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Clinical Pearl: Auspitz sign in psoriasis scale
PEARLS OF WISDOM I
Clinical Pearl: Auspitz sign in psoriasis scale Jeffrey D. Bernhard, M D Worcester, M a s s a c h u s e t t s The Auspitz sign--pinpoint bleeding when outer scales are removed from psoriatic plaques--is a classic finding in psoriasis, along with several more or less Well-known features, such as the Koebner reaction, 1 Woronoff's ring, 2 facial involvement as a marker of severity, 3 the candle sign, and the last cuticle phenomenon. 4 However, as noted by Holubar, 5 Hebra and Devergie described the focal bleeding phenomenon before Auspitz did, and Unna 6 pointed out that psoriatic papules do not always bleed when scratched. The Auspitz sign is not entirely specific for p~oriasis, either. 7 Over the years, however, I have occasionally observe d pinpoint dots of dried blood in scale removed from psoriatic plaques, even when the classic sign of fresh focal bleeding at the base does not occur (Fig. 1). I haw~ seen this only in psoriasis, not in any other scaly 0isorder. Therefore, when attempting to elicit the At~spitz sign, the clinician may find it worthwhile to ex~aaine the removed scale. Tiny red dots may signify traces of the same phenomenon caused by prior hapture of tortuous capillaries beneath thinned suprapapillary epidermis. Like a lithograph "signed in the Stone," an Auspitz "signed in the scale" may have almost as much value as the original. Smart J. Salasche, MD Feature Editor Direct all submissions to Dr. Stuart J. Salasche, 5300 N. Montezuma Trail, Tucson, AZ 85750. From the Division of Dermatology, University of Massachusetts Medical Center. Reprint requests: Jeffrey D. Bernhard, MD, Division of Dermatology, University of Massachusetts Medical Center, Worcester, MA 016550307. J Am Acad Dermatol 1997;36:621. Copyrigfit © 1997 by the American Academy of Dermatology, Inc. 0190-9622/97/55.00 + 0 1 6 / 5 4 / 7 9 5 2 5
Fig. 1. Auspitz sign in scale removed from psoriatic plaque. Several pinpoint red dots are seen near middle of the specimen. Paper clip is shown for size comparison.
REFERENCES 1. Melski JW, Bernhard JD, Stern RS. The Koebner (isomorphic) response in psoriasis. Arch Derrnatol 1983;119: 655-9. 2. Farber HM. Historicalcommentary.In: Farber EM, Cox AJ, editors. Psoriasis: proceedings of the Third International Symposium. New York: Grune & Stratton, 1982:7-11. 3. Bernhard JD. Facial involvement is a sign of severe psoriasis. In: Farber EM, Nail L, Morhenn V, et al, editors. Psoriasis: proceedings of the Fourth International Symposium. New York: Elsevier, 1987:405-6. 4. Braun-Falco O, Plewig G, Wolff HH, et al. Dermatology. Berlin: Springer-Verlag, 1991:420-1. 5, Holubar K. Remembering Heinrich Auspitz. Am J Dermatopathol 1986;8:83-5. 6, Unna PG. The histopathology of the diseases of the skin. Edinburgh: WF Clay, 1896:203. (Walker N, translator) 7. Bernhard JD. Auspitz sign is not sensitive or specific for psoriasis. J Am Acad Dermatol 1990;22:1079-81.
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Clinical Pearl: Auspitz sign in psoriasis scale Jeffrey D. Bernhard, M D Worcester, M a s s a c h u s e t t s The Auspitz sign--pinpoint bleeding when outer scales are removed from psoriatic plaques--is a classic finding in psoriasis, along with several more or less Well-known features, such as the Koebner reaction, 1 Woronoff's ring, 2 facial involvement as a marker of severity, 3 the candle sign, and the last cuticle phenomenon. 4 However, as noted by Holubar, 5 Hebra and Devergie described the focal bleeding phenomenon before Auspitz did, and Unna 6 pointed out that psoriatic papules do not always bleed when scratched. The Auspitz sign is not entirely specific for p~oriasis, either. 7 Over the years, however, I have occasionally observe d pinpoint dots of dried blood in scale removed from psoriatic plaques, even when the classic sign of fresh focal bleeding at the base does not occur (Fig. 1). I haw~ seen this only in psoriasis, not in any other scaly 0isorder. Therefore, when attempting to elicit the At~spitz sign, the clinician may find it worthwhile to ex~aaine the removed scale. Tiny red dots may signify traces of the same phenomenon caused by prior hapture of tortuous capillaries beneath thinned suprapapillary epidermis. Like a lithograph "signed in the Stone," an Auspitz "signed in the scale" may have almost as much value as the original. Smart J. Salasche, MD Feature Editor Direct all submissions to Dr. Stuart J. Salasche, 5300 N. Montezuma Trail, Tucson, AZ 85750. From the Division of Dermatology, University of Massachusetts Medical Center. Reprint requests: Jeffrey D. Bernhard, MD, Division of Dermatology, University of Massachusetts Medical Center, Worcester, MA 016550307. J Am Acad Dermatol 1997;36:621. Copyrigfit © 1997 by the American Academy of Dermatology, Inc. 0190-9622/97/55.00 + 0 1 6 / 5 4 / 7 9 5 2 5
Fig. 1. Auspitz sign in scale removed from psoriatic plaque. Several pinpoint red dots are seen near middle of the specimen. Paper clip is shown for size comparison.
REFERENCES 1. Melski JW, Bernhard JD, Stern RS. The Koebner (isomorphic) response in psoriasis. Arch Derrnatol 1983;119: 655-9. 2. Farber HM. Historicalcommentary.In: Farber EM, Cox AJ, editors. Psoriasis: proceedings of the Third International Symposium. New York: Grune & Stratton, 1982:7-11. 3. Bernhard JD. Facial involvement is a sign of severe psoriasis. In: Farber EM, Nail L, Morhenn V, et al, editors. Psoriasis: proceedings of the Fourth International Symposium. New York: Elsevier, 1987:405-6. 4. Braun-Falco O, Plewig G, Wolff HH, et al. Dermatology. Berlin: Springer-Verlag, 1991:420-1. 5, Holubar K. Remembering Heinrich Auspitz. Am J Dermatopathol 1986;8:83-5. 6, Unna PG. The histopathology of the diseases of the skin. Edinburgh: WF Clay, 1896:203. (Walker N, translator) 7. Bernhard JD. Auspitz sign is not sensitive or specific for psoriasis. J Am Acad Dermatol 1990;22:1079-81.
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