Horizontal sections for the presence of eccrine glands

Abstract

To the Editor: The presence of eccrine glands in the skin is often easily assessed by a good physical examination. The presence of sweat confirms the presence of some eccrine gland function. A few abnormalities of the eccrine glands are of importance to dermatologists. The presence of sweating can be confirmed with a starch iodine test. In some patients, such as infants, this test is difficult to perform. Occasionally dermatologists are called on to evaluate infants and children for disorders of sweat glands, namely anhidrotic ectodermal dysplasia and hidrotic ectodermal dysplasia.1Berg D. Weingold D.H. Abson K.G. Olsen E.A. Sweating in ectodermal dysplasia syndromes.Arch Dermatol. 1990; 126: 1075-1079Crossref PubMed Scopus (20) Google Scholar, 2Wisniewski S.A. Kobielak A. Trzeciak W.H. Kobielak K. Recent advances in understanding of the molecular basis of anhidrotic ectodermal dysplasia: discovery of a ligand, ectodyslpasian A and its two receptors.J Appl Genet. 2002; 43: 97-107PubMed Google Scholar Anhidrotic ectodermal dysplasia, also know as hypohidrotic ectodermal dysplasia, is a predominately x-linked recessive genodermatosis. Autosomal recessive patterns of inheritance can also be seen. Patients may have the characteristic facial features (frontal bossing, periorbital hyperpigmentation), abnormal teeth and hair, and hyperpyrexia secondary to severe hypohidrosis or anhidrosis. An important aspect of caring for these patients is to avoid overheating because they lack eccrine sweat glands. A way to help confirm the diagnosis is to perform a skin biopsy and to assess for eccrine glands. The most logical area to biopsy is the palm or sole, two areas with high concentrations of eccrine glands. We describe a technique of performing horizontal sections of a skin punch biopsy as a way to evaluate for eccrine glands. We feel this method has advantages over the standard vertical sectioning routinely performed to evaluate for eccrine glands, and this can be a useful method for studying ectodermal dysplasia syndromes. A 4-month-old Amish child was admitted to the hospital for fevers of unknown origin. He had a significant family history of a brother dying as an infant with similar fevers. A diagnosis was never made for the deceased brother. He was sent to us specifically to look into the possibility of anhidrotic ectodermal dysplasia. We examined the patient and found no obvious cutaneous disorders. He had no clinical features of anhidrotic ectodermal dysplasia. The parents said the child did not sweat. We proceeded to perform a punch biopsy of the palm. In our practice we evaluate scalp biopsy specimens for alopecia using a horizontal sectioning technique. That allows for all the hair follicles in the specimen to be reviewed. We used this method to search for eccrine glands. A routine hematoxylin and eosin stain was used to assess the eccrine glands. The biopsy specimen did indeed show a normal-appearing density of eccrine glands, which were evenly spaced throughout (Fig 1). This technique proved to be a simple and rapid way to demonstrate the presence of eccrine glands. We concluded the child did not have anhidrotic ectodermal dysplasia, because of the normal density of eccrine glands. The biopsy specimen, however, did not rule out the possibility of hidrotic ectodermal dysplasia, as the eccrine glands can appear normal in that condition. After further evaluation by his pediatricians no firm diagnosis was made. He was believed to have an immunodeficiency syndrome, but unfortunately he was lost to follow-up. In conclusion, we feel that horizontal sectioning of skin biopsy specimens is an excellent way to evaluate for eccrine glands.