Histologic Diagnosis of Inflammatory Skin Diseases

Errors and Reasons

Error: Abortive is an accurate modifier of particular pathologic processes, e.g., abortive dermatofibroma, abortive morphea, and abortive T-cell lymphoma. Reason: The idea itself is abortive! For example, what is called “abortive T-cell lympho…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 10.99.1A: Vasculitis, small vessel, neutrophilic; panniculitis, lobular; perivascular and interstitial dermatitis, and vesicular dermatitis, subepidermal + 10.99.1B: Thrombi in the lumen of venules and countless bacteria in the int…

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

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

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…

Histologic Diagnosis of Inflammatory Skin Diseases

Impetigo contagiosa

…simplex may mimic impetigo, particularly when the contents of vesicles become turbid, but lesions tend to be vesicles rather than bullae, and they do not assume figurate outlines. Tinea corporis usually is scaly, not simply crusted, and vesicles, wh…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

…cells in the spinous layer = Grover’s disease A distinct vesicle in Grover’s disease, like the one shown here, is exceptional. It began intraepidermal and was so tense that it ruptured to become subepidermal, too. Hardly ever do vesicles…