Dermatitis herpetiform pathology

Histology of dermatitis herpetiform

The scanning power of dermatitis herpetiformis shows vesicular reaction pattern (Figure 1), characterized by foci or small areas of subepidermal separation (Figures 2 and 3). Dense bunches of neutrophils and scattered eosinophils fill the papilla dermis forming microabscesses (Figure 4). Acantolytic keratinocytes may also be evident within the papillary microabscess (Figure 4). Over time, the small areas of the papilla dermal the separation can join to form larger vesicle areas.

Herpetiform dermatitis variants

Pénfigo herpetiforme: estrictamente una variante del pénfigo, se menciona aquí ya que puede presentarse como un imitador clínico de la dermatitis herpetiforme. La histología es la del pénfigo, típicamente de tipo foliáceo, con formación de intraepidermal vesicles.

Special spots in dermatitis herpetiformis.

Direct immunofluorescence studies show granular IgA deposits in the dermis papillae.

Differential diagnosis dermatitis herpetiformis

Herpes virus infection: Despite the occasional presence of acantholytic keratinocytes, dermatitis herpetiformis does not show multinucleation, nuclear chromatin changes or cellular inclusions.

Linear IgA bullous skin disease: The histological although the findings are largely identical acantholysis and fibrin at the tips of the dermal papillae and leukocytosis It is more frequent in dermatitis herpetiformis. Immunofluorescence results will show linear staining of the IgA basement membrane.

Bullous lupus erythematosus: Histology may be identical to discrimination only possible when linear IgG and IgM are found in the basement membrane. IgA deposits can also be viewed simultaneously. Frequently the dermal papillary neutrophilic infiltrate it is seen spreading towards the surroundings interstice.

Cicatricial pemphigoid: in early papillary lesions abscess you can see the formation although the eosinophilic the population increases with injury hour. The key distinguishing feature is the presence of dermal scars under the blister. Immunofluorescence also differs with linear IgG typically seen on the basement membrane. Exceptional cases may show IgA statement alone.