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Psoriasis

Reiter's

Lichen Simplex Chronicus

Fungal

Clear Cell Acanthoma

Epidermal acanthosis

Yes regular

Yes regular

Yes irregular

Yes variable mild

Yes regular focal

Parakeratosis

focal to confluent

++++ confluent

focal to confluent

focal over acanthosis

Loss of granular cell layer

Yes

Yes

No

No

Yes

Neutrophils in epidermis

Yes

Yes

No

Yes

Yes diffuse

Parakeratosis with admixed neutrophils

Yes in mounds

Yes in mounds

No

Yes focal to mounds

Yes over acanthosis

Spongiosis

+Guttate variant

No

No mild

No mild

No mild

Clear/pale epidermal keratinocytes

No

No

No

No

Yes

Periodic acid schiff/ Grocott methena-mine silver stain

Negative

Negative

Negative

Positive

(Continued )

Clinicopathologic Correlation:

Clinical Feature

Pathologic Feature

Thick erythematous plaques

Regular psoriasiform epidermal hyperplasia, thinned suprapapillary epidermal plates, dilated capillaries

Silver white scale

Parakeratosis

Hemorrhagic crusts

Shallow epidermal erosions with serum and red blood cells

Auspitz sign

Dilated tortuous papillary dermal blood vessels immediately beneath a thinned suprapapillary plate, which bleed when parakeratotic scale is removed

Thin guttate plaques

Mild epidermal acanthosis, spongiosis

Pustular plaques

Intraepidermal spongiform pustules

Clinical Differential Diagnosis:

Psoriasis

Guttate Psoriasis

Pustular Psoriasis

Erythrodermic Psoriasis

Lichen simplex Chronicus

Lichen simplex Chronicus

Impetigo

Atopic dermatitis

PRP (Pityriasis rubra pilaris)

Pityriasis rosea

Drug reaction

Drug reaction

Reiter's

Secondary syphilis

Reiter's

Mycosis fungoides

Fungal

Fungal

Fungal

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