Invisible dermatoses

Abstract

'Invisible dermatoses' is a concept which has not received wide recognition, but is nevertheless very important both clinically and histologically. The term invisible dermatoses has been used in two contexts: a) Diseases, with out definite clinical features, and are therefore "invisible" to the clinician, but yet can be diagnosed by special investigations. b) Dermatoses which present with definite and obvious clinical features, but subtle or hidden histological features and are therefore "invisible" histologically. Diagnosis of such diseases represents a great challenge to both the dermatologist and dermatopathologist. This article discusses such diseases and offers clues and tools for their diagnosis. Diagnosis of such 'Invisible dermatoses' needs proper awareness, recognition of subtle features, special stains, special investigations such as immunofluorescence and histochemistry and proper clinicopathological correlation.

Characterization of Gastric and Neuronal Histaminergic Populations Using a Transgenic Mouse Model

“…Such was consistent with previously published descriptions of enterochromaffin-like (ECL) cell distribution [7]. Within the gastric submucosa, muscularis, and less often, the mucosa, a generally weaker fluorescence was also observed within an oval-shaped cell type that had the appearance of a “fried egg”, with a dim fluorescent cytoplasm surrounding a more intensely fluorescent nucleus, as is commonly observed for mast cells (Figure 1, rightward facing arrowhead) [40]. The Tmt fluorescence was much brighter for the elongated, ECL cells (resulting in a yellowish, over-exposed center) than for the oval-shaped mast cells.…”

“…Mast cells were identified based on their Tmt fluorescence and their characteristic oval-shaped, “fried egg” appearance, in which a dim fluorescent cytoplasm appears surrounding a more intensely fluorescent nucleus [40]. Photomicrograph images of the mast cells were taken and the locations of the cells were carefully noted in order to pinpoint the same cells after staining.…”

Invisible dermatosis, diagnostic discrepancy between the general pathologist and dermatopathologist

“…Invisible dermatoses are diseases that have obvious clinical lesions, but subtle microscopic findings and are therefore easily overlooked by the inexperienced pathologist. A diagnosis of no significant pathological changes or nonspecific findings' is usually made by the general pathologist for these diseases …”

“…However, even with a skin biopsy of good quality some skin conditions are difficult to interpret under a microscope due to their close resemblance to normal skin. This group of diseases with skin manifestations that are clinically evident but histologically hidden are termed “invisible dermatoses.” General pathologists tend to label skin biopsies of this group as nonspecific dermatoses, overlooking the subtle changes that may be picked up by the experienced eye of a dermatopathologist …”

“…General pathologists tend to label skin biopsies of this group as nonspecific dermatoses, overlooking the subtle changes that may be picked up by the experienced eye of a dermatopathologist. 1,2 In this study, we reviewed a number of skin biopsies diagnosed by general pathologists as "nonspecific dermatitis" to determine the discrepancy between their diagnoses and the diagnosis of a dermatopathologist.…”