Epidermal Neutrophils


Fig. 7.1 Pustular psoriasis, generalized. 


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Fig. 7.2 Pustular psoriasis. Courtesy, Julie V Schaffer, MD. From Bolognia JL, Schaffer JV, Duncan KO, Ko CJ. Dermatology Essentials, 1e. Philadelphia: Saunders, 2014, with permission.





Histopathology:


Abundant neutrophils (arrow) below the stratum corneum (Fig. 7.3); may be indistinguishable from acute generalized exanthematous pustulosis and subcorneal pustular dermatosis


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Fig. 7.3 Pustular psoriasis. Pustules correspond to subcorneal collections of neutrophils. A, Courtesy, Kenneth Greer, MD. A, From Bolognia JL, Schaffer JV, Duncan KO, Ko CJ. Dermatology Essentials, 1e. Philadelphia: Saunders, 2014, with permission.


Pustular Psoriasis, Variants


Localized – pustules limited to plaques of psoriasis (Fig. 7.4)


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Fig. 7.4 Pustular psoriasis, localized. Courtesy, Yale Dermatology Residents’ Slide Collection. From Bolognia JL, Schaffer JV, Duncan KO, Ko CJ. Dermatology Essentials, 1e. Philadelphia: Saunders, 2014, with permission.

Annular – rings of erythema studded with peripheral pustules (Fig. 7.5)


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Fig. 7.5 Pustular psoriasis, annular. Courtesy, Yale Dermatology Residents’ Slide Collection. From Bolognia JL, Schaffer JV, Duncan KO, Ko CJ. Dermatology Essentials, 1e. Philadelphia: Saunders, 2014, with permission.

Palmoplantar (Fig. 7.6)


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Fig. 7.6 Pustulosis of the palm. Courtesy, Yale Dermatology Residents’ Slide Collection. From Bolognia JL, Schaffer JV, Duncan KO, Ko CJ. Dermatology Essentials, 1e. Philadelphia: Saunders, 2014, with permission.

Acrodermatitis continua of Hallopeau – distal digit with erythema/scale/pustules (see Fig. 4.11B)



Acute Generalized Exanthematous Pustulosis


Commonly induced by antibiotics (penicillins, macrolides)


Begins on the face/body folds and becomes generalized (Fig. 7.7)


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Fig. 7.7 Acute generalized exanthematous pustulosis, distribution. 

Small, sterile pustules over edema and erythema (Figs 7.8, 7.9)


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Fig. 7.8 Acute generalized exanthematous pustulosis. C, Courtesy, Kalman Watsky, MD. A,B, From Min JA, Park HJ, Cho BK, Lee JY. Acute generalized exanthematous pustulosis induced by Rhus (lacquer). J Am Acad Dermatol. 2010;63:166–8, © Elsevier. C, From Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology, 3e. London: Saunders, 2012, with permission.

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Fig. 7.9 Acute generalized exanthematous pustulosis. Courtesy, Yale Dermatology Residents’ Slide Collection. From Bolognia JL, Schaffer JV, Duncan KO, Ko CJ. Dermatology Essentials, 1e. Philadelphia: Saunders, 2014, with permission.

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Mar 5, 2017 | Posted by in Dermatology | Comments Off on Epidermal Neutrophils

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