acantholytic - HEALTHY
Transient acantholytic dermatosis (Grover disease) can mimic variable vesiculobullous entities, especially pemphigus vulgaris, Darier and Hailey-Hailey. Differentiation depends on clinical presentation, microscopic findings and direct immunofluorescence findings. High risk histologic variants Acantholytic: squamous cell carcinoma with acantholysis, pseudoglandular (CEA negative) (J Cutan Pathol 2022;49:133, J Clin Pathol 2006;59:1206, Dermatol Surg 2011;37:353) Acantholysis is the loss of cell to cell connections between keratinocytes, resulting in loss of intercellular cohesion Acantholysis: loss of appropriate keratinocyte cell-cell contact (pemphigus, transient acantholytic dermatosis, Hailey-Hailey, Darier's, Grover's / transient acantholytic dermatosis, irritant dermatitis) Reticular degeneration: ballooning degeneration with secondary rupture and death of the keratinocytes (viral, eczematous dermatitis) Group of acantholytic conditions caused by autoantibodies against various epidermal cell junction proteins, commonly presenting with flaccid blisters, erosions or scaling Skin nontumor Vesiculobullous and acantholytic reaction patterns Pemphigus vulgaris Author: Viktoryia Kozlouskaya, M.D., Ph.D.
Context Explanation
Editorial Board Member: Bethany R. Rohr, M.D. Although similar acantholytic dyskeratosis may be seen in a number of entities, given the clinical history of greasy papules in a seborrheic distribution, a positive family history and persistence of lesions, the findings are most consistent with Darier disease. Skin, right axilla, shave biopsy: Consistent with familial benign chronic pemphigus (Hailey-Hailey disease) (see comment) Comment: There is suprabasilar and intraepidermal clefting and acantholytic keratinocytes in a dilapidated brick wall appearance.
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Insight Material
Beneath this is a sparse, perivascular and interstitial lymphocytic inflammatory infiltrate. Warty dyskeratoma (WD) is an uncommon, benign follicular neoplasm characterized by acantholytic dyskeratosis; presents as a solitary papule or nodule with a central keratotic plug, commonly on the scalp, face, and neck of adults.