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The invisible dermatoses.

M H Brownstein, A D Rabinowitz

    Journal of the American Academy of Dermatology
    |April 1, 1983
    PubMed
    Summary
    This summary is machine-generated.

    Dermatopathologists face "invisible dermatoses" where skin biopsies appear normal despite clinical disease. A systematic approach examining epidermis and dermis helps identify these challenging diagnoses.

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    Area of Science:

    • Dermatopathology
    • Histopathology
    • Clinical Dermatology

    Background:

    • Clinically significant skin disorders can present with histological findings resembling normal skin, posing a diagnostic challenge.
    • These 'invisible dermatoses' require specialized examination techniques for accurate identification by dermatopathologists.

    Purpose of the Study:

    • To outline a systematic diagnostic strategy for identifying 'invisible dermatoses' in dermatopathology.
    • To highlight key histological features and special stains crucial for diagnosing clinically apparent skin conditions that lack distinct microscopic findings.

    Main Methods:

    • Examination of the epidermis for specific abnormalities like fungi, cornoid lamellae, and absence of the granular layer.
    • Analysis of the dermis for conditions such as hyalin deposition, mast cells, microfilaria, dermal melanocytosis, and absence of sweat glands.

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  • Utilizing special stains and comparing biopsy specimens with normal skin to detect subtle changes.

    • Main Results:

    • A structured approach aids in uncovering subtle histological clues in 'invisible dermatoses'.
    • Specific epidermal and dermal findings, along with special stains, are critical for diagnosing conditions like disseminated superficial actinic porokeratosis, dominant ichthyosis vulgaris, macular amyloidosis, and anhidrotic ectodermal dysplasia.
    • Consideration of technical issues like sampling errors and specimen mix-ups is essential for accurate diagnosis.

    Conclusions:

    • A methodical dermatopathological examination, including specialized stains and comparison with normal skin, is vital for diagnosing 'invisible dermatoses'.
    • Recognizing and addressing potential technical errors can improve diagnostic accuracy for challenging skin conditions.