Sebaceoma
Synonym Sebaceous epithelioma old term . Clinical Presentation Solitary yellowish circumscribed nodule or an ill-defined plaque Fig. 10A Usually on the face or scalp May be multiple in Muir-Torre syndrome Usually small size, symmetric, and well-circumscribed Figs. 10B and 11A Aggregations of neoplastic cells with great variation in size and shape Figs. 10B and 11A 1 Sebaceous lobules comprised of small, undifferentiated basaloid cells and mature sebocytes. The ratio of basaloid undifferentiated...
Acne Keloidalis Nuchae Also Known As Folliculitis Keloidalis
Figure 1 A Well-clrcumscribed areas of nonscarring hair loss in typical alopecia areata. B Marginal hair loss in ophiasis pattern alopecia areata. C Diffuse hair loss in diffuse alopecia areata. D Exclamation point hairs arrows in an active patch of alopecia areata. Figure 1 A Well-clrcumscribed areas of nonscarring hair loss in typical alopecia areata. B Marginal hair loss in ophiasis pattern alopecia areata. C Diffuse hair loss in diffuse alopecia areata. D Exclamation point hairs arrows in...
Info Pkv
Sun-exposed areas keratotic lesions on erythematous base Atypia limited to basal layer to full thickness atypia Keratotic lesions or patches on hands SCCIS full thickness atypia may not be seen focally Usually nonexposed area well Figs. 5A, B circumscribed erythematous plaque SCCIS full thickness atypia may not be seen focally Genital location multiple skin colored or pigmented papules SCCIS full thickness atypia may not be seen focally Glans penis in elderly males erythematous plaque SCCIS...
Info Loz
curling procedures, such as hot combs, relaxers permanents, or the use of tight curlers, and the use of hair weaves that may be attached too tightly or may be pulled off before reapplication to the proximal part of the growing hair shafts. These hair styling practices are often shared by members of specific ethnic groups and thus certain patterns of traction alopecia are more common in certain groups. The most common groups to present with traction alopecia are young Latina women who style...
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Periodic acid Schiff Grocott methena-mine silver stain for hyphae PITYRIASIS ROSEA Clinical Presentation Often starts with a herald patch Fig. 10A , one to four centimeter, round to oval, salmon-pink-patch Central collarette of scale Fig. 10B Followed after a few days by a generalized eruption Fir tree truncal distribution Usually lasts six to eight weeks Focal mounds of parakeratosis Mild acanthosis more prominent in herald patch Erythrocyte extravasation in papillary dermis Mild dermal...
Ectopic Sebaceous Glands
Synonyms Nevus sebaceus of Jadassohn organoid nevus. Usually on the scalp or face In infancy and childhood well-circumscribed, only slightly raised, hairless plaque in an often linear configuration Fig. 3A At puberty and in adulthood yellow verrucous, nodular plaque Fig. 4A Acanthotic epidermis with papillomatosis and hyper-keratosis Figs. 3C 4B and C Lack of normal mature hair follicles Figs. 3B and C 4B and C Incompletely differentiated immature hair follicles Figs. 3C and D Ectopic apocrine...
Folliculosebaceous Cystic Hamartoma
In childhood only a slightly raised, often linear, hairless plaque present at birth, usually on the scalp or face At puberty and in adulthood yellow verrucous, nodular plaque Flat epidermis, lack of normal terminal hair follicles but instead immature hair follicles, sebaceous glands greatly reduced in size and number, ectopic apocrine glands in the dermis Thickened papillomatous epidermis, immature hair follicles as opposed to terminal hair follicles, increased number of large sebaceous glands...
Foreign Body Granulomas Allergic Sarcoidal Granulomatous Reaction
Nodular sarcoidal type of granulomatous disease. Some foreign bodies can induce an allergic granulo-matous reaction that simulates a sarcoidal granulomatous reaction. Granulomata secondary to silica usually from glass or sand can occur the foreign body can be detected as doubly refractile crystals with polarizing lenses. Beryllium from cuts due to broken fluorescent light bulbs manufactured prior to 1950 results in granulomata often associated with central necrosis. Beryllium granuloma and...
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Hyperkeratosis, verrucous clear cell lobule of acanthosis containing glycogen PAS , diastase labile Palisading of basal layer around lobule common Sometimes thickened basement membrane Besides the main differential culprits in the table, also consider other clear cell tumors, such as sebaceous neoplasms. It may resemble actinic keratosis, verruca vulgaris, and inverted follicular keratosis except for the presence of more clear cells. The malignant counterpart, trichilemmocar-cinoma, is much...
Benign Lichenoid Keratosis
Synonym Lichen planus-like keratosis. Chest, back, neck, upper extremities of adults over 40 Light brown to red, may notice brown at periphery Often associated with or arising in a solar lentigo Fig. 12C Variety of histologic subtypes including atypical and bullous Atrophic to hyperplastic epidermis Compact ortho- and parakeratosis Lichenoid, predominantly mononuclear cell infiltrate, obscures dermal-epidermal junction Fig. 12D Scattered necrotic keratinocytes May have mild keratinocytic atypia...
Malignant Follicular Tumors
The major two malignant follicular tumors, pilomatrix carcinoma pilomatrical carcinoma and trichilemmocarcinoma trichilemmal carcinoma Fig. 23 have been discussed under their benign counterparts, pilomatrixoma and trichi-lemmoma respectively. Under the lumper philosophy, it has been proposed that both these are simply variants of squamous carcinoma, with shadow cells or clear cells being prominent features. 1. Hardisson D, Linaves MD, Cuevas-Santos J, Contreas F. Pilomatrix carcinoma a...
Muirtorre Syndrome And Its Cutaneous Manifestations
Syndrome characterized by the development of sebaceous tumors, often multiple Fig. 14A , and visceral neoplasms Autosomal dominant inheritance Sebaceous tumors vary from just one to more than 100 lesions Cutaneous tumors may precede or follow the manifestation of the visceral cancer 1 Visceral tumors usually of the gastrointestinal tract polyps of the large bowel and adenocarcinomas Other organs may be involved larynx, the genito-urinary system, ovary, and uterus Cutaneous sebaceous neoplasms...
Urticarial Vasculitis
Synonyms Urticarial venulitis hypocomplementemic or normocomplementemic urticarial vasculitis hypocomplementemic urticarial vasculitis syndrome. Women more than men 3 2-4 1 , fourth decade peak incidence lt 20 of patients presenting with chronic urticaria have urticarial vasculitis UV Cutaneous differences between UV and urticaria Painful, tender, burning or pruritic papules, and plaques Urticaria is mostly pruritic Lesions persist less than 24 hours and greater than 72 hours Urticaria lasts...
Rare And Unusual Cysts
These lesions are cystic and clinically recognized only by their unusual locations. The diagnoses depend on multiple specific criteria with the type of epithelial lining being most important. Clinical Presentation and Histology Pigmented Follicular Cyst Brown cystic lesion, face and neck, may resemble other pigmented neoplasms, usually solitary Epithelial lining similar to normal epidermis of the infundibulum of a hair follicle Amorphous pigmented keratin in cavity, with or without portions of...
Histology Porphyria
Pauci-inflammatory subepidermal bulla with variable neutrophils, depending on the degree of necrosis Fig. 12C Festooning with preservation of dermal papillae on the floor of the blister, another diagnostic feature Figs. 12C and D Dramatic homogeneous eosinophilic PAS deposits around thickened elongated papillary dermal vessels a diagnostic feature Figs. 12D and E Caterpillar bodies rows of dead keratinocytes in the epidermis less often seen
Epidermoid Cyst
Synonyms Keratin cyst epidermal inclusion cyst sebaceous cyst follicular cyst infundibular type . Extremely common, face, scalp, trunk, extremities Slow growing, round, firm, intradermal tumors Fig. 14A Normal skin surface, usually May have overlying pore or dell May be red, tender, or painful when inflamed Milia are very small cysts, usually on the face, often derived from vellus hairs Intradermal may extend into fat cystic structure Fig. 14B , round to oval, well circumscribed True epidermal...
Digital Myxoid Cyst
Most common on the dorsal surface of the index or middle finger, overlying the distal interphalangeal joint, just above the proximal nail fold Fig. 20C Ill-defined collection of mucin in superficial dermis, may have overlying collarette of epidermis Fig. 20D Mild inflammation at the periphery Figure 1 A Multiple well circumscribed, hyperpigmented, verrucous plaques with a stuck-on appearance. B Well circumscribed and symmetric lesion demonstrating papillomatosis and acanthosis of the...
References Svt
1. Cowper SE, et al. Nephrogenic fibrosing dermopathy. Am J Dermapathol 2001 23 5 383. 2. Cowper SE, Bucala R. Nephrogenic fibrosing dermopathy suspect identified, motive unclear. Am J Dermatopathol 2003 25 4 358. Table 1 Histopathologic Differential Diagnosis Nephrogenic Fibrosing Dermopathy Collagen bundles of various thickness Thickened collagen bundles that are haphazardly arranged CD-34 positive dermal dendrocytes increased CD-34 positive dermal dendrocytes normal or decreased CD-34...
Nodular Dermatitis
Pseudolymphoma and lymphoma Acute febrile neutrophilic dermatosis Leukocytoclastic vasculitis Neutrophils, eosinophils, and plasma cells prominent Granuloma faciale erythema elevatum diutinum Granuloma gluteale infantum Eosinophils and plasma cells prominent with lymphocytes Histiocytes predominate granulomatous Granuloma faciale erythema elevatum diutinum Neutrophils and eosinophils prominent Granuloma faciale erythema elevatum diutinum Rhinoscleroma, leishmaniasis, syphilis Urticaria...
CYTOPHAGIC HISTIOCYTIC PANNICULITIS Clinical Presentation
Crops of asymptomatic nodules bruising or ulceration Localized to the extremities Fig. 5A Associated with fever, hepatosplenomegaly, pancytope-nia, and lymphadenopathy Phagocytic histiocytes replace bone marrow and lymph nodes Development of severe anemia, thrombocytopenia, coagulation defects, hypocalcemia, and liver failure Reported in viral, bacterial, fungal, and protozoan infections, systemic lupus erythematosus SLE T-cell lymphoma, B-cell lymphoma, NK-cell lymphoma, atypical-lymphocytic...
Actinic Keratosis
Synonyms Solar keratosis senile keratosis. Clinical Presentation Most commonly found on sun-exposed areas of fair-skinned individuals in middle- or later-age groups Remarkable variance in clinical and pathologic characteristics An isolated scaly plaque with an erythematous base Fig. 1A Few millimeters in diameter to rarely a plaque a few centimeters in diameter Often multiple Fig. 1B and widely or locally distributed May appear as papulonodules, atrophic plaques, or with cutaneous horns...
Basal Cell Carcinoma
Occurs in sites chronically exposed to the sun and increased in frequency from the third decade onward, although they have been reported in children and young adults. Most frequently on the face and scalp, rarely arises on the digits, the back of the hand, dorsum of the foot, or on the ears. Typically are solitary opalescent nodules with telangiectasia Fig. 18A or ulceration Fig. 18B . Common variant is the superficial type Fig. 18C , which often appears as a thin plaque. Morphea-form may...
Cutaneous Leukocytoclastic Angiitis
Synonyms Hypersensitivity vasculitis allergic vasculitis necrotizing vasculitis leukocytoclastic vasculitis primary cutaneous small vessel vasculitis. All ages, both sexes affected, mostly middle-aged adults Most cases idiopathic prolonged exercise, infectious or drug trigger in remainder Single or recurrent crops of palpable purpura affecting lower extremities Dependent areas of buttocks, lower legs, ankles and feet Areas of friction or constant pressure such as skin underlying belt, or sock...
Nodular Vasculitis
Synonym Erythema induratum. Clinical Presentation Fig. 17 Nodular vasculitis lobular panniculitis with vasculitis was originally defined as erythema induratum red, indurated plaques on the lower legs associated with tuberculosis, treatment of which leads to clearing of skin lesions Fig. 17A Other etiologic agents include drugs and nonmyco-bacterial infections associated with circulating immune complexes Occurs in young to middle-aged females Presents as painful, tender, violaceous, and...
Histology
Scalp biopsies usually normal No increase in telogen follicles decreased telogen follicles in some reports No follicular miniaturization Some reports describe abnormalities of the outer or inner root sheath and clefting between the inner root sheath and the hair cuticle and between the hair cuticle and the hair cortex Anagen hairs obtained by pull tests often demonstrate dysmorphic bulbs, longitudinal grooves, and ruffled cuticles Figs. 9B and C
Pathophysiology 1
There is no known etiology to explain granuloma annulare. It is known that certain traumas such as insect bites, skin testing, sun exposure, viral infections can precipitate the lesions at local sites. It has been postulated that a delayed type hypersensitivity reaction to an unknown antigen may play a role in the pathophysiology of granuloma annulare. Cytokine and interferon producing lymphocytes in response to an unknown antigen could induce degradation of the dermal matrix thus inducing a...
Psoriasis
Clinical Presentation of Classic Psoriasis Well-demarcated erythematous plaques Fig. 1A Silver-white micaceous scale Symmetric distribution on extensor regions such as elbows, knees, and buttocks, may be diffuse Fig. 1B Hemorrhagic crusts, pinpoint bleeding when scale is removed Auspitz sign Nail changes pits and oil spots yellow-brown discoloration of the nails that look like oil Clinical Presentation of Guttate Variant Occurs more frequently in children than in adults Generalized multiple...
Pathophysiology Of Bfc
Elaboration of interferons and macrophage inflammatory protein 1 alpha by neoplastic and nonneoplastic lymphocytes, endothelial cells, and macrophages this activates macrophages to phagocytize
Info Vug
Figure 1 Multinucleated giant cells. A Langhan's multinucleated giant cell. B Touton multinucleated giant cell. C Foreign body multinucleated giant cell. D Asteroid body in a multinucleated giant cell. Figure 1 Multinucleated giant cells. A Langhan's multinucleated giant cell. B Touton multinucleated giant cell. C Foreign body multinucleated giant cell. D Asteroid body in a multinucleated giant cell. Figure 2 Granulomas. A Tuberculoid granuloma. B Sarcoidal granuloma. C Palisaded granuloma. D...
Intracorneal Or Subcorneal Vesicle And Pustule
Synonyms Staphylococcal scalded skin syndrome SSSS Clinical Presentation SSSS Fig. 1A Primarily affects neonates in young children but may occur in adults, particularly if immunocompromised Sudden onset of malaise, fever, irritability, cutaneous tenderness, and erythema Erythema often accentuated in flexural and periorificial areas Flaccid blisters and erosions developed within one to two days Cultures of blisters are negative Sudden onset of macular erythroderma with desquamation of tips of...
Intraepidermal Vesicles
Primary infection usually occurs in childhood and may be subclinical with acute gingivostomatitis Recurrent lesions occur at a similar site each time, usually on the lips, face, or genitalia Initial infection results in a generalized vesicular eruption chickenpox Recurrent infection results in an acute, self-limiting, vesicular eruption occurring in a dermatomal distribution Vesicles become pustular, then form crusts that may lead to scarring Pain, tenderness, or paresthesias precede or...
Granulomatous Dermatitis
Granulomatous dermatitis is a nodular or diffuse inflammatory pathologic process that is composed predominantly of histiocytes. The reaction pattern forms in response to an antigen that is usually insoluble, nondegradable, or slowly released. Deciding whether a pattern is perivascular, interstitial, nodular, or diffuse is rather subjective. A pattern is considered nodular when discrete perivascular inflammation extends beyond a single perivascular region and is relatively large and dense. One...
Granuloma Faciale
Nodular dermatitis with neutrophils, eosinophils, and plasma cells prominent. Solitary or several reddish brown nodules to plaques Fig. 3A Typically on the face although rarely extrafacial Persistent and asymptomatic Nodular mixed infiltrate with characteristic sparing of the papillary and periadnexal dermis together known as the adventitial dermis Fig. 3B . Polymorphous infiltrate consisting of numerous neutrophils, many of them with fragmented nuclei leukocytoclasis , eosinophils, plasma...
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Figure 3 Mild female pattern hair loss FPHL with early widening of the part on the crown A , compared with the occipital scalp B . Severe female pattern hair loss with thinning hair over the entire crown, vertex, and posterior vertex C with relative sparing of only the lower occipital scalp D . Figure 3 Mild female pattern hair loss FPHL with early widening of the part on the crown A , compared with the occipital scalp B . Severe female pattern hair loss with thinning hair over the entire...
Pathophysiology Lda
Foreign body granulomas are an inflammatory response to inorganic or high-molecular-weight organic materials that have been introduced into the skin. The skin responds to this foreign material with granulomatous inflammation. Routes of entry include accidental, self inflicted, surgery, topical medications, or a normally sequestered part of our own body that becomes treated as a foreign body if it comes into direct contact with the dermis keratin, nails, hair, etc. Examples of foreign body...
Clinicopathologic Correlation
Discharge of material from ulcerated lesions Discharge of urate crystals that have deposited in the skin Site of pathology in deep dermis and subcutis
Contents Dmm
Immunologic Criteria and Location of Bulla Formation Autoimmune vs. Nonimmunologic Etiology Composition of the Inflammatory Infiltrates and Other Histologic Features Immunofluorescence Patterns and Molecular Studies SUBEPIDERMAL VESICULOBULLOUS DISORDERS Bullous Pemphigoid Pemphigoid Gestationis Mucous Membrane Pemphigoid Cicatricial Pemphigoid Dermatitis Herpetiformis Linear IgA Bullous Disease and Chronic Bullous Disease of Childhood Bullous Lupus Erythematosus Epidermolysis Bullosa Acquisita...
Necrotic Keratinocytes
1. Cabanillas F, Armitage J, Pugh WC, et al. Lymphomatoid papulosis a T-cell dyscrasia with a propensity to transform into malignant lymphoma. Ann Intern Med 1995 122 3 210-217. 2. El-Azhary RA, Gibson LE, Kurtin PJ, et al. Lymphomatoid papulosis a clinical and histopathologic review of 53 cases with leukocyte immunophenotyping, DNA flow cytometry, and T-cell receptor gene rearrangement studies. J Am Acad Dermatol 1994 30 2 Pt 1 210-218. 3. Gellrich S, Wernicke M, Wilks A, et al. The cell...
Perivascular And Interstitial Dermatitis
Figure 1 A Urticae on the trunk. B Perivascular and interstitial dermatitis without epidermal changes. C Lymphocytes and eosinophils perivascular and numerous neutrophils interstitial. Figure 1 A Urticae on the trunk. B Perivascular and interstitial dermatitis without epidermal changes. C Lymphocytes and eosinophils perivascular and numerous neutrophils interstitial. Figure 2 A Sharply demarcated purpuric erythema on the leg, a bulla Is seen in the uppermost part of the lesion. B Perivascular...
Tumid Lupus Erythematosus
Synonyms Lymphocytic infiltration of Jessner and Kanof most likely is tumidus lupus erythematosus. Smooth surfaced red macules, papules, and plaques Often localized on sun-exposed sites such as the face, chest, and arms Perivascular and periadnexal infiltrate of lymphocytes, superficial and deep Mucin in abundance in the reticular dermis
Viral Exanthems
Exanthem of macules and or papules Sometimes morbilliform measles , and rubeoliform, German measles Variations include erythema infectiosum appearance of cheeks that have been slapped , roseola exanthema subitum discrete, small macules and papules similar to those of rubella Sparse perivascular infiltrate of lymphocytes Extravasate erythrocytes, sometimes Sparse superficial perivascular infiltrate
Vitiligo
Depigmented macules and patches Localized, segmental, or widespread often symmetric Association, episodically, with alopecia areata, Hashimoto's thyroiditis, diabetes mellitus, Addison's disease, lupus erythematosus, myasthenia gravis, primary biliary cirrhosis, or Vogt-Koyanagi-Harada's syndrome Sparse superficial perivascular infiltrate of lymphocytes Few lymphocytes sprinkled in the lower half of the epidermis sometimes Melanocytes at the dermoepidermal junction decreased markedly in number...
Interface Dermatitis
SUNY-Downstate Medical Center, Department of Dermatology, Brooklyn, New York, U.S.A. --VACUOLAR INTERFACE DERMATITIS SUPERFICIAL VACUOLAR INTERFACE DERMATITIS ERYTHEMA MULTIFORME Vacuolar Interface Dermatitis Superficial Acute Graft-vs.-Host Reaction Systemic Lupus Erythematosus Lichen Sclerosus and Atrophicus Vacuolar Interface Dermatitis Superficial and Deep Discoid Lupus Erythematosus Pityriasis Lichenoides and Varioliformis Acuta LICHENOID INTERFACE DERMATITIS Lichenoid Interface Dermatitis...
Persistent Pigmented Purpuric Dermatitis
Synonyms Pigmented purpuric dermatitis progressive pigmented prupura. Purpuric macules and papules, sometimes scaly Symmetrically involving legs and thighs, rarely the trunk and the upper extremities Variations include Schamberg's disease purpuric and pigmented macules , lichenoid purpura of Unknown, but drugs as well as infectious foci have been claimed to induce the eruption. 1. Ackerman AB, Boer A, Bennin B, Gottlieb GJ. Histologic Diagnosis of Inflammatory Skin Diseases. 3rd ed. New York...
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Uncertain but keratinocyte dysfunction and vitamin A may play a role 1. Magro CM, Crowson AN. The clinical and histomorphological features of pityriasis rubra pilaris. A comparative analysis with psoriasis. J Cutan Pathol 1997 24 7 416-424. 2. Allison DS, El-Azhary RA, Calobrisi SD, Dicken CH. Pityriasis rubra pilaris in children. J Am Acad Dermatol 2002 47 3 386-389. INFLAMMATORY LINEAR VERRUCOUS EPIDERMAL NEVUS Clinical Presentation Linear to curved, whorled Blaschkoid verrucous scaly...
Secondary Syphilis
Synonym Lues. Clinical Presentation Syphilis is an infectious, sexually-transmitted disease, the clinical manifestations of which are protean secondary syphilis is known as the great imitator, producing cutaneous lesions of every morphology except pustules Secondary syphilis generally presents 2 to 10 weeks after the appearance of the painless ulcer the chancre of primary syphilis Patients with secondary syphilis show a generalized lymphadenopathy associated with mucocutaneous lesions that may...
Erythema Figuratum
Synonyms Deep gyrate erythema deep type of erythema annulare centrifugum of Darier palpable migratory and arciform erythema erythema figuratum perstans figurate Annular, arcuate, polycyclic, and serpentine papules and plaques devoid of scale Localized or widespread, trunk and proximal extremities especially Superficial and deep perivascular infiltrate of lymphocytes, the interstitium of the reticular dermis usually being spared No increase in mucin in the reticular dermis No edema of the...
Lichenoid Interface Dermatitis
Dense, band-like inflammatory cell infiltrate, which obscures the dermoepidermal junction Infiltrate may be only in the superficial dermis, or both the superficial and deep dermis LICHENOID INTERFACE DERMATITIS SUPERFICIAL LICHEN PLANUS Clinical Presentation Chronic dermatosis with skin, hair follicle, and mucous membrane involvement 10 of cases show involvement of the nail unit, often with pterygium formation Presents clinically as pruritic, violaceous, flat-topped, polygonal papules, and...
Vacuolar Interface Dermatitis
Relatively sparse inflammatory cell infiltrate that obscures the dermoepidermal junction Vacuolar alteration of basal keratinocytes necrotic keratinocytes Infiltrate may be only in the superficial dermis, or in both the superficial and deep dermis Clinical Presentation Erythema Multiforme Minor Acute, self-limited, recurrent disease of the skin and mucous membranes, most commonly in response to infection with herpes simplex virus types I and II Pleomorphic eruption with erythematous and...
Postinflammatory Pigmentary Alteration
Synonyms Postinflammatory pigmentary change. Pigmented macules and patches Sites of a previous dermatitis More prominent in dark-skinned individuals Fading gradually over months or years Little or no infiltrate of lymphocytes around venules of the superficial plexus and along the dermoepidermal junction Hints of vacuolar alteration sometimes Melanophages in the papillary dermis and in the upper part of the reticular dermis range from few to many Papillary dermis thickened sometimes by subtle...