Spongiotic reaction patterns in autoimmune bullous dermatoses (Review)

Abstract

Spongiosis or a spongiotic reaction pattern is the histological hallmark of intercellular epidermal edema, viewed as clear spaces within the epidermis. Although considered a histopathological term, spongiosis has clinical correlations, with the variable degrees of spongiotic reaction leading to different dermatological findings. This review aimed to highlight the spongiotic reactive patterns found in different autoimmune bullous dermatoses, considering the paucity of publications in this domain. The pathogenesis of spongiosis assumes the passage of extravasated edema fluid from the dermis into the epidermis, frequently accompanied by dermal inflammatory cells, and classification of the spongiotic reaction patterns, as well as their associated spongiotic dermatitis, take into consideration the type and distribution of these inflammatory cells. It is mandatory to consider different reactive processes, specific for other skin disorders, which act as simulants of different spongiotic patterns for the diagnosis. Considering the possible transient occurrence, the heterogeneity and non-specificity of the histopathological features of these diseases, the diagnosis is very complex, requiring clinicopathological correlations and additional analyses. A deep insight into spongiosis pathogeny may open the perspectives of a classification refinement of autoimmune bullous dermatoses.

Spongiotic Pattern in Pemphigus: A Retrospective Observational Single-Center Study

“…Neutrophils and eosinophils predominantly infiltrated the spongiotic areas in the pemphigus group. Previous studies have suggested that although neutrophilic and eosinophilic spongiosis are rare, they have been documented in pemphigus [ 6 , 8 , 9 , 10 , 11 , 12 ]. Our findings suggested that the presence of spongiosis predominantly infiltrated with neutrophils or eosinophils in the lower to middle thirds of the epidermis may be a helpful clue in cases of pemphigus without prominent acantholysis ( Figure 1 and Figure 4 ).…”

“…The vesicle contents are usually composed of a few acantholytic cells, and occasionally neutrophils and eosinophils [ 5 ]. These non-specific findings may lead to a misdiagnosis of eczema [ 6 ].…”

“…Eosinophilic spongiosis and neutrophilic spongiosis have been described in pemphigus patients without acantholysis. These changes are rare [ 6 , 7 , 8 , 9 , 10 ]. Eosinophilic spongiosis has been noted in the periphery of acantholytic vesicles associated with dermal infiltrates composed of lymphocytes and eosinophils [ 6 , 7 , 9 , 10 ].…”

“…These changes are rare [ 6 , 7 , 8 , 9 , 10 ]. Eosinophilic spongiosis has been noted in the periphery of acantholytic vesicles associated with dermal infiltrates composed of lymphocytes and eosinophils [ 6 , 7 , 9 , 10 ]. Neutrophilic spongiosis was commonly associated with IgA pemphigus, but reports have shown its presence in pemphigus vulgaris and pemphigus foliaceus as well [ 9 , 11 , 12 ].…”

Photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis: a systematic review and proposal for a new diagnostic classification

“…Histopathologic features are identical to those seen in an allergic contact dermatitis, including epidermal spongiosis, vesiculation, exocytosis of lymphocytes, and a perivascular inflammatory infiltrate [ 100 , 102 ]. Spongiosis represents the histological hallmark of intercellular epidermal edema, corresponding with wide spaces between keratinocytes and elongated intercellular bridges (“spinous processes”), leading to a sponge-like appearance of the epidermis [ 103 ]. The most common cutaneous lesion associated with spongiosis is eczematous dermatitis [ 104 ], consistent with the eczematous type of rash seen in photoallergic reactions.…”