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Perivascular infiltration of upper dermis



5  Non-tumorous skin diseases

5.4  Perivascular infiltration of upper dermis

Introduction:

Large group of diseases with similar histological pictures. Classified according to the infiltrate distribution, cellular composition of the infiltrate and other signs.

5.4.1  Pityriasis lichenoides Mucha Habermann

Introduction:

Less common disorder, occuring in two forms: chronic and acute (PLEVA).

Etiology, pathogenesis:

  • etiology unknown
5.4.1.1  Pityriasis lichenoides acuta

Clinical signs:

  • symetrical eruption on the trunk and extremities
  • in acute form papules with central necrosis, hemorrhagic vesicles, resembling varicella
  • no pruritus
  • affects young individuals or children

Histology:

superficial and deep, wedge shaped perivascular infiltrate, vacuolar degeneration of basal layer, hemorrhage, epidermal necrosis.

Pictures

Pityriasis lichenoides acuta:
Pityriasis lichenoides acuta (PLEVA) Mucha Haberman, HE 40x (143)

Pityriasis lichenoides acuta (PLEVA) Mucha Haberman, Goldner 40x (144)

Another case:
PLEVA, HE 60x (6295)

Another case:
Pityriasis lichenoides acuta, early, HE 40x (2125)

Another case:
Pityriasis lichenoides acuta, HE 20x (4948)

And another case:
Pityriasis lichenoides acuta (PLEVA) Mucha Haberman, HE 20x (145)

Another case:
PLEVA, HE 20x (1601)

Another case:
Pityriasis lichenoides acuta ulcerating, HE 20x (5238)

PLEVA, HE 2.5x (1604)

PLEVA, HE 10x (1603)

PLEVA, HE 40x (1607)

Another case:
PLEVA, HE 40x (2255)

Another case:
PLEVA, HE 40x (2734)

Another case:
Pityriasis lichenoides acuta, HE 20x (4695)
  [zoomify]

Another case:
Pityriasis lichenoides acuta, HE 20x (5237)

Another case:
Pityriasis lichenoides acuta, HE 60x (12837)

Another case:
Pityriasis lichenoides acuta, HE 40x (6446)

Another case, with superficial infiltration, patient several days on steroids:
Pityriasis lichenoides acuta (Mucha Habermann), HE 20x (520)

Pityriasis lichenoides acuta (Mucha Habermann), HE 40x (521)

Another case, small lesion:
Pityriasis lichenoides acuta, HE 20x (4585)

Another case with only superficial infiltration:
Pityriasis lichenoides acuta, PLEVA, HE 40x (2370)

Another case with only superficial infiltration:
Pityriasis lichenoides acuta, HE 20x (5254)

Pityriasis lichenoides with prominent hemorrhage (patient was under anticoagulantion therapy (Warfarin):
Pityriasis lichenoides (Warfarin), HE 10x (146)

Pityriasis lichenoides (Warfarin), HE 20x (147)

Pityriasis lichenoides (Warfarin), HE 40x (148)

Pityriasis lichenoides (Warfarin), Goldner 20x (149)

Pityriasis lichenoides (Warfarin), Goldner 40x (150)

Fluorescence:
PLEVA, anti-fibrin, FITC 20x (597)

PLEVA, anti-fibrin, FITC 40x (598)

PLEVA, anti-fibrin, FITC 20x (640)

5.4.1.2  Pityriasis lichenoides chronica

Clinical signs:

  • in chronic formy lichenoid papules with scales, purpura
  • no pruritus
  • duration: several weeks, heals with hyperpigmentations

Histology:

Superficial lymphocytic infiltrate, slight exocytosis, sometimes slight spongiosis, parakeratosis, slight vacuolar degeneration of the basal layer.

5.4.2  Pityriasis rosea Gibert

Etiology, pathogenesis:

  • unknown, possibly Herpes virus
  • age 10 – 35 years

Clinical signs:

  • symetrical involvement of the trunk and extremities
  • pink macules and papules with central scaling and a collarette
  • generalized exanthema is preceded by a herald plaque; larger solitary lesion
  • mild pruritus
  • the dissemination is usually preceeded by aherald patch, a (usually) single, red, slightly elevated patch, size 2 – 5 cm
  • dull pink, scaling papules and plaques
  • trunk, neck, proximal parts of the extremities
  • lasts one or two months

Histology:

Perivascular infiltrate in upper dermis (lymphocytes), slight epidermotropism. Slight spongiosis, slight acanthosis, scattered necrotic keratinocytes, focal parakeratosis, dermal hemorrhage.



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