Pattern Analysis nach Lever

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Disorders of the superficial cutaneus reactive unit1[Bearbeiten]

Superficial perivascular dermatitis Lymphocytes predominant Morbilliform viral exanthem

Papular acrodermatitis
Stasis dermatitis
Early Pityriasis lichenoides et varioliformis acuta (PLEVA)
Jessner‘s lymphocytic infiltrate
Candidiasis
Superficial gyrate erythemas
Early Lupus erythematosus
Mixed connective tissue disease
Dermatomyositis
Early herpes simplex or zoster
Morbilliform drug eruption
Cytomegalovirus inclusion disease
Polymorphus drug eruption
Progressive pigmented purpura
Parapsoriasis, small plaque type (digitate dermatosis)
Mucocutaneous lymph node syndrome (kawasaki‘s disease)

Secondary syphilis
with eosinophils Arthropod-bite reaction

Allergic urticaria reaction (drug)
Bullous pemphigoid, urticarial phase
Erythema toxicum neonatorum
Wells‘ syndrome
Mastocytosis/teleangiectasia macularis eruptiva perstans
Angiolymphoid hyperplasia with eosinophilia
Kimura‘s disease

Langerhans cell histiocytosis (early)
with neutrophils Cellulitis

Erysipelas
Urticaria
Still‘s disease

Vasculitis
with plasmacells Secondary syphilis

Arthropod-bite reaction
Kaposi‘s sarcoma, patch stage
Actinic keratoses and Bowen‘s disease
Zoon‘s plasma cell balanitis circumscripta

Erythroplasia of Queyrat
with extravasated red cells Pityriasis rosea

Lupus erythematosus, early
Lupus erythematosus, subacute
Postinflammatory hyperpigmentation
Stasis dermatitis
Kaposi‘s sarcoma, patch stage
Pityriasis lichenoides et varioliformis acuta (PLEVA)
Pityriasis lichenoides chronica

Pigmented purpuric dermatoses (Schamberg‘s)
Melanophages prominent Postinflammatory hyperpigmentation

Postchemotherapy hyperpigmentation
Chlorpromazine pigmentation
Amyloidosis
Regressed pigmented lesion

Resolved lichenoid reaction uncluding fixed drug eruption
Mast cells predominant Urticaria pigmentosa, nodular type

Telangiectasia macularis eruptiva perstans (TMEP), adult mast cell

disease
Superficial dermatitis with spongiosis (spongiotic dermatitis) Lymphocytes predominant Eczematous dermatitis Atopic dermatitis

Allergic contact dermatitis
Photoallergic drug eruption
Irritant contact dermatitis
Nummular dermatitis (eczema)

Dyshidrotic dermatitis
Parapsoriasis, small-plaque type (digitate

dermatosis)
Polymoprhus light eruption
Lichen striatus
Chronic actinic dermatitis (actinic reticuloid)
Actinic prurigo, early lesions
„id“ reaction
Seborrheic dermatitis
Stasis dermatitis
Erythroderma
Miliaria
Pityriasis rosea
Sézary‘s syndrome

Papular acrodermatitis (Gianotti-Costi)
with eosinophils Spongiotic (eczematous) dermatitis Atopic dermatitis

Allergic contact dermatitis

Photoallergic eruption
Incontinentia pigmenti, vesicular stage

Eczematous nevus (Meyerson‘s nevus)
Erythema gyratum repens
Scabies

Erythema toxicum neonatorum
with plasma cells Syphilis, primary or secondary lesions

Pinta, primary or secondary lesions

Seborrheic dermatitis in HIV infection
with neutrophils Dermatophytosis

Seborrheic dermatitis

Toxic shock syndrome
Superficial dermatitis with epidermal atrophy (atrophic dermatitis) scant inflammatory infiltrates Aged skin

Chronic actinic damage
Radiation dermatitis
Porokeratosis
Acrodermatitis chronica atrophicans
Malignant atrophic papulosis

Poikiloderma atrophicans vasculare
lymphocytes predominant Parapsoriasis/early mycosis fungoides

Lupus erythematosus
Mixed connective tissue disease
Pinta, tertiary lesions

Dermatomyositis
epidermal atrophy, lymphocytes predominant with papillary dermal sclerosis / matrix changes Lichen sclerosus et atrophicus

Thermal burns
Parapsoriasis/early mycosis fungoides
Poikiloderma vasculare atrophicans

Radiation dermatitis
Superficial dermatitis with psoriasiform proliferation (psoriasiform dermatitis) Lymphocytes predominant Chronic spongiotic dermatitis Atopic dermatitis

Seborrheic dermatitis

Nummular dermatitis (eczema)
Lichen simplex chronicus

Prurigo nodularis
Psoriasis
Psoriasiform drug eruptions
Pityriasis rosea
Exfoliative dermatitis
Pityriasis rubra pilaris
Parapsoriasis/early mycosis fungoides
Verrucous hyperkeratotic mycosis fungoides
Inflammatory linear verrucous epidermal nevus (ILVEN)
Pellagra
Necrolytic migratory erythema (chronic lesions)
Acrodermatitis enteropathica
Kwashiorkor

Reticulated hyperpigmentations (e.g. Dowling-Degos disease)
Lymphocytes predominant with plasma cells Atrhopod-bite reactions

Secondary syphilis
Cutaneous T-cell lymphoma (mycosis fungoides)

Prurigo nodularis
Lymphocytes predominant with eosinophils Chronic spongiotic dermatitis Chronic allergic dermatitis
Chronic atopic dermatitis
Exfoliative dermatitis

Cutaneous T-cell lymphoma

Incontinentia pigmenti, verrucous stage
Neutrophils prominent Psoriasis vulgaris Pustular psoriasis
Reiter‘s syndrome, keratoderma blenorrhagicum
Pustular drug eruption

Acute generalized exanthematous pustulosis
Geographic tongue (lingua geographica)
Candidiasis
Pustular secondary syphilis (rare)

Dermatophytosis
with epidermal pallor or necrosis ("Nutritional Dermatosis") Necrolytic migratory erythema

Necrolytic acral erythema
Acrodermatitis enteropathica

Pellagra
Superficial

dermatitis with irregular epidermal proliferation (hypertrophic

dermatitis)
Lymphocytes predominant Lichen simplex chronicus

Inflammatory linear verrucous nevus (ILVEN)
Prurigo nodularis
Incontinentia pigmenti, verrucous stage
Pellagra (niacin deficiency)

Hartnup‘s disease
Lymphocytes predominant, Plasma cells present Squamous cell carcinoma in situ (Bowen‘s disease)

Erythroplasia of Queyrat
Rupial secondary syphilis, condyloma lata
Yaws, primary or secondary
Pinta, primary or secondary lesions
Actinic keratosis
Pseudoepitheliomatous hyperplasia

Pemphigus vegetans
Neutrophils prominent Deep fungal infections

Halogenodermas
Botryomycosis
Keratoacanthoma
Impetigo contagiosa

Granuloma inguinale
Neoplastic irregular epidermal proliferation Squamous cell carcinoma

Malignant melanoma („verrucous pattern“)

Granular cell tumor
Superficial dermatitis with lichenoid infiltrates (lichenoid dermatitis) Lymphocytes excusively Lichen planus-like keratosis (benign lichenoid

keratosis)
Lichen planus
Pityriasis lichenoides chroncia, Lupus erythematodes, lichenoid forms
Mixed connective tissue disease
Acrodermatitis chroncia atrophicans
Poikiloderma atrophicans vasculare
Pigmented purpuric dermatitis, lichenoid type (Gougerot-Blum)
Graft-versus-host disease (GVHD), lichenoid stage
Erythema multiforme
Pityriasis lichenoides et varioliformis acuta (PLEVA), early lesions
Parapsoriasis/mycosis fungoides, patch/plaque stage

Sèzary‘s syndrome
Lymphocytes predominant Lichen planus-like keratosis (benign lichenoid

keratosis)
Parapsoriasis/mycosis fungoides, patch/plaque stage
Sèzary‘s syndrome
Paraneoplastic pemphigus
Secondary syphilis
Halo nevus
Lichenoid tattoo reaction

Lichen striatus
Lymphocytes predominant, eosinophils present Lichenoid drug eruptions

Lichenoid actinic keratoses
Lichen planus, hypertrophic
Arthropod-bite reactions
Cutaneous T-cell lymphoma, mycosis fungoides, patch/plaque stage
Hitiocytosis X (letterer-Siwe

Mastocytosis/telangiectasia eruptiva macularis perstans
Lymphocytes predominent, plasma cells present Lichenoid actinic keratosis

Lichenoid keratosis (lichen planus-like keratosis)
Bowen‘s disease
Erythroplasia of Queyrat
Keratosis lichenoides chroncia
Secondary syphilis
Pinta, primary or secondary lesions
Arthropod-bite reaction
Cutaneous T-cell lymphoma, mycosis fungoides, patch/plaque stage
Zoon plasma cell balanitis

Lichen striatus
Lymphocytes predominant, with melanophages Postinflammatory hyperpigmentation
Histiocytes predominant Lichen nitidus

Actinic reticuloid/chronic actinic dermatitis
Histiocytosis X (Letterer-Siwe, Hand-Schüller-Christian)

Granulomatous slack skin
Superficial vasculitis and vasculopathies Neutrophilic vasculitis Cutaneous necrotizing (leukocytoclastic) vasculitis Henoch-Schönlein purpura

Cryoglobulinemia
Connective tissue associated (rheumatoid arthritis, lupus erythematosus)
Septicemia, especially meningococcemia/ gonococcemia
Urticarial vasculitis
Erythema elevatum diutinum

Miscellaneous
Polyarteritis nodosa
Vasculitis in exanthemic pustulosis (drug induced)
Mixes cell and granulomatous vasculitis Churg-Strauss vasculitis

Wegener granulomatosis
Giant-cell arteritis
Granuloma faciale

Buerger‘s disease
Vasculopathies with scant inflammation Atrophie blanche (segmental hyanizing vasculitis)

Malignant atrophic papulosis (Degos)
Mondor‘s disease

Pigmented purpuric dermatoses (Majcchi-Schamberg-Gougerot-Bloom)
Thrombotic, embolic and other microangiopathies Disseminated intravascular coagulation

Thrombotic thrombocytopenic purpura
Cryoglobulinemia/macroglobulinemia
Antiphospholipid syndrome
Lupus anticoagulant and anticardiolipin syndromes
Connective tissue disease (rheumatoid, mixed)
Calciphylaxis
Amyloidosis
Porphyria cutanea tarda and other porphyrias

Cholesterol emboli
Superficial dermatitis with interface vacuoles (interface dermatitis) Apoptotic / necrotic cells present Erythema multiforme Toxic epidermal necrolysis (Lyell)


Steven-Johnson syndrome
Fixed drug eruption

Phototoxic drug eruption
Radiation dermatitis
Sunburn reaction
Thermal burn
Pityriasis lichenoides et varioliformis acuta (PLEVA)
Graft-versus-host disease (GVHD), acute
Eruption of lymphocyte recovery

Bullous vasculitis
Apoptotic cells usually absent Dermatomyositis

Morbilliform viral exanthem
Poikiloderma vasculare atrophicans
Paraneoplastic pemphigus
Erythema dyschromicum perstans

Pinta, tertiary stage
variable apoptosis Cytotoxic drug eruptions

Lupus erythematosus

Drug-induced lupus
Basement membrane thickenend Lupus erythematosus

Referenz[Bearbeiten]

1. David E. Elder (Author), R. E. E., Bernett L. Johnson (Editor), George F. Murphy (Editor), Xiaowei Xu (Editor) (2008). "Lever's Histopathology of the Skin."