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Acne keloidalis. Transverse microscopy, immunohistochemistry, and electron microscopy
A J Herzberg1, S M Dinehart, B J Kerns
1Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710.
The American Journal of Dermatopathology
|April 1, 1990
Summary
Early acne keloidalis involves inflammation within hair follicles, particularly at deeper levels. This condition shows follicular wall destruction and scarring, with absent sebaceous glands in most cases.
Area of Science:
- Dermatopathology
- Histopathology of skin
Background:
- Acne keloidalis pathogenesis remains poorly understood, especially in its initial phases.
- Characterizing early histopathological changes is crucial for understanding disease progression.
Observation:
- Transverse sections of early acne keloidalis lesions reveal inflamed follicular units.
- Inflammation is most pronounced in the deep infundibular and isthmian regions of hair follicles.
- Early stages display acute folliculitis and perifolliculitis with follicular wall destruction and hair extrusion.
Findings:
- Central follicles exhibit acute neutrophilic or chronic lymphocytic inflammation at upper isthmian levels.
- Granulomatous inflammation is observed at deeper isthmian levels.
- Scarring at isthmian levels traps hair fragments, leading to granulomatous inflammation and fibrosis.
- Sebaceous glands are notably absent in most affected follicular units (7/8).
Implications:
- Understanding these early histopathological changes can inform targeted therapeutic strategies for acne keloidalis.
- The observed inflammation patterns suggest a complex immune response involving neutrophils, lymphocytes, and granulomas.
- The absence of sebaceous glands may indicate a distinct follicular pathology compared to other acneiform eruptions.