The Granular Layer Thickness in Atopy and Ichthyosis Vulgaris

i: JorKNAL OF I^'^'EsTlGATIVE DERMATOLOGY

Vol. 54, No. 1 J'rintcd in l\S.A.

;yright © 1970 by The Williams & Wilkins Co.

THE GRANULAR LAYER THICKNESS IN ATOPY AND ICHTHYOSIS VULGARISMLARRY ERICKSON, MAJOR, MC. USAF

AND G U I X T E R K A H X .

AI.]).

ABSTRACT Our data confirm the finding that the fjraniilar cell layer i,- niarkedh" decreased in thickness in ichthyosis vulgaris. The granular layer cannot be uer thickness were present in skin specimens from atopic patienis with normal skin or dr>- skin. l"he deficient granular layer in ichthyosis \ ulcaris as confirmed by Frost and Van Scott 11 i has provided fresh insight into the mechanism of the formation of dry skin. This Miidy was designed to determine whether the uianular layer also is diminished in another ilr\- skin stat(\ The extent of the granular :t\'er thickness of ])atients with atopy, with 'Ither dry or normal skin was evaluated by means of hematoxylin and eosin stained specimens of skin.

l)iops.\" was taken from t h e skiu of t h e l{>fl uiqier. outei-(juadi-ant of t h e luittock. ( i r a n u l a r la,\ ers of H a n d E sections were g r a d e d to t h e neai'f'st 0.5 unit b y t h e following; s c a l e : LO — g r a n u l a r layer \ irtually al)sent 2.0 •—granular l a y e r less than on(> cell thick 3.0 — g r a n u l a r layer m o r e than 1, l)ut less ( h a n 2 cell la.A'ei's thick 4.0 — g r a n u l a r la\-er moi'e than 2 cell l a y e r s thick J'Aahiation of t h e dryiiess of t h e .skin of t h e b u t t o c k s was accomplished b y subjective g r a d i n g 1 thi'ough 4. where 1 was m a x i m a l l y dr.v a n d 4 w a s n o r m a l skin. REST'LTS

MKTHODS AXD MATERIALS

T h e ditfei'eiices iu t h e n u m b e r of g r a n u l a r cell la>'ers a r e f(»iuul to be highly significant ( P < O.OO.ii, among all classifications (Table T). T h e difiereiices amontr ()bser\"ers A, B , a n d C, ihotiixh loiinall\- significant, ai'e u n i m p o r t a n t lor evaluation, since a relatively consistent l)ias, seen as low readings by observer A is noted without statistical ex'ich^tice of i n t e r a c tioiL T h e r e m a r k a b l e closene,-,- of raiikiii ' ,*T46-Kahn: U.SPHS R e s e a r c h Trainiu-: ' 'i.iiit ,«5 T O l AM05527. a n d b y a research u;ranl lated to t h e dr\-ue,-s ol' t h e skiti in 1be atopic : "ID ihe J o h n A . Hartt'ord J-'oundation, I n c . state. .\n attein]it tf) further sejiarate atopic The views expressed lierein a r e those ot the dermatitis into d r y a n d normal categories r e . '!'.' 2<). 1!K)1>: acce|)te(l for publication ular layer in ilie dry /:;• ( i . Arcliei-, SeJ.).. Dix-ision of l i i o m e t r i c s . ().] I. irtnient of }'re\-enTi\e M e d i c i n e , I'ni\<'rsity Since a p p r o x n n a t e h - one-half of tlie ])atients ' -lorado ^Medical C e n t e r . —i-tance in readin!.•-, (ierald D . W e i n s t e i n , R o b e r t W . ( i o l t z . and were takuiir ])rednisone, an a t t e m p t was m a d e .;;;/ Frost. Vi are i n d e b t e d t o t h e ])ersonne] a n d jiatients to ascertain the effect of t i n - t r e a t m e n t on tlie !;ildren's Astlinia R o e a r c h I n s t i t u i e a n d H o s - thickne.-,- ())• the granular la>-er. T b e mean 1 C A R I H ) , I ) e n \ e r . C'olorado ( C o n s t a n t i n e thickness of t h e irranular layer was deter• !-. M . D . , Medir-il D i r e c t o r ) , for their c o : I'lon a n d u s e of facilities in tlii.s stud.w mined, both in ])[itients t a k i n g prednisone a n d I'rum the Division of Dermatolog:y. T'ni\'ersity tho>e who h a d not t a k e n it for m o r e t h a n a olorado Medical Centor. 4200 Easi Xinth Avem o n t h p r i o r t o t h e s:tudy. N o effect of this D-nver. Colorado 80220.

l"ifty-six b o y s a n d girls, a^e 3-15. from tlie O u l i-iMeni P e d i a t r i c Allerarch I n s t i t u t e a n d H o s p i t a l ' C A P i I H ) . I)en\-er. C o l o r a d o , particijjated in t h e -Miiiy. Tlnrty-fi\-e of t h e children wei'e Ynnu'ri i o l NIWIMI hecaiise of atopic r e s p i r a t o r y dis(\'ise ( a s t h m a :ni| ha,\- fe\-er). Of iliese. 14 also h a d atojiic deriiia^iM-. T h e ])atient.s were chissifieii as in T a b l e 1. Twiiify-one children witli n o r m a l .skin aiul n o i.:iM\\n diseases ser\"ed as controls. A sjiecimen t o r

11

12

THE JOLRX.\L

OF INVESTIGATIVE

TAIiLi: I ( rK i l l Illll I Idljt'l

All

aiial\sis

of

the

(I l i d l 'IXI s

number

of

granular

cell

l a y e r s o f t h e s k i n i if .5(i p a t i e n t s l>\' t h i ' c e o b s e i ' v e r s (A, H, C ) . 'Jlieir a v e r a g e v a l u e for e a c h

condition

i s i n t h e l a s t c( il i * )l)>erver N o . of jiaticnts

N o r m a l .skin .\t opic d e r i n a t it is .\t o p \ ' (dvy skill) At o|)y (lioi'inal ski Icht h y o s i s

L'l

2.ss:!. r2 :;.25

:i.2l 1.1 1.4:;

. 1:1

Toial

:-;.21 1 .:'>:'>

5*')

di'uii; on t b e n i m i b c r of g r a n u l a r cell lay(a's w a s shown.

In

])osit(;

atopic

to

tbosc

i.<'., ])alieiits taking

definatitis, in

with

atopic,

])redni>one

Iliau

those

with

other

preduisone patients neither

not

had

Ind

were

not,

were

the

o-raiiular

drug, who

were

granular takinsx

the dilierence

were layers

wiiile

those takiufj;

la\'ers the

drti£.

coii-idered

of granular cells. Normal skin has more layers of granular cells than skin of atopic patients (normal or dr}-j, and while this difference is statistically significant, it is not large enotigh to use as reliable guide when ascertaining individual claims about atopic skin. As a grf)U]) it appears that atopies have a thinner granular layer than do normal people. An association l^etween atopic dermatitis atid ichthyosis ^^as first pointed out by Besnier and ]jroc(|, 75 years ago (2). This association has also b(>en noted more recently by Wells, ct (ll. (.3). Two of our subjects (one with atopic dermatitis and asthma and one with only asthma i also had ichthyosis vulgaris. The histologic seel ions f)f l)Uit()ck skin of both of these children rex'ealed virtual absence of the granulai' la\'(-r, similar to that seen in otir other five ])atieTits with ichthyosis vulgaris who were not

op-

(h^'matitis,

dcu'inatitis w h o

disease

thinner

case \\ a-

without

thicker

inkinji,-

atopic

who

atopy

resuHs

DERMATOLOGY

than In >ig-

()ur data conlirtu the finding that the granular cell l a \ c r is of markedly decreased thicknes- in ichthyosis vtihiaris. The granular layer cannot \)V used a- ati index of dr>' skin in the ato])ic stat(', because no significant difi'erences m granular cell l a \ e r tiiickness were present in skill s])(>cimen- from atopic patients with normal skill or dr\' >kni.

n)!icaiit.

In tbi> ,-tud\' ;m a t t ( i u p t is m a d e to ascert a i n if t h e r e h i i i i i n s h i p b e t w e e n t h e d i t n i u i s h e d l u u n h e r ol l i r a n u l a r cell la>ers a n d ilrvness oi t h e s k i n a- lioteil by l-'ro-t a n d \ ' a n Scoit in i c h t h y o - i s \ t i ' m a r i s , is also iouiul in a n o t h e r conditioti iti u h i e h tli(> --kui is d r y . A t o i n c p a t i e n t s h:i\itiLi
liKFI'Hl'A'CLS 1. I'rost. ] ' . and A'aii Scott. F . J.: Ichihyosiform d(finato--i s. Classification based on anat^oinic and biometric observations. Arcli. Derm.. 9.'^: 11?,. 1%(). 2. J^ostenl)eru\ A.. .)r.: Discussion of ])apcr by Wilkmsoti. 1;. 1).. Curtis. ('<. H. and Hawk, \\ . A.: N< ilii'iion',- l)i>ease. Arch. Derin., S9: :]. W e l l s , 1;. S. a n d K . ir. C . B . : C l i n i c a l f e a t u r e s ol a u t o s o m a l d o m i n a n t a n d s c x - I m k e d irlitliA'osi^ HI a n Lntilisli 1 l o p u l a M o i i . U r n . M e d . .L.