Vacuolar interface dermatitis

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Author: Mikael Häggström [notes 1]
Vacuolar interface dermatitis is a dermatitis with vacuolization at the dermoepidermal junction, with lymphocytic inflammation at the epidermis and dermis.[1]

Presentation

Mainly dermatitis

Microscopic evaluation

Look for characteristic findings among the causes of vacuolar interface dermatitis:

Causes of vacuolar interface dermatitis edit
Main conditions[2] Characteristics Micrograph Photograph
Generally/Not otherwise specified Typical findings, called "vacuolar interface dermatitis":[2]
  • Mild inflammatory cell infiltrate along the dermoepidermal junction (black arrow in image)
  • Vacuolization within the basal keratinocytes (white arrow in image)
  • Often necrotic, predominantly basal, individual keratinocytes, manifesting as colloid or Civatte bodies
Vacuolar interface dermatitis, annotated.jpg
Acute graft-versus-host-disease
  • Vacuolar alteration of various severity, from focal or diffuse vacuolation of the basal keratinocytes (grade I), to separation at the dermoepidermal junction (grade III)
  • Involvement of the hair follicle[2]
  • Rarely eosinophils[2]
Micrographs of grades of skin graft-versus-host-disease.jpg
Allergic drug reaction
  • Rarely involvement of hair follicles.[2]
  • Frequently eosinophils[2]
Spongiotic dermatitis from drug allergy.jpg
Lichen sclerosus Hyperkeratosis, atrophic epidermis, sclerosis of dermis and dermal lymphocytes.[3] Micrograph of lichen sclerosus.jpg
Erythema multiforme
Lupus erythematosis Typical findings in systemic lupus erythematosus:[4]
  • Fibrinoid necrosis at the dermoepidermal junction
  • Liquefactive degeneration and atrophy of the epidermis
  • Mucin deposition in the reticular dermis
  • Edema, small hemorrhages
  • Mild and mainly lymphocytic infiltrate in the upper dermis
  • Fibrinoid material in the dermis around capillary blood vessels, on collagen and in the interstitium
  • In non-bullous cases, perivascular and interstitial neutrophils are sometimes present in the upper dermis, with damage to blood vessels
Histopathology of systemic lupus erythematosus.jpg Butterfly rash of lupus erythematosus.jpg

An interface dermatitis with vacuolar alteration, not otherwise specified, may be caused by viral exanthems, phototoxic dermatitis, acute radiation dermatitis, erythema dyschromicum perstans, lupus erythematosus and dermatomyositis.[2]

Unclear cases

PAS-staining showing a thickened basement membrane indicates mainly systemic lupus erythematosus or dermatomyositis, but also possibly lichen sclerosus.[5]

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Bolognia, Jean L. (2007). Dermatology . St. Louis: Mosby. pp. 11. ISBN 1-4160-2999-0. 
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Unless else specified in boxes, reference is: Alsaad, K O (2005). "My approach to superficial inflammatory dermatoses ". Journal of Clinical Pathology 58 (12): 1233–1241. doi:10.1136/jcp.2005.027151. ISSN 0021-9746. 
  3. Lisa K Pappas-Taffer. Lichen Sclerosus. Medscape. Updated: May 17, 2018
  4. Mowafak Hamodat. Skin inflammatory (nontumor) > Lichenoid and interface reaction patterns > Lupus: systemic lupus erythematosus (SLE). PathologyOutlines. Topic Completed: 1 August 2011. Revised: 26 March 2019
  5. LeBoit, Philip E (2000). "A Thickened Basement Membrane is a Clue to … Lichen Sclerosus! ". The American Journal of Dermatopathology 22 (5): 457–458. doi:10.1097/00000372-200010000-00014. ISSN 0193-1091.