Spongiotic reaction pattern is characterised by inter and intracellular oedema of the epidermis and elongation of the intercellular bridges.
Progressive psoriasiform hyperplasia occurs with chronicity.
In the past this reaction pattern was known as ‘eczematous tissue reaction’.
The spongiosis may vary from microscopic foci to grossly visible vesicles.
Inflammatory cells are present in the dermis and their distribution and type may aid in making a specific diagnosis.
Five patterns of spongiosis :
1. Neutrophilic spongiosis (where there are neutrophils within foci of spongiosis)
Example- Pustular Psoriasis
2. Eosinophilic spongiosis (where there are numerous eosinophils within foci of spongiosis).
Example- Bullous Pemphigoid
3. Miliarial (acrosyringial) spongiosis (where edema is related to the acrosyringium).
Example – Miliaria Rubra.
4. Follicular spongiosis (where the spongiosis centered on the follicular infundibulum.
Example – Infundibulofolliculitis
5. Haphazard spongiosis (other spongiotic disorders in which there is no particular pattern).
Example- Spongiotic Drug Reaction
1. Neutrophilic spongiosis (where there are neutrophils within foci of spongiosis)
Examples of Neutrophilic Spongiosis:
Pustular psoriasis;
IgA pemphigus;
Palmoplantar pustulosis;
Dermatophytosis/candidosis;
Acute generalized exanthematous pustulosis.
2. Eosinophilic spongiosis (where there are numerous eosinophils within foci of spongiosis)
Examples of Eosinophilic Spongiosis:
Pemphigus (precursor lesions)
Pemphigus vegetans
Arthropod bites
Allergic contact dermatitis
Eosinophilic folliculitis
Incontinentia pigmenti (first stage)
3. Miliarial (acrosyringial) spongiosis (where edema is related to the acrosyringium).
Example: Miliaria
4. Follicular spongiosis (where the spongiosis centered on the follicular infundibulum
Example: Infundibulofolliculitis, atopic dermatitis
5. Haphazard spongiosis (other spongiotic disorders in which there is no particular pattern).
Other Spongiotic Disorders:
Irritant contact dermatitis
Allergic contact dermatitis Image
Nummular dermatitis ; Dermatopathology Case 122
Seborrheic dermatitis ;
Atopic dermatitis ;
Pityriasis rosea;
Stasis dermatitis ;
Chronic superficial dermatitis ;
Spongiotic drug reaction.
Histopathological features of some spongiotic diseases:
Irritant contact dermatitis:
Superficial ballooning, necrosis and neutrophils; mild irritants produce spongiotic dermatitis mimicking allergic contact dermatitis.
Allergic contact dermatitis:
Variable spongiosis and vesiculation at different horizontal and vertical levels, mild exocytosis, progressive psoriasiform hyperplasia with chronicity.
Superficial dermal oedema and eosinophils in superficial dermal infiltrate.
Seborrheic dermatitis:
Variable spongiosis and psoriasiform hyperplasia depending on activity and chronicity.
Scale crust and spongiosis may localize to follicular ostia.
Atopic dermatitis:
Mimics other spongiotic diseases.
There is variable spongiosis, focal parakeratosis, prominence of vessels in the papillary dermis, psoriasiform hyperplasia, exocytosis and perivascular infiltrate of lymphocytes.
Stasis dermatitis:
Mild spongiosis only ; proliferation of superficial dermal vessels, extravasation of erythrocytes, abundant hemosiderin.
Spongiotic drug reaction:
Spongiosis, conspicuous exocytosis of lymphocytes, rare apoptotic keratinocytes, eosinophils, plasma cells, lymphocytes in superficial dermis and sometimes in mid dermis.
Sometimes superficial dermal oedema.
Chronic superficial dermatitis:
Mild spongiosis, focal parakeratosis, variable psoriasiform hyperplasia, superficial perivascular infiltrate with upward extension and mild exocytosis.
Neutrophils in stratum corneum or compact orthokeratosis should alert observer to perform PAS stain.
Spongiotic vesicles may form on palms and soles.