Atlas of Pediatric Dermatoscopy by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783319711683
Publisher: Springer International Publishing

18.8 Histopathological Correlation

Histologically, PLEVA lesions are typically characterized by dermal lymphohistiocytic infiltrate, extravasated erythrocytes, dermal edema, and several epidermal changes, including disappearance of the dermal-epidermal junction, thinning of the granular layer, confluent parakeratosis, ballooning of keratinocytes, intraepidermal vesiculation, and variable degree of necrosis of keratinocytes [1]. It is likely that these last two histological findings are correlated with the presence of the central whitish area or amorphous brownish crust visible on dermatoscopic examination [3]. On the other hand, the vascular pattern seen by dermatoscopy corresponds to dilation and engorgement of blood vessels and microhemorrhages in the papillary dermis [3].

With regard to PLC, histology usually shows perivascular chronic inflammatory cell infiltrate in the superficial dermis, focal disappearance of the dermal-epidermal interface, slight acanthosis, extravasated erythrocytes (and consequent hemosiderin degradation products deposition), and hyperkeratosis with focal parakeratosis (Fig. 18.3) [1]. These last two features are respectively correlated with orange-yellowish structureless areas and whitish scaling seen on dermatoscopy [4]. Nondotted vascular structures and focal dotted vessels detectable by dermatoscopic examination are likely to be the result of dilatation of superficial dermal vessels and dilated blood vessels within focally elongated dermal papillae, respectively [4].

Fig. 18.3Pityriasis lichenoides chronica. Histopathology: perivascular chronic inflammatory cell infiltrate in the superficial dermis, focal disappearance of the dermal-epidermal interface, slight acanthosis, extravasated erythrocytes, and hyperkeratosis with focal parakeratosis [H&E staining; magnification ×100; courtesy of Carla Di Loreto, MD, Institute of Anatomic Pathology, University of Udine, Italy]

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