Disorders characterized by predominant or exclusive dermal inflammation
Section snippets
Dermal inflammation dominated by lymphoid cells
Chronic inflammatory disorders in the dermis may comprise relatively modest numbers of lymphoid cells, or, in counterpoint, they may efface almost the entire corium. Even when only perivascular aggregates of lymphocytes are present, their sizes and densities may lead the histological differential diagnosis in dissimilar directions. In addition, potential associations with pigment deposits, erythrocyte extravasation, zones of edema, or stromal mucinosis are likewise important (Fig. 1).
Dermal inflammation dominated by neutrophils
The prototypical pyodermas—dermatitides dominated by diffuse dermal neutrophilia—are infectious diseases. They include erysipelas, bacterial or fungal cellulitis, erysipeloid, and necrotizing fasciitis (formerly called “synergistic necrotizing cellulitis”). Causal organisms can include beta-hemolytic group-A streptococci, Staphylococcus aureus, Erysipelothrix rhusiopathiae, and various pathogenic fungi.41, 42, 43, 44, 45, 46 Diagnosis of these conditions is often made on clinical grounds, with
Eosinophilic dermal inflammation or infiltrates of eosinophils mixed with neutrophils
Diseases that may cause intense dermal eosinophilia include arthropod bite reactions,71 cutaneous parasitic infestation,72 the urticarial phase of bullous pemphigoid,73 Wells syndrome (eosinophilic cellulitis) 74(Fig. 16), hypereosinophilic syndrome 75(Fig. 17), and Churg-Strauss disease.76 In some other conditions, eosinophils are admixed with neutrophils in the corium, with or without small-vessel vasculitis. Exemplary disorders with those patterns include drug eruptions, chronic idiopathic
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2018, Seminars in Cutaneous Medicine and Surgery