Acantholysis

Acantholysis is the loss of intercellular connections, such as desmosomes, resulting in loss of cohesion between keratinocytes, seen in diseases such as pemphigus vulgaris, Grover’s disease, and Hailey-Hailey Disease. It is absent in bullous pemphigoid, making it useful for differential diagnosis. This disruption between cells causes intra-epidermal clefts, vesicles and bullae due to cells becoming rounded and no longer attached to one another.

Focusing on Pemphigus vulgaris, a blistering auto-immune disease, during acantholysis, circulating autoantibodies cause disruption of cell-cell and cell-matrix adhesion. The antibodies circulate against intercellular adhesion structures and demosomal protein desmoglein (DSG), which causes the disruption. Acantholytic cells also known as Tzanck cells are a distinguishing feature when diagnosing Pemphigus vulgaris. The Tzanck test can be used to diagnosis Pemphigus vulgaris for patients who are uncomfortable with a biopsy. he test can be used to identify acantholytic cells which are classified as large round keratinocytes characterized by an enlarged nucleus, indistinct or missing nucleoli and plentiful basophilic cytoplasm. This histological feature is also seen in herpes simplex infections (HSV 1 and 2) and varicella zoster infections (chicken pox and shingles).