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Background

Nowhere in pathology is the accurate correlation between the clinical appearance of a patient's lesions and the histologic appearance of the microscopic slide more important than the diagnosis of skin rashes.  Many skin rashes have similar histologic appearances, in spite of the very different clinical appearance on the patient.  Conversely, similar clinical lesions may have vastly different histologic appearances. 

Acne Vulgaris
Acral Pseudolymphomatous Angiokeratoma of Children (APACHE)
Acral persistent papular mucinosis
Acrodermatitis Enteropathica
Alopecia mucinosa (Follicular mucinosis)
Anti-p200 Pemphigoid
Anti-p450 Pemphigoid
Argyria
Arthropod Bites (Bug Bite)
Atopic Dermatitis
Axillary Granular Parakeratosis
Brachioradial Pruritis
Bullous pemphigoid
Calciphylaxis
Cellulitis
Chilblains
Cicatricial pemphigoid
Clear Cell Papulosis
Contact Dermatitis
Cryoglobulinemia
Cutaneous mucinosis of infancy
Cutaneous myxoma
Darier's Disease (Keratosis follicularis)
Deep lamina lucida pemphigoid (Anti-p105kd bullous dermatosis)
Degos Disease (Malignant Atrophic Papulosis)
Dermal disorders (Disorders of collagen, elastic fibers, mucin, scar, cicatrix)
Dermal mucinosis

Dermatitis herpetiformis
Dermatomyositis
Dermatophyte (Tinea, Ringworm)
Digital mucous cyst
Drug Reactions
Eczema
Epidermolysis Bullosa
Epidermolysis bullosa acquisita
Erythema Elevatum Diutinum
Erythema multiforme
Erythrasma
Erythroderma
Erythromelanosis follicularis et colli
Favre-Racouchot Disease (Nodular Elastosis with Cysts and Comedones)
Fixed drug eruption
Focal mucinosis
Gangrene
Gianotti-Crosti Syndrome
Graft-versus-host disease
Granuloma annulare
Grover's Disease (Transient Acantholytic Dyskeratosis)
Hailey-Hailey Disease (Benign Familial Pemphigus)
Hand Foot Mouth Disease
Herpes gestationis (Pemphigoid gestationis)
Hidradenitis Suppurativa
Hydroa Vacciniforme
Ichthyosis
Incontinentia pigmenti
Interstitial Granulomatous Dermatitis
Jessner's Lymphocytic Infiltrate of the Skin
Kawasaki's syndrome
Lichen nitidus
Lichen planus
Lichen planus-like keratosis
Lichen striatus
Lichenoid Dermatoses and tissue reactions
Linear IgA disease
Lupus erythematosus (SLE, DLE, SCLE)
Mucocele
Mucopolysaccharidoses
Myxedema, Generalized
Myxedema, Pretibial
Necrobiosis lipoidica
Necrobiotic xanthogranuloma
Necrolytic Migratory Erythema
Neonatal Cephalic Pustulosis
Neutrophilic Eccrine Hidradenitis
Nevus mucinosis
Onychomycosis
Papular mucinosis (Lichen myxedematosus)
Paraneoplastic Pemphigus
Pemphigus erythematosus
Pemphigus foliaceus
Pemphigus vegetans
Pemphigus vulgaris
Perniosis
Pigmented Purpuric Dermatoses
Pityriasis Lichenoides et Varioliformis Acuta (PLEVA, Mucha-Habermann Disease)
Pityriasis Lichenoides Chronica
Poikilodermas
Polymorphous Light Eruption
Porokeratosis
Porphyria
Pseudoporphyria
Psoriasis
Pustular Psoriasis
Pyoderma gangrenosum
Reactive angioendotheliomatosis
Reticular erythematous mucinosis
Rosacea
Scleredema
Scleromyxedema
Scurvy
Sneddon-Wilkinson Dermatosis (Subcornal Pustular Dermatosis)
Sweet's Syndrome (Acute Febrile Neutrophilic Dermatosis)
Tinea versicolor (Pityriasis versicolor)
Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS)
Urticaria
Vasculitis
Xanthoma


Commonly Used Terms With Skin Rashes

Cicatrix-Scar.

Diffuse/Nodular Dermatitis

Dermal Histologic Pattern Diagnosis
Lymphocytes Pseudolymphoma
Lymphoma
Neutrophils Sweet's syndrome
Inflammatory bowel disease
Rheumatoid neutrophilic dermatitis
Pyoderma gangrenosum
Follicular cyst, ruptured
Granuloma faciale
Erythema elevatum diutinum
Neutrophils and eosinophils Granuloma faciale
Erythema elevatum diutinum
Plasma cells Rhinoscleroma
Leishmaniasis
Syphilis, primary
Chancroid
Granuloma inguinale
Lymphogranuloma venereum
Pseudolymphoma
Granuloma faciale
Erythema elevatum diutinum
Mast cells Urticaria pigmentosa, nodular
Abnormal leukocytes Extramedullary hematopoisis
Pseudolymphoma
Lymphoma
Histiocytes Botryomycosis
Blastomycosis-like pyoderma
Rhinoscleroma
Actinomycosis
Nocardiosis
Streptomycosis
Cryptoococcosis
Histoplasmosis
Blastomycosis
Paracoccidioidomycosis
Chromomycosis
Coccidioidomycosis
Sporotrichosis
Rhinosporidiosis
Kerion
Candida granuloma
Eumycetoma
Phycomycosis
Alternariosis
Dermatophytosis (Majocchi's granuloma)
Protothecosis
Amebiasis
Acne congobata/acne keloidalis
Hidradenitis suppurativa
Dissecting cellulitis of the scalp
Pilondial sinus
Follicular cyst, ruptured
Halogenoderma
Tuberculosis cutis verrucosa
Atypical mycobaterial infections
Leprosy
Dermatofibroma, early
Langerhans' cell histiocytosis
Granulomatous slack skin
Histiocytes and Lipophages Xanthelasma
Xanthoma
Xanthoma disseminatum
Verruciform xanthoma
Xanthogranuloma
Generalized eruptive histiocytoma
Malacoplakia
Silicone granuloma
Paraffinoma

Interface Dermatitis

Interstitial-Refers to the location of inflammatory cells between vessels within the dermis. 

Lichenoid-Epidermal basal cell damage with vacuolar degenerative changes associated with inflammatory cells.

Panniculitis-Inflammation of the fat.

Spongiosis-Refers to edema or swelling between the epithelial cells.  It is the histologic correlation of eczema.

Subepidermal Vesicular Dermatitis

Dermal Histologic Pattern Diagnosis
Little or no infiltrate Epidermolysis bullosa, junctional, dermolytic, acquired
Bart syndrome
Hypoxemia plus pressure
Acute burn
Erythema multiforme, severe
Lymphocytes Erythema multiforme
LSEA
Mucha-Habermann disease
Lichen planus, bullous
Pseudolymphoma
Lymphoma
Eosinophils Bullous pemphigoid
Herpes gestationis
Acquired EB
Arthropod
Neutrophils Dermatitis herpetiformis
DH-like drug eruption
Linear IgA disease
EBA
SLE
Leukocytoclastic vasculitis
Septic vasculitis
Pyoderma gangrenosum
Cellulitis
Bullous pemphigoid
Herpes gestationis
Cicatricial pemphigoid
Eosinophils and neutrophils Dermatitis herpetiformis
DH-like drug eruption
Linear IgA disease
EBA
Bullous pemphigoid
Herpes gestationis
Mast Cells Urticaria pigmentosa

Superficial Perivascular Dermatitis-Refers to the location of inflammatory cells around the superficial portions of the dermal blood vessels.

Epidermal Changes Dermal Histologic Pattern Diagnosis
No epidermal changes    
  Superficial Perivascular Dermatitis  
 
Lymphocytes predominate
Tinea versicolor
Dermatophytosis
Erythrasma
Pitted keratolysis
Vitiligo
Schamberg's disease
Viral exanthems
Drug eruption (one type)
Urticaria, late
Erythema figuratum, superficial
  Superficial perivascular and interstitial dermatitis  
 
Lymphocytes predominate
Schamberg's disease
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
 
Neutrophils predominate
Dermatitis herpetiformis
Linear IgA dermatosis
Dermatitis herpetiformis-like drug eruptions
Acute discoid lupus erythematosus/SLE
Leukocytoclastic vasculitis
Erythema marginatum
 
Eosinophils predominate
Bullous pemphigoid/Herpes gestationis, urticarial
Pemphigus vulgaris, urticarial
Arthropod
PUPPP
 
Neutrophils and eosinophils predominate
Urticaria
 
Melanophages predominate
Postinflammatory pigmentary alteration
Macular amyloidosis
 
Siderophages predominate
Stasis
 
Macrophages with features of melanophages and siderophages predominate
Minocycline-induced eruption
 
Mast cells predominate
Urticaria pigmentosa
Brachioradial pruritis
Ballooning changes
Lymphocytes predominate-ballooning mostly
Herpesvirus infection
 
Lymphocytes predominate
Measles
 
Psoriasiform and lymphocytes predominate
Orf
Milker's nodule
Spongiosis    
 
Lymphocytes predominate
Allergic contact dermatitis
Nummular dermatitis
Dyshidrotic dermatitis
Id reaction
Photoallergic dermatitis, early
Dermatophytosis
Miliaria rubra
Gianotti-Crosti syndrome
Pityriasis rosea
Erythema annulare centrifugum
Seborrheic dermatitis
Lichen striatus
Pityriasis alba
Mycosis fungoides, macule/patch
 
Eosinophils predominate
PUPPP
Allergic contact dermatitis
Nummular dermatitis
Dyshidrotic dermatitis
Id reaction
Bullous pemphigoid
Herpes gestationis
Pemphigus vulgaris, urticarial
Incontinentia pigmenti
Toxic erythema of newborn
Arthropod assault
Spongiotic Psoriasiform
Lymphocytes predominate
Allergic contact dermatitis
Nummular dermatitis
Dyshidrotic dermatitis
Id reaction
Seborrheic dermatitis
Nonbullous congenital ichthyosiform erythroderma
Lichen striatus
Spongiotic Lichenoid
Lymphocytes predominate
Lichen striatus
Bullous pemphigoid
Herpes gestationis, urticarial
 
Mycosis fungoides
Spongiotic Psoriasiform Lichenoid
Lymphocytes predominate
Lichen striatus
Bullous pemphigoid
Herpes gestationis, urticarial
Mycosis fungoides
Psoriasiform only    
 
Lymphocytes predominate
Psoriasis
Allergic contact dermatitis
Nummular dermatitis
Dyshidrotic dermatitis
Pityriasis rubra pilaris
Seborrheic dermatitis
Dermatophytosis
Candidiasis
Lichen simplex chronicus
Prurigo nodularis
Acanthoma fissuratum
Pressure papule from prosthesis
Surfer's nodules
Chondrodermatitis nodularis helicis
Psoriasiform Lichenoid
Lymphocytes predominate
Lichen striatus
Mycosis fungoides
Inflammatory linear verrucous epidermal nevus
 
Histiocytes and plasma cells predominate
Syphillis, secondary

Superficial and Deep-Refers to the location of inflammatory cells around the superficial or deeper portions of the dermal blood vessels.

Epidermal Changes Dermal Histologic Pattern Diagnosis
No epidermal changes
 
 
Perivascular Dermatitis
 
 
Lymphocytes predominate
Polymorphous light eruption, early
Erythema figuratum
Erythema chronicum migrans
Pernio
Erythema nodosum
PMLE
DLE, tumid
CLL
B-cell lymphoma
 
Eosinophils prominent
Arthropod insult
 
Plasma cells prominent
Erythema chronicum migrans
Scleroderma
 
Histiocytes and lymphocytes prominent
Leprosy, indeterminate
 
Perivascular and Interstitial Dermatitis
 
 
Neutrophils
Suppurative folliculitis, periphery
Neutrophilic eccrine hidradenitis
Flea bite
Cellulitis
Erythropoietic protoporphyria
 
Eosinophils
Arthropod
Erythema chronicum migrans
Well's syndrome
 
Eosinophils and neutrophils
Urticaria
 
Plasma cells
Erythema chronicum migrans
 
Neutrophils, eosinophils, plasma cells
Scleroderma, early
 
Histiocytes predominate
Granuloma annulare
Necrobiosis lipoidica
Interstitial granulomatous dermatitis with arthritis
Mycosis fungoides, granulomatous
Ballooning Epidermal Changes    
  Lymphocytes predominate  
 
Ballooning only
Hyroa aestivale/Hydroa vacciniforme
 
Interface
Herpesvirus
Fixed drug eruption
 
Spongiosis
Toxic shock syndrome
Spongiotic    
  Lymphocytes Photoallergic dermatitis
Early PMLE
  Eosinophils Arthropod
Bullous pemphigoid
Herpes gestationis, urticarial
  Psoriasiform lymphocytes Photoallergic dermatitis
Mycosis fungoides, plaque
  Lichenoid lymphocytes Fixed drug eruption
Dermatophytosis
Acrodermatitis chronica atrophicans
Mycosis fungoides, plaque
  Psoriasiform lichenoid lymphocytes Mycosis fungoides, plaque
Psoriasiform    
  Psoriasiform lymphocytes Dermatophytosis
Norwegian scabies
Persistent light eruption
Actinic reticuloid
Pityriasis rosea, herald patch
  Lichenoid lymphocytes Lichen striatus
Mycosis fungoides, plaque
  Lichenoid histiocytes, plasma cells Syphilis, secondary

Adapted from Algorithms for Histologic Diagnosis of Inflammatory Skin Diseases. Second Edition. Williams and Wilkins. 1997


Last Updated 6/6/2002

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Copyright 2002
The Doctor's Doctor