Mimickers of classic acantholytic diseases

Abstract

Acantholysis is a commonly encountered histological pattern which typically generates a differential of the pemphigus variants, Hailey-Hailey, Darier's and Grover's diseases. In addition to these diseases, the dermatologist and dermatopathologist must be aware of entities that mimic classic acantholytic dermatoses and of rare disease variants, which are characterized by acantholysis.

Dermoscopic and reflectance confocal microscopic presentation of Hailey‐Hailey disease: A case series

“…Vegetating flexural lesions may be similar to those of pemphigus vegetans. [7][8][9] Histological examination of established HHD lesions reveals widespread acantholysis with suprabasilar vesicle or bulla formation. Acantholysis is typically incomplete with keratinocytes Although histopathology complemented by genetic testing are long considered gold standard for the diagnosis of HHD, emergent noninvasive techniques, including dermoscopy and reflectance confocal microscopy (RCM), may also play an important role.…”

“…Clinical differential diagnoses include candidiasis, inverse psoriasis, tinea corporis, allergic or irritant contact dermatitis, and Darier disease. Vegetating flexural lesions may be similar to those of pemphigus vegetans …”

Classic Findings, Mimickers, and Distinguishing Features in Primary Blistering Skin Disease

“…11 Direct immunofluorescence on perilesional skin may be required to differentiate between these 2 entities, revealing intercellular IgG with or without complement 3 (C3) in PF and negative findings in SSSS. 10 It should be noted that pemphigus erythematosus, which combines clinical features of PF with immunologic features of lupus erythematosus, histologically appears identical to pemphigus foliaceus (subcorneal blister containing acantholytic cells). 12 PEMPHIGUS VULGARIS MIMICKED BY HAILEY-HAILEY DISEASE Acantholysis within the epidermis leading to intraepidermal blistering is the characteristic finding of pemphigus vulgaris (PV), the most common subtype of pemphigus.…”

“…8 On H&E, the subcorneal and intragranular pattern of acantholysis is identical in SSSS and PF. 10 However, epidermal inflammation in SSSS is typically sparse because bullae are sterile. In contrast, PF typically shows a more prominent inflammatory infiltrate in the upper dermis, including eosinophils.…”

A case of warty dyskeratoma on an unusual location

“…The striking histological features of Warty dyskeratoma (WD) are a cup-shaped epidermal invagination filled with keratotic debris, grains, corps ronds and villi formation with supra basal acantholytic cells. The differential diagnosis of acantholytic dyskeratosis similar to that seen in warty dyskeratoma are Darier's disease, acantholytic dyskeratotic acanthoma, acantholytic dyskeratotic epidermal nevus, focal acantholytic dyskeratosis and squamous cell carcinoma of acantholytic type, relapsing linear acanhtolytic dermatosis and acantholytic dermatosis of genitocrural area[6] [Table 1].…”