Skin pathology

Dr. Saira Jahan

Lecturer
 SKIN ANATOMY AND PHYSIOLOGY
SKIN:LARGEST EXTERNAL ORGAN
EPIDERMIS
DERMIS
DERMAL-EPIDERMAL JUNCTION
HYPODERMIS (LOOSE CONNECTIVE TISSUE)
 EPIDERMIS
• Thin, avascular layer that regenerates itself every 4 to 6 weeks
• Divided into 5 layers or strata
• Stratum corneum—consists of dead keratinocyte cells; flakes and
sheds; is easily removed during bathing activities and more
efficiently by scrubbing the surface of the skin.
• Stratum granulosum—also contains Langerhans cells in addition to
keratinocytes
• Stratum spinosum—contains keratinocytes and Langerhans cells.
• • Stratum basale or germinativum—single layer of epidermal cells
(keratinocytes); contains melanocytes; can regenerate.
• the stratum lucidum, lies between the stratum corneum and the
stratum granulosum. This packed translucent line of cells is found
only on the palms and soles and is not seen in thin skin.
 DERMIS
Matrix that serves to support the epidermis
papillary dermis
reticular dermis
• The papillary dermis is composed of collagen and reticular fibers.
• fingerprint identification
• It contains capillaries for skin nourishment
• pain touch receptors (pacinian corpuscles and Meissner’s
corpuscles)
• The reticular dermis is composed of collagen bundles that anchor
the skin to the subcutaneous tissue.
• Sweat glands, hair follicles, nerves, and blood vessels can be found
in this layer.
 Cont..
• The main function of the dermis is to
• provide tensile strength, support, moisture
retention, and blood and oxygen to the skin
protects the underlying muscles, bones, and
organs.
• Sebaceous glands that secrete sebum-
lubricates skin
 HYPODERMIS
• The subcutaneous tissue, or hypodermis,
attaches the dermis to underlying structures.
• function is to promote an ongoing blood
supply to the dermis for regeneration. It’s
primarily composed of adipose tissue, which
provides a cushion between skin layers,
muscles, and bones. It promotes skin mobility,
molds body contours, and insulates the body.
 SKIN FUNCTIONS
Functions of the skin include:
• protection
• temperature regulation
• metabolism
• sensation
• synthesis
• communication.
The normal range of skin pH is 4 to 6.5 in healthy
people
 Skin pathology
• Skin diseases are common and diverse, ranging
from irritating acne to life-threatening
melanoma.

• Either intrinsic to skin, or systemic diseases

involving many tissues, or genetic syndromes
such as neurofibromatosis.
 Terms for Macroscopic Lesions
• Excoriation: Trauma breaking the epidermis; a red linear mark (i.e., a deep
scratch)
• Lichenification: Thickened and rough skin; usually the result of repeated
scratching
• Macule: Flat, circumscribed area, (<5 mm), distinguished by color. If >5
mm= a patch.
• Papule: Elevated dome- or flat-topped lesion (< 5 mm). If >5 mm = a
nodule.
• Plaque: Elevated flat-topped lesion, (>5 mm)
• Pustule: Discrete, pus-filled raised lesion.
• Scale: Dry excrescence
• Vesicle: Fluid-filled raised area (<5 mm). If >5 mm = a bulla.
• Blister is common term for both vesicles and bullae
 Microscopic Terms
• Acantholysis:
• Acanthosis:
• Hyperkeratosis:
• Papillomatosis:
• Parakeratosis:
• Spongiosis:
 Skin Conditions

• Rash: Nearly any change in the skin’s

appearance can be called a rash. Most rashes
are from simple skin irritation; others result from
medical conditions.
• Dermatitis: A general term for inflammation
of the skin. Atopic dermatitis (a type of
eczema) is the most common form.
• Eczema: Skin inflammation (dermatitis)
causing an itchy rash. Most often, it’s due to
an overactive immune system.
• Psoriasis: An autoimmune condition that
can cause a variety of skin rashes. Silver,
scaly plaques on the skin are the most
common form.
.
• Cellulitis: Inflammation of the dermis and
subcutaneous tissues, usually due to an
infection. A red, warm, often painful skin
rash generally results.
• Skin abscess (boil or furuncle): A localized skin
infection creates a collection of pus under the
skin. Some abscesses must be opened and
drained by a doctor in order to be cured
• Melanoma: The most dangerous type of skin
cancer, melanoma results from sun damage
and other causes. A skin biopsy can identify
melanoma.
• Basal cell carcinoma: The most common type
of skin cancer. Basal cell carcinoma is less
dangerous than melanoma because it grows
and spreads more slowly.
• Actinic keratosis: A crusty or scaly bump that
forms on sun-exposed skin. Actinic keratoses
can sometimes progress to cancer.
• Squamous cell carcinoma: A common form of
skin cancer, squamous cell carcinoma may
begin as an ulcer that won’t heal, or an
abnormal growth. It usually develops in sun-
exposed areas.
• Herpes: The herpes viruses
HSV-1 and HSV-2 can cause
periodic blisters or skin
irritation around the lips or
the genitals.
• Hives: Raised, red, itchy
patches on the skin that arise
suddenly. Hives usually result
from an allergic reaction.
• Tinea versicolor: A benign
fungal skin infection creates
pale areas of low
pigmentation on the skin.
• Viral exantham: Many viral infections can cause
a red rash affecting large areas of the skin. This is
especially common in children
 INFECTIOUS DERMATOSES
• Bacterial Infections
• Numerous; range from superficial (e.g. impetigo), to deeper
abscesses
• Impetigo: characterized by an accumulation of neutrophils
under stratum corneum  a subcorneal pustule.
• one of the most common bacterial infections of the skin
• seen primarily in children
• causative organism: m/c Staph. Aureus; then Strept. pyogenes
• Treatment: Microbiologic culture and antibiotics
 Fungal infections of skin
• simple (e.g. Tinea or Candida spp); or life-threatening in
immunosuppressed persons (e.g. Aspergillus spp).
• superficial (e.g. stratum corneum, hair, and nails); deep; or
systemic (hematogenous spread in immunocompromised
pts)
• Histologic appearance:
• Superficial infections  neutrophilic infiltrate in the
epidermis.
• Deep infections  greater tissue damage; a granulomatous
response
• Periodic acid-Schiff (PAS) and Gomori methenamine silver
stains can be helpful in identifying the fungal organisms
 Verrucae (Warts)
• common lesions of children and adolescents.
• caused by human papillomavirus (HPV)
• self-limited, most often regressing spontaneously within 6
months to 2 years.
• most warts are caused by low-risk HPV subtypes (6 and 11)
that lack transforming potential.
• Morphology:
• Verruca vulgaris, the most common type of wart, is found
most frequently on the hands, particularly on the dorsal
surfaces and periungual (around fingernail or toenail)
areas, where it appears as a gray-white to tan, flat to
convex, 0.1- to 1-cm papule with a rough, pebble-like
surface.
• Verruca plana, or flat wart, is common on the
face or dorsal surfaces of the hands; are flat,
smooth, tan macules.

• Verruca plantaris and verruca palmaris occur on

the soles and palms, respectively. These rough,
scaly lesions may reach 1 to 2 cm in diameter
• Condyloma acuminatum (venereal wart) occurs
on the male and female genitalia, urethra, and
perianal areas
Verrucae (Warts)