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Abscess
Contributed by Mark R. Wick, M.D.
Breast
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Hyperpigmented, brownish, velvety lesions
Right neck
Contributed by Mark R. Wick, M.D.
Breast
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Papillomatosis and hyperkeratosis, H&E
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Stages of acne
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Various images
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Neck lesion
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Granulomatous infiltrate of multinucleated giant cells in upper reticular dermis
Elastophagocytosis
and loss of elastic
fibers in center of lesion
(orcein staining)
Contributed by Dhiraj B. Nikumbh, M.B.B.S., M.D.
Multiple sinuses in foot
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Indurated lesion
Lesion over back
Left thigh lesion
Molar tooth appearance
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Outer / inner surface and cross section of excised tissue
Contributed by Kuroli Eniko, M.D., Yale Rosen, M.D. and Haitham Alfalah, M.D. (source: Wikipedia)
Suppurative and granulomatous inflammation
Dense sheets of neutrophils
Colony of Actinomyces
Thin gram positive filamentous organisms
Grocott stain
Gram stain
Contributed by Dhiraj B. Nikumbh, M.B.B.S., M.D.
Mixed inflammatory infiltrate with clumps of fibrillar organisms
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Gram stain
Contributed by Angel Fernandez-Flores, M.D., Ph.D.
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Proposed mechanism
Etiology
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Erythematous macules
Vesicles and desquamation
Sterile
micropustules
on a background
of macular erythema
Pruritic nonfollicular
based pustules
over edematous
erythema
Facial edema
Pustules occur in intertriginous areas such as the axilla
Eruption resolves with superficial desquamation
Contributed by University of Colorado Department of Pathology and Joshua Wisell, M.D.
Subcorneal neutrophilic pustules, spongiosis, scattered dermal eosinophils
Superficial epidermal pustulation, spongiosis, scattered dermal eosinophils
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Lesion on foot
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Various images
Internal septation
H&E, GMS and PAS
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Linear demarcation due to textile dyes
Due to hair dye
Contributed by Gabriela Rosa, M.D.
Severe acute spongiotic dermatitis
Early acute spongiotic dermatitis
Subacute spongiotic dermatitis
Chronic spongiotic dermatitis
Langherhans cell microabscess
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Patchy hair loss
Trichoscopy
Regrowth after treatment
Contributed by Jodi Speiser, M.D.
Vertical section of scalp biopsy
Perifollicular lymphocytes
Peribulbar / intrabulbar
lymphocytic infiltration
Contributed by Mowafak Hamodat, M.B.Ch.B., M.Sc.
Various images
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Superficial and deep,
perivascular and perifollicular,
infiltrate of lymphocytes and
numerous eosinophils
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On back of child
Hypopigmented patch on eyebrow
Contributed by Mowafak Hamodat, M.B.Ch.B., M.Sc.
Mucin seeming basophilic in appearance
Separation of layers produced by pools of mucin
Mucin accumulation within the dermis
Perifollicular mucin deposition
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Monoclonal products via PCR
TCR rearrangement via PCR
Follicular mucinosis with Antonina Kalmykova & Phillip McKee
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Ulcer on upper extremity
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Facial involvement
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Various images
Congo Red staining without (left) and with (right) polarization microscopy
Congo Red staining (left) and Thioflavin-T staining with fluorescent microscopy (right)
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Mesh-like pattern consisting of 6 - 10 nanometer nonbranching fibrils diagnostic of amyloid
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Hair shaft diameter variability
Contributed by Jodi Speiser, M.D.
Vertical section of scalp biopsy
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Lesion of lower leg
Lesions of shoulders and upper back
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Faintly eosinophilic separated collagen bundles in upper dermis
Minimal dermal perivascular chronic inflammatory cells infiltrate
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Various images
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Tiny, gray-brown-black granules in dermis and concentrated near eccrine glands
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Left: normal;
right: hyperkeratotic
skin due to arsenic
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Various images
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Wedge shaped and perivascular inflammatory infiltrate of lymphocytes and eosinophils
Contributed by Chelsea Huang, M.D. and Ashley N. Elsensohn, M.D., M.P.H.
Pruritic papules with hypopigmentation
Acute onset pruritic papules
Acute pruritic rash
Relapsing dry itchy rash
Contributed by Chelsea Huang, M.D. and Ashley N. Elsensohn, M.D., M.P.H.
Acute / subacute spongiotic dermatitis
Spongiosis and hyperkeratosis
Chronic psoriasiform / spongiotic dermatitis
Spongiotic dermatitis with excoriation
Spongiosis with intraepithelial microvesicle
Eczema / atopic contact dermatitis, etc.: spongiotic dermatitis pattern
Spongiotic dermatitis
Contributed by Kiran Motaparthi, M.D.
Malignant atrophic papulosis
Contributed by Kiran Motaparthi, M.D.
Atrophic papulosis in the context of systemic lupus erythematosus
Benign atrophic papulosis
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Papules on face, chest, abdomen and back; mass lesion on face
Exophytic lesion on neck
Small, cherry angiomata-like lesions and nodules
Contributed by Tammie Ferringer, M.D.
Bacillary angiomatosis profile
Contributed by Nathan Lee, M.D.
Bacillary angiomatosis
Contributed by Mark R. Wick, M.D.
Breast skin
Steiner stain, breast
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Erythematous papules and pustules resembling acne
Erythematous plantar maculae
Contributed by Amira Elbendary, M.B.B.Ch., M.Sc.
Acne-like lesion
Vasculitis
Erythema nodosum-like lesion
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Body louse
Scalp infection and scraping lesions
Pubic louse
Human infestations of pubic louse
Contributed by Angel Fernandez-Flores, M.D., Ph.D.
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Brown recluse
Dorsal view of the brown recluse spider
Necrotic rash from
a brown recluse
spider bite
Brown recluse spider bites
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Tense bullae
Ruptured bullae
Contributed by Michael Occidental, M.D. and Randie H. Kim, M.D., Ph.D.
Subepidermal blister with eosinophils
Eosinophil microabscesses in papillary dermis
Eosinophilic spongiosis
Eosinophilic spongiosis with adjacent subepidermal blister
Bullous pemphigoid
Dr. Phillip McKee
Bullous pemphigoid
Dr. Christine Ko
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Necrosis resembling a burn injury
Calciphylaxis on
abdomen of patient
with end stage
renal disease
Contributed by Sepideh N. Asadbeigi, M.D.
Calcium deposits
Calcium deposits in deep dermis
Calciphylaxis
involving small
blood vessels with
associated thrombi
Subcutaneous fat with vascular calcium deposits
Contributed by Mark R. Wick, M.D.
Breast skin
Contributed by Mark R. Wick, M.D. and Yale Rosen, M.D.
Breast skin
PAS, breast skin
Lung: GMS staining
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Various images
Contributed by Jonathan D. Ho, M.B.B.S., D.Sc.
CCCA affecting vertex
Advanced CCCA
Contributed by Jonathan D. Ho, M.B.B.S., D.Sc.
Premature desquamation of the inner root sheath
Inflammation, fibrosis and epithelial thinning
Perifollicular fibrosis
Deep fibrous tracts
Inflammation, fibrosis and dilated eccrine glands
Dilated eccrine gland
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Chondrodermatitis nodularis
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Dermoscopic appearance
Superior helix
Antihelix
Contributed by Cale Michael Max Fletcher, B.Med., M.P.H. and Ruta Gupta, M.D.
Excision of antihelix
Excision of helix
Contributed by Cale Michael Max Fletcher, B.Med., M.P.H. and Ruta Gupta, M.D.
Punch biopsy, helix
Cartilage erosion
Sinus tract with fibrin
Funnel shaped ulcer
Ulcer with adjacent acanthosis
Degenerate collagen and fibrin
Ulceration and parakeratotic crust
Homogenized dermis and inflammation
Adjacent acanthosis
Absence of squamous atypia
Chondrodermatitis nodularis helicis by Dr. Jerad Gardner
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Hyperkeratotic plaque
Cultures are
typically olive
black with a
suede-like surface
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Sclerotic bodies: H&E and KOH prep
H&E stain of
sclerotic bodies in
an intraepidermal
abscess
Skin biopsy specimen
Cladosporium carrionii (left) and Fonsecaea pedrosoi (right), the 2 most common pathogenic fungi causing chromoblastomycosis
Contributed by Kiran Motaparthi, M.D.
Discoid lupus erythematosus, nose
Discoid lupus erythematosus, scalp and ear
Tumid lupus erythematosus, chest
Chilblains lupus in patient with systemic lupus erythematosus
Lupus profundus
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Malar rash of face
Contributed by Kiran Motaparthi, M.D.
Discoid lupus erythematosus, late
Discoid lupus erythematosus, late
Tumid lupus erythematosus
Chilblains lupus
Chilblains lupus
Lupus panniculitis
Lupus panniculitis
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Various bullae
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Vacuolar change and subepidermal bullae with perivascular infiltration in dermis; indirect immunofluorescence on NaCl split skin shows antibodies on dermal side
Linear IgG deposition
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Facial infection
Ulcerated should lesion
Red plaque on finger
Disseminated disease
Contributed by Priya Nagarajan, M.D., Ph.D.
Epidermal hyperplasia, inflammation
Large yeast forms
PAS positive yeasts
Contributed by Rajendra Singh, M.D.
Erythrasma
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Cutaneous diphtheria
Coral-red fluorescence of erythrasma
Pitted keratolysis
Bacterial concretions in trichomycosis
KOH of trichomycosis
Contributed by Rajendra Singh, M.D.
Pitted keratolysis
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Various images
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Various images
Contributed by Jose A. Plaza, M.D.
Polyarteritis arteritis nodosa
Leukocytoclastic vasculitis
Urticarial vasculitis
Contributed by Jose A. Plaza, M.D. and Medical College of Wisconsin Dermatology Department
Polyarteritis arteritis nodosa
Urticarial vasculitis
Urticarial vasculitis
Leukocytoclastic vasculitis
Leukocytoclastic vasculitis
Leukocytoclastic
vasculitis
involving vessels
in the papillary
Leukocytoclastic vasculitis
Leukocytoclastic vasculitis
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Life cycle
Cysticercus
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Computed tomography
Cysts
Mammogram, tubular structure
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Gigantic cysticercosis pseudo tumour
Swelling over neck
Swellings over back
AFIP images
Breast cyst
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Cysticercosis pseudotumor
Well circumscribed nodule
Specimen from trunk
Breast: tubular, worm-like structure
Contributed by Thiriveni Balajji, M.D., M. Kavitha, M.D., Case #458 and Case #115
Subcutaneous cysticercosis with neurocysticercosis
CNS
Eyelid
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Breast: larval fragment
Bladder: wall of cysticercus
Wall of cysticercus
Epithelioid cell granulomas
Wall of cysticercosis cellulosae
Inflammatory infiltrate
Fibrillary stroma
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11 year old girl with perforin gene mutation
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Rosacea due to demodicosis
Granulomatous rosacea associated with Demodex
These face mites really grow on you
Demodex mite
Contributed by Maxwell A. Fung, M.D.
Crusted papules coalescing into plaques
Papules and lichenified plaques
Multiple papules on the leg
Urticarial papules and plaques
Contributed by Maxwell A. Fung, M.D.
Itchy red bump disease
Atopic dermatitis
Urticarial dermatitis
Perivascular dermatitis, invisible dermatoses and sclerosing disorders
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Dermatitis
herpetiformis
physiopathogenesis
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Grouped papules,
vesicles and
hypopigmentation
Contributed by Michael Occidental, M.D. and Randie H. Kim, M.D., Ph.D.
Blister
Skin directly adjacent to blister
Perilesional skin
Blister and perilesional skin
Neutrophilic microabscesses in perilesional skin
Dermatitis herpetiformis
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Purple plaques on knees
Heliotrope rash and Gottron papules
Various images
Contributed by Hillary Rose Elwood, M.D.
Subtle vacuolar interface change and increased dermal mucin highlighted by Alcian blue stain
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Erythrodermic dermatomyositis
Interface dermatitis
with vacuolar
alteration at dermal
epidermal junction
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Kerion celsi, Majocchi granuloma and Tinea capitis
Tinea corporis:
well demarcated
margins and
diffuse erythema
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Microsporum audouinii
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Clinical stages of dissecting cellulitis of scalp
Contributed by Pooria Zare, M.D., M.P.H. and Mazaher Ramezani, M.D.
Deep folliculitis
Perifolliculitis
Mixed inflammation
Abscess formation
Sinus tract
Follicular fusion
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Encapsulated abdominal mass
MRI
CT
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Subcutaneous nodule of right thigh
Mobile nodule with unusual mobility
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Subcutaneous encapsulated fat necrosis
Cut section of the gross lesion
Contributed by Aadil Ahmed, M.D.
Fibrous capsule surrounding
adipose tissue
Histiocyte within adipose tissue
Focal lipomembranous change
Posttraumatic fat necrosis (encapsulated subcutaneous fat necrosis) by Dr. Jerad Gardner
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Swollen plaques on right forearm
Diffuse erythematous plaque
Resembling bacterial cellulitis
Contributed by Favia Dubyk, M.S., M.D.
Nodular collections of eosinophils
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Diffuse dermal eosinophilic infiltrate
High power view of eosinophils and flame figures
Multiple flame figures
Interstitial infiltrate
with eosinophils
magnification 100x
Numerous eosinophils magnification 200x
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Lymphoplasmacytic infiltrate of fascia and skeletal muscle
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Widespread hyperpigmented patches
Various images
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Eosinophilic folliculitis
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Papillomatous and macular lesions
Hypopigmented papules and plaques
Contributed by @JMGardnerMD on Twitter
Epidermodysplasia verruciformis
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Various images
Characteristic enlarged keratinocytes with blue-gray pallor; no significant keratinocytic atypia, pleomorphism or mitotic figures
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Normal epidermis and components
Level of disruption in EB subtypes
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Typical noninflammatory blister
EB simplex blistered foot of infant
EB simplex, generalized, with Dowling-Meara variant
Junctional EB: marked pitting of enamel
Junctional EB-Herlitz
subtype: exuberant
granulation tissue
on child's neck
Dominant dystrophic
EB-milia arising within
erythematous patch
Generalized dominant dystrophic EB
Generalized dominant
dystrophic EB:
hypertrophic scarring
Generalized dominant
dystrophic EB: dystrophy
of all 20 nails
Recessive dystrophic EB
Severe generalized recessive dystrophic EB
Congenital absence of
skin in neonate with Bart
syndrome (not specific
for any EB subtype)
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EB simplex: intact stratum corneum and upper epidermis, with vesicle formation in the lower epidermis at the basal layer caused by degeneration of individual epidermal cells
Dystrophic EB: pretibial lesion
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EB simplex: epidermal basal keratinocytes
Epidermolysis bullosa acquisita
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Corrugated cardboard-like
Palms
Anterior ankles
Close up of ankle
Presenting as erythroderma and blistering
Hyperkeratotic papules
Papules in proximal thigh
Left palmar hyperkeratosis
Plantar hyperkeratosis
Thickened red hyperkeratotic corrugated plaques
Plaques distributed over neck, back and flexural surfaces
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Focal epidermolytic hyperkeratosis
Continuous epidermolytic hyperkeratosis
Mosaic
Epidermolytic ichthyosis
Parakeratosis, hypergranulosis
and vacuolar degeneration of
granular and spinous layer
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Atypical lymphocytes have indented and slightly larger cytoplasm with nucleoli
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Various images
Contributed by Silvija P. Gottesman, M.D.
Annular eruption with scale
Contributed by Silvija P. Gottesman, M.D.
Perivascular lymphohistiocytic inflammation
Subtle epidermal changes
Contributed by Kiran Motaparthi, M.D.
Plaque on the elbow
Nodules on the shin and foot
Nodule on the hand
Contributed by Kiran Motaparthi, M.D.
Neutrophilic infiltrate
Nodular mixed infiltrate
Dilated vessels and prominent fibrosis
Small vessel vasculitis
Storiform fibrosis
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Lyme disease U.S. distribution
Ixodes scapulais life cycle
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Large erythema migrans on abdomen
Erythema migrans on leg
Multiple erythema migrans lesions
Contributed by Mark R. Wick, M.D.
Contributed by Mark R. Wick, M.D.
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Various images
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Various images
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Red patches with raised clear central bumps
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Hailey-Hailey in right axilla
Hyperpigmented plaques over groin
Hailey-Hailey lesions on left groin
longitudinal leukonychia
and ridging
Contributed by Savita Ries, M.D.
Broad intraepidermal vesicles with dilapidated brick appearance
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Figure 1: HHD on
right sole, groin
and trunk
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Folliculitis
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Micro image of folliculitis
Contributed by Chico J. Collie, M.B.B.S. and Jonathan D. Ho, M.B.B.S., D.Sc.
Folliculitis decalvans affecting the vertex
Contributed by Chico J. Collie, M.B.B.S. and Jonathan D. Ho, M.B.B.S., D.Sc.
Decrease in follicular density
Superior follicle
Deep follicle
Perifollicular infiltrate and follicular destruction
Mixed inflammatory cell infiltrate
Intrafollicular neutrophils
Compound follicle
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Tongue nodule
Lower lip nodule
Contributed by Matthew Franklin, M.D.
Granulomatous inflammation
Foreign body giant cells
Splinter with inflammation
Histopathology of breast foreign body reaction
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Dry gangrene in patient with diabetes
Dry gangrene due to cryoglobulinemic vasculitis
Wet gangrene
Dry gangrene
Contributed by Pooja Rambhia, M.D. and Adele Shenoy, M.D.
Skin with hyperpigmentation and denudement
Skin with hyperpigmentation, denudement and hemorrhage
Palmar skin with erythema
Hypo and hyperpigmented coalescing patches
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Maculopapular rash; erythroderma
Rash affecting the palms
Acute GVHD mimicking toxic epidermal necrolysis
Contributed by Silvija P. Gottesman, M.D. and Ohoud Aljarbou, M.D.
Denuded skin
Follicle with interface changes
Interface dermatitis with pigment incontinence
Satellite cell necrosis
Acute GVHD with sparse inflammation and abundant dyskeratotic keratinocytes
Dense perivascular and interstitial eosinophilic infiltrate
Acute GVHD with vacuolar interface reaction and abundant dyskeratotic keratinocytes
Focal formation of subepidermal blister
Psoriasiform GVHD with regular acanthosis and parakeratosis
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Red macules and patches in groin and scrotum
Hyperpigmented papules in the infra-abdominal fold
Discrete, tiny,
filiform, hyper-
keratotic papules
on forehead
Contributed by David Crowe, M.D.
Annular patch
Annular plaque
Erythematous annular plaque
Contributed by Stephen Somach, M.D.
Deep dermal palisaded granuloma
Reticular dermal palisaded granuloma
Increased dermal mucin in necrobiotic zone
Predominantly sarcoidal granulomas
Interstitial histiocytic infiltrate
Small interstitial histiocytes
Palisaded
granuloma with
fibrinoid collagen
degeneration
Deep palisaded granuloma with fibrinoid degeneration
Granuloma Annulare
Dr. James Carton
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Plaques on the forehead
Plaque on the nose
Plaques on the forehead and cheek
Contributed by Kiran Motaparthi, M.D.
Polymorphous infiltrate with grenz zone
Plasma cells, neutrophils and fibrosis
Fibrosing vasculitis
Eosinophils
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Erythema annulare centrifugum - pregnant woman
Erythema gyratum repens
Erythema chronicum migrans
Case #71
Erythema gyrated repent
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Erythema annulare centrifugum - pregnant woman
Erythema chronicum migrans
Contributed by Mark R. Wick, M.D.
Breast skin
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Dermatomal distribution of zoster
Verrucous varicella zoster on leg
Contributed by Hillary Rose Elwood, M.D.
Viral cytopathic effect of multinucleation, molding, nuclear margination
Case #423
Herpes virus vesicular dermatitis
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Multinucleated cells, some with intranuclear inclusions
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Hidradenitis nodule (a) and abscess (b)
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Axilla
Contributed by Matthew Franklin, M.D. and @JMGardnerMD on Twitter
Dermal sinus tract
Sinus tract with rupture
Suppurative and granulomatous inflammation
Follicular occlusion and inflammation
Perifollicular abscess
Epithelial remnants with inflammation
Hidradenitis suppurativa
Hidradenitis suppurativa
Contributed by Mariantonieta Tirado, M.D.
Normal nail anatomy
Contributed by Mariantonieta Tirado, M.D.
Layers of the epidermis
Melanocytes
MelanA+ melanocytes
HMB45+ melanocytes
Stratum lucidum
Superficial and deep neurovascular plexuses
Pacinian corpuscle
Meissner corpuscles
Brown fat
Segments of hair follicle
Layers of terminal anagen hair follicle
Demodex folliculorum mites
Sebaceous gland
Adipophilin+ sebaceous gland
Eccrine gland, myoepithelial cell
Eccrine duct
Intraepidermal portion of eccrine duct (acrosyringium)
Apocrine gland
Apocrine gland with decapitation secretion
CD1a+ Langerhans cells
CK20+ Merkel cell
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Birbeck granules
Contributed by Mark R. Wick, M.D.
Breast skin, HIV+
Contributed by Mark R. Wick, M.D.
Breast skin
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Within macrophages
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Drug related:
Amiodarone
Bleomycin
Diltiazem
Imatinib (figs 1A - B)
Imipramine
(fig. 1)
Other:
Familial Progressive Hyperpigmentation
Pre and post treatment for Vitamin B12 deficiency
42 year old African American
woman with lesions
on left side of face
as a result of acne excoriée
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Amiodarone
Diltiazem
Imatinib (figs 2A - B)
Imipramine
(fig. 2)
Familial progressive hyperpigmentation
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Photoexposed pigmented skin
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Lamellar ichthyosis
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Nonbullous impetigo
Bullous impetigo in shoulder region
Bullous impetigo in abdomen
Crusted impetigo
Contributed by Jerad Gardner, M.D.
Impetigo contagiosa
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Subcorneal blister with inflammatory cells
Contributed by Mark R. Wick, M.D.
Contributed by Mark R. Wick, M.D.
Contributed by Mark R. Wick, M.D.
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Bilateral lid ectropion
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Chronic inflammatory cell infiltrate
CD3
Contributed by Michael Fitz-Henley, M.B.B.S., D.M. and Viktoryia Kazlouskaya, M.D. (Case #517)
Darier disease
Flexural Darier disease
Subtle flat topped acral papules
Nail changes in Darier disease
Leonine facies
Keratotic papules
Contributed by Jonathan D. Ho, M.B.B.S., D.Sc. and Viktoryia Kazlouskaya, M.D. (Case #517)
Hyperkeratosis and
intraepidermal
clefting
Acantholytic dyskeratosis
Corp ronds and grains
Grains forming tier
Villus formation
Acral papule
Mild perivascular superficial lymphocytic inflammation, intraepidermal acantholysis and dyskeratosis
Contributed by Gerardo Cazzato, M.D. and Domenico Bonamonte, M.D.
Erythematous nodule
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Cutaneous and mucosal forms
Contributed by Gerardo Cazzato, M.D. and Giuseppe Ingravallo, M.D., Ph.D.
Skin lesion
Leishmania amastigotes
Marquee sign
Leishmania infection
Contributed by Mowafak Hamodat, M.Sc.
Lepromatous leprosy
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Lepromatous leprosy, low magnification
Mycobacterium lepromatosis infection
Contributed by Jonathan D. Ho, M.B.B.S., D.Sc.
Pinpoint koebnerized papules
Subtle papules
Contributed by Jonathan D. Ho, M.B.B.S., D.Sc.
Expanded dermal papillae
Ball and claw appearance
Lymphohistiocytic infiltrate
Epidermal changes
PAS stain
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Frontotemporal and
eyebrow alopecia
/ multifocal scalp
alopecia
Trichoscopic view
Contributed by Pooria Zare, M.D., M.P.H. and Mazaher Ramezani, M.D.
Inflammation
Tufting
Infundibuloisthmic involvement
Upper follicular involvement
Scar
Follicular plugging
Follicular lichenoid inflammation
Lymphohistiocytic infiltrate and mucin
Contributed by Jennifer M. McNiff, M.D.
Lichen planus pigmentosus
Classic lichen planus
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Lichen planus on the arm
Wickham striae of lichen planus
Lichen planus on the wrist
Annular atrophic lichen planus
Contributed by Simon F. Roy, M.D., Jennifer M. McNiff, M.D. and PathPresenter
Lichenoid interface dermatitis
Civatte bodies in epidermis
Hyperplastic epidermis with hyperkeratosis
Hypertrophic lichen planus
Hypertrophic lichen planus
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Genital and extragenital LS
Contributed by Candice E. Brem, M.D.
Tiered appearance
Follicular plugging
Basal layer vacuolization
Homogenized dermal collagen
Subepidermal split
Hemorrhagic and bullous LS
Lichen sclerosus in 5 minutes
Lichen sclerosus mimicking mycosis fungoides
Basics of lichen sclerosus
Contributed by Cristian Rocha, M.D. and Jonathan D. Ho, M.B.B.S., D.Sc.
Left lower back lesion
Dorsal foot plaques
Contributed by Jose A. Plaza, M.D.
Psoriasiform pattern
Vertically oriented dermal fibrosis
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Lichen striatus
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Various images
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Lines of Blaschko
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Whorled pattern over trunk (fig. 2)
Macular hyperpigmentation
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Epidermal hypermelanosis
Diffuse melanosis (fig. 1)
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Annular bullous plaques ("cluster of jewels") with erosions and crusting, pre and posttherapy
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Subepidermal blisters with neutrophils
Neutrophilic microabscess
(B) and (C), respectively: vancomycin associated cases
Linear IgA basement membrane staining
Contributed by Merrick Kozak, M.D.
Bilateral lower extremities
Contributed by Shyam Raghavan, M.D.
Pseudocyst formation
Dermal sclerosis
Case #433
Beaded papules over bilateral eyelids
Waxy papules over back of forearm
Case #433
Eosinophilic homogenous material in the papillary dermis
PAS positive
Contributed by Robert E. LeBlanc M.D.
H&E (10x, 20x, 40x)
CD4, CD8, Ki67
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Madura foot
Contributed by Venna Maheshwar, M.D., Kiran Alam, M.D. and Anshu Jain, M.D.
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Various images
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Purple plaque
After treatment
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Michaelis-Gutmann body
Calcified structures
Periodic acid Schiff stain
PAS, Von Kossa, Prussian blue
Contributed by Mark R. Wick, M.D.
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Friction blister
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Blood blisters
Contributed by Sara C. Shalin, M.D., Ph.D.
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Friction blister
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Confluent hyperpigmented macules in a malar distribution
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Miliaria profunda
Contributed by Marely Santiago-Vazquez, M.D.
Dermoscopy features
Molluscum contagiosum morphology
Clustered papules
Contributed by Jorge L. Sánchez, M.D. and @zaalruwai83 on Twitter
Epidermal hyperplasia
Henderson-Patterson bodies
Eosinophilic inclusion bodies
Inflammatory infiltrate
Large intracytoplasmic inclusions
Molluscum contagiosum
Molluscum versus myrmecia wart - dermpath lookalikes
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13 year old boy with juvenile systemic sclerosis
Calcifications
Calcinosis cutis in a 15 year old boy
Whole body MRI in a juvenile with scleromyositis
Contributed by Cristian Rocha, M.D.
En coup de sabre
Generalized localized scleroderma / morphea
Contributed by Jose A. Plaza, M.D., Mark R. Wick, M.D. and Joel Pinczewski, M.D., Ph.D.
Early scleroderma lesion
Breast skin, morphea
Late stage morphea lesion
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Life cycle of D. hominis
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Close up, adult and larvae of D. hominis
Contributed by Bobbi Pritt, M.D.
Dermatobia hominis, the human botfly
Contributed by Priya Nagarajan, M.D., Ph.D.
2x magnification
10x magnification
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Necrobiosis lipoidica diabeticorum
Contributed by Gaurav Jain, M.B.B.S., M.D.
Degenerated collagen alternating with inflammation
Layers of degenerated collagen
Degenerated collagen
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Necrobiotic xanthogranuloma
Various images
Contributed by Joel Pinczewski, M.D., Ph.D.
Indurated and hyperpigmented skin lesions
Contributed by Joel Pinczewski, M.D., Ph.D.
Increased dermal mucin and spindled fibroblasts
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Violaceous plaques on the upper back
Erythematous plaques on the chest and abdomen
Solitary papules on the forearm
Erythematous, papular lesions on bilateral palms
Contributed by Jasmine Saleh, M.D., M.P.H. and Jodi Speiser, M.D.
Interface dermatitis
Neutrophils and squamous syringometaplasia
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Various images
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Pseudoepitheliomatous hyperplasia, epidermal abscesses and prominent dermal infiltrate
High power shows fungal organisms
Budding yeast
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Preoperative Xrays of right knee
MRI of right knee
Contributed by Jonathan D. Ho, M.B.B.S., D.Sc.
Forearm macules
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Pigmented knee cartilage
Pigmented papules
Facial pigmentation
Contributed by Jonathan D. Ho, M.B.B.S., D.Sc.
Ochronotic bodies
Ochronotic bodies embedded in elastosis
Ochronotic bodies staining with Verhoeff van Gieson
Pigmented, ochronosis associated colloid milium
Swollen collagen bundles
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Exogenous ochronosis
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Blackfly (Simulium damnosum)
Contributed by Eddie Fridman, M.D.
36 year old Ethiopian man with no previous history and a clinical diagnosis of inclusion cyst / pilomatrixoma of left thigh
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Figs C and D: Microfilariae of Onchocerca volvulus in tissue
Figs B and D: Adults of Onchocerca volvulus
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Toenail infections
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Porphyria cutanea tarda
Hepatoerythropoietic porphyria
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Porphyria cutanea tarda associated with HIV;
Subepidermal bulla formation has resulted
in loss of the epidermis (note the
rigid papillary dermal capillary walls)
Contributed by Angel Fernandez-Flores, M.D., Ph.D.
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Lace-like rash on extremities
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Bone marrow
Fetal spleen
Parvovirus B19 infection in formalin - fixed and paraffin - embedded placenta and fetal tissues
B19 positive immunostain
Contributed by Mark R. Wick, M.D.
Breast skin
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36 year old woman at 24 weeks gestation
Annular erythematous-edematous lesions
Exudative and erythematous lesions
Various images
Contributed by Mark R. Wick, M.D.
Breast skin
Collagen IV stain
IgG stain
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H&E and C3
H&E, subepidermal bulla with eosinophils
Perivascular infiltrate of lymphocytes and eosinophils
Linear C3 staining
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Bronchiolitis obliterans, paraneoplastic pemphigus
Castleman disease, paraneoplastic pemphigus
Contributed by Natalia Zhovta, M.D., Yi C. Lai, M.D., Maria Hannaway, M.D., Jamerson Loyal, M.D., Iryna Tsikhanouskaya, M.D., Ph.D., Timothy Patton, D.O. and Juliana Jung, M.D.
Pemphigus vulgaris:
Erosions on oral mucosa
Erosions on the hands
Erosions on the knees
Erosions on the back
Superficial erosions
Erosions on the scalp
Verrucous plaques
Pemphigus foliaceus:
Superficial erosions
Crusted plaques
Superficial crusts and erosions
Paraneoplastic pemphigus:
Severe stomatitis
Tense bullas
IgA pemphigus:
Superficial flaccid bullas
Annular lesions, flaccid bullas
Superficial pustules
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Paraneoplastic pemphigus
Paraneoplastic pemphigus associated with non-Hodgkin lymphoma
Pemphigus vulgaris
Contributed by Viktoryia Kazlouskaya, M.D., Ph.D., Juliana Jung, M.D. and Case #56
Pemphigus vulgaris:
Suprabasilar acantholysis
Suprabasilar split
Intact basal layer
Oral ulcer
Intraepidermal spilt on musoca
Pemphigus foliaceus:
Acanthosis and subcorneal split
Subcorneal split
Minimal subcorneal split
Focal subcorneal split
Subcorneal split
Subcorneal acantholysis
Pemphigus foliaceus
Pemphigus foliaceus
Paraneoplastic pemphigus:
Blister with lichenoid inflammation
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Large round acantholytic cells
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Loose keratinocytes, pemphigus
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Various images
Contributed by Michael Franzetti, M.D.
Schamberg disease
Annular patch
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Schamberg disease
Purpura annularis telangiectodes
Diet induced pigmented purpuric dermatosis
Pigmented purpuric dermatosis of Gougerot-Blum
Contributed by Sepideh N. Asadbeigi, M.D., Shabnam Momtahen, M.D. and Jeffrey McBride, M.D.
Perivascular lymphocytes
Schamberg disease
Vacuolization
Erythrocyte extravasation
Hemosiderin deposition
Contributed by Mark R. Wick, M.D.
Arms
Breast skin
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Oval red-brown papulosquamous lesion
Flattened scaly brown papules
Contributed by Gülçin (Güler) Şimşek, M.D. and Mark R. Wick, M.D.
Parakeratosis and exocytosis of lymphocytes
Parakeratosis, spongiosis and exocytosis of lymphocytes
Perivascular and lichenoid lymphocytic infiltrate
Lichenoid interface dermatitis with melanophages
Extravasated erythrocytes, fibrinoid necrosis
Intraepidermal erythrocytes and lymphocytes
Exocytosis of lymphocytes / extravasated erythrocytes
Breast skin
Contributed by Natalia Zhovta, M.D. and Yi Lai, M.D.
Elongated scaly patches
Inverse patch
Scaly patches
Disseminated scaly patches
Herald patch
Disseminated patches
Herald patch
Disseminated elongated patches
Contributed by Viktoryia Kazlouskaya, M.D., Ph.D.
Spongiosis with mounds of parakeratosis
Minimal spongiosis with mounds of parakeratosis
Spongiosis, parakeratosis, erythrocyte extravasates
Spongiosis, parakeratosis, superficial lymphocytic infiltrate
Contributed by VisualDx
Erythroderma
Perifollicular erythema and scale
Orange palmoplantar keratoderma
Ectropion and erythema
Contributed by Chau M. Bui, M.D.
Hyperkeratosis and acanthosis
Checkerboard pattern
Follicular plugging
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Polymorphic light eruption on arm
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Porphyria cutanea tarda
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Porphyria cutanea tarda associated with HIV;
Subepidermal bulla formation has resulted
in loss of the epidermis (note the
rigid papillary dermal capillary walls)
Case #332
Verhoeff Van Gieson stain for elastic fibers
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Polyarticular psoriatic arthritis
Sacroiliac involvement in psoriatic arthritis
Onychopathy and periostitis at base of phalanx
Contributed by Viktoryia Kazlouskaya, M.D., Ph.D., Mary-Katherine Collins, M.D. and Natalia Zhovta, M.D.
Verrucous psoriasis on the knee
Palmar psoriasis with well demarcated plaque
Localized pustular psoriasis
Plaque psoriasis, wrists
Plaque psoriasis, elbows
Intertriginous psoriasis
Pustular psoriasis
Erythrodermic psoriasis
Guttate psoriasis
Contributed by Mark R. Wick, M.D.
Breast skin
- See clinical images
Contributed by Viktoryia Kazlouskaya, M.D., Ph.D.
Acanthosis with subcorneal pustule
Subcorneal pustule
Parakeratosis with neutrophilic collections
Acanthosis and verrucous changes
Dilated dermal capillaries
Subcorneal pustules
Regular acanthosis
Acanthosis, parakeratosis with neutrophils
Acral subcorneal pustule
Contributed by Hillary Rose Elwood, M.D.
Classic features of psoriasiform hyperplasia, confluent parakeratosis, loss of granular layer and dilated capillaries with thinned suprapapillary plate
Contributed by Angel Fernandez-Flores, M.D., Ph.D.
Regular psoriasiform acanthosis
Dilated capillaries in the dermal papillae
Neutrophils in stratum corneum
Hypogranulosis and neutrophils in stratum corneum
Psoriasis: clinical presentation, histopathology and differential diagnosis
Contributed by Michi Shinohara, M.D.
Leg ulcer
Contributed by Michi Shinohara, M.D.
Early lesion
Late lesion
Pyoderma gangrenosum versus nonspecific chronic ulcer changes
Contributed by Christine J. Ko, M.D.
Upper extremity reactive granulomatous dermatitis
Symmetric upper
extremity reactive
granulomatous
dermatitis
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Plaque on thigh
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Classic rheumatoid nodules on the elbow
Faintly pink subcutaneous nodules
Contributed by Kiran Motaparthi, M.D.
Palisading granulomas
Palisading mononuclear histiocytes
Subcutaneous palisading granulomas
Granulomas surrounding fibrinoid necrosis
Palisading epithelioid histiocytes
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Various images
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Dermis of a patient with rosacea
Contributed by Kerri Purdy, M.D.
Annular hypopigmented lesions
Erythematous eruption
Lupus pernio
Annular hypopigmented lesions
Contributed by Thai Yen Ly, M.D., Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Superficial granulomatous inflammation
Superficial and deep granulomatous inflammation
Well formed granulomata
Granulomata with lymphocytic inflammation
Granulomata with lymphocytic cuff
Associated foreign material
Asteroid body
Schaumann bodies
Schaumann body
Small, tight granulomas
Noncaseating granulomas
Extension to subcutaneous fat tssue
Langhans giant cells
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Life cycle
Diagnostic criteria for scabies
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Penile nodules
Web spaces
Genital papulonodules
Areolar papules
Burrow
Contributed by Eric W. Hossler, M.D. and Bethany R. Rohr, M.D.
Crusted scabies
Numerous mites
Crusted scabies
Crusted scabies
Crusted scabies
Scraping of adult mite
Scraping of an egg
Ova and scybala
Mite anatomy
Intracorneal mite
Adult mite
Ova on skin scraping
Setae
Mite on skin scraping
Rudimentary front legs
Probe of scabies burrow under dermoscopy
Ask a dermatologist: how do I get rid of scabies?
Sarcoptes scabiei var. hominis
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Adult trombiculid mite
Chigger
Eschar
Contributed by Mark R. Wick, M.D.
Breast skin
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Redness (erythema) and mild scaling
Contributed by Mark R. Wick, M.D.
Breast skin
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Stasis dermatitis
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SJS vs. SJS / TEN overlap vs. TEN
SCORTEN severity of illness score
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Cutaneous and mucosal lesions
Widespread macules
Contributed by Hillary Rose Elwood, M.D.
Detached epidermis with full thickness necrosis and dyskeratotic cells
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Basal cell vacuolar change
Full thickness necrosis of epidermis
Contributed by Maria E. Mazzei, M.D.
Papulosquamous lesions
Annular lesions
No scarring or atrophy
Face lesions; midface preserved
Contributed by Maria E. Mazzei, M.D.
Epidermal thinning and vacuolar changes
Dyskeratotic keratinocytes
Vacuolar interface dermatitis