< Current issue
Dermatopathology: Practical & Conceptual January - March 1996
Searching for Diogenes: Uncloaking the Mantle
Martin Sangueza, MD
Michael Anthony Radonich, MD
A. Bernard Ackerman, MD
1876 Unna P
1889 Kölliker A
1895 Benda C
1897 Pinkus F
1902 Hertwig O
1927 Pinkus F
1935 Zimmermann KW
1956 Epstein W, Kligman AM
1963 Strauss JS, Pochi PE
1964 Madsen A
1971 Pinkus H
1972 Hegedus SL, Schorr WF
1976 Pinkus H and Mehregan AH
1987 Ishikawa K
1990 Leshin B, White WL
1991 Mehregan A, Hashimoto K
1992 Jakubovic H, Ackerman AB
1992 Montagna W, Kligman AM, Carlisle KS
1993 Narisawa Y, Hashimoto K, Kobda H
1993 Ackerman AB, deViragh P, and Chongchitnant N
1993 Steffen C
1994 Steffen C, Ackerman AB
1995 Mehregan AH, Hashimoto K, Mehregan DA, Mehregan DR
1995 deViragh PA
1996 Ackerman AB (
1956 Epstein W, Kligman AM
The pathogenesis of milia and benign tumors of the skin. J Invest Dermatol 1956;26:111 (
Fig. 7 (orig. Fig. 11). Unusual vellus hair follicles important in the histogenesis of milia A, Two cords or buds of indifferent epithelial cells extend from the external root sheath of a vellus hair follicle cut obliquely in longitudinal section. The cords arise approximately at the site of normal sebaceous gland anlagen. B, Two hair follicles cut in cross section show that these abnormal anlagen grow out from the follicle and tend to surround it in a ring of indifferent epithelial cells and poorly differentiated sebaceous cells. C, This cross sectional view shows that the two cords don't always form a ring but may grow irregularly and without purpose. D, The two cords have joined to form a complete ring of indifferent epithelial cells about the hair follicle. Note also a very early milium originating in the ring. Actually, this picture is deceptive, because when reconstructed in three dimensions this ring turns out to be an apron of indifferent cells arising from the surrounding hair follicle.
Vellus follicles often either lack sebaceous glands altogether or are formed imperfectly, showing transitions from undifferentiated epithelial buds to larger cords of undifferentiated cells with variable degrees of sebaceous differentiation or even none at all. These cords of epithelial cells represent abnormal anlage that grow out from the follicle and in cross section surround it as a ring. In three dimensions, this ring turns out to be an apron of undifferentiated cells.
Milia derive from the cords of epithelial cells.
The imperfectly formed sebaceous glands in the form of epithelial buds and cords that surround the follicle like an apron as described by Epstein and Kligman actually are mantles of Pinkus and collars of Zimmermann, i.e., normal structures continuous with normal follicles.
Mantles do not give rise to milia. The cystic structures pictured by Epstein and Kligman and referred to by them as milia are really sebaceous ducts within a mantle undergoing differentiation. Milia are cysts that form as a consequence of dilation of preexisting infundibula.
Herman Pinkus, the son of Felix Pinkus, following the presentation of this paper by Epstein and Kligman, commented to the effect that his father had described the mantle as an atrophic sebaceous gland and that he, himself, was pleased to learn from Epstein and Kligman that mantles were responsible for milia. In fact, Felix Pinkus regarded the mantle as a source of sebaceous cells, and milia as wholly unrelated to mantles.
This site is made possible in part by:
Copyright © Derm101.com. All Rights Reserved.