Difference between revisions of "Inflammatory skin disorders"

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Inflammatory skin disorders (view source)

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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.  Non-inflammatory skin disease is covered in ''[[dermatologic neoplasms]]'' and ''[[non-malignant skin disease]]''.


=Classification=
=Classification=
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| large "empty spaces"
| large "empty spaces"
| -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]]
| [http://commons.wikimedia.org/wiki/File:Pemphigus_vulgaris_-_low_mag.jpg (WC)]
| [[Image:Pemphigus_vulgaris_-_low_mag.jpg|thumb|150px|center|[[pemphigus vulgaris|PV]] (WC)]]
|-
|-
| Interface
| [[Interface_dermatitides|Interface]]
| inflammation at DE junction
| inflammation at DE junction
| -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 & diffuse  
| [[Nodular and diffuse dermatitides|Nodular & diffuse]]
| intradermal inflammatory infiltrate - nodular and/or diffuse
| intradermal inflammatory infiltrate - nodular and/or diffuse
| -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]]
| [http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg (WC)]
| [[Image:Cutaneous_T-cell_lymphoma_-_very_high_mag.jpg|thumb|center|110px|[[CTCL]] (WC)]]
|-
|-
| Spongiotic
| [[Spongiotic_dermatitides|Spongiotic]]
| small empty spaces between keratinocytes - can see squamous bridges (best seen at high power); +/- quasi-microvacuolar appearance
| small empty spaces between keratinocytes - can see squamous bridges (best seen at high power); +/- quasi-microvacuolar appearance
| -acute<br>-subacute<br>-chronic
| -acute<br>-subacute<br>-chronic
| -poison ivy<br>-nummular dermatitis<br>-atopic dermatitis
| -poison ivy<br>-nummular dermatitis<br>-[[atopic dermatitis]]
| [http://commons.wikimedia.org/wiki/File:Spongiotic_dermatitis_%282%29_Dyshidrotic_.JPG (WC)]
| [http://commons.wikimedia.org/wiki/File:Spongiotic_dermatitis_%282%29_Dyshidrotic_.JPG severe (WC)], [http://commons.wikimedia.org/wiki/File:Spongiotic_dermatitis_-_very_high_mag.jpg mild (WC)]
|-
|-
| [[Vasculitis]]
| [[Vasculitis]]
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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]]
| [http://commons.wikimedia.org/wiki/File:Churg-Strauss_syndrome_-_high_mag.jpg (WC)]
| [[Image:Churg-Strauss_syndrome_-_high_mag.jpg |thumb|150px|[[Eosinophilic granulomatosis with polyangiitis|EGPA]] (WC)]]
|-
|-
| Perivascular
| [[Dermatitides_with_perivascular_inflammation|Perivascular]]
| inflammation around vessels
| inflammation around vessels
| -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  
| [http://commons.wikimedia.org/wiki/File:Dermal_perivascular_lymphoeosinophilic_infiltrate_-_high_mag.jpg (WC)]
| [[Image:Dermal_perivascular_lymphoeosinophilic_infiltrate_-_high_mag.jpg |thumb|center|110px|DPLI (WC)]]
|-
|-
| [[Panniculitis]]
| [[Panniculitis]]
| inflammation of adipose tissue
| inflammation of adipose tissue
| -septal<br>-nodular
| -septal<br>-lobular
| -[[erythema nodosum]], [[scleroderma panniculitis]]<br>-[[erythema induratum]], infection
| -[[erythema nodosum]], [[scleroderma panniculitis]]<br>-[[erythema induratum]], infection
|
|
|-
|-
| Psoriasiform
| [[Psoriasiform dermatitides|Psoriasiform]]
| epidermal thickening<br>and long rete ridges  
| epidermal thickening<br>and long rete ridges  
| -regular<br>-irregular
| -regular<br>-irregular
| -[[psoriasis]]<br>-[[lichen simplex chronicus]]
| -[[psoriasis]]<br>-[[lichen simplex chronicus]]
| [http://commons.wikimedia.org/wiki/File:Lichen_simplex_chronicus_-_very_low_mag.jpg (WC)]
| [[Image:Lichen_simplex_chronicus_-_very_low_mag.jpg|thumb|150px|center|[[Lichen simplex chronicus|LSC]] (WC)]]
|}
|}
Notes:  
Notes:  
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*Psoriatic arthritis.
*Psoriatic arthritis.
*Drug-induced.
*Drug-induced.
*[[Dermatomycosis]] (fungal infection).
*Others.
*Others.


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===Microscopic===
===Microscopic===
Features:<ref>{{Ref PBoD8|1191}}</ref>
Features:<ref>{{Ref PBoD8|1191}}</ref>
*Spongiosis (epidermal edema).
*[[Spongiosis]] (epidermal edema).
*Acanthosis (epidermal thickening).
*Acanthosis (epidermal thickening).
*"Follicular lipping" = parakeratosis with neutrophils.
*"Follicular lipping" = parakeratosis with neutrophils.
*Perivascular neutrophils and lymphocytes.
*Perivascular neutrophils and lymphocytes.


==Systemic lupus erythematosus==
==Lupus erythematosus==
{{Main|Systemic lupus erythematosus}}
===General===
===General===
*Systemic disease with multi-organ manifestations.
*A group of skin diseases - includes:
 
**The systemic disease, [[systemic lupus erythematosus]], that typically has multi-organ involvement.
May present with different skin manifestations:
*[[Panniculitis]].
*Vacuolar interface dermatitis.
*Bullae (bullous systemic lupus erythematosus).
*Deep and superficial dermal, lymphocyte predominant, inflammation.  


===Microscopic===
===Microscopic===
Features:
Features - classic:
*Lymphocytic interface dermatitis.<ref>JAH. 20 February 2009.</ref>
*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>
*Basal layer vacuolization.<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.
*Intradermal mucin.
*Thin epidermis.
*Compact stratum corneum.
DDx:
*[[Discoid lupus erythematosus]].
*Drug reaction (drug-induced lupus erythematosus).
*[[Solar elastosis]] - may be confused with ''mucin''; vacuolar interface dermatitis ''not'' present
====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==
===General===
*Typically self-limited and isolated.
**It is '''not''' associated with ''[[systemic lupus erythematosus]]''.
===Microscopic===
Features:<ref>URL: [http://www.dermpedia.org/baby-dermpedia-for-beginners/discoid-lupus-erythematosus http://www.dermpedia.org/baby-dermpedia-for-beginners/discoid-lupus-erythematosus]. Accessed on: 7 March 2012.</ref>
*Lymphocytic interface dermatitis with basal layer vacuolation and keratinocyte apoptosis.
*Deep dermal lymphocytes.
*Basket weave stratum corneum.
*Dermal mucin.
*Thick dermal-epidermal basement membrane.
DDx:
*[[Lupus erythematosus]].
Image:
*[http://www.dermpedia.org/baby-dermpedia-for-beginners/discoid-lupus-erythematosus DLE (dermpedia.org)].


==Dermatomyositis==
==Dermatomyositis==
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**May precede or follow muscle pathology.
**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>
*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>
Clinical:
*Jo-1 +ve.


===Gross===
===Gross===
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==Lichen planus==
==Lichen planus==
:''Should '''not''' be confused with [[lichen planus-like keratosis]]''.
*Abbreviated ''LP''.
===General===
===General===
*An oral pathology.
*An [[oral pathology]] - classically.
*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>
*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>


Line 151: Line 185:
*6 Ps: pruritic (itchy), purple, polygonal, planar papules and plaques.
*6 Ps: pruritic (itchy), purple, polygonal, planar papules and plaques.


Note:
*Clinically, lichen planus and [[lichen sclerosus]] are similar. The main difference is lichen planus involves mucous membranes.<ref name=pmid20868406>{{Cite journal  | last1 = McPherson | first1 = T. | last2 = Cooper | first2 = S. | title = Vulval lichen sclerosus and lichen planus. | journal = Dermatol Ther | volume = 23 | issue = 5 | pages = 523-32 | month =  | year =  | doi = 10.1111/j.1529-8019.2010.01355.x | PMID = 20868406 }}</ref>
===Gross===
===Gross===
*Wickham striae = white lines/dots.
*Wickham striae = white lines/dots.
Line 163: Line 199:
*Hyperkeratosis; stratum corneum thickened.
*Hyperkeratosis; stratum corneum thickened.
*Necrotic basal cell in dermis = colloid bodies = Civatte bodies.<ref name=Ref_PCPBoD8_604>{{Ref PCPBoD8|604}}</ref>
*Necrotic basal cell in dermis = colloid bodies = Civatte bodies.<ref name=Ref_PCPBoD8_604>{{Ref PCPBoD8|604}}</ref>
 
**Pink bodies approximately the size of a keratinocyte.
DDx:
*[[Bullous disease]], subepithelial vesicular.
*[[Lichenoid keratosis]] - parakeratosis prominent.  


Notes:
Notes:
Line 173: Line 206:
**DDx: [[systemic lupus erythematosus]], [[lichen planus]], and [[graft-versus-host disease]].
**DDx: [[systemic lupus erythematosus]], [[lichen planus]], and [[graft-versus-host disease]].


Images:
DDx:
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_intermed_mag.jpg Lichen planus - intermed. mag. (WC)]
*[[Bullous disease]], subepithelial vesicular.
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_low_mag.jpg Lichen planus - low mag. (WC)].
*[[Lichenoid keratosis]] (lichen planus-like keratosis) - parakeratosis prominent, no oral mucosal involvement.
*Fungal infection.<ref name=Ref_Derm36>{{Ref Derm|36}}</ref>
*Lichenoid drug reaction - unusual body site affected, separated clinically.
*Lichenoid [[actinic keratosis]] - basal atypia, [[solar elastosis]].
 
====Images====
<gallery>
Image:Lichen_planus_intermed_mag.jpg | Lichen planus - intermed. mag. (WC/Nephron)
Image:Lichen_planus_low_mag.jpg | Lichen planus - low mag. (WC/Nephron)
</gallery>
 
===Stains===
*PAS-D or PAS-F to exclude a fungal infection.
 
===Sign out===
<pre>
FORESKIN, CIRCUMCISION:
- LICHEN PLANUS.
</pre>
 
<pre>
VULVA, LEFT POSTERIOR FOURCHETTE, BIOPSY:
- COMPATIBLE WITH LICHEN PLANUS.
</pre>
 
====Micro====
The sections show skin with a lymphoplasmacytic interface dermatitis, basal cell loss, hypergranulosis, hyperkeratosis, loss of the rete ridges and Civatte bodies.
 
The epidermis matures to the surface. No significant nuclear atypia is identified.
 
Fungal organisms are not identified with a PAS-D stain.


==Lichen sclerosus==  
==Lichen sclerosus==  
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===General===
===General===
*Chronic skin condition +/- systemic involvement:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref>
*Chronic skin condition +/- systemic involvement:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref>
**[[Arthritis]].
**[[Arthritis]], i.e. psoriatic arthritis.
**[[Myopathy]].
**[[Myopathy]].
**Enteropathy, e.g. [[inflammatory bowel disease]].
**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>).
**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:
*Other considerations:
**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====
*''Auspitz sign'' = pin-point bleeding on removal of scale.
*''Auspitz sign'' = pin-point bleeding on removal of scale.
*''Koebner phenomenon'' = lesions form at site of trauma.
*''Koebner phenomenon'' = lesions form at site of trauma.
Common locations:<ref name=Ref_PCPBoD8_603>{{Ref PCPBoD8|603}}</ref>
*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>
*Acanthosis + long rete ridges - '''key feature'''.
*"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 = 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.
**The epidermis between rete ridges is thinner than in the normal adjacent skin.
**The epidermis between rete ridges is thinner than in the normal adjacent skin - '''key feature'''.
 
DDx:
*[[Dermatomycosis]] ([[Fungi|fungal infection]]).
*Drug reaction.
 
Note:
*[[Dermatophytosis]] = ring worm; dermatophystosis != [[dermatomycosis]].
 
====Images====
www:
*[http://missinglink.ucsf.edu/lm/dermatologyglossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/Psoriasis_low_power.jpg Psoriasis - low mag. (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/dermatologyglossary/psoriasis.html http://missinglink.ucsf.edu/lm/dermatologyglossary/psoriasis.html]. Accessed on: 4 September 2013.</ref>
 
===Stains===
*[[PASD stain]] -ve for [[fungi|fungal]] organisms.
 
===Sign out===
<pre>
SKIN LESION, LEFT ARM, PUNCH BIOPSY:
- SKIN WITH ACANTHOSIS, HYPERKERATOSIS, FOCAL PARAKERATOSIS, PROMINENT
  DILATED VESSELS IN THE SUPERFICIAL DERMIS, SUPERFICIAL SPONGIFORM PUSTULES.
- MILD NONSPECIFIC PERIVASCULAR INFLAMMATION.
- NEGATIVE FOR FUNGAL ORGANISMS WITH PAS STAINING.
 
COMMENT:
The findings are compatible with psoriasis. 
</pre>
 
====Micro====
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.
 
There is no epidermal necrosis. Eosinophils are not apparent. The lymphocytes do not have significant atypia.


==Lichen striatus==
==Lichen striatus==
Line 225: Line 326:
*Hyperkeratosis.
*Hyperkeratosis.
*Parakeratosis.
*Parakeratosis.
DDx:
*[[Lichen planus]].


Images:  
Images:  
Line 251: Line 355:


===Microscopic===
===Microscopic===
Features:
Features:<ref name=Ref_Derm198-9>{{Ref Derm|198-9}}</ref>
*Neutrophilic vasculitis - often subtle:
**Neutrophils within blood vessel walls.
**Vessels destruction ([[fibrinoid necrosis]] or nuclear dust).
*Mixed inflammatory superficial dermal infiltrate.
*Mixed inflammatory superficial dermal infiltrate.
**Eosinophils.
**Eosinophils, neutrophils, plasma cells, histiocytes.
**Neutrophils.
**Plasma cells.
**Histiocytes.
*Lesion separated from the (normal) epidermis (Grenz zone).<ref name=dermatlas_gf>URL: [http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=1289066309 http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=1289066309]. Accessed on: 23 September 2011.</ref>
*Lesion separated from the (normal) epidermis (Grenz zone).<ref name=dermatlas_gf>URL: [http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=1289066309 http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=1289066309]. Accessed on: 23 September 2011.</ref>
DDx of chronic fibrosing [[leukocytoclastic vasculitis]]:<ref name=Ref_Derm198-9>{{Ref Derm|198-9}}</ref>
*Granuloma faciale.
*Erythema elevatum diutinum - lacks Grenz zone.
*Inflammatory pseudotumour.


Image:
Image:
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=1289066309 Granuloma faciale (dermatlas.med.jhmi.edu)].
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=1289066309 Granuloma faciale (dermatlas.med.jhmi.edu)].
==Atopic dermatitis==
*[[AKA]] ''atopic eczema'', [[AKA]] ''infantile eczema''.
===General===
*Very common - especially in children.<ref name=ad_nih>URL: [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001856/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001856/]. Accessed on: 28 December 2011.</ref>
**Most children outgrow the condition.
===Microscopic===
Features:
*Spongiotic dermatitis.
DDx:
*[[Spongiotic dermatitides]].
====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==
===General===
*Uncommon.
===Microscopic===
Features:
*Nodular and diffuse pattern - neutrophils predominant - without pus.
DDx ''rips'':
*Rheumatoid neutrophilic dermatitis.
*[[Bowel-associated dermatosis-arthritis syndrome]] (BADAS).
*[[Pyoderma gangrenosum]].
*Sweet syndrome.
Image:
*[http://dermatology.cdlib.org/94/NYU/Apr2002/041602-7b.jpg Sweet syndrome (cdlib.org)].<ref>URL: [http://dermatology.cdlib.org/94/NYU/Apr2002/7.html http://dermatology.cdlib.org/94/NYU/Apr2002/7.html]. Accessed on: 4 January 2012.</ref>
==Granuloma inguinale==
:'''Not''' to be confused with ''[[granuloma annulare]]''.
*Previously known as ''donovanosis''.
===General===
*Infection caused by ''Klebsiella granulomatis'' - [[Gram stain|Gram]]-negative, rod-shaped bacteria.
**Used to be known as ''Calymmatobacterium granulomatis''.<ref name=pmid12473810>{{cite journal |author=O'Farrell N |title=Donovanosis |journal=Sex Transm Infect |volume=78 |issue=6 |pages=452–7 |year=2002 |month=December |pmid=12473810 |pmc=1758360 |doi= |url=http://sti.bmj.com/cgi/pmidlookup?view=long&pmid=12473810}}</ref>
Location:
*[[Penis]].
*[[Vulva]].
Clinical:<ref name=pmid21738983>{{Cite journal  | last1 = Bezerra | first1 = SM. | last2 = Jardim | first2 = MM. | last3 = Silva | first3 = VB. | title = Granuloma inguinale (Donovanosis). | journal = An Bras Dermatol | volume = 86 | issue = 3 | pages = 585-6 | month = Jun | year = 2011 | doi =  | PMID = 21738983 |URL = http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0365-05962011000300028&lng=en&nrm=iso&tlng=en }}</ref>
*Sexually transmitted.
*Nodule or papule developing into a painless ulcer in the inguinal region.
*No lymphadenopathy (unlike [[syphilis]]).
===Microscopic===
Features:
*Donovan bodies - '''key feature''':
**Rod-shaped bodies within histiocytes.
DDx:
*[[Syphilis]].
Image:
*[http://microblog.me.uk/213 Granuloma inguinale - crappy image (microblog.me.uk)].
===Stains===
*[[Giemsa stain]] - highlights organisms.
==Pyoderma gangrenosum==
{{Main|Pyoderma gangrenosum}}
==Necrobiotic xanthogranuloma==
*Abbreviated ''NXG''.
{{Main|Necrobiotic xanthogranuloma}}


=DDx for pattern=
=DDx for pattern=
==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>
*Atopic dermatitis.
*[[Atopic dermatitis]].
*Contact dermatitis.
*[[Contact dermatitis]].
*Stasis dermatitis.
*Stasis dermatitis.
*[[Seborrheic dermatitis]].
*[[Seborrheic dermatitis]].
Line 277: Line 459:
*Psoriasis vulgaris.
*Psoriasis vulgaris.
*Dermatophyte infection.
*Dermatophyte infection.
*Pityriasis rubra pilaris.
*[[Pityriasis rubra pilaris]].


===Irregular psoriasiform dermatitis===
===Irregular psoriasiform dermatitis===
Line 301: Line 483:
*Lichen sclerosis et atrophicus.
*Lichen sclerosis et atrophicus.
*[[Erythema dyschromicum perstans]] (ashy dermatosis).
*[[Erythema dyschromicum perstans]] (ashy dermatosis).
Super lame mnemonic ''Danny G & SLE'':
*'''D'''ermatomyositis, '''G'''VHD, '''S'''LE, '''L'''ichen sclerosus, '''E'''rythema multiforme.


===Lichenoid interface dermatitides===
===Lichenoid interface dermatitides===
Line 311: Line 496:


Additional:<ref name=pmid16311340>{{Cite journal  | last1 = Alsaad | first1 = KO. | last2 = Ghazarian | first2 = D. | title = My approach to superficial inflammatory dermatoses. | journal = J Clin Pathol | volume = 58 | issue = 12 | pages = 1233-41 | month = Dec | year = 2005 | doi = 10.1136/jcp.2005.027151 | PMID = 16311340 | PMC = 1770784}}</ref>
Additional:<ref name=pmid16311340>{{Cite journal  | last1 = Alsaad | first1 = KO. | last2 = Ghazarian | first2 = D. | title = My approach to superficial inflammatory dermatoses. | journal = J Clin Pathol | volume = 58 | issue = 12 | pages = 1233-41 | month = Dec | year = 2005 | doi = 10.1136/jcp.2005.027151 | PMID = 16311340 | PMC = 1770784}}</ref>
*Lichen planus-like keratosis.
*[[Lichen planus-like keratosis]].
*Lichenoid [[actinic keratosis]].
*Lichenoid [[actinic keratosis]].
*Lichen nitidus.
*Lichen nitidus.
Line 326: Line 511:
===Subcorneal bullous disorders===
===Subcorneal bullous disorders===
DDx '''with''' acantholysis:<ref name=pmid18418089/>
DDx '''with''' acantholysis:<ref name=pmid18418089/>
*[[Pemphigus foliaceous]].
*[[Pemphigus foliaceus]].
*[[Bullous impetigo]].
*[[Bullous impetigo]].
*[[Staphylococcual scaled skin syndrome]].
*[[Staphylococcal scalded skin syndrome]].


DDx '''without''' acantholysis:DDx:<ref name=pmid18418089/>
DDx '''without''' acantholysis:DDx:<ref name=pmid18418089/>
*Subcorneal pustular dermatosis (Sneddon-Wilkinson disease)
*Subcorneal pustular dermatosis (Sneddon-Wilkinson disease).
*Pustular psoriasis.
*Pustular psoriasis.
*Pustular drug eruption ([[acute generalized exanthematous pustulosis]]).
*Pustular drug eruption ([[acute generalized exanthematous pustulosis]]).
Line 350: Line 535:
*[[Porphyria cutanea tarda]].
*[[Porphyria cutanea tarda]].
*Epidermolysis bullosa acquista.
*Epidermolysis bullosa acquista.
*[[Dermatitis herpetiformsis]].
*[[Dermatitis herpetiformis]].
*Linear IgA disease.
*Linear IgA disease.


Line 366: Line 551:
*Linear '''I'''gA disease.
*Linear '''I'''gA disease.


==Perivascular inflammation==
==Dermatitides with perivascular inflammation==
===Lymphocytes===
===Lymphocytes===
Lymphocytes (tightly cuffed):<ref name=pmid18418089/>
Lymphocytes (tightly cuffed):<ref name=pmid18418089/>
Line 392: Line 577:
*'''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)


Line 405: Line 590:
===Eosinophils===
===Eosinophils===
DDx:<ref name=pmid18418089/>
DDx:<ref name=pmid18418089/>
*Hypersensitivity reaction/drug reaction.
*[[Hypersensitivity]] reaction/drug reaction.
*Insect bite.
*Insect bite.
*Bullous pemphigoid, urticarial.
*Bullous pemphigoid, urticarial.
Line 432: Line 617:
*[[Microscopic polyangiitis]].
*[[Microscopic polyangiitis]].
*Mixed cryoglobulinemia.
*Mixed cryoglobulinemia.
*Connective tissue diseases.
*[[Connective tissue diseases]].


Large vessel:
Large vessel:
*[[Giant cell arteritis]].
*[[Giant cell arteritis]].


==Nodular and diffuse==
==Nodular and diffuse dermatitides==
===Neutrophils===
===Neutrophils===
====With pus (suppurative)====
====With pus (suppurative)====
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*[[Pyoderma gangrenosum]].
*[[Pyoderma gangrenosum]].
*[[Rheumatoid arthritis|Rheumatoid neutrophilic dermatitis]].
*[[Rheumatoid arthritis|Rheumatoid neutrophilic dermatitis]].
*Bowel-associated ermatosis-arthritis syndrome.
*Bowel-associated dermatosis-arthritis syndrome.


===Lymphocytes===
===Lymphocytes===
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**Insect bites.
**Insect bites.
*Hypereosinophilic syndrome (HES).
*Hypereosinophilic syndrome (HES).
*Angiolymphoid hyperplasia with eosinophilia (ALHE).
*[[Angiolymphoid hyperplasia with eosinophilia]] (ALHE).
*[[Kimura disease]].
*[[Kimura disease]].


Line 483: Line 668:


=====Tuberculoid=====
=====Tuberculoid=====
*Tuberculosis.
*[[Tuberculosis]].
*Tertiary [[syphilis]] - usu. abundant plasma cells.
*Tertiary [[syphilis]] - usu. abundant plasma cells.
*Cutaneous leishmaniasis.
*Cutaneous leishmaniasis.
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*[[Rheumatoid nodule]].
*[[Rheumatoid nodule]].
*[[Necrobiosis lipoidica]].
*[[Necrobiosis lipoidica]].
*Necrobiotic xanthogranuloma.
*[[Necrobiotic xanthogranuloma]].
*[[Churg-Strauss syndrome]].
*[[Churg-Strauss syndrome]].


Michael
48,466

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