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 | Micrograph | Photograph |
|---|---|---|---|
| Spongiotic dermatitis | |||
| Interface dermatitis | |||
| Psoriaform dermatitis |
Non vesicullobullous, non-pustular lesions without epidermal changes
Lymphocytic infiltrate
| Main conditions[1] | Characteristics | Micrograph | Photograph |
|---|---|---|---|
| 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] |  Dermal edema [solid arrows in (A,B)] and a sparse superficial predominantly perivascular and interstitial infiltrate of lymphocytes and eosinophils without signs of vasculitis (dashed arrow).[5]
|
|
| Fungal skin infection | Often visible fungus. Other signs depend on fungus species.[6] | ||
| Pigmented purpuric dermatosis |
|
|
|
| Erythema annulare centrifugum |
Deep lesions: Sharply demarcated perivascular mononuclear cell infiltrate in middle to deep dermis[8] |
File:Micrograph of erythema annulare centrifugum.jpg | File:Erythema annulare centrifugum on arms and legs.jpg |
| Not otherwise specified[notes 3] | A lesion with superficial lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.[1][notes 3] |
Lymphoeosinophilic infiltrate
| Main conditions[1] | Characteristics | Micrograph | Photograph |
|---|---|---|---|
| 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] | Error creating thumbnail: Dermal edema (solid arrows) and a sparse superficial predominantly perivascular and interstitial infiltrate of lymphocytes and eosinophils (dashed arrow) | Error creating thumbnail: |
| Prevesicular stage of bullous pemphigoid | Image at right shows influx of inflammatory cells including eosinophils and neutrophils in the dermis (solid arrow) and blister cavity (dashed arrows), and deposition of fibrin (asterisks).[9] However, the diagnosis of bullous pemphigoid consist of at least 2 positive results out of 3 criteria:[10]
|
File:Micrograph of infiltrate in bullous pemphigoid.jpg | |
| Not otherwise specified[notes 3] | A lesion with superficial lymphoeosinophilic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites.[1][notes 3] |
Lymphoplasmacytic infiltrate
| Main conditions[1] | Characteristics | Micrograph | Photograph |
|---|---|---|---|
| Rosacea | Typically enlarged, dilated capillaries and venules located in the upper dermis, angulated telangiectasias, perivascular and perifollicular lymphocytic infiltration, and superficial dermal edema.[11] | File:Micrograph of rosacea.jpg | File:Rosacea.jpg |
| Secondary syphilis | Various, but often one or a combination of:[12]
|
File:Micrograph of secondary syphilis, HE.jpg | File:Secondary stage syphilis sores (lesions) on the soles of the feet. Plantar lesions-CDC.jpg |
| Erythema migrans | Typically a superficial and deep perivascular lymphocytic infiltrate.[13] Plasma cells are typically located at the periphery of the lesion, whereas eosinophils are in the center.[13] | File:Erythema migrans - erythematous rash in Lyme disease - PHIL 9875.jpg | |
| Kaposi’s sarcoma in patch stage | The patch stage typically shows irregular proliferation of jagged vascular channels in the dermis below an integral epidermis. The so-called promontory sign is sometimes found in patch stage lesions and denotes vascular spaces surrounding pre-existing blood (see image).[14]
vessels |
File:Micrograph of promontory sign of kaposi's sarcoma.jpg | File:Patch stage Kaposi's sarcoma.jpg |
| Not otherwise specified[notes 3] | 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.[1][notes 3] |
_on_the_soles_of_the_feet._Plantar_lesions-CDC.jpg){kind=link}
Mastocytosis
| Main conditions[1] | Characteristics | Micrograph | Photograph |
|---|---|---|---|
| Urticaria pigmentosa | Mastocytosis with a clinical picture of darkish spots. | File:Histopathology of urticaria pigmentosa.jpg | File:Urticaria pigmentosa lesions on a child.jpg |
| Not otherwise specified[notes 3] | Includes the rare disease of primary mastocytosis.[1][notes 3] |
Lymphohistiocytic infiltrate
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.[1] If negative, an unspecific lymphohistocytic dermatosis may be caused by drug reactions and viral infections.[1][notes 3]
Neutrophilic infiltrate
Notes
- ↑ PAS is for evaluation of the epidermal basement membrane, blood vessels, and the presence of fungal organisms
- ↑ Pigmented purpuric dermatitis of Gougerot and Blum particularly have a tendency for lichenoid infiltrate.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 A description of the findings attained so far is generally enough as a diagnosis in "not otherwise specified" cases.
- ↑ 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 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 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. .
- ↑ 4.0 4.1 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.
- ↑ Giang, Jenny; Seelen, Marc A. J.; van Doorn, Martijn B. A.; Rissmann, Robert; Prens, Errol P.; Damman, Jeffrey (2018). "Complement Activation in Inflammatory Skin Diseases ". Frontiers in Immunology 9. doi:. ISSN 1664-3224.
- ↑ 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.
- ↑ 7.0 7.1 7.2 7.3 7.4 Stephen Lyle. Pigmented purpuric dermatoses. Dermpedia.org. Retrieved on 2019-11-05.
- ↑ 8.0 8.1 . Histology of erythema annulare centrifugum. DermNet NZ. Retrieved on 2019-11-05.
- ↑ Giang, Jenny; Seelen, Marc A. J.; van Doorn, Martijn B. A.; Rissmann, Robert; Prens, Errol P.; Damman, Jeffrey (2018). "Complement Activation in Inflammatory Skin Diseases ". Frontiers in Immunology 9. doi:. ISSN 1664-3224.
- ↑ "Assessment of diagnostic strategy for early recognition of bullous and nonbullous variants of pemphigoid. ". JAMA Dermatol 155 (2): 158–165. December 2018. doi:. PMID 30624575.
- ↑ Celiker, Hande; Toker, Ebru; Ergun, Tulin; Cinel, Leyla (2017). "An unusual presentation of ocular rosacea ". Arquivos Brasileiros de Oftalmologia 80 (6). doi:. ISSN 0004-2749.
- ↑ . Syphilis pathology. Dermnet NZ (2013).
- ↑ 13.0 13.1 Wilson, Thomas C.; Legler, Allison; Madison, Kathi C.; Fairley, Janet A.; Swick, Brian L. (2012). "Erythema Migrans ". The American Journal of Dermatopathology 34 (8): 834–837. doi:. ISSN 0193-1091.
- ↑ Soyer, H. Peter; Jakob, Lena; Metzler, Gisela; Chen, Ko-Ming; Garbe, Claus (2011). "Non-AIDS Associated Kaposi's Sarcoma: Clinical Features and Treatment Outcome ". PLoS ONE 6 (4): e18397. doi:. ISSN 1932-6203.
Image sources