Blistering skin diseases: a bridge between dermatopathology and molecular biology

Bullous, pseudobullous, & pustular dermatoses

Several dermatoses are typified by the formation of spaces (blisters; bullae) within or beneath the epidermis. These may be acellular or filled with particular species of inflammatory cells. Etiological categories include infectious, immune-mediated, genetic, drug-related, and idiopathic lesions. Examples of such disorders include impetigo, Herpes virus infections, pemphigus, bullous pemphigoid and pemphigoid gestationis, epidermolysis bullosa acquisita, IgA-related dermatoses, inherited epidermolysis bullosa variants, Hailey-Hailey disease, and porphyria cutanea tarda. Other conditions manifest microscopic acantholysis within the surface epithelium but are not associated with clinical bullae, such as Darier disease and Grover disease. Finally, both infectious and non-infectious causes exist for the development of neutrophilic pustules in the epidermis, as seen in pustular psoriasis, Sneddon-Wilkinson disease (subcorneal pustular dermatosis), and acute generalized exanthematous pustulosis. This review considers the clinical and histological features of all of these diseases.

Stevens-Johnson syndrome and toxic epidermal necrolysis: what do we know?

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but severe cutaneous adverse reactions related to a variety of medications. Although rare, SJS and TEN have a significant impact on public health because of high mortality. Also, if the SJS/TEN physiopathology is still unclear, a specific immune response to one or more drugs is involved, constituting a form of delayed-type hypersensitivity. Patients with SJS/TEN are often critically ill; therefore, they must be admitted to hospitals capable of delivering critical care. Currently, no treatment modality has been established as standard for these patients; therefore, therapy is primarily supportive and symptomatic and involves a multidisciplinary approach.

Genetic analyses of integrin signaling

The development of multicellular organisms, as well as maintenance of organ architecture and function, requires robust regulation of cell fates. This is in part achieved by conserved signaling pathways through which cells process extracellular information and translate this information into changes in proliferation, differentiation, migration, and cell shape. Gene deletion studies in higher eukaryotes have assigned critical roles for components of the extracellular matrix (ECM) and their cellular receptors in a vast number of developmental processes, indicating that a large proportion of this signaling is regulated by cell-ECM interactions. In addition, genetic alterations in components of this signaling axis play causative roles in several human diseases. This review will discuss what genetic analyses in mice and lower organisms have taught us about adhesion signaling in development and disease.