Pathology
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Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
Index
Contents
Authors
ExpSys: non-tumors
ExpSys: tumors
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+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Psoriasis
Introduction

Chronic disease with multiple recurrences, affecting 1 – 2% of Western population. Severity variable (from several patches to severe exfoliation).

Etiology

Unknown, multifactorial, genetic, autoimmune. Trigger factors: stress, infections, drugs and other.

Pathogenesis

Abnormal cellular proliferation of keratinocytes; proliferation is not limited to basal layer; mitotic rate is many times higher than in normal skin.

T-cells mediated inflammation.

Clinical signs
  • acute (guttate) psoriasis: generalized symmetric eruption
  • chronic psoriasis: the elbows, knees, scalp, sacral region, palmoplantar psoriasis
  • psoriasis inversa: mostly intertriginous localization, psoriasis pustulosa: the palms, soles or generalized eruption
  • psoriatic papule with silvery hyperkeratosis
  • pustules in psoriasis pustulosa
  • papules coalesce in round marginated lesions sometimes resembling geographical maps
  • nail changes (pits, oil spots, subungual hyperkeratosis); more on nail changes in psoriasis see the corresponding chapter
  • changes of the genital and oral mucosa, heavy scaling in the scalp
  • Köbner's phenomenon in acute phase
  • healing with temporary depigmentation: leukoderma
  • psoriatic arthropathy, hepatopathy
  • onset at any age, peak in adolescence
  • Auspitz's sign: pinsize hemorrhage from the elongated capillaries after the removal of the scales (thinned epidermis)

Chronic psoriasis, forearm (887)

Chronic psoriasis, plaque (3278)

Chronic psoriasis, nails (1121)

Köbner phenomenon (1120)

Psoriatic arthropathy (2809)

Psoriasis capillitii (3274)

Psoriasis, hairline (1111)

Psoriasis (1113)

Pictures

Psoriasis vulgaris: Psoriasis, Clinical picture (886)

Psoriasis vulgaris chronica: Psoriasis, Clinical picture (887)

Psoriasis vulgaris chronica exacerbans: Psoriasis, Clinical picture (888)

Psoriasis vulgaris chronica: Psoriasis, Clinical picture (889)

Psoriasis vulgaris chronica: Psoriasis, Clinical picture (890)

Psoriasis vulgaris: Psoriasis, Clinical picture (893)

Psoriasis vulgaris: Psoriasis, Clinical picture (1111)

Psoriasis chronica: Psoriasis, Clinical picture (1112)

Psoriasis chronica: Psoriasis, Clinical picture (1113)

Psoriasis vulgaris: Psoriasis vulgaris, Clinical picture (5846) Psoriasis vulgaris, Clinical picture (5847) Psoriasis vulgaris, Clinical picture (5848) Psoriasis vulgaris, Clinical picture (5849)

Psoriasis, detail: Psoriasis, Clinical picture (1114)

Psoriasis vulgaris: Psoriasis vulgaris, Clinical picture (3277) Psoriasis vulgaris, Clinical picture (3278) Psoriasis vulgaris, Clinical picture (3279)

Psoriasis guttata: Psoriasis, Clinical picture (1117)

Psoriasis guttata: Psoriasis, Clinical picture (1118)

Psoriasis guttata: Psoriasis vulgaris guttata, Clinical picture (3275) Psoriasis vulgaris guttata, Clinical picture (3276)

Psoriasis inversa: Psoriasis, Clinical picture (1119)

Psoriasis, Köbner's sign: Psoriasis, Clinical picture (1120)

Psoriasis of the nails (onycholysis, pits): Psoriasis, Clinical picture (1121)

Psoriasis chronica: Psoriasis, Clinical picture (1122)

Palmar psoriasis: Psoriasis, Clinical picture (1115)

Psoriasis palmaris, palms: Psoriasis, Clinical picture (894)

Plantar psoriasis, plantar: Psoriasis, Clinical picture (892)

Psoriasis geographica, psoriatic arthropathy: Psoriasis vulgaris, arthropatia psoriatica, psoriasis geographica, Clinical picture (2808) Psoriasis vulgaris, arthropatia psoriatica, psoriasis geographica, Clinical picture (2809) Psoriasis vulgaris, arthropatia psoriatica, psoriasis geographica, Clinical picture (2810) Psoriasis vulgaris, arthropatia psoriatica, psoriasis geographica, Clinical picture (2811) Psoriasis vulgaris, arthropatia psoriatica, psoriasis geographica, Clinical picture (2812) Psoriasis vulgaris, arthropatia psoriatica, psoriasis geographica, Clinical picture (2813)

Psoriasis, scalp: Psoriasis vulgaris capilitii, Clinical picture (3274)

Psoriasis inveterata: Psoriasis vulgaris inveterata, Clinical picture (3281) Psoriasis vulgaris inveterata, Clinical picture (3282) Psoriasis vulgaris inveterata, Clinical picture (3283) Psoriasis vulgaris inveterata, Clinical picture (3284) Psoriasis vulgaris inveterata, Clinical picture (3285)

Psoriasis, penis: Psoriasis vulgaris, penis, Clinical picture (3291) Psoriasis vulgaris, penis, Clinical picture (3292) Psoriasis vulgaris, Macro (3933) Psoriasis vulgaris, Macro (3937) Psoriasis vulgaris, Macro (3931)

Psoriatic arthropathy: Psoriasis vulgaris, arthropathy, Macro (3707) Psoriasis vulgaris, arthropathy, Macro (3708) Psoriasis vulgaris, arthropathy, Macro (3709) Psoriasis vulgaris, arthropathy, Macro (3710)

Further examples of psoriasis:

Histology

The picture of the developed lesion of the most common variant is quite typical:

  • thickened epidermis with regular, club shape acanthosis
  • dermal papillae richly vascularized, close to the surface
  • hyperkeratosis, parakeratosis
  • decreased or disappeared stratum granulosum
  • ectatic, proliferating and tortuous capillaries of dermal papillae
  • neutrophils trapped in the stratum corneum (Munro microoabscesses)

Psoriasis vulgaris (48)

Psoriasis vulgaris (50)

Munroův mikroabsces (55)

Psoriasis (10885)

Psoriasis (10896)

Psoriasis (13682)

Pictures

Psoriasis: Psoriasis vulgaris, HE 20x (44) Psoriasis vulgaris, HE 20x (45) Psoriasis vulgaris with hyperkeratosis, HE 10x (48) Psoriasis vulgaris with hyperkeratosis, HE 20x (49)

Another case: Psoriasis vulgaris, early, HE 10x (50) Psoriasis vulgaris, early, HE 20x (51) Psoriasis vulgaris, early, HE 40x (52) Psoriasis vulgaris, HE 10x (46) Psoriasis vulgaris, HE 20x (47)

Another case: Psoriasis vulgaris, HE 10x (600) Psoriasis vulgaris, HE 40x (601)

Another case of psoriasis: Psoriasis vulgaris, HE 40x (4149) Psoriasis vulgaris, HE 40x (4150)

Another case of psoriasis: Psoriasis vulgaris, HE 40x (4152)

Psoriasis: Psoriasis vulgaris, HE 20x (5249)

Psoriasis: Psoriasis vulgaris, HE 60x (13682)

Psoriasis vulgaris, scalp: Psoriasis vulgaris, HE 60x (14315)

Early psoriasis without developed acanthosis: Psoriasis guttata, HE 20x (53) Psoriasis, early, HE 20x (54)

Intracorneal collections of neutrophils — Munro microabscesses: Psoriasis, Munro abscess, HE 40x (55)

Psoriasis vulgaris: Psoriasis vulgaris, HE 60x (10885) Psoriasis vulgaris, HE 60x (10886)

Psoriasis vulgaris: Psoriasis vulgaris, HE 60x (10896)

Psoriasis vulgaris: Psoriasis vulgaris, HE 20x (13244)

Psoriasis vulgaris: Psoriasis vulgaris, HE 40x (12632)

Psoriasis vulgaris: Psoriasis vulgaris, HE 40x (12633)

Psoriasis inversa: Psoriasis inversa, HE 40x (10897)

Psoriasis vulgaris: Psoriasis vulgaris, HE 40x (10921)

Psoriasis vulgaris: Psoriasis vulgaris, HE 60x (12121)

Case of chronic eczematoid dermatitis turning into psoriasis: Chronic eczem dermatitis, HE 60x (14046) Chronic eczem dermatitis, HE 60x (14047) Psoriasis vulgaris early, HE 60x (14209)

Psoriatic erytroderma
Palmoplantar psoriasis and palmoplantar pustulosis
Generalized pustular psoriasis of Zumbusch
Lingua geographica
Psoriatiform keratosis