Pustular psoriasis
LEGEND
However, pustular psoriasis is a more acute phenomenon. Therefore, there is less acanthosis, a less pronounced loss of the granular layer, and a normal stratum corneum.
- Spongiform pustules of Kogoj:
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Unilocular intraepidermal collections of numerous neutrophils that have migrated from the tortuous, dilated capillaries of the papillary dermis and accumulated in the epidermis.
- They are accompanied by intracellular edema, giving the epidermis a spongiotic appearance.
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You may also find the characteristic changes of psoriasis vulgaris in pustular psoriasis (see the psoriasis section):
- Hypogranulosis
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Regular elongation and fusion of epidermal ridges (only mild in this case)
- Thinning of suprapapillary epidermal plates (barely visible here)
- Edema of the papillary dermis and tortuous dilated capillaries
- Superficial perivascular infiltrate of lymphocytes and neutrophils
Pustular psoriasis
LEGEND
Munro microabscesses are located more superficially in the epidermis (stratum corneum) than the spongiform pustules of Kogoj. (“Marilyn Monroe is always on top!”)
Spongiform pustules of Kogoj
Munro microabscess: large intracorneal pustule composed of neutrophils
- Over time, neutrophils migrate to the stratum corneum to form these microabscesses, which are characteristic of pustular psoriasis
