fig4-7 lues

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Fig. 4: Yellow arrows mark the interface between the superficial and basal functioning units of the epidermis. There is a lytic defect in the basal unit to the left of the left-most yellow arrow. At the interface marked with blue arrows the basement membrane is thickened and the epidermis is thin. In this area, a basal unit cannot be defined. Only a thin superficial unit is recognizable. A colloid body is to the left of a green arrow. A duplicated basement membrane, well away from the defined dermal-epidermal interface curves down and to the right from the green arrowhead. Basement membrane material is identifiable along the surface defined by the blue arrows. Near the right margin, a short rete with a pointed extremity is represented. In this field, the patterns take on some of the aspects of a senescent lichenoid reaction. Depending on sites selected for study, the life-history of a lichenoid reaction can be demonstrated in this single lesion.


Fig. 5: In this area in the reticular dermis, the infiltrates are micronodular and focally show a pale acidophilia, reflecting the amount of cytoplasm of some of the cells of the infiltrates. Those cells are histiocytes and the acidophilia identifies a granulomatous quality of the infiltrate. Focally the infiltrates extend into arrector muscles.


Fig. 6: The early (primary) interface reaction is represented. This rich intermingling of basal keratinocytes, and lymphocytes and histiocytes is characteristic of the lichenoid variants of the pityriasic disorders. The yellow arrows mark the interface between the basal and superficial functioning units.


Fig. 7: Red arrows identify membranous structures interpreted as portions of old or new basement membrane. Focally, the membrane cannot be defined and focally, fragments appear to be isolated in the infiltrates of what now appears to be a portion of the dermis. This delicate fibrous matrix may represent an inlay of newly formed fibrous tissue in what was once a lytic defect in the basal unit of the original epidermal domain. This can be interpreted as accretive fibrosis and as a consequence of the lytic effects of a lichenoid reaction. The elongated wavy (and apparently naked) nuclei in the epidermis are migratory histiocytes. They may be attracted to the epidermis in this disorder in response to the presence of microorganisms among the keratinocytes. The kinetics of a special lichenoid reaction are evident.

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