PEEPO: papular eruption with elimination of papillary oedema*

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Abstract
Multiple biopsies from a patient with a pruritic papular eruption of endogenous origin demonstrated a sequence of histopathological changes which varied markedly with the age of the lesion. Early lesions showed marked papillary edema but no evidence of epidermal involvement. The next phase was characterized by the appearance of focal spongiosis and intraepidermal vesiculation without involvement of the stratum corneum. Late lesions were characterized by residual spongiosis in the epidermis and groups of pyknotic nuclei in a parakeratotic stratum corneum. This sequence of events seems to be due to the elimination of papillary edema through the epidermis. The fact that this process produces changes indistinguishable from those seen in eczema may indicate the eczema itself is a condition characterized by sub-epidermal edema in which the epidermis is involved only as a secondary event. The title TEEPO (trans-epidermal elimination of papillary edema) is suggested as a suitable acronym for this phenomenon. The term PEEPO (papular eruption with elimination of papillary edema) is proposed for the eruption seen in this patient.

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