Pale cells in the epidermis

Pale cells in the Epidermis              See DX Path for details of the conditions below

Pellagra

For me I think of Acrodermatitis enteropathica, Necrolytic migratory erythema, Necrolytic acral erythema, Pellagra and Epidermolytic hyperkeratosis.
Here the clear cells are usually in the upper third of the epidermis.



You can also get clear cell neoplasms where processing removes glycogen, mucin or lipid from the cells. eg Clear cell acanthoma and clear cell variants of other tumours or nevi.
Sebaceous gland tumours and metastatic renal tumours are also clear celled but the pale cells are in the dermis although some may appear to invade the epidermis in a pagetoid fashion.

Clear Cell Acanthoma

Vacuolisation of keratinocytes can simulate pale cells but this usually occurs because of a processing artefact but remember papilloma virus causing this (koilocytosis around a shrunken raisin like nucleous in the upper spinous layer.)

Verruca Vulgaris

Individual and nests of pale cells can be seen in the epidermis with the conditions causing Pagetoid spread.( Melanoma, Mammary and Extra mammary Pagets, Pagetoid reticulosis (T cell lymphoma) Bowen's disease, Sebaceous carcinoma and rarely Merkel cell carcinoma)

Extramamary Paget's Disease

Check GlobalSkinAtlas for the Clinical images of these conditions

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