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The Incidence of Acantholysis in Pityriasis Rubra Pilaris-Histopathological Study Using Multiple-Step Sections and
Emily Avitan-Hersh1, Reuven Bergman
1*Department of Dermatology, Rambam Health Care Campus, Haifa, Israel; and †The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Background:
The classical histopathological findings in the epidermis of pityriasis rubra pilaris (PRP) do not include acantholysis; however, acantholysis was described in several case reports and a few series of PRP with variable frequencies. We sought to establish the incidence of acantholysis in biopsies from consecutively referred PRP cases using multiple-step sections and clinicopathologic correlations.
Methods:
Twenty-three biopsies from 12 consecutively referred patients with classical (type 1) PRP were studied histopathologically. Each specimen was completely step sectioned. The clinical files of the patients were also reviewed.
Results:
Small foci of acantholysis were observed in some of the step sections of 5 of 23 (22%) biopsies obtained from 4 patients. Three biopsies showed suprabasal acantholysis, 1 of which also demonstrated mild dyskeratosis and 2 showed midepidermal acantholytic foci as well. The remaining 2 biopsies demonstrated midepidermal and subcorneal acantholysis, respectively. Small erosions were described in the physical examination of 2 of the 4 (50%) patients with acantholysis and in 1 of the 8 (12.5%) patients without acantholysis.
Limitations:
The number of cases.
Conclusions:
Small foci of acantholysis may be found in the minority of PRP biopsies, and it may be related to small erosions clinically in some patients.
Insights
Acantholysis, a finding not typically seen in pityriasis rubra pilaris (PRP), was present in 22% of PRP biopsies. This histological feature may correlate with clinical erosions in some patients.
Area of Science:
- Dermatopathology
- Histopathology
- Clinical Dermatology
Background:
- Classical histopathology of pityriasis rubra pilaris (PRP) does not typically include acantholysis.
- Acantholysis has been anecdotally reported in PRP cases with varying frequencies.
- The precise incidence and clinical significance of acantholysis in PRP remain unclear.
Purpose of the Study:
- To determine the incidence of acantholysis in PRP.
- To correlate histopathological findings of acantholysis with clinical presentation in PRP patients.
- To investigate the diagnostic value of step sectioning in identifying acantholysis in PRP.
Main Methods:
- Histopathological examination of 23 biopsies from 12 patients with classical (type 1) PRP.
- Complete step sectioning of all biopsy specimens to maximize detection of subtle changes.
- Review of clinical files for correlation with histopathological findings.
Main Results:
- Acantholysis was identified in 5 of 23 biopsies (22%), originating from 4 patients.
- Observed acantholysis included suprabasal, midepidermal, and subcorneal types.
- Clinical erosions were noted in 50% of patients with acantholysis versus 12.5% of those without.
Conclusions:
- Acantholysis can be found in a minority of PRP biopsies, particularly when extensive sectioning is performed.
- The presence of acantholysis in PRP may be associated with clinical erosions.
- Further research is needed to fully understand the implications of acantholysis in PRP.
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