The DOI matches its Crossref record; 65 of the 66 references it cites were found in a registry or an index.
Approach to the so-called “Invisible Dermatosis”: When Subtle Histopathological Findings Guide Diagnosis
Abstract
ABSTRACT: Invisible dermatosis is a concept that can be applied either to clinical or histopathological findings. We will focus on the dermatopathological aspect of this invisible dermatosis that can be seen as dermatosis with subtle histopathological findings that are mandatory to known to stablish the diagnosis. With a proper approach facing in depth the different skin layers from stratum corneum to subcutaneous tissue combined with some especial stains, special investigations and mostly a proper clinicopathological correlation, the problem of missing out a diagnosis can be decreased. We will review the general aspects for diagnosis and the peculiar findings of an in-depth review of them because it is important to note that minor changes on a skin biopsy do not mean it is disease free. We will review classic clues, we will add some new useful ones, and we will also provide a guide on the special stains helpful, such as periodic acid-Schiff when facing fungi, orcein-Giemsa and van Gieson when altered elastic fibers are suspected, or Pearl and Masson Fontana when an altered skin pigmentation is suspected.
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“To date, only a single recent study has investigated the use of DL in identifying fungal organisms in skin tissue sections [26].”
From Artificial Intelligence in the Histopathological Assessment of Non-Neoplastic Skin Disorders: A Narrative Review with Future Perspectives (2025) · cites this paper as [26]
In the citing paper
“Additionally, the dependence on special stains meant there was less potential of shortening turnaround times and reducing the use of resources [26,27,28,29,30,31,32].”
From Artificial Intelligence in the Histopathological Assessment of Non-Neoplastic Skin Disorders: A Narrative Review with Future Perspectives (2025) · cites this paper as [26]
In the citing paper
“Sensitivity, specificity, and F1 score (indicating precision) were higher for GMS (0.93, 0.99, and 0.95, respectively) compared to PAS (0.8, 0.97, and 0.78, respectively) [26].”
From Artificial Intelligence in the Histopathological Assessment of Non-Neoplastic Skin Disorders: A Narrative Review with Future Perspectives (2025) · cites this paper as [26]
In the citing paper
“The algorithm demonstrated overall low false-positive and false-negative results.”
From Artificial Intelligence in the Histopathological Assessment of Non-Neoplastic Skin Disorders: A Narrative Review with Future Perspectives (2025) · cites this paper as [26]
In the citing paper
“These cases usually require careful histological examination and the use of special stains, such as periodic acid–Schiff (PAS) and Gomori methenamine silver (GMS) [24,25,26].”
From Artificial Intelligence in the Histopathological Assessment of Non-Neoplastic Skin Disorders: A Narrative Review with Future Perspectives (2025) · cites this paper as [26]
Citations
Cites
Defining early mycosis fungoides
Pimpinelli, N., Olsen, E. A., Santucci, M., Vonderheid, E., Haeffner, A. C., Stevens, S., Burg, G., Cerroni, L., Dreno, B., Glusac, E., et al. (2005) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2005.08.057 · Cited by 550
Presence or Absence of Melanocytes in Vitiligo Lesions: An Immunohistochemical Investigation
Poole, I. C. L., van den Wijngaard, R. M., Westerhof, W., Dutrieux, R. P., & Das, P. K. (1993) · Journal of Investigative Dermatology · doi:10.1111/1523-1747.ep12476645 · Cited by 214
Histopathologic Features of Early (Patch) Lesions of Mycosis Fungoides
Massone, C., Kodama, K., Kerl, H., & Cerroni, L. (2005) · The American Journal of Surgical Pathology · doi:10.1097/01.pas.0000153121.57515.c6 · Cited by 203
Cutaneous reactions at sites of herpes zoster scars: an expanded spectrum
Requena, Kutzner, Escalonilla, Ortiz, Schaller, & Rohwedder (1998) · British Journal of Dermatology · doi:10.1046/j.1365-2133.1998.02045.x · Cited by 157
Skin biopsy for the diagnosis of peripheral neuropathy
Lauria, G., Lombardi, R., Camozzi, F., & Devigili, G. (2008) · Histopathology · doi:10.1111/j.1365-2559.2008.03096.x · Cited by 139
Pérez, A., Rütten, A., Gold, R., Urbina, F., Misad, C., Izquierdo, M. J. M. E., Requena, C., Aliaga, A., Kutzner, H., & Requena, L. (2002) · Journal of the American Academy of Dermatology · doi:10.1067/mjd.2002.120466 · Cited by 133
Cutaneous Graft-versus-Host Disease: A Guide for the Dermatologist
Häusermann, P., Walter, R. B., Halter, J. P., Biedermann, B. C., Tichelli, A., Itin, P. H., & Gratwohl, A. A. (2008) · Dermatology · doi:10.1159/000113941 · Cited by 118
Severe generalized argyria secondary to ingestion of colloidal silver protein
White, J. M. L., Powell, A. M., Brady, K., & Russell‐Jones, R. (2003) · Clinical and Experimental Dermatology · doi:10.1046/j.1365-2230.2003.01214.x · Cited by 114
The sunburn cell: Regulation of death and survival of the keratinocyte
Laethem, A. V., Claerhout, S., Garmyn, M., & Agostinis, P. (2005) · The International Journal of Biochemistry & Cell Biology · doi:10.1016/j.biocel.2005.02.015 · Cited by 111
Dermatomyositis: A Clinicopathological Study of 40 Patients
Smith, E. S. C., Hallman, J. R., DeLuca, A. M., Goldenberg, G., Jorizzo, J. L., & Sangüeza, O. P. (2009) · American Journal of Dermatopathology · doi:10.1097/dad.0b013e31818520e1 · Cited by 91
Wells, R. S., & Kerr, C. (1966) · Journal of Investigative Dermatology · doi:10.1038/jid.1966.80 · Cited by 80
Resolution of plaque-type psoriasis: what is left behind (and reinitiates the disease)
Benezeder, T., & Wolf, P. (2019) · Seminars in Immunopathology · doi:10.1007/s00281-019-00766-z · Cited by 77
Sudomotor innervation in transthyretin amyloid neuropathy: Pathology and functional correlates
Chao, C., Huang, C., Chiang, H., Luo, K., Kan, H., Yang, N. C., Chiang, H., Lin, W., Lai, S., Lee, M., et al. (2015) · Annals of Neurology · doi:10.1002/ana.24438 · Cited by 69
Poroqueratosis. Revisión de su etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento
Vargas‐Mora, P., Morgado‐Carrasco, D., & Fustà‐Novell, X. (2020) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2020.03.005 · Cited by 66
Aquagenic (pseudo) keratoderma: a clinical series with new pathological insights
Rongioletti, F., Tomasini, C. F., Crovato, F., & Marchesi, L. (2012) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2012.11003.x · Cited by 64
Kligman, A. M. (1991) · Archives of Dermatology · doi:10.1001/archderm.1991.01680080111013 · Cited by 64
Invisible mycosis fungoides: A diagnostic challenge
Pujol, R. M., Gallardo, F., Llistosella, E., Blanco-Font, A., Bernadb, L., Bordes, R., Nomdedeu, J. F., & Servitje, O. (2000) · Journal of the American Academy of Dermatology · doi:10.1016/s0190-9622(00)90103-8 · Cited by 61
Dermoscopy of Subcorneal Hematoma
Zalaudek, I., Argenziano, G., Soyer, H. P., Saurat, J. ‐., & Braun, R. P. (2004) · Dermatologic Surgery · doi:10.1111/j.1524-4725.2004.30381.x · Cited by 53
Local subcutaneous atrophy after corticosteroid injection
Jacobs, M. B. (1986) · Postgraduate Medicine · doi:10.1080/00325481.1986.11699543 · Cited by 48
The “Sandwich Sign” of Dermatophytosis
Gottlieb, G. J., & Ackerman, A. B. (1986) · American Journal of Dermatopathology · doi:10.1097/00000372-198608000-00013 · Cited by 43
Invisible mycosis fungoides: A diagnostic challenge
Pujol, R. M., Gallardo, F., Llistosella, E., Blanco-Font, A., Bernadó, L., Bordes, R., Nomdedeu, J. F., & Servitje, O. (2002) · Journal of the American Academy of Dermatology · doi:10.1067/mjd.2002.107231 · Cited by 40
Brownstein, M. H., & Rabinowitz, A. D. (1983) · Journal of the American Academy of Dermatology · doi:10.1016/s0190-9622(83)80078-4 · Cited by 36
Hafner, J., Haenseler, E., Ossent, P., Burg, G., & Panizzon, R. G. (1995) · American Journal of Dermatopathology · doi:10.1097/00000372-199508000-00010 · Cited by 34
Ständer, S., Richter, L., Osada, N., & Metze, D. (2014) · Acta Dermato Venereologica · doi:10.2340/00015555-1639 · Cited by 33
Maculopapular eruption with enlarged macrophages in eight patients receiving G‐CSF or GM‐CSF
Álvarez‐Ruiz, S., Fernández‐Peñas, P., Fernández‐Herrera, J., Sánchez-Pérez, J., Fraga, J., & García‐Díez, A. (2004) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2004.00872.x · Cited by 32
Elwood, H. R., Berry, R. S., Gardner, J. M., & Shalin, S. C. (2015) · Journal of Cutaneous Pathology · doi:10.1111/cup.12482 · Cited by 27
Sézary syndrome without erythroderma
Henn, A., Michel, L., Fite, C., Deschamps, L., Ortonne, N., Oro, S., Marinho, E., Beylot-Barry, M., Bagot, M., Laroche, L., et al. (2015) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2014.11.015 · Cited by 26
Pink pigtails are a clue for the diagnosis of scabies
Kristjansson, A. K., Smith, M. K., Gould, J. W., & Gilliam, A. C. (2007) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2007.03.018 · Cited by 24
Diagnosis of human scabies by epidermal shave biopsy
Martin, W. E., & Wheeler, C. E. (1979) · Journal of the American Academy of Dermatology · doi:10.1016/s0190-9622(79)70026-0 · Cited by 22
Histopathological diagnosis of graft‐versus‐host disease of the skin – an interobserver comparison
Ziemer, M., Haeusermann, P., Janin, A., Massi, D., Ziepert, M., Wolff, D., Greinix, H., & Hillen, U. (2013) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.12215 · Cited by 22
Lehmer, L. M., Ulibarri, G. E., Ragsdale, B. D., & Kunkle, J. (2017) · Dermatology Online Journal · doi:10.5070/d3237035732 · Cited by 21
Epidermodysplasia verruciform-like Lesions in an HIV patient
Berk, D. R., Bruckner, A. L., & Lu, D. (2009) · Dermatology Online Journal · doi:10.5070/d36ks5t6qw · Cited by 20
Grape Cells (Multinucleated Keratinocytes) in Noninfectious Dermatoses
Sweeney, S. A., Sulit, D. J., Adams, E. G., Shvartsman, K., & Rapini, R. P. (2015) · American Journal of Dermatopathology · doi:10.1097/dad.0000000000000330 · Cited by 20
Lora, V., Ardigò, M., Catricalà, C., & Cota, C. (2013) · Journal of Cutaneous Pathology · doi:10.1111/cup.12241 · Cited by 16
Llamas‐Velasco, M., Fraga, J., Requena, L., Sánchez-Pérez, J., Ovejero‐Merino, E., & García‐Diez, A. (2012) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2012.01.002 · Cited by 16
Self-citationA case of invisible leukemic cutaneous T cell lymphoma with a regulatory T cell clone
Shiue, L. H., Ni, X., Prieto, V. G., Jorgensen, J. L., Curry, J. L., Goswami, M., Sweeney, S. A., & Duvic, M. A. (2012) · International Journal of Dermatology · doi:10.1111/j.1365-4632.2011.05351.x · Cited by 14
Dermoscopy of subcorneal hematoma
(2005) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2004.10.583 · Cited by 14
Pagetoid Dyskeratosis in Dermatopathology
Santos-Briz, A. J., Cañueto, J., del Carmen, S., Mir-Bonafé, J. M., & Fernandez, E. (2015) · American Journal of Dermatopathology · doi:10.1097/dad.0000000000000284 · Cited by 12
Comment regarding the histopathology of terra firma‐forme dermatosis
Berk, D. R., & Mutizwa, M. M. (2011) · Journal of Cutaneous Pathology · doi:10.1111/j.1600-0560.2011.01818.x · Cited by 11
Miteva, M. I., Castillo, D., & Sabiq, S. (2019) · American Journal of Dermatopathology · doi:10.1097/dad.0000000000001349 · Cited by 11
Mysore, V. N. (2010) · Indian Journal of Dermatology Venereology and Leprology · doi:10.4103/0378-6323.62962 · Cited by 11
Llamas‐Velasco, M., Fraga, J., Requena, L., Sánchez-Pérez, J., Ovejero‐Merino, E., & García‐Diez, A. (2012) · Actas Dermo-Sifiliográficas · doi:10.1016/j.adengl.2012.07.011 · Cited by 10
Self-citationLipomatous metaplasia of superficial dermis
Googe, P. B., Tidwell, W. J., & Rosenberg, A. E. (2015) · Journal of Cutaneous Pathology · doi:10.1111/cup.12631 · Cited by 9
Collagen Anomalies as Clues for Diagnosis: Part 2
Alarcón, S. S., López-López, O., Flores-Terry, M. Á., Villamil-Cerda, D., Allemant-Ortiz, L. J., Ríos-Martín, J. J., Alegria, V. R., & Requena, L. (2017) · American Journal of Dermatopathology · doi:10.1097/dad.0000000000000758 · Cited by 9
A clinical mimicker of melanoma with distinctive histopathology: Topical silver nitrate exposure
Ondrasik, R. M., Jordan, P., & Sriharan, A. (2020) · Journal of Cutaneous Pathology · doi:10.1111/cup.13851 · Cited by 9
Histological Classification and Differential Diagnosis of Nonepisodic Angioedema With Eosinophilia
Goto, K., Ishizaki, S., Tanese, K., Oshitani, Y., Kaku, Y., Kaneko, R., Takama, H., Ishikawa, M., & Tanaka, M. (2015) · American Journal of Dermatopathology · doi:10.1097/dad.0000000000000414 · Cited by 8
Invisible dermatosis, diagnostic discrepancy between the general pathologist and dermatopathologist
Alhumidi, A. A., Alshamlan, N., Alfaraidi, M., & Mohajer, K. A. (2019) · Journal of Cutaneous Pathology · doi:10.1111/cup.13554 · Cited by 8
Frictional amyloidosis in Oman--a study of ten cases.
Mysore, V. N., Bhushnurmath, S. R., Muirhead, D. E., & Al‐Suwaid, A. R. (2002) · PubMed · Cited by 7
Early Angiosarcoma of the Scalp: A Clinicopathological Pitfall
Paolino, G., Lora, V., Cota, C., Panetta, C., Muscardin, L., & Donati, P. (2016) · American Journal of Dermatopathology · doi:10.1097/dad.0000000000000677 · Cited by 7
Invisible dermatoses from the perspective of the dermatopathologist: new observations
Tomasini, C. F. (2017) · Italian Journal of Dermatology and Venereology · doi:10.23736/s0392-0488.17.05720-0 · Cited by 6
Gardner, K. M., & Crawford, R. I. (2018) · Journal of Cutaneous Medicine and Surgery · doi:10.1177/1203475418819992 · Cited by 6
Rietschel, R. L., & Lewis, C. W. (1978) · PubMed · Cited by 6
Dermatoscopia de la disqueratosis pagetoide palmar
Pascual, L. L., Mitxelena, J., Córdoba, A., & Yanguas, I. (2014) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2013.12.005 · Cited by 5
Rohdenburg, C., Liersch, J., Kutsche, K., & Schaller, J. (2019) · American Journal of Dermatopathology · doi:10.1097/dad.0000000000001579 · Cited by 5
Camporro, Á. F., Roncero‐Riesco, M., Revelles‐Peñas, L., Revilla‐Nebreda, D., Estenaga, Á., de la Pinta, J. D., & Terrón, Á. S.-B. (2022) · JAMA Dermatology · doi:10.1001/jamadermatol.2022.0015 · Cited by 5
A clinically invisible melanoma
Perera, E., Mellick, N., Teng, P., & Beardmore, G. L. (2013) · Australasian Journal of Dermatology · doi:10.1111/ajd.12022 · Cited by 4
In Locus Minoris Resistentiae—Or Not?
Bickers, D. R. (2004) · Journal of Investigative Dermatology · doi:10.1111/j.0022-202x.2004.23463.x · Cited by 4
Adult colloid milium. An underdiagnosed and difficult to treat entity
Zamora, A., Simon, M., Sánchez, A. T., & Olivera, R. M. P. (2015) · Revista Médica Del Hospital General De México · doi:10.1016/j.hgmx.2015.10.002 · Cited by 4
Derm dotting: una técnica novedosa para mejorar la precisión diagnóstica de lesiones cutáneas
Romero, J. A. M., Muñoz, N. P., Sánchez, A. C., Carrillo, M., & Fernández‐Figueras, M. T. (2018) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2018.09.012 · Cited by 4
Diffuse congenital hypotrichosis simplex with associated hair shaft fragility
Willems, A., & Sinclair, R. D. (2021) · Australasian Journal of Dermatology · doi:10.1111/ajd.13736 · Cited by 4
Invisible dermatoses versus nonrashes
Bernhard, J. D. (1983) · Journal of the American Academy of Dermatology · doi:10.1016/s0190-9622(83)80248-5 · Cited by 2
Dermoscopic Features of Pagetoid Dyskeratosis of the Palm
Pascual, L. L., Mitxelena, J., Córdoba, A., & Yanguas, I. (2014) · Actas Dermo-Sifiliográficas · doi:10.1016/j.adengl.2013.12.006 · Cited by 2
Peeling skin syndrome: A pathologically invisible dermatosis
Hanbuli, H. M. E., Elmahdi, M., & Kamal, N. (2019) · Journal of Microscopy and Ultrastructure · doi:10.4103/jmau.jmau_5_19 · Cited by 2
Hyperpigmented Asymptomatic Macule in a Fingertip With Suspicious Dermoscopic Pattern —Quiz Case
Llamas‐Velasco, M. (2012) · Archives of Dermatology · doi:10.1001/archdermatol.2011.1073a · Cited by 1
Self-citationCarlotti, A. (2009) · Annales de Dermatologie et de Vénéréologie · doi:10.1016/j.annder.2008.12.004 · Cited by 1
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Metadata
- Authors
- Llamas-Velasco, M., Pérez-Muñoz, N., Rozas-Muñoz, E., Ballester, R., Posada, R., & Figueras, M. F.
- Affiliations
- Faculty, Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain;
- Faculty, Department of Pathology, Hospital Universitari General de Catalunya-Quirónsalud, Sant Cugat del Vallès, Barcelona, Spain;
- Dermatology Department, Hospital San Pablo, Coquimbo, Chile.
- Hospital General de Catalunya (ES)
- ORCID
- Llamas-Velasco, Mar
- Venue
- The American Journal of Dermatopathology
- Published
- 2023-10-02
- Volume
- 45
- Issue
- 12
- Pages
- 801-811
- ISSN
- 0193-1091 (ISSN-L)
- OpenAlex
- W4388826455
- Cited by
- 9
- References
- 66
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 1
- FWCI
- 2.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Dermatopathology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Dermatology › Medicine and Dermatology Studies History
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Health Sciences › Medicine › Dermatology › Cancer and Skin Lesions
- Keywords
- dermatopathology, skin biopsy, histopathological diagnosis, clinicopathological correlation, special stains, periodic acid-Schiff reaction, fungal infection, stratum corneum, subcutaneous tissue
- MeSH terms
- Biopsy, Epidermis, Fungi, Humans, Skin, Skin Diseases
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