Inflammatory Diseases Of The Dermis And Epidermis

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Eczematous dermatitis(DDx)
(AND PIPAS)

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•Atopic
•Nummular
•Dyshidrosis
•Papular
•Irritant Contact
•Pityriasis Rosea
•Allergic Contact
•Seborrheic

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ATOPIC EXCEMA(Cx)

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•Children
•after 3 months of age
•extremities and face

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ATOPIC EXCEMA (Histopathology)

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++Superficial perivascular lymphocytes
+/- Follicular spongiosis
+/- Dermal eosinophils
+/- Lymphocyte exocytosis

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Irritant Contact Dermatitis

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++Superficial perivascular lymphocytes
++Epidermal Necrosis
+/- Dermal eosinophils
+/- Lymphocyte exocytosis

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Dyshidrosis

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++Superficial perivascular lymphocytes
+/- Dermal eosinophils
+/- Lymphocyte exocytosis

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Nummular Dermatitis

Back 6

++Superficial perivascular lymphocytes
+/- Dermal eosinophils
+/- Lymphocyte exocytosis

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Seborrheic Dermatitis

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++Superficial perivascular lymphocytes
++Follicular spongiosis
+/- Dermal eosinophils
+/- Lymphocyte exocytosis

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Allergic Contact Dermatitis

Back 8

++Superficial perivascular lymphocytes
+/- Dermal eosinophils
+/- Lymphocyte exocytosis

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Papular dermatitis

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++Superficial perivascular lymphocytes
++ Dermal eosinophils
+/- Deep perivascular lymphocytes
+/- Epidermal necrosis
+/- Follicular spongiosis
+/- Lymphocyte exocytosis

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Pityriasis Rosea

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++Superficial perivascular lymphocytes
++lymphocyte exocytosis
++erythrocyte extravasation

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Spongiotic dermatitis (Acute)

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spongiosis with or without intraepidermal vesicle

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Spongiotic dermatitis (subacute)

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spongiosis and parakeratosis

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Spongiotic dermatitis (chronic)

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psoriasiform epidermal hyperplasia

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Spongiotic dermatitis (DDX)

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Tinea
Mycosis fungoides
Spongiotic drug reaction
Viral exanthems

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Psoriasiform dermatitis

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Psoriasis
Chronic spongiotic dermatitis
Lichen simplex chronicus
Prurigo nodularis
Pityriasis rubra pilaris

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Psoriasis

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++superficial perivascular lymphocytes
++hypogranulosis
+/-dermal eosinophils
+/-checkerboard parakeratosis
++Parakeratosis with neutraphils
+/-papillary dermal fibrosis

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Chronic spongiotic dermatitis

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++superficial perivascular lymphocytes
++hypergranulosis
++papillary dermal fibrosis

Front 18

Pityriasis rubra pilaris

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++superficial perivascular lymphocytes
++checkerboard parakeratosis

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Acute spongiotic dermatitis. Spongiotic microvesiculation is the full expression of intercellular edema (spongiosis) that is the hallmark of all forms of spongiotic dermatitis, particularly the so-called eczematous dermatitides, allergic contact, nummular, dyshidrotic, and atopic dermatitis. In most of these cases, the diagnosis is established without biopsy;

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Chronic spongiotic dermatitis is characterized by compact orthokeratosis and/or parakeratosis, psoriasiform epidermal hyperplasia, and spongiosis. Compared with psoriasis, the granular layer is retained or thickened in many areas. Spongiosis is often less prominent.

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Hint 21

Lichen simplex chronicus. Compact orthokeratosis, hypergranulosis, papillary dermal fibrosis, and vertically oriented blood vessels within papillary dermal tips. In this case the dermal fibrosis is more obvious because it displaces solar elastosis.

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LICHEN SIMPLEX CHRONICUS

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•compact orthokeratosis
•variable parakeratosis
•psoriasiform hyperplasia
•hypergranulosis
•papillary dermal fibrosis
•vertically oriented blood vessels within papillary dermal tips

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What is the difference histologically between LSC and prurigo nodularis?

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Prurigo nodularis exhibits the same features in a dome-shaped configuration.

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PITYRIASIS RUBRA PILARIS

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•alternating orthokeratosis and parakeratosis
•psoriasiform hyperplasia
•granular layer preservation
•follicular plugging

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Hint 25

Pityriasis rubra pilaris. A, Coalescent orange red papules with islands of sparing; B, Alternating orthokeratosis and parakeratosis (checkerboard pattern), psoriasiform epidermal hyperplasia, and sparse superficial perivascular lymphocytes.

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NECROLYTIC MIGRATORY ERYTHEMA

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•paraneoplastic reaction usually associated with an islet cell glucagon-secreting malignancy (glucagonoma) of the pancreas

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NECROLYTIC MIGRATORY ERYTHEMA

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•pallor of the upper epidermis associated with necrolysis
•necrolysis characterized by vacuoles within the cytoplasm of keratinocytes resulting in confluent necrosis in the upper epidermis
•confluent parakeratosis
•psoriasiform hyperplasia
•neutrophilic crust
•neutrophilic spongiosis
•subcorneal pustule formation
•single necrotic or dyskeratotic keratinocytes.

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Hint 28

Necrolytic migratory erythema (glucagonoma syndrome) in a 74-year-old man with markedly elevated serum glucagon level and pancreatic mass. A, Erythematous, erosive desquamating plaques in a flexural distribution. B, Initial biopsy revealed vacuolization and pronounced pallor in the superficial epidermis. Necrolysis is not yet evident.

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INTERFACE DERMATITIS

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•Erythema Multiforme
•Stevens Johnson/Toxic Epidermal Necrolysis
•Lichen Planus
•Pityriasis Lichenoides •Lupus Erythematosus
•Lichen Striatus
•GVHD
•Fixed Drug Reaction

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ERYTHEMA MULTIFORME

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•vacuolar interface damage

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STEVENS JOHNSON/TOXIC EPIDERMAL NECROLYSIS

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•vacuolar interface damage
•epidermal necrosis

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LICHEN PLANUS

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•lichenoid interface
•basilar squamatization

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PITYRIASIS LICHENOIDES

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•lymphocyte exocytosis
•erythrocyte extravasation

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LUPUS ERYTHEMATOSUS

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•deep perivascular inflammation
•follicular involvement
•eccrine involvement

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GVHD

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•follicular involvement

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FIXED DRUG REACTION

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•deep perivascular inflammation
•dermal eosinophils

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Molluscum contagiosum

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inverted lobules of squamous epithelium with molluscum bodies maturing toward the surface