Acantholysis or the Auspitz sign? A revelation of the life of Carl Heinrich Auspitz

Shahajah Shareef¹ , Faizah Shareef¹ , Emily Tongdee² , Mercedes Florez-White²

¹ Department of Dermatology, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
² Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA

Correspondence Address:
Emily Tongdee
BS 2810 SW 149^th Avenue, Miami, FL 33185
USA

Carl Heinrich Auspitz was born in Nikolsburg, now known as Mikulov, in the Czech Republic in 1835.^[1] He studied at the Medical School of Vienna University under the direction of dermatologist Ferdinand Ritter von Hebra and joined Hebra's skin department around the year 1863.^[1] During his time there, he made outstanding contributions to the field of dermatology and public health.^[1] To many, Carl Auspitz is recognized for describing the “Auspitz phenomenon,” a clinical aid in the diagnosis of psoriasis.^[1]

The key attribution that Auspitz made to the description of psoriasis was his indication of the presence of pinpoint bleeding of papillary vessels under readily detachable scaly plaques.^[2] Contrary to what the name suggests, Auspitz was not the first to describe this particular diagnostic measure that we know today as the Auspitz sign. Twenty years preceding his work, Hebra, Cazenave and Rayer commented on psoriasis, albeit simply mentioning redness of the skin beneath the scales.^[1] Auspitz's mentor Hebra as well as Marie-Guillaume-Alphonse Devergie were actually the first to note this diagnostic clue that Auspitz was credited for.^[1] One reason leading to the misnomer was Auspitz's meticulous writing on the general pathology and therapeutics of the skin published in Hugo Ziemssen's Handbook of Diseases of the Skin.^[1]

Auspitz's true discovery was comparatively less recognized. He was the first to coin the term and describe the detailed histopathology of acantholysis in his System of Skin Diseasesin 1881.^[3] In his novel take on the indicative benchmarks of the disease, Auspitz described acantholysis as the lifting of the epidermis causing a separation seen in the stratum spinosum.^[2] This dermatopathologic finding is still used today as a distinguishing characteristic seen in pemphigus and other blistering epidermal diseases. Ironically, he was not formally given credit for this discovery. Rather, his work was largely forgotten until 1936 when Darier et al. resuscitated the concept.^[3]

In 1869, Auspitz cofounded and coedited the Archiv fur Dermatologie und Syphilis, a pioneering publication in dermatology.^[1] Between 1871 and 1872, he received the Golden Medal of Merit for his service during the epidemic of smallpox in Vienna.^[1] In 1884, Auspitz gained chairmanship of the Department of Syphilology at the Vienna General Hospital.^[1] Unfortunately, Auspitz was not able to succeed against his rival Moritz Kaposi for Hebra's chair.^[1] Auspitz's only son died young and his beloved wife died shortly after.^[1] Through all of these unfortunate circumstances, Auspitz displayed his strong-willed character and unstoppable drive.^[1] After fighting a progressive heart ailment for many years, he died on May 23, 1885.^[1]

Inscribed into dermatologic lore are the two phenomena of the Auspitz sign and acantholysis.^[1] We are deeply indebted to this gifted man, who advanced our understanding of dermatology and venereology during his short and tragic, but prolific life.

1.	Holubar K. The man behind the eponym. Remembering Heinrich Auspitz. Am J Dermatopathol 1986;8:83-5. [Google Scholar]
2.	Ziemssen HV. Handbook of Diseases of the Skin. New York: Wood; 1885. [Google Scholar]
3.	King DF. Modern textbooks of dermatopathology and acantholysis of Auspitz. J Am Acad Dermatol 1984;11(2 Pt 1):301-3. [Google Scholar]