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Histopathology of cutaneous changes in drug-induced coma
E Sánchez Yus1, L Requena, P Simón
1Department of Dermatology, Hospital Universitario San Carlos, Madrid, Spain.
Abstract:
Present knowledge of the histopathology of cutaneous changes seen in drug-induced coma is very incomplete: Only 1 of the 11 papers on this subject mentions follicular or sebaceous gland damage, with very little attention focused on vascular changes. We made a careful study of serial sections from eight cutaneous biopsy specimens from seven patients who suffered drug-induced coma with the following findings: (a) The secretory portion of the eccrine sweat coil is the epithelium most susceptible to necrosis. It is followed by, ex aequo, eccrine sweat duct, hair follicle, and sebaceous gland, and, lastly, the epidermis. (b) In the eccrine sweat duct, the outer root sheath of the hair follicle, and the epidermis, necrosis does not usually appear first in the outermost (basal cell) layer. (c) Necrosis of the outer root sheath of the telogen "club" follicle is usually more advanced than that of the secondary hair germ, and, at times, a spared anagen bulb can be seen in closest proximity. (d) Vascular changes correlate proportionately with epidermal damage and consist of a largely neutrophilic inflammatory infiltrate and blood vessel wall damage, mainly involving arterioles. Our findings contradict the widely accepted hypothesis that pressure is the main cause of the cutaneous changes in drug-induced coma.
Insights
Histopathology of drug-induced coma reveals eccrine sweat coils are most susceptible to necrosis. Findings challenge the pressure-ulcer hypothesis for skin damage in these patients.
Area of Science:
- Dermatopathology
- Histology
- Drug-induced skin reactions
Background:
- Limited understanding of cutaneous histopathology in drug-induced coma.
- Previous studies inadequately addressed follicular, sebaceous gland, and vascular changes.
Purpose of the Study:
- To investigate the histopathology of skin in drug-induced coma.
- To identify the most susceptible cutaneous structures to damage.
- To examine vascular changes and their correlation with epidermal damage.
Main Methods:
- Analysis of serial sections from eight cutaneous biopsy specimens.
- Histopathological examination of skin from seven patients in drug-induced coma.
Main Results:
- Eccrine sweat coil epithelium showed highest susceptibility to necrosis, followed by eccrine sweat duct, hair follicle, sebaceous gland, and epidermis.
- Necrosis patterns in eccrine sweat ducts, hair follicles, and epidermis did not primarily originate in basal cell layers.
- Vascular changes, including neutrophilic infiltrate and arteriolar damage, correlated with epidermal damage.
- Observed damage patterns contradicted the pressure-ulcer hypothesis.
Conclusions:
- The study elucidates the specific patterns of cutaneous histopathology in drug-induced coma.
- Findings indicate a specific hierarchy of cellular susceptibility to necrosis.
- Results challenge the prevailing theory attributing skin changes solely to pressure.