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• RECEIVED SKIN COVERED GREY WHITE PUNCH BIOPSY BIT MEASURING 3 X 3 mm.
A/E - 1
• Hyperkeratosis
• Follicular plugging
• Focal thinned out epidermis
• Basal cell layer vacuolation
• Melanin incontinence
• Interface dermatitis
Perivascular and periadnexal lymphocytic infiltration
Periadnexal lymphocytic infiltration
DIFFERENTIAL DIAGNOSIS
• Discoid lupus erythematosus
• Systemic lupus erythematosus
• Subacute cutaneous lupus erythematosus
DLE
MICROSCOPY
DLE SCLE
SLE
HYPERKERATOSIS Prominent Less prominent Less prominent
COLLOID BODIES Less common Common Common
DERMAL EDEMA Less common Common Common
FIBRINOID DEPOSITS Less prominent Less prominent Prominent
MICROSCOPY DLE SCLE SLE
INFLAMMATORY
INFILTRATE
Prominent Less severe Less severe
VASCULARITY Less marked Less marked Increased
SUBCUTANEOUS
FAT
Not involved Not involved Involved
M U C I N
DEPOSITION
Lesser Increased Increased
BASEMENT MEMBRANE
Mild thickening Mild thickening Marked thickening
• Moderate mononuclear infiltrate
• Dermal edema
• Subepidermal vacuolization
• Melanin incontinence
SCLE
SLE
•ACUTE FORMS
DISCOID LUPUS ERYTHEMATOSUS
HISTOPATHOLOGICAL FINDINGS
• STRATUM CORNEUM Hyperkeratosis with follicular plugging
• EPITHELIUM Thinning and flattening of stratum malpighii , hydropic degeneration of basal cells , squamatisation of basilar keratinocytes
• BASEMENT MEMBRANE Thickening and tortuosity
• STROMA Lymphocytic infiltrate along dermal epidermal junction ,
around hair follicles and other appendages , interstitial mucin
deposition , vasodilation
Atrophy of pilosebaceous units
COLLOID BODIES ( CIVATTE BODIES ) may be present in
the lower epidermis .
LICHEN PLANUS
DIFFERENTIAL DIAGNOSIS
• Lymphocytic lymphoma : atypical lymphocytes , do not surround pilosebaceous units .
• Lymphocytoma cutis : extensive inflammation , polymorphous lymphocyic population .
• Polymorphous light eruption : dermal edema , no BV.
• Lymphocytic infiltration of the skin of Jessner
• Poikiloderma
• Erythema multiforme
• Drug eruptions
POLYMORPHOUS LIGHT ERUPTION
POIKILODERMA
NO BASAL VACUOLATION , HYPERKERATOSIS , NO INTERFACE CHANGES
SPECIAL STUDIES
REFERENCES
THANK YOU