Chronic Inflammatory
Dermatoses
Disorders that persist for many INFLAMMATORY BLISTERING
months to years. DISORDERS
The skin surface is roughened as a
result of excessive or abnormal scale 1. Pemphigus
formation and shedding Is a blistering disorder caused by
autoantibodies that result in the
1. PSORIASIS dissolution of intercellular
affects the skin of the elbows, knees, attachments within the epidermis and
scalp, lumbosacral areas, intergluteal mucosal epithelium.
cleft, and glans penis
lesion is a well-demarcated, pink to a. Pemphigus vulgaris
salmon-colored plaque covered by o most common type
loosely adherent scale that is o involves the mucosa and skin,
characteristically silver-white in color especially on the scalp, face,
cause of total body erythema and axilla, groin, trunk, and points of
scaling known as erythroderma pressure
o Primary lesions are superficial
psoriasis seems to be multifactorial,
vesicles and bullae
with contributions from genetic and
b. Pemphigus vegetans
environmental factors
o A rare form that usually
o HLA-C, particularly with the
presents not with blisters but
HLA-Cw*0602 allele
with large, moist, verrucous
(wart-like), vegetating plaques
2. SEBORRHEIC DERMATITIS
studded with pustules on the
classically involves regions with a high
groin, axillae, and flexural
density of sebaceous glands, such as
surfaces.
the scalp, forehead (especially the
c. Pemphigus foliaceus
glabella), external auditory canal,
o a more benign form that is
retroauricular area, nasolabial folds,
endemic in Brazil
and the presternal area.
d. Pemphigus erythematosus
Not a disease of the sebaceous glands. o localized, less severe form of
Lesions are macules and papules on pemphigus foliaceus that may
an erythematous-yellow, often greasy selectively involve the malar
base, typically in association with area of the face in a lupus
extensive scaling and crusting. erythematosus
Dandruff is the common clinical e. Paraneoplastic pemphigus
expression o occurs in association with
various malignancies, most
3. LICHEN PLANUS commonly non-Hodgkin
6 Ps - Pruritic, purple, polygonal, lymphoma
planar papules, and plaques
Papules are often highlighted by white ***the common histologic denominator in all
dots or lines called Wickham striae, forms of pemphigus is acantholysis, the
which are created by areas of dissolution, or lysis, of the intercellular
hypergranulosis. adhesions that connect squamous epithelial
T lymphocyte infiltrates and cells
hyperplasia of Langerhans cells are
characteristic features of this ***All forms of pemphigus are caused by IgG
autoantibodies against desmogleins
Bullous Pemphigoid
lesions are tense bullae, filled with
clear fluid, on normal or erythematous 2. Porphyria
skin refers to a group of uncommon inborn
Lesions are usually up to 2 cm in or acquired disturbances of porphyrin
diameter but occasionally may reach 4 metabolism
to 8 cm in diameter Porphyrins are pigments normally
present in hemoglobin, myoglobin,
and cytochromes.
The five major types are
DERMATITIS HERPETIFORMIS (1) congenital erythropoietic porphyria
is a rare disorder characterized by (2) erythrohepatic protoporphyria
urticaria and grouped vesicles (3) acute intermittent porphyria
affects predominantly males (4) porphyria cutanea tarda
(5) mixed porphyria.
occurs in association with intestinal
celiac disease and responds to a
gluten-free diet. Disorders of Epidermal Appendages
urticarial plaques and vesicles of
dermatitis herpetiformis are extremely ACNE VULGARIS
pruritic. believed to occur as a result of
The lesions are bilateral, symmetric physiologic hormonal variations and
and grouped, involving preferentially alterations in hair follicles, particularly
the extensor surfaces, elbows, knees, the sebaceous gland
upper back, and buttocks
Open comedones - are small follicular
NONINFLAMMATORY papules containing a central black keratin
plug. This color is the result of oxidation of
BLISTERING DISORDERS melanin pigment (not dirt).
1. Epidermolysis bullosa Closed comedones - are follicular papules
Constitutes a group of disorders without a visible central plug. Because the
caused by inherited defects in keratin plug is trapped beneath the
structural proteins that lend epidermal surface, these lesions are
mechanical stability to the skin. potential sources of follicular rupture and
The common feature is a proclivity to inflammation.
form blisters at sites of pressure,
rubbing, or trauma, at or soon after ***it has been postulated that bacterial
birth lipases of Propionibacterium acnes break
down sebaceous oils, liberating highly
Simplex type - defects of the basal cell irritating fatty acids and resulting in the
layer of the epidermis result from mutations earliest inflammatory phases of acne.
in the genes encoding keratins 14 or 5.
Junctional type - blisters occur in otherwise ROSACEA
histologically normal skin at precisely the is characterized by a nonspecific
level of the lamina lucida
perifollicular infiltrate composed of
lymphocytes surrounded by dermal
Scarring dystrophic types - blisters
edema and telangiectasia
develop beneath the lamina densa, in
a common disease of middle age and
association with rudimentary or defective
beyond
anchoring fibrils
Individuals with rosacea have high cutaneous
Dystrophic epidermolysis bullosa - is an
levels of the endogenous antimicrobial
inherited disease resulting from mutations in
peptide cathelicidin, an important
the COL7A1 gene that encodes type VII
mediator of the innate immune response
collagen
substances.
Four stages are recognized
(1) flushing episodes (pre-rosacea) Infection
(2) persistent erythema and VERRUCAE (WARTS)
telangiectasia caused by human papillomaviruses.
(3) pustules and papules Transmission of disease usually
(4) rhinophyma. involves direct contact between
individuals or auto-inoculation.
Panniculitis Verrucae are generally self-limited,
is an inflammatory reaction in the regressing spontaneously within 6
subcutaneous adipose tissue that may months to 2 years.
preferentially affect the connective
tissue septa separating lobules of fat Verruca vulgaris
or the lobules of fat themselves is the most common type of wart.
The lesions of verruca vulgaris occur
Erythema nodosum
anywhere but most frequently on the
the most common form of Panniculitis
hands, particularly on the dorsal
Presents as poorly defined, exquisitely surfaces and periungual areas, where
tender, erythematous plaques and they appear as gray-white to tan, flat
nodules that may be more readily to convex, 0.1- to 1-cm papules with a
palpated than seen. rough, pebble-like surface
Fever and malaise may accompany
the cutaneous signs.
Biopsy of a deep wedge of tissue to Verruca plana, or flat wart
generously sample the subcutis is is common on the face or the dorsal
usually required for histologic surfaces of the hands.
diagnosis. The warts are slightly elevated, flat,
smooth, tan papules that are generally
Erythema induratum smaller than verruca vulgaris.
is an uncommon type of panniculitis
that affects primarily adolescents and Verruca plantaris and verruca Palmaris
menopausal women occur on the soles and palms
presents as an erythematous, slightly
tender nodule that usually goes on to Condyloma acuminatum (venereal wart)
ulcerate Occurs on the penis, female genitalia,
urethra, perianal areas, and rectum.
Weber-Christian disease Venereal warts appear as soft, tan,
relapsing febrile nodular panniculitis cauliflower-like masses that
is a rare form of lobular, nonvasculitic occasionally reach many centimeters
panniculitis seen in children and in diameter
adults.
It is marked by crops of erythematous MOLLUSCUM CONTAGIOSUM
plaques or nodules, predominantly on is a common, self-limited viral disease
the lower extremities, created by of the skin caused by a poxvirus
deep-seated foci of inflammation with Lesions are firm, often pruritic, pink to
aggregates of foamy histiocytes skin-colored umbilicated papules
admixed with lymphocytes, generally ranging in diameter from 0.2
neutrophils, and giant cells. to 0.4 cm.
Rarely, giant forms occur measuring
Factitial panniculitis up to 2 cm in diameter.
Is a form of secondary panniculitis A curd-like material can be expressed
caused by self-inflicted trauma or from the central umbilication.
injection of foreign or toxic
IMPETIGO
Two forms exist, classically referred to
as impetigo contagiosa and
impetigo bullosa; they differ from
each other simply by the size of the
pustules.
involves exposed skin, particularly
that of the face and hands.
It presents as an erythematous
macule, but multiple small pustules
rapidly supervene.
characteristic clinical appearance of
honey-colored crust.
SUPERFICIAL FUNGAL INFECTIONS
confined to the stratum corneum, and
are caused primarily by
dermatophytes
Tinea capitis is a dermatophytosis of the
scalp characterized by asymptomatic, often
hairless patches of skin associated with mild
erythema, crust formation, and scaling.
Tinea barbae is a dermatophyte infection of
the beard area that affects adult men
Tinea cruris occurs most frequently in the
inguinal areas of obese men during warm
weather
Tinea pedis (athlete's foot)
Tinea versicolor usually occurs on the
upper trunk and is highly distinctive in
appearance. Caused by Malassezia furfur, a
yeast rather than a dermatophyte.
