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WELCOME!

ELEMENTARY LESIONS
AND INFECTIOUS
DISEASES OF THE SKIN

Learning Objectives
Describe the macroscopic and
microscopic changes in frequent
lesions of the skin.
Define the most frequent forms of
infectious skin disease and their
pathogenic organisms.

WALKING DOWN
MEMORY LANE
REMEMBERING FEATURES OF

NORMAL SKIN

1. EPIDERMIS
Is subdivided into 4 layers:
Horny layer (stratum corneum)
Granular layer (stratum granulosum)
Malpighian layer (prickle-cell layer)
Basal layer

There is an extra layer found only in

palms/soleslucid layer

...(Continues)
Keratinocytes are cells that matures from the
basal layer to stratum corneum and their
function is related to form a barrier, to
secrete PGs, leukotrienes, Ils and induction of
Vitamin D by UV rays.
Melanocytes (3%) are dendritic cells derived
from the neural crest and located into the
basal layer, that produce melanin
(endogenous screen against UV rays in
sunlight).
Langerhans cells (4%) can recognize and
process Ags and communicate to lymphoid
cells.

A, The skin is composed of an epidermal layer (e) from which specialized

adnexa (hair follicles, h; sweat glands, g; and sebaceous glands, s) descend
into the underlying dermis (d). B, This projection of the epidermal layer (e)
and underlying superficial dermis demonstrates the progressive upward
maturation of basal cells (b) into cornified squamous epithelial cells of the
stratum corneum (sc). Melanin-containing dendritic melanocytes (m) (and
rare Merkel cells containing neurosecretory granules) and midepidermal
dendritic Langerhans cells (lc) are also present. The underlying dermis
contains small vessels (v), fibroblasts (f), perivascular mast cells (mc), and
dendrocytes (dc), potentially important in dermal immunity and repair.

...(Continues)
Merkel cells (<1%) are located also
into the basal layer of skin/mucous
membranes and function as tactile
mechanoreceptor.
The basal layer is responsible for
epidermal-dermal adherence and
probably is a macromolecular filter. It
is also a major site for Igs localization.

2. DERMIS
Papillary dermis is immediately beneath the epidermis
and is formed by collagen fibers. It reacts conjointly with
epidermis and superficial capillary-venular bed.
Reticular dermis contains most of dermal collagen

3. EPIDERMAL ADNEXA.
Includes modified keratinized structures (nails, hair) and
sebaceous, eccrine and apocrine glands
(axilla, ano-genital areas, nipple and areola)

4. BLOOD VESSELS, NERVES, LYMPHATICS

MUSCLES, CELLS (mast cells)

SKIN PATHOLOGY
DEFINITIONS OF
MACROSCOPIC AND
MICROSCOPIC TERMS

SKIN PATHOLOGY
MACROSCOPIC TERMS

SKIN PATHOLOGY
RESPONSES OF THE SKIN TO INJURY
Clinical lesions Macroscopic terms
Macule
Patch
Papule
Nodule
Plaque
Vesicle
Bulla

Blister
Pustule
Wheal
Scale
Lichenification
Excoriation
Onycholysis

SKIN PATHOLOGY
MACROSCOPIC TERMS
MACULE
A circumscribed lesion of up to 5 mm in diameter,
characterized by flatness and usually
distinguished from surrounding skin by its
coloration.

PATCH
A circumscribed lesion of more than 5 mm in
diameter, characterized by flatness and usually
distinguished from surrounding skin by its
coloration.

Patch

Macules and
patches

SKIN PATHOLOGY
MACROSCOPIC TERMS
PAPULE
Elevated dome-shaped or flat-topped
lesion 5 mm or less across.

PLAQUE
Elevated flat-topped lesion usually
greater than 5 mm across (may be
caused by coalescent papules).

Plaque

SKIN PATHOLOGY
MACROSCOPIC TERMS
NODULE
Elevated lesion with spherical contour
greater than 5 mm across.

SKIN PATHOLOGY
MACROSCOPIC TERMS
VESICLE
Fluid-filled raised lesion 5 mm or less
across.

SKIN PATHOLOGY
MACROSCOPIC TERMS
BULLA
Fluid-filled lesion greater than 5 mm
across.

SKIN PATHOLOGY
MACROSCOPIC TERMS
BLISTER
Common term used for vesicle or bulla.

SKIN PATHOLOGY
MACROSCOPIC TERMS
PUSTULE
Discrete, pus-filled, raised lesion.

SKIN PATHOLOGY
MACROSCOPIC TERMS
WHEAL
Itchy, transient, elevated lesion with
variable blanching and erythema formed
as the result of dermal edema.

SKIN PATHOLOGY
MACROSCOPIC TERMS
SCAR
Is a hard plaque of dense fibrotic tissue covered
by a thin epidermis. A mark of injury from any sort
of process.

ATROPHY
Usually refers to thinning of the epidermiseasily
wrinkled and/or shiny surface. It may also apply to
dermal and/or subcutaneous tissue, with or
without changes in epidermis.

SKIN PATHOLOGY
MACROSCOPIC TERMS
ULCER
Loss of skin tissue or substance from the
surface downward, leaving an uncovered
or denuded wound that is slow to heal.

EROSION
A superficial denudation of the skin,
usually implying loss of epidermis.

SKIN PATHOLOGY
MACROSCOPIC TERMS
FISSURE
Is a vertical splitting/separation of the skin

CRUST
Dried surface of fluid, often serous (inspissated
serum) in nature, with or without tissue debris
(same as scab)

EXCORIATION
A scratch mark, often with denudation of the skin
to form a small ulcer

SKIN PATHOLOGY
MACROSCOPIC TERMS
SCALE
A thin flake of epithelium (mostly of corneum
layer) which is separated from the underlying
intact skin.

LICHENIFICATION
A thickening of the skin and an increase of skin
markings, usually seen w/chronic coalescence of
papular lesions (atopic eczema).

ONYCHOLYSIS
Separation of nail plate from nail bed.

SKIN PATHOLOGY
MICROSCOPIC TERMS

SKIN PATHOLOGY
RESPONSES OF THE SKIN TO INJURY
MICROSCOPIC TERMS
Hyperkeratosis
Parakeratosis
Hypergranulosis
Acanthosis
Papillomatosis
Dyskeratosis
Acantholysis

Spongiosis
Hydropic swelling (ballooning)
Exocytosis
Erosion
Ulceration
Vacuolization
Lentiginous

SKIN PATHOLOGY
MICROSCOPIC TERMS
HYPERKERATOSIS:
Thickening of the stratum corneum, often
associated with a qualitiative abnormality
of the keratin.

PARAKERATOSIS:
Modes of keratinization characterized by
the retention of the nuclei in the stratum
corneum. On mucous membranes,
parakeratosis is normal.

Hyperkeratosis

Parakeratosis

SKIN PATHOLOGY
MICROSCOPIC TERMS
HYPERGRANULOSIS:
Hyperplasia of the statum granulosum,
often due to intense rubbing

ACANTHOSIS:
Diffuse epidermal hyperplasia

PAPILLOMATOSIS:
Surface elevation caused by hyperplasia
and enlargement of contiguous dermal
papillae.

Acanthosis

SKIN PATHOLOGY
MICROSCOPIC TERMS
DYSKERATOSIS:
Abnormal keratinization occurring prematurely
within individual cells or groups of cells below the
stratum granulosum.

ACANTHOLYSIS:
Loss of intercellular connections resulting in loss
of cohesion between keratinocytes.

SPONGIOSIS:
Intercellular edema of the epidermis.

Acantholysis

Spongiosis

SKIN PATHOLOGY
MICROSCOPIC TERMS
HYDROPIC SWELLING (BALLOONING)
Intracellular edema of keratinocytes,
often seen in viral infections.

EXOCYTOSIS:
Infiltration of the epidermis by
inflammatory or circulating blood cells.

Hydropic swelling
(ballooning)

SKIN PATHOLOGY
MICROSCOPIC TERMS
VACUOLIZATION:
Formation of vacuoles within or adjacent to cells;
often refers to basal cell-basement membrane
zone area.

LENTIGINOUS:
Referring to a linear pattern of melanocyte
proliferation within the epidermal basal cell layer.
Lentiginous melanocytic hyperplasia can occur as
a reactive change or as part of a neoplasm of
melanocytes.

BONUS MATERIAL

SKIN PATHOLOGY
Bonus Material

SKIN RESPONSE IN SYSTEMIC

DISEASES.
HYPERPIGMENTATION
-Addisons disease
Hemochromatosis
-Heavy metal
poisoning (As,Ag)
-Chronic renal failure
-Chronic
liver disease

SKIN PATHOLOGY
Bonus Material

SKIN RESPONSE IN SYSTEMIC

DISEASES
HYPOPIGMENTATION
-Albinism
Chediak-Higashi syndrome
-Hypopituitarism

SKIN PATHOLOGY

Bonus Material

SKIN RESPONSE IN SYSTEMIC...

DARK SPOTS
Peutz-Jeghers syndrome
-Albrights syndrome
-Neurofibromatosis
ORANGE-YELLOW PIGMENT
-Jaundice
-Hypervitaminosis A, etc.
PRURITUS
Chronic renal failure
-Obstructive jaundice
-Hodgkins disease

SKIN PATHOLOGY
Bonus Material

SKIN RESPONSE IN SYSTEMIC...

HEMORRHAGIC PETECHIAE
-Bacterial endocarditis
-Scurvy
-Thrombocytopenic
purpura
Septicemia
-Vasculitis
BRUISES
-Amyloidosis
-Leukemia
-Bacteremia
-Scurvy
-Cushings syndrome

SKIN PATHOLOGY
Bonus Material

SKIN RESPONSE IN SYSTEMIC...

TELANGIECTASIA
-Chronic liver failure

-Osler-

Weber-Rendu syndrome
HIRSUTISM
-Cushings syndrome
Increased levels of androgens
HAIR LOSS
-Hypothyroidism
-SLE

SKIN PATHOLOGY
Bonus Material

SKIN RESPONSE IN SYSTEMIC...

HYPERKERATOSIS
-Hypervitaminosis A
-Scurvy
ACANTHOSIS NIGRICANS
-Mostly abdominal carcinomas
(stomach)
-Also:
some lung and breast carcinomas
DERMATITIS
-Hypervitaminosis A
-Parkinsons
diease
-Pellagra

END OF BONUS MATERIAL

SKIN PATHOLOGY
INFECTIOUS DISEASES AND
INFESTATION

INFECTION AND
INFESTATION
Verrucae (warts)
Common lesions of children and adolescents,
may be encountered at any age.
Caused by human papillomaviruses.
Generally self-limited, regressing
spontaneously.
Verruca vulgaris
Verruca plana
Verruca plantaris
Verruca palmaris
Condyloma acuminatum (venereal wart)

 (Continues)
(Continues)
Pathogenesis:
Anogenital warts are caused
predominantly by HPV types 6 and 11
(HPV type 16 shows some degree of
dysplasia, associated with in situ
squamous cell carcinoma of the
genitalia).
HPV types 5 and 8 have been detected
also.

(Continues)
Molluscum Contagiosum
Is a common self-limited viral disease
of the skin caused by a poxvirus
(largest pathogenic poxvirus in
humans).
Clinically, multiple lesions may occur
on the skin and mucous membranes
(trunk and anogenital areas).

SKIN PATHOLOGY
VIRUSES
Herpes simplex I (oral blisters) and
herpes simplex II (genital blisters).
Varicella (blisters on
trunkperiphery)

(Continues)
Impetigo
Common superficial bacterial
infection of the skin.
Pathogenesis:
Beta-hemolytic streptococci and
Staphylococcus aureus (most of the cases
nowadays).

(Continues)
Superficial fungal infections
Caused primarily by dermatophytes.
Tinea
Tinea
Tinea
Tinea
Tinea

capitis
barbae
corporis
cruris
pedis (athletes foot)

Spread to or primary infection of the

nails is referred to as onychomycosis.

(Continues)
(Continues)
Tinea versicolor (Malassezia furfur), a
yeast.

(Continues)
Arthropod bites, stings, and
infestations
Arachnida (spiders, scorpions, ticks,
and mites)
Insecta (lice, bedbugs, bees, wasps,
fleas, flies, and mosquitoes)
Chilopoda (centipedes).

(Continues)
(Continues)
Arthropods can produce lesions:
1. By direct irritant effects of insesct parts or
secretions.
2. By immediate or delayed hypersensitivity
responses (including an anaphylactic reaction)
3. By specific effects of venoms (e.g. black widow
spider venom produces severe cramps and
excruciating pain, the brown recluse spider venom
contains potent enzymes that produce tissue
necrosis)
4. By serving as vectors for secondary invaders,
such as viruses, bacteria, rickettsiae, and
parasites.

(Continues)
(Continues)
Ixodes dammini, a tick vector for the
spirochete that causes Lyme disease.
Pediculosis, caused by the head louse,
crab louse, and body louse.
Scabies, caused by the mite
Sarcoptes scabei.

THANK YOU!
Dr. Olga Gonzlez Rascn

CREDITS
Books:
Robbins and Cotrans Pathologic Basis
of Disease

Images:
Department of Pathology collections
(special thanks to Dr. Martinez, Dr.
Montiel), Dermatology: U of Iowa,
Elsevier - PBD, and various public
Internet sources.