PSORIASIFORM, SPONGIOTIC, AND INTERFACE DERMATITIS Flashcards
IDENTIFY THE PATTERN
Superficial Perivascular Dermatitis (with minimal epidermal change)
IDENTIFY THE PATTERN
Superficial Perivascular Dermatitis (with minimal epidermal change)
Pityriasis Rosea
What are the 9 basic inflammatory patterns
- Superficial perivascular dermatitis
- Superficial and deep perivascular dermatitis
- Nodular and diffuse dermatitis
- Intraepidermal vesicular and pustular dermatitis
- Subepidermal vesicular dermatitis
- Fibrosing dermatitis
- Folliculitis and perifolliculitis
- Vasculitis
- Panniculitis
2 MOST IMPORTANT HISTOLOGIC FEATURES OF PSORIASIS
Munro Microabscesses
Spongiform Pustule of Kogoj
give differentials for psoriasiform dermatitis
*Psoriasis
*Lichen Simplex Chronicus/ Prurigo Nodularis
*Pityriasis Rosea
LICHEN SIMPLEX CHRONICUS/PRURIGO NODULARIS
PITYRIASIS ROSEA
give differentials for spongiotic dermatitis
DIFFERENTIALS: “D’ CAIN”
1)Dyshidrotic eczema
2)Contact Dermatitis
3)A- llergic contact dermatitis/ Atopic Dermatitis
4)I-rritant contact dermatitis
5)N-ummular eczema
give differentials for spongiotic dermatitis
DIFFERENTIALS: “D’ CAIN”
1)Dyshidrotic eczema
2)Contact Dermatitis
3)A- llergic contact dermatitis/ Atopic Dermatitis
4)I-rritant contact dermatitis/ Id reaction
5)N-ummular eczema
Acute/ subacute or chronic?
Acute Spongiosis
✓ Intraepidermal vesicles
✓ Prominent epidermal edema
Acute/ subacute or chronic?
Subacute spongiotic dermatitis
✓ Intraepidermal edema less prominent
✓ Acanthosis
✓ Beginning papillary dermal fibrosis
Acute/ subacute or chronic?
Chronic Spongiotic Dermatitis
- “psoriasiform-like”
- Acanthosis
- Papllary dermal fibrosis
EOSINOPHILIC SPONGIOSIS
give differentials for EOSINOPHILIC SPONGIOSIS
S- CABIES
H -ERPES GESTATIONIS
A - RTHROPOD BITE/ ALLERGIC CONTACT DERMATITIS
P- EMPHIGUS
P- EMPHIGOID
I - NCONTINENTIA PIGMENTI
E - RYTHEMA TOXICUM NEONATORUM
what are the features of vacuolar interface dermatitis
1.BASAL LAYER VACUOLIZATION (Black arrows) *other term: vacuolar interface change
- PIGMENT INCONTINENCE
give differentials for vacuolar interface dermatitis
1.Ashy Dermatosis
2.Post-inflammatory hyperpigmentation
3.LATE STAGE fixed drug eruption
VACUOLAR INTERFACE: ERYTHEMA MULTIFORME
FEATURES:
1.BASAL LAYER VACUOLIZATION (Black arrows) other term: vacuolar interface change
- APOPTOTIC KERATINOCYTES (Green arrows)
- Orthokeratosis (acute process)
give differentials for VACUOLAR INTERFACE: ERYTHEMA MULTIFORME
DIFFERENTIALS:
1.Stevens-Johnson Syndrome (beginning)
2.Graft-versus-host disease (GVHD)
VACUOLAR INTERFACE: STEVENS JOHNSON SYNDROME /TOXIC EPIDERMAL NECROLYSIS
FEATURES:
1.SUBEPIDERMAL SPLIT
- FULL THICKNESS EPIDERMAL NECROSIS
- Orthokeratosis (acute process)
VACUOLAR INTERFACE: CUTANEOUS LUPUS ERYTHEMATOSUS
- Basal layer vacuolization (black arrows) with thickening of basement membrane (Green arrows)
FEATURES:
✓ PATTERN: INTERFACE
✓ Basal layer vacuolization
✓ Superficial AND deep perivascular, perieccrine, and periadnexal infiltrates of lymphocytes and plasma cells
What’s the DIF and stain pattern of Cutaneous Lupus Erythematosus
BANDLINKE deposits of immunoglobulin G (IgG) in the basement membrane zone
Ddx of Lupus
Dermatomyositis
LICHENOID INTERFACE: LICHEN PLANUS
FEATURES:
✓ PATTERN: LICHENOID – band-like pattern of infiltrates in the papillary dermis
✓ Wedge-shaped hypergranulosis
✓ Saw-tooth appearance of the rete ridges
Identify. What disease is this seen?
Max Joseph Space
- seen in Lichen planus
- The eponym “Max Joseph space” stands for “the appearance of the liquefaction degeneration of the basal cells and extracellular fluid accumulation about the individual basal cells (that) is strongly suggestive of mild irritation. (from google)
Identify. What disease is this seen?
Basal layer vacuolization with “CIVATTE BODIES” (black arrows)
- seen in lichen planus
LICHENOID INTERFACE: LICHEN NITIDUS
FEATURES:
✓ PATTERN: lichenoid
✓ Dense infiltrate of lymphocytes and histiocytes in an expanded dermal papilla
✓ CLAWLIKE epidermal lateral borders
DDx for Neutrophils in the Stratum corneum
PTICSS! (Neuts in the SC)
Psoriasis
Tinea
Impetigo
Candida
Seborrheic dermatitis
Syphilis
DDx for Eosinophilic spongiosis
“SHAPPIE”
Scabies
Herpes gestationis
Arthropod bite/ACD
Pemphigus
Pemphigoid
Incontinentia pigmenti
Erythema toxicum neonatorum
What type of psoriasis
Guttate Psoriasis
- pronounced inflammatory infiltrate
- less acanthosis
- basket-weave orthokeratotic stratum corneum
- overlying mounds of parakeratosis with neutrophils -“seagull”
What type of psoriasis
Pustular Psoriasis
- presents as macropustule
- spongiform pustule formation:
⚬ aggregates of neutrophils
⚬ cytolysis of epidermal cells
⚬ cornified layer: pyknotic - upper dermis contains lymphocytes
- migrating neutrophils in the papillae to epidermis
Differentials for Subcorneal Pustules
CAT SIPS
Candida
Acropustulosis of infancy
Transient neonatal pustular melanosis
Sneddon-Wilkinson
Impetigo
Pustular psor
SSSS
Pityriasis Rubra Pilaris
- acanthosis with broad and short rete ridges
- thick suprapapillary plates
- hypergranulosis
- mild superficial perivascular lymphocytic infiltrate
Pityriasis Rubra Pilaris
- alternating ortho and parakeratosis in both vertical and horizontal directions
Pityriasis Rosea
- acanthosis, epidermal spongiosis (bracket)
- exocytosis of lymphocytes
- superficial perivascular infiltrate
Pityriasis Rosea
- extravasated erythrocytes in the papillary dermis
- MOUNDS of parakeratosis
Seborrheic Dermatitis
- “shoulder parakeratosis”
- regular acanthosis and elongation of the rete ridges
- mild spongiosis sparse
- mononuclear cell infoltrate
Inflammatory linear verrucous epidermal nevus (ILVEN)
- papillated epidermal hyperplasia
- thick, elongated rete
- spongiosis
- alternating ortho and parakeratosis
Lichen Simplex Chronicus
- compact orthokeratosis
- irregular psoriasiform acanthosis
- elongation of the rete ridges
- wedge-shaped hypergranulosis
- vertically-oriented collagen bundles
Nutritional deficiency dermatitis
