Superficial and Deep Dermal Infiltrate

Superficial and Deep Dermal Infiltrate

This is a classic David Weedon clue which he refers to as the 8Ls and the Mnemonic Drugs. A superficial and deep cellcellular infiltrate should present as a red non scaly disease so the diagnoses to consider will be within the mnemonic CUL DVA EVIE ( See www.ddderm.blogspot.com)

David's Ls include Lupus, Light eruptions, Lues (Syphilis) , Leprosy (Infiltrate) , Lipoidica (Necrobiotic), Lichen striatus, Lymphoma and Lepidoptera (Insect bite).

The Mnemonic DRUGS stands for Dermatophye, Reticular Erythematous Mucinosis (Infiltrate), Urticarial stage of bullous pemphigoid, Gyrate erythemas (Annular erythema), Localised Scleroderma (Morphoea) and Drugs.

The nature of the infiltrate will help. If Lymphocytic then Lupus, Light eruptions , Lichen Striatus and Lymphomas.

If eosinophilic then Bite reactions or Drugs or early Bullous pemphigoid, Well's syndrome

If plasma cells then Lues.

If mucin deposition then Lupus or Reticular erythematous mucinosis

If involvement of adnexal structures especially eccrine glands then Lichen striatus

If perivascular tightly then Gyrate erythema.

If atypical lymphocytes then lymphoma or Bite reaction