Mb. Morgan et al., FIBRONECTIN AND THE EXTRACELLULAR-MATRIX IN THE PERFORATING DISORDERSOF THE SKIN, The American journal of dermatopathology, 20(2), 1998, pp. 147-154
Despite detailed microscopic descriptions and clinical observation, li
ttle is known regarding the pathogenesis of the perforating disorders
of skin, which have traditionally been subdivided into numerous micros
copic entities associated with various clinical settings. An increasin
g body of evidence now suggests that the perforating disorders of skin
are akin, and may constitute an expanded single pathologic entity. Ea
ch of the classic perforating disorders of skin, including elastosis p
erforans serpiginosa, perforating folliculitis, reactive perforating c
ollagenosis, Kyrle's disease, and perforating disorder of uremia, have
been shown to extrude collagen, elastin, and related extracellular ma
trix components through the epidermis. Considering a shared pathogenic
mechanism among these entities, we explored the possible role of the
extracellular matrix, in particular fibronectin, in perforating disord
ers of skin. Using immunohistochemical and serum determinations of ext
racellular matrix constituents, including fibronectin, collagen type I
V, laminin, and tenascin, we showed consistent serum elevation and/or
deposition of fibronectin, in each case, without a commensurate increa
se in laminin, collagen type TV, and tenascin. We propose that elevate
d serum and tissue concentrations of fibronectin may be responsible fo
r inciting, in a physiologically aberrant manner, increased epithelial
migration and proliferation culminating in perforation.