Top 30 Skin Diseases

Feb 12 2003
S Radhakrishna
 Top 30 Skin Diseases
• Scaly Red Rashes (5) • Benign Growths (3)
• Pigment Changes (2) • Premalignant
• Nodules (2) Growths (2)
• Purpura (1) • Malignant Growths
• Blisters (4) (3)
• Systemic (3)
 Scaly Red Rash 1: Seborrhea

Greasy yellow scaly plaques are

characteristically distributed in the scalp,
Tzone of face, hairy areas of face
(eyebrows, eyelashes, beard), behind the
ears, on the forehead, trunk, body folds,
and genitalia.Unknown etiology.

"cradle cap" focal parakeratosis, moderate acanthosis, slight

spongiosis and a mild, mixed inflammatory infiltrate.

 Scaly Red Rash 2: Psoriasis

Red or pink papule/plaque with silvery

or micaceous scaling. The fingernails
may show dystrophy, depressions known
as "pits" and subungual debis

presence of a thickened epidermis and

stratum corneum containing neutrophils and
neutophilic debris; no granular layer,
elongation of the rete ridges; T cell
involvement in etiology
Centrifugally spreading, reddish or pink
plaques or patches with slightly raised
advancing edge. Annular. Itchy rash
caused by fungus Tricophytum rubrum
Scaly Red Rash 3: Tinea
in most cases.

Tinea corporis Tinea corporis

Tinea capitis KOH prep on hair

Tinea capitis
Tinea cruris “spaghetti and meatballs”
Tinea versicolor

thick stratum
corneum

Tinea versicolor
Tinea unguium
Parakeratosis PAS stain showing fungi

Tinea pedis
 Scaly Red Rash 4: Eczema

Eczema is very itchy. There are variants

of eczema, the so-called "messy" rash,
for example, "irritant" eczema, atopic
eczema, and contact eczema, all of which
are characterized by rashes that are quite
itchy and appear "messy" because they Flexural distribution
are often scratched.TH2 mediated DTH

Lichenification from scratching

crusting in the stratum corneum (making one

think of a "messy rash") and the "spongiosis"
or epidermal edema, as evidenced by the
relative pallor around the keratinocytes.
Scaly Red Rash 5: Scabies
Scabies (or infestation with the
Sarcopetes mite), especially when
untreated, can lead to a widespread
eczema rash with a few additional
distintive features such as heavy
involvement in the groin or skin folds
and, in particular, involvement of the
interdigital web spaces with crusting.

one finds a lot going on in the

stratum corneum. Here one
can see traces of the mite.
 Pigment Changes 1: Vitiligo

With Fontana Masson stain, lesions of

long standing vitiligo (right hand panel)
show no melanocytes. In normal skin (left
panel) darkly stain melanocytes are
visible along the dermoepidermal
junction.
Pigment Changes 2: Melasma

large amount of melanin in the basal layer

HPV mediated. Here shown is common wart Papules/Plaques 1: Warts

Flat wart

Genital wart
Aka condyloma
acuminatum

Plantar wart
The hallmarks of warts are hyperkeratosis, papillomatosis
(outward expansion of the spinous layer) and acanthosis.
The epidermis contains foci of vacuolated cells (koilocytes),
clumped keratohyaline granules, and vertical tiers of
parakeratotic cells (stratum corneum with retained nuclei).
 Papules/Plaques 2: Molluscum

dome-shaped pink-brown papules with

secondary umbilication noted in mnay of the
well-developed lesions

ballooning-like changes in the keratinocytes as

they approach the granular layer. There are
intracellular inclusion bodies known as molluscum
bodies.
Papules/Plaques 3: Acne Vulgaris
Papules/Plaques 4: Urticaria (Hives)

There is little that appears wrong in this histology except for

the fact that there is a separation of the collagen bundles,
more so than one would usually see in normal skin. There is
also a sparse infiltrate in which an occasional lymphocyte
may be seen
 Papules/Plaques 5: Erythema
Multiforme

The pathologic features of erythema multiforme include a perivascular,

lymphocytic infiltrate of variable intensity, vacuolization of the dermal-
epidermal junction, extravasation of red blood cells without vasculitis,
papillary dermal edema, and variable eosinophilic necrosis of the
epidermis.
Nodules 1: Erythema Nodosum

histologic findings associated with erythema nodosum are

largely localized to the deep dermis and the subcutaneous
tissue. There is an accumulaton of lymphocytes,
neutrophils, histiocytes, and giant cells accumulate in the
fibrous septae between fat lobules and perivascular
infiltration of lymphocytes in the dermis.
Nodules 2: Keloids

change in the diameter of the collagen bundles

and a kind of bluish background, the latter
indicating that there is some mucin there.
 Purpura 1: Vasculitis

larger vessel is involved in an inflammatory porcess

vasculitis of the
superficial
vascular plexus.
One sees
extravation of red
blood cells,
indicating that
the vessels must
have been
damaged. There
is a lot of
neutrophilic
debris.
 Blisters 1: Herpes

Note: these images are kind of weak, also,

not sure if they are only referring to HSV 1
or HSV 1 and HSV 2.

cells in the epidermis are undergoing degenerative changes. There is

acantholysis (epidermal cells falling apart) and enlarging of the nuclei. In
some specimens, one might be lucky enough to see the diagnostic mlti-
nucleated giant cells
 Blisters 2: Bullous Pemphigoid

sub-epidermal blister and an infiltrate with

plenty of eosinophils
 Blisters 3: Pemphigus Vulgaris

INTRAEPIDERMAL split! (above

basal layer)

Mucosal involvement
Blisters 4: Acute Contact Dermatitis
Systemic 1: Lupus

discoid lupus. There is a

perivascular and
periappendageal lymphocytic
infiltrate that also tends to hug
the dermo-epidermal junction,
the latter type of infiltrate
being referred to as "lichenoid
 Systemic 2: Scleroderma

The collagen bundles are thickened and homogenized.

Systemic 3: Drug Eruption
 Benign Growths 1: Lentigo

two features here: the excess pigment in the basal layer and the
peculiar elongation of the epidermis itself, sometimes likened to a
"hockey stick".

LentiginesThese brown macules are sometimes

inappropriately referred to as "liver spots" by
lay people.
Benign Growths 2: Seborrheic
Keratosis

epidermal growth whose borders can almost be distinguished by a

pencil line drawing. The cells are banal and basophilic. There are often
"pseudo-horn cysts" or keratinaceous intra-epidermal inclusions.
Benign Growths 3: Nevi

Junctional Nevus
nests of melanocytes
occupy the junction
of the epidermis and
dermis

Compound Nevus
nests of melanocytes
occupy not only the
junction of the epidermis
and dermis, but are also
solidly in the dermis.

Dermal Nevus
nests of melanocytes are all
in the dermis.
 Premalignant Growths 1: Dysplastic
(Dysplastic nevi are pre-melanomas) Nevi

nevi are dysplastic. They are larger than most common nevi and
show a slight (minimal) variation in color and border.
(Aks are pre-squamous cell carcinoma) Premalignant Growths 2: Actinic Keratosis

Actinic keratoses are single (<6 mm) or multiple discrete, dry,

rough, adherent scaly lesions which occur on the sun-exposed
skin of adults. Prolonged or repeated sun exposure leads to
cumulative UVB-damage to keratinocytes. Skin lesions have
adherent, disorganized, hyperkeratotic scale which is not
easily removed. Lesions are often easier to feel (they fill like
sandpaper) than to see. They are typically distributed on the maturation disarray in the epidermis and the cells
face, ears, neck, forearms and dorsa of hands. appear lsightly atypical
 Malignant Growths 1: Basal Cell Carcinoma
Nodular bcc

Basal cell carcinomas typically contain nests of basophilic cells

Superficial bcc arising from the basilar portion of the epidermis and extending
into the dermis. The nests of basal cells show a distinct
perpindicular arrangement of the cells at the periphery of the
nests called palisading. The nests are also surrounded by a fibrous
stroma and retraction artefact is often observed at the edges of
Nodular bcc many nest.

Pigmented bcc
 Malignant Growths 2: Squamous Cell Carcinoma

tumor islands
have irregularly
invaded the
dermis. There are
many atypical
cells
 Melanomas are recognizable by their irregular and
indistinct boarders, multiple colors, asymmetry, Malignant Growths 3: Melanoma
and varigate contours (raised and flat arease
within the same lesion). Particularly worrisome
colors are black, red, gray or blue

Large islands of atypical pigment-containing cells invade the

dermis irregularly

Melanoma arising from nevi