What are histologic findings of fixed drug eruptions (FDE)?

Updated: Oct 09, 2020
  • Author: David F Butler, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Histological examination of inflammatory/acute lesions shows an interface dermatitis with vacuolar change and Civatte bodies [13] (see the image below).

Acute interface dermatitis with prominent vacuolar Acute interface dermatitis with prominent vacuolar change and individual necrotic keratinocytes within the epidermis (X10).

The overall pattern may mimic that seen in erythema multiforme. Dyskeratosis and individual necrotic keratinocytes within the epidermis may be a prominent feature (see the image below).

Interface dermatitis, vacuolar change, necrotic ke Interface dermatitis, vacuolar change, necrotic keratinocytes, and incontinent pigment in the dermis (X40).

On occasion, the lymphocytic infiltrate can be prominent enough to obscure the dermoepidermal junction. Spongiosis, dermal edema, eosinophils, and occasional neutrophils may be present. Pigmentary incontinence within the papillary dermis is a characteristic feature and may be the only feature seen in older, noninflamed lesions. Chronic or inactive lesions may also show mild acanthosis, hyperkeratosis, and relatively few inflammatory cells.


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