[Histological diagnosis of inflammatory skin diseases. Use of a simple algorithm and modern diagnostic methods]

[Inflammatory dermatoses]

The seven basic patterns of inflammatory dermatoses according to Ackerman can be applied to infectious dermatoses. However, it should be borne in mind that infection caused by one agent may induce differing patterns according to the stage of disease. Dermatophytosis and the arthropod reaction belong to perivascular dermatoses with spongiosis. Secondary syphilis and acrodermatitis chronica atrophicans regularly show a lichenoid infiltrate with interface dermatitis, whereas epidermal involvement is typically absent in erythema migrans, virus exanthema and bacillary angiomatosis. Lupus vulgaris, atypic mycobacteriosis, lepra, actinomycosis, cutaneous leishmaniosis and erysipelas belong to the nodular and diffuse dermatoses. In the group of vasculitides, septic vasculitis is induced by a biological agent, and the pattern of vesicular dermatitis is reflected by infections with herpes viruses, impetigo contagiosa and staphylococcal scalded-skin syndrome. Follicular dermatitis shows a pattern of furuncles and carbuncles which are mainly caused by bacteria or fungi.

[Sinonasal sarcoidosis]

BACKGROUND

The sinonasal system is rarely involved in the clinical picture of sarcoidosis. In the absence of pulmonary disease, sinonasal sarcoidosis is extremely rare.

PATIENTS AND METHODS

Four patients with isolated sarcoidosis of the nose and the sinuses are reported; in one of these patients the histological evidence was found in the mucosa of the nasopharynx.

RESULTS

None of these patients was found to have a pulmonary illness or any other extrapulmonary manifestation of sarcoidosis. Retrospectively, two patients fulfilled the more specific diagnostic criteria for sinonasal sarcoidosis reported in the literature.

CONCLUSION

Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease, especially if the mucosa shows signs of granulation, but it should also be considered when an incidental finding of rhinosinusitis is recorded. Rhinosurgical intervention seems to be an appropriate therapy in terms of improving the symptoms of the disease, despite the prolonged period of postoperative healing and the necessity for individual treatment with medication. Following histological confirmation of the diagnosis, adequate medication and further appropriate diagnostic procedures drawing on internal medicine are essential.