Dermatology Practical & Conceptual

Hyperkeratotic necrobiosis lipoidica

Case report A 56-year-old Caucasian male with a history of uncontrolled diabetes mellitus and multiple other comorbidities was evaluated for slowly expanding plaques of his right lower leg, left forearm and left dorsal hand that had been present for…

Histologic Diagnosis of Inflammatory Skin Diseases

Algorithms Predicated on “Nonspecific” Findings

In this section, algorithms used to reach specific diagnosis are predicated on “nonspecific” findings recognized best at higher magnification. Other changes requisite for specific diagnoses, i.e., denominators that are essential, then ar…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 10.1.1A: Pustular dermatitis, infundibular + 10.1.1B: A comedo in association with granulomatous and fibrosing peri-infundibulitis = Acne vulgaris Many of the findings pictured here may be seen in other types of suppura…

Histologic Diagnosis of Inflammatory Skin Diseases

a-1 antitrypsin deficiency

α-1 antitrypsin deficiency Presentation stereotypical Age and sex Any age, predominantly women Distribution of lesions Particularly on the trunk and extremities Configuration of lesions Shapes of subcutaneous nodules bizarre, ulceration with dischar…

Histologic Diagnosis of Inflammatory Skin Diseases

Errors and Reasons

…l be the enlargement of endothelial cells. Error: Eosinophilic cellulitis, eosinophilic fasciitis, eosinophilic folliculitis, eosinophilic panniculitis, and eosinophilic spongiosis describe accurately those pathologic processes. Reason: The celluliti…

Histologic Diagnosis of Inflammatory Skin Diseases

Identification of Basic Patterns: Skin: Fibrosing Dermatitis

See Fig. 5.350 A&B. Figure 5.350 Fibrosing dermatitis. A. Early. B. Late (sclerosis). Fibrosing dermatitis (as well as fibrosing peri-infundibulitis/perifolliculitis and fibrosing panniculitis) results, in every instance, from injury to nonep…

Histologic Diagnosis of Inflammatory Skin Diseases

The Algorithmic Method

An algorithm is a method for calculation based on logical thought and orderly sequence, one that can be utilized for diagnosis of diseases of all kinds, including inflammatory ones of the skin. Once a disorder of the skin and/or subcutaneous fat has…

Histologic Diagnosis of Inflammatory Skin Diseases

Lymphedema

Lymphedema Presentation stereotypical Age and sex Adults usually, women more than men Distribution of lesions Distal extremities, legs more than arms; genitalia episodically Arrangement of lesions Diffuse involvement of parts, e.g., elephantiasis In…

Histologic Diagnosis of Inflammatory Skin Diseases

Acne vulgaris

Synonyms Acne simplex Presentation stereotypical Age and sex Adolescents of both sexes; usually more severe in males. May affect neonates. Distribution of lesions Regions in which large sebaceous units are joined to vellus follicles, i.e., the face,…

Histologic Diagnosis of Inflammatory Skin Diseases

Deep fungal infections

Deep fungal infections Synonyms Mycetoma Subcutaneous mycoses Dermal mycoses Presentation stereotypical Age and sex Any age, both sexes Distribution of lesions Localized or widespread; some infections favor exposed sites; internal organs sometimes…