psoriasis and erythema multiformae 3 .ppt
- 2. Stellate fibroblasts within the superficial connective tissue Giant cellfibroma
- 3. lipoma
- 4. Hemangiomas
- 6. Psoriasis
- 7. • Non contagious skin disorder commonly appearing as Edematous, inflammed skin lesions covered by Silvery White scale • Commonly occuring on Scalp, Trunk and Limbs • Oral Manifestations are RARE
- 9. • Genetic Predisposition – Strong association with HLA Cw6 and B57 region • Possible autoimmune disease – Lesions are associated with increased activity of T-cells in underlying skin – 2.5% of HIV patients develop psoriasis • Could be Stress-related disease as Stress causes exacerbation of the disease Etiology
- 10. • Increase in the turn-over rate of dermal cells, from the normal turn-over duration of 23 days to approx. 3-5 days in the affected areas. • Very high rate of mitotic index when compared to normal epithelium Pathogenesis
- 12. • Skin lesions are painless and rarely pruritic • Rare in children and patients usually diagnosed around 2nd & 3rd decades. • Slightly more common in females • More severe in winter and less severe in summer due to exposure to UV light rays General Clinical Features
- 13. • Bilaterally symmetrical and generally seen on Extensor surfaces, scalp, back, chest, face, etc. • Small, Sharply delinated dry papules, each covered by a delicate silvery scale which resembles Mica. • Removal of deep scales can cause many tiny bleeding points – Auspitz Sign • Papules may enlarge to form plaques which become slightly infiltrating, elevated and irregular in outline • Psoriatic arthritis is a complication inn 12% patients General Clinical Features
- 15. • Rarely affects oral mucosa • Lesions on tongue similar to Geographic tongue and reiters syndrome • Lesions seen on lips, buccal mucosa, palate, gingiva and floor of mouth • Various clinical manifestations: Grey – yellowish white plaques Silvery-white scaly lesions with erythematous base Multiple papular eruptions which may be ulcerated Small, Papillary, elevated lesions with a scaly surface Oral Manifestations
- 17. • Uniform parakeratosis with absence of Stratum Granulosum • Intraepithelial microabscesses in the superficial strata of epithelium (Monro’s Abscesses) • Elongation and clubbing of retepegs • Epithelium over the connective tissue papilla is thinned due to which there is bleeding upon peeling of scales • Prominent dilated capillaries high in the papillae • Mild lympho-histiocytic infiltrate in the stroma Histologic Features
- 19. Schwann cells of Antoni A form a palisaded arrangement around acellular zones known as Verocay bodies. Spindled cells in delicately collagenized and myxoid stroma typical for Antoni type B pattern;
- 24. MULTIPLEMYELOMA
- 26. • Acute Self-limiting dermatitis characterized by Iris or Target Lesions • Distinct spectrum of severity EM Minor EM Major Stevens-Jhonson syndrome (SJS) Toxic Epidermal Necrolysis
- 27. • Triggered by Drugs and infectious agents • EM minor is usually precipitated because of HSV infection • Drugs such as Sulfa drugs precipitate EM major or SJS • Other Infectious agents such as Mycoplasma infection, etc Etiology
- 28. • Young adults between 2nd – 4th decades, Males more • Asymptomatic, erythematous discrete macules, papules, vesicles or bullae distributed in symmetrical pattern commonly on hands, arms, feet, legs, face and neck General Clinical Features
- 29. • Concentric ring like appearing lesions, resulting from varying shades of erythema – Target / Iris / Bulls-eye lesion • Common on hands, wrists and ankles • Mucous membrane involvement is also common • Lesions appear rapidly within a day or two and persist for several days to few weeks gradually fading General Clinical Features
- 31. • Causes Pain and discomfort • Hyperemic macules, papules or vesicles may erode or ulcerate and bleed freely • Tongue, palate, buccal mucosa, gingiva commonly involved • Sometimes mucous membrane lesions can occur before skin manifestations Oral Manifestations
- 34. • Severe bullous form of EM with widespread involvement of skin, eyes, oral cavity and genetalia • Abrupt occurrence of Fever, malaise, photophobia, eruptions of oral mucosa, genitalia and skin • Cutaneous lesions are haemorrhagic and often vesicular or bullous Stevens-Johnson Syndrome (SJS)
- 35. • Mucosal involvement in SJS is more severe than EM • Extremely severely painful • Vesicles or Bullae rupture leaving surface covered with thick white or yellow exudate • Erosions of pharynx also common • Lips exhibit ulceration with bloody crusting and are painful Oral Manifestations
- 38. • Eye lesions: Photophobia, corneal ulceration, Panopthalmitis. Blindness may result due to intercurrent bacterial infection • Genital lesions: Nonspecific urethritis, balanitis and genital ulcers Other Manifestations
- 39. • Non-diagnostic • Intracellular edema or spinous cell layer along with edema of superficial connective tissue which may produce a subepidermal vesicle • Liquefaction degeneration in upper layers of epithelium with intraepithelial vesicle formation • Dilation of superficial capillaries and lymphatics • Inflammatory cell infiltrate of lymphocytes, Neutrophils, Eosinophils , etc Histologic Features
- 40. • Serious, fatal bullous drug eruption • Large sheets of skin peel off giving appearance of widespread scalding burn • Oral erosions may occur • Should be differentiated from Staphylococcal Scalded Skin Syndrome (SSSS) Toxic Epidermal Necrolysis (TEN)