LAB.

ACTIVITY 7

Immune complex mediated skin diseases and inflammatory skin disorders

GE E!I! "#LABORATORIUM ACTIVITY

$soriasis %ul&aris $ustular psoriasis $emp'i&us %ul&aris $emp'i&us foleaceus Bullous pemp'i&oid (ermatitis !e)orr'eic keratosis Eryt'ema *ultiforme !u)corneal pustular dermatosis Lupus Eryt'ematosus

Psoriasis vulgaris

Clinical data + A ,-.year old male presents to your office /it' )ro/nis' red papules and pla0ues on 'is )ack. Lesions are dry and co%ered /it' sil%ery scales. *acroscopic+ Tissue sample is ,mm x 1mm x 2mm in si3e. T'e color is )ro/nis' red /it' scalin& parts. *icroscopic+ Tissue sample is a)undant /it' s0uamous epit'elial cells /it' parakeratosis. Acant'olysis is %isi)le /it'in t'e epidermis4 /it' accompanyin& spon&iosis and prominent rete rid&es. $apillary dermis is infiltrated /it' capillary %essels.

Pustular psoriasis

Clinical data+ An "5.year old male presents /it' pustular lesions on 'is trunk and lo/er extremities. *acroscopic+ Tissue sample of 2mm x 2mm x2mm /as recei%ed6 )ro/n in color and soft in texture. *icroscopic+ $arakeratosis and acant'olysis present in t'e epidermis. inflammatory cells are present in t'e su)corneal and malp'i&ian layers. eutrop'ils and

Pemphigus vulgaris

Clinical data+ A ,2.year old female pr esented to your office /it' a )ullae on 'er ri&'t upper extremity. A )iopsy specimen /as o)tained at t'at time. o/ s'e returns to you after t'at )ullae ruptured 7)y accident8 accordin& to t'e patient. *acroscopic+ Tissue o)tained from t'e )iopsy is red /it' a si3e of 1mm x2mm x1mm. *icroscopic+ An intraepidermal )lister is present containin& acant'olytic cells. T'ere is marked intercellullar edema and eosinop'ilic spon&iosis.

Pemphigus foleaceus

Clinical data+ A ,".year old female pr esents /it' a flaccid )ullous lesions on 'er )ack. T'e lesion appears eryt'ematous /it' crusts on se%eral of t'e lesions. A tissue )iopsy /as o)tained. *acroscopic+.Biopsy specimen is )ro/nis' red and tender. s *icroscopic+ !u)corneal )lister is apparent /it' acant'olysis.

Bullous pemphigoid

Clinical data+ A -5.year old female /as admitted for a 'yper&lycemic attack of 'er dia)etes. 9pon admission you /ere consulted )ecause s'e presented /it' se%eral eryt'ematous )ullous lesions on 'er trunk and )ilateral arms. *acroscopic+ Biopsy specimen is )ro/nis' red and tender. *icroscopic+ A su)epidermal )ullae is prominent containin& a net of fi)rin4 )ut only containin& a fe/ inflammatory cells.

Eczematous Dermatitis

Clinical data+ A 1- year old female presents /it' a c'ief complaint of dryness on )ilateral 'ands. !'e reports scalin& and itc'in& )ut denies any %esicular eruptions. *acroscopic+ !kin tissue /as recei%ed 1mmx 2mmx 2mm /it' milnimal scales. *icroscopic+ !pon&iosis4 acant'osis and parakertosis are prominent. Lymp'ocytic infiltrates are seen in t'e area of spon&iosis.

Contact dermatitis

Dermatitis

Clinical data+ A 1, :year old male presents /it' red %esicular lesions on 'is upper arms. $atient /orks as a construction /orker and 'as )een /orkin& /it' a ne/ set of paints for t'e past /eek. *acroscopic+ !kin tissue /as o)tained6 color /as red. *icroscopic+ ;yperkeratosis4 acant'osis and inflammation of t'e rete rid&es are seen. T'ere is dermal infiltration /it' inflammatory cells consistin& of $* s and lymp'ocytes.

Seborrheic keratosis

Clinical data+ A 7#.year old male presents /it' a c'ief complaint of )ro/n spots in 'is face. T'e lesions are on t'e ri&'t temple and upper c'eek4 s'arply demarcated raised4 /it' a %errucous surface. A )iopsy /as o)tained as t'e patient /as o%erly concerned and reported a 0uestiona)le family 'istory of skin cancer. *acroscopic+ A 1mm x 1mm x 2 mm specimen /as r ecei%ed4 soft and tender in consistency. *icroscopic+ T'ick inter/o%en tracts of epidermal )asal cells are seen. <ell defined small )asaloid cells present /it' an endop'itc proliferation of mature s0amous cells.

Erythema multiforme

Clinical data+ A 2-.year old male /it' acute respiratory failure from $C$ 'as recently started 'is t'erapy on trimet'oprim.sulfamet'oxa3ole. ;o/e%er4 'e is no/ de%elopin& 7tar&et lesions8 consistin& of red macules /it' a pale4 %esicular center on 'is )ilateral arms and c'est. A )iopsy /as taken. *acroscopic+ Biopsy specimen is )ri&'t red and soft4 measurin& 1mm x 2 mm x 2 mm. *icroscopic+ !uperficial peri%ascular and interface dermatitis /it' ta&&in& of lymp'ocytes alon& t'e dermoepidermal =unction /it' apoptotic keratinocytes are present.

Subcorneal pustular dermatosis

Clinical data+ A 2". year old male presents /it' a red )lister in t'e intertri&inous areas >axilla4 in&uinal folds?. *acroscopic+ Tissue specimen consists of red skin tissue /it' a ruptured )lister. *icroscopic+ A su)corneal )lister is present containin& inflammatory neutrop'ils. o acant'olysis is seen.

Lupus Erythematosus

Clinical data+ A 2@.year old female /it' renal nep'ropat'y and a medical 'istor y of lon&standin& =oint pro)lems presents /it' a ras' on )ilateral c'eeks and nose. *acroscopic+ !kin tissue /as o)tained. *icroscopic+ Atrop'ic epidermis is seen /it' 'ydropic de&eneration .

PER !"#!!" ".Aelaskan pato&enesis4 makrostruktur dan mikrostruktur dari psoriasis %ul&aris B 2.Aelaskan pato&enesis4 makrostruktur dan mikrostruktur dari pemp'i&us %ul&aris B 1.Aelaskan pato&enesis4 makrostruktur dan mikrostruktur dari pemp'i&us foleaceus B ,.Aelaskan pat'o&enesis4 makrostruktur dan mikrostruktur dari )ullous pemp'i&oid B

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Patogenesis + adanya populasi T cell yan& tersensitasi masuk kulit >C(,C4 T; cell4 C(5C4 T cells?

!ekresi cytokine dan &ro/t' factor

;yperproliferasi keratinosit

$soriasis %ul&aris &akroskopik + $lak )er)atas te&as4 /arna mera' muda kekunin&an dan ditutupi ole' s0uama lon&&ar )er/arna puti' keperakan &ikroskopik + Adanya penin&katan turn o%er sel epidermis se'in&&a epidermis san&at te)al >akantosis? disertai peman=an&an teratur rete rid&es ke ara' )a/a'4 stratum &ranulosum menipis dan tampak s0uama parakeratosis te)al diatasnya4 lapisan epidermis yan& terletak diatas u=un& papilla dermis dan pem)ulu' dara'nya mele)ar dan )erkelok.kelok di dalam papilla ini4 neutrofil D terdapat pustul spon&iform >sel.sel inflamasi intarepidermal atau di supra)asl? di su)corneum dan di startum corneum parakeratotik terdapat mikroa)ses monro.

Patogenesis + Eeaksi 'ypersensiti%itas type 1Fadanya anti)ody I&G pato&enik ter'adap 3at perekat antarsel >desmo&elin? dikulit dan selaput lendir D menyeran& desmosom. &akroskopik + lesi )erupa %esikel dan )ullae yan& san&at superficial dan muda' peca'4 menin&&alkan erosi den&an krusta dan serum kerin&. &ikroskopik + Adanya )entuk akantosis >disolusi4 lisis tempat perlekatan antarsel dipermukaan epitel s0uamosa? di lapisan s0uamosa? di lapisan sel yan& terletak diatas lapisan )asal se'in&&a ter)entuk lepu' akantolitik supra)asal. Adanya infiltrasi limfosit4 'istiosit4 dan eosinofil dari dermis superfisial.

Patogenesis + Eeaksi 'ypersensiti%itas Type 2

anti)odi >I&* atau I&G? G )eraksi den&an anti&en di permukaan mem)ran sel G Akti%asi sistem komplemen G Ter=adi membrane attack complex >C-.H? G Drill trough membrane G !el lisis &akroskopik + Bullae ter)atas dikulit4 superfisial se'in&&a terli'at eryt'ema dan krusta di tempat )ekas lepu' yan& tela' peca'. &ikroskopik + Akantolisis secara selektif men&enai epidermis superficial setin&&i stratum &ranulosum.
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Patogenesis +

Eeaksi 'ypersensiti%itas 1

(eposisi linear anti)odi I&G dan complement di 3ona )asement mem)ran

Eeakti%itas 'emisclerosom aki)at adanya anti&en )ullous pemp'y&oid &akroskopis + Bullae )erisi cairan =erni' pada kulit normal4 adanya eryt'ema. &ikroskopis + (itandai den&an lepu' su)epidermis non akantolitik4 lesi a/al memperli'atkan infiltrasi peri%askular limfosit den&an eosinofil yan& )er%ariasi4 kadan&.kadan& ada netrofil4 edema dermis4 superficial4 dan %asodilasi lapisan sel )asal.