ABSTRACT
More severe disease leads to pronounced acanthosis with little spongiosis, along with dermal fibrosis, scattered stellate fibroblasts and vertical orientation of collagen fibers, similar
to that seen in lichen simplex from persistent scratching, but in this case showing considerably more dermal inflammation (150). This inflammatory infiltrate may be band-like or diffuse, extending into the mid-and lower dermis, with a polymorphic phenotype consisting of lymphocytes (including hyperchromatic or convoluted forms resembling Sézary cells), plasma cells, eosinophils, giant cells, blast cells, and mitotic figures (151). The lymphoid cells may infiltrate the epidermis and mimic Pautrier micro-abscesses. The microscopic picture in this end of the pathologic spectrum simulates cutaneous T cell lymphoma, and is often referred to as actinic reticuloid.
