Histologic Diagnosis of Inflammatory Skin Diseases

Identification of Basic Patterns: Skin: Nodular and Diffuse Dermatitis

See Fig. 5.174 A&B. Figure 5.174 A&B. Nodular dermatitis and diffuse dermatitis. Nodular dermatitis is distinguished from perivascular dermatitis (see Fig. 5.16 A&B) by the density of the infiltrate of inflammatory cells. In the periv…

Histologic Diagnosis of Inflammatory Skin Diseases

Fixation of the Specimen

The usual fixative for skin specimens is 10% buffered formalin. The amount of formalin should be approximately 20 times by volume that of the specimen. A surgeon, not an assistant, should be responsible for ensuring that the specimen is prevented fr…

Histologic Diagnosis of Inflammatory Skin Diseases

Suction blister

Suction blister Presentation stereotypical Individual lesions Vesicles and bullae Findings histopathologic Fully developed Subepidermal blister beneath which dermal papillae are preserved No infiltrate of inflammatory cells Correlation clinicopath…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 10.88.1A: Perivascular dermatitis, neutrophils predominant + 10.88.1B: Neutrophils in edematous dermal papillae = Prurigo pigmentosa ¬†Findings similar to these may be seen in dermatitis herpetiformis at a very early stage of the pr…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 10.47.1A: Perivascular dermatitis, interface, patchy lichenoid + 10.47.1B: Keratocytes with steel-gray nuclei, “margination” of chromatin, ballooned cytoplasm, and multinucleate and necrotic keratocytes = Infection by h…

Histologic Diagnosis of Inflammatory Skin Diseases

Pattern Analysis in Historical Perspective

In 1963, the year that one of us (A.B.A.) began a residency in dermatology, Walter Lever’s textbook, Histopathology of the Skin, was in its third edition and was deemed, universally, to be “the bible” of dermatopathology. To a firs…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

…came into being as a result of rupture of tense intraepidermal vesicles. The intraepidermal vesicles developed mostly as a consequence of ballooning of keratocytes, rather than of spongiosis. 10.32.4A: Vesicular dermatitis, subepidermal, lympho…

Histologic Diagnosis of Inflammatory Skin Diseases

Farmyard pox

…alignant pustule) begins as a papule, but soon develops into a vesicle associated with necrosis and surrounded at times by small satellite vesicles. Findings histopathologic Fully developed Ballooning of cells in the upper third of the spinous zone…