Clinical-Pathologic Correlation of Lesions

Question 1

distribution

Answer 1

regions of the skin affected by the lesions

solitary, multifocal, generalized

Question 2

configuration

Answer 2

spatial relationship between individual lesions

Question 3

annular

Answer 3

circular

Question 4

serpiginous/serpentine

Answer 4

snake-like; coalesce to form serpent-like patterns

Question 5

targetoid

Answer 5

bulls-eye

Question 6

primary lesions

Answer 6

changes in color, appearance, or texture

can be congenital or acquired

Question 7

secondary lesions

Answer 7

changes in skin that result from primary skin lesions

can be caused by progression (ex. pustule –> epidermal collarette) or manipulation (scratching and biting)

Question 8

macules

Answer 8

changes in color (depigmentation, hyperpigmentation, or redness) without elevation or depression of the surface

Question 9

what causes macules to be red

Answer 9

hemorrhages (petechiations)

Question 10

what causes depigmentation/leukoderma

Answer 10

interface dermatitis

immune mediated attacks on keratinocytes leading to single cell necrosis –> release of melanocytes into the dermis –> pigmentary incontinence

Question 11

papules

Answer 11

circumscribed, solid elevation of the skin involving the epidermis and dermis (with domed surface)

accumulation of inflammatory cells underneath the surface

Question 12

plaques

Answer 12

large, flat topped circumscribed elevation of the skin

often a coalescence of papules

Question 13

nodules

Answer 13

larger or solid
deep mass in dermal or subcutaneous tissue with visible and palpable elevation of the skin

Question 14

nodular to diffuse dermatitis

Answer 14

inflammation leading to the formation of papules +/- masses that expand

Question 15

what causes nodular to diffuse dermatitis

Answer 15

infectious
immune mediated
idiopathic

Question 16

neoplastic populations of the skin

Answer 16

can expand the skin (benign) or infiltrate and replace the skin (malignant)

can be primary or metastatic

Question 17

wheals

Answer 17

hives; well-circumscribed, flat topped, firm elevation of the skin with a well demarcated, palpable margin

pits with pressure

associated with urticaria

Question 18

urticaria

Answer 18

skin reaction leading to wheals

Question 19

vesicles & bullae

Answer 19

circumscribed elevation of the epidermis containing serous fluid either within the epidermis or at the dermo-epidermal junction

vesicles < 1 cm
bullae > 1 cm

Question 20

what do vesicles form

Answer 20

rupture to form erosions or ulcerations

Question 21

intraepidermal vesicles

Answer 21

formation of vesicles within the epidermis

caused by:
- spongiosis
- acantholysis
- intracellular edema
- apoptosis

Question 22

subepidermal vesicles

Answer 22

formation of vesicles at the dermo-epidermal junction (BMZ)

Question 23

primary subepidermal vesicles

Answer 23

result from damaged BMZ causing the epidermis to no longer be attached to underlying dermis

complete detachment occurs

Question 24

secondary subepidermal vesicles

Answer 24

results from damaged basal cells leading to necrosis of basal cells and superficial keratinocytes –> vacuolization or apoptosis

Question 25

pustules

Answer 25

circumscribed elevation of the epidermis containing purulent material (pus - fluid and cells)

Question 26

epidermal collarettes

Answer 26

narrow rim of loosened stratum corneum that hangs over the peripheral edge of a circumscribed skin lesion occurs secondary to chronic pustules can become hyperpigmented

Question 27

erosions

Answer 27

superficial denudation of the skin confined to the epidermis - does NOT cross the BMZ - basal cell layer remains intact - does NOT bleed - progresses to ulcerations

Question 28

ulceration

Answer 28

defect of the skin extending through the dermo-epidermal junction (BMZ) into the dermis - actively bleeds - can be caused by vascular damage leading to triangular regions of necrosis and ulcerations

Question 29

excoriations

Answer 29

erosions and ulcers produced by self-trauma surrounding tissues show signs of chronic irritation

Question 30

what are signs of chronic irritation

Answer 30

- acanthosis (epidermal hyperplasia) - rete peg formation - hypergranulosis - compact hyperkeratosis

Question 31

scale

Answer 31

accumulated fragments of dead, cornified epidermal cells (stratum corneum) nonadherent

Question 32

what conditions result in scale

Answer 32

- ichthyosis - zinc responsive dermatosis

Question 33

crusts

Answer 33

accumulated fragments of cornified epidermal cells (scale) + dried residue of serum, pus

Question 34

what does crust indicate

Answer 34

inflammation in the superficial dermis

Question 35

lichenification

Answer 35

thickening of the skin; usually with hyperpigmentation and increased prominence of normal surface epidermal architecture

Question 36

what does lichenification indicate

Answer 36

chronic self trauma

Question 37

alopecia

Answer 37

decreased number of hair shafts per given area of body surface leading to partial or complete loss of hair coat

Question 38

what are possible causes of alopecia

Answer 38

1. congenital malformation of the follicles 2. breaking of hair shafts 3. cyclic arrest of follicular cycle 4. follicular destruction 5. follicular atrophy