S5C9P3-LE-Interface

S5C9P3-2: In this example (LE), infiltrates are prominent at the dermal-epidermal interface; there are lytic defects in the partially preserved basal unit. The basement membrane zone is obscured. In this field, the patterns take on a lichen planus-like character. An occasional apoptotic cell has migrated upward.

S5C9P3-3: The basal layer is distorted and disorganized. There are small lytic defects. A green arrow identifies a necrotic keratinocyte, but it is uncertain whether the cell is in the original epidermal, or original dermal, domain. The basement membrane zone is obscured. The epidermis contains irregular deposits of melanin (LE).


S5C9P3-1: The interface changes of lupus erythematosus (LE) are characterized by vacuolar changes on both sides of the basement membrane and by atrophy of the epidermal basal unit. The interface between the epidermis and the dermis is straight. The inflammatory infiltrates are rich in migratory histiocytes (green arrows); there are fragments of nuclear debris (red arrows). Fragments of nuclear debris are common near the D-E junction in lesion of LE. Basement membrane changes are variable; they are least prominent in acute LE and most prominent in discoid LE.

S5C9P3-4: The basement membrane is accentuated; focally, it is reduplicated. The thickened membrane has hyaline qualities There are vacuolar changes on both sides of the basement membrane. In areas, the basal layer, as a morphologically distinctive zone, is interrupted.

S5C9P3-5: This faded photograph shows a pattern of discoid LE, late in the evolution of the lesion. In the region of the red arrows, there is a thickened, homogeneous (hyalinized) basement membrane. The upper portion of the dermis is fibrotic. Vessels are ectatic. They have hyalinized walls (green arrows). The erosive process, although cell-poor, affects a follicle that is well on its way to atrophy. This is the senescent phase of LE. The patterns might be mistaken for those of a lesion of lichen sclerosis et atrophicus.

S5C9P3-6: The basic patterns in subacute LE differ from those of both discoid and acute variants. In this example, the patterns have an erythema multiforme-like quality, in that the necrotic keratinocytes are prominent above the basal layer. Some of the necrotic cells have been delivered into the keratin layer. This pattern of single cell necrosis and of discharge of the necrotic cells at the surface is not a usual feature of the more common forms of lupus erythematosus. Yellow arrows define the boundary between the basal and the superficial units of the epidermis. The basal unit is not only preserved, but is hyperplastic; in most other variants of LE, the basal unit is atrophic. In addition, the lichenoid patterns (as identified by the distribution and spacing of necrotic keratinocytes) are linear in distribution at this same boundary between the basal and the superficial units. The distribution of the infiltrates (not the character of the infiltrating cells), is similar to the distribution of neutrophils in the variant of pemphigus (IgA variant) that is classified as intermediate variant (in the section on vesiculo-bullous diseases).

S5C9P3-7: Linear lymphoid infiltrates that are intermediate in distribution (i.e., between the superficial and the basal units of the epidermis) are evident in the center of the field. The lichenoid reaction is expressed in this region. The basal unit, as well as the basal layer, are relatively intact. The superficial unit is hyperplastic; it contains scattered necrotic keratinocytes. Some of the necrotic cells are present in the keratin layer on the right.

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