Difference between revisions of "Inflammatory skin disorders"

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Inflammatory skin disorders (view source)

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| -small vessel <br> -medium vessel <br> -large vessel
| -small vessel <br> -medium vessel <br> -large vessel
| -[[leukocytoclastic vasculitis]]<br>-[[PAN]]<br>-[[giant cell arteritis]]
| -[[leukocytoclastic vasculitis]]<br>-[[PAN]]<br>-[[giant cell arteritis]]
| [[Image:Churg-Strauss_syndrome_-_high_mag.jpg |thumb|150px|[[Churg-Strauss syndrome|CCS]] (WC)]]
| [[Image:Churg-Strauss_syndrome_-_high_mag.jpg |thumb|150px|[[Eosinophilic granulomatosis with polyangiitis|EGPA]] (WC)]]
|-
|-
| [[Dermatitides_with_perivascular_inflammation|Perivascular]]
| [[Dermatitides_with_perivascular_inflammation|Perivascular]]
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Common locations:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref>  
Common locations:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref>  
*Knees, elbows, scalp, glands [[penis]].
*Knees, elbows, scalp, glans [[penis]].


===Microscopic===
===Microscopic===
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DDx ''rips'':
DDx ''rips'':
*Rheumatoid neutrophilic dermatitis.
*Rheumatoid neutrophilic dermatitis.
*Bowel-associated dermatosis-arthritis syndrome.
*[[Bowel-associated dermatosis-arthritis syndrome]] (BADAS).
*[[Pyoderma gangrenosum]].
*[[Pyoderma gangrenosum]].
*Sweet syndrome.  
*Sweet syndrome.  
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==Pyoderma gangrenosum==
==Pyoderma gangrenosum==
===General===
{{Main|Pyoderma gangrenosum}}
*May be seen in [[IBD]] (UC and CD) - approximately 30% of cases.<ref name=pmid16858047/>
 
Clinical
*''[[Pathergy]]'' = minor trauma (to the skin) results in a non-healing lesion.<ref name=pmid22202507>{{Cite journal  | last1 = Wong | first1 = WW. | last2 = Machado | first2 = GR. | last3 = Hill | first3 = ME. | title = Pyoderma gangrenosum: the great pretender and a challenging diagnosis. | journal = J Cutan Med Surg | volume = 15 | issue = 6 | pages = 322-8 | month =  | year =  | doi =  | PMID = 22202507 }}</ref>
 
===Gross===
*Skin ulceration - classically on the legs.<ref name=pmid16858047>{{Cite journal  | last1 = Brooklyn | first1 = T. | last2 = Dunnill | first2 = G. | last3 = Probert | first3 = C. | title = Diagnosis and treatment of pyoderma gangrenosum. | journal = BMJ | volume = 333 | issue = 7560 | pages = 181-4 | month = Jul | year = 2006 | doi = 10.1136/bmj.333.7560.181 | PMID = 16858047 | PMC = 1513476 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513476/?tool=pubmed }}</ref>
 
===Microscopic===
Features:<ref name=pmid16858047/>
*Early: lymphocytes cells only in the dermis - often perivascular & vascular.
**+/-Fibrinoid necrosis of vessels at edge of lesion.
*Late: abscess formation ([[neutrophil]]s).
 
DDx:
*[[Vasculitis]].
*[[Sweet syndrome]].
 
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513476/figure/fig5/ Pyoderma gangrenosum (nih.gov)].


==Necrobiotic xanthogranuloma==
==Necrobiotic xanthogranuloma==
*Abbreviated ''NXG''.
*Abbreviated ''NXG''.
===General===
{{Main|Necrobiotic xanthogranuloma}}
*Usually elderly.<ref name=Ref_Derm629>{{Ref Derm|629}}</ref>
 
===Gross===
Features:
*Periorbital - classic location.<ref name=pmid17544963>{{Cite journal  | last1 = Fernández-Herrera | first1 = J. | last2 = Pedraz | first2 = J. | title = Necrobiotic xanthogranuloma. | journal = Semin Cutan Med Surg | volume = 26 | issue = 2 | pages = 108-13 | month = Jun | year = 2007 | doi = 10.1016/j.sder.2007.02.008 | PMID = 17544963 }}</ref>
 
===Microscopic===
Features:<ref name=Ref_Derm629>{{Ref Derm|629}}</ref>
*"Necrobiotic granuloma":
**Palisading granuloma with a core collagen-like material.
*+/-Cholesterol clefts - common.
*+/-[[Touton giant cell]]s.
*+/-Atypical foreign body-type giant cells +/- asteroid bodies.
 
DDx:
*[[Granuloma annulare]].
*[[Necrobiosis lipoidica]] - has plasma cells.
*Granuloma-forming infections - positive stains for microorganisms.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Asteroid_bodies_high_mag_cropped.jpg Asteroid body (WC)].


=DDx for pattern=
=DDx for pattern=
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*Psoriasis vulgaris.
*Psoriasis vulgaris.
*Dermatophyte infection.
*Dermatophyte infection.
*Pityriasis rubra pilaris.
*[[Pityriasis rubra pilaris]].


===Irregular psoriasiform dermatitis===
===Irregular psoriasiform dermatitis===
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*'''L'''upus erythematosus.
*'''L'''upus erythematosus.
*'''L'''ymphocytic infiltrate of Jessner / tumid lupus erythematosus.
*'''L'''ymphocytic infiltrate of Jessner / tumid lupus erythematosus.
*Polymorphous '''l'''ight eruption.
*[[polymorphous light eruption|Polymorphous '''l'''ight eruption]].
*'''L'''yme disease.
*'''L'''yme disease.


===Neutrophils===
===Neutrophils===
DDx:<ref name=pmid18418089/>
DDx:<ref name=pmid18418089/>
*Cellulitis.
*[[Cellulitis]].
*Neutrophilic eccrine hidradenitis (idiopathic palmar-plantar hidradenitis)
*Neutrophilic eccrine hidradenitis (idiopathic palmar-plantar hidradenitis)


Michael
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