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Quantitative Measurements of Dermoepidermal Alterations

Steven B. Smith, MD; Terence J. Harrist, MD; George F. Murphy, MD; Alan J. Halperin, MD; John B. Newell, PhD; John T. Fallon, MD; J. David Fine, MD; Martin C. Mihm, Jr, MD

Arch Dermatol. 1984;120(3):324-328.

Abstract
• Linear IgA bullous dermatosis (LAD), also known as "atypical dermatitis herpetiformis," is a disorder that is distinct from classic dermatitis herpetiformis (DH). In eight patients with DH and six with LAD, quantitative assessment of a variety of histopathologic variables was made. The number of rete tips with neutrophils in basal vacuoles and the length of the epidermal basement membrane zone (BMZ) associated with these findings were greater in LAD than DH. The number of microabscesses of neutrophils in the dermal papillae and the length of epidermal BMZ associated with them were greater in DH than in LAD. By using the number of microabscesses and the number of rete tips with neutrophils in basal vacuoles in a probability model, we found by retrospective analysis that a correct diagnosis could be made for LAD in 75% of biopsy specimens with a probability of 97% and in all cases of DH with a probability of 92%. Using this model, we made no misdiagnoses. This is the first diagnostic probability model in dermatopathology that expresses a confidence level in diagnosis.

(Arch Dermatol 1984;120:324-328)

Author Affiliations
From the Departments of Dermatology, Bronx (NY) Hospital Center (Dr Halperin) and Albert Einstein School of Medicine (Dr Halperin), Bronx; and the Departments of Pathology (Drs Smith, Harrist, Murphy, Fallon, and Mihm) and Dermatology (Dr Mihm) and the Ischemic Specialized Center of Research (Dr Newell), Massachusetts General Hospital and Harvard Medical School, Boston.

Footnotes
Accepted for publication March 28, 1983.

Presented in part at the annual meeting of the American Society of Dermatopathology in conjunction with the International Academy of Pathology, Boston, Feb 28, 1982.

Reprint requests to Pathology Department, Warren 2, Massachusetts General Hospital, Boston, MA 02114 (Dr Harrist).

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