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Incidental acantholysis
E Sánchez Yus1, L Requena, P Simón
1Department of Dermatology, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
Abstract:
The incidental finding of microscopic foci of acantholytic dyskeratosis, reproducing the histological pattern of Darier's disease, has been the subject of a number of papers in the last few years. In contrast, the incidental finding of other types of acantholysis has not been mentioned in the literature. In the last 5 years, we have noticed such a microscopic finding in 14 biopsy specimens (0.15% of our cutaneous specimens). they were from 13 patients (7 men and 6 women); their ages ranged from 37 to 79 years (mean, 63). Three lesions were located on the head, 7 on the trunk, and 4 on the limbs. The histological diagnoses were basal cell carcinoma (6 cases), keratoacanthoma (2 cases), psoriasis (2 cases), elastolytic granuloma, acral arteriovenous angioma, tinea corporis, and leukocytoclastic vasculitis (1 case each). The histological patterns of the acantholytic foci simulated pemphigus vulgaris (9 cases), superficial pemphigus (1 case), Hailey-Hailey disease (3 cases), and unclassifiable acantholysis (1 case). None of the patients had familial or personal history of acantholytic disorders. We propose a classification of the primary acantholytic disorders based on both their acantholytic pattern and their clinical extent.
Insights
Microscopic acantholysis, a feature usually seen in Darier's disease, was incidentally found in various skin conditions. This study details 14 cases, highlighting the diverse histological patterns and proposing a new classification for acantholytic disorders.
Area of Science:
- Dermatopathology
- Histology
- Oncodermatology
Background:
- Microscopic foci of acantholytic dyskeratosis mimicking Darier's disease are documented.
- Incidental findings of other acantholytic patterns in skin biopsies are not well-described in literature.
Purpose of the Study:
- To report and characterize incidental microscopic acantholysis in cutaneous biopsy specimens.
- To propose a classification for primary acantholytic disorders based on histological patterns and clinical extent.
Main Methods:
- Retrospective analysis of 14 cutaneous biopsy specimens showing incidental acantholysis over 5 years.
- Histopathological review to identify patterns of acantholysis and associated diagnoses.
- Clinical data review for patient demographics, lesion location, and history of acantholytic disorders.
Main Results:
- 14 cases (0.15% of specimens) from 13 patients (mean age 63) exhibited incidental acantholysis.
- Associated diagnoses included basal cell carcinoma, keratoacanthoma, psoriasis, and others.
- Histological patterns simulated pemphigus vulgaris, superficial pemphigus, and Hailey-Hailey disease, with no patient history of these conditions.
Conclusions:
- Incidental microscopic acantholysis occurs in diverse dermatological conditions beyond Darier's disease.
- A proposed classification system for primary acantholytic disorders integrates histological features and clinical presentation.