Miniaturization of sebaceous glands – a novel histopathological finding in pemphigus vulgaris and pemphigus foliaceus of the scalp

ABSTRACT

Background

Intraepidermal acantholysis is a characteristic histopathological feature of pemphigus. The histopathology of scalp biopsies in pemphigus has not been widely discussed in the literature, although the scalp is commonly involved in pemphigus.

Methods

A total of 32 consecutive patients with scalp involvement (seventeen with pemphigus vulgaris and fifteen with pemphigus foliaceus) were enrolled into the study. The histopathological examination of scalp biopsies was performed in all patients. Tissue specimens were stained with hematoxylin and eosin.

Results

Acantholysis extended down the entire length of the outer root sheath of the hair follicle in 12/17 (70.6%) patients with pemphigus vulgaris. Follicular acantholysis in pemphigus foliaceus was restricted to the infundibulum and occurred in 12/15 (80.0%) patients. Acantholysis in the vellus hair follicles was observed in 12/17 (70.6%) and 9/15 (60.0%) cases, respectively. The miniaturization of sebaceous glands was seen in 14/17 (82.4%) and 12/15 (80.0%) patients, respectively.

Conclusions

Follicular acantholysis is a common histopathological feature of pemphigus. It may serve as a clue to the diagnosis of pemphigus subtypes, as pemphigus vulgaris and foliaceus differ in the depth of follicular acantholysis. The miniaturization of sebaceous glands is a common histopathological feature observed in scalp specimens of patients with pemphigus.

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