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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

Scrofuloderma

Scrofuloderma Findings histopathologic Fully developed Tuberculoid granulomas, many with extensive caseous necrosis in their center, present throughout the entire dermis and far into the subcutis Abscesses in some granulomas Fibroplasia in the uppe…

Histologic Diagnosis of Inflammatory Skin Diseases

Definition of Inflammation in Historical Perspective

The word “inflammation” was introduced about 2,000 years ago by Celsus in one of the eight volumes he devoted to the history of medicine. In the third volume of that monumental work, Celsus mentioned four signs and symptoms he deemed to…

Histologic Diagnosis of Inflammatory Skin Diseases

Lupus vulgaris

Lupus vulgaris Findings histopathologic Fully developed Collections of epithelioid histiocytes in the upper half of the dermis, some impinging on the epidermis, which is thinned Dense infiltrates of lymphocytes surrounding granulomas Fibrosis and t…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 10.90.1A: Perivascular dermatitis, psoriasiform + 10.90.1B: Lymphocytes and neutrophils around venules, dilated tortuous capillaries in edematous dermal papillae, spongioform pustules, and tiers of neutrophil-containing mounds of p…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 10.94.1A: Infundibulitis, spongiotic, and peri-infundibulitis, granulomatous + 10.94.1B: Lymphocytes and plasma cells around collections of epithelioid histiocytes = Rosacea, papular ┬áSpongiosis in an infundibulum is a finding comm…

Histologic Diagnosis of Inflammatory Skin Diseases

Epidermis

Generative cells of the epidermis, follicles, and nail units all mature to become dead cornified cells that contain large quantities of the protein, keratin. The filament of cornified cells that takes the form of hair is akin to the layer of cornifi…

Histologic Diagnosis of Inflammatory Skin Diseases

Cells That Mediate Inflammation (Inflammatory Cells)

Neutrophils, eosinophils, lymphocytes, plasma cells, and histiocytes are called inflammatory cells because they enter tissue during the process of inflammation. A more exact designation for them is “cells of an inflammatory process”; the…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 11.10.1A: Infundibular plug of corneocytes in a widened infundibulum + 11.10.1B: A cast of parakeratotic cells in the dilated infundibulum = Keratosis pilaris ┬áChanges identical to these are seen in lichen spinulosus, a variant cli…

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