Related Experiment Video
Updated: Jul 13, 2026

Skin Biopsy for Diagnosing Discoid Lupus Erythematosus
Published on: June 10, 2025
Dyskeratosis as a histologic feature in epidermolysis bullosa simplex-Dowling Meara
Reuven Bergman1, Avikam Harel, Eli Sprecher
1Department of Dermatology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel, Institute of Technology, Haifa 31096, Israel. r_bergman@rambam.health.gov.il
Background:
Intracellular keratin aggregation and clumping is a characteristic ultrastructural feature in epidermolysis bullosa simplex (EBS)-Dowling Meara (DM) yet without histologic correlates in routinely stained specimens.
Objective:
We sought to detect histologic clues to keratin aggregation and clumping in the involved epidermis of EBS-DM.
Methods:
Four cases of EBS-DM caused by dominant keratin (KRT)5 and KRT14 mutations were studied histologically and ultrastructurally. The histologic slides of 11 additional EBS cases (9 Weber-Cockayne subtypes and two Koebner subtypes) were also reviewed histologically.
Results:
Intracytoplasmic aggregation and clumping of tonofilaments were observed ultrastructurally in all 4 EBS-DM cases. Intracytoplasmic eosinophilic homogenizations and inclusions (ie, dyskeratosis) in individual keratinocytes were detected histologically in 3 of the 4 EBS-DM cases, but in none of the 9 EBS-Weber-Cockayne cases or the two EBS-Koebner cases.
Limitations:
This was a relatively small studied group.
Conclusion:
The histopathological detection of dyskeratosis in individual keratinocytes may provide a valuable clue to keratin aggregation and clumping, and to the diagnosis in EBS-DM.
Related Concept Videos
Desmosomes
Cells of the Epidermis
The cells in all these layers except the stratum basale are called keratinocytes, a type of cell that manufactures and stores the protein keratin. The keratinocytes in the stratum corneum are dead and regularly slough away, being replaced by cells from...
Papillary Dermis
The dermis might be considered the "core" of the integumentary system, as distinct from the epidermis and hypodermis. It contains blood and lymph vessels, nerves, and other structures, such as hair follicles and sweat glands. The dermis is made of two layers of connective tissue that comprise an interconnected mesh of elastin and collagenous fibers, produced by fibroblasts.
Papillary Layer
The papillary layer is made of loose, areolar connective tissue, which means the collagen and...
Skin Cancer
Basal Cell Carcinoma (BCC): BCC is the most common type of skin cancer, accounting for about 80% of cases. It typically develops in...
Layers of the Epidermis
Stratum Basale
Stratum basale, also known as the stratum germinativum, is the deepest layer of the epidermis. It is composed of a single layer of actively dividing cells called basal cells or basal keratinocytes. These cells constantly undergo cell division to replenish the upper layers of the epidermis. Additionally, melanocytes, which...
Renewal of Skin Epidermal Stem Cells

