Resolving Quandaries in Dermatology, Pathology & Dermatopathology

Spongiform Pustular Diseases?

…ribed in 1938 by Kogoj, who likened the diffuse collections of neutrophils in the middle and upper parts of the epidermis to the appearance of a sponge. Why he thought that is baffling. In a spongiform pustule, neutrophils in variable number are spri…

Histologic Diagnosis of Inflammatory Skin Diseases

Behçet’s Disease

…round venules in the reticular dermis and the subcutaneous fat Neutrophils with variable amounts of nuclear “dust” of neutrophils in perivascular and interstitial location, as well as in infundibular epidermis Fibrin in the wall of venule…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

…nd in the spinous zone, spongiosis, ballooned keratocytes, and neutrophils in parakeratotic foci = Mucha-Habermann disease, acute  No interface dermatitis other than Mucha-Habermann disease in lesions evolving is accompanied consistently by neutrophi…

Histologic Diagnosis of Inflammatory Skin Diseases

The Algorithmic Method

…ned so eccentrically. Figure 6.4 A&B. Identification of neutrophils at scanning and high magnifications. Neutrophils in this lesion of pyoderma gangrenosum are recognizable at scanning magnification by their resemblance to “salt and pepp…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

…inding in the absence of necrosis of the epidermis is numerous neutrophils in an intraepidermal vesicle induced by the “bite” of an insect. Necrosis, in general, is chemotactic for neutrophils. 10.5.4A: Vesicular dermatitis, intraep…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

…ed around venules; interstitial involvement by eosinophils and neutrophils is slight. 10.111.2A: Perivascular and interstitial dermatitis, mixed-cell + 10.111.2B: Lymphocytes, eosinophils, and neutrophils around venules, and neutrophils and…

Histologic Diagnosis of Inflammatory Skin Diseases

Prurigo pigmentosa

…histopathologic Early Superficial perivascular infiltrate of neutrophils mostly Edema of the papillary dermis Spongiosis in foci Neutrophils scattered in the epidermis Ill-formed abscesses in the epidermis Necrotic keratocytes in the vicinity of ne…

Histologic Diagnosis of Inflammatory Skin Diseases

Syphilis

…dermis may be scant, lacking prominent acanthosis, pallor, and neutrophils. Episodically, the epidermis of a fully developed lesion of secondary syphilis may appear to be uninvolved. Neutrophils in the epidermis of secondary syphilis, whether in con…

Resolving Quandaries in Dermatology, Pathology & Dermatopathology

Lymphocytic Vasculitis?

…nce of leukocytoclasis, that is, nuclear “dust” of neutrophils in company with intact neutrophils and, in lesions developed fully, with fibrin in the wall of venules. In septic vasculitis, neutrophils predominate, but are unaccompanied by…

Histologic Diagnosis of Inflammatory Skin Diseases

Identification of Basic Patterns: Subcutaneous Fat: Panniculitis

See Fig. 5.385 A-C. Figure 5.385 Patterns of panniculitis. A. Septal mostly. B. Lobular mostly. C. Septal and lobular “equally.” At scanning magnification, the normal subcutaneous fat is seen to be segregated by struts of fibrous tiss…