Hsi Andy C, Rosman Ilana S
1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
2 Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri.
Pediatr Dev Pathol. 2018 Mar-Apr;21(2):115-149. doi: 10.1177/1093526617748781.
Inflammatory dermatoses encompass a variety of histologic patterns that affect different portions of the skin. In spongiotic, psoriasiform, lichenoid, pityriasiform, and blistering disorders, there are predominately epidermal and junctional activities with variable superficial dermal inflammation. Hypersensitivity reactions can show either epidermal or mostly dermal changes depending on whether the exposure of the exogenous allergen occurs through an external or internal route, respectively. Exceptions include erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis, where the etiology is often due to infection or ingested medications, but the histologic features are almost exclusively confined to the epidermis and dermoepidermal junction. Autoimmune disorders are unique in that lesions typically incorporate a mixture of epidermal and dermal inflammatory patterns with periadnexal inflammation, while the vast majority of vasculitis/vasculopathy and alopecia have changes limited to only the vessels and hair follicles, respectively. It is critical to recognize that a relatively limited number of histologic patterns are seen in a large array of clinical entities. Therefore, clinicopathologic correlation and careful examination of histologic details are of the utmost importance when evaluating skin biopsies for inflammatory disorders.
炎症性皮肤病包括多种影响皮肤不同部位的组织学模式。在海绵状、银屑病样、苔藓样、糠疹样和水疱性疾病中，主要存在表皮和交界性活动，并伴有不同程度的浅表真皮炎症。超敏反应根据外源性变应原是通过外部还是内部途径暴露，可表现为表皮或主要是真皮的变化。例外情况包括多形红斑和史蒂文斯 - 约翰逊综合征/中毒性表皮坏死松解症，其病因通常是感染或摄入药物，但组织学特征几乎完全局限于表皮和真皮表皮交界处。自身免疫性疾病的独特之处在于，病变通常包含表皮和真皮炎症模式的混合以及附属器周围炎症，而绝大多数血管炎/血管病和脱发分别仅局限于血管和毛囊的变化。必须认识到，在大量临床实体中可见的组织学模式数量相对有限。因此，在评估炎症性疾病的皮肤活检时，临床病理相关性和对组织学细节的仔细检查至关重要。
