Eosinophilic spongiosis: a clinicopathologic review of seventy-one cases.

Eosinophilic spongiosis has a distinctive but not diagnostic histologic pattern of the epidermis. This pattern may be seen in a wide variety of clinical disorders. We have observed it most commonly in bullous pemphigoid, particularly the urticarial stage. In most biopsy specimens that show eosinophilic spongiosis, additional definable histologic criteria allow a specific clinical diagnosis to be made. Rarely, clinical correlation and immunofluorescent data may be needed for a precise diagnosis. The location of eosinophilic spongiosis within the epidermis is generally not helpful in making a definite diagnosis. The peripheral eosinophilia, found in 61% and 46% of our pemphigoid and pemphigus cases, respectively, may be an important laboratory parameter in the evolution of this distinctive histologic pattern. Eosinophilic spongiosis occurs in early pemphigus lesions. However, its presence does not necessarily herald pemphigus, as a similar histologic pattern can be seen in pemphigoid and other disorders.