Morfology MUDr. Anna Žáková I. DVK FNUSA a LF MU v Brně 1) Types of skin lesions •A lesion is any single area of altered skin •Primary - macule, papule, nodule, wheal, vesicle, bulla, pustule •Secondary – scale, crust, fissure, erosion, excoriation •Other –plaque, cyst • •A rash is a widespread eruption of lesions •Exanthema - generalized, symetric •Enanthema – mucous membranes • Decision- rozhodnutí a) Primary Lesions •Are the initial manifestation of the disease, unaffected by the course of the disease or manipulation by the patient. • MACULE = is a flat lesion, identified only by color change and not palpable - Large macules- are sometimes called patches - Example: it can be caused by leakage of blood, changes in the blood flow, hemosiderin, melanin Primary Lesions PAPULE = A raised lesion, usually defined as less than 1 cm in diameter, a papule may consist of a thickened epidermis, dermis or combination of them - Larger similar lesions are nodules, they are occupying subcutaneous space - Example: psoriasis vulgaris , pityriasis rubra pilaris Primary Lesions Raised- vyrostlý Thickened – fiknd - zesílený psoriasis vulgaris – červená se šupinou na povrchu pityriasis rubra pilaris- červená vázaná na vlasové folikuly •Papulopustule – papule with pustule on the top (acne vulgaris) • • • •Papulovesicule – papule with central vesicule (prurigo acuta) Prurigo acuta- akutní svědivé onem. Malých dětí (2-7 let), vznik v letních a podzimních měsících, charakter alergické reakce - etiologie- kombinace I. A IV. Typu alergické reakce, vznik nejčastěji následkem štípnutí hmyzem PLAQUE = a flat-topped lesions larger than 1 cm in diameter Primary Lesions VESICLE = a fluid-filled lesion less than 1 cm, herpes simplex, herpes zoster BLISTER = a fluid-filled lesion larger than 1 cm -The site of fluid may be within the epidermis or subepidermal -It is either clear or hemorhagic Primary Lesions Either- bud Vezikula- může být intraepidermální (např. ekzém, herpes simplex) - nebo subepidermální (pemfigoid) PUSTULE = a pus-filled vesicle -it can be primary (psoriasis pustulosa), or secundary, when a vesicle becomes cloudy (impetigo) Primary Lesions HIVE = also known as urtica or wheal, this elevated lesion is caused by leakage of fluid from a vessel, it is ussually pruritic and transient, disappears < 24 hours - Example: urticaria Primary Lesions HIVE- (hajv) b) Secondary Lesions -Are showing changes during next development of the disease, it is caused by degeneration or reparation of the skin, or by influence of external factors ULCER A defect in the epidermis and dermis with impaired healing, caused by trauma, impaired vascular supply, tumors, and infections - It heals with scar EROSION A superficial loss of epidermis, caused by ruptured intraepidermal blister or slight trauma EXCORIATION A defect in the epidermis, and often the dermis, induced by scratching or manipulation - It is bleeding, it heals with crust without scar Impaired healing- zhoršeným hojením Eroze i exkoriace- se hojí bez jizvy, někdy depigmentací • ulcus-cruris-atrophie-alba ulcus-cruris-smiseny pyoderma-gangrenosum-berec FISSURE A crack or split in the epidermis and dermis - Fissures around circular orifices are known as rhagades Fišr (praskliny), orifices- otvory Fisury- např. hluboké praskliny ústí análního otvoru, radiálně uspořádané SCALE An abnormal accumulation of corneocytes, secondary to excassive epidermal turnover (psoriasis) or delayed shedding Types include: - Psoriasiform - silvery - Pityriasiform - fine - Rupiar – thick, coarse - Collarette – prominent at the periphery nik18625 nik18627 Delayed- zpožděný, shedding- olupování CRUST - A surface coating consisting of dried serum, pus, or blood, sometimes with scale. ATROPHY Thinning of the skin because of loss of dermis, epidermal atrophy is a microscopic finding SCLEROSIS Dermal scar-like induration, such as in morphea or systematic sclerosis SCAR The site of repair of a dermal defect, scars may be: -hypertrophic- thickened -flat -atrophic (depressed) LICHENIFICATION A distinctive response to inflammation, leading to pronounced skin markings. Rubbing produces epidermal thickening with many small smooth papules, as in lichen simplex chronicus or atopic dermatitis Description of lesion •Localisation •Arrangement •Size •Shape (circular, geografical) •Surface (flat, depressed) •Borders (sharpened / unsharpened) •Color (brown-red, yellow, white) •Consistency • Kromě správné diagnostiky jednotlivých eflorescencí je třeba při popisu objektivních změn uvést jejich: 1.Lokalizaci 2.Konfiguraci 3.Velikost 4.Tvar (kruhovitý, ledvinovitý, mapovitý) 5.Povrch (hladký, svraštělý, vkleslý) 6.Ohraničení (ostré/ neostré) 7.Barvu (hnědočervená, žlutavá, bělavá) 8.Konzistenci u hmatných projevů Location and Distribution •It is important to notice: •Lesions are single or multiple •It could create groups with typical arrangement •Distribution is random or patterned, symmetric or asymmetric •Localized – on certain place •Disseminated - scattered in several places •Generalized - lesions everywhere •Erythroderma - continuous skin involvement • 2) Arrangement of lesions •= can make a group of shapes • •Linear ( in the line) •Anular (circular), circinár (to the ring), semicircinální • (into semicircle) •Herpetiform (grouped vesicles, as in herpes simplex) •Zosteriform (group of lines) •Geographical - psoriasis • • • • • • WP_000876 123-2367_IMG Tinea corporis- circinární (do kroužku), semicircinální (do polokruhu) Texture •Some skin lesions have visible or palpable texture that suggests a diagnosis. • •Verrucous lesions have an irregular, pebbly, or rough surface. Examples include warts and seborrheic keratoses. • •Lichenification is thickening of the skin with accentuation of normal skin markings; it results from repeated scratching or rubbing. • •Induration, or deep thickening of the skin, can result from edema, inflammation, or infiltration, including by cancer. Indurated skin has a hard, resistant feeling. Induration is characteristic of panniculitis, some skin infections, and cutaneous metastatic cancer • Diseminované = rozeseté Generalizované- pokud se projevy (morfy) vyskytují všude Erytrodermie = souvislé (difúzní) postižení celého kožního povrchu 3) Localization of skin diseases •= describe where the lessions are placed •- Predilections = typical localization of each disease -Intertriginous -Embolization -Seborhoic -Solar • • • (intertridžinrs), Predilections of atopic dermatitis Infants- (2nd-6th month after birth) - cheeks, forehead, gradually to the whole head, body, arms and legs Children's form - (preschool, school children) - elbow, knee holes, neck, wrists, backs of hands Adult form - the same places as children's Predilections of Psoriasis •Acute – gutate form •Chronical Chronical form – over large joints – knees, elbows, sacral area, in hair, on nails Psoriasis inversa – cubitas, popliteas, intergluteal, under the braest •Acute – gutate form • •Chronical - psoriasis vulgaris, psoriasis inversa • Predilections of Acne, or rosacea acne-open-comedo-63 Související obrázek Akne – the places with many subaceous glands – central part of the face, between scapule bone, above the sternum, around the genital - seboriická dermatittis, akné Rosacea – forehead, cheeks Predilections of scabies Interdigital place, volar side of the wrist, axillas, areolas, navel – pupek, genital, arches of the feet – papules in pairs Intertriginous localization - In the places with the number of sweat glands and at the site of skin folds – inguinas, under breast, axilas – very easy there can be intertrigo, psoriasis inversa Embolic localization- drug exantemas affected by blood spread – symetricaly lateral part of the trunk, inner part of arms a legs – drug eruptions Seborhoic localization Seborrheic Dermatitis the places with many subaceous glands – central part of the face, between scapule bone, above the sternum, around the genital - seboriická dermatittis, akné Solar localization Sun exposed body parts – face, neck, cleavage – dekolt, back of hands – skin tumors What is what? • nik18636 Ulcus- vřed- sekundární morfy • nik18595 Vitiligo- makula – primární morfa • nik18621 Bazaliom- nádory- typicky- nodulus- primární morfy • nik18625 Skvama- šupina- sekundární morfy • nik18615 Urtica- epikutánní testy- primární morfy • nik18630 Krusta- sekundární morfy- tkáňový mok • nik18596 Erysipelas bullosum- bula- primární morfy • nik18633 Ragády, fisury- sekundární morfy • nik18599 Gutátní psoriáza- papula- primární morfa • nik18622 Kaposiho sarkom- nodulus- nádor- primární morfy • nik18641 Ulcus- sekundární morfa • nik18612 Pustuly- primární morfy • nik18619 Nodulus- tuber- primární morfy • nik18629 Krusta- strup- sekundární morfy- krev • (acne vulgaris) - Papulopustula – papula s pustulou na vrcholku- primární morfy •Thank you for your attention