Dermatitis: Difference between revisions
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→Interface dermatitis with vacuolar change: Fixed width |
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==Staining== | ==Staining== | ||
3 H&E sections and one section with periodic acid Schiff (PAS)<ref group=" | 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 | ||
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! Generally/Not otherwise specified<ref group=" | ! 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=" | 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=" | | 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 || | ||
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! 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=" | *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]] | ||
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! Not otherwise specified<ref group=" | ! 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=" | | 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=" | ! 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=" | | 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]] | ||
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! Not otherwise specified<ref group=" | ! 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=" | | 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]] | ||
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! Not otherwise specified<ref group=" | ! Not otherwise specified<ref group="note" name="not-otherwise-specified" /> | ||
| Includes the rare disease of primary mastocytosis.<ref name="Alsaad2005" /><ref group=" | | 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=" | 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===== | ||