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Skin lesions and oral lesions in particular may be identified as viral diseases by cytologic smears and finding of characterstic multinucleated giant cells and intranuclear inclusions known as tzanck test.
HISTOPATHOLOGY:
INTRAEPITHELIAL
Definition: It is a cutaneous response seen in dermatoses, which appears on uninvolved skin of lesions typical of the skin disease at the site of trauma or scars.
Sometimes just rubbing the skin can cause a lesion to develop.
Koebner's phenomenon is seen most often in psoriasis, eczema, lichen planus, and vitiligo. Also Known As: isomorphic phenomenon, isomorphic reaction
phenomenon, including psoriasis, dermatitis, eczema, herpes, lichen planus, chickenpox and vitiligo.
FEATURES
There is no effect of sex and age distribution in
koebners phenomenon. Fresh lesions may appear on scratch marks or at sites of other non-specific traumas.(Koebner phenomenon)
Definition: The Auspitz sign is simply bleeding that occurs after psoriasis scales have been removed. It occurs because the capillaries run very close to the surface of the skin under a psoriasis lesion, and removing the scale essentially pulls the tops off the capillaries, causing bleeding. also found in Darier's disease and actinic keratos
psoriasis. The combination of inflamed, thickened skin with silvery scales and Auspitz Sign, however, appears to be unique to psoriasis.
Autoimmune skin disorders sometimes are characterized by acantholysis , or loss of the normal epithelial cell-to-cell adhesion within the skin.
Clinically, these disorders present with blistering of the skin and include the pemphigus and pemphigoid groups of disorders. On visual inspection only, these skin conditions are difficult to diagnose and may be confused with other types of skin disorder.
Nikolskys sign is a well-described clinical sign that can be helpful in differentiating the autoimmune skin disorders and determining their prognosis.
ELICITATION
Positive Nikolskys sign included the ability to
dislodge both affected skin (i.e , skin within or immediately adjacent to pemphigus lesions) and normal skin. It helps to differentiate as it occurs in pemphigus foliaceus and not pemphigus vulgaris because, in the latter disorder, unaffected normal skin could not be removed by lateral pressure.
PATHOPHYSIOLOGY:
Primary histologic finding in patients with pemphigus is acantholysis with the occurrence of suprabasal epidermal / intraepidermal splits . These events presumably contribute to the epidermal separation , characteristic of a positive Nikolskys sign.
useful in differentiating the bullous skin diseases. Specifically, elicitation of the sign can help distinguish pemphigus vulgaris, which is strongly associated with the sign, from bullous pemphigoid, in which the sign is usually absent.
LE CELL:
These are cell , which appears i n blood of patients with Systemic Lupus Erythematous
(SLE).
The LE cell is a result of an immunological mechanism where nucleoprotein or part (but not DNA) can be regarded as the Ag and LE cell factor as an Ab.
PRINCIPLE:
The test is based on the principle that ANAs (Anti
Nuclear Antibodies) cant penetrate the intact cells & thus cell nuclei s/b exposed to bind them with the ANAs . The binding of exposed nucleus with ANAs result in homogenous mass of nuclear chromatin material which is c/d LE body or haematoxylin body.
Procedure
Blood from SLE suspected patient is withdrawn
It is centrifuged to separate serum This serum is added to buffy coat of blood from
normal person Observed under microscope Positive reaction consists of rosettes of neutrophils surrounding the nuclear material from a lymphocytes
It results from the action upon leukocytes of a substance in patients serum which migrates on electrophoresis .
This results in binding of denatured & damaged nucleus with ANAS.
The ANA-coated denatured nucleus is chemotactic for phagocytic cells. If this mass is engulfed by a neutrophil , displacing the nuclei of neutrophil to the rim of the cell, it is c/d LE cell. If the mass , more often an intact lymphocyte is phagocytosed by a monocyte, it is c/d TART cell.
These altered nuclei then extruded from the cell and are phagocytized by other viable leukocytes.
The altered nuclei in their cytoplasm, are the LE cells.
CLINICAL FEATURES:
LE cell is +ve in 70% cases of SLE. While newer &
more sensitive immunoflourescence tests for AutoAb Are +ve in almost 100% of cases of SLE.
Other conditions showing +ve LE test Rheumatoid arthritis Lupoid hepatitis Penicillin sensitivity