Dermal Hypersensitivity Reaction
In my practice, it is often that I come across slides showing only dermal hypersensitivity reaction. In such cases one encounter a mild superficial perivascular lymphocytic infiltrate with no or minimal deep dermal extension, associated with some perivascular and interstitial esinophils and mild dermal edema. Usually the epidermis is normal or only mildly spongiotic. Sometimes, lymphocytic vasculitis is associated.
In such cases, going back to the clinical presentation will be of no help as one usually encounters non specific intensely pruritic erythematous edematous papules. Such cases are sometimes annoying to the patients as itching might be severe, and both patients and clinicians try to find the answer at the dermatopathologist who simply disappoints them by just signing out these cases as: dermal hypersensitivity reaction!!!
It is important to identify dermal hypersensitivity reaction as a histopathological reaction pattern that can be encountered as a reaction to many etiological factors such as: insect bites, drugs, vaccines or as a non specific cutaneous reaction to internal malignancies including lymphoma. Such cases are difficult as thorough history taking and work up are needed to identify the exact underlying cause.
In such cases, going back to the clinical presentation will be of no help as one usually encounters non specific intensely pruritic erythematous edematous papules. Such cases are sometimes annoying to the patients as itching might be severe, and both patients and clinicians try to find the answer at the dermatopathologist who simply disappoints them by just signing out these cases as: dermal hypersensitivity reaction!!!
It is important to identify dermal hypersensitivity reaction as a histopathological reaction pattern that can be encountered as a reaction to many etiological factors such as: insect bites, drugs, vaccines or as a non specific cutaneous reaction to internal malignancies including lymphoma. Such cases are difficult as thorough history taking and work up are needed to identify the exact underlying cause.
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