INTRACORNEAL NUCLEAR DUST AGGREGATES IN DERMATITIS-HERPETIFORMIS - A CLUE TO DIAGNOSIS

Dermatitis herpetiformis has a characteristic histologic pattern consi sting of subepidermal blisters often containing fibrin, infiltrates of neutrophils and nuclear dust at tips of dermal papillae, and papillar y dermal edema. These are features of early and evolving lesions. We p resent two cases of clinically typical dermatitis herpetiformis with p reviously unreported histologic features that may provide a significan t diagnostic clue. In each of these cases there were focal collections of nuclear dust in the cornified layer of the epidermis, a finding th at may represent a resolving phase of dermatitis herpetiformis, beyond the usual papillary dermal neutrophilic microabscesses seen in early lesions. Biopsy material was available for immunofluorescent studies i n one of the cases presented. In addition to the granular pattern of I gA positivity at the dermal-epidermal junction, which is diagnostic of dermatitis herpetiformis, this biopsy also showed similar IgA positiv ity in the intracorneal nuclear dust aggregates. In the second case, i nitial sections showed only intracorneal nuclear dust, but at deeper l evels there were more typical diagnostic microabscesses at the tips of dermal papillae.