Sébastien Menzinger1,2,3, Annonciade Frassati-Biaggi4, Stéphanie Leclerc-Mercier5, Christine Bodemer6, Thierry Jo Molina1,1, Sylvie Fraitag2,2. 1. Resident, Department of Pathology, Hôpital Necker-Enfants Malades, Paris, France. 2. Department of Dermatology, Hôpital Necker-Enfants Malades, Paris, France. 3. Department of Dermatology and Venereology, Hôpitaux Universitaires de Genève, Geneva, Switzerland. 4. Consultant, Department of Pathology, Hôpital Necker-Enfants Malades, Université Paris Descartes-Sorbonne Paris Cité, Paris, France. 5. Practicien Hospitalier, Department of Pathology, Hôpital Necker-Enfants Malades, Université Paris Descartes-Sorbonne Paris Cité, Paris, France. 6. Head of the Department of Dermatology, Hôpital Necker-Enfants Malades, Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
Abstract
INTRODUCTION: Pityriasis lichenoides (PL) is an infrequent skin disorder. The clinical manifestations are usually specific enough for a reliable diagnosis, although the histopathological assessment of a biopsy is sometimes needed to differentiate between PL and a range of other diseases. The objectives of this study were to review cases of PL managed in our hospital, confirm the classical histopathological features of PL, and identify signs that may be of value in the diagnosis of PL. MATERIALS AND METHODS: All cases of PL assessed in our pathology department between January 2007 and December 2017 were retrieved, and all slides were reviewed. Cases were selected only if a diagnosis of PL was initially suggested by a dermatologist and then confirmed by the histopathological assessment. RESULTS: Seventy-one cases met the study criteria. The following features were almost always present: vacuolar changes or necrotic keratinocytes (100%), both superficial and deep lymphocytic infiltrates (99%), and the infiltration of lymphocytes into the adnexal epithelium (97%). The inflammatory cells were always small- to medium-sized lymphocytes. There were no eosinophilic infiltrates. Superficial perivascular and/or intraepidermal red blood cells were observed in 83% of cases. DISCUSSION: We highlighted the presence of a deep dermal lymphocytic infiltrate, with a "T-shaped" periadnexal arrangement along the full length of the follicular and sudoral epithelia. This might be a feature that enables the differentiation of PL from other diseases. Our findings also prompted a number of physiopathological hypotheses for PL. CONCLUSIONS: Our present results confirmed the classical histological aspects of PL and provided some useful new diagnostic features.
INTRODUCTION:Pityriasis lichenoides (PL) is an infrequent skin disorder. The clinical manifestations are usually specific enough for a reliable diagnosis, although the histopathological assessment of a biopsy is sometimes needed to differentiate between PL and a range of other diseases. The objectives of this study were to review cases of PL managed in our hospital, confirm the classical histopathological features of PL, and identify signs that may be of value in the diagnosis of PL. MATERIALS AND METHODS: All cases of PL assessed in our pathology department between January 2007 and December 2017 were retrieved, and all slides were reviewed. Cases were selected only if a diagnosis of PL was initially suggested by a dermatologist and then confirmed by the histopathological assessment. RESULTS: Seventy-one cases met the study criteria. The following features were almost always present: vacuolar changes or necrotic keratinocytes (100%), both superficial and deep lymphocytic infiltrates (99%), and the infiltration of lymphocytes into the adnexal epithelium (97%). The inflammatory cells were always small- to medium-sized lymphocytes. There were no eosinophilic infiltrates. Superficial perivascular and/or intraepidermal red blood cells were observed in 83% of cases. DISCUSSION: We highlighted the presence of a deep dermal lymphocytic infiltrate, with a "T-shaped" periadnexal arrangement along the full length of the follicular and sudoral epithelia. This might be a feature that enables the differentiation of PL from other diseases. Our findings also prompted a number of physiopathological hypotheses for PL. CONCLUSIONS: Our present results confirmed the classical histological aspects of PL and provided some useful new diagnostic features.