.

Psychodermatosis..?

“Identifying your Goal is like identifying the North Star--you fix your

compass on it and then use it as the means of getting back on track when

you tend to stray”--Marshall Dimock

What am I doing? Where am I going?Where I want to be in 5 years time?