Incidental Acantholytic Dyskeratosis and Hailey‐Hailey Like Acantholysis

Abstract

Materials and Methods: 247 consecutive skin specimens covering a three‐month period (1/04–3/04) were reviewed to identify incidental foci of Hailey‐Hailey (HH) like acantholysis and focal acantholytic dyskeratosis (FAD). Cases in which these patterns comprised the primary process were excluded. All cases were formalin fixed, paraffin embedded, and hematoxylin‐eosin stained. Results: Six cases were identified: three shave biopsies (chest, back, face), two excisions (back, face), and one punch biopsy (scalp). This represented 2.4% of total reviewed. Four specimens had a HH like pattern (1.6%); two had FAD (0.8%). The average patient age was 68 years (range 41–86). Four patients were male; two were female. Three cases were associated with epidermal neoplasia: basal cell carcinoma (HH), actinic keratosis (HH), and malignant melanoma in situ (HH). Two were associated with significant inflammation: seborrheic keratosis (HH) and bullous lichen planus (FAD). One biopsy was of lichen simplex chronicus (FAD). The average diameter of acantholysis was 0.3 mm. Four cases showed associated prominent solar elastosis. Discussion: Incidental acantholysis with FAD and HH like patterns is uncommon. This has previously been postulated to reflect possible pre‐neoplastic epidermal damage. The discussed cases show an association with epidermal neoplasia, solar change, and inflammation.