The correct answer is E. Eosinophils.

The presentation is consistent with pityriasis lichenoides et varioliformis acuta (PLEVA). Histopathologic findings in PLEVA typically include parakeratosis, a lichenoid lymphocytic infiltrate, extravasation of red blood cells, and acute epidermal changes such as dyskeratosis, necrotic keratinocytes, and ulceration. A characteristic V-shaped wedge of lymphocytic infiltrate in the dermis is often described. Importantly, eosinophils are absent in both PLEVA and PLC, helping to distinguish them from other inflammatory dermatoses. Therefore, eosinophils would not be expected on histology.

Option A, Lichenoid infiltrate, is commonly seen in PLEVA as a dense, bandlike lymphocytic infiltrate. Option B, Extravasation of red blood cells, is a hallmark finding reflecting vascular damage in PLEVA lesions. Option C, Dyskeratosis, or necrotic keratinocytes, is a classic acute epidermal change in PLEVA. Option D, Parakeratosis, is frequently present in PLEVA and is milder in PLC.

References: Alikhan A, Hocker TL. Review of Dermatology. 2nd ed. Elsevier; 2024.