Auspitz Sign

Medical Conditions in Which Auspitz Sign May Occur

What is the "auspitz sign,' what does it look like, and what does it mean? In what conditions may this sign occur?

Auspitz Sign - Definition

The Auspitz sign refers to the bleeding that occurs when the surface of a scaling rash (such as psoriasis or another condition) has been removed. Removing the top of a scale results in bleeding as the capillaries which run just under the skin are sheered off.

This bleeding occurs due the thinning of the epidermis—the outermost layer of the skin—in conditions such as psoriasis.

When the epidermis is thin, the dermis (the layer of the skin which is rich in blood vessels) is in close contact with the scale allowing the surface of the capillaries to be pulled off along with the scale. This causes the classic multiple, minute bleeding points of the Auspitz sign.Cond

The Auspitz sign was named in honor of Heinrich Auspitz (1835-1886) who ... its relation to psoriasis.

Conditions in Which Auspitz Sign May Occur

While many physicians think of psoriasis when they see the pinpoint bleeding of Auspitz's sign, many people with psoriasis will not have this sign when a scale is removed. In addition, there are conditions other than psoriasis which may show this sign as well. These include:

  • Psoriasis
  • Darier's disease
  • Actinic keratoris

Let's take a look at each of these separately, including other signs which may help distinguish between these conditions.

Psoriasis

Psoriasis is a common condition affecting roughly two percent of the population.

If you've ever wondered (perhaps after skinning your knees) what would happen if your skin grew more quickly - for example, if new cells took just a few days to grow rather than weeks - psoriasis is an example. Psoriasis is essentially an immune disorder in which your skin grows too quickly, but unlike our example in hoping that a skinned knee would heal more rapidly, the old cells stay put.

The result is a pile of cells which form the characteristic plaques and scales of psoriasis.

There are several different types of psoriasis, and even without these groups the severity of the disease can vary greatly. Common types include:

As with Darier's disease discussed below, some people with psoriasis have other conditions as well, such as type II diabetes, inflammatory bowel disease, heart disease, obesity, cancer, and psoriatic arthritis.

Darier's Disease

Darier's disease is a another condition which can cause scales and plagues on the skin, often on the scalp, knees, and elbows, as with psoriasis. It is an uncommon genetic condition caused by a mutation in the ATP2A2 gene and is inherited in an autosomal dominant fashion.

The lesions on the skin look similar to warts, and often have a yellow tinge. They may appear greasy (in contrast to psoriasis and actinic keratoses which have a dry appearance.) They may also emit a strong and unpleasant odor.

A different sign, the carpet tack sign, is a characteristic of Darier's disease which is not seen in psoriasis or actinic keratoses. This sign describes the appearance of the underside of a scale, which appears to have horn-like projections. These horns or plugs are which has been removed which may contain due to the presence of tissue which was present in a follicle being attached to, and removed along with, a scale.

People with Darier's disease may have lesions inside of their mouth as well, and may have other conditions related to the gene mutation such as epilepsy or mild intellectual disability.

Actinic Keratoses

Actinic keratoses are precancerous skin growths which are most often caused by sun exposure. As such, they most commonly occur on skin surfaces exposed to the sun. By themselves they pose no threat, but can turn into squamous cell carcinomas of the skin if not treated. It's thought that 20 to 40 percent of squamous cell cancers first present as an actinic keratosis.

Atinic keratoses may be flesh-colored, pink, brown, or black an have a rough texture. They may appear like something is stuck to the skin rather than being a part of the skin.

Like psoriasis, actinic keratoses are also very common. While they are more common in people over the age of 50, they may occur for people in their 20's as well.

Photos of Some Conditions Which Can Reveal the Auspitz Sign

The adage that a picture is worth a thousand words was never more true than in dermatology. Check out these photos of actinic keratoses and these images of psoriasis which illustrate both the similarities and differences between these conditions.

Sources:

Kumar, Vinay, Abul K. Abbas, Jon C. Aster, and James A. Perkins. Robbins and Cotran Pathologic Basis of Disease. Philadelphia, PA: Elsevier/Saunders, 2015. Print.

Nellen, R., Steijlen, P., van Steensel, M. et al. Mendelian Disorders of Cornification Caused by Defects in Intracellular Calcium Pumps: Mutation Update and Database for Variants in ATP2A2 and ATP2C1 Associated with Darier Disease and Hailey-Hailey Disease. Human Mutation. 2016 Dec 30. (Epub ahead of print).

Continue Reading