2008 04 Lecture 2 Psoriasiform Dermatitis Cassarino
Transcript of 2008 04 Lecture 2 Psoriasiform Dermatitis Cassarino
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PSORIASIFORM DERMATITISDavid Cassarino, MD, PhD
UCLA Department of Pathology & Laboratory
Medicine
LASOP Meeting April 2008
Histology showed psoriasiform epidermal acanthosis with
parakeratosis, focal hypogranulosis, minimal spongiosis, andexocytosis of scattered lymphocytes
What is your histologic diagnosis and what special
studies should be done?
DIAGNOSIS:
MYCOSIS FUNGOIDES/LARGE
PLAQUE PARAPSORIASIS
Psoriasiform pattern: often mimics chronicspong derm or psoriasis, both clinically and
histologically
Clues: look for epidermotropism, cytologic
atypia of lymphocytes, lining up oflymphocytes along basal epidermis, andPautriers microabscesses (~30%)
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CD2, CD3,
CD4+
CD5, CD7,
CD8-
LARGE PLAQUE
PARAPSORIASIS Somewhat controversial entity, now accepted as a
variant of MF
Clinically, presents as large erythematous patches
and plaques
Often progresses to poikilodermatous lesions
Histology: mild psoriasiform hyperplasia with
spongiosis and few atypical lymphocytes Small plaque parapsoriasis (digitate dermatosis)
unrelated, and not considered variant of MF
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PSORIASIFORM DERMATITIS
DIFFERENTIAL DIAGNOSIS:
1. Psoriasis
2. Subacute/chronic spongiotic dermatitis
3. Lichen simplex chronicus (LSC) & prurigonodularis
4. Pityriasis rubra pilaris (PRP)
5. Syphilis (secondary)
6. Reiters syndrome
7. Mycosis fungoides/large plaque parapsoriasis
1. PSORIASIS: Clinical
Chronic dermatitis characterized by oftensymmetric, erythemetous plaques with silvery scale,
variants include guttate and pustular psoriasis
PSORIASIS: Histology Regular acanthosis, hypogranulosis, parakeratosis with
neutrophils Increased epidermal turnover (increased basal mits) and
tortuous papillary dermal capillaries Guttate, early and treated psoriasis exhibit less acanthosis
and may show significant spongiosis
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GUTTATE PSORIASIS EARLY OR TREATED PSORIASIS
2. SUBACUTE AND CHRONICSPONGIOTIC DERMATITIS
Irregular or uneven hyperplasia w/parakeratosis;spongiosis may be minimal
Almost any spongiotic dermatitis in subacute tochronic phase
PITYRIASIS ROSEA (PR) Common dermatosis in young patients, scaly plaque-like
herald patch shows most psoriasiform features
Spongiosis and spongiotic vesicles, mounds ofparakeratosis, RBC extravasation
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3. LICHEN SIMPLEX CHRONICUS(LSC) AND PRURIGO
NODULARIS
Hyperkeratosis, irregular acanthosis, hypergranulosis,
papillary dermal fibrosis and chronic inflammation
4. PITYRIASIS RUBRA PILARIS Rare dermatosis, classic presentation with
erythroderma, hykeratotic patches and plaques with
follicular plugging
Histology shows psoriasiform acanthosis with
hypergranulosis and alternating hyperkeratosis and
parakeratosis; follicular plugging
Lack of neutrophils and suprapapillary thinning
5. SYPHILIS (SECONDARY)
Erythematous and scaly papules and nodules, often
on palms and soles, but may be anywhere on thebody, including scalp and mucosal sites
Often marked epidermal acanthosis andneutrophilic infiltrate with plasma cells
Organisms may be difficult to find; use silverstains and/or anti-spirochetal antibody
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6. REITERSSYNDROME
Clinical: classic triad of
urethritis, uveitis andarthritis, with
mucocutaneous lesions
Crusted erythematous to
pustular papules andplaques on feet, genitalia,
buttocks, and scalp
Histology shows psoriasiform hyperplasia with
parakeratosis and numerous neutrophils, often
forming pustules
May be indistinguishable from pustular psoriasis