Case Number : Case 1740 - 27 January - Dr Richard A Carr Posted By: Guest

A beautiful set of images for today's Spot Diagnosis Case from Dr Richard A Carr

Geoff Cross - DermpathPRO Projects

Spongiotic dermatitis with Langerhans cell microabscesses.

In spongiotic bullous pemphigoid the dermal infiltrate is usually mixed, lymphocytic and eosinophilic, and a mild dermal fibroplasia and the focal parakeratosis in fig 5 make me think of a not so early eruption...So agree with Robledo ( maybe an allergic contact dermatitis ).

agree spongiotic dermatitis now with nice langerhans cell microabscesses

Agree with acute spongiotic dermatitis.

Me too, eczema, could be ACD

Yes well done, definitely spongiotic/eczematous! These are the (wide bottomed) vase or flask shaped Langerhan's cell-rich, pseudo-pautrier's microabscesses that can be a clue to allergic contact dermatitis.

For comparison see case 1730 (now >500 views!):

My apologies for the image quality - I suspect it's my old camera and a poor section but it's my only really spectacular case as our clinicians don't biopsy allergic contact very often. In fact the story was interesting as the patient had a long history of chronic atopic eczema and had been recently self-medicating with a neomycin containing topical steroid that had resulted in an acute flare. Clinical colleagues had concluded most likely this was and allergic reaction to the neomycin. I had raised the possibility of a drug reaction at that time not being so aware of the implications of the Langerhan's cell-rich microabscesses.