Dermatitis - Revision history

Mikael Häggström: Note

2022-06-19T20:49:34Z

Note

← Older revision		Revision as of 16:49, 19 June 2022
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	==Staining==		==Staining==
	3 H&E sections and one section with periodic acid Schiff (PAS)<ref group="~~notes~~">PAS is for evaluation of the epidermal basement membrane, blood vessels, and the presence of fungal organisms</ref><ref name="Alsaad2005" />		3 H&E sections and one section with periodic acid Schiff (PAS)<ref group="note">PAS is for evaluation of the epidermal basement membrane, blood vessels, and the presence of fungal organisms</ref><ref name="Alsaad2005" />

	*If suspected bacterial and fungal microorganisms, consider Gram stain and Gomori methenamine silver stain.<ref name="Alsaad2005" />		*If suspected bacterial and fungal microorganisms, consider Gram stain and Gomori methenamine silver stain.<ref name="Alsaad2005" />
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	\| Acute \|\| Subacute \|\| Chronic		\| Acute \|\| Subacute \|\| Chronic
	\|-		\|-
	! Generally/Not otherwise specified<ref group="~~notes~~" name="not-otherwise-specified" />		! Generally/Not otherwise specified<ref group="note" name="not-otherwise-specified" />
	\| Typical findings:<ref name="Alsaad2005" />		\| Typical findings:<ref name="Alsaad2005" />

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	\|}		\|}

	In addition to above, an unspecific spongiotic dermatitis can be consistent with nummular dermatitis, dyshidrotic dermatitis, Id reaction, dermatophytosis, miliaria, Gianotti-Crosti syndrome and pityriasis rosea.<ref name="Alsaad2005" /><ref group="~~notes~~" name="not-otherwise-specified" />		In addition to above, an unspecific spongiotic dermatitis can be consistent with nummular dermatitis, dyshidrotic dermatitis, Id reaction, dermatophytosis, miliaria, Gianotti-Crosti syndrome and pityriasis rosea.<ref name="Alsaad2005" /><ref group="note" name="not-otherwise-specified" />

	====Interface dermatitis====		====Interface dermatitis====
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	\|-		\|-
	! Pityriasis rubra pilaris		! Pityriasis rubra pilaris
	\| Compact \|\| Shoulder parakeratosis<ref group="~~notes~~">Parakeratotic mounds at the edge of follicular ostia.</ref>; alternating orthokeratosis and parakeratosis \|\| Regular or irregular \|\| Normal or thick \|\| Spongiosis; lymphocytic infiltrate; rare acantholysis \|\|		\| Compact \|\| Shoulder parakeratosis<ref group="note">Parakeratotic mounds at the edge of follicular ostia.</ref>; alternating orthokeratosis and parakeratosis \|\| Regular or irregular \|\| Normal or thick \|\| Spongiosis; lymphocytic infiltrate; rare acantholysis \|\|
	\|-		\|-
	! Pityriasis rosea		! Pityriasis rosea
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	\|		\|
	*Perivascular infiltrate, but may involve the dermis, further away from blood vessels.<ref name="dermpedia">{{cite web\|url=http://www.dermpedia.org/dermpedia-textbook/pigmented-purpuric-dermatoses\|title=Pigmented purpuric dermatoses\|author=Stephen Lyle\|accessdate=2019-11-05\|website=Dermpedia.org}}</ref>		*Perivascular infiltrate, but may involve the dermis, further away from blood vessels.<ref name="dermpedia">{{cite web\|url=http://www.dermpedia.org/dermpedia-textbook/pigmented-purpuric-dermatoses\|title=Pigmented purpuric dermatoses\|author=Stephen Lyle\|accessdate=2019-11-05\|website=Dermpedia.org}}</ref>
	*Sometimes tendency for lichenoid infiltrate<ref group="~~notes~~">Pigmented purpuric dermatitis of Gougerot and Blum particularly have a tendency for lichenoid infiltrate.</ref><ref name="dermpedia" />		*Sometimes tendency for lichenoid infiltrate<ref group="note">Pigmented purpuric dermatitis of Gougerot and Blum particularly have a tendency for lichenoid infiltrate.</ref><ref name="dermpedia" />
	*Mild vascular damage, mainly endothelial swelling and focal karyorrhectic debris.<ref name="dermpedia" />		*Mild vascular damage, mainly endothelial swelling and focal karyorrhectic debris.<ref name="dermpedia" />
	*Red blood cell extravasation.<ref name="dermpedia" />		*Red blood cell extravasation.<ref name="dermpedia" />
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	\| [[File:Erythema annulare centrifugum on arms and legs.jpg\|190px]]		\| [[File:Erythema annulare centrifugum on arms and legs.jpg\|190px]]
	\|-		\|-
	! Not otherwise specified<ref group="~~notes~~" name="not-otherwise-specified">In '''"not otherwise specified"''' cases, a description of the findings attained so far is generally enough as a diagnosis, but may mention when it can be consistent with a diagnosis that is clinically suspected according to the referral. A more comprehensive approach is to include a comment such as the following:<br>"Differential diagnosis for this condition include: ____, ____ and ____. Clinical correlation is recommended.</ref>		! Not otherwise specified<ref group="note" name="not-otherwise-specified">In '''"not otherwise specified"''' cases, a description of the findings attained so far is generally enough as a diagnosis, but may mention when it can be consistent with a diagnosis that is clinically suspected according to the referral. A more comprehensive approach is to include a comment such as the following:<br>"Differential diagnosis for this condition include: ____, ____ and ____. Clinical correlation is recommended.</ref>
	\| A lesion with superficial lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.<ref name="Alsaad2005" /><ref group="~~notes~~" name="not-otherwise-specified" />		\| A lesion with superficial lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.<ref name="Alsaad2005" /><ref group="note" name="not-otherwise-specified" />
	\|}		\|}

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	\|		\|
	\|-		\|-
	! Not otherwise specified<ref group="~~notes~~" name="not-otherwise-specified" />		! Not otherwise specified<ref group="note" name="not-otherwise-specified" />
	\| A lesion with superficial lymphoeosinophilic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.<ref name="Alsaad2005" /><ref group="~~notes~~" name="not-otherwise-specified" />		\| A lesion with superficial lymphoeosinophilic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.<ref name="Alsaad2005" /><ref group="note" name="not-otherwise-specified" />
	\|		\|
	\|		\|
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	\| [[File:Patch stage Kaposi's sarcoma.jpg\|190px]]		\| [[File:Patch stage Kaposi's sarcoma.jpg\|190px]]
	\|-		\|-
	! Not otherwise specified<ref group="~~notes~~" name="not-otherwise-specified" />		! Not otherwise specified<ref group="note" name="not-otherwise-specified" />
	\| A lesion with superficial lymphoplasmacytic infiltrate without additional histopathologic characteristics can be due to for example trauma, ulceration, scar and early cutaneous connective tissue diseases.<ref name="Alsaad2005" /><ref group="~~notes~~" name="not-otherwise-specified" />		\| A lesion with superficial lymphoplasmacytic infiltrate without additional histopathologic characteristics can be due to for example trauma, ulceration, scar and early cutaneous connective tissue diseases.<ref name="Alsaad2005" /><ref group="note" name="not-otherwise-specified" />
	\|}		\|}

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	\| [[File:Urticaria pigmentosa lesions on a child.jpg\|190px]]		\| [[File:Urticaria pigmentosa lesions on a child.jpg\|190px]]
	\|-		\|-
	! Not otherwise specified<ref group="~~notes~~" name="not-otherwise-specified" />		! Not otherwise specified<ref group="note" name="not-otherwise-specified" />
	\| Includes the rare disease of primary mastocytosis.<ref name="Alsaad2005" /><ref group="~~notes~~" name="not-otherwise-specified" />		\| Includes the rare disease of primary mastocytosis.<ref name="Alsaad2005" /><ref group="note" name="not-otherwise-specified" />
	\|		\|
	\|		\|
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	====Lymphohistiocytic infiltrate====		====Lymphohistiocytic infiltrate====
	[[File:Histopathology of leprosy.jpg\|thumb\|Leprosy]]		[[File:Histopathology of leprosy.jpg\|thumb\|Leprosy]]
	These include bacterial infections including leprosy, and the sample should therefore be stained with Ziel-Neelsen, acid fast stains, Gomori methenamine silver, PAS, and Fite stains.<ref name="Alsaad2005" /> If negative, an unspecific lymphohistocytic dermatosis may be caused by drug reactions and viral infections.<ref name="Alsaad2005" /><ref group="~~notes~~" name="not-otherwise-specified" />		These include bacterial infections including leprosy, and the sample should therefore be stained with Ziel-Neelsen, acid fast stains, Gomori methenamine silver, PAS, and Fite stains.<ref name="Alsaad2005" /> If negative, an unspecific lymphohistocytic dermatosis may be caused by drug reactions and viral infections.<ref name="Alsaad2005" /><ref group="note" name="not-otherwise-specified" />

	=====Granulomatous inflammation=====		=====Granulomatous inflammation=====

Mikael Häggström: /* Interface dermatitis with vacuolar change */ Fixed width

2022-06-19T03:41:16Z

Interface dermatitis with vacuolar change: Fixed width

Show changes

Mikael Häggström: /* Neutrophilic infiltrate */ Moved

2021-03-16T15:42:35Z

Neutrophilic infiltrate: Moved

← Older revision		Revision as of 11:42, 16 March 2021
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	\|		\|
	*Neutrophilic infiltrate not conforming to any of the above mentioned conditions.		*Neutrophilic infiltrate not conforming to any of the above mentioned conditions.
			\| [[File:Histopathology of dermal edema.jpg\|thumb\|180px\|Dermal edema in a case of cellulitis.]]
	\|		\|
	~~\| [[File:Histopathology of dermal edema.jpg\|thumb\|180px\|Dermal edema in a case of cellulitis.]]~~
	\|}		\|}

Mikael Häggström: /* Neutrophilic infiltrate */ +Acute

2021-03-16T14:06:48Z

Neutrophilic infiltrate: +Acute

← Older revision		Revision as of 10:06, 16 March 2021
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	\| [[File:Micrograph of cutaneous small-vessel vasculitis.jpg\|190px]]		\| [[File:Micrograph of cutaneous small-vessel vasculitis.jpg\|190px]]
	\| [[File:Cutaneous small-vessel vasculitis.jpg\|190px]]		\| [[File:Cutaneous small-vessel vasculitis.jpg\|190px]]
			\|-
			! Acute inflammation (not otherwise specified)
			\|
			*Neutrophilic infiltrate not conforming to any of the above mentioned conditions.
			\|
			\| [[File:Histopathology of dermal edema.jpg\|thumb\|180px\|Dermal edema in a case of cellulitis.]]
	\|}		\|}

Mikael Häggström: Expanded

2021-03-04T21:33:48Z

Expanded

← Older revision		Revision as of 17:33, 4 March 2021
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	\| [[File:Erythema annulare centrifugum on arms and legs.jpg\|190px]]		\| [[File:Erythema annulare centrifugum on arms and legs.jpg\|190px]]
	\|-		\|-
	! Not otherwise specified<ref group="notes" name="not-otherwise-specified">A description of the findings attained so far is generally enough as a diagnosis ~~in "not otherwise specified" cases~~, but may mention when it can be consistent with a diagnosis that is clinically suspected according to the referral.</ref>		! Not otherwise specified<ref group="notes" name="not-otherwise-specified">In '''"not otherwise specified"''' cases, a description of the findings attained so far is generally enough as a diagnosis, but may mention when it can be consistent with a diagnosis that is clinically suspected according to the referral. A more comprehensive approach is to include a comment such as the following:<br>"Differential diagnosis for this condition include: ____, ____ and ____. Clinical correlation is recommended.</ref>
	\| A lesion with superficial lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.<ref name="Alsaad2005"/><ref group="notes" name="not-otherwise-specified"/>		\| A lesion with superficial lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.<ref name="Alsaad2005"/><ref group="notes" name="not-otherwise-specified"/>
	\|}		\|}

Mikael Häggström: /* Microscopic evaluation */ Formatting

2020-11-19T20:53:30Z

Microscopic evaluation: Formatting

← Older revision		Revision as of 16:53, 19 November 2020
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	:::*Lymphohistiocytic		:::*Lymphohistiocytic
	:::*Neutrophilic		:::*Neutrophilic
	~~:::~~*No visible pathology		*No visible pathology
	Continue in corresponding section:		Continue in corresponding section:

Mikael Häggström: /* Microscopic evaluation */ No visible

2020-11-19T20:50:06Z

Microscopic evaluation: No visible

← Older revision		Revision as of 16:50, 19 November 2020
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	:::*Lymphohistiocytic		:::*Lymphohistiocytic
	:::*Neutrophilic		:::*Neutrophilic
			:::*No visible pathology
	Continue in corresponding section:		Continue in corresponding section:

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	\| [[File:Cutaneous small-vessel vasculitis.jpg\|190px]]		\| [[File:Cutaneous small-vessel vasculitis.jpg\|190px]]
	\|}		\|}

			====No visible pathology====
			In a referral with a rash or other suspicion of dermatitis, but no visible pathology is seen, generally do a fungal stain, as fungal infections may have no visible pathology on H&E stain.

	{{Bottom}}		{{Bottom}}

Mikael Häggström: Merged

2020-07-29T18:09:53Z

Merged

@@ Line 303: / Line 303: @@
 [[File:Histopathology of leprosy.jpg|thumb|Leprosy]]
 These include bacterial infections including leprosy, and the sample should therefore be stained with Ziel-Neelsen, acid fast stains, Gomori methenamine silver, PAS, and Fite stains.<ref name="Alsaad2005"/> If negative, an unspecific lymphohistocytic dermatosis may be caused by drug reactions and viral infections.<ref name="Alsaad2005"/><ref group="notes" name="not-otherwise-specified"/>
 ====Neutrophilic infiltrate====
@@ Line 350: / Line 358: @@
 | [[File:Cutaneous small-vessel vasculitis.jpg|190px]]
 |}
 {{Bottom}}

Mikael Häggström: Moved

2020-07-29T14:46:31Z

Moved

← Older revision		Revision as of 10:46, 29 July 2020
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	! Lichen nitidus		! Lichen nitidus
	\|		\|
	*Localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla		*Localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla.
	*Thinning of overlying epidermis and downward extension of the rete ridges at the lateral margin of the infiltrate, resulting in a typical "claw clutching a ball" appearance.<ref name="Mutairi">{{cite journal \|vauthors=Al-Mutairi N, Hassanein A, Nour-Eldin O, Arun J \|title=Generalized lichen nitidus \|journal=Pediatr Dermatol \|volume=22 \|issue=2 \|pages=158–60 \|year=2005 \|pmid=15804308 \|doi=10.1111/j.1525-1470.2005.22215.x \|url=}}</ref>		*Thinning of overlying epidermis and downward extension of the rete ridges at the lateral margin of the infiltrate, resulting in a typical "claw clutching a ball" appearance.<ref name="Mutairi">{{cite journal \|vauthors=Al-Mutairi N, Hassanein A, Nour-Eldin O, Arun J \|title=Generalized lichen nitidus \|journal=Pediatr Dermatol \|volume=22 \|issue=2 \|pages=158–60 \|year=2005 \|pmid=15804308 \|doi=10.1111/j.1525-1470.2005.22215.x \|url=}}</ref>
	\| [[File:Histopathology of lichen nitidus.jpg\|190px]] \|\| [[File:Photography of lichen nitidus.jpg\|190px]]		\| [[File:Histopathology of lichen nitidus.jpg\|190px]] \|\| [[File:Photography of lichen nitidus.jpg\|190px]]
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	\| [[File:Cutaneous small-vessel vasculitis.jpg\|190px]]		\| [[File:Cutaneous small-vessel vasculitis.jpg\|190px]]
	\|}		\|}
	====~~Multinucleated giant cells~~====		====Granulomatous inflammation====
	*Look for '''foreign bodies''', ~~conferring a diagnosis of ''foreign body granuloma''~~.		{{further\|Granulomatous skin inflammation}}
	*Look for any specific '''appearance''' of the giant cells.		Granulomatous inflammation is defined by the presence of mononuclear leukocytes, specifically histiocytes, appearing as epithelioid cells with round to oval nuclei, often with irregular contours and abundant granular eosinophilic cytoplasm with indistinct cell borders. They may also coalesce to form multinucleated giant cells.<ref name="ShahPritt2017">{{cite journal\|last1=Shah\|first1=Kabeer K.\|last2=Pritt\|first2=Bobbi S.\|last3=Alexander\|first3=Mariam P.\|title=Histopathologic review of granulomatous inflammation\|journal=Journal of Clinical Tuberculosis and Other Mycobacterial Diseases\|volume=7\|year=2017\|pages=1–12\|issn=24055794\|doi=10.1016/j.jctube.2017.02.001}}</ref>
	*Look for '''relation''' to adnexae or other particular structures.
	<gallery mode=packed heights=220>		<gallery mode=packed heights=220>
	File:Histopathology of suture granuloma.jpg\|Foreign body: '''Suture''' granuloma, with multinucleated giant cells surrounding (grey) suture material.		File:Histopathology of suture granuloma.jpg\|Foreign body: '''Suture''' granuloma, with multinucleated giant cells surrounding (grey) suture material.
	File:Touton giant cell (annotated).jpg\|Appearance: A '''Touton giant cell''' contains a ring of nuclei surrounding a central homogeneous cytoplasm, with foamy cytoplasm surrounding the nuclei.<ref>{{cite book \| last = Grant-Kels \| first = Jane \| title = Color Atlas of Dermatopathology \| publisher = Informa Healthcare \| location = City \| year = 2007 \| isbn = 978-0-8493-3794-9 \| pages = 107, 119 }}</ref><ref>{{cite journal \|last1=Carmen Gómez-Mateo \|first1=Maria \|last2=Monteagudo \|first2=Carlos \|date=2013 \|title=Nonepithelial skin tumors with multinucleated giant cells \|url=http://www.semdiagpath.com/article/S0740-2570(12)00009-3/fulltext \|journal=Seminars in Diagnostic Pathology \|volume=30 \|issue=1 \|pages=58–72 \|pmid=23327730 \|doi=10.1053/j.semdp.2012.01.004}}</ref> The central cytoplasm (surrounded by the nuclei) may be both amphophilic and eosinophilic.<ref>{{cite journal \|last1=Sequeira \|first1=Fiona \|last2=Gandhi \|first2=Suneil \|date=2012 \|title=Named cells in dermatology \|url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=2;spage=207;epage=216;aulast=Sequeira \|journal=Indian Journal of Dermatology, Venereology and Leprology \|volume=78 \|issue=2 \|pages=207–16 \|doi=10.4103/0378-6323.93650 \|pmid=22421663}}</ref>
	~~File:Histopathology of granulomatous folliculitis.jpg\|thumb\|Relation: '''Folliculitis''' with multinucleated giant cells surrounding a hair follicle.~~
	</gallery>		</gallery>

	{{Bottom}}		{{Bottom}}

Mikael Häggström: /* Multinucleated giant cells */ cleanup

2020-03-16T12:05:54Z

Multinucleated giant cells: cleanup

← Older revision		Revision as of 08:05, 16 March 2020
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	*Look for '''relation''' to adnexae or other particular structures.		*Look for '''relation''' to adnexae or other particular structures.
	<gallery mode=packed heights=220>		<gallery mode=packed heights=220>
	File:Histopathology of suture granuloma.jpg~~\|thumb\|220px~~\|Foreign body: '''Suture''' granuloma, with multinucleated giant cells surrounding (grey) suture material.]]		File:Histopathology of suture granuloma.jpg\|Foreign body: '''Suture''' granuloma, with multinucleated giant cells surrounding (grey) suture material.
	File:Touton giant cell (annotated).jpg\|Appearance: A '''Touton giant cell''' contains a ring of nuclei surrounding a central homogeneous cytoplasm, with foamy cytoplasm surrounding the nuclei.<ref>{{cite book \| last = Grant-Kels \| first = Jane \| title = Color Atlas of Dermatopathology \| publisher = Informa Healthcare \| location = City \| year = 2007 \| isbn = 978-0-8493-3794-9 \| pages = 107, 119 }}</ref><ref>{{cite journal \|last1=Carmen Gómez-Mateo \|first1=Maria \|last2=Monteagudo \|first2=Carlos \|date=2013 \|title=Nonepithelial skin tumors with multinucleated giant cells \|url=http://www.semdiagpath.com/article/S0740-2570(12)00009-3/fulltext \|journal=Seminars in Diagnostic Pathology \|volume=30 \|issue=1 \|pages=58–72 \|pmid=23327730 \|doi=10.1053/j.semdp.2012.01.004}}</ref> The central cytoplasm (surrounded by the nuclei) may be both amphophilic and eosinophilic.<ref>{{cite journal \|last1=Sequeira \|first1=Fiona \|last2=Gandhi \|first2=Suneil \|date=2012 \|title=Named cells in dermatology \|url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=2;spage=207;epage=216;aulast=Sequeira \|journal=Indian Journal of Dermatology, Venereology and Leprology \|volume=78 \|issue=2 \|pages=207–16 \|doi=10.4103/0378-6323.93650 \|pmid=22421663}}</ref>		File:Touton giant cell (annotated).jpg\|Appearance: A '''Touton giant cell''' contains a ring of nuclei surrounding a central homogeneous cytoplasm, with foamy cytoplasm surrounding the nuclei.<ref>{{cite book \| last = Grant-Kels \| first = Jane \| title = Color Atlas of Dermatopathology \| publisher = Informa Healthcare \| location = City \| year = 2007 \| isbn = 978-0-8493-3794-9 \| pages = 107, 119 }}</ref><ref>{{cite journal \|last1=Carmen Gómez-Mateo \|first1=Maria \|last2=Monteagudo \|first2=Carlos \|date=2013 \|title=Nonepithelial skin tumors with multinucleated giant cells \|url=http://www.semdiagpath.com/article/S0740-2570(12)00009-3/fulltext \|journal=Seminars in Diagnostic Pathology \|volume=30 \|issue=1 \|pages=58–72 \|pmid=23327730 \|doi=10.1053/j.semdp.2012.01.004}}</ref> The central cytoplasm (surrounded by the nuclei) may be both amphophilic and eosinophilic.<ref>{{cite journal \|last1=Sequeira \|first1=Fiona \|last2=Gandhi \|first2=Suneil \|date=2012 \|title=Named cells in dermatology \|url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2012;volume=78;issue=2;spage=207;epage=216;aulast=Sequeira \|journal=Indian Journal of Dermatology, Venereology and Leprology \|volume=78 \|issue=2 \|pages=207–16 \|doi=10.4103/0378-6323.93650 \|pmid=22421663}}</ref>
	File:Histopathology of granulomatous folliculitis.jpg\|thumb\|Relation: '''Folliculitis''' with multinucleated giant cells surrounding a hair follicle.		File:Histopathology of granulomatous folliculitis.jpg\|thumb\|Relation: '''Folliculitis''' with multinucleated giant cells surrounding a hair follicle.