Eczema/Atopic, Contact Dermatitis, etc: Spongiotic Dermatitis Pattern - Inflammatory Dermpath Basics

This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.

Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.

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[wolpumba]

*Summary*
* *(**0:10**) Spongiotic Dermatitis Pattern:* This is a common pattern in skin biopsies characterized by fluid (edema) between skin cells (keratinocytes) in the epidermis. Imagine a sponge soaking up water, hence the name.

* *(**1:42**) Key Features:* Look for these clues under the microscope:
* *(**1:42**) Spongiosis:* The spaces between the keratinocytes are widened.
* *(**1:42**) Desmosome Spines:* Visible connections between the cells that look like spines, more pronounced due to the spongiosis.
* *(**1:42**) Scattered Lymphocytes:* A type of white blood cell found amongst the keratinocytes.
* *(**1:42**) Serum and Perikeratosis:* Fluid and retained cell nuclei on the skin's surface, often leading to a scaly or crusty appearance.

* *(**2:20**) Common Causes:* Several conditions can lead to this pattern, including:
* *(**2:20**) Atopic Dermatitis (Eczema)*
* *(**2:20**) Contact Dermatitis*
* *(**2:20**) Numbular Dermatitis*

* *(**2:50**) Eosinophils:* The presence of these white blood cells *can* suggest Contact Dermatitis, but they can also be present in other conditions, so their presence alone isn't definitive.

* *(**3:41**) Langerhans Cell Collections:* These collections of specific skin cells can be seen and are a normal part of this pattern. Don't confuse them with signs of skin cancer.

* *(**4:47**) Subcorneal Pustules:* If pus-filled bumps (pustules) are present, it's important to report them, as they can point to specific, rarer conditions.

* *(**5:11**) Important Note:* If you see this pattern and neutrophils (another type of white blood cell) in the outer layer of skin, always check for fungal infection! This can look very similar and requires different treatment.

* *(**6:54**) Clinical Context is Key:* While the microscope can show the spongiotic pattern, it's difficult to tell the exact cause just by looking at the biopsy. The patient's symptoms and the dermatologist's examination are crucial for making a diagnosis.

In short, spongiotic dermatitis is a pattern seen under a microscope characterized by fluid-filled spaces in the skin. It can be caused by a number of things and requires additional information to pinpoint the specific cause.

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[luisinaa]

I experienced this condition for the very first time on my right hand and fingers! It was unbelievably uncomfortable and it happened the end of December and gotten worse with blisters and inflammation over a month… thank goodness the doctor in the hospital did the biopsy procedure to find more details and boom! Spongiotic dermatitis! I had to take multiple anti creams and pills before the results were final. I gotta say, this was the scariest condition I’ve received in my life!

[angeloforido]

I currently have this condition. Very itchy spots developing in my arms back and legs. Usually gets worse at night I have bought creams recommended by doctors all useless.
I am now getting much relief from hydrogen peroxide I dab it on with cotton wool. This is working well for me

[drew]

Have you ever used an electron microscope? Do you think it would be useful for anything dermpath related?