Spongiotic Dermatitis (compressed) - lasop.com

1 Spongiosis Spongiosis and Spongiotic What is spongiosis'? Dermatitis Intra-epidermal and intercellular edema Widening of intercellular spaces between keratinocytes Elongation of Sarantopoulos, MD intercellular bridges UCLA Medical Center Spongiosis vs. Spongiotic Spongiosis Dermatitis Spongiosis' as a histologic concept (not a Not everything Spongiotic ' is a diagnosis!) Spongiotic Dermatitis Intra-epidermal edema accompanies many (if not all). inflammatory skin diseases to some degree So-called patterns of spongiosis'.

2 Important to distinguish spongiosis as Neutrophilic The predominant histologic finding Eosinophilic A non-specific feature of other inflammatory Follicular dermatoses ( lichenoid/interface, vasculopathic, psoriasiform, etc). Miliarial Sometimes, there is overlap Dermatitis with Spongiosis' Dermatitis with Spongiosis' *. Neutrophilic: Eosinophilic: Miliarial: Neutrophilic: Eosinophilic: Miliarial: Pustular psoriasis Pemphigus (precursor) M. Crystallina Pustular psoriasis Pemphigus (precursor) M. Crystallina Reiter's syndrome Pemphigus vegetans M.

3 Rubra Reiter's syndrome Pemphigus vegetans M. Rubra IgA Pemphigus Bullous pemphigoid M. profunda IgA Pemphigus Bullous pemphigoid M. profunda Pemphigus herpetiformis Cicatricial pemphigoid Pemphigus herpetiformis Cicatricial pemphigoid Infantile acropustulosis Pemphigoid (herpes) Infantile acropustulosis Pemphigoid (herpes). AGEP gestationis Follicular: AGEP gestationis Follicular: Palmoplantar pustulosis Idiopathic eosinophilic Infundibulofolliculitis Palmoplantar pustulosis Idiopathic eosinophilic Infundibulofolliculitis SSSS spongiosis Atopic Dermatitis (follicular SSSS spongiosis Atopic Dermatitis (follicular Allergic contact Dermatitis lesions) Allergic contact Dermatitis lesions).

4 Neisserial infections Neisserial infections Atopic Dermatitis Apocrine miliaria Atopic Dermatitis Apocrine miliaria Dermatophytoses Dermatophytoses Arthropod dermatitits Eosinophilic folliculitis Arthropod dermatitits Eosinophilic folliculitis Candidosis Candidosis Beetle Dermatitis Ofuji's Disease Beetle Dermatitis Ofuji's Disease (Paederus) Incontinentia pigmenti (Paederus) Incontinentia pigmenti Pustular contact Drug reactions Pustular contact Drug reactions Dermatitis Autoeczematization ( Id') Dermatitis Autoeczematization ( Id').

5 * Some overlap exists between what Dermatopathologists consider Spongiotic Dermatitis ' and so-called patterns of spongiosis 1. Spongiotic Dermatitis Spongiotic Dermatitis Select entities commonly encountered in Nummular eczema daily practice Clinical: Tiny papules / papulo- Nummular eczema vesicles, may coalesce to form coin-shaped Contact Dermatitis patches, single or Seborrheic Dermatitis multiple Dorsum of hands, Pityriasis rosea extensor forearms, lower legs / outer thigh, posterior trunk Spongiotic Dermatitis Spongiotic Dermatitis Nummular eczema Nummular eczema Early lesions spongiosis Early lesions spongiosis leading to vesiculation, leading to vesiculation.

6 Vesicles often contain vesicles often contain inflammatory cells (may inflammatory cells (may mimic Pautrier's mimic Pautrier's microabscesses!) microabscesses!). Later lesions progressive Later lesions progressive psoriasiform hyperplasia psoriasiform hyperplasia (less regular than allergic CD!). Spongiotic Dermatitis Spongiotic Dermatitis Contact Dermatitis Contact Dermatitis Clinical: Irritant CD Clinical: Allergic CD. Reactions vary simple Erythematous papules, erythema to purpura to small vesicles or eczematous to weeping plaques vesiculobullous Lesions arise 12-48 hrs reactions following exposure to Identified at sites of allergen, lesions often exposure extend beyond site of exposure 2.

7 Spongiotic Dermatitis Spongiotic Dermatitis Contact Dermatitis Contact Dermatitis Spongiosis leads to Spongiosis leads to intraepidermal vesicles intraepidermal vesicles Irritant' often more marked Irritant' often more marked changes, ballooning / changes, necrosis, possible neuts; ballooning/necrosis, varies with irritant possible neuts; varies with concentration irritant concentration Allergic', spongiosis often Allergic', spongiosis often with eos, persistent lesions with eos, persistent lesions often show scale crust with often show scale crust with Weedon, Skin Pathology, 2002.

8 Regular psoriasiform regular psoriasiform hyperplasia hyperplasia Spongiotic Dermatitis Spongiotic Dermatitis Contact Dermatitis Seborrheic Dermatitis Spongiosis leads to Clinical: intraepidermal vesicles Erythematous, scaling Irritant' often more marked papules and plaques, changes, sometimes with a ballooning/necrosis, greasy appearance possible neuts; varies with Found upon irritant concentration seborrheic' areas . scalp, ears, eyebrows, Allergic', spongiosis often eyelid margins, with eos, persistent lesions nasolabial areas often show scale crust with Males, after puberty.

9 Regular psoriasiform common manifestation hyperplasia in AIDS. Spongiotic Dermatitis Spongiotic Dermatitis Seborrheic Dermatitis Seborrheic Dermatitis Acute / subacute - Acute/subacute - spongiosis with scale crust spongiosis with scale crust Later psoriasiform Later psoriasiform epidermal hyperplasia epidermal hyperplasia Lymphocytes, Lymphocytes, macrophages, occasional macrophages, occasional neuts upon a mildly neuts upon a mildly edematous superficial edematous superficial papillary dermis papillary dermis Note: folliculocentric scale Note.

10 Folliculocentric scale crust favors SD over crust favors SD over psoriasis psoriasis 3. Spongiotic Dermatitis Spongiotic Dermatitis Seborrheic Dermatitis Seborrheic Dermatitis Acute/subacute - Acute/subacute - spongiosis with scale crust spongiosis with scale crust Later psoriasiform Later psoriasiform epidermal hyperplasia epidermal hyperplasia Lymphocytes, Lymphocytes, macrophages, occasional macrophages, occasional neuts upon a mildly neuts upon a mildly edematous superficial edematous superficial papillary dermis papillary dermis Note: folliculocentric scale Note.