Pathology of common skin disorders for undergraduate medical students.

1. “ Life’s battles don’t go always to the stronger or faster man, sooner or later, the man who wins is the man who thinks he can ” Aim for the Moon… even if you miss, you will land among Stars…..!

3. DERMATOPATHOLOGY Acute, Chronic, Infections, Blistering, Neoplastic Dr. Shashi dhar Venkatesh Murthy Associate Prof. & Head of Pathology

5. Normal Skin: (Thin)

6. Thick Skin: Prominent granular layer

10. Urticaria (Hives)

11. URTICARIA – Histopathology Perivascular inflammatory infiltrate: lymphocytes, neutrophils, eosinophils. * Note lack of spongiosis or other epidermal changes.

15. ECZEMA dry - (atopic)

19. ECZEMA (irritant)

20. ECZEMA (contact dermatitis)

22. ERYTHEMA MULTIFORME Target Lesions

26. "The gem cannot be polished without friction, nor man perfected without trials or problems (or exams) …!." --Chinese proverb

32. PSORIASIS – Arthritis.

33. Psoriasis: Histopathology Acanthosis, Parakeratosis, neutrophilic microabscesses.

34. PSORIASIS - histology Parakeratosis Diminished granular layer Regular elongation of the rete ridges Tortuous papillary dermal vessels neutrophil abscess in epidermis

36. Lichen Planus: Mucosal involvement

39. Impetigo: Epithelium Ulcer + Inflam

41. Acne: Hair fol. infection: Neutrophil Abscess Hair Follicle (infected) Hair Follicle (infected) Block  sebum  infection Harmonal, excess/drying/oily Comedo

42. Bacterial Skin Infections: Types

50. “ The worst thing in your life may contain seeds of the best. When you can see crisis as an opportunity, your life becomes not only easier, but more satisfying.” –Joe Kogel

54. Pemphigus vulgaris

56. Acanthocytes - Acantholysis:

57. PEMPHIGUS – Immunoflourescence Deposition of immunoglobulin and complement along keratinocyte membranes giving a “fish net” appearance

61. Intraepidermal bulla:

64. BULLOUS PEMPHIGOID 82 year old nursing home, dementia, gastrostomy tube, treated for urinary tract infection

65. BULLOUS PEMPHIGOID Hemorrhagic blisters annular arrangement  in bullous pemphigoid

66. BULLOUS PEMPHIGOID Antibody against bullous pemphigoid antigen in basement membrane causing subepidermal separation Type II hypersensitivity reaction.

67. BULLOUS PEMPHIGOID Eosinophils at the DE junction. Subepidermal bulla

68. BULLOUS PEMPHIGOID - histology Subepidermal blister Inflammation characterized by eosinophils Intact acanthocytic layer.

72. PEMPHIGUS PEMPHIGOID DH age mid - older elderly 30-40 antibody IgG IgG IgA location Suprabasilar Subepidermal subepidermal inflammation mixed eosinophils neutrophils Site of dysfunction Desmosomes Basement membrane and hemidesmosomes Anchoring fibrils Antibody against: Desmoglein Bullous pemphigoid antigen reticulin Immuno “ fish net” Linear basement membrane Dermal tip

73. "When you speak, speak the truth; perform when you promise; discharge your trust... Withhold your hands from striking, and from taking that which is unlawful and bad...“ - - APJ Abdul Kalam, President of India.

77. Nevi types & Pathology:

83. SEBORRHEIC KERATOSIS

84. SEBORRHEIC KERATOSIS

85. Seborrheic Keratosis:

87. Seborrheic Keratoses: Exophytic (outward) growth of Epidermal hyperplasia

90. ACTINIC KERATOSIS - histology Parakeratosis Atrophy Basilar atypia

91. ACTINIC KERATOSIS - histology Parakeratosis, atypical basal layer, solar elastosis Note: atypical cells “spare” hair follicle epithelium.

92. Actinic Keratosis – Horn / Ca.

93. "Thinking is progress. Non-thinking is stagnation of the individual, organisation and the country. Thinking leads to right action. Knowledge without action is useless and irrelevant. Knowledge with action, converts adversity into prosperity.” - - APJ Abdul Kalam, President of India.

95. SQUAMOUS CELL CARCINOMA

96. Epithelial (Keratin) pearl in SCC: Keratinized – ep. pearl Dysplastic ep. cells

101. BASAL CELL CARCINOMA

102. Basal Cell Carcinoma: Squamous cells (malignant) extending deep breaking through basement membrane Squamous eddies or “ep. pearls”

103. BASAL CELL CARCINOMA

104. BASAL CELL CARCINOMA Cords and islands of basaloid cells Hyperchromatic nuclei Peripheral palisading Clefting between tumor and stroma Mucinous stroma

106. Melanoma Clinical Features: note ABCD..

108. Melanoma :

109. Melanoma : ABCD.. Multiple Nevi one of them changing recently  Melanoma

114. Melanoma Staging: Clark’s levels

115. "If you always put limit on everything you do, physical or anything else it will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them." - Bruce Lee 1940-1973, Martial Artist and Actor

117. Psychodermatosis