cpc final kurban nov 2009

8/8/2019 CPC Final Kurban Nov 2009

1/84


2/84

CPCCPC

KURBANKURBAN

MUHAMMAD KHAWAR NAZIRMUHAMMAD KHAWAR NAZIR

1111--0909--0909


3/84

CASE1

CASE1


4/84


5/84


6/84


7/84


8/84

FoamyFoamy histiocyteshistiocytes laden with intracellular fatdeposits primarily withinladen with intracellular fatdeposits primarily withinthe upper reticular dermisthe upper reticular dermis


9/84


10/84

XANTHOMA CELLSXANTHOMA CELLS


11/84

Foamcells in dermis ( positive for lipid withFoamcells in dermis ( positive for lipid with

special stains such asspecial stains such as OILOIL REDRED--O STAINO STAIN


12/84

XANTHELASMAXANTHELASMA

derived from the Greekderived from the Greek xanthosxanthos(yellow) and(yellow) and elasmaelasma (beaten metal(beaten metalplate).plate).

Yellow plaquesthatoccur mostcommonlynear the inner canthusofYellow plaquesthatoccur mostcommonlynear the inner canthusofthe eyelid,more oftenon the upper lid than the lower lidthe eyelid,more oftenon the upper lid than the lower lid

Xanthelasma palpebrarum is the mostcommoncutaneousXanthelasma palpebrarum is the mostcommoncutaneousxanthoma.xanthoma.

canbe soft,semisolid,or calcareouscanbe soft,semisolid,or calcareous One halfof these lesionsare associated with elevated plasma lipidOne halfof these lesionsare associated with elevated plasma lipid

levelslevels Occurs in individuals> 50yrsOccurs in individuals> 50yrs

Inchildrenor young adults, associated with familialInchildrenor young adults, associated with familialhypercholestrolemiaor familial dysbetalipidemiahypercholestrolemiaor familial dysbetalipidemia

Management: Laser, excision, Electrodesiccation, topical applicationManagement: Laser, excision, Electrodesiccation, topical applicationof trichloroacetic acidof trichloroacetic acid


13/84

CASE2


14/84


15/84


16/84


17/84


18/84


19/84

VariableVariable epidermalepidermal spongiosisspongiosis or necrosis, Intense papillarydermalor necrosis, Intense papillarydermaledema, superficial anddeepedema, superficial anddeep perivascularperivascular lymphocytic infiltrate,lymphocytic infiltrate,


20/84

FluffyFluffy edema"of vessel walls. Lymphocyticedema"of vessel walls. Lymphocytic vasculitisvasculitis may be presentmay be present


21/84

PERNIOPERNIO

Inflammatory skin condition presentingafter exposure tocoldasInflammatory skin condition presentingafter exposure tocoldaspruriticpruritic and/or painfuland/or painful erythematouserythematous toto violaceousviolaceous acralacral lesionslesions

idiopathicor secondary toan underlyingdisease, likeidiopathicor secondary toan underlyingdisease, like ChronicChronicmyelomonocyticmyelomonocytic leukemia, Anorexia nervosa,leukemia, Anorexia nervosa, DysproteinemiasDysproteinemias,, MacroglobulinemiaMacroglobulinemia,,CryoglobulinemiaCryoglobulinemia,,cryofibrinogenemiacryofibrinogenemia,coldagglutinins,,coldagglutinins, AntiphospholipidAntiphospholipid antibodyantibody

syndrome,Raynaudsyndrome,Raynaud diseasedisease

due toan abnormal vascular response tocold exposure and is mostdue toan abnormal vascular response tocold exposure and is mostfrequent when damp or humidconditions coincidefrequent when damp or humidconditions coincide

Prophylactic warmingofProphylactic warmingofacralacral areas,achieved by heatandareas,achieved by heatandappropriate clothing,appropriate clothing, preventsprevents perniopernio

TTopicalopical and systemic steroids, vasodilators, IVcalcium followed byand systemic steroids, vasodilators, IVcalcium followed by

IM vitamin K,and ultraviolet B radiationIM vitamin K,and ultraviolet B radiation Calcium channel blockersCalcium channel blockers Peripheral arterial vasodilatorsPeripheral arterial vasodilators


22/84

DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS

ErythemaErythema MultiformeMultiforme

HypersensitivityHypersensitivityVasculitisVasculitis((LeukocytoclasticLeukocytoclastic VasculitisVasculitis))

SarcoidosisSarcoidosis


23/84

CASE3


24/84


25/84


26/84


27/84


28/84


29/84

AAllll show a similarshow a similar histologichistologic appearanceappearance ,,perivascularperivascular infiltrate of lymphocytesinfiltrate of lymphocytes

andmacrophages is centeredon the superficial small blood vessels of the skin,andmacrophages is centeredon the superficial small blood vessels of the skin,

endothelial cell swellingand narrowingofendothelial cell swellingand narrowingof luminalumina,,


30/84

Extravasation of red bloodcells with marked hemosiderin deposition inExtravasation of red bloodcells with marked hemosiderin deposition inmacrophagesmacrophages


31/84

SCHAMBERG,S DISEASESCHAMBERG,S DISEASE


32/84

LICHEN AUREUSLICHEN AUREUS


33/84

PIGMENTED PURPURIC DERMATOSISPIGMENTED PURPURIC DERMATOSIS

GroupGroup ofchronicdiseases ofmostly unknown etiology that have a veryofchronicdiseases ofmostly unknown etiology that have a verydistinctive clinical appearancedistinctive clinical appearance

CharacterizedCharacterized byby extravasationextravasation of erythrocytes in the skin with markedof erythrocytes in the skin with markedhemosiderinhemosiderin depositiondeposition

characteristicorangecharacteristicorange--brown, speckled,cayenne pepperbrown, speckled,cayenne pepperlike discolorationlike discoloration IIncludesncludes SchambergSchamberg disease (disease (ieie, progressive, progressive pigmentarypigmentary dermatosisdermatosis),),purpurapurpura annularisannularis telangiectodestelangiectodes ((MajocchiMajocchi disease), lichendisease), lichen aureusaureus, itching, itchingpurpurapurpura,, eczematidlikeeczematidlike purpurapurpura ofof DoucasDoucas andand KapetanakisKapetanakis,and the,and thepigmentedpigmented purpuricpurpuric lichenoidlichenoid dermatosisdermatosis ofof GougerotGougerotand Blumand Blum

LLlowerlower limbs are affected inlimbs are affected in SchambergSchamberg diseasedisease LLichenichen aureusaureus, the eruption is usuallya solitary lesion or a localizedgroup, the eruption is usuallya solitary lesion or a localizedgroup

of lesionsof lesions MajocchiMajocchi diseasedisease isis characterized by small annular plaques ofcharacterized by small annular plaques ofpurpurapurpura that contain prominentthat contain prominent telangiectasiatelangiectasia

PigmentedPigmented purpurapurpura withwith lichenoidlichenoid--typetype skin change is yet anotherskin change is yet anotherclinical variant, whichclinical variant, which GougerotGougerot and Blumand Blum first reported.first reported.


34/84

CAYENNE PEPPERCAYENNE PEPPER


35/84

DIFFERENTIALDIFFERENTIAL

ScurvyScurvy Other Problems to Be ConsideredOther Problems to Be Considered earlyearly cutaneous Tcutaneous T--cell lymphomacell lymphoma purpuricclothingdermatitispurpuricclothingdermatitis stasis pigmentation, scurvystasis pigmentation, scurvy leukocytoclastic vasculitisleukocytoclastic vasculitis purpuricgeneralized lichen nitiduspurpuricgeneralized lichen nitidus

drug hypersensitivity reactions (eg,allergy to rituximab,drug hypersensitivity reactions (eg,allergy to rituximab,carbamazepine,meprobamate,chlordiazepoxide,carbamazepine,meprobamate,chlordiazepoxide,furosemide, nitroglycerin,or vitamin Bfurosemide, nitroglycerin,or vitamin B--1).1,2,3,4,1).1,2,3,4,


36/84

CASE4


37/84


38/84


39/84


40/84


41/84


42/84

interface dermatitis,difficult todifferentiate from lupus erythematosus ,interface dermatitis,difficult todifferentiate from lupus erythematosus ,


43/84

DERMATOMYOSITISDERMATOMYOSITIS

idiopathic inflammatoryidiopathic inflammatorymyopathymyopathy (IIM) with characteristic(IIM) with characteristiccutaneouscutaneous findingsfindings

systemicdisorder that frequentlyaffects the joints, the esophagus,systemicdisorder that frequentlyaffects the joints, the esophagus,the lungs,and, less commonly, the heartthe lungs,and, less commonly, the heart

pathognomonicpathognomonic features are the heliotrope rash andfeatures are the heliotrope rash and GottronGottronpapulespapules PoikilodermaPoikiloderma mayoccur on exposed skin, such as the extensormayoccur on exposed skin, such as the extensor

surfaces of the arm, the Vofsurfaces of the arm, the Vof the neck ,the neck ,or the upper partof theor the upper partof theback (Shawl sign).back (Shawl sign).

PoikilodermaPoikiloderma mayoccur on exposed skinmayoccur on exposed skin cause ofcause ofdermatomyositisdermatomyositis is unknownis unknown genetic predisposition may existgenetic predisposition may exist Infectious agents, including viruses (particularlyInfectious agents, including viruses (particularlycoxsackieviruscoxsackievirus,,

echovirus, human Techovirus, human T--lymphotropiclymphotropic virus 1 [HTLVvirus 1 [HTLV--1],and human1],and humanimmunodeficiency virus [HIV]),immunodeficiency virus [HIV]), ToxoplasmaToxoplasma species,andspecies,and BorreliaBorrelia

species, have been suggestedas possible triggers of the disease.species, have been suggestedas possible triggers of the disease.


44/84

DIFFERENTIALDIAGNOSISDIFFERENTIALDIAGNOSIS

CREST SyndromeCREST Syndrome ParapsoriasisParapsoriasis GraftVersus Host DiseaseGraftVersus Host Disease Pityriasis Rubra PilarisPityriasis Rubra Pilaris

Lichen MyxedematosusLichen Myxedematosus Polymorphous Light EruptionPolymorphous Light Eruption Lichen PlanusLichen Planus Psoriasis, PlaquePsoriasis, Plaque Lupus Erythematosus, AcuteLupus Erythematosus, Acute RosaceaRosacea

Lupus Erythematosus, DiscoidLupus Erythematosus, Discoid SarcoidosisSarcoidosis Lupus Erythematosus, Subacute CutaneousLupus Erythematosus, Subacute Cutaneous Tinea CorporisTinea Corporis MorpheaMorphea Urticaria, ChronicUrticaria, Chronic

Multicentric ReticulohistiocytosisMulticentric Reticulohistiocytosis


45/84

CASE5


46/84


47/84


48/84


49/84

ADIPOCYTESADIPOCYTES


50/84


51/84

LIPOMASLIPOMAS

A benign neoplasmofadipocytes that forms in the subcutaneous fatA benign neoplasmofadipocytes that forms in the subcutaneous fat(as well as in other organs sometimes)(as well as in other organs sometimes)

manifests itselfclinicallyas either an elevated tumor or a tumor thatmanifests itselfclinicallyas either an elevated tumor or a tumor thatcannot be visualizedclinically, but thatcan be palpated,cannot be visualizedclinically, but thatcan be palpated,

the skin overlying it in both circumstances being normalthe skin overlying it in both circumstances being normal A lipoma,once it presents itself, remains there for the lifetime ofaA lipoma,once it presents itself, remains there for the lifetime ofaperson whocarries it.person whocarries it.

Itmay stay small or become larger, sometimes assuminggiganticItmay stay small or become larger, sometimes assuminggiganticdimensionsdimensions

benign neoplasmmade up ofadipocytes,benign neoplasmmade up ofadipocytes,

Surgical excision is curative ifa patient wants surgery for a notSurgical excision is curative ifa patient wants surgery for a not--tootoo--large tumor. For those lipomas thatare too large to be excised,large tumor. For those lipomas thatare too large to be excised,liposuction may be employedliposuction may be employed


52/84

DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS

sebaceous cystsebaceous cyst abscessabscess

LiposarcomasLiposarcomas


53/84

CASE6


54/84


55/84


56/84


57/84

SYPHILITIC CHANCRESYPHILITIC CHANCRE


58/84

PLASMA CELLSPLASMA CELLS


59/84

SYPHILLISSYPHILLIS

Treponema pallidumTreponema pallidum is the microaerophilic spirochete thatcauses syphilis, ais the microaerophilic spirochete thatcauses syphilis, achronic systemic venerealdisease with multiple clinicalpresentationschronic systemic venerealdisease with multiple clinicalpresentations

Syphilis is characterized by episodes of active disease (primary, secondary,Syphilis is characterized by episodes of active disease (primary, secondary,tertiary stages) interrupted byperiods oflatency.tertiary stages) interrupted byperiods oflatency.

Primary syphilis occurs within3 weeks ofcontact with aninfectedindividualPrimary syphilis occurs within3 weeks ofcontact with aninfectedindividual Secondary syphilis usuallypresents with acutaneous eruptionwithin2Secondary syphilis usuallypresents with acutaneous eruptionwithin2--1010

weeks after the primarychancre andis most florid 3weeks after the primarychancre andis most florid 3--4 months after4 months afterinfectioninfection

lesions of benigntertiary syphilis usually developwithin3lesions of benigntertiary syphilis usually developwithin3--10 years of10 years ofinfectioninfection

primarylesion(chancre) occurs onthe penis orscrotum of 70% of menprimarylesion(chancre) occurs onthe penis orscrotum of 70% of menwith syphilis and on the vulva,cervix, orperineum of more than50% ofwith syphilis and on the vulva,cervix, orperineum of more than50% ofwomenwith syphilis.womenwith syphilis.

single ulceratedlesionwith a surroundingred areola. The edge and base ofsingle ulceratedlesionwith a surroundingred areola. The edge and base ofthe ulcerhave acartilaginous (buttonlike) consistency onpalpation.the ulcerhave acartilaginous (buttonlike) consistency onpalpation.


60/84

Differential DiagnosisDifferential Diagnosis

ChancroidChancroid Herpes SimplexHerpes Simplex

LymphogranulomaVenereumLymphogranulomaVenereum Erosive balanitisErosive balanitis Traumatic superinfected lesionsTraumatic superinfected lesions


61/84

CASE7


62/84


63/84


64/84


65/84


66/84


67/84

PerivascularPerivascular andand perijunctionalperijunctional infiltrate of lymphocytes, plasmacells,andinfiltrate of lymphocytes, plasmacells,andmacrophagesmacrophages


68/84


69/84


70/84


71/84


72/84


73/84

DISCOID LUPUS ERYTHEMATOUSDISCOID LUPUS ERYTHEMATOUS

chronic, scarring,atrophy producing,chronic, scarring,atrophy producing,photosensitivephotosensitive dermatosisdermatosis..

primary lesion is anprimary lesion is an erythematouserythematous papule orpapule orplaque with slightplaque with slight--toto--moderate scalingmoderate scaling Resolution of the active lesion results in atrophyResolution of the active lesion results in atrophy

and scarring.and scarring.

Therapy with sunscreens, topical corticosteroids,Therapy with sunscreens, topical corticosteroids,andandantimalarialantimalarial agents is usually effective.agents is usually effective.


74/84

DIFFERENTIALDIAGNOSISDIFFERENTIALDIAGNOSIS

ActinicActinic KeratosisKeratosis Psoriasis, PlaquePsoriasis, Plaque DermatomyositisDermatomyositis RosaceaRosacea

GranulomaGranulomaAnnulareAnnulare SarcoidosisSarcoidosis GranulomaGranuloma FacialeFaciale SquamousSquamous Cell CarcinomaCell Carcinoma KeratoacanthomaKeratoacanthoma

SyphilisSyphilis LichenLichen PlanusPlanus Warts,Warts, NongenitalNongenital LupusLupus ErythematosusErythematosus,, SubacuteSubacute CutaneousCutaneous


75/84

CASE8


76/84


77/84


78/84


79/84


80/84


81/84


82/84

POLYMORPHOUS LIGHT ERUPTIONPOLYMORPHOUS LIGHT ERUPTION

an acquireddisease and is the mostcommon of the idiopathican acquireddisease and is the mostcommon of the idiopathicphotodermatosesphotodermatoses

characterized by recurrent,abnormal,delayed reactions to sunlight,characterized by recurrent,abnormal,delayed reactions to sunlight,ranging from erythematous papules, papulovesicles,and plaques toranging from erythematous papules, papulovesicles,and plaques toerythemamultiformeerythemamultiformelike lesions on sunlightlike lesions on sunlight--exposed surfaces.exposed surfaces.

Within any 1 patient,only 1 clinical form is consistentlymanifestedWithin any 1 patient,only 1 clinical form is consistentlymanifested Papules (greatest incidence), plaques, papulovesicles,and erythemaPapules (greatest incidence), plaques, papulovesicles,and erythema

multiformemultiformelike lesions are the mostcommon morphologieslike lesions are the mostcommon morphologies Prophylactic phototherapyor photochemotherapyat the beginningProphylactic phototherapyor photochemotherapyat the beginning

of spring for several weeks may prevent flareof spring for several weeks may prevent flare--ups throughout theups throughout thesummersummer

Topical corticosteroidsTopical corticosteroids Antimalarials at low doses are sometimes helpfulAntimalarials at low doses are sometimes helpful Nicotinamide , AzathioprineNicotinamide , Azathioprine


83/84

Differential DiagnosesDifferential Diagnoses

Contact Dermatitis, AllergicContact Dermatitis, Allergic

Lupus Erythematosus, SubacuteLupus Erythematosus, SubacuteCutaneousCutaneous


84/84

THANK YOUTHANK YOU

cpc final kurban nov 2009

Documents