2. Top-Down

  1. Christine J. Ko1 and
  2. Ronald J. Barr2,3

Published Online: 8 MAR 2011

DOI: 10.1002/9781444340235.ch2

Dermatopathology: Diagnosis by First Impression, 2nd edition

Dermatopathology: Diagnosis by First Impression, 2nd edition

How to Cite

Ko, C. J. and Barr, R. J. (2011) Top-Down, in Dermatopathology: Diagnosis by First Impression, 2nd edition, Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444340235.ch2

Author Information

  1. 1

    Yale University School of Medicine, New Haven, Connecticut, USA

  2. 2

    Laguna Pathology Medical Group, Laguna Beach, California, USA

  3. 3

    University of California, Irvine, California, USA

Publication History

  1. Published Online: 8 MAR 2011
  2. Published Print: 11 MAR 2011

ISBN Information

Print ISBN: 9780470657119

Online ISBN: 9781444340235



  • top-down hyperkeratosis/parakeratosis - and lymphocytic infiltrate;
  • Flegel disease - and vacuolar change at dermoepidermal junction;
  • Pityriasis rubra pilaris - hyperkeratosis, alternating with parakeratosis;
  • axillary granular parakeratosis - slightly refractile organisms (spheres and tubules) in stratum corneum;
  • hyperkeratosis/parakeratosis and lymphocytic infiltrate;
  • clonal seborrheic keratosis - upper epidermal change of keratinocytes, with blue-gray expanded cytoplasm and haloes around nuclei;
  • epidermolytic hyperkeratosis - angular, clumped tonofilaments in cytoplasm;
  • Verruca plana - toeing-in (arborization) of rete ridges;
  • subcutaneous fat necrosis of newborn - lobular involvement of inflammation;
  • allergic contact dermatitis – and eosinophilic spongiosis


This chapter contains sections titled:

  • Hyperkeratosis/parakeratosis

  • Upper epidermal change

  • Acantholysis

  • Eosinophilic spongiosis

  • Subepidermal space/cleft

  • Perivascular infiltrate

  • Band-like upper dermal infiltrate

  • Interface reaction

  • Granular “material” in cells

  • “Busy” dermis

  • Dermal material

  • Change in the fat