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Dermatopathology: Practical & Conceptual January - March 2006
>
5. New Heights: An assist to the next (10th) edition of “Lever’s”
Renata A. Joffe, M.D.
Content
Introduction
1. Small plaque parapsoriasis
2. Dysplastic nevus
3. Solar keratosis
4. Inverted follicular keratosis/trichilemmoma
5. Discoid lupus erythematosus vs. systemic lupus erythematosus
6. Lentigo maligna
7. Atopic dermatitis
8. Sebaceous adenoma
9. Muir-Torre syndrome
10. Bowen’s disease
11. Follicular mucinosis/alopecia mucinosa
12. Granuloma faciale and erythema elevatum diutinum
13. Follicular degeneration syndrome
14. Eccrine papillary adenoma
15. Degos’ disease
16. Dermatofibroma
17. Proliferating tricholemmal cyst
18. Erythema multiforme (dermal and epidermal types)
19. Lichen sclerosus et atrophicus vs. morphea
20. Malignant melanoma (classification)
21. Malignant melanoma—ABCD’s
22. Malignant melanoma—wide/deep excision
23. Sentinel node biopsy for melanoma
24. Malignant melanoma: nontumorigenic compartment of primary malignant melanoma (radial growth phase), tumorigenic compartment of primary malignant melanoma (vertical growth phase)
25. Minimal deviation melanoma
26. Nevoid melanoma
27. Malignant melanoma—in infancy and childhood
28. Malignant blue nevus
29. MELTUMP and SAMPUS
30. Bulge activation hypothesis
Conclusion
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7. Atopic dermatitis
Quotation from the 9th edition of Lever's:
"Understanding of the disease [atopic dermatitis] remains incomplete. Atopic dermatitis develops as a result of complex interactions of genetic, environmental, and immunologic factors. Allergic reactions appear to play a role in some patients, but in other patients, factors such as disturbance of skin function, infection and stress may be more important. Factors identified as being involved in the pathogenesis of atopic dermatitis include the differentiation of helper T cells, increased life span of eosinophils, multiple roles of IgE, the pattern of local cytokine expression, infectious agents, and superantigens."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
Statements contrary by ABA:
"Error: Atopic dermatitis is an allergic disease, analogous to allergic rhinitis, allergic conjunctivitis, and allergic asthma, and displays in sections of tissue, in repeatable fashion, findings of a primary pathologic process. Reason: The only consistent findings histopathologic in atopic dermatitis are those that reflect trauma externally in the form of animated scratching (erosions, ulcerations, and hemorrhagic crusts), vigorous rubbing (lichen simplex chronicus and prurigo nodularis), and a combination of rubbing and scratching (picker"s nodule); the condition is not analogous to allergic rhinitis, allergic conjunctivitis, and allergic asthma, each of which comes into being without the participation actively of the person affected, that is, the effect of inhalant allergens on mucous membranes especially is sufficient. Without the participation actively of a patient, nary a single lesion of atopic dermatitis comes into being."
Ackerman AB, Böer A, Bennin B, Gottlieb GJ.
Histologic Diagnosis of Inflammatory Skin Diseases: An Algorithmic Method Based on Pattern Analysis,
3rd edition, New York: Ardor Scribendi, 2005
Other works of ABA in which the ideas contrary are expressed:
1. Ackerman AB, Chongchitnant N, Sanchez J, Guo Y.
Histologic Diagnosis of Inflammatory Skin Diseases: An Algorithmic Method Based on Pattern Analysis,
2nd ed, Baltimore: Lippincott Williams & Wilkins, 1997.
2. Ackerman AB, Cavegn BM, Casintahan MF, Robinson MJ.
Resolving Quandaries in Dermatology, Pathology and Dermatopathology.
Promethean Medical Press/Waverly, 1995.
3. Atopic Dermatitis: Fact or Factitious (video), available at: www.derm101.com
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