Difference between revisions of "Non-malignant skin disease"

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Non-malignant skin disease (view source)

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An introduction to dermatopathology is in the ''[[dermatopathology]]'' article.  [[Nevi]] (moles) and other melanocytic lesions are dealt with in the article ''[[melanocytic lesions]]''.
An introduction to dermatopathology is in the ''[[dermatopathology]]'' article.  [[Nevi]] (moles) and other melanocytic lesions are dealt with in the article ''[[melanocytic lesions]]''.
=Inflammatory conditions=
==Classification==
*Bullous.
*Interface.
*Nodular & diffuse.
*Spongiotic.
*Vasculitis.
*Perivascular.
*Panniculitis.
*Psoriasiform.
'''Tabular comparison of inflammatory skin disease (adapted from ''Brinster''<ref name=pmid18418089>{{cite journal |author=Brinster NK |title=Dermatopathology for the surgical pathologist: a pattern based approach to the diagnosis of inflammatory skin disorders (part I) |journal=Adv Anat Pathol |volume=15 |issue=2 |pages=76–96 |year=2008 |month=March |pmid=18418089 |doi=10.1097/PAP.0b013e3181664e8d |url=}}</ref>):'''
{| class="wikitable"
| '''Pattern'''
| '''Key histologic feature'''
| '''Subclassifications'''
| '''Example'''
|-
| [[Bullous disease|Bullous]]
| "Empty space"
| -Subcorneal<br>-Suprabasillar<br>-Subepidermal
| -Pemphigus foliaceus<br>-[[Pemphigus vulgaris]]<br>-[[Dermatitis herpetiformis]]
|-
| Interface
| Inflammation at DE junction
| -Vacuolar (minimal)<br>-Lichenoid (band-like)
| -[[Erythema multiforme]], [[SLE]]<br>-[[Lichen planus]]
|-
| Nodular & diffuse
| Nodular & diffuse
| ?
|
|-
| Spongiotic
| Edema between keratinocytes
| -Acute<br>-Subacute<br>-Chronic
| -Poison Ivy<br>-Nummular dermatitis<br>-Atopic dermatitis
|-
| [[Vasculitis]]
| Inflammation of vessel wall
| ?
| ?
|-
| Perivascular
| Inflammation around vessels
| ?
| ?
|-
| [[Panniculitis]]
| Inflamm. of adipose tissue
| -Septal<br>-Nodular
| -[[Erythema nodosum]]<br>-[[Erythema induratum]]
|-
| Psoriasiform
| Epidermal thickening<br>and long rete ridges
| -Regular<br>-Irregular
| -Psoriasis<br>-[[Lichen simplex chronicus]]
|}
Notes:
*''DE junction'' = dermal-epidermal junction.
*The "empty space" in bullous disease ''in situ'' is filled with fluid.
===Psoriasis===
====General====
*Can be subclassified.
DDx:
*Psoriasis vulgaris (most common).
*Psoriatic arthritis.
*Drug-induced.
*Others.
====Microscopic====
Features:<ref>{{Ref PBoD8|1191}}</ref><ref name=pmid18418089>{{cite journal |author=Brinster NK |title=Dermatopathology for the surgical pathologist: a pattern based approach to the diagnosis of inflammatory skin disorders (part I) |journal=Adv Anat Pathol |volume=15 |issue=2 |pages=76–96 |year=2008 |month=March |pmid=18418089 |doi=10.1097/PAP.0b013e3181664e8d |url=}}</ref>
*Regular epidermal thickening - as very long rete ridges (described as "test tube-morphology") - '''key feature'''.
**Epidermis between rete ridges thin ("thinning of suprapapillary plate").
*Parakeratosis.
*Thin/absent granular layer.
*Dilated blood vessels in superficial dermis.
*Neutrophil clusters (Munro microabscess).
==Seborrheic dermatitis==
===General===
*Very common.
===Microscopic===
Features:<ref>{{Ref PBoD8|1191}}</ref>
*Spongiosis (epidermal edema).
*Acanthosis (epidermal thickening).
*"Follicular lipping" = parakeratosis with neutrophils.
*Perivascular neutrophils and lymphocytes.
==Systemic lupus erythematosus==
===General===
*Systemic disease with multi-organ manifestations.
===Microscopic===
Features:
*Lymphocytic interface dermatitis.<ref>JAH. 20 February 2009.</ref>
*Basal layer vacuolation.<ref name=pmid18384217>{{cite journal |author=Crowson AN, Magro CM, Mihm MC |title=Interface dermatitis |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=4 |pages=652–66 |year=2008 |month=April |pmid=18384217 |doi= |url=http://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282008%29132%5B652%3AID%5D2.0.CO%3B2}}</ref>
*Intradermal mucin.
==Dermatomyositis==
:''For the muscle manifestations see: [[Neuromuscular_pathology#Dermatomyositis]]''.
===General===
*Complement mediated disease - membrane attack complex.
*Usually middle age.
*Associated skin rash is common.
**May precede or follow muscle pathology.
*Associated with malignancy in approximately 10% of cases.<ref name=pmid20398365>{{cite journal |author=Chen YJ, Wu CY, Huang YL, Wang CB, Shen JL, Chang YT |title=Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan |journal=Arthritis Res. Ther. |volume=12 |issue=2 |pages=R70 |year=2010 |pmid=20398365 |pmc=2888225 |doi=10.1186/ar2987 |url=}}</ref>
===Gross===
*Have lesions on the knuckles - ''Gottron's papules''.
===Microsopic===
Features:
*Lymphocytic interface dermatitis (inflammation at the dermal-epidermal junction).
*Loss of rete ridges.
==Lichen planus==
===General===
*An oral pathology.
*May be seen where the sun don't shine - [[penis]],<ref name=pmid20082512>{{Cite journal  | last1 = Teichman | first1 = JM. | last2 = Sea | first2 = J. | last3 = Thompson | first3 = IM. | last4 = Elston | first4 = DM. | title = Noninfectious penile lesions. | journal = Am Fam Physician | volume = 81 | issue = 2 | pages = 167-74 | month = Jan | year = 2010 | doi =  | PMID = 20082512 }}</ref> [[vulva]] and [[vagina]].<ref name=pmid20062629>{{Cite journal  | last1 = Gupta | first1 = R. | last2 = Bansal | first2 = B. | last3 = Singh | first3 = S. | last4 = Yadav | first4 = I. | last5 = Gupta | first5 = K. | last6 = Kudesia | first6 = M. | title = Lichen planus of uterine cervix - the first report of a novel site of occurrence: a case report. | journal = Cases J | volume = 2 | issue =  | pages = 9306 | month =  | year = 2009 | doi = 10.1186/1757-1626-2-9306 | PMID = 20062629 }}</ref>
Etiology:
*Autoimmune disease, T-cell–mediated.<ref>URL: [http://emedicine.medscape.com/article/1078327-overview http://emedicine.medscape.com/article/1078327-overview]. Accessed on: 11 September 2010.</ref>
Clinical:<ref name=Ref_PBoD8_1191>{{Ref PBoD8|1191}}</ref>
*6 Ps: pruritic (itchy), purple, polygonal, planar papules and plaques.
===Gross===
*Wickham striae = white lines/dots.
**Due to hypergranulosis.
===Microscopic===
Features:<ref>URL: [http://emedicine.medscape.com/article/1078327-overview http://emedicine.medscape.com/article/1078327-overview]. Accessed on: 11 September 2010.</ref><ref name=Ref_PBoD8_1192>{{Ref PBoD8|1192}}</ref>
*Loss of basal cells (stratum basale) -- '''key feature'''.
*Loss of rete ridges/formation of pointed rete ridges "sawtoothing".
*Interface dermatitis (lymphocytes at dermal-epidermal junction).
*Hypergranulosis; stratum granulosum thickened (grossly seen as "Wickham stria" = white lines).
*Hyperkeratosis; stratum corneum thickened.
*Necrotic basal cell in dermis = colloid bodies = Civatte bodies.<ref name=Ref_PCPBoD8_604>{{Ref PCPBoD8|604}}</ref>
DDx:
*[[Bullous disease]], subepithelial vesicular.
*[[Lichenoid keratosis]] - parakeratosis prominent.
Notes:
*Hyperkeratosis and hypergranulosis are not seen in [[erythema multiforme]].
*Colloid bodies = cytoid bodies = Civatte bodies = hyaline bodies = apoptotic bodies.<ref>URL: [http://www.careforumwales.org/cell-carcinoma/histopathologic-terminology.html http://www.careforumwales.org/cell-carcinoma/histopathologic-terminology.html]. Accessed on: 28 August 2011.</ref>
**DDx: systemic lupus erythematosus, lichen planus, and [[graft-versus-host disease]].
Images:
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_intermed_mag.jpg Lichen planus - intermed. mag. (WC)]
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_low_mag.jpg Lichen planus - low mag. (WC)].
==Lichen sclerosus==
{{Main|Lichen sclerosus}}
===Microscopic===
Features:<ref name=Ref_PBoD1065-6>{{Ref PBoD|1065-6}}</ref>
*Subepithelial fibrosis - '''key feature'''.
==Psoriasis==
===General===
*Chronic skin condition +/- systemic involvement:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref>
**[[Arthritis]].
**[[Myopathy]].
**Enteropathy, e.g. [[inflammatory bowel disease]].
**Syondylitic joint disease (spondylos = vertebrae<ref>URL: [http://medical-dictionary.thefreedictionary.com/spondylosis http://medical-dictionary.thefreedictionary.com/spondylosis]. Accessed on: 28 August 2011.</ref>).
Clinical:
*''Auspitz sign'' = pin-point bleeding on removal of scale.
*''Koebner phenomenon'' = lesions form at site of trauma.
===Microscopic===
Features:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref>
*Acanthosis + long rete ridges - '''key feature'''.
*Parakeratosis.
*Dilated vessels in superficial dermis (give rise to ''Auspitz sign'').
*Spongiform pustules = PMNs in stratum spinosum.
*PMNs in parakeratotic stratum corneum (Munro microabscess).


=Other=
=Other=
Michael
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