Spongiotic reaction is subdivided into six subtypes;
Neutrophilic spongiosis in other words spongiosis with neutrophils present and perhaps the important one is IgA pemphigus is a number of conditions in which that can occur and there is AGEPic generalized extent Infantile acropustulosis and one can see quite a lot of neutrophilic spongiosis. Notice the basket-weave is still on the top so this is happened very quickly indeed.
Eosinophilic spongiosis is the next category and there’s a precursor of bullous pemphigoid is one of the most important but a precursors of other bullous diseases can also have eosinophilic. Arthropods of course are a major group. EPPER which is the acidophilic periodic eruption of radiotherapy is another one that can be present. it was interesting that we see this is a rare condition but there was a series from the same institution in France that reported about 25 cases of this eruption. It has been called bullous pemphigoid incorrectly in the past. And then of course incontinentia pigmenti so there is eosinophilic spongiosis notice the nice prickles the widening of the space due to the spongiosis. There’s a baby with incontinentia pigmenti which remember is excelling dominant most of the males die in utero I think there are about 50 living males with this particular condition in the whole world. it’s a disorder of the Nemo Gene found on XQ28. It’s excelling dominant disorder and death in utero for affected males. As well as the eosinophilic spongiosis there are three stages in incontinentia pigmenti. There is the blistering stage does the aphotic dyskeratotic cells and out on the right hand side of that blister there are two aphotic keratinocytes which you don’t normally see in eosinophilic spongosis at all. The third late stage is pigment incontinence as a result of appetizers going on at different levels of the epidermis.
Follicular spongiosis is really seen only in infundibular folliculitis mainly a disorder of black Americans’ but it can also be sometimes seen in the follicular lesions on the abdomen in piece of patients with atopic dermatitis. Occasionally you can get an infundibular folliculitis in atopic eczema.
Pityriasiform Spongiosis is the spongiosis with langerhans cells within the vesicle as well as lymphocytes. it’s particularly seen in pityriasis rosea also in pityriasiform drug reactions in erythema annulare centrifugum. The old thing we used to call erythema annulare centrifugum has been reallocated and is probably a deep form of annular erythema. No longer is it a superficial and deep perivascular lymphocytic infiltrate. It is a pityriasiform tissue reaction. If you separate that group off from the great unwashed in that particular group, you’ve got a well-defined condition which is identical to pityriasis rosea. EAC is a Queensland phenomenon. It’s a long-standing term that’s peculiar to Queensland. There is a pityriasiform Spongiosis you can see in there are localized areas of spongiotic fasciculation and within those vesicles there are usually large cells which actually are Langerhans cells here’s also some lymphocytes. Just to say the herald patch in pityriasis rosea if someone by mistake biopsies that because that’s the only lesion to start with they’re much sorrier as a form in their parents and they shade off into the sorry as a form tissue reaction and pityriasiform spongiosis is probably fairly uncommon in that. Erythema annulare centrifugum again with the pityriasiform tissue reaction against either spongiotic fasciculation there is a little bit of sub-epidermal edema that’s variable in these conditions and within the vesicles Langerhans cells and lymphocytes.
There’s a great group of haphazard spongiosis and a PAS compulsory for any spongiotic vesiculation of palms and soles. There’s the old rule that you can see the matter fights on H and E by turning down the power and lowering your sub stage condenser. These are the important disorders within the haphazard spongiotic group you’re allergic and irritant contact and often there is an overlap between the two. They’re not pure disorders.
- Atopic which often doesn’t have much spongiosis,
- Nummular or discord eczema,
- Seborrhoeic dermatitis,
- Dermatophyde infection