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Electron microscopic features in generalized pustular psoriasis.

M C Heng, J A Heng, S G Allen

    The Journal of Investigative Dermatology
    |August 1, 1987
    PubMed
    Summary

    Generalized pustular psoriasis involves abnormal basal keratinocyte herniations (BKH), indicating high proteolytic activity. Neutrophilic proteases likely cause BKH in this condition, distinct from psoriasis vulgaris.

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    Area of Science:

    • Dermatology
    • Cell Biology
    • Biochemistry

    Background:

    • Basal keratinocyte herniations (BKH) are recognized markers of psoriatic activity.
    • Multipolar BKH associated with alpha 1-antitrypsin deficiency suggest excessive proteolytic activity in psoriasis vulgaris.

    Purpose of the Study:

    • To investigate multipolar BKH in generalized pustular psoriasis (von Zumbusch).
    • To determine if BKH in this form of psoriasis is linked to neutrophilic proteases.

    Main Methods:

    • Histopathological examination of skin biopsies from patients with generalized pustular psoriasis.
    • Correlation of BKH morphology and density with dermal neutrophil presence and distribution.

    Main Results:

    • Similar multipolar BKH were observed in generalized pustular psoriasis patients without alpha 1-antitrypsin deficiency.

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  • A significant association was found between BKH and dermal neutrophils.
  • High-density BKH clusters frequently overlaid dermal neutrophil collections.

    • Conclusions:

    • Multipolar BKH in generalized pustular psoriasis suggest significant dermal proteolytic activity.
    • Neutrophilic proteases are implicated as the primary cause of BKH formation in this condition.