Inflammatory

Question 1

Seborrheic dermatitis?

H and E?

GMS?

Answer 1

Sponge derm on face, eyebrows, chest, back, behind hears

Lots of neutrophils and parakeratosis shouldering follicular units

Look for hypae to call dermatophite infection

Question 2

Psoriasiform dermatitis H and E?

Answer 2

Regular epidermal hyperplasia; confulent parakeratosis with HYPO-granulosis

Neutrophilic collections in stratum corneum (Munro’s microabscess) and in epidermis

Suprapapillary plate thinning and dilated blood vessels

Lack of eosinoiphils unless treated

Spongiosis mostly in acal sites

Question 3

Pityriasis rubrea H and E?

Lichen simplex chornicus?

Clear cell achantoma?

Answer 3

Vertical and horizontal alternating ortho and parakeratosis at surface; follicular plugging and lack of neutrophils

Lichen simplex chronicus: Forms stratum lucidem; lacks confluent parakeratoic scale and neutrophils

CCA: Pappules and not plaques; need clinical

Question 4

What is AGEP?

Does tinea versicolor have neutrophils?

Answer 4

Acute generalized exanthematous pustulosis: Drug reaction

No

Question 5

Key differences between lichenoid and interface?

Dead cells at all levels of epidermis with interface changes think?

If caused by drugs think?

Answer 5

Lichenoid has Epidermal changes like hypergranulosis, saw toothing, Rete changes, band like infiltrate; interface is vacules at junction

Erythema multiforme

SjS (<10% body area) TEN> 30% body area; caused by drugs; full thickness epidermal necrosis

Question 6

GVHD staging?

Answer 6

Interface dermatitis

G1; Vaculoles at DEJ
G2: Dyskeratotic cells in epidermis or follicle, dermal lymphocytes

G3: Fusion of basal vacuoles with clefts

G4: Seperation of epidermis from dermis

Question 7

Lupus H and E?

Answer 7

Interface derm: Lymphocytes abutting DEJ
Squamatization of basal keratinocytes (pink)

• *Compact ortho/hyerkeratosis with follicular plugging (discoid)**
• *Superficial and deep perivascular and periadnexa**l lymphocytic infiltrate (NOT EOS!)

Thicken basement membrane (PAS)

Granular pattern IgG, IggA, IgM and C3 on DIF

Question 8

Lichen planus?

What if lichenoid and psoriasiform, what IHC?

If eosinophils present thing in LP pattern?

Answer 8

Lichenoid; epidermal changes with hypergranulosis and lymphocytes at DEJ;

Syphillis; Warthin-stary

Lichenoid drug reaction

Question 9

Urticaria?

If greater than 24 hours think?

Answer 9

Evanescent wheals <6 hrs (Clinical)

H and E: Very sparse infilatrate and collagen seperated by edema

Urticaria vasculitis (not actually urticaria but Vasculitis from autoimmune dx); leucoclastic vasculitis

Question 10

Syphillis patterns?

Superficial and deep without epidermis think?

Answer 10

Any; but lichenoid and superifical and deep without superficial changes

Virus, erythema annulare centrifugum, morbilliform drug rxn

Question 11

Superficial and deep perivascular dermatitis with perineural involvement think?

Others that lack PNI?

If epidermal involvement and superficial and deep ddx?

Lichen striatus?

Answer 11

Leprosy and atypical microbacterial inovolvment
Syphillis and Lyme

Epidermal involvement: Light reaction, photo drug reaction, Lichen striatus, Lupus (think lupus)

Only thing that has spongiosis, acanthosis, interface inflamm, and superficial and deep (linear plaque on patient)

Question 12

Granulomatous dermatitis (5 patterns); overview slide?

Answer 12

Sarcoid; Epithelioid cells with giant asteroid bodies; nated granuloma (little to now ringing of lymphs)
Tuberculoid; caseation necrossis; Langhans giant cells (horseshoe shapped)
Necrobiotic: Granuloma annulare, epithelioid histiocytes, lymphocytes, aand giant cells with necrobiosis

Suppurative: Neutrophils and possible pyoderma gangrenosus

Foreign body: Polarize

Question 13

Granuloma annulare?

Necrobiosis lipoidica?

Rheumatoid nodule?

Answer 13

Palasaded granulomatous dermatitis; some interstital; MUCIN!!! (colloidal iron)

Tends to be on lower leg of diabetes: Low power “cake layered” with epithelial cells and denerated collagen

Palasaded granulomatous dermatitis with Fibrin (amorphous pink) in center

Question 14

If you think squamous cell with granulomas consider?

Answer 14

Chromoblastomycosis; COPPER PENNIES

Question 15

Subcorneal vsiculobullous dermatitis:
Pemphigus Foliaceus DIF and H and E?

Answer 15

PF: Split subcorneal or 1st layer of epidermis; DIF intercellualr staining of IgG C3 (NET LIKE PATTERN)

Question 16

Pemphigus vulgaris H and E and DIF?

Answer 16

PV: Intercellular IgG (netlike) +/0 C3, IgM, IgA

H and E: Tombstoning of basal cells with suprabasalar split and tracks down follicular units

Intradermal!!!

Question 17

Subepidermal: Bullous Pemphigoid H and E, DIF?

Dermatitis Herpetiformis?

Answer 17

BP: Can be paciinflammatory or with eosinophils

H and E: Subepidermal inflammatory with lots of eosinophils (classically); DIF linear IgG and or C3 at DEJ

DH: Microabscess in the top of dermal papillae

Question 18

Atrophie Blanche?

Leukocystoclastic vasculitis?

Lyoderma Gangenosum?

Answer 18

Vessels with fibrin (Pink around vessel wall) on ankle or lower leg

LCV: Inflammation around and going into vessels with fibrin; see spilled RBC’s

PG: Dx of exclusion: H and E: Lots of neutrophils in dermis (some follicular remnants)

Question 20

Lichen Scerosus (et Atrophicus)?

Morphea/Scleroderma?

Answer 20

H and E: Atrophy and papillary dermal edema with sclerosis

Lichenoid infiltrate between sclerotic and non-sclerotic dermis

Morphea (localized scleroderma): Increased dermal collagen (atrophy of adnexal structures), tichening of vessel walls, lymphocytic and plasma cell infiltrate around blood vessels and lower dermis/subq

Scerloderma is systemic

SQUARE BIOPSY

Question 21

Panniculitis?

Erythema nodusum?

Answer 21

Subq inflammation

EN: Fibrous septate in fat with associated inflammation; GIANT CELLS PRESENT