A 7-year-old boy has widespread fine, white scales on the extensor surfaces of limbs since early childhood. Palmar skin shows accentuated creases. Histopathology of a skin biopsy would most likely reveal:

• A Compact orthokeratosis with markedly diminished or absent granular layer ✓
• B Epidermal vacuolation and clumping of keratin intermediate filaments
• C Parakeratosis with neutrophils in the stratum corneum
• D Thickened orthokeratosis with normal granular layer and perivascular lymphocytic infiltrate

Explanation

This vignette describes ichthyosis vulgaris, which histologically shows orthohyperkeratosis with a markedly reduced or absent granular layer (granular layer atrophy). This correlates with filaggrin deficiency. Epidermal vacuolation and keratin clumping characterize epidermolytic ichritis. Parakeratosis with neutrophils suggests psoriasis. Normal granular layer with perivascular inflammation suggests inflammatory dermatoses.

Reference: McKee's Pathology of the Skin, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.