PSORIASIFORM, SPONGIOTIC, AND INTERFACE DERMATITIS

Question 1

IDENTIFY THE PATTERN

Answer 1

Superficial Perivascular Dermatitis (with minimal epidermal change)

Question 2

IDENTIFY THE PATTERN

Answer 2

Superficial Perivascular Dermatitis (with minimal epidermal change)

Question 3

Answer 3

Pityriasis Rosea

Question 4

What are the 9 basic inflammatory patterns

Answer 4

1. Superficial perivascular dermatitis
2. Superficial and deep perivascular dermatitis
3. Nodular and diffuse dermatitis
4. Intraepidermal vesicular and pustular dermatitis
5. Subepidermal vesicular dermatitis
6. Fibrosing dermatitis
7. Folliculitis and perifolliculitis
8. Vasculitis
9. Panniculitis

Question 5

2 MOST IMPORTANT HISTOLOGIC FEATURES OF PSORIASIS

Where are they located?

Answer 5

Munro Microabscesses - Stratum corneum
Spongiform Pustule of Kogoj - Stratum spinosum

Question 6

give differentials for psoriasiform dermatitis

Answer 6

*Psoriasis

*Lichen Simplex Chronicus/ Prurigo Nodularis

*Pityriasis Rosea

Question 7

Answer 7

LICHEN SIMPLEX CHRONICUS/PRURIGO NODULARIS

Question 8

Answer 8

PITYRIASIS ROSEA

Question 9

give differentials for spongiotic dermatitis

Answer 9

DIFFERENTIALS: “D’ CAIN”

1)Dyshidrotic eczema

2)Contact Dermatitis

3)A- llergic contact dermatitis/ Atopic Dermatitis

4)I-rritant contact dermatitis

5)N-ummular eczema

Question 10

give differentials for spongiotic dermatitis

Answer 10

DIFFERENTIALS: “D’ CAIN”

1)Dyshidrotic eczema

2)Contact Dermatitis

3)A- llergic contact dermatitis/ Atopic Dermatitis

4)I-rritant contact dermatitis/ Id reaction

5)N-ummular eczema

Question 11

Acute/ subacute or chronic?

Answer 11

Acute Spongiosis

✓ Intraepidermal vesicles
✓ Prominent epidermal edema

Question 12

Acute/ subacute or chronic?

Answer 12

Subacute spongiotic dermatitis

✓ Intraepidermal edema less prominent
✓ Acanthosis
✓ Beginning papillary dermal fibrosis

Question 13

Acute/ subacute or chronic?

Answer 13

Chronic Spongiotic Dermatitis

• “psoriasiform-like”
• Acanthosis
• Papllary dermal fibrosis

Question 14

Answer 14

EOSINOPHILIC SPONGIOSIS

Question 15

give differentials for EOSINOPHILIC SPONGIOSIS

Answer 15

S- CABIES
H -ERPES GESTATIONIS AKA PEMPHIGOID GESTATIONIS
A - RTHROPOD BITE/ ALLERGIC CONTACT DERMATITIS
P- EMPHIGUS
P- EMPHIGOID
I - NCONTINENTIA PIGMENTI
E - RYTHEMA TOXICUM NEONATORUM

Question 16

what are the features of vacuolar interface dermatitis

Answer 16

Question 17

give differentials for vacuolar interface dermatitis

Answer 17

1.Ashy Dermatosis

2.Post-inflammatory hyperpigmentation

3.LATE STAGE fixed drug eruption

Question 18

Diagnosis?
Identify the features.
Give differentials

Answer 18

VACUOLAR INTERFACE: ERYTHEMA MULTIFORME

FEATURES:
1. BASAL LAYER VACUOLIZATION (Black arrows) other term: vacuolar interface change

2. APOPTOTIC KERATINOCYTES (Green arrows)
3. Orthokeratosis (acute process)

Question 19

give differentials for VACUOLAR INTERFACE: ERYTHEMA MULTIFORME

Answer 19

DIFFERENTIALS:

1.Stevens-Johnson Syndrome (beginning)

2.Graft-versus-host disease (GVHD)

Question 20

Diagnosis?
What are the features?

Answer 20

VACUOLAR INTERFACE: STEVENS JOHNSON SYNDROME /TOXIC EPIDERMAL NECROLYSIS

FEATURES:

1.SUBEPIDERMAL SPLIT

2.FULL THICKNESS EPIDERMAL NECROSIS

3.Orthokeratosis (acute process)

Question 21

Diagnosis?
Give differential diagnosis.

Answer 21

VACUOLAR INTERFACE: CUTANEOUS LUPUS ERYTHEMATOSUS
Differential: Dermatomyositis

• Basal layer vacuolization (black arrows) with thickening of basement membrane (Green arrows)

FEATURES:

✓ PATTERN: INTERFACE
✓ Basal layer vacuolization
✓ Superficial AND deep perivascular, perieccrine, and periadnexal infiltrates of lymphocytes and plasma cells

LE and dermatomyositis may have the same histologic feature

Question 22

What’s the DIF and stain pattern of Cutaneous Lupus Erythematosus

Answer 22

BANDLINKE deposits of immunoglobulin G (IgG) in the basement membrane zone

Question 23

Ddx of Lupus

Answer 23

Dermatomyositis

Question 24

Diagnosis?
What are the important features?

Answer 24

LICHENOID INTERFACE: LICHEN PLANUS

FEATURES:

✓ PATTERN: LICHENOID – band-like pattern of infiltrates in the papillary dermis
✓ Wedge-shaped hypergranulosis
✓ Saw-tooth appearance of the rete ridges

Question 25

Identify. In what condition is this seen?

Answer 25

Max Joseph Space - seen in Lichen planus - The eponym “Max Joseph space” stands for “the appearance of the liquefaction degeneration of the basal cells and extracellular fluid accumulation about the individual basal cells (that) is strongly suggestive of mild irritation. (from google)

Question 26

Identify. In what condition is this seen?

Answer 26

Basal layer vacuolization with “CIVATTE BODIES” (black arrows) - seen in lichen planus

Question 27

Diagnosis? Features?

Answer 27

LICHENOID INTERFACE: LICHEN NITIDUS FEATURES: ✓ PATTERN: lichenoid ✓ Dense infiltrate of lymphocytes and histiocytes in an expanded dermal papilla ✓ CLAWLIKE epidermal lateral borders

Question 28

DDx for Eosinophilic spongiosis

Answer 28

"SHAPPIE" Scabies Herpes gestationis Arthropod bite/ACD Pemphigus Pemphigoid Incontinentia pigmenti Erythema toxicum neonatorum

Question 29

What type of psoriasis

Answer 29

Guttate Psoriasis - pronounced inflammatory infiltrate - less acanthosis - basket-weave orthokeratotic stratum corneum - overlying mounds of parakeratosis with neutrophils -"seagull"

Question 30

What type of psoriasis

Answer 30

Pustular Psoriasis - presents as macropustule - spongiform pustule formation: ⚬ aggregates of neutrophils ⚬ cytolysis of epidermal cells ⚬ cornified layer: pyknotic - upper dermis contains lymphocytes - migrating neutrophils in the papillae to epidermis

Question 31

Differentials for Subcorneal Pustules

Answer 31

CAT SIPS Candida Acropustulosis of infancy Transient neonatal pustular melanosis Sneddon-Wilkinson Impetigo Pustular psor SSSS

Question 32

Answer 32

Pityriasis Rubra Pilaris - acanthosis with broad and short rete ridges - thick suprapapillary plates - hypergranulosis - mild superficial perivascular lymphocytic infiltrate

Question 33

Answer 33

Pityriasis Rubra Pilaris - alternating ortho and parakeratosis in both vertical and horizontal directions

Question 34

Answer 34

Pityriasis Rosea - acanthosis, epidermal spongiosis (bracket) - exocytosis of lymphocytes - superficial perivascular infiltrate

Question 35

Answer 35

Pityriasis Rosea - extravasated erythrocytes in the papillary dermis - MOUNDS of parakeratosis

Question 36

Answer 36

Seborrheic Dermatitis - "shoulder parakeratosis" - regular acanthosis and elongation of the rete ridges - mild spongiosis sparse - mononuclear cell infoltrate

Question 37

Answer 37

Inflammatory linear verrucous epidermal nevus (ILVEN) - papillated epidermal hyperplasia - thick, elongated rete - spongiosis - alternating ortho and parakeratosis

Question 38

Answer 38

Lichen Simplex Chronicus - compact orthokeratosis - irregular psoriasiform acanthosis - elongation of the rete ridges - wedge-shaped hypergranulosis - vertically-oriented collagen bundles

Question 39

Answer 39

Nutritional deficiency dermatitis

Question 40

DDx for Neutrophils in the Stratum corneum

Answer 40

PTICSS! (Neuts in the SC) Psoriasis Tinea Impetigo Candida Seborrheic dermatitis Syphilis

Question 41

Diagnosis

Answer 41

Psoriasis

Question 42

1. Diagnosis 2. give a DDx

Answer 42

1. Lichen simplex chronicus/ prurigo nodularis 2. Psoriasis

Question 43

Vertical Streaking of collagen bundles in between rete ridges + HYPERgranulosis

Answer 43

Lichen simplex chronicus/ prurigo nodularis

Question 44

(+) mound of parakeratosis give DDx

Answer 44

1. Pityriasis rosea 2. Guttate psoriasis

Question 45

1. PATTERN: _____________ 2. Located in the finger. What is your diagnosis? (BE SPECIFIC)

Answer 45

1. Spongiosis 2. Dyshidrotic dermatitis