Skin Pathologies

7/25/2019 Skin Pathologies

1/130

Skin

Jeffrey Sosnowski M.D., Ph.D.


2/130

Learning Objectives

Understanding of brn ty!es

"now#edge of skin #esion ter$ino#ogy

Discss #esions of e!ithe#i$, $e#anocyte

and der$is within conte%t of #esion

ter$ino#ogy and !atho#ogy

Understanding of reactive and hy!ertro!hic

skin #esions

"now#edge of b#istering and infectios #esions


3/130

Skin &isto#ogy


4/130


5/130


6/130


7/130


8/130


9/130


10/130


11/130

'taneos (rns

)st* degree, congestion, !ain, vasodi#ation,

ede$a bt no necrosis

+nd * degree, necrosis of e!ider$is bt s!ares

der$is

(#isters se!arating e!ider$is fro$ der$is

Partia# thickness brn

-rd* degree, carbonied e!ider$is andder$is with #ost of tisse strctre

/## thickness brn


12/130

&ea#ing of 'taneos (rns

)st degree brns have #itt#e ce###ar da$age and

re0ires basa# ce##s to re!#ace da$ages e!ithe#ia#

ce##s, withot scar for$ation

+nd

degree brns a#so hea# withot a scar becasebasa# ce##s of the e!ider$is are s!ared and

regenerate the e!ider$is

-rd degree brns with s!ared skin a!!endages can

resrface the da$aged skin. Der$a# tisse re!#acesda$ages skin with dense scar

Skin grafts can redce the density of scar

/#id #oss and infection are $ajor !rob#$es


13/130

Lesion 1er$ino#ogy


14/130

/#at Lesions

Mac#e

Less than 2 $$,

different co#or than

srronding skin Patch

3reater than 2 $$


15/130

4aised Lesions

Pa!#e

#ess than 2 $$,

discrete so#id e#evated

#esion P#a0e

3reater than 2$$


16/130

/#id*/i##ed Lesions

5esic#e

Less than 2 $$, f#id

$ay be c#ear, seros,

he$orrhagic or!r#ent

(##a

3reater than 2 $$

Pst#e Usa##y #ess than 2

$$, fi##ed with !s


17/130

Sca#e and 'rst

Sca#e 6%cess strat$ corne$,

sa##y white or gray co#or

'rst

7 hardened #ayer ofser$, b#ood or !r#ent

e%date on the srface of

skin

6schar

7dherent thick, dry b#ack

crst


18/130

Pr!ra8skin he$orrhage9

Petechiae )*+ $$, nonb#anchab#e

$ac#es res#ting fro$

tiny he$orrhages

6cchy$osis 'o##ection of b#ood into

skin or $cos

$e$brane for$ing

$ac#es and !atches Pa#!ab#e !r!ra

P#a0es of ecchy$oses


19/130

Skin Loss

U#cer

Loss of e!ider$is and

at #east the !!er

der$is 6rosion

Loss of e!ider$a# or

$cosa# e!ithe#i$


20/130

6P:1&6L:7L 1UMO4S O/6P:1&6L:7L 1UMO4S O/

S":;S":;


21/130

Seborrheic "eratosisSeborrheic "eratosis

7rise s!ontaneos#y in7rise s!ontaneos#y in

ad#tsad#ts

4ond, f#at,4ond, f#at,


22/130

/ibroe!ithe#ia# Po#y!/ibroe!ithe#ia# Po#y!

7"7 skin tag, acrochordon,7"7 skin tag, acrochordon,

s0a$os !a!i##o$as0a$os !a!i##o$a

(ag*#ike, f#esh*co#ored !rotrsions(ag*#ike, f#esh*co#ored !rotrsions

/ibrovasc#ar core covered by/ibrovasc#ar core covered by

benign s0a$os e!ithe#i$benign s0a$os e!ithe#i$

7%i##a, neck, trnk, face,7%i##a, neck, trnk, face,

intertriginos areasintertriginos areas 7>? diabetes and intestina#7>? diabetes and intestina#

!o#y!osis!o#y!osis


23/130

7canthosis ;igricans7canthosis ;igricans

1hickened hy!er!ig$ented skin in f#e%ra#1hickened hy!er!ig$ented skin in f#e%ra#

areasareas 7canthosis of e!ider$is, increased $e#anin !ig$ent7canthosis of e!ider$is, increased $e#anin !ig$ent

(enign ty!e @AB, deve#o!s grada##y in(enign ty!e @AB, deve#o!s grada##y inchi#dhood or !bertychi#dhood or !berty

7ssociated with7ssociated with diabetes, obesitydiabetes, obesity, endocrine, endocrine

t$ors, !o#ycystic ovary syndro$est$ors, !o#ycystic ovary syndro$es Ma#ignant ty!e ad#ts, sdden onset,Ma#ignant ty!e ad#ts, sdden onset,

associated with 3: carcino$aassociated with 3: carcino$a


24/130

7canthosis ;igricans7canthosis ;igricans


25/130

7ctinic "eratosis7ctinic "eratosis

Dys!#asia of the s0a$os e!ithe#i$Dys!#asia of the s0a$os e!ithe#i$

secondary to sn e%!osresecondary to sn e%!osre

:oniing radiation:oniing radiation, hydrocarbons, arsenica#s, hydrocarbons, arsenica#s Precrsor of s0a$os ce## carcino$aPrecrsor of s0a$os ce## carcino$a

1an, red or skin co#oredC rogh sand!a!er*1an, red or skin co#oredC rogh sand!a!er*

#ike consistencyC ctaneos horn, )c$#ike consistencyC ctaneos horn, )c$ "eratinocytic aty!ia, hy!erkeratosis,"eratinocytic aty!ia, hy!erkeratosis,

!arakeratosis, and der$a# e#astosis!arakeratosis, and der$a# e#astosis


26/130

ActinicKeratosis


27/130

S0a$os 'e## 'arcino$aS0a$os 'e## 'arcino$a

Second $ost co$$on t$or arising onSecond $ost co$$on t$or arising on

sn*e%!osed sites in o#der !eo!#esn*e%!osed sites in o#der !eo!#e

U5 #ightU5 #ight, o#d scars, chronic #cers, fair skin, o#d scars, chronic #cers, fair skin

:$$nos!!ression, %eroder$a:$$nos!!ression, %eroder$a

!ig$entos$!ig$entos$

Ma#es E fe$a#esMa#es E fe$a#es Potentia# for $etastases 82B9Potentia# for $etastases 82B9


28/130

Squamous CellCarcinoma

S ' ## ' iS ' ## ' i


29/130

S0a$os 'e## 'arcino$aS0a$os 'e## 'arcino$ainvasive nests of ce##s showing keratiniation g#assy !inkinvasive nests of ce##s showing keratiniation g#assy !ink

cyto!#as$ 8s$a## arrow9, s0a$os !ear#s of e%trace###arcyto!#as$ 8s$a## arrow9, s0a$os !ear#s of e%trace###ar

keratin 8#arge arrow9keratin 8#arge arrow9


30/130

(asa# ce## carcino$a(asa# ce## carcino$a

Most co$$on invasive cancerMost co$$on invasive cancer,, EFAA,AAA !er year.EFAA,AAA !er year.

Most co$$on t$or on sn*e%!osed skinMost co$$on t$or on sn*e%!osed skin U5 #ight, fair skin, i$$nos!!ression, GPU5 #ight, fair skin, i$$nos!!ression, GP

Pear#y !a!#es, !ig$entation, #cerationPear#y !a!#es, !ig$entation, #ceration

Loca##y invasive Loca##y invasive


31/130

Basal CellCarcinoma


32/130

(asa# ce## carcino$a(asa# ce## carcino$a 'e##s rese$b#e nor$a# basa# e!ithe#ia# ce##s'e##s rese$b#e nor$a# basa# e!ithe#ia# ce##s

;od#es, is#ands or cords e%tend downward fro$;od#es, is#ands or cords e%tend downward fro$

e!ider$is or otward fro$ fo##ic#ar e!ithe#i$e!ider$is or otward fro$ fo##ic#ar e!ithe#i$

Peri!hera# !a#isading, c#efts, $cinos or fibrosPeri!hera# !a#isading, c#efts, $cinos or fibros

$atri%$atri%


33/130

Skin 'arcino$a PathogenesisSkin 'arcino$a Pathogenesis

6niviron$enta# carcinogens *6niviron$enta# carcinogens *

U5 #ightU5 #ight

D;7 da$age 8P1'&, !2-9D;7 da$age 8P1'&, !2-9 direct i$$nos!!ressive effects 8Langerhans ce##s9direct i$$nos!!ressive effects 8Langerhans ce##s9

5ira# transfor$ation5ira# transfor$ation

&P5 se0ences detected in !recrsors&P5 se0ences detected in !recrsors

'he$ica# Mtagens'he$ica# Mtagens


34/130

7dne%a# 1$ors


35/130

7dne%a# 1$ors7dne%a# 1$ors

1$ors arising fro$ skin a!!endages1$ors arising fro$ skin a!!endages &air fo##ic#e origin&air fo##ic#e origin trichoe!ithe#io$a, trichi#e$$o$a, trichoe!ithe#io$a, trichi#e$$o$a,

trichofo##ic#o$atrichofo##ic#o$a 6ccrine g#and origin6ccrine g#and origin eccrine !oro$a, chondroid eccrine !oro$a, chondroid

syringo$asyringo$a 7!ocrine g#and origin7!ocrine g#and origin * cy#indro$a* cy#indro$a Sebaceos g#and originSebaceos g#and origin sebaceos adeno$a, sebaceos adeno$a,

carcino$acarcino$a

Usa##y benign, bt $a#ignant for$s e%istUsa##y benign, bt $a#ignant for$s e%ist '#inica##y $ay be confsed with basa# ce##'#inica##y $ay be confsed with basa# ce##

carcino$acarcino$a /#esh co#ored !a!#e or nod#e/#esh co#ored !a!#e or nod#e


36/130

'y#indro$a'y#indro$a

'o$$on on forehead'o$$on on forehead

and sca#!and sca#!

Often $#ti!#eOften $#ti!#e

:s#ands of basa#oid:s#ands of basa#oidce##s 8!#e !ieces9ce##s 8!#e !ieces9

/ibros $atri%/ibros $atri%


37/130

Me#anocyte Lesions


38/130

D:SO4D64S O/ P:3M6;171:O;

VitiligoH $e#anocyte #oss

AlbinismH tyrosinase eny$e defect Freckle8e!he#is9H increased $e#anin

!rodction

MelasmaH increased $e#anin 6!ider$a# ty!e

Der$a# ty!e


39/130

5:1:L:3O

Loss of $e#anocytes withine!ider$is, res#ting in areasof hy!o!ig$entation

7## ages and races

7sy$!to$atic, f#at

May occr at sites ofre!eated tra$a

I7toi$$ne $echanis$

;O1 a#binis$ 8tyrosinasedeficiency9


40/130

L6;1:3O

Ova# tan brown

$ac#es, that do not

darken when e%!osed

to sn 8dd% freck#e9 )A$$

:nvo#ve $cos

$e$branes and skin

Linear $e#anocytic

hy!er!#asia,

non*nested, basa#,

8#entiginos9


41/130

;evi


42/130

Jnctiona# ;evinests of $e#anocytes at D6 jct


43/130

(enign ;evi

Jnctiona#, co$!ond,

der$a#


44/130

M7L:3;7;1 M6L7;OM7

;eo!#as$ derived fro$ $e#anocytes 8or

!ossib#y fro$ nevs ce##s9

Most ra!id#y increasing cancer

:ncidence has dob#ed over #ast -A years

th$ost co$$on cancer 8)stin yong

fe$a#es9


45/130

Me#ano$a 4isk /actors

/air skin

M#ti!#e benign nevi 8E2A9

Dys!#astic nevi Persona# or fa$i#y history of $e#ano$a

U5 radiation, severe b#istering snbrns

and chronic tanning :$$nodeficiency


46/130

4isk factors for Me#ano$a

/air skin, $#ti!#e nevi, severesnbrns


47/130


48/130

Malignant Melanoma

:rreg#ar sha!e and co#or,#arge, intense#y b#ack, nod#ar

and f#at

M #


49/130

Me#ano$ansa# sites


50/130

?arning signs of $e#ano$a

7sy$$etry

(order irreg#arity

'o#or variation

Dia$eter E)A $$

6#evation or for$ation of anod#e

Any change in a nevus


51/130

3rowth !atterns of $e#ano$a

4adia# growth !hase 8non*t$origenic9 &orionta# growth within e!ider$is and

s!erficia# der$isH no ca!acity to $etastasie

Lentigo $a#igna $e#ano$a sn da$aged facia#skin

S!erficia# s!reading $e#ano$a

7cra# #entiginos $e#ano$a

5ertica# growth !hase 8t$origenic9H 3rowth into dee!er der$isH ca!acity to

$etastasie

;od#e for$ation, e%!ansi#e $ass

Di f t i i


52/130

Diagra$ of t$or !rogression in

$e#ano$a


53/130

(etter Prognosis in Me#ano$a ifK

De!th ). $$

Low $itotic>!ro#iferative rate

Lack of #ceration

(risk #y$!hocytic inf#a$$ation

7bsence of regression

/e$a#e gender

Location on e%tre$ity

Lack of $etastasis

Mo#ec#ar 3enetics of Skin 'arcino$aMo#ec#ar 3enetics of Skin 'arcino$a


54/130

Mo#ec#ar 3enetics of Skin 'arcino$aMo#ec#ar 3enetics of Skin 'arcino$a83or#in Syndro$e983or#in Syndro$e9

;evoid basa# ce## carcino$a;evoid basa# ce## carcino$asyndro$esyndro$e

M#ti!#e ('' at yong age M#ti!#e ('' at yong age

n$eros syste$icn$eros syste$ic

abnor$a#itiesabnor$a#ities

7toso$a# do$inant, chN0++7toso$a# do$inant, chN0++

Defect of P1'& gene withDefect of P1'& gene with

$tations characteristic for$tations characteristic forU5 da$ageU5 da$age

Si$i#ar P1'& gene $tationsSi$i#ar P1'& gene $tations

in s!oradic (''in s!oradic (''

D # # i


55/130

Der$a# #esions


56/130


57/130

Li


58/130

Li!o$a


59/130

Skin #eio$yo$a


60/130

"e#oid


61/130

Skin 5asc#ar Lesions


62/130

&e$angio$as

(enign, $ore co$$on in fe$a#es 82H)9 7!!ear at birth and sa##y invo#te by

fibrosis with ti$e 8NAB of cases by N yrs of

age9


63/130

Port ?ine Stains


64/130

Port ?ine Stains

/#at often #arge he$angio$as, !resent at

birth and grow in sie as the chi#d grows.

'o$$on on the face


65/130

Strge*?eber Syndro$e

2B of !atients with P?S that invo#ve the

!!er eye#id or forehead

P?S with distribtion of the trige$ina#

nerve and inc#des vasc#ar $a#for$ation

in the ';S


66/130


67/130

"a!osi Sarco$a

;eo!#astic ce##s that #ine #y$!h or b#ood vesse#s Lesions are !r!#e, red to brown, vio#aceos

!#a0es Most co$$on#y fond on #egs and face bt co#d

a#so be $cosa# 1y!es

7:DS*re#ated '#assic 8Mediterranean9

6nde$ic 87frican9 1rans!#ant*re#ated

'ased by "a!osis sarco$a*associatedher!esvirs or &&5*@


68/130


69/130

Skin +

Jeffrey Sosnowski M.D., Ph.D.

;erofibro$atosis :


70/130

;erofibro$atosis :

;erofibro$as are the$ost co$$on t$ors

Usa##y deve#o!

arond !berty

or $ore caf*a*#ait

s!ots, !ig$ented

$ac#es

Lisch nod#es on theiris


71/130

:nfections


72/130


73/130

&er!es Si$!#e% 5irs : and ::

:, ora# her!es

:: genita# her!es

S!read throgh

kissing, sharingtoothbrshes, eating

tensi#s and se%a#

contact


74/130


75/130

:nfection>:nfestation:nfection>:nfestation

Mo##sc$ contagios$Mo##sc$ contagios$

!o%virs!o%virs

contagios, bt se#f*#i$itedcontagios, bt se#f*#i$ited

s!read by direct contacts!read by direct contact

$bi#icated !a!#es seen es!ecia##y on$bi#icated !a!#es seen es!ecia##y on

trnk and anogenita# regiontrnk and anogenita# region


76/130


77/130


78/130

1richoti##o$ania

7 disorder thatinvo#ves recrrent

rges to !## ot hair

fro$ yor sca#!


79/130

(ed (gs 8Mites9

Parasitic insects thatfeed on b#ood


80/130

Disorders of 6!ider$a#Matration

: hth i


81/130

:chthyosis


82/130

7cte :nf#a$$atory7cte :nf#a$$atory

Der$atosesDer$atoses

U i iU ti i


83/130

UrticariaUrticaria

7#so known as7#so known as


84/130


85/130


86/130

U ti i th iU ti i th i


87/130

Urticaria, !athogenesisUrticaria, !athogenesis

7ntigen*indced re#ease of vasoactive $ediators7ntigen*indced re#ease of vasoactive $ediatorsfro$ $ast ce## gran#es throgh sensitiationfro$ $ast ce## gran#es throgh sensitiation

fro$ s!ecific :g6 antibodiesfro$ s!ecific :g6 antibodies

/o##ows e%!osre to antigens sch asH !o##ens,/o##ows e%!osre to antigens sch asH !o##ens,foods, insects, drgsfoods, insects, drgs

'an a#so be :g6*inde!endent as in reactions to'an a#so be :g6*inde!endent as in reactions to

o!iates, crare, radiogra!hic contrast $edia,o!iates, crare, radiogra!hic contrast $edia,

and antibioticsand antibiotics 1hese sbstances direct#y case $ast ce##1hese sbstances direct#y case $ast ce##

degran#ationdegran#ation


88/130

/igre +2*++ Urticaria. '#inica##y, there are erythe$atos, ede$atos, often circ#ar !#a0es covered by a nor$a# e!ider$a# srface.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 5 December 2007 09:0 P!"

# 2007 $lse%ier


89/130


90/130

7 t 6 t D titi7 t 6 t D titi


91/130

7cte 6ce$atos Der$atitis7cte 6ce$atos Der$atitis

&isto#ogyH&isto#ogyH 'haracteried by s!ongiosis 8synony$ is'haracteried by s!ongiosis 8synony$ is

s!ongiotic der$atitis9s!ongiotic der$atitis9

'ases interce###ar bridges to a!!ear'ases interce###ar bridges to a!!ear!ro$inent!ro$inent

May res#t in shearing of interce###arMay res#t in shearing of interce###ar

attach$ent sites and the for$ation ofattach$ent sites and the for$ation of

intrae!ider$a# vesic#esintrae!ider$a# vesic#es


92/130


93/130


94/130

/igre +2*+2 6ce$atos der$atitis. 7, :n an acte a##ergic contact der$atitis, n$eros vesic#es a!!ear at the site of antigen e%!osre 8in this case, #andry detergent

that !ersisted in c#othing9. (, &isto#ogica##y, interce###ar ede$a !rodces widened interce###ar s!aces within the e!ider$is, eventa##y res#ting in s$a##, f#id*fi##ed

intrae!ider$a# vesic#es.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 5 December 2007 09:0 P!"

# 2007 $lse%ier

I


95/130

I


96/130

'hronic :nf#a$$atory'hronic :nf#a$$atoryDer$atosesDer$atoses


97/130

PsoriasisPsoriasis


98/130

PsoriasisPsoriasis

'o$$on'o$$on

7## ages7## ages

7rthritis, $yo!athy, entero!athy,7rthritis, $yo!athy, entero!athy,s!ondy#itic joint disease, or 7:DSs!ondy#itic joint disease, or 7:DS

Skin of e%tensor srfaces, sca#!,Skin of e%tensor srfaces, sca#!,

interg#tea# c#eft, and g#ans !enisinterg#tea# c#eft, and g#ans !enis

Psoriasis grossPsoriasis gross


99/130

Psoriasis, grossPsoriasis, gross

?e##*de$arcated,?e##*de$arcated,


100/130


101/130


102/130

Psoriasis histo#ogyPsoriasis histo#ogy


103/130

Psoriasis, histo#ogyPsoriasis, histo#ogy


104/130


105/130

L!s erythe$atossL!s erythe$atoss


106/130

L!s erythe$atossL!s erythe$atoss

7cte, sbacte, and chronic7cte, sbacte, and chronic

7cteH $a#ar erythe$aC NNB wi## have SL67cteH $a#ar erythe$aC NNB wi## have SL6

SbacteH s$a##, genera#ied,SbacteH s$a##, genera#ied,erythe$atos, so$eti$es sca#y #esionsCerythe$atos, so$eti$es sca#y #esionsC

2AB wi## have SL62AB wi## have SL6

'hronicH Loca#ied ctaneos for$ with no'hronicH Loca#ied ctaneos for$ with noassociated syste$ic $anifestations,associated syste$ic $anifestations,

discoid #!s erythe$atoss 8DL69discoid #!s erythe$atoss 8DL69


107/130


108/130


109/130

(#istering 8(##os9 Diseases(#istering 8(##os9 Diseases


110/130

Pe$!higsPe$!higs


111/130

Pe$!higsPe$!higs

4are, atoi$$ne disease, M/, age -A*4are, atoi$$ne disease, M/, age -A*2A2A

Loss of integrity of the nor$a# interce###arLoss of integrity of the nor$a# interce###ar

attach$ents within the e!ider$is andattach$ents within the e!ider$is and$cosa# e!ithe#i$$cosa# e!ithe#i$

/or variantsH/or variantsH Pe$!higs v#garisPe$!higs v#garis

Pe$!higs vegetansPe$!higs vegetans

Pe$!higs fo#iacesPe$!higs fo#iaces

Pe$!higs erythe$atossPe$!higs erythe$atoss

Pe$!higs v#garisPe$!higs v#garis


112/130

Pe$!higs v#garisPe$!higs v#garis

@AB of !e$!higs cases wor#dwide@AB of !e$!higs cases wor#dwide Mcosa and skinC often !resents with #cers inMcosa and skinC often !resents with #cers in

the $oththe $oth

S!erficia# vesic#es and b##ae that r!treS!erficia# vesic#es and b##ae that r!treeasi#yeasi#yC can invo#ve the who#e bodyC can invo#ve the who#e body

7cantho#ysis se#ective#y invo#ves the #ayer of7cantho#ysis se#ective#y invo#ves the #ayer ofce##s above the basa# ce## #ayer 8s!rabasa#ce##s above the basa# ce## #ayer 8s!rabasa#

acantho#ytic b#ister9acantho#ytic b#ister9

Unifor$#y fata# if ntreatedUnifor$#y fata# if ntreated

Pe$!higs $or!ho#ogyPe$!higs $or!ho#ogy


113/130

Pe$!higs, $or!ho#ogyPe$!higs, $or!ho#ogy

7## for$s e%hibit acantho#ysis7## for$s e%hibit acantho#ysis 6!ithe#ia# ce##s #ose attach$ents and6!ithe#ia# ce##s #ose attach$ents and

beco$e rondedbeco$e ronded

1he sing#e #ayer of basa# ce##s at the b#ister1he sing#e #ayer of basa# ce##s at the b#isterbase rese$b#es a row of to$bstonesbase rese$b#es a row of to$bstones

:n a## for$s, there is a s!erficia# der$a#:n a## for$s, there is a s!erficia# der$a#

infi#trate of #y$!hocytes, histiocytes, andinfi#trate of #y$!hocytes, histiocytes, andeosino!hi#seosino!hi#s


114/130


115/130

Pemphigus vulgaris


116/130

Pe$!higs !athogenesisPe$!higs !athogenesis


117/130

Pe$!higs, !athogenesisPe$!higs, !athogenesis

Sera contain :g3 to interce###ar ce$entSera contain :g3 to interce###ar ce$entsbstance of skin and $cossbstance of skin and $cos

$e$branes$e$branes

D:/H net*#ike !attern of interce###ar :g3D:/H net*#ike !attern of interce###ar :g3de!osits to sites of acantho#ysisde!osits to sites of acantho#ysis

5#garisH antibody to des$og#ein -5#garisH antibody to des$og#ein -

(##os !e$!higoid(##os !e$!higoid


118/130


Distinct fro$ !e$!higsDistinct fro$ !e$!higs

'o$$on, atoi$$ne'o$$on, atoi$$ne

3enera##y affects e#der#y3enera##y affects e#der#y

Many c#inica# !resentationsMany c#inica# !resentations

Less co$$on $cosa# invo#ve$ent thanLess co$$on $cosa# invo#ve$ent than

!e$!higs 8)A*)2B9!e$!higs 8)A*)2B9



119/130


1ense b##ae with c#ear f#id on nor$a# or1ense b##ae with c#ear f#id on nor$a# orerythe$atos skinerythe$atos skin

Do not r!tre as easi#y as the b#isters inDo not r!tre as easi#y as the b#isters in

!e$!higs!e$!higs &ea# withot scarring, n#ess infected&ea# withot scarring, n#ess infected

:nner thigh, f#e%or srfaces of forear$s,:nner thigh, f#e%or srfaces of forear$s,

a%i##a, groin, and #ower abdo$ena%i##a, groin, and #ower abdo$en

(##os !e$!higoid !athogenesis(##os !e$!higoid, !athogenesis


120/130

(##os !e$!higoid, !athogenesis(##os !e$!higoid, !athogenesis

7ntibodies directed to !roteins at the7ntibodies directed to!roteins at theder$o*e!ider$a# jnctionder$o*e!ider$a# jnction

8he$ides$oso$e98he$ides$oso$e9

LinearLinearone de!osition of :g andone de!osition of :g andco$!#e$ent 8L!sgran#ar9co$!#e$ent 8L!sgran#ar9

(#ister deve#o!s within the #a$ina #cida(#ister deve#o!s within the #a$ina #cida


121/130


122/130


123/130

Der$atitis her!etifor$isDer$atitis her!etifor$is


124/130

Der$atitis her!etifor$isDer$atitis her!etifor$is

4areC M E /C age +A*-A4areC M E /C age +A*-A Pa!#es, vesic#es, and occasiona# b##aePa!#es, vesic#es, and occasiona# b##ae

on an erythe$atos, rticaria# baseon an erythe$atos, rticaria# base

Major association with ce#iac diseaseMajor association with ce#iac disease 4es!onds to g#ten free diet4es!onds to g#ten free diet

6%tre$e#y !rritic6%tre$e#y !rritic

(i#atera# and sy$$etrica#C e%tensor(i#atera# and sy$$etrica#C e%tensorsrfaces, !!er back, and bttockssrfaces, !!er back, and bttocks

Der$atitis her!etifor$is, histoDer$atitis her!etifor$is, histo


125/130

Der$atitis her!etifor$is, histoDer$atitis her!etifor$is, histo

Microabscesses at the ti!s of der$a#Microabscesses at the ti!s of der$a#

!a!i##ae!a!i##ae

Microsco!ic b#ister for$ation beneath theMicrosco!ic b#ister for$ation beneath thebasa# ce##s over#ying thesebasa# ce##s over#ying these

$icroabscesses 8sbe!ider$a# b#isters9$icroabscesses 8sbe!ider$a# b#isters9

6osino!hi#s cases confsion with b##os6osino!hi#s cases confsion with b##os!e$!higoid 8#ook at b#ister edge9!e$!higoid 8#ook at b#ister edge9


126/130


127/130


128/130


129/130


130/130

Skin Pathologies

Documents

Transcript of Skin Pathologies