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The oldest new finding in atopic dermatitis: subclinical miliaria as an origin
Maryam S Haque1, Tesfu Hailu, Ellen Pritchett
1Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania 19107, USA.
Importance:
In 1947, Sulzberger and colleagues published a micrograph of a blocked acrosyringium in a patient with atopic dermatitis (AD), believing that it had a large role in the disease process. Lacking appropriate probes, they could not confirm the finding.
Objective:
To confirm the observations by Sulzberger et al on the blockage of sweat ducts in AD in pathologic specimens.
Design And Setting:
Biopsy specimens diagnostic of various inflammatory diseases and with a secondary differential diagnosis of eczema were evaluated at an academic medical center.
Exposures:
Evidence of ductal obstruction in each specimen was examined following staining with hematoxylin-eosin, periodic acid-Schiff, and Gram stain.
Main Outcomes And Measures:
Comparison of biopsy specimens with control specimens and additional controls consisting of noninflamed skin.
Results:
Using 36 biopsy specimens, this study confirmed the observations by Sulzberger et al on the blockage of sweat ducts in AD. Blocked acrosyringia were noted in each specimen on routine staining with hematoxylin-eosin. The study also confirmed the findings by earlier investigators about the blockage of sweat ducts in miliaria, showing eosinophilic material in the ducts that was positive for periodic acid-Schiff. Previous researchers also observed bacteria in the blockages, and this study demonstrated the same findings in AD, rather than miliaria.
Conclusion And Relevance:
Subclinical miliaria may be the earliest change in AD and likely initiates the process that causes intense pruritus.
Insights
Blocked sweat ducts, or acrosyringia, are confirmed in atopic dermatitis (AD) patients. This finding suggests subclinical miliaria may initiate AD and its associated itching.
Area of Science:
- Dermatology
- Pathology
- Sweat Gland Biology
Background:
- A 1947 study by Sulzberger et al. suggested blocked acrosyringia play a key role in atopic dermatitis (AD).
- Previous research lacked definitive proof due to limitations in available investigative tools.
Purpose of the Study:
- To histologically confirm the presence of blocked sweat ducts (acrosyringia) in patients diagnosed with atopic dermatitis.
- To re-evaluate the role of sweat duct obstruction in the pathogenesis of AD.
Main Methods:
- Biopsy specimens from patients with inflammatory skin diseases, including eczema, were analyzed.
- Histological examination employed hematoxylin-eosin, periodic acid-Schiff, and Gram staining techniques.
- Specimens were compared against healthy, non-inflamed skin controls.
Main Results:
- The study confirmed blocked acrosyringia in all evaluated atopic dermatitis (AD) biopsy specimens using routine hematoxylin-eosin staining.
- Findings corroborated earlier research on sweat duct blockage in miliaria, identifying periodic acid-Schiff-positive material.
- Bacteria were observed within the blocked ducts in AD specimens, consistent with findings in miliaria.
Conclusions:
- Subclinical miliaria, characterized by blocked sweat ducts, may represent an early pathological change in atopic dermatitis (AD).
- This obstruction is hypothesized to be an initiating factor for the intense pruritus characteristic of AD.
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