Acantholysis revisited: Back to basics

Acantholysis means loss of coherence between epidermal cells due to the breakdown of intercellular bridges. It is an important pathogenetic mechanism underlying various bullous disorders, particularly the pemphigus group, as well as many non-blistering disorders. Although a well-known concept, the student often has to refer to many sources to comprehend acantholysis completely. Thorough knowledge of this topic helps in clinching many diagnoses. We have focused on various distinguishing points in different disorders for an easy

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grasp of the topic.

The term acantholysis, coined by Auspitz in 1881, is derived from the Greek words akantha, meaning a thorn or prickle, and lysis, i.e. loosening. [1],[2] Acantholysis is defined as the loss of coherence between epidermal cells due to the breakdown of their intercellular bridges. [3],[4] The cells remain intact but are no longer attached to each other; they tend to acquire the smallest possible surface area and become rounded up, resulting in intra-epidermal clefts, vesicles and bullae. Acantholysis is the primary pathological change occurring in pemphigus and its variants and other conditions like Hailey-Hailey disease (HHD)

Desmosomal cadherins are the primary pathological targets in the pemphigus group of disorders and some conditions like bullous impetigo. The intercellular space of desmosomes includes two chief glycoproteins; the desmogleins (Dsg) and desmocollins, which in conjunction with the cytoplasmic counterparts plakoglobin and plakophilin, bring about the complex intercellular attachment. [6] Experiments in the recent past have partially elucidated the multiple triggers, targets, and steps involved in acantholysis.

Full article can be viewed here:;year=2013;volume=79;issue=1;spage=120;epage=126;aulast=Seshadri

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