1- 52yof SLE. arms worse in sun
HK quite thick epi, vac basal change, lichenoid, thick BM, pig incont,
no dermal muchin, some scarring of deep dermis.
consistent with SLE
2- 42yof sun exposed skin, itchy
hk, focal pk, thin epid, vac basal change, civatte + colloid bodies,
pig incont, perivascular and periadnexal lymphocytic infiltrate.
consistent with lupus.
Since no history of lupus given, would suggest DIF, exclude drugs, gvhd, EM,
dermatomyositis, sunburn, ple (but no dermal oedema).
3- 15yof pink plaques on face. cheek bx ?Jess, ?lupus
punch bx focal spongiosis epidermis, deep infiltrate and
lichenoid damage to adnexal basal epithelium. granulomatous appearance
of histiocytoid cells and lymphocytes cuffing adnexae. Exclude
atypical infections leprosy, exclude lymphoma (bottom heavy).
More history given in talk and PAS stain shown -
Folliculitis with fungal hyphae - Trichophyton mentagrophytes
Clues, asymmetrical rash unlike lupus
4- 45 yof, back lesions, similar 5 yrs previously
normal epidermis and superficial dermis. deep dermal perivascular and
periadnexal lymphocytic infiltrate. fat necrosis obliteration of
panniculae and fibrosis with inflammation of septae. septal and
lobular panniculitis. no vasculitis. Sometimes calcified but not in this case.
Lupus profundus/ lupus panniculitis.
Always polarise to exclude foreign body. Long term
waxing and waning lesions can predispose to lymphoma
Erythema induratum, often Tb associated immunological reaction, not so
inflammatory as this but can look similar
Plasma cells in skin biopsies. Always think of autoimmune, syphilis,
5- 58yof nodule on R forearm ?Erythema nodosum
skin excision, some hk, no pk, n epiderm. septal panniculitis with ill
defined granuloma-like clusters of inflamm cells, lym, hist, neu. no
eos, no vasculitis.
Septal pann consistent with erythema nodosum
Spectrum of disease. Often bx not diagnostic need large ex bx
6- 65 yof BCC upper lip
heavily sd skin with microcystic prolif. v bland. extends to deep
dermis/sc tissue. perineural invasion very common, use mnf and s100 to
microcystic adnexal ca.
Follicular apocrine and sebaceous diff occur together. Bcc is
follicular. Follicular things calcify squamous doesn't usually
7- 77yof rash elbows/knees. blistering ?DH ?linear IGA ?lich drug
reaction. Immuno neg
punch mild hk. norm epi. perivascular lymp, neut, fibroblasts, mild
interstitial mucin, prominent eos. Quite deep infiltrate
Diag. Interstitial granulomatous drug reaction
Dd interstitial GA, insect bite
8- 55yof rash with pustules, ?sec penicillin
multiple subcorneal neu pustules. neutrophils in dermis. Folliculitis,
plugging. no vasculitis.
Acute generalised exanthematous dermatosis (agep)
Dd bullous impetigo
see article on drug induced cutaneous pathology from JCP
9- 50yom 3/12 itchy skin. ?PV
Focal suprabasal blister at edge of bx
perivascular lymphocytic no much else
Diag. Pemphigus vulgaris
DD. Acantholytic dermatoses
10- 86yof l arm scalp blisters
subcorneal blister, eos
Diag. Bullous Pemphigoid
Salt split skin test to distinguish from epidermolysis bullosa
11- 71yof tense blisters hands and fingers ?pomphylx/pseudoporphoria
subepithelial. blister a few neuts. Festooning along base of blister.
Diag. Porph or pseudoporph
12- 78yof bullae most of body, bedsores. Immuno pos
scarred dermis, subepidermal blister (much more common than
intraepixermal blisters in exam). Re-epithelialisation from hair
Diag. Drug induced IgA bullous dermatosis