The clinical and histopathologic spectrum of "dermal hypersensitivity reactions," a nonspecific histologic diagnosis that is not very useful in clinical practice, and the concept of a "dermal hypersensitivity reaction pattern"

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Abstract

Background: "Dermal hypersensitivity reaction" (DHR) is diagnosed by dermatopathologists but is not an accepted clinical disease entity. There are no clear guidelines for its diagnosis, differential diagnosis, or management. Objectives: The objectives were to define the histologic criteria for cases histologically diagnosed as DHR and identify corresponding clinical disorders. Methods: Skin biopsy specimens from 130 patients diagnosed as "consistent with DHR" were reviewed. Additional information was obtained from patients, their dermatologists, and medical records. Results: Follow-up in 74 of 110 patients (median, 26.6 mo) revealed, most commonly, diagnoses of urticaria, drug reactions, and spongiotic (eczematous) dermatitis. Among the remaining cases, 37 of 59 reported persistence of disease, some exhibiting a uniform phenotype characterized by excoriated, edematous papules on the trunk. Histopathologic features present in more than 90% of 143 biopsy specimens included superficial and mid-perivascular lymphocytic infiltrates with eosinophils. Conclusion: DHR is a perivascular lymphocytic dermatitis with eosinophils involving the papillary and upper reticular dermis and minimal, if any, primary epidermal alteration. The term DHR does not represent any known clinical disorder; rather, it corresponds to many clinical disorders. The use of the phrase "dermal hypersensitivity reaction pattern" may be helpful in conveying the idea that a particular histologic pattern may be seen in a number of clinical disorders.

Original languageEnglish (US)
Pages (from-to)898-907
Number of pages10
JournalJournal of the American Academy of Dermatology
Volume47
Issue number6
DOIs
StatePublished - Dec 1 2002

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Hypersensitivity
Skin
Eosinophils
Biopsy
Eczema
Urticaria
Dermatitis
Dermis
Medical Records
Differential Diagnosis
Guidelines
Phenotype
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Dermatology

Cite this

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title = "The clinical and histopathologic spectrum of {"}dermal hypersensitivity reactions,{"} a nonspecific histologic diagnosis that is not very useful in clinical practice, and the concept of a {"}dermal hypersensitivity reaction pattern{"}",
abstract = "Background: {"}Dermal hypersensitivity reaction{"} (DHR) is diagnosed by dermatopathologists but is not an accepted clinical disease entity. There are no clear guidelines for its diagnosis, differential diagnosis, or management. Objectives: The objectives were to define the histologic criteria for cases histologically diagnosed as DHR and identify corresponding clinical disorders. Methods: Skin biopsy specimens from 130 patients diagnosed as {"}consistent with DHR{"} were reviewed. Additional information was obtained from patients, their dermatologists, and medical records. Results: Follow-up in 74 of 110 patients (median, 26.6 mo) revealed, most commonly, diagnoses of urticaria, drug reactions, and spongiotic (eczematous) dermatitis. Among the remaining cases, 37 of 59 reported persistence of disease, some exhibiting a uniform phenotype characterized by excoriated, edematous papules on the trunk. Histopathologic features present in more than 90{\%} of 143 biopsy specimens included superficial and mid-perivascular lymphocytic infiltrates with eosinophils. Conclusion: DHR is a perivascular lymphocytic dermatitis with eosinophils involving the papillary and upper reticular dermis and minimal, if any, primary epidermal alteration. The term DHR does not represent any known clinical disorder; rather, it corresponds to many clinical disorders. The use of the phrase {"}dermal hypersensitivity reaction pattern{"} may be helpful in conveying the idea that a particular histologic pattern may be seen in a number of clinical disorders.",
author = "Fung, {Maxwell A}",
year = "2002",
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N2 - Background: "Dermal hypersensitivity reaction" (DHR) is diagnosed by dermatopathologists but is not an accepted clinical disease entity. There are no clear guidelines for its diagnosis, differential diagnosis, or management. Objectives: The objectives were to define the histologic criteria for cases histologically diagnosed as DHR and identify corresponding clinical disorders. Methods: Skin biopsy specimens from 130 patients diagnosed as "consistent with DHR" were reviewed. Additional information was obtained from patients, their dermatologists, and medical records. Results: Follow-up in 74 of 110 patients (median, 26.6 mo) revealed, most commonly, diagnoses of urticaria, drug reactions, and spongiotic (eczematous) dermatitis. Among the remaining cases, 37 of 59 reported persistence of disease, some exhibiting a uniform phenotype characterized by excoriated, edematous papules on the trunk. Histopathologic features present in more than 90% of 143 biopsy specimens included superficial and mid-perivascular lymphocytic infiltrates with eosinophils. Conclusion: DHR is a perivascular lymphocytic dermatitis with eosinophils involving the papillary and upper reticular dermis and minimal, if any, primary epidermal alteration. The term DHR does not represent any known clinical disorder; rather, it corresponds to many clinical disorders. The use of the phrase "dermal hypersensitivity reaction pattern" may be helpful in conveying the idea that a particular histologic pattern may be seen in a number of clinical disorders.

AB - Background: "Dermal hypersensitivity reaction" (DHR) is diagnosed by dermatopathologists but is not an accepted clinical disease entity. There are no clear guidelines for its diagnosis, differential diagnosis, or management. Objectives: The objectives were to define the histologic criteria for cases histologically diagnosed as DHR and identify corresponding clinical disorders. Methods: Skin biopsy specimens from 130 patients diagnosed as "consistent with DHR" were reviewed. Additional information was obtained from patients, their dermatologists, and medical records. Results: Follow-up in 74 of 110 patients (median, 26.6 mo) revealed, most commonly, diagnoses of urticaria, drug reactions, and spongiotic (eczematous) dermatitis. Among the remaining cases, 37 of 59 reported persistence of disease, some exhibiting a uniform phenotype characterized by excoriated, edematous papules on the trunk. Histopathologic features present in more than 90% of 143 biopsy specimens included superficial and mid-perivascular lymphocytic infiltrates with eosinophils. Conclusion: DHR is a perivascular lymphocytic dermatitis with eosinophils involving the papillary and upper reticular dermis and minimal, if any, primary epidermal alteration. The term DHR does not represent any known clinical disorder; rather, it corresponds to many clinical disorders. The use of the phrase "dermal hypersensitivity reaction pattern" may be helpful in conveying the idea that a particular histologic pattern may be seen in a number of clinical disorders.

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