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Spongiform pemphigoid: A case series of an uncommon histopathologic pattern
Author(s) -
Merton Armand,
Wu YuHung
Publication year - 2020
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/cup.13627
Subject(s) - bullous pemphigoid , papillary dermis , medicine , dermatology , pemphigoid , pathology , dermis , direct fluorescent antibody , immunology , antibody
Bullous pemphigoid is an autoimmune bullous disease characterized by subepidermal separation. We encountered cases of bullous pemphigoid confirmed by direct immunofluorescence study but demonstrating spongiotic dermatitis without subepidermal clefting. Many of them occurred in volar sites, mimicking dyshidrotic dermatitis. Methods We retrospectively collected patients who were pathologically and/or immunopathologically diagnosed with bullous pemphigoid from 2002 to 2017. Patients who presented with prominent spongiosis without subepidermal clefting were included and compared with patients who were diagnosed with dyshidrotic dermatitis. Results A total of nine cases of spongiform pemphigoid out of 385 bullous pemphigoid patients (2.3%) were identified and compared with 15 patients with dyshidrotic dermatitis. Average age of spongiform pemphigoid patients (76 years) was much older than that of the control group (34 years). Microvesicles in the mid‐ to lower epidermis ( P < 0.001), eosinophils exocytosis ( P < 0.001), and eosinophils microabscess ( P < 0.001) in both the epidermis and papillary dermis were more common in spongiform pemphigoid. Conclusion Spongiform pemphigoid mimics spongiotic dermatitis may result in a pathological diagnostic pitfall. The presence of eosinophil microabscess and exocytosis in the epidermis and papillary dermis were important clues. Immunofluorescence studies should be conducted to confirm the diagnosis of bullous pemphigoid.