Weedon Ch 5 - Spongiotic Reaction Pattern

Front 1

Describe Irritant Contact Dermatitis

Back 1

Superficial ballooning, necrosis and neutrophils; superficial apoptotic keratinocytes may be seen

Front 2

Describe Allergic Contact Dermatitis

Back 2

Variable spogiosus and vesiculation at different horizontal and vertical levels with an 'ordered' pattern; mild exocytosis; progressive psoriasiform hyperplasia with chronicity; usu eos in superficial dermal infiltrate; superficial dermal edema

Front 3

The inflammatory infiltrate in Spongiotic Process is Ortho or Parakeratotic?

Back 3

Parakeratotic

Front 4

DDX of Neutrophilic Spongiosis

Back 4

Pustular psoriasis, Reiter's Syndrome, palmoplantar pustulosis;
IgA pemphigus;
Infantile acropustulosis;
AGEP;
Staph TSS,
Neisserial pustular lesions;
secondary syphilis;
impetigo;
dermatophytes;
beetle dermatitis;
pustular contact dermatitis;
irritant contact dermatitis

Hint 4

PAIRS GC
Psoriasis; Acrodermatitis Continua; Impetigo; Reiter's; Syphilis; Gonoccocal; Candida

Front 5

DDX of Eosinophilic Spongiosis

Back 5

Pemphigus
Herpetiform pemphigus
Pemphigus vegetans
Bullous Pemphigoid (urticarial stage)
Herpes Gestationis
Arthropod Bites
Incontinentia Pigmenti
Drug Reactions
Eosinophilic Folliculitis (Ofuji's disease)
Grover's Disease
Allergic Contact Dermatitis
Lymphocytic spongiosis

Hint 5

"A HAPPIE FD"
Arthropod, Herpes Gestationis; Allergic Contact; Pemphigus/Pemphigoid, PUPPP, Incontinentia Pigmenti; Erythema Toxicum Neonatorum; Fungal; Drug

Front 6

Focal lymphocytic spongiosis

Back 6

Miliaria crystalline
Miliaria profunda
Follicular spongiosis
Apocrine miliaria

Front 7

Diffuse Lymphocytic spongiosis

Back 7

Allergic Contact Dermatitis
Atopic Dermatitis
Nummular Dermatitis
Sulzberger-Garbe Syndrome
Seborrheic Dermatitis
Dyshidrotic eczema (Pompholyx)
Auto-eczematous dermatitis (ID)
Stasis Dermatitis
Pityriasis Rosea (PR)
Papular Acrodermatitis of Childhood (Gianotti-Crosti)
Spongiotic Drug Reactions
Photoallergic Reactions
Erythema annulare centrifugum
Gyrate erythema
Small Plaque Parapsoriasis (aka chronic superficial dermatitis)

Front 8

What % IgA pemphigus is assoc with IgA gammopathy?

Back 8

50%

Front 9

Histology of IgA pemphigus

Back 9

subcorneal or intraepidermal collections of PMNs; slight spongiosis then acantholysis

Front 10

Describe atopic dermatitis

Back 10

broad based acanthosis; resembles chronic allergic contact, but with fewer eos

Front 11

Another name for Acroangiodermatitis?

Back 11

Pseudo-Kaposi Sarcoma

Front 12

Describe Stasis Dermatitis

Back 12

proliferation of dermal blood vessels, extravasated RBCs and hemosiderin, overlying spongiosis

Front 13

Pityriasis Rosea

Back 13

focal spongiosis & Pautrier-like foci, focal mounded parakeratosis, diminished granular layer, dermal RBC extravasation, superficial perivascular infiltrate, undlating epidermis, apoptotic keratinocytes in lower epidermis

Front 14

Name causes of PR-like drug eruption

Back 14

gold, penicillamine, captopril

Front 15

#1 cause of gianotti-crosti in US? worldwide?

Back 15

in US EBV, in world Hep B

Front 16

Name types of cells involved with lymphocytic spongiosis

Back 16

Lymphocytes, Langerhans cells (+Cd1a, S100, CD36, CD68) and monocytes

Front 17

What is the "Dolly Parton" Sign?

Back 17

Too much for Too little -- associated with follicular mucinosis. In MF, the lymphocytes are large and atypical within the follicle with limited spongiosis

Front 18

Another name for Fox Fordyce disease?

Back 18

Apocrine Miliaria -- spongiosis in the apocrine duct

Front 19

Name the genodermatosis that involve Atopic dermatitis

Back 19

Ichthyosis vulgaris, Netherton's syndrome, Wiskott-Aldrich, Ataxia-telangiectasia, hyper-IgE syndrome and PKU.

Front 20

Describe Atopic Dermatitis histologically

Back 20

similar to other spongiotic dermatosis with less pronounced spongiosis and less pronounced exocytosis of lymphocytes. Vessels are prominent within the dermis with perivascular infiltrate of lymphocytes and scattered eosinophils; acanthosis with mild psoriasiform changes

Front 21

What is Sulzberger-Garbe syndrome?

Back 21

Nummular dermatitis variant seen in male, Jews with facial and penile lesions

Front 22

What is the #1 skin manifestation in AIDS?

Back 22

Seborrheic dermatitis

Front 23

What do you need to r/o if there is a child with recalcitrant seborrheic dermatitis?

Back 23

Langerhans cell histiocytosis

Front 24

What is Gianotti-Crosti?

Back 24

Papular Acrodermatitis of Childhood -- uncommon, self-limited triad of erythematous papular eruption on face and limbs (No Trunk Involvement), acute hepatitis and lymphadenopathy

Front 25

What can cause Gianott-Crosti?

Back 25

EBV (in US), CMV, Coxsackie A16, HIV, Parainfluenza and hepatitis B (in Europe)

Front 26

Describe histo for Gianotti-Crosti

Back 26

Triad pattern of lichenoid, spongiotic, and vasculopathy

Front 27

Name Dz affects middle aged males --> onset of round to oval patches with fine cigarette-paper scale that are reddish-brown or yellow on the trunk, proximal extremities often in a finger like pattern. No progression to lymphoma.

Back 27

Small Plaque Parapsoriasis

Front 28

DDX of Mounding Parakeratosis in Spongiotic Dermatosis: follicular distribution

Back 28

Pityriasis Rubra Pilaris

Front 29

DDX of Mounding Parakeratosis in Spongiotic Dermatosis: Random distribution

Back 29

Pityriasis Rosea, Nummular Eczema, Pityriasis Lichenoides Chronica (Guttate Parapsoriasis), Small Plaque ParaPsoriasis (Chronic superficial dermatitis)

Front 30

P-TICS

Back 30

Neuts in the Horn:
Pustular psoriasis, Rieter's, Palmoplantar pustulosis
Tinea
Impetigo
Candida
Secondary syphillis
Seborrheic Dermatitis

Front 31

Neutrophilic spongiosis + Psoriasiform Kogoj and Munro

Back 31

Pustular psoriasis, Reiter's, palmoplantar pustulosis

Front 32

Neutrophilic spongiosis plus Hyphae in the stratum corneum

Back 32

Tinea, look for 'sandwich sign'

Front 33

Neutrophilic spongiosis plus Hyphae & spores in the stratum corneum; PMNs in the epidermis

Back 33

Candida

Front 34

Neutrophilic spongiosis plus neutrophilic/lymphocytic in a lichenoid and superficial & deep pattern

Back 34

secondary syphilis

Front 35

Neutrophilic spongiosis plus, parakeratosis and a few PMNs on either side of follicular ostium; mixed mild perivascular infiltrate

Back 35

Seborrheic dermatitis

Front 36

A CAT PISS

Back 36

focus on subcorneal pustule:
AGEP
Candid
Acropustulosis of infancy (eos)
Transient neonatal pustular melanosis
Pustular psoriasis
Impetigo
Sneedon Wilkeson/IgA pemphigus (spongiosis and acantholysis)
Staph Scalded Skin

Front 37

HAAPPIE FD

Back 37

Eosinophilic Spongiosis:
Herpes Gestationis
Arthropod Bite
Allergic Contact Dermatitis
Pemphigus/Bullous Pemphigoid (urticarial stage)
PUPPP
Incontinentia Pigmenti
Erythema toxicum neonatorum
Fungal
Drug

Front 38

What can be confused with IP?

Back 38

Subungal KA

Front 39

Histo for Arthropod bites?

Back 39

superficial and deep lymphocytes and eos in a wedge shape; eosinophilic spongiosis/central epidermal necrosis at bite site

Front 40

Distinguishing finding in IP?

Back 40

dyskeratotic/apoptotic keratinocytes

Front 41

What are some other dzs with eosinophilic folliculitis (outside of HAAPPIE)?

Back 41

Herpetiform pemphigus
Pemphigus vegetans
Drug Reactions
Eosinopilic Folliculitis (Ofuji's Dz)
Grover's Dz

Front 42

What has lymphocytic spongiosis that forms vesicles that peripherally displace the acrosynringium?

Back 42

Dyshidrotic eczema/Pompholyx/ID reactions

Front 43

What are some things to look for histologically in stasis dermatitis?

Back 43

small capillaries thick walled in the upper dermis, variable dermal fibrosis, hemosiderin.

Front 44

For a spongiotic process that has extravasated RBCs? Lichenoid?

Back 44

PR vs PPE of Doucas and Kapetanakis
Lichenoid:
PLEVA/PLC vs PPE of Gougerot and Blum

Front 45

What process has coatsleeving?

Back 45

Erythema Annulare Centrifugum

Front 46

If you see mounding parakeratosis in a perifollicular pattern, DDX?

Back 46

PRP
Seborrheic Dermatitis
Infundibulofolliculitis

Front 47

Mounding parakeratosis in a Random distribution over focal areas of spongiosis?

Back 47

Pityriasis Rosea
Nummular Eczema
PLC

Front 48

What is baboon syndrome?

Back 48

diffuse erythematous eruption from drug sensitivity: on buttocks, genital areas, elbow flexures, axillae, eyelids, side of neck

Front 49

What has epidermal spongiosis at all layers of the epidermis, can result in vesiculation, there is often more exocytosis than spongiosis (similar to MF). There may be a mid-moderate papillary dermal edema and a perivascular lymphocytic infiltrate with rare eosinophils, +/- RBC extravasation.

Back 49

spongiotic drug reaction

Front 50

what has spongiosis and apoptotic keratinocytes in superficial layers?

Back 50

photoallergic reactions

Front 51

Difference between gyrate erythema and EAC?

Back 51

no epidermal alterations; tight superficial and deep lyphocytic perivascular dermal infiltrate