Benign Familial Pemphigus

Clinical Presentation: Eczematous Dermatitis:

Eczematous dermatitis is a general term for a pruritic rash composed of minute papules and intraepidermal vesicles. Common types of eczematous dermatitis include

■ Contact dermatitis (allergic and irritant) (Fig. 7A)

■ Vesicles and juicy papules

■ Sharp margins

■ Geometric or linear configuration

■ Conforms to area of contact

■ Atopic dermatitis

■ Chronic pruritic disease that begins in childhood and follows the remitting/recurrent course that may continue through life

■ Occurs in patients with the personal or family history of atopy (hay fever, asthma, dry skin, and eczema)

■ Juicy papules and vesicles; lichenified plaques

■ Head, neck, antecubital, and popliteal fossae

■ Dyshidrotic dermatitis

■ Pruritic deep-seated vesicles involving lateral aspects of digits, palms, and soles

■ Nummular dermatitis

■ Oval patches or plaques with crusted papules and vesicles

■ Trunk and extremities

■ Eczematous drug eruption

■ Nonspecific dermatitis that is usually widespread and pruritic

■ Poorly defined papular eruption that follows an acute dermatitis of the hands or feet

Vesicular Dermatophytosis:

■ erythematosus, scaly patches, and plaques on the feet and in intertriginous areas

Pityriasis Rosea:

■ erythematosus round to oval patches with overlying scale that is located near the border

■ widespread eruption commonly preceded by solitary large lesion on trunk termed "herald patch"

■ lesions on neck and trunk follows the skin lines in a pattern that has been compared to that of a Christmas tree

Seborrheic Dermatitis:

■ scaling erythematosus papules and patches

■ scalp, eyebrows, nose, and sternum

Stasis Dermatitis:

■ pruritic erythematous and hyperpigmented papules and lichenified plaques

Histology:

Acute Spongiotic Dermatitis (Fig. 7B):

■ Normal basket-woven stratum corneum

■ Intercellular edema often with intraepidermal microvesicles

■ Superficial perivascular infiltrate of lymphocytes +/ — eosinophils

Subacute Spongiotic Dermatitis:

■ Parakeratosis

■ Mild acanthosis

■ Intercellular edema

■ Superficial perivascular infiltrate of lymphocytes +/ — eosinophils

Special Stains:

■ Vesicular dermatophytosis: PAS stain highlights septate hyphae in the stratum corneum

Clinicopathologic Correlation and Differential Diagnosis of Spongiotic Microvesicles:

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