Vesicobullous Diseases Research Articles

Histomorphological Study of Skin Lesions in a Specialized Tertiary Care Hospital: A Descriptive Study

Introduction: The skin is the largest organ of the integumentary system in human. Dermatological lesions are commonly encountered in all countries and it encompasses a wide spectrum, varies from country to country and various regions within a country. Skin diseases are much common in developing countries. The spectrum varies according to geographic distribution, gender, age, and coexisting disorder. We conducted this study to find out the prevalence of different skin lesions and to evaluate their frequency and site of distribution. Aim of the Study: The aim of this study was to find out the prevalence of different skin lesions and to evaluate their frequency and site of distribution. Methods: This was a descriptive study and was conducted in the Department of Histopathology of Bangladesh Specialized Hospital, Dhaka, Bangladesh during the period from January 2019 to December 2021.We included 133 skin biopsies in our study. Result: Among 133 skin biopsies examined, non-infectious vesicobullous and vesicopustular disease were found in 53 (48.18%) cases followed by microbial disease in 20 (18.18%) and non-infectious erythematous papular and squamous disease in 28 (21.05%) cases. Lichen simplex chronicus was the most common vesicobullous disease seen in 08 (15.09%) cases. Dermatophytes were the commonest microbial disease found in 10 (50%) cases. The commonest non- infectious erythematous papular and squamous disease was lichen planus and psoriasis 08 (15.09%) cases. The commonest neoplastic lesion was keratinocytic tumor seen in 13 (56.53%) cases. The commonest tumor of the skin was seborrheic keratosis and squamous cell carcinoma in 13 (56.53 %) cases. Upper extremities were the most frequently involved site by skin lesions. Conclusion: In our study prevalence of lichen simplex chronicus was higher. We observed a wide spectrum of skin lesions ranging from dermatitis to malignant neoplasm. The importance of specific histomorphological features lies in distinguishing various skin lesions and play a major role in making the final diagnosis of these diverse skin lesions. This highlights the role of histopathological examination for the proper management of patient.

Histomorphological Study of Non Neoplastic Skin Lesions: A Retrospective Approach

Introduction: Non-neoplastic skin disorders encompass a wide spectrum of pathological processes which show age, sex and geographical variation in distribution. Histopathological examination continues to play an invaluable role in diagnosis and management of non neoplastic skin disorders. The present study aims to analyse the histomorphological spectrum of non-neoplastic skin lesions received in a tertiary care hospital, to study their age and sex distribution and to classify the lesions into categories that predict clinically important attributes. Material and Methods: The current study is an observational retrospective study conducted in Department of Pathology in a Tertiary Care Hospital in South Gujrat. 205 skin specimen of non neoplastic skin lesions received over a period of one year (February 2019 to January 2020) were studied. Results: Among 205 cases of non neoplastic skin lesions, male predominance was seen. 21-30 years and 31-40 years were the most common age group. Infectious disorders were the most common category (73 cases) followed by non-neoplastic cutaneous cysts (72 cases). Epidermoid cyst was the common skin lesion closely followed by Leprosy. Borderline Tuberculous was the most frequent subtype of leprosy. Leprosy was most common in 21-30 years age group. Most common vesicobullous disease was Spongiotic Dermatitis followed by Pemphigus Vulgaris. Psoriaform and lichenoid dermatitis showed equal incidence. Conclusion: Heterogeneity in the clinical presentation of skin diseases makes histopathological examination a gold standard technique for final diagnosis. Cutaneous cysts and infectious formed the bulk of cases. Leprosy was the most common non cystic non neoplastic skin lesion of our study.

Dermatitis Herpetiformis (Duhring Disease)

A19-years-old male patient presented to the dermatology clinic complaining of severe itching with excoriations of the skin for 7 months ago. On examination, there were multiple crusted erosions, some vesicles, and scars of previous attacks on both elbows (Panel A), knees, thigh, upper back, forehead, scalp, and sides of the face. Punch biopsy was taken that revealed neutrophilic microabscess at the tip of the dermal papillae with subepidermal separation with mainly neutrophils infiltrates (Panel B-X10 and C-X40). Immunofluorescence studies and enzymes assays for dermatitis herpetiformis (DH) and celiac disease are not available in our locality. Accordingly, DH was diagnosed and treated with Dapsone 100 mg/day after no remarkable changes on hematological investigations. DH is a vesicobullous disease manifested as severely pruritic and grouped excoriations of the skin. The lesions are symmetrically distributed on the extensor surfaces of the elbows, knees, scalp, back, and buttocks. There is usually an associated gluten-sensitive enteropathy. Histopathologically, subepidermal separation with neutrophilic microabscess at the tips of dermal papillae are seen. Immunofluorescence shows granular IgA deposits at the dermo-epidermal junction that differentiate it from a linear IgA bullous disease which resembles it clinically. Dapsone is the drug of choice with a gluten-free diet. At three-months follow-up, the patient was put on Dapsone 75 mg/day and advise him to attend regular follow-ups every three months in order to reduce the dose of Dapsone to a minimum dose to control his condition.

Histopathological Study of Skin Lesions in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Skin diseases are much common in developing countries. The spectrum varies according to geographic distribution, gender, age, and coexisting disorder. We conducted this study to find out the prevalence of different skin lesions and to evaluate their frequency and site of distribution. A descriptive cross-sectional study was done in the pathology department of Kathmandu Medical college from June 2019 to November 2019 after ethical clearance. The skin biopsies were processed, sectioned and stained with Haematoxylin and eosin and evaluated. A convenience sampling method was used. Data was collected and entry was done in Statistical Packages for Social Services version 20.0, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Among 133 skin biopsies examined, noninfectious vesicobullous and vesicopustular disease were found in 42 (46.6%) cases followed by microbial disease in 22 (24.5%) and noninfectious erythematous papular and squamous disease in 21 (23.4%) cases. Spongiotic dermatitis was the most common vesicobullous disease seen in 26 (28.9%) cases. Leprosy was the commonest microbial disease found in 7 (7.8%) cases. The commonest noninfectious erythematous papular and squamous disease was erythema dyschromicum perstans seen in 7 (7.8%) cases. The commonest neoplastic lesion was keratinocytic tumor seen in 12 (32.5%) cases. The commonest tumor of the skin was intradermal nevus seen in 6 (16.3%) cases. Spongiotic dermatitis is a predominating non-neoplastic and overall skin lesion which was similar to the other studies done. Histopathological examination is the gold standard for the proper diagnosis as histomorphological features distinguish various skin lesions.

Nail changes in various dermatoses: an observational study conducted at tertiary care center, Ujjain, Madhya Pradesh, India

<p class="abstract"><strong>Background:</strong> Nail apparatus forms an integral part to be examined for all dermatological conditions. Nail changes are seen in various dermatosis like psoriasis, onychomycosis, lichen planus, collagen vascular disease, vesicobullous diseases and other papulosquamous diseases. Aims and objective of the study was to determine the prevalence of nail changes in various dermatological conditions.</p><p class="abstract"><strong>Methods:</strong> After applying inclusion and exclusion criteria, 269 cases with various nail changes were enrolled in the study. Detailed history and thorough nail examination was carried out along with other necessary investigations like CBC, RFT, LFT, nail clipping for fungal hyphae culture and microscopy.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 269 cases with nail disorders, male to female ratio was 1.5:1 and most common age group was 31-40 years. The most common abnormality observed was onychomycosis (34.2%) followed by nail changes in psoriasis (30.4%), LP (18.5%), eczema (4%), trachonychia (3.3%), paronychia (2.9%), lichen striatus (2.2%) and darier’s disease (0.37%). Among onychomycosis most common pattern observed was DLSO (82.6%) followed by PSO (7.6%), SWO (5.4%) and TDO (4.34%). The pattern of nail changes in psoriasis patients was pitting (30.4%), subungual hyperkeratosis (21.9%) and onycholysis (10.9%). Cases with LP had longitudinal striations (52%), thinning of nail plate and trachonychia (10% each). V shaped notching and distal splitting was seen in one of the Dariers’ disease patient.</p><p class="abstract"><strong>Conclusions:</strong> Nail changes form an indispensible part of various dermatological conditions. The pattern of involvement is unique in each and every disease. Hence examination of all the 20 nails should never be missed.</p>

Oral autoimmune vesicobullous diseases: Classification, clinical presentations, molecular mechanisms, diagnostic algorithms, and management.

Mucocutaneous blistering autoimmune diseases are a group of systemic, rare, chronic disorders characterized by humoral-mediated immunologic mechanisms against epithelial, basement membrane, and subepithelial tissues. Morbidity and mortality can be completely different among these diseases, with outcome being dependent on an early and accurate diagnosis, systemic comorbidities, and the patient's response to treatment. Definitive diagnosis is based on clinical and histopathologic findings. Because clinical presentations among these diseases are often similar, different immunofluorescence tests and ELISAs are used to confirm the specific diagnosis. Oral mucosa may often be the first site of clinical manifestation from which the disease spreads to other mucosal surfaces and skin. Thus, often dentists and oral medicine specialists may be the first to encounter patients with such diseases. In this review we discuss the most frequent autoimmune vesicobullous disorders, namely pemphigus vulgaris, mucous membrane pemphigoid, bullous pemphigoid, and linear IgA disease.

Histopathological spectrum of skin diseases in a tertiary skin health and referral centre

Background: Skin diseases are very much prevalent in the developing countries. The pattern of skin diseases varies from country to country and even region to region within a country. The histological diagnosis is used by clinicians to aid in the management of patients & most appropriate clinical interventions.
 Materials and methods: The study included a total of 1040 skin biopsies from January 2016 to December 2018 in the department of pathology, DI skin health and referral centre, Kathmandu, Nepal.
 Results: The majority of the patients were in the age group of 31-40 years. The most common skin disease is non-infectious vesicobullous and vesicopustular disease (28.6%), followed by non-infectious erythematous papular and squamous disease (25.9%). The most common vesicobullous disease is spongiotic dermatitis (84.8%). Erythema dyschromicum perstans (31.8%) is the commonest non-infectious erythematous papular and squamous disease. The most common microbial disease is fungal infection, followed by leprosy. Among the neoplastic diseases of skin, tumors of epidermis are commonest diseases and the most common epidermal tumor is basal cell carcinoma. The commonest tumor of skin is melanocytic nevus. The most frequent site is upper extremities.
 Conclusions: Eczema is predominating non-infectious vesicobullous and vesicopustular disease. A relatively higher, prevalence of fungal infections was observed. Basal cell carcinoma is the commonest epidermal tumor and melanocytic nevus is commonest of all skin tumors.

Bullous Systemic Lupus Erythematosus

Bullous systemic lupus erythematosus (BSLE) is extremely rare but distinct disease, characterized by vesicobullous skin eruptions in systemic lupus erythematosus (SLE). It can develop either before or after a diagnosis of SLE has been established. BSLE is characterized by a dermatitis herpetiformis-like histology and an autoimmunity to type VII collagen. It must be differentiated from other autoimmune vesicobullous diseases such as epidermolysis bullosa acquisita, dermatitis herpetiformis, linear IgA disease, and bullous pemphigoid. Its important to combine clinical, histological, and immunofluorescence findings to establish a diagnosis of BSLE. We report a case of BSLE to illustrate and emphasize the need for an integrative diagnostic approach.J MEDICINE JUL 2018; 19 (2) : 123-125

An Overview of Vesicobullous Conditions Affecting the Oral Mucosa.

Vesicobullous diseases are characterised by the presence of vesicles or bullae at varying locations in the mucosa. The most common occurring in the oral cavity are mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). Both are autoimmune diseases with a peak age onset of over 60 years and females are more commonly affected than men. This paper reviews the structure of the oral mucosa, with specific reference to the basement membrane zone, as well as bullous conditions affecting the mucosa, including PV and pemphigoid, their aetiology, clinical presentation, and management.

Management of Suspected Pemphigus Vulgaris in Elderly Patient with Chronic Diseases

72 1024x768 Pemphigus vulgaris (PV) is a group of vesicobullous disease affecting skin and mucous membranes. PV is associated with autoimmune diseases, characterized by binding of IgG autoantibodies to desmoglein 3. PV lesion is a thin-walled bulla arising on the skin or mucosa. Oral mucous bulla are fragile and easily breakdown, forming irreguler ulcers. There are several factors that trigger PV, including genetic factors, age, drugs and food. This paper aimed to report treatment of suspected pemphigus vulgaris in elderly patient with history of chronic diseases. A 75-year-old woman with 2 months history of bulla formation on skin and history of persistent oral ulceration. Ulcers were covered with fibrin and erosive erythematous on labial, buccal and gingival mucosa. History of hypertension, diabetes mellitus and hepatitis was revealed. Routine complete blood count showed thrombocytopenia. Diagnosis was confirmed by anamnesis, clinical examination and complete blood investigation. PV should be distinguished from other vesicobullous disease. Systemic corticosteroid was given concurrently with hepato-protector, mouthwash, supportive therapy and topical lip cream. Bulla on skin and persistent erosive ulcers of the oral mucosa are the manifestations of PV. Elderly patient with history of chronic diseases showed a complex care of PV requiring more intensive and comprehensive treatment. DOI: 10.14693/jdi.v20i1.129

Bullous systemic lupus erythematosus – a case report

Bullous systemic lupus erythematosus (BSLE) is a rare but distinct disease, characterized by vesicobullous skin eruptions in systemic lupus erythematosus (SLE). It can arise either before or after a diagnosis of SLE has been established. BSLE is characterized by a dermatitis herpetiformis-like histology and an autoimmunity to type VII collagen. It must be differentiated from other autoimmune vesicobullous diseases such as epidermolysis bullosa acquisita, dermatitis herpetiformis, linear IgA disease, and bullous pemphigoid. A combination of clinical, histological, and immunofluorescence findings are necessary to establish a diagnosis of BSLE. We present a case of BSLE to illustrate and emphasize the need for an integrative diagnostic approach. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15691 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 90-92

Epidermolizis Büllozalı bir olguda rekürren Kornea Erozyonu

Epidermolysis bullosa is genetically determined, congenital and vesicobullous disease. Ophthalmic complications are common and treatment modality is associated with the severity of complications. The major treatment modality is use of ocular lubricants and visual acuity can be maintained.

Clinical and bacteriological profile and outcome of sepsis in dermatology ward in tertiary care center in New Delhi

There is paucity of data regarding the clinical and bacteriological profile of sepsis in dermatology in-patients. To study the frequency, etiology, and outcome of sepsis dermatology in-patients. The study was conducted in a 30-bedded dermatology ward of a tertiary care center. Sepsis was defined by presence of ≥2 SIRS (systemic inflammatory response syndrome) criteria along with evidence of infection (clinically obvious/culture proven infection of skin or internal organs). Patients were also assessed for known (common) risk factors of sepsis. In suspected sepsis patients, at least two samples of blood cultures by venepuncture were taken. Pus, skin swab, urine, and sputum samples were also collected for culture as needed with avoidance of contamination. Among 860 admitted patients studied from November 2004 to July 2006, 103 (12%) fulfilled SIRS criteria. Of these, 63 had nonsepsis causes of SIRS positivity, while 40 (4.65%) had sepsis. Majority of the sepsis patient had vesicobullous diseases (42.5%), erythroderma (25%), toxic epidermal necrolysis (TEN) (22.5%). Severe sepsis developed in 17 (42.5%) patients, while 15 (37.5%) died. Methicillin-resistant Staphylococcus aureus (MRSA) was the commonest organism isolated (99; 25.9%) in all culture specimens followed by Acinetobacter spp. (52; 13.6%), Pseudomonas spp. (40; 10.5%), Methicillin-sensitive S. aureus (MSSA: 33; 8.7%), and Klebsiella spp. (22; 5.8%). Various risk factors affecting mortality and sensitivity patterns for various isolates were also analyzed. Sepsis occurred in 40 (4.65%) inpatients in dermatology ward. The frequency of sepsis was highest in TEN (90%), followed by drug-induced maculopapular rash (20.0%), erythroderma (17.5%), and vesicobullous diseases (8.5%). MRSA, acinetobacter, pseudomonas, MSSA, and Klebsiella were important etiological agents involved in sepsis in dermatology in-patients.

Bullous pemphigoid

Bullous pemphigoid (BP) is a relatively common autoimmune vesicobullous disease encountered in India. It is a subepidermal bullous disorder most commonly seen in the elderly and manifests as tense blisters on urticarial base, predominantly over flexures, and is associated with pruritus. The diagnosis can be confirmed by histology, direct and indirect immunofluorescence. Several new diagnostic techniques have also been developed. Treatment of BP is based on the extent and rate of progression of the disease. Several topical and systemic anti-inflammatory and immunosuppressive agents have been used with variable results.

Pompholyx: what's new?

Background: Pompholyx is a chronic relapsing inflammatory vesicobullous skin disease of the hands and feet belonging to the spectrum of eczema. Established treatments, both topical and systemic, are limited in efficacy, risk:benefit ratio and prevention of further relapses. New treatment options are needed. Objective: The article will discuss new treatment options, in particular for cheiropompholyx. Methods: A MEDLINE® and ClinicalTrials.gov® research has been conducted and publications about new and emerging treatments for pompholyx have been analysed. Results/conclusions: Among the recent developments, topical calcineurin inhibitors (TCI) and botulinum toxin A (BTXA) seem to be effective against pompholyx. The major disadvantage of BTXA is the need for injections, but efforts are being made to develop a topical form of application. Bexaroten gel has been used for chronic hand dermatitis, with good efficacy in the hyperkeratotic type. Further studies on pompholyx are needed. There is currently widespread interest in plant-based pharmaceuticals. Studies involving such topical drugs are on the way. In systemic treatment, retinoid alitretinoin has been most extensively studied in hand dermatitis. However, experiences relating to pompholyx are more limited. New types of anti-inflammatory oral drugs such as leukotriene inhibitors and phosphodiesterase-4 (PDE4) inhibitors have become available. These seem to have potential in the adjuvant treatment of pompholyx. Monoclonal antibodies of various types have been investigated in small series, but have failed to demonstrate consistent efficacy. Further investigations with new monoclonals are needed. Phototherapy of pompholyx is a cornerstone in treatment. High-dose UVA1 has been established as an effective modality in centres where the rather expensive equipment is available. Recently, UV-free phototherapy has been introduced, but more data are needed before final conclusions can be drawn.

The role of immunoflorescence in the physiopathology and differential diagnosis of recurrent aphthous stomatitis

SummaryRecurrent aphthous stomatitis (RAS) is a disease characterized by the periodic appearance of aphthous lesions on the oral mucosa, of which etiology and physiopathology are not well explained. Recent studies with direct immunofluorescence show controversial results. Some reveal that the basic disorder is associated with humoral immunity, while others point to changes in cellular immunity. Atypical forms of aphthous stomatitis may have its differential diagnosis carried out with vesicobullous diseases, such as pemphigus vulgaris.AimCheck the presence of immunocomplexes in the mucosa of patients with aphthous stomatitis and the usefulness of the differential diagnosis method with bullous skin diseases.Materials and methods23 patients with aphthous stomatitis were prospectively included in the study. There were all submitted to mucosa biopsy under local anesthesia for the removal of two fragments. One of these was sent to histology and, the other to direct immunofluorescence.ResultsThe 23 samples from the histology exam revealed an ulcerated inflammatory process. The samples referred to immunofluorescence resulted negative and only one showed the presence of complement in the basal membrane.ConclusionBased on our results, we conclude that the patients with RAS do not show deposits of immunocomplexes in their oral cavity mucosa and immunofluorescence is useful in the differential diagnosis between this disease and bullous skin diseases.

Tacrolimus: Approved and Unapproved Dermatologic Indications/Uses—Physician's Sequential Literature Survey: Part II

Tacrolimus has been a useful therapeutic tool in dermatology practice ever since its inception. Accordingly, many "off-label" applications have been reported. Thus, its local immunosuppressive and steroid-sparing action stands recognized. Hence, its indications/uses were extended beyond atopic dermatitis to cover several dermatoses including other types of eczema, papulosquamous disorder of cornification, rosacea, other inflammatory skin conditions, vesicobullous disease, connective tissue disease, graft versus host disease, and follicular disorders. Many such diseases found to respond to tacrolimus therapy have been briefly recounted. It is worthwhile to conceive, however, that this topical immunomodulator should be reserved for use only as an alternative, should the conventional treatment be unresponsive. Hence, guarded use is warranted.

Localized flexural bullous pemphigoid

A 63-year-old male agriculturist presented with a spontaneously appearing bullous eruption localized to the axillae and groins, with intense pruritus of 3 weeks duration. He was also a known hypertensive, diagnosed with renal failure on treatment with ACE inhibitors and amlodepin since 1 year. On examination there were tense vesicles and bullae associated with crusting and erosions in the axillae (Fig. 1), upper medial aspect of arms and groins bilaterally (Fig. 2). The rest of the skin including the mucous membranes, palms, soles, genitalia were normal. Histopathology revealed subepidermal blisters, direct immunofluorescence assay of perilesional skin showed linear deposits of IgG and C3 along the basement membrane zone and the indirect immunofluorescence demonstrated antibasement membrane antibodies bound to the epidermal side of the salt split normal human skin thus confirming our diagnosis of localized bullous pemphigoid. Patient was accordingly started on prednisolone 60 mg daily in tapering doses which resulted in complete healing of the erosions within a month. Fig. 1 Tense vesicles and bullae in the axilla Fig. 2 Tense vesicles and bullae in the groins Localized bullous pemphigoid (LBP) is a rare autoimmune subepidermal blistering disease of the elderly characterized by chronic intermittent eruptions affecting only a restricted area of the body. Though it accounts for 16% to 29% of all cases of bullous pemphigoid, the true incidence may be greater as it is often misdiagnosed and is highly responsive to topical steroids. LBP has got similar clinical, histopathological and immunofluorescence features to generalized bullous pemphigoid.1 Three types have been identified which include: 1) mucous membrane pemphigoid or cicatricial pemphigoid 2) localized scarring pemphigoid or Brunsting Perry pemphigoid affecting the head and neck 3) localized non scarring pemphigoid usually seen over the pretibial region, vulva, breast and the soles. The diagnosis of this last entity tends to be delayed because it can mimic other localized vesicobullous diseases and dyshidrotic eczema.2 While the pathogenesis of generalized bullous pemphigoid is well elucidated, it is unknown why patients with LBP have limited disease. The pathogenesis most likely could be similar to that of generalized bullous pemphigoid because patients in both the groups recognize the same BP antigens.3 LBP has been documented following radiotherapy,4 PUVA therapy, trauma,5 sunexposure,6 split skin grafting for burns,7 around peristomal lesions8 and several authors have thus postulated that these local factors might play a role in the induction of lesions in immunologically susceptible individuals. In a study on the distribution of bullous pemphigoid antigens in normal human skin the greatest expression was seen in the skin obtained from the flexor aspect of arms, legs and thighs9 which probably explains the predominant flexural localization of lesions in our case. Whether the ACE inhibitors contributed in triggering the bullous eruption here is not clear as the patient had been taking the above medications for almost a year. Nevertheless this case emphasizes the need to follow-up such patients regularly as they are at risk of developing a generalized eruption later in life.

Peeling skin syndrome: 11 cases from Saudi Arabia

BACKGROUNDPeeling skin syndrome (PSS) is a rare genodermatoses of probable autosomal recessive inheritance. In Saudi Arabia, consanguinity of parents is common and consequently the occurrence of familial disease, including that of the skin, is not uncommon.METHODSTo characterize the clinical and pathological features of PSS in Saudi Arabia, we reviewed the medical records and clinical photographs of patients with recurring blistering diseases and conducted a histopathologic evaluation of skin biopsies to identify the site of cleavage.RESULTSEleven patients with PSS were seen at King Khalid National Guard Hospital in Jeddah between the years 1986 and 2005. Ages ranged between 2 and 15 years and there were 9 males (81.8%) and 2 females (18.2%). The most common presentation in the majority of patients was localized spontaneous peeling of the skin. Eight patients (72.7%) had a history of vesicles that were small, dry and peeled away. Trauma did not play a role in blister formation. All patients were local from Bedouin tribes where a family history of a similar complaint was documented in 8 cases (72.7%) and consanguinity of marriage was evident in 6 patients (54.5%). Histological examination of skin biopsies showed either intracorneal or superficial subcorneal cleavage above the granular layer in all biopsied patients.CONCLUSIONAlthough rare, PSS occurs in Saudi Arabia and is most likely related to consanguinity of marriages. This disease is generally mild and is characterized by intracorneal cleavage within the superficial epidermis. The disease should be recognized and not confused with other vesicobullous disease.

Book review

LeBoit, PE, Harvell, JD . Dermatopathology CD-ROM from ‘The Pathology Masters Series’. Pomona, CA, USA : Universal Multmedia, Inc., 2001. Dermatopathology, by Philip LeBoit MD and Jeff D. Harvell MD is the latest edition of ‘The Pathology Masters Series’, a line of CD-ROMs produced by Universal Multimedia. The target audience for the series is pathologists in training as well as practising pathologists who desire a brief refresher course in any of 10 selected topics in pathology. This latest disk provides an overview of dermatopatholgy with roughly 3 hours of audio lecture and over 350 color slides, the majority of which are clinical and microscopic images. The subject matter is divided broadly into inflammatory skin diseases and tumors of the skin. The inflammatory disorders are subdivided further into histological patterns such as psoriasiform dermatitis, vasculitis and vesicobullous diseases. The tumors are subdivided according to cell type of origin. Each of these smaller categories is then presented as a 10–20-minute lecture. These lectures are concise and instructive, and all diseases are depicted well in clear clinical and histological photographs. In this manner the disk meets its objective of introducing the field of dermatopathology. The CD is also well formatted. The content is easy to access by simply ‘pointing and clicking’ with the mouse, and the photographs are copied easily to the user's desktop for use in creating presentations. However, the disc does not have any self-assessment tools that would reinforce the learning of the material presented. This would be a welcome addition to future installments in this series.