Transient acantholytic dermatosis: a reevaluation

Transient acantholytic dermatosis is a self-limited, primary acantholytic disease that occurs predominantly in persons over 50 years old. The primary lesions, discrete papules and papulovesicles, are distributed mainly on the chest, back, and thighs and may be intensely pruritic. The disease lasts less than three months in the majority of patients, but occasionally may go on for two or three years. Four distinct histologic patterns are present in the biopsy specimens, namely, Darier-like in which there is focal acantholysis and dyskeratosis overlying suprabasilar clefts; pemphigus vulgaris-like, in which there are a few acantholytic cells above discrete suprabasal clefts having a mostly intact overlying epidermis; Hailey-Hailey-like, in which there are numerous acantholytic cells overlying suprabasilar clefts; and, finally, spongiotic, in which a few acantholytic cells are present within, or contiguous with, spongiotic foci. Some cases show a predominance of one pattern, but more frequently two or more of these patterns can be found in a single biopsy specimen.