The ñ Sign

Camporro, Á. Fernández; Roncero-Riesco, Mónica; Revelles-Peñas, Leonor; Nebreda, David Revilla; Estenaga, Ángela; Pinta, Javier Díaz de la; Terrón, Ángel Santos-Briz

doi:10.1001/jamadermatol.2022.0015

Cited by 6 publications

(9 citation statements)

References 5 publications

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“…All skin biopsy specimens showed neutrophil-imbued parakeratotic stratum corneum reminiscent of psoriasis. 5 In addition, hypogranulosis and irregular non-psoriatic acanthosis were evident in all the biopsies. Abbreviations: F, female; GC, glucocorticoids; M, male; MTX, methotrexate; P, patient; P-P, palmo-plantar.…”

Section: Resultsmentioning

confidence: 86%

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Coexistence of psoriasiform stratum corneum and underlying lichenoid features in skin biopsies of cutaneous reactions to anti‐PD1

et al. 2023

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Section: Resultsmentioning

confidence: 86%

“…All skin biopsy specimens showed neutrophil‐imbued parakeratotic stratum corneum reminiscent of psoriasis 5 . In addition, hypogranulosis and irregular non‐psoriatic acanthosis were evident in all the biopsies.…”

Section: Resultsmentioning

confidence: 90%

Coexistence of psoriasiform stratum corneum and underlying lichenoid features in skin biopsies of cutaneous reactions to anti‐PD1

et al. 2023

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“…However, Camporro et al . 6 recently discovered that the ñ sign could be a visual clue for the histopathologic diagnosis of psoriasis.…”

Section: Discussionmentioning

confidence: 99%

“…Under these circumstances, it is helpful to identify the more specific histopathologic signs (“visual clues”) to indicate the possibility of psoriasis, although it is always important to ensure that both the clinical and pathological findings support the diagnosis. 5 Very recently, Camporro et al 6 discovered that the “ñ sign” may be a visual clue for the histopathologic diagnosis of psoriasis. The ñ sign includes the sum of 2 histologic criteria: the tilde represents a wavy laminar, parakeratotic, and separated stratum corneum, and the n denotes epidermal hyperplasia and regularly elongated rete ridges.…”

Section: Introductionmentioning

confidence: 99%

Visual clues for the histopathological diagnosis of psoriasis

Song¹,

Yang²,

Jiang³

2023

International Journal of Dermatology and Venereology

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Objective: The histopathologic diagnosis of psoriasis remains challenging. This study aimed to uncover clues for the histopathologic diagnosis of psoriasis in patients whose lesions required differentiation from other inflammatory skin disorders.Methods: A retrospective analysis was conducted between psoriasis biopsy sections and other inflammatory skin diseases sections. The psoriasis and control groups were compared regarding the pathological characteristics, including the ñ sign, hypogranulosis, and neutrophilic infiltration or pustules within the epidermis. We also summarized the clinical information and the classic and non-classic histologic features of psoriasis. Comparisons between psoriasis and control groups were performed using the c-square test.Results: Biopsy sections from 190 patients were analyzed. Of these patients, 100 had a confirmed clinicopathological diagnosis of psoriasis, while 90 were diagnosed with an inflammatory skin disorder other than psoriasis (control group). The classic histologic features included the mound of parakeratosis (68.0%), confluent parakera tosis (42.0%), hypogranulosis (86.0%), regular psoriasiform hyperplasia (79.0%), Munro microabscess (85.0%), spongiform pustule of Kogoj (43.0%), suprapapillary plate thinning (87.0%), and dermal papilla capillary ectasia (98.0%). The ñ sign was present in 79.0% and 21.1%, respectively, of the lesional biopsy samples from the psoriasis and control groups (P < 0.001). The combination of the ñ sign and neutrophil infiltration in the upper epidermis was present in 74.0% and 10.0%, respectively, of the lesional biopsy samples from the psoriasis and control groups (P < 0.001). The combination of these 2 features had a sensitivity of 0.89 and specificity of 0.76 in distinguishing between the psoriasis and control groups. Conclusion:The ñ sign is a useful visual clue for the histopathologic diagnosis of psoriasis. However, for some inflammatory skin disorders that are very similar to psoriasis, such as pityriasis rubra pilaris, the combination of the ñ sign and neutrophil infiltration in the upper epidermis is needed to distinguish the condition from psoriasis.

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“…In fact, the combination of these features in the corneum stratum with the psoriasiform hyperplasia have been named as the “ Ñ sign ” and are considered a visual clue for the diagnosis of psoriasis. 12 Some epidermal findings such as focal hypogranulosis and suprabasal mitosis are useful findings to add if we find the typical psoriasis' stratum corneum findings (Fig. 3).…”

Section: Corneal Layermentioning

confidence: 94%

Approach to the so-called “Invisible Dermatosis”: When Subtle Histopathological Findings Guide Diagnosis

Llamas-Velasco,

Pérez-Muñoz,

Rozas-Muñoz

et al. 2023

The American Journal of Dermatopathology

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Invisible dermatosis is a concept that can be applied either to clinical or histopathological findings. We will focus on the dermatopathological aspect of this invisible dermatosis that can be seen as dermatosis with subtle histopathological findings that are mandatory to known to stablish the diagnosis. With a proper approach facing in depth the different skin layers from stratum corneum to subcutaneous tissue combined with some especial stains, special investigations and mostly a proper clinicopathological correlation, the problem of missing out a diagnosis can be decreased. We will review the general aspects for diagnosis and the peculiar findings of an in-depth review of them because it is important to note that minor changes on a skin biopsy do not mean it is disease free. We will review classic clues, we will add some new useful ones, and we will also provide a guide on the special stains helpful, such as periodic acid–Schiff when facing fungi, orcein-Giemsa and van Gieson when altered elastic fibers are suspected, or Pearl and Masson Fontana when an altered skin pigmentation is suspected.

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The ñ Sign

Cited by 6 publications

References 5 publications

Coexistence of psoriasiform stratum corneum and underlying lichenoid features in skin biopsies of cutaneous reactions to anti‐PD1

Coexistence of psoriasiform stratum corneum and underlying lichenoid features in skin biopsies of cutaneous reactions to anti‐PD1

Visual clues for the histopathological diagnosis of psoriasis

Approach to the so-called “Invisible Dermatosis”: When Subtle Histopathological Findings Guide Diagnosis

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