Dermatitis
Author:
Mikael Häggström [note 1]
Sampling
- For punch biopsies, a size of 4 mm is preferred for most inflammatory dermatoses.[1]
- Panniculitis or cutaneous lymphoproliferative disorders: 6 mm punch biopsy or skin excision.[1]
A superficial or shave biopsy is regarded as insufficient.[1]
Fixation
- Generally: Buffered 4% formaldehyde.[2]
- Suspected immunologic disease:[3] Fixation for immunofluorescence, with for example Michel's solution.[2] For details, see immunofluorescense of skin tissues
Staining
3 H&E sections and one section with periodic acid Schiff (PAS)[notes 1][1]
- If suspected bacterial and fungal microorganisms, consider Gram stain and Gomori methenamine silver stain.[1]
Microscopic evaluation
One approach is to classify into mainly either of the following, primarily based on depth of involvement:[1]
- Epidermis, papillary dermis, and superficial vascular plexus:
- Vesiculobullous lesions
- Pustular dermatosis
- Non vesicullobullous, non-pustular
- With epidermal changes
- Without epidermal changes. These characteristically have a superficial perivascular inflammatory infiltrate, and can be classified by type of cell infiltrate:[1]
- Lymphocytic (most common)
- Lymphoeosinophilic
- Lymphoplasmacytic
- Mast cell
- Lymphohistiocytic
- Neutrophilic
Continue in corresponding section:
Non vesicullobullous, non-pustular lesions with epidermal changes
| Main types[1] | Characteristics | Image |
|---|---|---|
| Spongiotic dermatitis | ||
| Interface dermatitis | ||
| Psoriaform dermatitis |
Non vesicullobullous, non-pustular lesions without epidermal changes, lymphocytic infiltrate
| Main conditions[1] | Characteristics | Image |
|---|---|---|
| Urticaria, lymphocyte predominant | Perivascular location. Mast cells are relatively sparse, potentially demonstrated with special stains, preferably tryptase stain. Extravasated erythrocytes are present in about 50% of the cases. No vasculitis.[4] | |
| Fungal skin infection | Visible fungus. Other signs depend on fungus species.[5] | |
| Pigmented purpuric dermatosis |
|
|
| Erythema annulare centrifugum |
Deep lesions: Sharply demarcated perivascular mononuclear cell infiltrate in middle to deep dermis[7] |
|
| Not otherwise specified | A lesion with superficial lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.[1] |
Notes
- ↑ 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
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 Alsaad, K O (2005). "My approach to superficial inflammatory dermatoses ". Journal of Clinical Pathology 58 (12): 1233–1241. doi:. ISSN 0021-9746.
- ↑ 2.0 2.1 Katarzyna Lundmark, Krynitz, Ismini Vassilaki, Lena Mölne, Annika Ternesten Bratel. Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - Instructions for sampling, cutting and incision. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-09.
- ↑ Page 678 in: Chhabra, Seema; Minz, RanjanaWalker; Saikia, Biman (2012). "Immunofluorescence in dermatology ". Indian Journal of Dermatology, Venereology, and Leprology 78 (6): 677. doi:. ISSN 0378-6323. Archived from the original. .
- ↑ Barzilai, Aviv; Sagi, Lior; Baum, Sharon; Trau, Henri; Schvimer, Michael; Barshack, Iris; Solomon, Michal (2017). "The Histopathology of Urticaria Revisited—Clinical Pathological Study ". The American Journal of Dermatopathology 39 (10): 753–759. doi:. ISSN 0193-1091.
- ↑ Guarner, J.; Brandt, M. E. (2011). "Histopathologic Diagnosis of Fungal Infections in the 21st Century ". Clinical Microbiology Reviews 24 (2): 247–280. doi:. ISSN 0893-8512.
- ↑ 6.0 6.1 6.2 6.3 6.4 Stephen Lyle. Pigmented purpuric dermatoses. Dermpedia.org. Retrieved on 2019-11-05.
- ↑ 7.0 7.1 . Histology of erythema annulare centrifugum. DermNet NZ. Retrieved on 2019-11-05.
Image sources