docPsoriasiform Reaction Pattern
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Psoriasiform Reaction Pattern
Psoriasiform Reaction Pattern August 20, 2009 12. • 62 year old woman • brown macule, superior medial left knee Hypogranulosis Confluent parakeratosis Regular acanthosis Dilated capillaries in dermal papillae Extremely ugly squamous cells Squamous cell carcinoma in situ 13. • 65 year old man • Right anterior thigh Hyperkeratosis (generally ortho) Hypergranulosis IRREGULAR acanthosis Lichen simplex chronicus 14. • 65 year old man • Red, scaly plaque on the gluteal cleft • Clinical diagnosis: – Psoriasis – Eczema – Rule out squamous cell carcinoma in situ Look for suprapapillary thinning Hypogranulosis Confluent parakeratosis Regular acanthosis Neutrophils (Munro microabscesses) Look for neutrophils (spongiform pustules of Kogoj) Psoriasis “Psoriasiform dermatitis, consistent with psoriasis” 15. • 43 year old man • 1.2 cm verrucous plaque on the left knee • Clinical diagnosis: – Verruca vulgaris Munro microabscess Psoriasis “Psoriasiform dermatitis, consistent with psoriasis” 16. • 71 year old woman • Longstanding rash on legs that recently developed lakes of pus that is not improving on antibiotics • Clinical diagnosis: – Pustular psoriasis – Impetiginized dermatitis Neutrophils (spongiform pustules of Kogoj) Pustular Psoriasis 17. • 69 year old man • Diffuse rash – scaly purple plaques • Clinical diagnosis: – Lichen planus – other “Checkerboard” parakeratosis Shoulder parakeratosis Follicular plug Perivascular lymphocytes Pityriasis rubra pilaris “Psoriasiform dermatitis, consistent with pityriasis rubra pilaris” 18. • 58 year old man • 15 year history of psoriasis (never bx’d) – presenting with 6-month history of tender, red, scaly plaques on the lower extremities • Clinical diagnosis: – Psoriasis – T cell lymphoma - Tinea corporis Early \ Partially-Treated Psoriasis BONUS • 31 year old woman • 1.1 cm round, pink patch with unusual irritation / tenderness, and slightly sclerotic • Clinical diagnosis: – Vitiligo – Lichen sclerosis - Tinea BONUS • 31 year old woman • 1.1 cm round pink patch with unusual irritation / tenderness, slightly sclerotic • Clinical diagnosis: – Vitiligo – Lichen planus - Tinea BONUS • 31 year old woman • 1.1 cm round pink patch with unusual irritation / tenderness, slightly sclerotic • Clinical diagnosis: – Vitiligo – Lichen planus - Tinea Fungus “Superficial Dermatophytosis / Dermatomycosis”
