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The
term 'Inflammatory skin disease' is used to described all non-neoplastic
conditions.
-Biopsy should be
taken from the edge of the lesion. The specimen should include normal
tissue and should be deep enough to include subcutaneous adipose tissue.
(Gross examination of the skin specimen) - Decide on the major patterns of involvement . The inflammatory skin disease is classified according to the type of tissue reaction and nature and distribution of the inflammatory infiltrate.
Types of Tissue Reaction: Lichenoid (Interface)Tissue Reaction Pattern Granulomatous Reaction Pattern Vesiculobullous Reaction Pattern Vasculopathic Reaction Pattern Nature of inflammatory Infiltrate: NEUTROPHILS -
Abscess/folliculitis
; Vasculitis ; Superficial dermatophyte inf. LYMPHOCYTE -
Lupus
erythematosus ; Lichen planus ; Erythema multiforme; EOSINOPHILS -
Drug/allergic reaction ; Insect bite reaction ; Bullous
pemphigoid ; Superficial dermatophyte infection ; Granuloma faciale ; MIXED INFILTRATE - Urticarial reactions ; Dermatophyte infection ; Insect bites ; Sweet's syndrome ; Granuloma faciale. MAST CELLS - Urticaria pigmentosa ; Telangiectasia macularis eruptiva. PLASMA CELLS - Syphilis ; Lyme disease; Zoon's balanitis ; Necrobiosis lipoidica. CELL POOR - Porphyria/pseudoporphyria ; Cell poor bullous pemphigoid ; Cutaneous amyloidosis ; Mucinosis. When biopsy looks
relatively normal: Examples of invisible dermatosis: Toluidene Blue
- Urticaria pigmentosa Invisible
dermatoses with subtle, but diagnostic abnormalities on H&E stain: Bullous lesions require immunofluorescence for confirmation of diagnosis. Immunofluorescence plays an important role in the investigation of inflammatory skin disease specially in vesiculo-bullous disorders.
I EPIDERMIS : Hyperkeratosis ; parakeratosis ; hypergranulosis ; spongiosis & spongiotic vesicles ; acantholysis ; papillomatosis ; acanthosis (irregular, saw-tooth or psoriasiform) ; atrophy ; intraepidermal bulla ; inflammatory cellular infiltrate ; presence of viral inclusion ; Civatte body ; erosions and ulceration. II DERMOEPIDERMAL JUNCTION : Subepidermal bulla formation (with eosinophils , neutrophils or little or no inflammatory infiltrate) ; vacuolar degeneration; an inflammatory infiltrate (band-like, patchy, plasma cells) ; basement membrane thickening. III DERMIS: Solar elastosis: Change in collagen pattern: (presence of edema fluid ; edema fluid and eosinophils ; edema fluid & mast cells ; thickening of bundles ; dense superficial bands of collagen ; thickening and obliteration of fibres; deep extension and entrapment of sweat glands and subcutaneous adipose tissue ; hyalinization with swirling pattern ; deposition of mucin ; presence of flame figures ; destruction of collagen. ) Inflammatory infiltrate: Type : Neutrophilic ; Mast cells ; Lymphocytic ; Lymphoplasmacytic ; follicular ; granulomatous ; histiocytic. Distribution: Band-like ; V-shaped ; Perivascular inflammation ( superficial or superficial & deep) ; Neutrophils around hair follicles ; Mononuclear inflammatory infiltrate around nerves. Primary Vasculitis: ( Arterial ; arteriolar ; capillary ; venous ) Abnormalities of hair follicle. Microbes ( special stains are often used to demonstrate organisms ). IV SUBCUTIS Septal panniculitis or lobular panniculits / presence of calcification / vasculitis/ extension of reticular dermis . |
March 2009
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