Presentation is loading. Please wait.

Presentation is loading. Please wait.

Dermatology and Infectious Diseases Disorders of Keratinisation Dermatitis Blistering Disorders Immunology.

Similar presentations


Presentation on theme: "Dermatology and Infectious Diseases Disorders of Keratinisation Dermatitis Blistering Disorders Immunology."— Presentation transcript:

1 Dermatology and Infectious Diseases Disorders of Keratinisation Dermatitis Blistering Disorders Immunology

2 Disorders of Keratinisation 4 Overview 4 Psoriasis 4 Icthyosis

3 Objectives 4 Disorders of Keratinisation

4 Disorders of Keratinization Keratinization Terminal differentiation of epithelia –epithelial proteins (Keratin) –Glycoproteins (Cell Envelope) –intercellular lipids

5 Disorders of Keratinization 4 Cause changes in the skin –Dry, Scaly, Thickened, Flaky –Blistering 4 Cause changes in Mucous membranes, Nails and Hair

6 Disorders of Keratinization 4 Change in Type of Keratin Made

7 Disorders of Keratinisation

8

9 Disorders of Keratinization 4 Psoriasis 4 Icthyosis

10 Disorders of Keratinization Psoriasis 4 Chronic, relapsing and remitting skin disease. 4 May appear at any age 4 may affect any part of the skin 4 Common Locations: –Extensor surfaces Knees and Elbows

11 Disorders of Keratinization Psoriasis 4 Characterised by hyperproliferation of skin and inflammation

12 4 Etiology –Inherited Abnormality of Ca ++ metabolism Genetic Predisposition –HLA Cw6 –HLA DR7 –HLA B27 (Pustular) Disorders of Keratinization Psoriasis

13 4 Etiology –Environmental Factors Stress, Smoking and Alcohol Systemic Drugs Infection –Immunological Factors

14 Psoriasis Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. (1992)

15 Disorders of Keratinization Psoriasis 4 Abnormalities in Psoriatic Skin –  transit time through epidermis –  mitotic activity –  rate of DNA synthesis –high levels of Ca ++ binding protein calmodulin –Presence of keratin 6 & 16 in epidermis These five are must knows

16 Disorders of Keratinization Psoriasis 4 Abnormalities in Psoriatic Skin –  levels of phospholipase A2 activity –  levels of polyamine synthesis –  levels of plasminogen activator –  cGMP levels leading to a high ratio cGMP/cAMP These 4 are included for the sake of completeness

17 Disorders of Keratinization Psoriasis 4 Pathology –Stratum Corneum contains nuclei –Stratum granulosum doesn’t exist –Stratum Spinosum expanded bulbous downward projections mitosis

18 Disorders of Keratinization Psoriasis 4 Pathology contd. –Papillary Dermis Papillae thickened large dilated thin walled blood vessels –Dermis/Epidermis infiltrated with leukocytes in Stratum corneum these clump together to form Spongiform pustules (aka Munro microabscesses)

19 Psoriasis Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. (1992)

20 Psoriasis Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. (1992) Koebner Phenomenon

21 Required Reading 4 Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. (1992) 4 Psoriasis

22 Disorders of Keratinisation Icthyoses 4 A variety of hereditary keratinisation disorders 4 visible scales on the skin 4 Forms include –autosomal dominant –x-linked –associated with multisystem changes

23 Disorders of Keratinisation Icthyoses 4 May vary from very mild to very severe 4 The keratinisation process which is changed varies from condition to condition

24 Icthyosis Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. (1992)

25 Required Reading 4 Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. on Keratinization and Blistering Syndromes

26 Dermatitis/eczema  dermatitis = eczema  non-infective inflammation of the skin  Greek for ‘to boil over’  reaction to various stimuli –some known, some unknown

27 Dermatitis Classification  current classification unsatisfactory/inconsistent  distinctions are often difficult to determine  endogenous (internal factors)  exogenous (external factors)  acute  chronic

28 Dermatitis Acute  acute eczema leads to epidermal oedema (spongiosis), with separation of keratinocytes  leads to epidermal vesicles  dermal vessels become dilated  inflammatory cells invade the dermis and epidermis

29 Dermatitis Chronic  chronic eczema leads to a thickening of the stratum spinosum (acanthosis) & stratum corneum (hyperkeratosis)  also get retention of nuclei by some corneocytes  rete ridges are lengthened  dermal vessels are dilated  inflammatory mononuclear cells infiltrate the skin

30 Dermatitis Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. (1992)

31 Dermatitis Types of dermatitis/eczema  contact dermatitis/eczema –contact with an irritant  atopic dermatitis/eczema –associated with a history of asthma, allergic rhinitis, conjunctivitis  seborrhoeic dermatitis/eczema –commonly affects the scalp and face

32 Dermatitis Types of dermatitis/eczema cont.  discoid (nummular) dermatitis/eczema –often presents as coin-shaped lesions on the limbs of middle aged or older people  venous stasis dermatitis/eczema –associated with venous disease –commonly involves the medial aspect of the ankle

33 Required Reading 4 Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston., D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. 4 Chapters on Eczema

34 Bullous Disorders 4 blistering (bullous) disorders are often seen with skin disease 4 found with common skin conditions like acute contact dermatitis 4 Etiology-autoimmune mechanisms, inheredited errors in metabolism and mechanical trauma

35 Types of Bullous Disorders 4 Pemphigus 4 Pemphigoid 4 Epidermolysis bullosa 4 dermatitis herpetiformis 4 linear lgA disease 4 Fungi 4 Friction 4 Systemic lupus erythematosis (SLE) 4 Erythema multiforme 4 Stevens-Johnson syndrome 4 Bullous impetigo 4 Bullous diabeticorum

36 Bullous disorders 4 Blisters are classified according to their position in the epidermis. 4 SubCorneal :Stratum Corneum 4 Intraepidermal: Lower levels of the epidermis 4 Sub Epidermal: At the dermo-epidermal junction

37 Blistering Disorders

38 Friction Blisters 4 direct mechanical trauma 4 Treatment: avoidance-look at footwear, protective taping and padding, 2 pairs of socks, lubrication. 4 sock design and reduction of blistering 4 Ref.-Herring and Ritchie in JAPMA 1990 and 1993.

39 Required Reading 4 Gawkrodger, D.J. (1992) Dermatology. Edinburgh: Churchill Livingston. 4 Read Chapter on Blistering Disorders and chapter on Keratinization and Blistering Syndromes

40 Hypersensitivity Reactions and the Skin 4 inappropriate or exaggerated response to the degree that tissue damage occurs. 4 4 Types 4 Type l -immediate 4 Type ll -antibody dependant cytotoxicity 4 Type lll-immune complex disease 4 Type lV-cell mediated or delayed


Download ppt "Dermatology and Infectious Diseases Disorders of Keratinisation Dermatitis Blistering Disorders Immunology."

Similar presentations


Ads by Google