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Dr. Mona Abdel Halim's Blog

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Dermal Hypersensitivity Reaction

Dr. Mona Abdel-Halim


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.


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Dr. Phillip McKee


Personally, when I have managed to contact the clinician, in the main I have beeen able to make the final diagnosis, but not always. Such cases are extremely frustrating!
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Dr. Hafeez Diwan


True! Dermal hypersensitivity reaction should be a springboard to trying to figure out what may be going on.
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Dr. King-Chung Lee


When there is some epidermal component, some may also use the term urticarial dermatitis. Is it true that drug is the most common cause?
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