Incidental cutaneous reaction patterns: epidermolytic hyperkeratosis, acantholytic dyskeratosis, and hailey-hailey-like acantholysis: a potential marker of premalignant skin change

Abstract

Focal acantholytic dyskeratosis (FAD), epidermolytic hyperkeratosis (EHK), and Hailey-Hailey-like acantholysis (HH) represent unique histology reaction patterns, which can be associated with defined phenotypic and genotypic alterations. Incidental microscopic foci demonstrating these patterns have been identified in skin and mucosal specimens in association with a gamut of disease processes. These changes, when secondary, are of unclear etiology and significance. The following study further analyzes the incidence and association of these histologic patterns in a routine pathology/dermatopathology practice.

Figure 1

Incidental epidermolytic hyperkeratosis occurring in association with a dysplastic junctional nevus. (200X magnification, hematoxylin, and eosin stain).

Figure 2

Incidental focal acantholytic dyskeratosis occurring in a biopsy of lichen simplex chronicus. (200X magnification, hematoxylin, and eosin stain).

Figure 3

Incidental focal acantholytic dyskeratosis associated with prominent solar elastosis. This occurred in association with an excision of a melanoma in situ. (400X magnification, hematoxylin, and eosin stain).

Figure 4

Incidental focus of Hailey-Hailey-like acantholysis, occurring in association with a benign keratosis with features of seborrheic keratosis. (200X magnification, hematoxylin, and eosin stain).