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'''Inflammatory skin disorders''', also '''inflammatory skin diseases''', are a significant part of [[dermatopathology]]. They lead to trepidation among pathologists that don't see lots of skin. | '''Inflammatory skin disorders''', also '''inflammatory skin diseases''', are a significant part of [[dermatopathology]]. They lead to trepidation among pathologists that don't see lots of skin. | ||
=Classification= | |||
*Bullous. | |||
*Interface. | |||
*Nodular & diffuse. | |||
*Spongiotic. | |||
*Vasculitis. | |||
*Perivascular. | |||
*Panniculitis. | |||
*Psoriasiform. | |||
'''Tabular comparison of inflammatory skin disease (adapted from ''Brinster''<ref name=pmid18418089>{{cite journal |author=Brinster 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 |year=2008 |month=March |pmid=18418089 |doi=10.1097/PAP.0b013e3181664e8d |url=}}</ref>):''' | |||
{| class="wikitable" | |||
| '''Pattern''' | |||
| '''Key histologic feature''' | |||
| '''Subclassifications''' | |||
| '''Example''' | |||
|- | |||
| [[Bullous disease|Bullous]] | |||
| "Empty space" | |||
| -Subcorneal<br>-Suprabasillar<br>-Subepidermal | |||
| -Pemphigus foliaceus<br>-[[Pemphigus vulgaris]]<br>-[[Dermatitis herpetiformis]] | |||
|- | |||
| Interface | |||
| Inflammation at DE junction | |||
| -Vacuolar (minimal)<br>-Lichenoid (band-like) | |||
| -[[Erythema multiforme]], [[SLE]]<br>-[[Lichen planus]] | |||
|- | |||
| Nodular & diffuse | |||
| Nodular & diffuse | |||
| ? | |||
| | |||
|- | |||
| Spongiotic | |||
| Edema between keratinocytes | |||
| -Acute<br>-Subacute<br>-Chronic | |||
| -Poison Ivy<br>-Nummular dermatitis<br>-Atopic dermatitis | |||
|- | |||
| [[Vasculitis]] | |||
| Inflammation of vessel wall | |||
| ? | |||
| ? | |||
|- | |||
| Perivascular | |||
| Inflammation around vessels | |||
| ? | |||
| ? | |||
|- | |||
| [[Panniculitis]] | |||
| Inflamm. of adipose tissue | |||
| -Septal<br>-Nodular | |||
| -[[Erythema nodosum]]<br>-[[Erythema induratum]] | |||
|- | |||
| Psoriasiform | |||
| Epidermal thickening<br>and long rete ridges | |||
| -Regular<br>-Irregular | |||
| -Psoriasis<br>-[[Lichen simplex chronicus]] | |||
|} | |||
Notes: | |||
*''DE junction'' = dermal-epidermal junction. | |||
*The "empty space" in bullous disease ''in situ'' is filled with fluid. | |||
=Non-specific patterns= | |||
==Psoriasiform pattern== | |||
===General=== | |||
*Can be subclassified. | |||
DDx: | |||
*Psoriasis vulgaris (most common). | |||
*Psoriatic arthritis. | |||
*Drug-induced. | |||
*Others. | |||
===Microscopic=== | |||
Features:<ref>{{Ref PBoD8|1191}}</ref><ref name=pmid18418089>{{cite journal |author=Brinster 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 |year=2008 |month=March |pmid=18418089 |doi=10.1097/PAP.0b013e3181664e8d |url=}}</ref> | |||
*Regular epidermal thickening - as very long rete ridges (described as "test tube-morphology") - '''key feature'''. | |||
**Epidermis between rete ridges thin ("thinning of suprapapillary plate"). | |||
*Parakeratosis. | |||
*Thin/absent granular layer. | |||
*Dilated blood vessels in superficial dermis. | |||
*Neutrophil clusters (Munro microabscess). | |||
=Specific diseases= | |||
==Seborrheic dermatitis== | |||
===General=== | |||
*Very common. | |||
===Microscopic=== | |||
Features:<ref>{{Ref PBoD8|1191}}</ref> | |||
*Spongiosis (epidermal edema). | |||
*Acanthosis (epidermal thickening). | |||
*"Follicular lipping" = parakeratosis with neutrophils. | |||
*Perivascular neutrophils and lymphocytes. | |||
==Systemic lupus erythematosus== | |||
===General=== | |||
*Systemic disease with multi-organ manifestations. | |||
===Microscopic=== | |||
Features: | |||
*Lymphocytic interface dermatitis.<ref>JAH. 20 February 2009.</ref> | |||
*Basal layer vacuolation.<ref name=pmid18384217>{{cite journal |author=Crowson AN, Magro CM, Mihm MC |title=Interface dermatitis |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=4 |pages=652–66 |year=2008 |month=April |pmid=18384217 |doi= |url=http://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282008%29132%5B652%3AID%5D2.0.CO%3B2}}</ref> | |||
*Intradermal mucin. | |||
==Dermatomyositis== | |||
:''For the muscle manifestations see: [[Neuromuscular_pathology#Dermatomyositis]]''. | |||
===General=== | |||
*Complement mediated disease - membrane attack complex. | |||
*Usually middle age. | |||
*Associated skin rash is common. | |||
**May precede or follow muscle pathology. | |||
*Associated with malignancy in approximately 10% of cases.<ref name=pmid20398365>{{cite journal |author=Chen YJ, Wu CY, Huang YL, Wang CB, Shen JL, Chang YT |title=Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan |journal=Arthritis Res. Ther. |volume=12 |issue=2 |pages=R70 |year=2010 |pmid=20398365 |pmc=2888225 |doi=10.1186/ar2987 |url=}}</ref> | |||
===Gross=== | |||
*Have lesions on the knuckles - ''Gottron's papules''. | |||
===Microsopic=== | |||
Features: | |||
*Lymphocytic interface dermatitis (inflammation at the dermal-epidermal junction). | |||
*Loss of rete ridges. | |||
==Lichen planus== | |||
===General=== | |||
*An oral pathology. | |||
*May be seen where the sun don't shine - [[penis]],<ref name=pmid20082512>{{Cite journal | last1 = Teichman | first1 = JM. | last2 = Sea | first2 = J. | last3 = Thompson | first3 = IM. | last4 = Elston | first4 = DM. | title = Noninfectious penile lesions. | journal = Am Fam Physician | volume = 81 | issue = 2 | pages = 167-74 | month = Jan | year = 2010 | doi = | PMID = 20082512 }}</ref> [[vulva]] and [[vagina]].<ref name=pmid20062629>{{Cite journal | last1 = Gupta | first1 = R. | last2 = Bansal | first2 = B. | last3 = Singh | first3 = S. | last4 = Yadav | first4 = I. | last5 = Gupta | first5 = K. | last6 = Kudesia | first6 = M. | title = Lichen planus of uterine cervix - the first report of a novel site of occurrence: a case report. | journal = Cases J | volume = 2 | issue = | pages = 9306 | month = | year = 2009 | doi = 10.1186/1757-1626-2-9306 | PMID = 20062629 }}</ref> | |||
Etiology: | |||
*Autoimmune disease, T-cell–mediated.<ref>URL: [http://emedicine.medscape.com/article/1078327-overview http://emedicine.medscape.com/article/1078327-overview]. Accessed on: 11 September 2010.</ref> | |||
Clinical:<ref name=Ref_PBoD8_1191>{{Ref PBoD8|1191}}</ref> | |||
*6 Ps: pruritic (itchy), purple, polygonal, planar papules and plaques. | |||
===Gross=== | |||
*Wickham striae = white lines/dots. | |||
**Due to hypergranulosis. | |||
===Microscopic=== | |||
Features:<ref>URL: [http://emedicine.medscape.com/article/1078327-overview http://emedicine.medscape.com/article/1078327-overview]. Accessed on: 11 September 2010.</ref><ref name=Ref_PBoD8_1192>{{Ref PBoD8|1192}}</ref> | |||
*Loss of basal cells (stratum basale) -- '''key feature'''. | |||
*Loss of rete ridges/formation of pointed rete ridges "sawtoothing". | |||
*Interface dermatitis (lymphocytes at dermal-epidermal junction). | |||
*Hypergranulosis; stratum granulosum thickened (grossly seen as "Wickham stria" = white lines). | |||
*Hyperkeratosis; stratum corneum thickened. | |||
*Necrotic basal cell in dermis = colloid bodies = Civatte bodies.<ref name=Ref_PCPBoD8_604>{{Ref PCPBoD8|604}}</ref> | |||
DDx: | |||
*[[Bullous disease]], subepithelial vesicular. | |||
*[[Lichenoid keratosis]] - parakeratosis prominent. | |||
Notes: | |||
*Hyperkeratosis and hypergranulosis are not seen in [[erythema multiforme]]. | |||
*Colloid bodies = cytoid bodies = Civatte bodies = hyaline bodies = apoptotic bodies.<ref>URL: [http://www.careforumwales.org/cell-carcinoma/histopathologic-terminology.html http://www.careforumwales.org/cell-carcinoma/histopathologic-terminology.html]. Accessed on: 28 August 2011.</ref> | |||
**DDx: systemic lupus erythematosus, lichen planus, and [[graft-versus-host disease]]. | |||
Images: | |||
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_intermed_mag.jpg Lichen planus - intermed. mag. (WC)] | |||
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_low_mag.jpg Lichen planus - low mag. (WC)]. | |||
==Lichen sclerosus== | |||
{{Main|Lichen sclerosus}} | |||
===Microscopic=== | |||
Features:<ref name=Ref_PBoD1065-6>{{Ref PBoD|1065-6}}</ref> | |||
*Subepithelial fibrosis - '''key feature'''. | |||
==Psoriasis== | |||
===General=== | |||
*Chronic skin condition +/- systemic involvement:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref> | |||
**[[Arthritis]]. | |||
**[[Myopathy]]. | |||
**Enteropathy, e.g. [[inflammatory bowel disease]]. | |||
**Syondylitic joint disease (spondylos = vertebrae<ref>URL: [http://medical-dictionary.thefreedictionary.com/spondylosis http://medical-dictionary.thefreedictionary.com/spondylosis]. Accessed on: 28 August 2011.</ref>). | |||
Clinical: | |||
*''Auspitz sign'' = pin-point bleeding on removal of scale. | |||
*''Koebner phenomenon'' = lesions form at site of trauma. | |||
===Microscopic=== | |||
Features:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref> | |||
*Acanthosis + long rete ridges - '''key feature'''. | |||
*Parakeratosis. | |||
*Dilated vessels in superficial dermis (give rise to ''Auspitz sign''). | |||
*Spongiform pustules = PMNs in stratum spinosum. | |||
*PMNs in parakeratotic stratum corneum (Munro microabscess). | |||
=DDx for groups= | |||
==Spongiotic dermatitides== | ==Spongiotic dermatitides== | ||
DDx:<ref name=pmid18418089>{{cite journal |author=Brinster 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 |year=2008 |month=March |pmid=18418089 |doi=10.1097/PAP.0b013e3181664e8d |url=}}</ref> | DDx:<ref name=pmid18418089>{{cite journal |author=Brinster 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 |year=2008 |month=March |pmid=18418089 |doi=10.1097/PAP.0b013e3181664e8d |url=}}</ref> |
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