Fundamentals of Pathology of Skin
Fundamentals of Pathology of Skin
FIFTH EDITION
Editor
Venkataram Mysore MBBS DVD DNB MD DipRCPath (London) FRCP (Glasgow) FISHRS
Dermatologist, Hair Plant Surgeon, Dermatopathologist Venkat Center for Skin, Hair Transplant, ENT and Plastic Surgery Centre for Advanced Dermatology and Postgraduate Training (Accredited to Rajeev Gandhi University of Health Sciences, Bengaluru) Bengaluru, Karnataka, India
Associate Editors
Namitha Chathra MBBS MD DVL FRGUHS (Aesthetic Dermatology)
Assistant Professor Department of DVL PES Institute of Medical Sciences and Research Kuppam, Andhra Pradesh, India
Kisalay Ghosh MBBS MD DVL
Consultant Dermatologist ALO Clinic Kolkata, West Bengal, India
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Fundamentals of Pathology of Skin / Venkataram Mysore
First Edition: 2003
Fifth Edition: 2022
9789354654107
Printed at:
Editor
- Venkataram Mysore MBBS DVD DNB MD DipRCPath (London) FRCP (Glasgow) FISHRS
- Dermatologist, Hair Plant Surgeon, Dermatopathologist
- Venkat Center for Skin, Hair Transplant, ENT and Plastic Surgery
- Centre for Advanced Dermatology and Postgraduate Training (Accredited to Rajeev Gandhi University of Health Sciences, Bengaluru)
- Bengaluru, Karnataka, India
Associate Editors
- Namitha Chathra MBBS MD DVL FRGUHS (Aesthetic Dermatology)
- Assistant Professor
- Department of DVL
- PES Institute of Medical Sciences and Research
- Kuppam, Andhra Pradesh, India
- Kisalay Ghosh MBBS MD DVL
- Consultant Dermatologist
- ALO Clinic
- Kolkata, West Bengal, India
Contribution to Chapter
- Raghavendra Rao MBBS MD DVL DNB
- Professor and Head
- Department of Dermatology
- Kasturba Medical College, Manipal
- Manipal Academy of Higher Education
- Manipal, Karnataka, India
Assistant Editors
- Anuradha Jindal MBBS MD DVL FRGUHS (Aesthetic Dermatology)
- Consultant Dermatologist
- Skin–Win Clinic
- Udupi, Karnataka, India
- Arpita Arghya MBBS DDVL
- Consultant Dermatologist
- Venkat Center for Skin,
- Hair Transplant, ENT and
- Plastic Surgery
- Bengaluru, Karnataka, India
- Deepthi Malayanuru MBBS MD DVL FRGUHS (Aesthetic Dermatology)
- Consultant Dermatologist
- Venkat Center for Skin,
- Hair Transplant, ENT and
- Plastic Surgery
- Bengaluru, Karnataka, India
- Malcom Noronha MBBS MD DVL FRGUHS (Aesthetic Dermatology)
- Consultant Dermatologist
- Skin–Win Clinic
- Udupi, Karnataka, India
- Manasa Narayan Kayarkatte MBBS MD DVL DNB
- Consultant Dermatologist
- Specialty Doctor in Dermatology
- Luton and Dunstable
- University Hospital
- United Kingdom
- Pooja Kanumuru MBBS MD DVL
- Fellow in Aesthetic
- Dermatology
- Venkat Center for Skin,
- Hair Transplant, ENT and Plastic Surgery Bengaluru,
- Karnataka, India
- Rashmi Singh MBBS DDVL
- Consultant Dermatologist
- Charité – Universitätsmedizin
- Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin
- Department of Dermatology,
- Venereology and Allergology
- Charitéplatz 1, 10117
- Berlin, Germany
- Sajin Alexander MBBS MD DVL FRGUHS (Aesthetic Dermatology)
- Consultant Dermatologist
- Schieffelin Institute of
- Health – Research and Leprosy
- Centre (SIH-R & LC)
- Karigiri, Vellore, Tamil Nadu,
- India
- Srishti Dubey MBBS MD DVL FRGUHS (Aesthetic Dermatology)
- Consultant Dermatologist
- Venkat Charmalaya
- Bengaluru, Karnataka, India
Copy Editors
- Ankit Gupta MBBS MD DNB DVL
- Fellow in Aesthetic
- Dermatology
- Venkat Center for Skin,
- Hair Transplant, ENT and Plastic Surgery
- Bengaluru, Karnataka, India
- Nivedita Sashidhar MBBS MD(DVL)
- Observer
- Venkat Centre for Skin,
- Hair Transplant, ENT and Plastic
- Surgery Bengaluru, Karnataka, India
- Prateek Pathak MBBS MD DVL
- Fellow in Aesthetic
- Dermatology
- Venkat Center for Skin,
- Hair Transplant, ENT and Plastic Surgery
- Bengaluru, Karnataka, India
- Suvigya Sachan MBBS MD DVL
- Fellow in Aesthetic
- Dermatology
- Venkat Center for Skin,
- Hair Transplant, ENT and Plastic Surgery
- Bengaluru, Karnataka, India
- Ushma Ravi MBBS MD DVL FRGUHS (Aesthetic Dermatology)
- Consultant Dermatologist
- Skin to Bone Superspeciality
- Clinic
- Vijayawada, Andhra Pradesh,
- India
It has been a matter of great satisfaction that what started as an effort to teach dermato-pathology to dermatology residents and postgraduate students during weekly seminars in the laboratory has resulted in educating residents both in dermatology and in pathology at large, across India and abroad, over two decades. The first edition of Fundamentals of Pathology of Skin was released in 2003. Since then, it has remained popular among the students, residents, practicing dermatologists, and pathologists. The book has seen several reprints and editions after that and it gives us immense pleasure to release the fifth edition of the book.
This edition is thoroughly and extensively revised; several new topics, conditions, illustrations, and facts have been added. The number of photographs used in this revised edition is considerably more as compared to the previous editions. However, the essence of the book remains unchanged; the objective continues to be providing basic relevant information in a reader-friendly format using simple and lucid language. Similar to earlier editions, this book is meant to be, and will always be, a ready reckoner and a desktop reference for postgraduate students of dermatology and pathology, particularly for those who are preparing for exams. In addition, it can also serve as a source of ready information for the practicing dermatologists and pathologists.
I have pleasure in acknowledging the contribution of two younger colleagues Drs Kisalay Ghosh and Namitha Chathra. Kisalay Ghosh with his inciteful knowledge and eye for detail has brough in several new additions. Namitha Chathra spent hours on the drafts and coordinated the effort painstakingly. My team of assistant editors, all of them my fellows at different times, revised different chapters. I also thank Dr Raghavendra Rao for his inputs in the chapter on immunofluorescence.
The earlier editions received compliments on the nature and content of the book from scores of students and practitioners. I sincerely hope that this edition too will be receive in the same way. Authoring a book always means spending time away from the family. Nothing I say can ever fully express the support that I received from my loving wife, Jayashree Venkataram.
I am thankful for her patience and support during the development of this project.
Venkataram Mysore
Preface to the First Edition
What is most difficult of all? It is to see what is in front of your eyes!
– Goethe
A dermatologist needs to know and understand pathology thoroughly. This is partly because clinicopathological correlation is of utmost necessity in most dermatological diseases. Also, dermatopathology is a subspecialty most general pathologists dislike. This makes it essential that a student in dermatology should learn dermatopathology in detail.
The idea for this book originated while lecturing postgraduate residents at the Al Nahda Hospital, Muscat, and Salmaniya Medical Complex, Bahrain. The book is meant as a ready reckoner – a desktop reference for postgraduate students of dermatology and pathology – particularly for those who are preparing for their board exams. In addition, it can also serve as a source of ready information for the practicing dermatologists and pathologists. I make no claims that this is my original work. I surely have nothing to say what the masters such as Lever, Ackerman, Mehregan, and others have not already said. This book is not a replacement for standard textbooks of dermatopathology, of which there are many. The student is advised to read these books for a full understanding of the subject.
The standard textbooks, useful as they are, often load the student with a plethora of information, which may be both confusing and difficult to remember. There are very few concise books which supply data in a capsule form. This book seeks to fill that void. The book is designed to provide information in a format which can be easily remembered by a student, in the form of numbered points. Key points are highlighted in italics and textboxes. A number of tables help the reader to remember facts easily. Simple explanations are provided to explain concepts, wherever necessary. A separate section on immunofluorescence is included. There is also a section which provides a set of clues to the practicing pathologist. It is hoped that students of dermatopathology will find these features useful.
The necessity of keeping the book as a short concise guide also meant that many diseases could not be included. The student may refer any of the eminent textbooks of dermatopathology for such needs. Again, for reasons of simplicity and brevity, I have avoided extensive references. A section on recommended reading is provided at the end. I humbly accept any errors and inaccuracies that may have crept in and welcome suggestions for improvement from the readers.
A venture of this type is never possible without the active help and co-operation of many people. I am grateful to Dr Khaleel Arrayed, Chief of Dermatology and Assistant Undersecretary, Salmaniya Medical Complex, for his continuous encouragement. My sincere thanks to Dr Abdul Raouf Al Suwaid, who encouraged me in many different ways during my long stint in Al Nahdha Hospital. (Late) Dr Shiva Kumar, Professor of Dermatology, Medical College, Mysore, was instrumental in my entry into the speciality in the early days of my career. Professor S.R. Bhushnurmath and Dr Leenadevi have been helpful at the time of my entry into the field of dermatopathology. Professor K.S. Rathnakar, Consultant Pathologist, Salmaniya Hospital, has been a constant source of inspiration and guidance. My postgraduate residents at the Salmaniya Hospital, particularly Dr Haitham Al Qari, Dr Wassam Al Arrayedh, Dr Hussain Al Mahdi, Dr Rania Abbas, and Dr Mersal Al Arrayed, have assisted me in many ways.
And lastly, I wish to thank my family – my mother who has been a source of continuous support and understanding. My loving wife Jayashree, a gynecologist, has been ever understanding and supportive of my ventures despite her extremely busy schedule. My son Aniketh and daughter Ankitha have provided much needed diversion by their antics during the preparation of this manuscript. My humble thanks to all.
Venkataram Mysore
Acknowledgments
The schematic diagrams are drawn artistically by Dr Madhulika and Dr Namitha. I gratefully acknowledge my fellow dermatopathologists: Dr M Ramam, Dr Meera Mahalingam, Dr Jag Bhawan, Dr Raghavendra Rao, Dr G Nanda Kumar, and Dr Kisalay Ghosh for providing photomicrographs used in this edition.