psoriasis and erythema multiformae 3 .ppt

psoriasis, erythema multiformae

2. Stellatefibroblasts within the
superficial connective tissue
Giant cell fibroma

3. lipoma

4. Hemangiomas

5. Palatal exostosis

6. Psoriasis

7. •Noncontagiousskindisordercommonlyappearingas
Edematous,inflammedskinlesionscoveredbySilveryWhite
scale
•CommonlyoccuringonScalp,TrunkandLimbs
•OralManifestationsareRARE

9. •GeneticPredisposition
–StrongassociationwithHLACw6andB57region
•Possibleautoimmunedisease
–LesionsareassociatedwithincreasedactivityofT-cellsin
underlyingskin
–2.5%ofHIVpatientsdeveloppsoriasis
•CouldbeStress-relateddiseaseasStresscauses
exacerbationofthedisease
Etiology

10. •Increaseintheturn-overrateofdermalcells,fromthe
normalturn-overdurationof23daystoapprox.3-5daysin
theaffectedareas.
•Veryhighrateofmitoticindexwhencomparedtonormal
epithelium
Pathogenesis

12. •Skinlesionsarepainlessandrarelypruritic
•Rareinchildrenandpatientsusuallydiagnosedaround2
nd
&3
rd
decades.
•Slightlymorecommoninfemales
•Moresevereinwinterandlesssevereinsummerdueto
exposuretoUVlightrays
General Clinical Features

13. •BilaterallysymmetricalandgenerallyseenonExtensor
surfaces,scalp,back,chest,face,etc.
•Small,Sharplydelinateddrypapules,eachcoveredbya
delicatesilveryscalewhichresemblesMica.
•Removalofdeepscalescancausemanytinybleedingpoints
–AuspitzSign
•Papulesmayenlargetoformplaqueswhichbecomeslightly
infiltrating,elevatedandirregularinoutline
•Psoriaticarthritisisacomplicationinn12%patients
General Clinical Features

15. •Rarelyaffectsoralmucosa
•LesionsontonguesimilartoGeographictongueandreiters
syndrome
•Lesionsseenonlips,buccalmucosa,palate,gingivaandfloor
ofmouth
•Variousclinicalmanifestations:
Grey–yellowishwhiteplaques
Silvery-whitescalylesionswitherythematousbase
Multiplepapulareruptionswhichmaybeulcerated
Small,Papillary,elevatedlesionswithascalysurface
Oral Manifestations

17. •UniformparakeratosiswithabsenceofStratum
Granulosum
•Intraepithelialmicroabscessesinthesuperficialstrataof
epithelium(Monro’sAbscesses)
•Elongationandclubbingofretepegs
•Epitheliumovertheconnectivetissuepapillaisthinneddue
towhichthereisbleedinguponpeelingofscales
•Prominentdilatedcapillarieshighinthepapillae
•Mildlympho-histiocyticinfiltrateinthestroma
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;

20. Herring bone pattern

21. Codmans triangle
Sunray pattern

22. Starry sky appearance

23. Reed-sternberg cell

24. MULTIPLE MYELOMA

25. Erythema Multiforme

26. •AcuteSelf-limitingdermatitischaracterizedbyIrisorTarget
Lesions
•Distinctspectrumofseverity
EMMinorEMMajor Stevens-Jhonsonsyndrome(SJS)
ToxicEpidermalNecrolysis

27. •TriggeredbyDrugsandinfectiousagents
•EMminorisusuallyprecipitatedbecauseofHSVinfection
•DrugssuchasSulfadrugsprecipitateEMmajororSJS
•OtherInfectiousagentssuchasMycoplasmainfection,etc
Etiology

28. •Youngadultsbetween2
nd
–4
th
decades,Malesmore
•Asymptomatic,erythematousdiscretemacules,papules,
vesiclesorbullaedistributedinsymmetricalpattern
commonlyonhands,arms,feet,legs,faceandneck
General Clinical Features

29. •Concentricringlikeappearinglesions,resultingfrom
varyingshadesoferythema–Target/Iris/Bulls-eyelesion
•Commononhands,wristsandankles
•Mucousmembraneinvolvementisalsocommon
•Lesionsappearrapidlywithinadayortwoandpersistfor
severaldaystofewweeksgraduallyfading
General Clinical Features

31. •CausesPainanddiscomfort
•Hyperemicmacules,papulesorvesiclesmayerodeor
ulcerateandbleedfreely
•Tongue,palate,buccalmucosa,gingivacommonlyinvolved
•Sometimesmucousmembranelesionscanoccurbeforeskin
manifestations
Oral Manifestations

34. •SeverebullousformofEMwithwidespreadinvolvementof
skin,eyes,oralcavityandgenetalia
•AbruptoccurrenceofFever,malaise,photophobia,eruptions
oforalmucosa,genitaliaandskin
•Cutaneouslesionsarehaemorrhagicandoftenvesicularor
bullous
Stevens-Johnson Syndrome (SJS)

35. •MucosalinvolvementinSJSismoreseverethanEM
•Extremelyseverelypainful
•VesiclesorBullaeruptureleavingsurfacecoveredwiththick
whiteoryellowexudate
•Erosionsofpharynxalsocommon
•Lipsexhibitulcerationwithbloodycrustingandarepainful
Oral Manifestations

38. •Eyelesions:Photophobia,cornealulceration,Panopthalmitis.
Blindnessmayresultduetointercurrentbacterialinfection
•Genitallesions:Nonspecificurethritis,balanitisandgenital
ulcers
Other Manifestations

39. •Non-diagnostic
•Intracellularedemaorspinouscelllayeralongwithedemaof
superficialconnectivetissuewhichmayproducea
subepidermalvesicle
•Liquefactiondegenerationinupperlayersofepitheliumwith
intraepithelialvesicleformation
•Dilationofsuperficialcapillariesandlymphatics
•Inflammatorycellinfiltrateoflymphocytes,Neutrophils,
Eosinophils,etc
Histologic Features

40. •Serious,fatalbullousdrugeruption
•Largesheetsofskinpeeloffgivingappearanceof
widespreadscaldingburn
•Oralerosionsmayoccur
•ShouldbedifferentiatedfromStaphylococcalScaldedSkin
Syndrome(SSSS)
Toxic Epidermal Necrolysis (TEN)