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Dermatopathology Quick Reference Guide

Inflammatory
Superficial perivascular with:
1. Normal epidermis
a. Lymphocyte-predominant
i. Tinea versicolor basket-weave stratum corneum (SC) w hyphae AND spores.
ii. Dermatophyte compact SC w hyphae; pink cuticle; +/- neuts in SC.
iii. Erythrasma/pitted keratolysis filamentous bacteria in SC; PK = volar w
dells/pits in SC.
iv. Ichthyosis vulgaris no granular layer.
v. Vitiligo no melanocytes.
vi. Macular amyloid eosinophilic globules in papillary dermis; rete ridges
surround; pigment incontinence.
vii. Schambergs extravasated RBCs, hemosiderin.
viii. Postinflammatory pigmentary alteration (PIPA) melanophages in papillary
dermis.
ix. Minocycline pigmentation grayish, refractile (grainy), on collagen bundles,
often deep.
x. TMEP sparse mast cell infiltrate.
b. Eosinophil-predominant
i. Urticaria chronic only; sparse infiltrate
ii. Urticarial drug sparse infiltrate
iii. Urticarial BP lining up along DEJ, may have early splitting
iv. PUPPP moderate infiltrate (neither dense nor very deep)
v. Arthropod assault dense and deep infiltrate; wedge-shaped
c. Other (paucity of action)
i. Viral exanthem/morbilliform drug may have slight interface, NO eos.
ii. Urticarial DH neuts at DEJ.

2. Interface dermatitis (NEED dyskeratotic keratinocytes)


a. Vacuolar (bubbly DEJ)
i. Lupus scaly w/o parakeratosis; thin epidermis; follicular plugging (dilated
ostia w keratin); mucin; usually superficial & deep.
ii. Dermatomyositis similar to lupus but mucin >> infiltrate/interface.
iii. EM basket weave SC (acute); necrotic keratinocytes at/above DEJ.
iv. Fixed drug eruption identical to EM but w eos.
v. TEN/SJS full0thickeness epidermal necrosis, subepidermal blister; pauci-
inflammatory.
vi. GVHD satellite necrosis and dyskeratotic cells along adnexa; sparse
infiltrate.
vii. PLEVA scale; necrotic keratinocytes at all epidermal layers; ulceration,
extravasated RBCs, epidermal pallor.
viii. Lymphomatoid papulosis (LyP) like PLEVA, but w eos & bizarre CD30+
lymphs.
ix. Phototoxic drug necrotic keratinocytes on top layers = sunburn cells
x. MF exocytosis of abnl lymphs w/o spongiosis, lining along DEJ; papillary
dermal fibrosis; maybe interface + spongiosis; Pautriers microabscesses.
xi. LS&A atrophic epidermis; red/white/blue = epidermis/sclerosis/infiltrate;
follicular plugging; glans penis = balanitis xerotic obliterans (BXO).
xii. Radiation dermatitis stellate fibroblasts; telangiectasias w thickened walls.
xiii. Erythema dyschromicum perstans (EDP) spares interface (if any); dermal
melanophages.
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xiv. Viral exanthem/morbilliform drug (as described above).
b. Lichenoid (implies interface; if NO interface = band-like)
i. LP compact orthokeratosis (NO para); focal wedge-shaped hypergranulosis;
sawtooth rete ridges; necrotic keratinocytes at DEJ (Civatte, colloid bodies);
lymphs only.
1. Oral LP no granula layer; + plasma cells (location-specific)
ii. Lichenoid drug parakeratosis, hypogranulosis; eos, infiltrate less dense.
iii. Lichenoid keratosis/LPLK parakeratosis, hypogranulosis; mixed infiltrate w
plasma cells; thin epidermis; similar to lichenoid drug.
iv. Lichenoid purpura of Gougerot and Blum (LPGB) like Schambergs, but w
band-like infiltrate
v. Lichen aureus more pigment than LPGB.
vi.

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