Differential Diagnosis of Disorders with Acantholysis:

Distinguishing Clinical Features

Distinguishing Histologic Features

Pemphigus, foliaceus, and erythematosus

Pemphigus vulgaris and pemphigus vegetans

Benign familial pemphigus

Keratosis follicularis

Transient acantho-lytic dermatosis

Herpesvirus infections


Subcorneal pustular dermatosis

Tumors of the epidermis (actinic keratoses, warty dyskeratoma, squamous cell carcinoma) may at times have acantholysis associated with the keratinocytic proliferation

Superficial crusted erosions on head and trunk

Cutaneous and mucosal bullae and erosions

Verrucous plaques in intertriginous areas

Warty hyperkeratotic papules and plaques on face, trunk, and flexural areas of the extremities

Small, pruritic crusted papules on the trunk

Tense vesicles, clustered (HSV) or in a dermatomal distribution (HV-Z)

Honey-crusted lesions typically on the face and extremities

Minute flaccid pustules

Intragranular acantholysis

Suprabasilar acantholysis

Hyperkeratosis, acanthosis, and diffuse acantholysis throughout the spinous layer of the epidermis

Acantholytic dyskeratosis in the upper epidermis forming corps grains and corps ronds

Suprabasilar acantholysis

Focal acantholytic changes at any level of the epidermal

Ballooned and multi-nucleate acantholytic keratinocytes

Intraepidermal pustule with scattered acantho-lytic keratinocytes

Intraepidermal pustule with a few acantholytic keratinocytes

Abbreviation: HSV, herpes simplex virus.

Differential Diagnosis of Intraepidermal Eosinophilic Microabscesses:

Differential Diagnosis of Intraepidermal Eosinophilic Microabscesses: Continued

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