E Ruiz1, J S Deng, E A Abell. 1. Department of Dermatology, University of Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Epidermal spongiosis with exocytosis of eosinophils (ES) has been reported in biopsy specimens from patients with various dermatoses. Its diagnostic value and the patient's outcome remain poorly understood in those cases in which ES is not associated directly with diagnostic features of a bullous dermatosis. OBJECTIVE: We evaluated the clinical, histopathologic, and immunopathologic findings and their clinical correlation in patients who had ES in a biopsy specimen but who had no evidence of a bullous dermatosis. METHODS: A retrospective study of 150 cases with ES was performed. Clinical, histopathologic, direct immunofluorescence, and subsequent follow-up data were collected to assess final diagnosis and outcome. RESULTS: A total of 144 patients had generalized eruptions; of these, 34 (24%) had autoimmune bullous disease. Fourteen (41%) of those patients had neither a bullous nor a vesicular eruption. Other diagnoses included eczematous dermatitis, arthropod bites, scabies, and drug eruption. CONCLUSION: The majority of patients whose biopsy specimen revealed only ES had either dermatitis or autoimmune bullous disease, often in the prodromal phase. Direct immunofluorescence is often necessary to distinguish these diseases, and repeated testing may be needed for final diagnosis.
BACKGROUND: Epidermal spongiosis with exocytosis of eosinophils (ES) has been reported in biopsy specimens from patients with various dermatoses. Its diagnostic value and the patient's outcome remain poorly understood in those cases in which ES is not associated directly with diagnostic features of a bullous dermatosis. OBJECTIVE: We evaluated the clinical, histopathologic, and immunopathologic findings and their clinical correlation in patients who had ES in a biopsy specimen but who had no evidence of a bullous dermatosis. METHODS: A retrospective study of 150 cases with ES was performed. Clinical, histopathologic, direct immunofluorescence, and subsequent follow-up data were collected to assess final diagnosis and outcome. RESULTS: A total of 144 patients had generalized eruptions; of these, 34 (24%) had autoimmune bullous disease. Fourteen (41%) of those patients had neither a bullous nor a vesicular eruption. Other diagnoses included eczematous dermatitis, arthropod bites, scabies, and drug eruption. CONCLUSION: The majority of patients whose biopsy specimen revealed only ES had either dermatitis or autoimmune bullous disease, often in the prodromal phase. Direct immunofluorescence is often necessary to distinguish these diseases, and repeated testing may be needed for final diagnosis.