VIRAL DERMATITIS; CLINICALLY CHICKENPOX (VARICELLA) IN AN ADULT
The cytologic alterations in keratinocytes in herpes simplex and in zoster/varicella are similar. The keratinocytes enlarge, the nuclear chromatin pattern is lost, and there is irregular condensation of nuclear material on the nuclear membrane. Cell that resemble the corps ronds of Darier's disease or Grover's disease may be seen, and some of the cells may look like doll's eyes or teddy bear eyes. Multinucleated keratinocytes occur, but they are not necessary for the diagnosis. The blister/s may be intraepidermal, or may extend into the suprabasal location. Reticular degeneration is seen, and there may be apoptotic keratinocytes in the middle and upper levels of the epidermis. The dermal inflammatory response is variable.
 
Scan showing a blister plus superficial and deep perivascular inflammatory infiltrates.
Multinucleated keratinocytes (MN), necrotic keratinocytes (NK), and a "doll's eye"cell (EC).
High power near base of vesicle.
Cell resembling a corp rond (CR). Note the lack of distinct chromatin granules plus irregular condensation of nuclear material on the nuclear membranes of other keratinocytes.
Apoptotic keratinocyte (AK). Note reticular change in the epidermis and enlargement of keratinocytes. 
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