Question
In which of the following dermatological conditions is acantholysis not seen?
| A. |
Lichen planus
|
| B. |
Bullous pemphigoid
|
| C. |
Dermatitis herpetiformis
|
| D. |
Hailey-Hailey disease
|
| D. |
Pemphigus vulgaris
|
Show Answer
|
Correct Answer » A
Explanation
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Clinical Reasoning for the Correct Answer:
– Acantholysis is loss of intercellular connections (desmosomes), leading to breakdown of keratinocyte cohesion in the epidermis.
– Lichen planus is characterized by lichenoid interface dermatitis without acantholysis. The main histopathology is a band-like lymphocytic infiltrate at the dermoepidermal junction and “saw-toothing” of the rete ridges.
– All other listed diseases (except lichen planus) show or can show acantholysis as a key feature.
Why Option A (Lichen planus) is correct:
– No acantholysis; primary pathology is interface dermatitis and basal cell liquefaction.
Why Option B (Bullous pemphigoid) is incorrect:
– Bullous pemphigoid has subepidermal blisters without acantholysis; however, some sources describe rare acantholytic variants, but classic hallmark is absence of acantholysis.
Why Option C (Dermatitis herpetiformis) is incorrect:
– Presents with subepidermal blisters and neutrophilic microabscesses at dermal papillae; acantholysis is not a feature.
Why Option D (Hailey-Hailey disease) is incorrect:
– Classic example of intraepidermal acantholysis (“dilapidated brick wall” appearance).
