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Spongiotic reaction
pattern is characterised by inter and intracellular oedema of the
epidermis and elongation of the intercellular bridges. Progressive
psoriasiform hyperplasia occurs with chronicity.
In the past this reaction pattern was known as 'eczematous tissue
reaction'.
The spongiosis may vary from microscopic foci to grossly visible
vesicles.
Inflammatory cells are present in the dermis and their distribution and
type may aid in making a specific diagnosis.
FIVE
PATTERNS OF SPONGIOSIS:
1.
Neutrophilic spongiosis
(where there are
neutrophils within foci of spongiosis)
Examples of
Neutrophilic Spongiosis:
Pustular psoriasis
IgA pemphigus
Palmoplantar pustulosis
Dermatophytosis/candidosis
Acute generalized exanthematous pustulosis
2.
Eosinophilic spongiosis
(where there are numerous eosinophils within foci of spongiosis)
Examples of
Eosinophilic Spongiosis:
Pemphigus (precursor lesions)
Pemphigus vegetans
Bullous pemphigoid
Arthropod bites
Allergic contact dermatitis
Eosinophilic folliculitis
Incontinentia pigmenti (first stage)
3. Miliarial (acrosyringial)
spongiosis
(where edema is
related to the acrosyringium).
Example:
Miliaria
4.
Follicular spongiosis
(where the spongiosis centered on the follicular infundibulum
Example:
Infundibulofolliculitis, atopic dermatitis
5.
Haphazard spongiosis
(other spongiotic disorders in which there is no particular pattern).
OTHER SPONGIOTIC
DISORDERS:
Irritant
contact dermatitis
Allergic contact dermatitis
Image
Nummular dermatitis
Seborrheic dermatitis
Atopic dermatitis
Pityriasis rosea
Stasis dermatitis
Chronic superficial dermatitis
Spongiotic drug reaction
HISTOPATHOLOGICAL
FEATURES OF SOME SPONGIOTIC DISEASES:
Irritant
contact dermatitis:
Superficial
ballooning, necrosis and neutrophils; mild irritants produce spongiotic
dermatitis mimicking allergic contact dermatitis.
Allergic
contact dermatitis:
Variable spongiosis and vesiculation at different horizontal and vertical
levels, mild exocytosis, progressive psoriasiform hyperplasia with
chronicity .Superficial dermal oedema and eosinophils in superficial
dermal infiltrate.
Seborrheic
dermatitis:
Variable spongiosis and psoriasiform hyperplasia depending on activity and
chronicity. Scale crust and spongiosis may localize to follicular ostia.
Atopic
dermatitis:
Mimics other spongiotic diseases. There is variable spongiosis, focal
parakeratosis,prominence of vessels in the papillary dermis , psoriasiform
hyperplasia , exocytosis and perivascular infiltrate of lymphocytes.
Stasis
dermatitis:
Mild spongiosis only ; proliferation of superficial dermal vessels,
extravasation of erythrocytes, abundant hemosiderin.
Spongiotic
drug reaction:
Spongiosis,
conspicuous exocytosis of lymphocytes, rare apoptotic keratinocytes,
eosinophils, plasma cells, lymphocytes in superficial dermis and sometimes
in mid dermis. Sometimes superficial dermal oedema.
Chronic
superficial dermatitis:
Mild spongiosis,
focal parakeratosis, variable psoriasiform hyperplasia, superficial
perivascular infiltrate with upward extension and mild exocytosis.
Dermatophytoses:
Neutrophils in
stratum corneum or compact orthokeratosis should alert observer to perform
PAS stain. Spongiotic vesicles may form on palms and soles.
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