Difference between revisions of "Epidermal necrosis"

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[[Image:Confluent_epidermal_necrosis_-_very_high_mag.jpg|thumb|right|250px|Confluent epidermal necrosis. [[H&E stain]].]]
'''Epidermal necrosis''' is an important finding in [[dermatopathology]].  Full-thickness necrosis, especially is very serious.
'''Epidermal necrosis''' is an important finding in [[dermatopathology]].  Full-thickness necrosis, especially is very serious.


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Notes:
Notes:
*SJS and TEN are on a spectrum, EM (depending on who you ask) is considered separate.
*SJS and TEN are on a spectrum, EM (depending on who you ask) is considered separate.
**These are signed-out as "confluent epidermal necrosis - see comment".
***Comment: The histomorphologic findings are consistent with EM/SJS/TEN.
**The clinical DDx of EM/SJS/TEN includes ''[[acute generalized exanthematous pustulosis]]'' (AGEP).


==Erythema multiforme==
==Erythema multiforme==
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===General===
===General===
Features:<ref name=Ref_PBoD8_1189>{{Ref PBoD8|1189}}</ref>
Features:<ref name=Ref_PBoD8_1189>{{Ref PBoD8|1189}}</ref>
*Hypersensitivity disorder due to a drug ''or'' infection.
*[[Hypersensitivity]] disorder due to a drug ''or'' infection.
**Associated with the following: [[HSV]], Mycoplasma, [[Histoplasma]], others.
**Associated with the following: [[HSV]], Mycoplasma, [[Histoplasma]], others.


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*+/-Epidermal blistering.
*+/-Epidermal blistering.
*+/-Epidermal sloughing.
*+/-Epidermal sloughing.
====Images====
<gallery>
Image: Confluent epidermal necrosis - low mag.jpg |  Confluent epidermal necrosis - low mag. (WC)
Image: Confluent epidermal necrosis - intermed mag.jpg |  Confluent epidermal necrosis - intermed. mag. (WC)
Image: Confluent epidermal necrosis - high mag.jpg |  Confluent epidermal necrosis - high mag. (WC)
Image: Confluent epidermal necrosis - very high mag.jpg |  Confluent epidermal necrosis - very high mag. (WC)
</gallery>


==Stevens-Johnson syndrome==
==Stevens-Johnson syndrome==
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===General===
===General===
Rx causes of SJS:
Rx causes of SJS:
*NSAIDs.  
*[[NSAID]]s.  
*Anticonvulsants.  
*Anticonvulsants.  
*Sulfonamides.  
*Sulfonamides.  
Line 46: Line 58:
Features:
Features:
*Similar [[erythema multiforme]].
*Similar [[erythema multiforme]].
====Images====
<gallery>
Image: Confluent epidermal necrosis - low mag.jpg |  Confluent epidermal necrosis - low mag. (WC)
Image: Confluent epidermal necrosis - intermed mag.jpg |  Confluent epidermal necrosis - intermed. mag. (WC)
Image: Confluent epidermal necrosis - high mag.jpg |  Confluent epidermal necrosis - high mag. (WC)
Image: Confluent epidermal necrosis - very high mag.jpg |  Confluent epidermal necrosis - very high mag. (WC)
</gallery>


==Toxic epidermal necrolysis==
==Toxic epidermal necrolysis==
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Features:
Features:
*Like [[erythema multiforme]] - but usu. less inflammation.<ref>S. Sade. 8 September 2011.</ref>
*Like [[erythema multiforme]] - but usu. less inflammation.<ref>S. Sade. 8 September 2011.</ref>
====Images====
<gallery>
Image: Confluent epidermal necrosis - low mag.jpg |  Confluent epidermal necrosis - low mag. (WC)
Image: Confluent epidermal necrosis - intermed mag.jpg |  Confluent epidermal necrosis - intermed. mag. (WC)
Image: Confluent epidermal necrosis - high mag.jpg |  Confluent epidermal necrosis - high mag. (WC)
Image: Confluent epidermal necrosis - very high mag.jpg |  Confluent epidermal necrosis - very high mag. (WC)
</gallery>


==Staphylococcal scalded skin syndrome==
==Staphylococcal scalded skin syndrome==
*Abbreviated ''SSSS''.
*Abbreviated ''SSSS''.
===General===
===General===
*Caused by S. aureus.<ref name=pmid17582744>{{Cite journal  | last1 = Nishifuji | first1 = K. | last2 = Sugai | first2 = M. | last3 = Amagai | first3 = M. | title = Staphylococcal exfoliative toxins: "molecular scissors" of bacteria that attack the cutaneous defense barrier in mammals. | journal = J Dermatol Sci | volume = 49 | issue = 1 | pages = 21-31 | month = Jan | year = 2008 | doi = 10.1016/j.jdermsci.2007.05.007 | PMID = 17582744 }}</ref>
*Due to keratinocyte cell-cell adhesion loss in the superficial epidermis - caused by ''S. aureus''.<ref name=pmid17582744>{{Cite journal  | last1 = Nishifuji | first1 = K. | last2 = Sugai | first2 = M. | last3 = Amagai | first3 = M. | title = Staphylococcal exfoliative toxins: "molecular scissors" of bacteria that attack the cutaneous defense barrier in mammals. | journal = J Dermatol Sci | volume = 49 | issue = 1 | pages = 21-31 | month = Jan | year = 2008 | doi = 10.1016/j.jdermsci.2007.05.007 | PMID = 17582744 }}</ref>


Clinical:
Clinical:
*Blisters.
*Blisters  


===Microscopic===
===Microscopic===
Features:<ref name=pmid17582744/>
Features:<ref name=pmid17582744/>
*Keratinocyte cell-cell adhesion loss in the superficial epidermis.
*Superficial dermis separates from underlying tissue - looks artefactual.
*Minimal/scant inflammation is typical.<ref>URL: [http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=2105774586 http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=2105774586]. Accessed on: 22 September 2011.</ref>
 
Image:
*[http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=2105774586 SSSS (jhmi.edu)].


==See also==
==See also==
*[[Dermatopathology]] - an introduction to the topic.
*[[Dermatopathology]] - an introduction to the topic.
*[[Non-malignant skin disease]].
*[[Non-malignant skin disease]].
*[[Inflammatory skin disease]].


==References==
==References==

Latest revision as of 05:47, 9 November 2014

Confluent epidermal necrosis. H&E stain.

Epidermal necrosis is an important finding in dermatopathology. Full-thickness necrosis, especially is very serious.

General

Full thickness DDx:

  • Erythema multiform (EM).
  • Toxic epidermal necrolysis (TEN).
  • Stevens-Johnson syndrome (SJS).
  • Trauma.
  • Others. (???)

Partial thickness DDx:

  • Staphylococcal scalded skin syndrome.
  • Trauma. (???)
  • Others. (???)

Notes:

  • SJS and TEN are on a spectrum, EM (depending on who you ask) is considered separate.
    • These are signed-out as "confluent epidermal necrosis - see comment".
      • Comment: The histomorphologic findings are consistent with EM/SJS/TEN.
    • The clinical DDx of EM/SJS/TEN includes acute generalized exanthematous pustulosis (AGEP).

Erythema multiforme

  • Abbreviated EM.

General

Features:[1]

Clinical:

  • Target-like lesion.

Microscopic

Features:[1]

  • Lymphocytic interface dermatitis (lymphocytes at the dermal-epidermal junction).
  • Necrotic/degenerative keratinocytes - key feature.
  • +/-Epidermal blistering.
  • +/-Epidermal sloughing.

Images

  • Confluent epidermal necrosis - low mag. (WC)

  • Confluent epidermal necrosis - intermed. mag. (WC)

  • Confluent epidermal necrosis - high mag. (WC)

  • Confluent epidermal necrosis - very high mag. (WC)

Stevens-Johnson syndrome

  • Abbreviated SJS.

General

Rx causes of SJS:

  • NSAIDs.
  • Anticonvulsants.
  • Sulfonamides.
  • Penicillins.

Microscopic

Features:

Images

  • Confluent epidermal necrosis - low mag. (WC)

  • Confluent epidermal necrosis - intermed. mag. (WC)

  • Confluent epidermal necrosis - high mag. (WC)

  • Confluent epidermal necrosis - very high mag. (WC)

Toxic epidermal necrolysis

  • Abbreviated TEN.

General

  • TEN more severe form SJS.

Definition:

  • >30% sheet-like epidermal detachment, diffuse erythema, severe mucous membrane involvement.
  • Most TEN (80%) Rx-related, only 50% of SJS Rx-related.

Microscopic

Features:

Images

  • Confluent epidermal necrosis - low mag. (WC)

  • Confluent epidermal necrosis - intermed. mag. (WC)

  • Confluent epidermal necrosis - high mag. (WC)

  • Confluent epidermal necrosis - very high mag. (WC)

Staphylococcal scalded skin syndrome

  • Abbreviated SSSS.

General

  • Due to keratinocyte cell-cell adhesion loss in the superficial epidermis - caused by S. aureus.[3]

Clinical:

  • Blisters

Microscopic

Features:[3]

  • Superficial dermis separates from underlying tissue - looks artefactual.
  • Minimal/scant inflammation is typical.[4]

Image:

See also

References

  1. ↑ 1.0 1.1 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1189. ISBN 978-1416031215.
  2. ↑ S. Sade. 8 September 2011.
  3. ↑ 3.0 3.1 Nishifuji, K.; Sugai, M.; Amagai, M. (Jan 2008). "Staphylococcal exfoliative toxins: "molecular scissors" of bacteria that attack the cutaneous defense barrier in mammals.". J Dermatol Sci 49 (1): 21-31. doi:10.1016/j.jdermsci.2007.05.007. PMID 17582744.
  4. ↑ URL: http://dermatlas.med.jhmi.edu/derm/display.cfm?ImageID=2105774586. Accessed on: 22 September 2011.
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