interface disorders - animal health australia
TRANSCRIPT
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Interface Disorders
Elizabeth A. Mauldin, Dip ACVP & ACVDAssistant Professor
University of PennsylvaniaSchool of Veterinary Medicine
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Interface pattern
• Superficial perivascular dermatitis with obscuring of the DEJ interface
• Due to – (1) vacuolar alteration– (2) lichenoid infiltrate– Or both
• Immune rxn targeting basal keratinocytes and BMZ
Ackerman, B. Histologic Diagnosis of Inflammatory Skin Disease, 1978.
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Interface
• Vacuolar alteration (hydropic degeneration/vacuolar change)– Does not always have a lichenoid infiltrate
• Lichenoid Infiltrate – Always associated with vacuolar alteration
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Problems with “Lichenoid” and “Interface” in Veterinary Dermpath
• Both terms are often used incorrectly • #1 Can see subtle “interface-type” changes in many
inflammatory reactions
• #2 Lichenoid has two interpretations– Should imply interface change– Also used to describe a band of inflammatory cells without
interface change
• “Lichenoid interface”- now being used when there is lichenoid inflammation with interface change
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Lichenoid
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Is this Lichenoid?
Plasmacytic gingivitis in a cat
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Is this lichenoid?
Chronic gingivitis in a dog
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Interface or Not?
Same case as last slide, pigmentary incontinence
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• Lichenoid?: inflammation of mucous membranes nonspecific band of inflammatory cells
• Vacuolar alteration: seen with any inflammatory infiltrate that extends to the DEJ
• Apoptotic or necrotic keratinocytes can be seen incidentally in many inflammatory rxns
• Pigmentary incontinence is not a specific change to interface rxns
• Use terms carefully!
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Interface disorders
• Erythema multiforme/drug eruption • Thymoma associated dermatosis • Lupoid disorders
– Cutaneous vesicular lupus – Exfoliative lupus – Discoid lupus
• Dermatomyositis • Rabies vaccine associated ischemic
dermatopathy• Graft vs. Host disease• Symmetric lupoid onychodystrophy (onychitis)
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Interface dermatitis
Damage to basal keratinocytes
atrophic cell rich
plasma cells
Multifocal keratinocyte apoptosis
Dermatomyositis Erythema multiformeGVHD
Discoid Lupus?
lymphohistiocytic
Cutaneous lupus
vasculitis
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Graft vsHost Disease (GVHD)
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GVHD
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GVHD
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GVHD
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Erythema multiforme
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Erythema Multiforme
• Mutifactorial *cutaneous rxn pattern*• EM Major/SJS
– Drugs, infectious dz, neoplasia– Young dogs- more likely drug-associated
– Old dogs- more likely idiopathic
• TEN/SJS distinction- clinical features– Pathologists view TEN
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Erythema Multiforme
• Ulcerated serpiginous to targetoiderythematous ulcers and plaques– Hyperkeratotic and ulcerated
• +/- mucous membrane involvement
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Interface Disorders – cell poor
• Erythema multiforme
• Multiforme = MULTIPLE FORMS!
– Transepidermal individual keratinocytenecrosis/apoptosis
– Satellitosis– Hyperkeratosis (orthokeratotic to
parakeratotic) with multifocal ulcers
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Erythema multiforme
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EM/SJS/TEN
• Many diseases with individually necrotic/apoptotic cells ≠ equivalent with EM
• Limited in our indentification and documentation of patterns of eruptions
• Histopathology provide DDX for drug eruption in veterinary medicine
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Idiopathic Erythema Mulforme
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Erythema multiforme Major/Stevens Johnson Syndrome
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EMM/SJS