TABLE 1.
Histologic features of erythroderma observed in 47 skin biopsies
| Feature | CTCL (n=18) | Drug (n=5) | Psoriasis (n=9) | Eczema (n=5) | Other (n=10) | EID (n=29) | Total (n=47) | P (Chi-2) CTCL vs EID |
|---|---|---|---|---|---|---|---|---|
| Epidermal changes | ||||||||
| Orthokeratosis | 5 (28%) | 1 (20%) | 2 (22%) | 0 | 2 (20%) | 5 (17%) | 10 (21%) | 0.618 |
| Parakeratosis | 7 (39%) | 1 (20%) | 7 (77%) | 4 (80%) | 5 (50%) | 17 (59%) | 24 (51%) | 0.307 |
| Thickened granulous layer | 1 (6%) | 0 | 1(11%) | 1 (20%) | 0 | 2 (7%) | 3 (6%) | >0.9 |
| Psoriasiform hyperplasia | 3 (17%) | 0 | 4 (44%) | 3 (60%) | 1 (10%) | 8 (28%) | 11 (23%) | 0.608 |
| Irregular hyperplasia | 6 (33%) | 4 (80%) | 2 (22%) | 2 (40%) | 3 (30%) | 11 (38%) | 17 (36%) | >0.9 |
| Atrophic epidermis | 2 (11%) | 1 (20%) | 0 | 0 | 1 (10%) | 2 (7%) | 4 (9%) | >0.9 |
| Suprapapillary thinning | 0 | 0 | 2 (22%) | 0 | 0 | 2 (7%) | 2 (4%) | 0.688 |
| Presence of spongiosis | 5 (28%) | 1 (20%) | 4 (44%) | 4 (80%) | 6 (60%) | 15 (52%) | 20 (43%) | 0.188 |
| Marked spongiosis (pre-vesicles) | 0 | 0 | 0 | 3 (60%) | 2 (20%) | 5 (17%) | 5 (11%) | 0.165 |
| Vesicles | 0 | 0 | 0 | 0 | 0 | 0 | 0 | - |
| Number of necrotic keratinocytes per mm | 0.34 | 0.07 | 0 | 0,12 | 0.57 | 0,19 | 0,22 | 0.353 |
| Number of mitoses per mm (mean) | 0,68 | 0.98 | 1.80 | 2.15 | 0.73 | 1,42 | 1.27 | 0.099 |
| Dermo-epidermal junction | ||||||||
| Focal interface dermatitis | 6 (33%) | 1 (20%) | 2 (22%) | 3 (60%) | 2 (20%) | 8 (28%) | 14 (30%) | >0.9 |
| Widespread interface dermatitis | 1 (6%) | 0 | 0 | 0 | 2 (20%) | 2 (7%) | 3 (6%) | >0.9 |
| Melanophages | 3 (17%) | 0 | 0 | 0 | 2 (20%) | 2 (7%) | 5 (11%) | 0.562 |
| Presence of exocytosis | 14 (78%) | 4 (80%) | 6 (67%) | 4 (80%) | 4 (40%) | 18 (62%) | 32 (68%) | 0.419 |
| Single lymphocytes epidermotropism | 5 (28%) | 4 (80%) | 6 (67%) | 2 (40%) | 4 (40%) | 16 (55%) | 21 (45%) | 0.006 |
| Basilar lymphocytes | 1 (6%) | 0 | 0 | 0 | 0 | 0 | 1 (2%) | - |
| Pagetoid epidermotropism | 0 | 0 | 0 | 2 (40%) | 0 | 2 (7%) | 2 (4%) | 0.581 |
| Pautrier’s microabcess | 8 (44%) | 0 | 0 | 0 | 0 | 0 | 8 (17%) | 0.004 |
| Exocytosis of eosinophils | 0 | 0 | 0 | 0 | 0 | 0 | 0 | - |
| Exocytosis of isolated neutrophils | 1 (6%) | 0 | 1 (11%) | 1 (20%) | 0 | 2 (7%) | 3 (6%) | 0.680 |
| Corneal/subcorneal pustules | 2 (11%) | 1 (20%) | 6 (67%) | 1 (20%) | 1 (10%) | 9 (31%) | 11 (23%) | 0.222 |
| Atypical lymphocytes | 12 (66%) | 1 (20%) | 0 | 0 | 0 | 1 (3%) | 13 (28%) | 0.014 |
| Circonvoluted nuclei | 4 (22%) | 0 | 0 | 0 | 0 | 0 | 4 (9%) | - |
| Dermal infiltrate | ||||||||
| Superficial infiltrate | 18 (100%) | 5 (100%) | 9 (100%) | 5 (100%) | 10 (100%) | 28 (100%) | 47 (100%) | - |
| Superficial and deep infiltrate | 0 | 0 | 0 | 0 | 0 | 0 | 0 | - |
| Deep infiltrate | 0 | 0 | 0 | 0 | 0 | 0 | 0 | - |
| Hypodermic infiltrate | 0 | 0 | 0 | 0 | 0 | 0 | 0 | - |
| Band like infiltrate | 13 (72%) | 1 (20%) | 5 (56%) | 1 (20%) | 5 (50%) | 12 (41%) | 25 (53%) | 0.164 |
| Perivascular infiltrate | 5 (28%) | 4 (80%) | 4 (44%) | 4 (80%) | 5 (50%) | 17 (59%) | 22 (47%) | 0.077 |
| Diffuse infiltrate | 0 | 0 | 0 | 0 | 0 | 0 | 0 | - |
| Slight density | 1 (6%) | 4 (80%) | 7 (78%) | 2 (40%) | 7 (70%) | 20 (69%) | 21 (44%) | <0.001 |
| Moderate density | 12 (67%) | 1 (20%) | 2 (22%) | 3 (60%) | 3 (30%) | 9 (31%) | 21 (45%) | 0.036 |
| High density | 5 (28%) | 0 | 0 | 0 | 0 | 0 | 5 (11%) | 0.011 |
| Eosinophils | 0 | 0 | 0 | 0 | 0 | 0 | 0 | - |
| Neutrophils | 1 (6%) | 1 (20%) | 3 (33%) | 2 (40%) | 3 (30%) | 9 (31%) | 10 (2%) | 0.086 |
| Dermal changes | ||||||||
| Vasculitis | 0 | 0 | 0 | 0 | 0 | 0 | 0 | - |
| Papillary dermal fibrosis | 7 (39%) | 1 (20%) | 0 | 3 (60%) | 1 (10%) | 5 (17%) | 12 (26%) | 0.188 |
| Telangiectasias | 8 (44%) | 3 (60%) | 8 (89%) | 5 (100%) | 8 (80%) | 24 (83%) | 32 (68%) | 0.015 |
| Edema of papillary dermis | 4 (22%) | 1 (20%) | 7 (78%) | 3 (60%) | 5 (50%) | 16 (55%) | 20 (43%) | 0.054 |
| Angiogenesis | 11 (61%) | 1 (20%) | 5 (56%) | 5 (100%) | 3 (30%) | 14 (48%) | 25 (53%) | 0.573 |
Results are expressed in percentage within each category of erythroderma. CTCL, cutaneous T cell lymphoma; EID, erythrodermic inflammatory dermatoses.