dermatitis herpetiformis

DERMATITIS HERPETIFORMIS

Clusters of polymorphonuclear leukocytes and nuclear debris within necrotic dermal papillae are characteristic of early lesions of dermatitis herpetiformis. This produces subepidermal vesiculation with the accumulation of PMN's within the vesicle. Eosinophilic leukocytes are mixed with the PMN's in a few cases. The papillae may become basophilic, but this is not constant. Although dermatitis herpetiformis is not usually thought of as being an acantholytic disease, acantholysis can be seen in later lesions.

Although linear IgA bullous dermatosis is usually seen in children, it can be seen in adults, and the pathology can be the same as is seen here. Furthermore, there is a subset of linear IgA disease in adults that is clinically indistinguishable from dermatitis herpetiformis. Those cases do not respond to gluten-free diets, so immunofluorescent studies are warranted in cases such as this.

Low power view of a biopsy of an early lesion.

High power view of above. The inflammatory cells within the vesicle are PMN's. Slight basophilia is seen in the partly necrotic dermal papilla.

High power view of a late lesion from the same patient. The large, round, dark cells are acantholytic keratinocytes.

Click on your browser's 'Back' button to go to the previous page.

	Low power view of a biopsy of an early lesion.
	High power view of above. The inflammatory cells within the vesicle are PMN's. Slight basophilia is seen in the partly necrotic dermal papilla.
	High power view of a late lesion from the same patient. The large, round, dark cells are acantholytic keratinocytes.