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Dermatopathology: Practical & Conceptual July - September 2002
Prurigo Pigmentosa: New Observations and Comprehensive Review
Almut Böer, M.D.
Noriyuki Misago, M.D.
Manfred Wolter, M.D.
Hiromaro Kiryu, M.D.
Xiao Dong Wang, M.D.
A. Bernard Ackerman, M.D.
Differential Diagnosis Clinically
Differential Diagnosis Histopathologically
What is Your Diagnosis?
Figs 26AB These clinical pictures appeared as being representative of dermatitis herpetiformis in A Clinical Atlas of 101 Common Skin Diseases by A.B. Ackerman, H. Kerl, J. Sanchez et al.
What is your diagnosis
This young woman has red papules, papulovesicles, and crusted erosions in the lumbosacral region. The region of the scapula is involved, too. The differential diagnosis clinically includes dermatitis herpetiformis, linear IgA dermatosis, and prurigo pigmentosa.
Sections of tissue of a biopsy specimen taken from a fully developed lesion in this patient are pictured in Figures
. The findings in this subepidermal vesicular dermatitis are those of prurigo pigmentosa and not of dermatitis herpetiformis, for reasons that follow:
Fig. 26C At low magnification, no collections of neutrophils can be seen in dermal papillae at the side of the subepidermal blister.
Fig. 26D At higher magnification, lymphocytes and eosinophils are scattered along the dermo-epidermal junction.
Fig. 26E At still higher magnification, lymphocytes and eosinophils are seen better, and keratocytes at the dermo-epidermal junction show vacuolar alteration.
Fig. 26F Neutrophils are not prominent in the subepidermal blister or in the subepidermal space to the right of it. The infiltrate around the venules in the upper part of the reticular dermis consists of lymphocytes mainly.
Fig. 26G Although there is a mixture of inflammatory cells in the upper part of the dermis and in the subepidermal blister, eosinophils, rather than neutrophils, predominate.
Fig. 26H The eosinophils are more numerous than neutrophils in both the upper part of the dermis and in the subepidermal blister.
In sum, on the basis of the clinical features and the histopathologic findings, we belive that this patient has prurigo pigmentosa and not dermatitis herpetiformis. Staining by direct immunofluorescence was not performed.
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