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Questions and Answers
What type of hypersensitivity reaction is associated with contact dermatitis?
What type of hypersensitivity reaction is associated with contact dermatitis?
Which of the following is NOT a common contactant in contact dermatitis?
Which of the following is NOT a common contactant in contact dermatitis?
What is a characteristic lesion of erythema multiforme?
What is a characteristic lesion of erythema multiforme?
In chronic contact dermatitis, what type of lesion is typically observed?
In chronic contact dermatitis, what type of lesion is typically observed?
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Which of the following conditions can lead to the development of eosinophils in the skin?
Which of the following conditions can lead to the development of eosinophils in the skin?
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What type of blisters are primarily associated with Pemphigus Vulgaris?
What type of blisters are primarily associated with Pemphigus Vulgaris?
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Which of the following histological features is indicative of Pemphigus Vulgaris?
Which of the following histological features is indicative of Pemphigus Vulgaris?
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Which age group is primarily affected by Bullous Pemphigoid?
Which age group is primarily affected by Bullous Pemphigoid?
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What pattern is observed in direct immunofluorescence for Pemphigus Vulgaris?
What pattern is observed in direct immunofluorescence for Pemphigus Vulgaris?
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Which autoimmune blistering disease is characterized by involvement of mucous membranes and flaccid blisters?
Which autoimmune blistering disease is characterized by involvement of mucous membranes and flaccid blisters?
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What is a key histological feature observed early in erythema multiforme?
What is a key histological feature observed early in erythema multiforme?
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Which of the following describes Stevens-Johnson syndrome?
Which of the following describes Stevens-Johnson syndrome?
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What is a common characteristic of psoriasis?
What is a common characteristic of psoriasis?
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Which histological feature is NOT typical for lichen planus?
Which histological feature is NOT typical for lichen planus?
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What is the primary cause of the severe variant of erythema multiforme?
What is the primary cause of the severe variant of erythema multiforme?
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What is NOT a documented feature of psoriasis?
What is NOT a documented feature of psoriasis?
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What are the characteristic skin lesions of lichen simplex chronicus?
What are the characteristic skin lesions of lichen simplex chronicus?
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Which of the following describes the skin lesions of psoriasis when scale is lifted?
Which of the following describes the skin lesions of psoriasis when scale is lifted?
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Which histologic feature is characteristic of dermatitis herpetiformis?
Which histologic feature is characteristic of dermatitis herpetiformis?
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What is a common clinical feature of bullous pemphigoid?
What is a common clinical feature of bullous pemphigoid?
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What distinguishes pemphigus vulgaris from other blistering diseases?
What distinguishes pemphigus vulgaris from other blistering diseases?
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Which condition is commonly associated with gluten sensitivity?
Which condition is commonly associated with gluten sensitivity?
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Erythema nodosum is characterized histologically by which feature?
Erythema nodosum is characterized histologically by which feature?
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What is a common viral cause of verruca vulgaris?
What is a common viral cause of verruca vulgaris?
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What is a characteristic clinical presentation of toxic epidermal necrolysis?
What is a characteristic clinical presentation of toxic epidermal necrolysis?
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Which of the following conditions is characterized by intensely pruritic papulovesicular eruption?
Which of the following conditions is characterized by intensely pruritic papulovesicular eruption?
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Study Notes
Dermatopathology - Inflammatory Skin Diseases
- Inflammatory skin diseases are categorized into acute and chronic inflammatory dermatoses.
- Acute inflammatory dermatoses include urticaria, acute eczematous dermatitis, and erythema multiforme.
- Chronic inflammatory dermatoses include psoriasis, lichen planus, lichen simplex chronicus, and autoimmune bullous diseases (including pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, and dermatitis herpetiformis).
- Infectious disorders of the skin are also a category of inflammatory skin diseases.
Acute Inflammatory Dermatoses
- Urticaria: Characterized by edematous collagen bundles, potentially with eosinophils present.
- Acute eczematous dermatitis: A hypersensitivity reaction, often to exogenous agents like poison ivy, nickel, rubber, or preservatives. Acute lesions present as vesiculobullous, while chronic lesions are erythematous plaques.
- Erythema multiforme: A mucocutaneous eruption, often with drug or infection as underlying etiology. Early lesions show vacuolar interface dermatitis with scant lymphocytic infiltrate. Later, the disease shows subepidermal bullae with possible necrosis and degeneration in the overlying epidermis. Severe variants include Stevens-Johnson syndrome (more diffuse erythema and skin necrosis, <10% epidermal detachment, often secondary to medication) and toxic epidermal necrolysis (extensive mucocutaneous tenderness and denudation, >30% epidermal detachment, usually secondary to medication).
Chronic Inflammatory Dermatoses
- Psoriasis: A chronic, papulosquamous disorder affecting 2% of the population. Features include well-demarcated erythematous plaques with silvery scales, most commonly on the scalp, nails, extremities, and sacral region. Histologically, there is epidermal thickening (acanthosis) with elongated rete ridges, hyperkeratosis with parakeratosis, and inflammatory infiltrate in the superficial dermis. Neutrophils are present in parakeratosis layers.
- Lichen planus: Characterized by purple, pruritic, polygonal papules. Histological features include hyperkeratosis (usually no parakeratosis), acanthosis, and saw-toothed elongation of rete ridges. A lichenoid lymphocytic infiltrate is present, potentially with occasional eosinophils and plasma cells.
- Lichen simplex chronicus: Often presents with acanthosis, hyperkeratosis, and hypergranulosis. There is elongation of rete ridges and fibrosis of the papillary dermis with a chronic inflammatory infiltrate.
Bullous Diseases
- Pemphigus vulgaris is characterized by flaccid blisters and erosions, often involving mucous membranes. Histological features include intraepidermal bullae, suprabasilar acantholysis, and a "tombstone row" of basal layer keratinocytes. IgG circulating antibodies to desmoglein cause the loss of normal cell-to-cell adhesion, leading to blister formation. Direct immunofluorescence reveals a "chicken wire" pattern.
- Pemphigus foliaceus is characterized by superficial pemphigus, with erythematous patches and crusted erosions. The primary difference is a subcorneal split and superficial acantholysis. IgG circulating antibodies to desmoglein cause loss of cell-to-cell adhesion.
- Bullous pemphigoid is a chronic autoimmune blistering disease prevalent in the 60-80 age group. Histologically, subepidermal bullae with eosinophils or neutrophils are common features. The most important finding, however, is the presence of circulating anti-basement membrane IgG.
- Dermatitis herpetiformis is a pruritic, papulovesicular eruption appearing in 20–60-year-olds, commonly on elbows, knees, and buttocks. Histologically, the feature is a neutrophil-rich subepidermal bulla with granular IgA in papillary dermal tips. It often co-occurs with gluten-sensitive enteropathy.
Infectious and Infestation Disorders
- Verruca vulgaris is a common viral infection (HPV). The histological appearance exhibits hyperkeratosis, parakeratosis, papillomatosis, and koilocytosis.
- Molluscum contagiosum is a self-limiting viral infection. It's characterized by the presence of molluscum bodies, which are large cells with cytoplasmic, granular, eosinophilic inclusions that displace and contain viral particles.
- Herpes simplex is characterized by painful lesions with multinucleated keratinocytes and nuclear inclusions, potentially with late epidermal necrosis or acantholysis.
- Scabies is an infestation-driven condition.
- Erythema nodosum is characterized by thickened septa with inflammatory infiltrate that extends to the periphery of the fat lobule. Subcutaneous nodules with a bright red color and raised slightly above the skin are commonly observed.
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Description
This quiz covers the classification and characteristics of inflammatory skin diseases, distinguishing between acute and chronic dermatoses. Topics include urticaria, acute eczematous dermatitis, and various chronic conditions like psoriasis and autoimmune bullous diseases. Test your knowledge on these dermatological conditions and their underlying mechanisms.
