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| -subcorneal<br>-suprabasillar<br>-subepidermal | | -subcorneal<br>-suprabasillar<br>-subepidermal | ||
| -[[pemphigus foliaceus]]<br>-[[pemphigus vulgaris]]<br>-[[dermatitis herpetiformis]] | | -[[pemphigus foliaceus]]<br>-[[pemphigus vulgaris]]<br>-[[dermatitis herpetiformis]] | ||
| [ | | [[Image:Pemphigus_vulgaris_-_low_mag.jpg|thumb|150px|center|[[pemphigus vulgaris|PV]] (WC)]] | ||
|- | |- | ||
| [[Interface_dermatitides|Interface]] | | [[Interface_dermatitides|Interface]] | ||
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| -vacuolar (minimal)<br>-lichenoid (band-like) | | -vacuolar (minimal)<br>-lichenoid (band-like) | ||
| -[[erythema multiforme]], [[SLE]]<br>-[[lichen planus]] | | -[[erythema multiforme]], [[SLE]]<br>-[[lichen planus]] | ||
| | | [[Image:Vacuolar interface dermatitis - high mag.jpg|thumb|center|150px|[[vacuolar interface dermatitis|VID]] (WC)]] | ||
|- | |- | ||
| [[Nodular and diffuse dermatitides|Nodular & diffuse]] | | [[Nodular and diffuse dermatitides|Nodular & diffuse]] | ||
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| -neutrophic<br>-lymphocytic<br>-plasmic<br>-eosinophilic<br>-histocytic | | -neutrophic<br>-lymphocytic<br>-plasmic<br>-eosinophilic<br>-histocytic | ||
| -follicular occlusion triad, ruptured cyst/follicle<br>-[[CTCL]], reactive<br>-[[plasma cell neoplasm]], [[syphilis]]<br>-eosinophilic cellulitis, [[Kimura disease]]<br>-[[granuloma annulare]], [[sarcoidosis]], [[TB]] | | -follicular occlusion triad, ruptured cyst/follicle<br>-[[CTCL]], reactive<br>-[[plasma cell neoplasm]], [[syphilis]]<br>-eosinophilic cellulitis, [[Kimura disease]]<br>-[[granuloma annulare]], [[sarcoidosis]], [[TB]] | ||
| [ | | [[Image:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg|thumb|center|110px|[[CTCL]] (WC)]] | ||
|- | |- | ||
| [[Spongiotic_dermatitides|Spongiotic]] | | [[Spongiotic_dermatitides|Spongiotic]] | ||
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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|[[Eosinophilic granulomatosis with polyangiitis|EGPA]] (WC)]] | ||
|- | |- | ||
| [[Dermatitides_with_perivascular_inflammation|Perivascular]] | | [[Dermatitides_with_perivascular_inflammation|Perivascular]] | ||
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| -neutrophilic<br>-lymphocytic<br>-mastocytic<br>-eosinophilic | | -neutrophilic<br>-lymphocytic<br>-mastocytic<br>-eosinophilic | ||
| -[[cellulitis]]<br>-viral exanthem, Rx reaction<br>-[[mastocytosis]]<br>-insect bite, Rx reaction | | -[[cellulitis]]<br>-viral exanthem, Rx reaction<br>-[[mastocytosis]]<br>-insect bite, Rx reaction | ||
| [ | | [[Image:Dermal_perivascular_lymphoeosinophilic_infiltrate_-_high_mag.jpg |thumb|center|110px|DPLI (WC)]] | ||
|- | |- | ||
| [[Panniculitis]] | | [[Panniculitis]] | ||
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| -regular<br>-irregular | | -regular<br>-irregular | ||
| -[[psoriasis]]<br>-[[lichen simplex chronicus]] | | -[[psoriasis]]<br>-[[lichen simplex chronicus]] | ||
| [ | | [[Image:Lichen_simplex_chronicus_-_very_low_mag.jpg|thumb|150px|center|[[Lichen simplex chronicus|LSC]] (WC)]] | ||
|} | |} | ||
Notes: | Notes: | ||
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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==== | ||
<gallery> | |||
Image:Vacuolar_interface_dermatitis_-_low_mag.jpg | Vacuolar interface dermatitis with dermal mucin - low 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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*Fungal infection.<ref name=Ref_Derm36>{{Ref Derm|36}}</ref> | *Fungal infection.<ref name=Ref_Derm36>{{Ref Derm|36}}</ref> | ||
*Lichenoid drug reaction - unusual body site affected, separated clinically. | *Lichenoid drug reaction - unusual body site affected, separated clinically. | ||
*Lichenoid [[actinic keratosis]] - basal atypia, [[solar elastosis]]. | |||
====Images==== | ====Images==== | ||
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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, | *Knees, elbows, scalp, glans [[penis]]. | ||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref> | Features:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref> | ||
* | *"Regular" acanthosis + long rete ridges (psoriasiform hyperplasia). | ||
**"Regular" ([[Psoriasiform dermatitides|psoriasiform change]]) = rete ridges are of similar length and thickness. | |||
*Parakeratosis. | *Parakeratosis. | ||
*Dilated vessels in superficial dermis (give rise to ''Auspitz sign''). | *Dilated vessels in superficial dermis (give rise to ''Auspitz sign''). | ||
*Spongiform pustules = | *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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===Sign out=== | ===Sign out=== | ||
<pre> | <pre> | ||
SKIN LESION, | SKIN LESION, LEFT ARM, PUNCH BIOPSY: | ||
- SKIN WITH ACANTHOSIS, HYPERKERATOSIS, FOCAL PARAKERATOSIS, PROMINENT | - SKIN WITH ACANTHOSIS, HYPERKERATOSIS, FOCAL PARAKERATOSIS, PROMINENT | ||
DILATED VESSELS IN THE SUPERFICIAL DERMIS, SUPERFICIAL SPONGIFORM PUSTULES. | DILATED VESSELS IN THE SUPERFICIAL DERMIS, SUPERFICIAL SPONGIFORM PUSTULES. | ||
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COMMENT: | COMMENT: | ||
The findings are compatible with psoriasis. | The findings are compatible with psoriasis. | ||
</pre> | </pre> | ||
====Micro==== | ====Micro==== | ||
The sections show skin with | 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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*[[Spongiotic dermatitides]]. | *[[Spongiotic dermatitides]]. | ||
Images | ====Images==== | ||
<gallery> | |||
Image:Spongiotic_dermatitis_-_high_mag.jpg | Mild spongiotic dermatitis - high mag. (WC) | |||
Image:Spongiotic_dermatitis_-_very_high_mag.jpg | Mild spongiotic dermatitis - very high mag. (WC) | |||
</gallery> | |||
==Sweet syndrome== | ==Sweet syndrome== | ||
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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== | ||
{{Main|Pyoderma gangrenosum}} | |||
==Necrobiotic xanthogranuloma== | ==Necrobiotic xanthogranuloma== | ||
*Abbreviated ''NXG''. | *Abbreviated ''NXG''. | ||
{{Main|Necrobiotic xanthogranuloma}} | |||
=DDx for pattern= | =DDx for pattern= | ||
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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> | ||
*[[Atopic dermatitis]]. | *[[Atopic dermatitis]]. | ||
*Contact dermatitis. | *[[Contact dermatitis]]. | ||
*Stasis dermatitis. | *Stasis dermatitis. | ||
*[[Seborrheic dermatitis]]. | *[[Seborrheic dermatitis]]. | ||
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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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=====Tuberculoid===== | =====Tuberculoid===== | ||
*Tuberculosis. | *[[Tuberculosis]]. | ||
*Tertiary [[syphilis]] - usu. abundant plasma cells. | *Tertiary [[syphilis]] - usu. abundant plasma cells. | ||
*Cutaneous leishmaniasis. | *Cutaneous leishmaniasis. |
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