ABSTRACT
Erythroderma is an uncommon, potentially life-threatening condition, which has many causes, including uncontrolled psoriasis. We present a 58-year-old woman with psoriasis who, after an abrupt discontinuation of systemic corticosteroids, developed erythrodermic psoriasis with extensive body surface involvement requiring hospital admission. Erythrodermic psoriasis requires a high index of suspicion to diagnose it in a timely fashion and treat it to prevent complications.
ABSTRACT
BACKGROUND: Bullous pemphigoid (BP) is an autoimmune vesiculobullous dermatitis that primarily affects the elderly and presents with tense, fluid-filled blisters. The histological hallmark on routine hematoxylin & eosin (H&E)-stained specimens is a subepidermal blister with luminal eosinophils. However, there are histologic variants than can produce diagnostic confusion. METHODS: All immunofluorescence reports from an independent certified dermatopathology laboratory (2006-2015) were inspected, and those with findings consistent with an autoimmune subepidermal blistering process were selected. Seventy-seven cases were identified, and the corresponding H&E-stained specimens were reviewed by two dermatopathologists who tabulated the histopathologic findings. RESULTS: Just over half of biopsies showed subepidermal clefting (54%). The histologic variants included: urticarial or eczematous findings (17%), partial or complete re-epithelialization (28%), and epidermal necrosis (7%). CONCLUSION: While re-epithelialization of subepidermal blisters is a commonly accepted phenomenon, there are no published data demonstrating its incidence. Because only half of the biopsies showed the classic subepidermal blister, it is important to be aware of the spectrum of histopathologic findings that occur in this disease. Specifically, the presence of an intraepidermal blister and/or epidermal necrosis on routine H&E-stained specimens does not preclude the diagnosis of pemphigoid.
