INTRODUCTION TO AND
HISTOPATHOLOGY OF:
* HERPES
* MOLLUSCUM CONTAGIOSUM
* WARTS
* PITYRIASIS ROSEA
PRESENTATION BY: DR JALIL PGR DERMATOLOGY.
SKIN IS THE LARGEST ORGAN OF OUR BODY , COMPRISES
OF ABOUT 16% OF BODY WEIGHT .
SKIN CONSIST OF 3 LAYERS
• EPIDERMIS
• DERMIS
• SUBCUTIS OR PANNICULUS
SKIN DERMIS
EPIDERMIS FOLDS INTO THE DERMIS IN THE FORM OF
DOWN GROWTHS CALLED RETE RIDGES, WHILE DERMAL
PAPILLAE PROJECT AS FINGER-LIKE PROCESSES, UP INTO THE
EPIDERMIS IN BETWEEN RETE RIDGES AS DERMAL PAPILLAE.
DERMIS CONSISTS OF TWO PARTS:
• PAPILLARY DERMIS: IT IS LOCATED JUST BENEATH
EPIDERMIS, AND CONSISTS OF LOOSE AREOLAR TISSUE,
SUPERFICIAL CAPILLARIES, AND NERVE ENDINGS.(1:10)
• RETICULAR DERMIS: IT IS THE LOWER PART OF DERMIS
AND CONSISTS OF DENSE COLLAGEN FIBERS, ELASTIC
FIBERS, ARTERIOLES, VENULES, AND APPENDAGES.(9:10)
SKIN
SUBCUTIS
• THE PANNICULUS OR SUBCUTIS CONSISTS OF
SUBCUTANEOUS FAT. THE FAT IS ARRANGED IN LOBULES
SEPARATED FROM EACH OTHER BY SEPTAE. THE SEPTAE
CONTAIN BLOOD VESSELS, LYMPHATICS, AND NERVE FIBERS.
SKIN ABNORMALITIES
HYPERKERATOSIS:
THICKENING OF STRATUM CORNIUM TO MORE THEN ONE THIRD OF TOTAL THICKNESS OF
EPIDERMIS.
PARAKERATOSIS:
RETENTION OF NUCLEUS IN STRATUM CORNIUM. WHICH IS NORMALLY ABSENT IN STRATUM
CORNIUM.
SIGN OF EPIDERMIS GROWING QUICKLY
DYSKERATOSIS:
DYSKERATOSIS IS THE PRESENCE OF PREMATURE OR ALTERED/ ABNORMAL KERATINOCYTE
DIFFERENTIATION.
SPONGIOSIS:
EXTRACELLULAR ACCUMULATION OF FLUID IN STRATUM SPINOSUM. SEEN IN ACUTE
ECZEMA.
BALLOONING:
INTRACELLULAR ACCUMULATION OF FLUID IN STRATUM SPINOSUM. SEEN IN ACUTE
ECZEMA.
•INTRACELLULAR FLUID CAN BE NOTICED BY
VISIBLE INTERCELLULAR
BRIDGES(DESMOSOMES).SPONGIOSIS
SKIN
ABNORMALITIES
ACANTHOSIS:
• DIFFUSE EPIDERMAL HYPERPLASIA CAUSED BY THE INCREASED
THICKNESS OF THE STRATUM SPINOSUM CONSTITUTED BY THE PRICKLE
CELLS.
ACANTHOLYSIS:
• SEPERATION OF KERATINOCYTE DUE TO DEFECT DESMOSOME IS
CALLED ACANTHOLYSIS..
• NORMAL SHAPE OF KERATINOCYTE IS POLYGONAL BUT IN
ACANTHOLYSIS THEY LOOK LIKE OVAL SHAPE..MOST OF SHAPE OF
PORTION OF CELL OCCUPIED BY NUCLEUS ALMOST 7/8 PORTION AND
CYTOPLASM CONDENSED AT PERIPHERY GIVING APPEARANCE OF
PERINUCLEAR HALO.SACH CELL ARE CALLED ACANTHOLYTIC CELLS.
HYPERGRANULOSIS:
• THICKENING OF STRATUM GRANULISUM..SEEN IN LP.
• WEDGE SHAPED HYPERGRANULOSIS..
• NET LIKE PATTERNS SEEN IN LP WHICH ARE DUE TO HYPERGRANULOSIS
IN THE LESION.
ANGRANULOSIS:
• ABSENCE OF STRATUM GRANULOSUM..SEEN IN PSORIASIS AND
ICTHYOSIS VULGARIS.
HERPES SIMPLEX
• HERPES SIMPLEX BELONGS TO HUMAN HERPES
VIRUS ALPHA FAMILY.
• THIS IS DNA VIRUS REPLICATE IN NUCLEUS .
• SPECIFIC PROPERTY
• LATENCY. THEY ENTER BODY OF HOST CAUSE
PRIMARY INFECTION AFTER THAT THEY STAYED
DORMANT OR LATENT IN CERTAIN CELLS IN
BODY ,UPON REACTIVATION DUE TO TRIGGERS
THEY CAUSE SECONDARY ERUPTIONS.
• PRIMARY LESION
• VESICLE. DUE TO BALLOONING DEGENERATION
OF KERATINOCYTE
HERPES SIMPLEX
• BALLOONING DEGENERATION OF
KERATINOCYTES
• MULTINUCLEATED EPITHELOID GIANT CELL
• INTRANUCLEAR INCLUSION BODIES
• INTRADERMAL MONONUCLEAR INFILTRATES
BENEATH THE VESICLE
HERPES HERPES ZOSTER:
• BALLOONING DEGENERATION OF KERATINOCYTES
• MULTINUCLEATED EPITHELOID GIANT CELLS
• INTRANUCLEAR INCLUSION BODIES
• INTRADERMAL MONONUCLEAR INFILTRATES
• RETICULAR DEGENERATION IN UPPER LAYERS OF
EPIDERMIS
MOLLUSCUM
CONTAGIOSUM
• VIRUS IS MOLLUSCI POX VIRUS.
• FAMILY POXVIRIDAE
TYPE 1: CAUSE DISEASE IN
CHILDREN INVOLVING TRUNK,
EXTREMITIES AND AXILLA.
TYPE 2: ADULT AND HIV PATIENTS .
• SITES ARE LOWER
ABDOMEN,THIGH,GENITALS ,PERIA
NAL AND FACE.
C/F:
• PEARLY WHITE DOME SHAPED
PAPULES WITH CENTRAL
UMBILICATION.
HISTOPATHOLOGY OF MC
• EPIDERMIDIS CHANGES IN EPIDERMIS.
• LOBULATED GROWTH OF EPIDERMIS INTO
DERMIS.
• EOSINOPHILIC INCLUSION BODIES IN THE
EPIDERMIS.THESE ARE INTRACYTOPLASMIC IN
LOCATION AND CALLED HENDERSON
PATTERSON BODIES
• THESE ARE LARGEST INCLUSION BODIES AS
MOLLUSCUM IS THE LARGEST VIRUS.
• WARTS ARE GENERALLY A SMALL ,ROUGH
GROWTH,TYPICALLY ON THE HUMAN HANDS
OR FEETS BUT OFTEN ON OTHER
LOCATIONS,THAT CAN RESEMBLE A
CAULIFLOWER OR SOLID BLISTER.
WHAT ARE • CAUSATIVE AGENT: HPV (DOUBLE STRANDED
DNA VIRUS)
WARTS? • MODE OF TRANSMISSION:SEXUALLY
TRANSMITTED DISEASE(GENITAL WARTS)
AND DIRECT CONTACT (COMMON WARTS)
• PORTAL OF ENTRY :SKIN
TYPES OF WARTS:
COMMON WARTS, PLANTAR WARTS, PLANE
WARTS, PERIUNGUAL WARTS, FILIFORM WARTS,
ANOGENITAL WARTS, DIGITATE WARTS AND
BUTCHERS WARTS
PLANE WARTS (VERRUCA PLANA):
1. MINIMAL HYPERKERATOSIS
WARTS 2. PARAKERATOSIS
3. DIFFUSE VACUOLATION OF KERATINOCYTE
CONDYLOMA ACUMINATUM:
1. ACANTHOSIS: HYPERKERATOSIS IS NOT
SIGNIFICANT
2. PARAKERATOSIS
3. KOILOCYTOSIS
VERRUCA VULGARIS:
• HYPERKERATOSIS
• . VERTICAL PARAKERATOSIS
• HYPERGRANULOSIS
• BASOPHILIC INCLUSIONS IN THE KERATINOCYTES-
THE INCLUSION BODIES DO NOT DISPLACE THE
NUCLEUS, UNLIKE IN MOLLUSCUM CONTAGIOSUM
• KOILOCYTES
WARTS • ARCHITECTURE OF THE LESION: THE LESION IS
FLOWER SHAPED WITH INCURVING OF THE RETE AT
THE MARGINS
• MONONUCLEAR INFILTRATE
PLANTAR WARTS (VERRUCA PLANTARIS):
THE CHARACTERISTIC FEATURE IS PRONOUNCED IN
VACUOLATION OF CELLS. CELLS APPEAR CLEAR AND
SIMILAR TO EPIDERMOLYTIC HYPERKERATOSIS.
•HYPERKERATOSIS,
PAPILLOMATOSIS,
HYPERGRANULOSIS ,
KOILOCYTOSIS AND
INWARD BENDING OF
RETE RIDGES AT BORDERS
OF LESION. DERMAL
PAPILLAE SHOW DILATED
CAPILLARIES.
PAPILLOMATOSIS EPIDERMIS WITH PULLING OF RETE
RIDGES AT EDGE OF LESION.
• P. ROSEA IS AN ACUTE SELF LIMITING DISEASE,
PROBABLY INFECTIVE IN ORIGIN, AFFECTING
MAINLY CHILDREN AND YOUNG ADULTS
MANIFESTED USUALLY BY APPEARANCE OF THE
HERALD PATCH. WHICH IS LARGER AND MORE
CONSPICUOUS THAN THE LESIONS OF THE
LATER ERUPTION, IS A SHARPLY DEFINED
ERYTHEMATOUS TO DULL PINK ROUND OR
PITYRIARIS OVAL PLAQUE COVERED BY FINE DRY SILVERY-
GRAY SCALES. THE CENTRE TENDS TO CLEAR
ROSEA AND ASSUMES WRINKLED, ATROPHIC
APPEARANCE WITH A MARGINAL COLLARETTE
OF SCALES ATTACHED PERIPHERALLY.
• INVOLVEMENT OF TWO HERPES VIRUSES HHV6
AND HHV7 HAS BEEN SUGGESTED..
• DIAGNOSIS: IS MAINLY MADE ON CLINICAL
GROUNDS BUT WHEN UNCERTAINTY SKIN
BIOPSY HELP TO DISTINGUISH.
•HISTOPATHOLOGY
•PATCHY PARAKERATOSIS
WITH PERIPHERAL ZONE
OF NORMAL EPI.
•UNDERLYING SPONGIOSIS
AND VESICLE FORMATION.
•THERE IS ABSENCE OR
DECREASE IN GRANULAR
CELL LAYER.
•ACANTHOSIS
•PRESENCE OF RBCS IN
DERMIS INFLAMMATORY
INFILTRATE AND PAPILLARY
EDEMA.
PITYRIARIS ROSEA
(1) PATCHY EPIDERMAL
SPONGIOSES & LYMPHOCYTES
(2) LYMPHOCYTES
SURROUNDING DERMAL
VESSELS
(3) EXTRAVASATED RED
BLOOD CELLS
(4) PATCHY HYPERKERATOSIS
& PARAKERATOSIS
•MILD
ACANTHOSIS ,SPONGIOSIS,PE
RIVASCULAR SUPERFICAL
LYMPHOCYTIC INFILTRATE
WITH OVERLYING MOUNDS OF
PARAKERATOSIS
THANK YOU
