Acantholysis

Compartment: Epidermis

Diagram comparing normal epidermis to acantholytic epidermis, showing loss of cell-to-cell adhesion, an intraepidermal cleft, and rounded free-floating keratinocytes above an intact basal layer.
Acantholysis: intraepidermal cleft formation with free-floating keratinocytes and basal cell “tombstoning.”

Definition: Loss of cohesion between keratinocytes from breakdown of desmosomal connections, producing intraepidermal clefts and free-floating keratinocytes.

Clinical Context: Pemphigus vulgaris, Pemphigus foliaceus, Darier disease, Hailey-Hailey disease

Key Feature: Intraepidermal cleft with rounded, free-floating keratinocytes; basal cells remain attached to the basement membrane (“tombstoning”).

🔗 Related Terms: Koilocyte, Grenz Zone