Immunohistopathological Analysis of Spongiosis Formation in Atopic Dermatitis Compared with Other Skin Diseases
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors submit a very interesting, comprehensive and well written study analysing the immunopathological features of intraepidermal cells associated with various forms of spongiotic dermatitis, comparing also with cutaneous T-cell lymphoma. The study adds to our knowledge about the pathophysiology of spongiotic dermatitis and may have some impact in practical diagnosis.
- The main flaw I perceive in the article is the quality of the photomicrographs depicting the HE pictures and immunohistochemistry. Many of the pictures are dark and uneven between one another, which makes comparisons difficult for the readers. Remarkably, many of the pictures have a green background. This will need some adjustments.
- Table 2 is very complete and I think it should be kept for consultation if needed. However, it is too detailed to extract data easily from it; I would suggest adding a table summarizing the main findings in terms of descriptive or comparative statistics (means/medians, standard deviation, etc) for each group of conditions.
- In page 10, what do the authors mean by "atopy patch test"? Why not just "patch test"?
Author Response
To Reviewer 1
We greatly appreciate your positive evaluation of our article and valuable comments and suggestions to it.
Based on your comments and suggestions, we have revised our manuscript as follows:
Your comment and suggestions: The main flaw I perceive in the article is the quality of the photomicrographs depicting the HE pictures and immunohistochemistry. Many of the pictures are dark and uneven between one another, which makes comparisons difficult for the readers. Remarkably, many of the pictures have a green background. This will need some adjustments.
Our reply: We have corrected the overall brightness and contrast of the photographs in the figures. Unfortunately, due to differences in the expression levels of the target antigens in the immunostaining, the brightness of the photographs is still somewhat uneven.
Your comment and suggestions: Table 2 is very complete and I think it should be kept for consultation if needed. However, it is too detailed to extract data easily from it; I would suggest adding a table summarizing the main findings in terms of descriptive or comparative statistics (means/medians, standard deviation, etc) for each group of conditions.
Our reply: Thank you for your suggestion. We have considered it, but we have given up on creating a new table because it overlaps significantly with the description in the text. We believe that the detailed data display in Table 2 is also valuable for inferring the characteristics of each case. I would appreciate your understanding.
Your comment and suggestions: In page 10, what do the authors mean by "atopy patch test"? Why not just "patch test"?
Our reply: Patch test with allergens capable of inducing specific IgE antibodies is conventionally called atopy patch test, which is a standard term in the field of atopic dermatitis practice and research, and we therefore did not provide a detailed description or citations to this in this article.
Additional fixes: Based on the suggestions of reviewer 2, the introduction text has been revised. The English typographical errors and the legend of Figure 6 have been also revised.
Reviewer 2 Report
Comments and Suggestions for AuthorsSpongiosis is the hallmark of "eczema". However, many other skin diseases may also cause spongiosis and it is therefore usually not possible for the dermatopathologist to classify the type of spongiotic dermatitis. In this study, comparing different types of spongiosis development, IgE dendritic cells were unique for igE-dependent atopic dermatitis. Also, Pautrier microabscesses can be distinguished from eczematous spongiotic vesicles by immunohistochemistry/immunofluorescence.
"Spongiosis in the epidermis is considered to result from impaired or lost adhesion between keratinocytes ..." Is this true? Is it not the other way around?
This is certainly an interesting study but its limits are the relatively small numbers of different diseases.
There are some English language issue to be corrected.
Author Response
To Reviewer 2
We greatly appreciate your positive evaluation of our article and valuable comments and suggestions to it.
Based on your comments and suggestions, we have revised our manuscript as follows:
Your comment and suggestions: "Spongiosis in the epidermis is considered to result from impaired or lost adhesion between keratinocytes ..." Is this true? Is it not the other way around?
Our reply: Thank you very much for giving good suggestions. We changed the text to “Spongiosis in the epidermis is considered to result from keratinocyte apoptosis caused by the infiltrating mononuclear cells from the dermis and the associated impairment or loss of adhesion between keratinocytes, for example, through disruption of E-cadherin, allowing the influx of fluid (intercellular edema).”
Your comment and suggestions: This is certainly an interesting study but its limits are the relatively small numbers of different diseases.
Our reply: I agree with your comments. We had initially planned to include more cases of eczematous dermatitis and non-eczematous diseases in the analysis. However, we felt that including them all would make the paper redundant and the research focus unclear. Therefore, we ended up the present cases only. I would appreciate your understanding.
Your comment and suggestions: There are some English language issue to be corrected.
Our reply: The English typographical errors and the legend of Figure 6 have been revised.
Additional fixes: Based on the suggestions of reviewer 1, we have corrected the overall brightness and contrast of the photographs in the figures.
