1. EXANTHEMIC DRUG ERUPTIONS

3. The epidermis has necrotic keratinocytes at all levels of the epidermis and a minimal dermal inflammatory infiltrate. The eosinophils suggest the drug induced etiology.
Differential Diagnosis.: Viral exanthema , TEN , EM and fixed drug eruption.

4. ERYTHEMA MULTIFORME
there is a mild lichenoid infiltrate with dyskeratotic keratinocytes
Exocytosis of lymphocytes is present
 Dermal inflammatory infiltrate containing eosinophils and keratinocyte necrosis would suggest a drug mediated process

5. TOXIC EPIDERMAL NECROLYSIS AND STEVENS-JOHNSON SYNDROME

6. There is extensive dyskeratosis
of the epidermis with early blister formation. A mild perivascular lymphocytic infiltrate is seen in the superficial dermis
Display keratinocyte necrosis and inflammatory infiltrate

8. LICHENOID DRUG ERUPTION
Histopathology : Histologically it is similar with LP , EM & TEN

10. FIXED DRUG ERUPTION Similar to EM and TEN
Characteristic lichenoid lymphocytic infiltrate and abundant pigment incontinence with scattered melanophages.
In addition, basal vacuolar alteration and dyskeratotic cells occur in the epidermis.

11. FIGURE 11-6. Fixed drug eruption
FIGURE 11-6.Fixed drug eruption. This section shows the characteristic lichenoid lymphocytic infiltrate and abundant pigment incontinence with scattered melanophages. In addition, basal vacuolar alteration and dyskeratotic cells occur in the epidermis.

12. ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS
have subcorneal or intraepidermal pustules,
papillary dermal edema,
lymphohistiocyticj perivascular infiltrate with some eosinophils and neutrophils
Differential diagnosis:
pustularpsoriasis
subcornealpustulardermatos

13. FIGURE 11-8. Acute generalized exanthematouspustulosis
FIGURE Acute generalized exanthematouspustulosis. Diffuse spongiosis and a mild upper dermal perivascular inflammatory infiltrate are seen in this case caused by amoxicillin.

14. vacuolar degeneration of basilar keratinocytes with cleft formation.
TOXIC ACRAL ERYTHEMA (Hand-foot syndrome, palmar-plantar erythrodysethesia syndrome,)
vacuolar degeneration of basilar keratinocytes with cleft formation.
Mild epidermal dysmaturation may be seen.
  Keratinocyte necrosis is also present in the lower third of the epidermis.
In the dermis, there is a mild perivascular infiltrate of lymphocytes with few eosinophils.

15. DRUG-INDUCED SCLERODERMA-LIKE CONDITIONS
  fibrosis of the dermis and subcutis,
adnexal structure entrapment,
mild vascular dilation with minimal to no inflammatory infiltrate.

16. NEPHROGENIC SYSTEMIC FIBROSIs
mild to moderate increased fibrous
cellularity in the mid to deep reticular dermis.
Increased collagen and dermal mucin are also characteristically seen.
The cellularity and collagen deposition may extend along the subcutaneous septa and fascia.

17. Nephrogenic systemic fibrosis
Nephrogenic systemic fibrosis. The deep dermis shows increased cellularity composed of activated fibroblasts with stellate morphology and occasional multinucleation. Increased collagen and dermal mucin are also present.

18. BULLAE AND SWEAT GLAND NECROSIS IN DRUG-INDUCED COMA
The epidermis shows varying degrees of necrosis.
In areas of complete necrosis of the epidermis, the bullae arise subepidermally

19. Drug-induced coma bulla
Drug-induced coma bulla. There is extensive necrosis of the epidermis with subepidermal blister formation. Inflammation in the blister cavity is secondary to adjacent ulceration. The dermis shows only a mild inflammatory infiltrate.  

20. DRUG-INDUCED BULLOUS DISORDERS
  a picture identical to that seen in pemphigus vulgaris and/or pemphigus foliaceus.
The autoantibody response to desmoglein 1 and desmoglein3 is similar in both

21. DRUG-INDUCED LUPUS ERYTHEMATOSUS

22. DRUG-INDUCED LUPUS ERYTHEMATOSUS
same as in lupus erythematosus
Pathogenesis:genetic predisposition, in particular, HLA-DR4, has a role in drug-induced lupus.
ANA is positive

23. Photoallergic Drug Eruption
Similar to allergic contact dermatitis and includes spongiosis, mild acanthosis, and a superficial perivascular lymphocytic infiltrate with eosinophilis

24. Photoallergic dermatitis
Photoallergic dermatitis. There is spongiosis with microvesicle formation, exocytosis of lymphocytes, and a perivascular lymphocytic infiltrate admixed with scattered eosinophils.

25. Phototoxic Drug Eruption
like a sunburn reaction, shows vacuolated keratinocytes, and apoptotic keratinocytes

26. Dermal edema and enlargement of endothelial cells

27. PHOTODISTRIBUTED HYPERPIGMENTATION
 There is variable amount of melanin in the basal layer of the epidermis.
Accumulation of pigment-laden macrophages in dermis .
Fontana-Masson silver stain is positive

28. Chlorpromazine pigmentation
Chlorpromazine pigmentation. Perivascular pigmentladen macrophages are seen in this case of chlorpromazine pigmentation.

29. DRUG-INDUCED PSEUDOLYMPHOMA SYNDROME
similar to MF(also known as psudo MF).
In cutaneous nodules, large masses of atypical lymphocytes are present in the dermis.

30. Cutaneous pseudolymphoma
Cutaneous pseudolymphoma. There is a dense inflammatory infiltrate with exocytosis of atypical-appearing lymphocytes and absence of spongiosis in this Dilantin-induced pseudolymphoma.

31. CUTANEOUS REACTIONS TO ANTINEOPLASTIC CHEMOTHERAPEUTIC DRUGS

33. CUTANEOUS REACTIONS TO ANTINEOPLASTIC CHEMOTHERAPEUTIC DRUGS
Epidermal dysmaturation, may develop in epidermis after chemotherapeutic administration.
Accompanied by upper dermal melanophage
Neutrophili ceccrine hidradenitis consists of variable infiltration of the eccrine coil by neutrophils and lymphocytes with necrosis of secretory epithelium.

34. Severe epidermal dysmaturation due to antineoplasticchemotherapy
Severe epidermal dysmaturation due to antineoplasticchemotherapy. Loss of polarity and disorganization of keratinocytesare specimen

35. CUTANEOUS ERUPTIONS RESULTING FROM ADMINISTRATION OF HUMANRE COMBINANT PROTEINS
The upper dermis contains a perivascular and interstitial infiltrate of neutrophils, eosinophils, and lymphocytes.
The epidermis may display intercellular edema with exocytosis of inflammatory cells. Vasculitis is absent.

36. A diffuse perivascular and interstitial inflammatory cell infiltrate is present with associated vascular dilation and spongiosis.

37. MINOCYCLINE PIGMENTATION
increased melanization of the basal cell layer and melanin within macrophages in the upper dermis.

38. Minocycline hyperpigmentation
Minocycline hyperpigmentation. Pigment is presentin dermal melanophages and dendritic cells

39. CLOFAZIMINE-INDUCED PIGMENTATION
The upper dermis contains numerous foamy macrophages that possess cytoplasm with brown granular pigment.

40. Penicillamine-Induced Atrophy of the Skin
The anetoderma shows diminution or absence of elastic tissue and the areas of easy bruising of the skin.

41. HALOGEN ERUPTIONS

42. Bromoderma. There is downward proliferation of the epidermis with a large intraepidermal abscess. A dense inflammatory infiltrate is present in the dermis.

43. HALOGEN ERUPTIONS
bromoderma and iododerma shows a dense infiltrate of neutrophils, which, in areas of dermal necrosis, show nuclear dust.
There may be intradermal abscesses. Eosinophils are present in most cases and may be numerous

44. ARGYRIA
In the dermis, there are extracellular fine,small, round, uniformly sized brown-black silver granules.
They are present in the greatest numbers in the basement membrane zone surrounding the sweat glands and dermal papillae
In addition to silver, there is an increase in the amount of epidermal melanin

45. Argyria. Silver granules are present in the basement membrane surrounding the sweat glands

46. CHRYSIASIS
Gold granules are found predominantly within cells, particularly within endothelial cells and macrophages.
However, extracellular granules may also be observe

47. MERCURY PIGMENTATION
Irregular, brown-black granules are found in the upper dermis, both extracellularly and within macrophages.
Traumatic implantation of mercury results in variably sized, often large amorphous deposits of mercury in the dermis and subcutis
Chronic changes include dermal fibrosis and granulomatous inflammation.