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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

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

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
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Clinical Details: F60. Elbow. Persistent eczematous eruption with vesicles exterior limbs. ?Acute eczema.  ?Drug eruption.  DD: ?Prebullous pemphigoid.

Case Posted by Dr Richard A Carr


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Admin_Dermpath

Posted

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

 

Geoff Cross - DermpathPRO Projects

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Robledo F. Rocha

Posted

Spongiotic dermatitis with Langerhans cell microabscesses.

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vincenzo polizzi

Posted

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 ).

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Raul Perret

Posted

agree spongiotic dermatitis now with nice langerhans cell microabscesses

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Dr. Richard Carr

Posted

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.

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