Inflammatory skin disorders: Difference between revisions

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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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*[[Solar elastosis]] - may be confused with ''mucin''; vacuolar interface dermatitis ''not'' present
*[[Solar elastosis]] - may be confused with ''mucin''; vacuolar interface dermatitis ''not'' present


Images:
====Images====
*[[WC]]:
<gallery>
**[http://commons.wikimedia.org/wiki/File:Vacuolar_interface_dermatitis_-_intermed_mag.jpg Vacuolar interface dermatitis with dermal mucin - intermed. mag. (WC)].
Image:Vacuolar_interface_dermatitis_-_low_mag.jpg | Vacuolar interface dermatitis with dermal mucin - low mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Vacuolar_interface_dermatitis_-_high_mag.jpg Vacuolar interface dermatitis with dermal mucin - high mag. (WC)].
Image:Vacuolar_interface_dermatitis_-_intermed_mag.jpg | Vacuolar interface dermatitis with dermal mucin - intermed. mag. (WC)
Image:Vacuolar_interface_dermatitis_-_high_mag.jpg | Vacuolar interface dermatitis with dermal mucin - high mag. (WC)
Image:Vacuolar_interface_dermatitis_-_very_high_mag.jpg | Vacuolar interface dermatitis with dermal mucin - very high mag. (WC)
</gallery>


==Discoid lupus erythematosus==
==Discoid lupus erythematosus==
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*Other considerations:
*Other considerations:
**Drug-induced psoriasis.<ref>{{Cite journal  | last1 = Milavec-Puretić | first1 = V. | last2 = Mance | first2 = M. | last3 = Ceović | first3 = R. | last4 = Lipozenčić | first4 = J. | title = Drug induced psoriasis. | journal = Acta Dermatovenerol Croat | volume = 19 | issue = 1 | pages = 39-42 | month = Mar | year = 2011 | doi =  | PMID = 21489366 }}</ref>
**Drug-induced psoriasis.<ref name=pmid21489366>{{Cite journal  | last1 = Milavec-Puretić | first1 = V. | last2 = Mance | first2 = M. | last3 = Ceović | first3 = R. | last4 = Lipozenčić | first4 = J. | title = Drug induced psoriasis. | journal = Acta Dermatovenerol Croat | volume = 19 | issue = 1 | pages = 39-42 | month = Mar | year = 2011 | doi =  | PMID = 21489366 }}</ref>


====Clinical====
====Clinical====
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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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*Parakeratosis.
*Parakeratosis.
*Dilated vessels in superficial dermis (give rise to ''Auspitz sign'').
*Dilated vessels in superficial dermis (give rise to ''Auspitz sign'').
*Spongiform pustules = PMNs in stratum spinosum.
*Spongiform pustules = [[PMN]]s in stratum spinosum.
*PMNs in parakeratotic stratum corneum (Munro microabscess).
*PMNs in parakeratotic stratum corneum (Munro microabscess).
*Thinning of the suprapapillary plate.
*Thinning of the suprapapillary plate.
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====Micro====
====Micro====
The sections show skin with acanthosis, hyperkeratosis, focal parakeratosis, prominent
The sections show skin with regular psoriasiform change, hyperkeratosis, focal parakeratosis, prominent dilated vessels in the superficial dermis, superficial clusters of intraepidermal neutrophils (spongiform pustules) and thinning of the suprapapillary plate is present. A few perivascular inflammatory cells are present.
dilated vessels in the superficial dermis, superficial clusters of intraepidermal
neutrophils (spongiform pustules) and thinning of the suprapapillary plate is present.
A few perivascular inflammatory cells are present.


There is no epidermal necrosis. Eosinophils are not apparent. The lymphocytes do not have
There is no epidermal necrosis. Eosinophils are not apparent. The lymphocytes do not have significant atypia.
significant atypia.


==Lichen striatus==
==Lichen striatus==
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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)


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