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Polarization Optical Studies of Hyperkeratosis, Parakeratosis and Dyskeratosis* Daphne Anderson Roe, M.D., M.R.C.P

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Polarization Optical Studies of Hyperkeratosis, Parakeratosis and Dyskeratosis* Daphne Anderson Roe, M.D., M.R.C.P View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector POLARIZATION OPTICAL STUDIES OF HYPERKERATOSIS, PARAKERATOSIS AND DYSKERATOSIS* DAPHNE ANDERSON ROE, M.D., M.R.C.P. Previous polarization optical studies of adultlife, the epidermis reaches its final state; at this and embryonic human epidermis have beenstage the eornified layer shows intense double devoted to the elucidation of the morphology ofrefraction. It is of interest that in the chick its fibrous structure. In unstained verticalembryo, the long axis of the cells of the periderm sections of human abdominal skin, the mostand of the embryonic horny layer is parallel to intense double refraction occurs in the stratumthe skin surface and the early keratin fibres are corneum and stratum lucidum. In these layersalso oriented in the same plane. birefringent material is oriented parallel to the There is only one polarization optical study of surface plane; below this region the birefringentpathologic epidermis. Nieuwmeijer examined the fibres are oriented perpendicularly to the surfacetonofibrils in bullous dermatoses by this method (1). and found differences between the tonofibrillar Similar observations have been made by othersystems in pemphigus and dermatitis herpeti- authors (2, 3), among them Mercer, who hasformis (6). In pemphigus, in the areas of acan- compared the appearance of the epidermis undertholysis, the tonofibrils were greatly decreased, the polarization and electron microscopes. Hewhereas in dermatitis herpetiformis the tonofibrils noted that the fibrils (tonofibrils) in the lowerwere pushed aside by the fluid in the bullae. layers of the epidermis were weakly birefringent. Recently, I used polarization optical methods At the level of the appearance of keratohyalinto investigate the anomaly of keratin formation there was a sudden rise in birefringenee associatedin psoriasis (7). It was found that the birefringent with a change in orientation of the fibres from atonofibrillar system persisted throughout the vertical to a horizontal direction. psoriatic epidermis and in the parakeratotic scale, In tissue cultures of stripped epidermis,but the mature keratin fibres failed to develop Matoltsy has shown that in 3 to 5 days' oldinto a coherent horny layer. These changes were explants the originally vertically oriented bire-reflected in the psoriatic nail (8) where immature fringent material becomes reoriented in a planekeratinization was evident from the extensive parallel to the surface (4). On the 7th day, aparakeratosis combined with persistence of a low definite keratogenous zone became visible, whiledegree of double refraction in much of the fibrous all the birefringent epidermal fibres were stillstructure of the nail plate and in the adherent oriented parallel to the skin surface. The signifi-hyponychium. These abnormalities were as- cance of these findings will be discussed later. sociated with alterations in the non-fibrous com- Studies of the development of the birefringentponents of the nail and epidermis, manifested fibrillar system of the human epidermis have yethistochemically by cytoplasmie metachromasia to be carried out, but similar observations of thein the parakeratotie cells and by an increased chick embryo have been made (5) and it has beenuptake of the Gram stain in the affected areas. shown that around the 16th day of embryonic In the present work the defects in the fibrous life the periderm or epitrichium reveals a verystructure of the epidermis were investigated in weak birefringenee. However, moderate birefrin-conditions characterized by the formation of gence appears during the next 2 days of embry-anomalous horny layers. onic life when the true cornified layer is formed. Between the 18th and 21st days of embryonic METHOD AND MATERIALS *Fromthe Department of Pathology, Memorial For the polarization optical investigations we Hospital, Wilmington, Delaware. used a Reichert monocular microscope fitted with This study was supported by a grant from thepolaroid discs as substage polarizer and tube Permanent Science Fund of the Americananalyzer. Photographic records were made with a Academy of Arts and Sciences. Presented at the Twentieth Annual Meeting ofRetina IIC camera, used in conjunction with a The Society for Investigative Dermatology, Inc.,Kodak photomicrographic unit. The sign of bire- Atlantic City, N. J., June 6, 1959. fringence was determined by means of a Zeiss first 257 258 THEJOURNAL OF INVESTIGATIVE DERMATOLOGY order red retardation plate, together with a capalso stained with hematoxylin and eosin, buffered analyzer (9). As in our previous studies (7, 8),thionin (10) and by a modified Gram-Weigert birefringenee referred to the optic axis of themethod (11). keratin and pre-keratin fibres (tonofibrils) in the Previous routine staining technics had estab- histologic material under examination. With thislished in the specimens histologic characteristics equipment, unstained skin sections were ex-associated with hyperkeratosis, parakeratosis or amined. Biopsy specimens were fixed in 10 perdyskeratosis. The sections were classified as fol- cent formalin, embedded in paraffin and sectionedlows: to 3 m thickness. The sections were then depar- 1. Simple hyperkeratosis: callus. affinized, cleared in xylene and mounted in syn- 2. Hyperkeratosis with acanthosis: lichen thetic resin. From each specimen sections weresimplex chronicus. FIG. 1. Pseudo-epitheliomatous hyperplasia associated with stasis dermatitis. The normal pattern of epidermal birefringenee is exaggerated with a widened keratogenous zone and increased tonofibrils. Magnification X400. FIG. 2. Chronic radiation dermatitis showing moderate hypcrkeratosis and orientation of birefringent tonofibrils parallel to the surface. Magnification X400. HYPERKERATOSIS, PARAKERATOSIS AND DYSKERATOSIS 259 FIG.3 FIG. 4 Fias. 3 and 4. Keratotie basal celled carcinoma showing horn cyst and orientation of tonofibrils paral- lel to the surface. Magnification X200, X400. 3. Hyperkeratosis with epidermal hyperplasia: 8. Parakeratosis, hyperkeratosis and dyskera- a) Pseudo-epitheliomatous hyperplasia in stasistosis: senile keratosis. dermatitis b) Verrucous nevus pigmentosus. 0. Dyskeratosis: Darier's disease. 4. Hyperkeratosis with epidermal atrophy: 10.Dyskeratosisand hyperkeratosis involv- chronic radiation dermatitis. ing epidermal and mucosal surfaces: leukoplakia. 5. Hyperkeratosis, parakeratosis and aean- thosis: Verruca plantaris. RESULTS 6. Hyperkeratosis with dyskeratosis: cornu cutaneum. In simple hyperkeratosis, the normal pattern of 7. Parakeratosis: a) psoriasis, h) seborrheic der-epidermal birefringence was observed, though matitis, c) keratotic basal cell carcinoma. the stratum corneum containing highly hire- 260 THEJOURNAL OF INVESTTGATIVE DERMATOLOGY I - a. a I' h Fro. 5. Early leukoplakia showing orientation of cells and doubly refractile fibres parallel to the sur- face. Section stained buffered thionin and viewed under polarized light. Magnification X400. .1 7-4 t*t_t4 1 • Ad5 Fio. 6. Plantar wart with a central area occupied by compressed cornifled cells displaying intense birefringence. Magnification X300. fringent mature keratin fibres was increased in In chronic radiation dermatitis, when hy- thickness. perkeratosis was associated with epidermal Where the hyper/ceratosis was associated withatrophy, there was a paucity of tonofibrils and acanthosis, especially in lesions with pseudo-these were oriented parallel to the skin sur- epitheliomatous hyperplasia, as in a case offace (Fig. 2). A similar orientation of the tono- chronic stasis dermatitis, this normal patternfibrils was seen in an example of keratotic basal was exaggerated. In particular, the keratogenouscell carcinoma with epidermal atrophy and in zone was broadened and very sharply defined;leukoplakia involving the muco-cutaneous junc- the hirefringent tonofibrils were increased intion of the lip (Figs. 3, 4, 5)* number, hut their orientation was identical with *Ithas been shown that in sections of the those in the normal epidermis (Fig. 1). huceal mucosa and in sections of the cow's nose HYPERKERATOSTS, PARAKERATOSIS AND DYSKERATOSIS 261 Inpsoriasis, as previously described (7), the prekeratin fibrils persisted throughout the epi- dermis and in the parakeratotie scale. The birefringent fibres were oriented perpendicularly or at an angle to the surface plane. Mature kera- tin fibres occurred in isolated groups, oriented parallel to the surface. This pattern is appar- ently specific for psoriasis; in other pathologic material no comparable distribution was found. Thus in seborrheic dermatitis, with marked parakeratosis, the normal orientation of the doubly refractilc epidermal fibres was retained, though in parakeratotic areas the bircfringcnce was less intense than in the normal horny layer. Dyskeratosis, defined as a faulty keratinization of individual cpidermal cells (12), is reflected £ under the polarization microscope. In Darier's disease, the villous epidermal projections showed normal tonofibrils. The corps ronds contained bircfringent fibres of low intensity, oriented parallel to the long axis of the cells. In the ab- normal horny layer, the grains appeared to be FIG. 7. Plantar wart showing peripheral area with alternating columns of highly bircfringent and poorly birefringcnt fibres, following the areas of fully cornified and parakeratotic cells and ori- ented in the long axis of these cells. A well-defined keratogenous zone can be
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