Pityriasis rubra pilaris: Difference between revisions
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| Micro = alterating [[orthokeratosis]] and [[parakeratosis]] (known as "checkerboard pattern"), marked uniform [[acanthosis]] with broad dermal papillae and broad epidermal ridges, , +/-eosinophils (common), follicular plugging, scattered foci of [[acantholysis]] (common), occasional mild spongiosis | | Micro = alterating [[orthokeratosis]] and [[parakeratosis]] (known as "checkerboard pattern"), marked uniform [[acanthosis]] with broad dermal papillae and broad epidermal ridges, , +/-eosinophils (common), follicular plugging, scattered foci of [[acantholysis]] (common), occasional mild spongiosis | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[Dermatomycosis|fungal infection]], | | LMDDx = [[Dermatomycosis|fungal infection]], [[psoriasis]], [[Darier disease]], [[seborrhoeic dermatitis]] | ||
| Stains = PASD -ve (to r/o fungal infections) | | Stains = PASD -ve (to r/o fungal infections) | ||
| IHC = | | IHC = | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| IF = | | IF = negative (changes in ''Desmoglein 1'' & ''Desmoglein 3'' in [[pemphigus vulgaris]]) | ||
| Gross = salmon-coloured plaques, well-demarcated | | Gross = salmon-coloured plaques, well-demarcated | ||
| Grossing = | | Grossing = | ||
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| Assdx = HIV infection - recalcitrant PRP | | Assdx = HIV infection - recalcitrant PRP | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = Classic adult - self-limited exfoliative, erythematous dermatitis that starts over the head and neck and extends downwards forming orange plaques with spared islands of normal skin, follicular hyperkeratosis, palmar involvement with orange hyperkeratosis | | Clinicalhx = Classic adult - self-limited exfoliative, erythematous dermatitis that starts over the head and neck and extends downwards forming orange plaques with spared islands of normal skin, follicular hyperkeratosis, palmar involvement with orange hyperkeratosis | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
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*Occasional mild spongiosis. | *Occasional mild spongiosis. | ||
Notes: | |||
*PRP is easy to miss - clinical history (r/o PRP) usually needed to prompt correct diagnosis. | *PRP is easy to miss - clinical history (r/o PRP) usually needed to prompt correct diagnosis. | ||
*Psoriasis vulgaris <ref name=pmid18418089>{{Cite journal | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern based approach to the diagnosis of inflammatory skin disorders (part I). | journal = Adv Anat Pathol | volume = 15 | issue = 2 | pages = 76-96 | month = Mar | year = 2008 | doi = 10.1097/PAP.0b013e3181664e8d | PMID = 18418089 }}</ref> - thinned suprapapillary plates, hypogranulosis, neutrophils in the stratum corneum, dilated papillary dermal blood vessels, acantholysis absent | |||
*Lichen simplex chronicus - usually a localized process, not a widespread process. | ===Microscopic DDx=== | ||
*[[Psoriasis vulgaris]]<ref name=pmid18418089>{{Cite journal | last1 = Brinster | first1 = NK. | title = Dermatopathology for the surgical pathologist: a pattern based approach to the diagnosis of inflammatory skin disorders (part I). | journal = Adv Anat Pathol | volume = 15 | issue = 2 | pages = 76-96 | month = Mar | year = 2008 | doi = 10.1097/PAP.0b013e3181664e8d | PMID = 18418089 }}</ref> - thinned suprapapillary plates, hypogranulosis, neutrophils in the stratum corneum, dilated papillary dermal blood vessels, acantholysis absent. | |||
*[[Lichen simplex chronicus]] - usually a localized process, not a widespread process. | |||
*Darier disease - acantholysis is prominent with corps ronds and grains, follicular plugging absent. | *Darier disease - acantholysis is prominent with corps ronds and grains, follicular plugging absent. | ||
*Pemphigus vulgaris - PRP with extensive acantholysis | *[[Pemphigus vulgaris]] - PRP with extensive acantholysis can mimic; [[immunofluorescence|IF]] will be negative in PRP. | ||
*Hailey-Hailey - | *[[Hailey-Hailey disease]] - falling brick wall pattern of acantholysis. | ||
*Seborrhoeic dermatitis - more spongiotic, often with neutrophils. | *Seborrhoeic dermatitis - more spongiotic, often with neutrophils. | ||
*[[ | *[[Dermatophytosis|Fungal infection]]. | ||
==Associated Diagnoses== | ==Associated Diagnoses== | ||
*HIV infection - recalcitrant PRP | *[[HIV infection]] - recalcitrant PRP. | ||
===Images=== | ===Images=== | ||
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[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Dermatopathology]] | |||