Connective Tissue Disease Vasculitis

Synonyms Lupus vasculitis rheumatoid vasculitis. Cutaneous vasculitis occurs frequently in systemic lupus erythematosus, rheumatoid arthritis (RA), and Sjogren's syndrome, and less commonly in dermatomyositis, scleroderma, and polychondritis More widespread organ involvement is found and the caliber of vessel affected shows more variation in connective tissue disease vasculitis than cutaneous leukocytoclas-tic angiitis Coexistence of prothombotic antiphospholipid antibodies, which can lead to...

Epidermolytic Acanthoma

Synonyms Solitary or multiple epidermolytic acanthomas. Component of dominantly inherited bullous congenital ichthyosiform erythroderma. Some linear epidermal nevi. Palmar plantar keratodermas. Incidental finding in normal skin. Clinical Presentation (Solitary or Multiple Type) Keratotic papule resembling a seborrheic keratosis or verruca vulgaris Brownish, 2 to 8 mm in diameter Hyperkeratosis with focal parakeratosis Well-circumscribed zone of acanthosis (Fig. 11A) Granular degeneration...

Urticaria

Clinical Presentation (Fig. 1A) Edematous papules and plaques, discrete or confluent Localized, regional, or widespread Individual lesions disappear in hours Lesions are intensely pruritic Perivascular infiltrate of neutrophils and eosinophils early Lymphocytes perivascular, neutrophils, and eosinophils interstitial later Sparse perivascular infiltrate of lymphocytes and a few eosinophils in a resolving lesion Edema located mostly in the reticular

Alopecia Areata

Many diseases of hair follicles result in alopecia, which is simply defined as any type of hair loss. The alopecias are conventionally grouped into nonscarring and scarring categories. Nonscarring alopecias may be localized or diffuse. Since the follicles are not destroyed in the nonscar-ring alopecias, there is potential for regrowth or return to normal hair density in these conditions. Follicular diseases that result in follicular destruction and permanent hair loss are termed scarring...

Recurrentpersistent Melanocytic Nevus

The recurrent (persistent) nevus is defined as the appearance of macular pigmentation within the confines of the clinical scar of a previously biopsied (usually by shave technique) melanocytic nevus, usually after the passage of about six weeks to six months (Fig. 5A). Histologically regenerative and often irregular single cell and nested intraepidermal melanocytic proliferation, sometimes mimicking melanoma, overlies the dermal scar (Table 9) (Fig. 5B). On occasion, the latter intraepidermal...

Nodular And Diffuse Dermatitis

Nodular and diffuse dermatitis represents a group of diverse inflammatory conditions, each of which presents with inflammatory cells present in nodules filling portions of the dermis or diffusely filling the entire dermis. As with all inflammatory patterns, there is significant overlap between nodular dermatitis and diffuse dermatitis many of the same diseases may present with either pattern. Similarly, cutaneous inflammatory conditions which are most often superficial or superficial and deep...

Nevoid Melanoma Definition

The term nevoid melanoma has been used to describe papular, predominantly intradermal proliferations of deceptively banal-appearing atypical melanocytes that are small and fairly symmetric thus resembling the architecture of a benign nevus. The concept is in evolution and is not universally accepted. Nevoid melanomas are rare and often are diagnosed retrospectively after metastases have occurred. It is likely that many so-called nevoid melanomas represent early NMs 6 . Others are made up of...

Melanocytic Neoplasms Neoplasms

Location of melanocytes in the skin depth Superficial Intraepidermal Papillary dermis Upper half of reticular dermis Deep Lower half of reticular dermis Subcutaneous Fascial Disposition of melanocytes Intraepidermal Basilar melanocytes single cell pattern Normal numbers Increased frequency - With elongated rete lentiginous - Without elongated rete Pagetoid pattern Patchy perivascular, periadnexal, perineurial Wedge pattern deep apex of nests, fascicles of melanocytes extend into reticular...

Intradermal Nevus Fibrosis

Giant Congenital Melanocytic Nevus

Clark WH Jr, Elder DE, Guerry D IV, et al. A study of tumor progression the precursor lesions of superficial spreading and nodular melanoma. Human Pathol 1984 15 1147-1165. 2. Elder DE. The dysplastic nevus. Pathology 1985 17 291-297. 3. Barnhill RL, Roush GC, Duray PH. Correlation of histologic and cytoplasmic features with nuclear atypia in atypical dysplastic nevomelanocytic nevi. Hum Pathol 1990 21 51-58. 4. Piepkorn MW. An appraisal of the dysplastic nevus syndrome concept. Adv Dermatol...

Other Intracytoplasmic Organisms

Leukocytoclasis

capsulatum fungus Rhinoscleroma Klebsiella rhinoscleromatis gram-negative bacillus Granuloma inguinale-Calymmatobacterium granulomatis gram-negative bacillus Donovan body . 1. Hepburn MC. Cutaneous leishmaniasis. Clin Exp Dermatol 2000 25 363-370. 2. Grevlink SA, Lerner EA. Leishmaniasis. J M Acad Dermatol 1996 34 257-272. Diffuse dermatitis with prominent mast cells. Orange-brown macules papules and nodules on trunk less often extremities Fig. 8A Lesions develop wheal and flare following...

Acne Keloidalis Nuchae Also Known As Folliculitis Keloidalis

Ophiasis Pattern 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 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

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...

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

Dilated Pore Winer And Epidermal Cyst

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

Asymmetric Border With Lesion

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...

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...

References

Radiation Dermatitisdermatopathology

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...

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

Squamous Cell Carcinoma Dermatopathology

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...

Nodular Vasculitis

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...

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...

Tuberculoid Leprosy

Erector Muscle Hair Jpg

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...

Telogen Effluvium

Loose Anagen

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...

Necrotic Keratinocytes

Necrotic Keratinocytes

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

Erythema Figuratum

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

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...

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...

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...

Rl81a85434 2007

Visit the Informa Web site at www.informa.com and the Informa Healthcare Web site at www.informahealthcare.com This book is dedicated to the memory of my Dad, George H. Grant, D.D.S. who died on June 8, 2006 at noon and to my husband, Barry D. Kels, M.D., J.D. They are both gentle yet strong, demonstrate an absolute love of life and family, and my greatest supporters. In their arms, I have learned what it means to feel safe and secure. My Dad was the first man in my life that I loved with every...